Iron: The Deficiency Hiding in Plain Sight
Why This One Matters Here
India has one of the highest rates of anaemia in the world. The National Family Health Survey has consistently found more than half of women of reproductive age affected, along with a majority of young children and a significant share of men.
Those are not small numbers, and they describe a condition that is very often treated as normal. Tiredness gets attributed to work, to age, to having young children, to the weather. It is frequently iron.
I am writing this one carefully, because unlike most things on this site it is genuinely a medical matter rather than a lifestyle one. Iron deficiency is diagnosed with a blood test and treated by a doctor. What I can usefully offer is the food side — what I learned about how iron actually gets absorbed, which changed how I eat regardless of any supplement.
The Signs That Get Dismissed
The reason this goes unnoticed for years is that every symptom has a more convenient explanation.
- Persistent tiredness that sleep does not fix
- Breathlessness on stairs or mild exertion
- Pale skin, and more reliably, pale inner eyelids, gums and nail beds
- Frequent headaches and light-headedness on standing
- Cold hands and feet
- Brittle nails, or spoon-shaped nails in longer-standing cases
- Hair fall — a very common presentation, and often the one that finally sends people to a doctor
- Restless legs at night
- Poor concentration and low mood
- Unusual cravings for ice, clay or chalk — this is called pica and is worth taking seriously if it appears
Who is at higher risk: menstruating women, particularly with heavy periods; pregnant women; growing adolescents; vegetarians and vegans; frequent blood donors; and anyone with a gastrointestinal condition affecting absorption.
Get tested rather than guess. The relevant tests are haemoglobin, and more usefully serum ferritin, which reflects your iron stores. Haemoglobin can still look acceptable while stores are already depleted, so ferritin catches it earlier.
Two Kinds of Iron, and Why It Matters
This is the fact that reframed the whole subject for me.
Haem iron comes from animal sources — meat, fish, poultry, liver. The body absorbs roughly 15-35% of it, and that absorption is barely affected by anything else in the meal.
Non-haem iron comes from plants — dal, spinach, jaggery, ragi, sesame. The body absorbs only about 2-20% of it, and that figure swings enormously depending on what else is on the plate.
So a vegetarian eating the same amount of iron on paper may absorb a fraction of what someone eating meat absorbs. This is why the Indian RDA for vegetarians is set higher than for non-vegetarians — the guidance assumes lower absorption.
The practical consequence: for those of us eating plant iron, the question is not only how much iron am I eating but how much of it am I actually absorbing. And that second part is something you can influence considerably, with no supplement at all.
How to Absorb Far More of What You Eat
This is the genuinely useful part, and it costs nothing.
Add vitamin C to iron-containing meals. This is the big one — vitamin C can increase non-haem iron absorption by up to three or four times. In practice:
- A squeeze of lemon over dal or sabji
- Amla, guava, orange or tomato with the meal
- Raw onion and tomato in the salad alongside
- Coriander and mint chutney
The traditional habit of lemon with dal-chawal is not decoration. It is functional.
Keep tea and coffee away from meals. Tannins can cut non-haem iron absorption by more than half. Leave an hour on either side. For a country that drinks chai immediately after lunch, this single change is significant.
Also separate calcium from your main iron meal. Calcium competes with iron for absorption, so a large glass of milk alongside a dal-heavy lunch works against you. Have dairy at a different time.
Soak, sprout and ferment. Phytates in grains and pulses bind iron and block absorption. Soaking pulses overnight, sprouting them, and fermenting batters for idli and dosa all reduce phytate content meaningfully. Our traditional preparation methods were solving this problem long before anyone named it.
Cook in a cast iron kadhai. This genuinely transfers iron into food, and the effect is larger with acidic dishes like tomato-based gravies. It is one of the few genuinely free interventions available.
The Best Vegetarian Sources
Strong sources
- Garden cress seeds (halim / aliv) — exceptionally high, traditionally given to new mothers for exactly this reason
- Sesame seeds (til), especially black
- Jaggery — a much better sweetener choice than white sugar for this reason alone
- Ragi (finger millet)
- Soya chunks and soya beans
- Dried apricots and raisins
- Pumpkin seeds
- Amaranth (rajgira)
Everyday staples that add up
- Whole pulses — masoor, rajma, chana, moong
- Green leafy vegetables — but see the note below
- Poha, which is often iron-fortified
- Dates
- Tofu
A correction worth making about spinach. Palak is not the iron powerhouse it is famous for being. It does contain iron, but it is also high in oxalates, which bind that iron and block much of its absorption. The reputation traces back to a misplaced decimal point in a nineteenth-century analysis that overstated the content tenfold. Eat palak — it is excellent for other reasons — but do not rely on it as your iron strategy.
A traditional combination that works well: til and jaggery, as in til-gud laddoo or chikki. High iron, plus the vitamin C question aside, it is a genuinely sensible pairing that has been in our kitchens for generations.
Where This Stops Being a Food Question
I want to be clear about the boundary here, because iron is one of the few nutrients where self-treating carries real risk.
Do not take iron supplements without a test. Iron is not flushed out like vitamin C. Excess accumulates, and in people with haemochromatosis — an inherited condition that is not rare — supplementation can cause serious organ damage. Iron tablets are also a leading cause of poisoning in young children, so if they are in the house, they need to be out of reach.
Diagnosed deficiency is treated by a doctor, with the right form and dose, usually for three to six months, followed by a repeat test. Supplements are commonly taken with vitamin C and away from tea, calcium and food, but the specifics should come from your doctor.
Anaemia also has causes other than diet — heavy menstrual bleeding, ulcers, coeliac disease, parasitic infection, or bleeding elsewhere in the gut. Treating the iron without finding the cause can mask something that needed attention.
So: if the symptoms above sound familiar, get a haemoglobin and ferritin test rather than starting tablets. The food practices in this article are worth adopting either way — they helped my own energy noticeably and they cost nothing.
This is my reading and my experience, not medical advice. On this topic in particular, please involve a doctor.