Causes, symptoms, and treatment of iron deficiency and anemia

anemia - graphic design showing iron molecules in the blood stream

The body needs iron for blood formation and for several metabolic processes, such as supplying oxygen to the cells. Iron deficiency and anemia often occurs after severe blood loss (e.g., after operations, blood donations, menstruation). Bad diet or illnesses can also be causes of iron deficiency. The body cannot produce iron itself, so it is dependent on the intake of food. Iron deficiency anemia can develop from iron deficiency. This describes a disease that does not allow adequate blood formation due to a persistent iron deficiency.

Frequency of iron deficiency1

  • In the last thirty years, the prevalence of anemia in all age groups has decreased from 27% to 22%.
  • However, total cases of anemia have increased from 1.42 billion cases to 1.74 billion cases in the same period.
  • Prevalence was highest among children under five years, with a combined prevalence of almost 40%.

How does iron deficiency arise?

The iron present in the body forms the red blood pigment hemoglobin, among other things. If the body is insufficiently supplied with iron, the hemoglobin concentration in the blood drops. The protein hemoglobin is vital for the body because it transports oxygen from the lungs to every single cell in the body. If the body receives too little iron, hemoglobin cannot be formed, the oxygen supply is insufficient and the “classic” symptoms such as tiredness, headaches, etc. occur.

The absorption (resorption) of iron takes place in the upper part of the small intestine. However, a maximum of 20% of the iron supplied can be absorbed. In the small intestine, it is carried into the bone marrow with the help of the transport protein “transferrin”. There red blood cells (erythrocytes) are formed, and acutely unusable iron can be stored with the help of the iron storage protein ferritin or is absorbed and excreted by phagocytes.

When someone has iron-deficiency anemia:
  • Women, if the hemoglobin concentration is below 12 g/dL.
  • Men, when the hemoglobin concentration in the blood falls below 13 g/dl.

The body contains 3-5 grams of iron, in men and women after menopause only about 1 gram. The largest part is used for hemoglobin formation, about 500-1000 mg (men) and 300-400mg (women) are stored. Women lose around 1-3mg of iron daily during menstruation. With an average daily intake, however, the body can absorb a maximum of one-fifth, the rest is excreted in the stool. Men should consume around 10mg of iron daily through their diet and women 15mg.

The requirement is increased during pregnancy, here the expectant mother should come to a daily dose of 30mg. If iron deficiency anemia is left untreated, it can lead to serious illnesses such as changes in the mucous membrane of the tongue, throat, and esophagus (Plummer-Vinson syndrome).

Causes of Iron Deficiency

  • Blood loss: chronic blood loss due to certain gastrointestinal diseases, polyps, carcinomas, intestinal ulcers, etc. Severe blood loss during menstruation, due to operations, or after frequent blood donations.
  • Low iron diet: deficiency results from a mismatch between actual intake and iron requirement. The daily iron requirement can be covered with a balanced diet. Especially people in special metabolic situations (pregnant women, breastfeeding women, children, the elderly) need more iron than the usual daily dose.
The following groups of people are most likely to have iron deficiency:
  • Women (due to menstruation, pregnancy, and childbirth)
  • People after surgery (blood loss)
  • Chronically ill (especially heart disease)
  • People with intestinal diseases (e.g.  Crohn’s diseasewith chronic blood loss)
  • High-performance athletes (especially women)
  • People with rheumatoid diseases, cancer, or kidney diseases
  • Blood donor (the body loses around 250 mg of iron when donating blood)
  • Elderly people
  • Vegetarians and vegans (who eat less iron because they avoid meat)
  • Growing children
  • Babies who are not breastfed (breast milk is a source of iron)

Course and symptoms of iron deficiency

An iron deficiency can gradually become noticeable. Symptoms such as headaches and lack of energy can sometimes appear for years without those affected thinking about an iron deficiency. But through the many years did not notice iron deficiency leads to anemia and a deficiency of red blood cells. The body cells are no longer adequately supplied with oxygen, fatigue, listlessness, headaches, concentration disorders or iron deficiency anemia are the consequences.

Therapy for iron deficiency

If iron deficiency is left untreated, iron deficiency anemia can develop. There are three therapy options to treat this:

  • Conscious nutrition
  • Oral iron supplements
    • Conventional oral supplements
    • New generation oral supplements
  • Iron infusions

Conscious nutrition

To fill the iron stores, it is important to ensure that there is an adequate supply of iron. To replenish the iron reserves after illnesses, operations, or severe blood loss, a long-term, conscious diet is required, which can be supported by giving iron tablets if necessary. Good sources of iron are meat, fish, whole grain products, eggs, and vegetables (spinach). Green fresh spices (thyme, parsley, marjoram) also contain plenty of iron. If there is a pronounced iron deficiency, this cannot be remedied with iron-containing foods alone.

Oral iron supplements

In addition to eating foods that are rich in iron, you may have to take oral iron supplements. There are many different types of oral iron supplements, including pills, capsules, drops, and extended-release tablets. The purpose of oral iron supplementation is to treat your symptoms by increasing the levels of iron and hemoglobin in your body.

The iron in your body is called “elemental iron.” Oral iron supplements contain different amounts of elemental iron. When you choose a supplement, be sure to check the label to see how much elemental iron it contains; a greater amount means that more iron will be absorbed by your body.

You do not need a prescription to buy iron supplements. Working with your doctor, you can choose which type is best for you.

Conventional iron supplements

Conventional oral iron therapy is associated with a variety of limitations. These iron supplements have low bioavailability, metallic taste, low consumer compliance, and cause side effects like nausea, constipation, diarrhea, or abdominal pain.

New generation iron supplements

To address the shortcomings of conventional iron supplements and the market needs, new generations of iron supplements have been introduced.

BMG Pharma’s IronOne™, is a range of highly bioavailable iron supplements, utilizing innovative formulation technologies with several benefits compared to conventional and other new-generation supplements.

graphic describing BMG Pharma's IronOne

IronOne™ supplements deliver tiny particles (micronized) of iron encapsulated within a phospholipid membrane. Several clinical studies2 on IronOne™ supplements have demonstrated high absorption and bioavailability of these products; plus, a low incidence of gastrointestinal (GI) side effects has been reported because these products avoid direct contact of iron with the intestinal lining (thereby avoiding oxidative damage to the GI lining).

Also, a recent clinical study3 published in 2020 has shown that the IronOne™ range has much higher bioaccessibility and bioavailability compared to its new generation competitors like Sucro iron. This means that the fraction of iron released from the matrix in the gastrointestinal tract is much higher in the IronOne™ range.

Graph showing superiority of IronOre in comparative study
Figure 1. Iron bioaccessibility and excretion of general-purpose (a,d), pediatric (b,e), and obstetrics and gynecology (c,f) iron supplements. ME: Microencapsulation; SS: Sucrosome; LS: Liposome; PIC: Polydextrose–iron complex; ISPC: Iron-succinylated proteins complex. * p < 0.05.
Benefits of BMG Pharma’s IronOne™ supplements:
  • Predicable iron availability
  • 2 hours after administration, 4.7x higher iron concentration than ferrous fumarate
  • 5x more bioavailable than ferric pyrophosphate
  • 7x more bioavailable than ferrous sulfate
  • High bioavailability
  • Little or no gastric side effects

Iron infusions

With the iron infusion, there is a possibility to restore the iron reserves quickly. The infusion is given through the vein. This also excludes possible side effects that can occur with oral administration. This form of iron substitution is particularly suitable for those affected who cannot tolerate oral iron supplements or for whom oral supplements are insufficient. With new infusions, approximately 1000mg of iron can be given per infusion. This treatment is a good choice, especially for people who already have iron deficiency anemia.

What you can do even if you are iron deficient

If you eat a well-balanced, conscious diet, you will usually meet your iron needs with fresh foods. It is beneficial to promote the absorption of iron with various foods. For example, you can drink a vitamin C-rich fruit juice with your meal or have citrus fruits for dessert. Avoid having coffee, tea or red wine with your meal, the tannins contained in them inhibit iron absorption.


  1. Gardner, William & Kassebaum, Nicholas. (2020). Global, Regional, and National Prevalence of Anemia and Its Causes in 204 Countries and Territories, 1990–2019. Current Developments in Nutrition. 4. 830-830. 10.1093/cdn/nzaa053_035.
  2. Data on file.
  3. Pastore, P.; Roverso, M.; Tedesco, E.; Micheletto, M.; Mantovan, E.; Zanella, M.; Benetti, F. Comparative Evaluation of Intestinal Absorption and Functional Value of Iron Dietary Supplements and Drug with Different Delivery Systems. Molecules 2020, 25, 5989.