Recognising and treating iron deficiency
Tiredness, exhaustion, headaches or hair loss can be signs of iron deficiency. As long as there is no anaemia, iron deficiency is often not taken seriously, and the suffering simply continues. Yet iron infusions can help.
Why is iron important for the body?
As part of the red blood pigment (haemoglobin), iron is irreplaceable for transporting oxygen from the lungs to the organs. It is also found in numerous enzymes, for example those of cellular respiration in the mitochondria.
Like hardly any other element in our metabolism, iron can change its ionic charge: it switches between divalent (Fe²⁺) and trivalent iron (Fe³⁺). This allows it to control and influence our metabolism far more strongly. Iron is, so to speak, the Superman among the elements.
Divalent iron: 14 electrons in shell M
Trivalent iron: 13 electrons in shell M
The nucleus of iron (Fe) contains 26 positively charged protons; the negatively charged electrons orbit it in shells K, L and M. When Fe²⁺ gives up the electron marked in red, it becomes Fe³⁺; the empty ring shows the gap. When Fe³⁺ takes up an electron again, it becomes Fe²⁺.
Common symptoms of iron deficiency
Iron deficiency causes symptoms even without anaemia. This is how common they are:
| Symptom | Frequency |
|---|---|
| States of exhaustion | 83 % |
| Difficulty concentrating | 57 % |
| Depressive moods | 49 % |
| Neck tension, headaches | 49 % |
| Dizziness | 45 % |
| Sleep disorders | 42 % |
| Hair loss, brittle nails | 26–31 % |
| Restless legs | common |
Source: Beat Schaub, iron deficiency without anaemia.
Iron deficiency without anaemia is often not taken seriously
If the ferritin level lies within the normal range and there is no anaemia, iron deficiency is often not recognised or not treated. If anything at all, oral iron preparations are prescribed. Many of those affected, women above all, therefore receive no help, although iron infusions could help them. Their suffering simply continues.
How did this misjudgement come about? Decades ago it was not yet possible to measure the ferritin level. Doctors found anaemia and saw that giving iron brought a cure. That was the birth of iron-deficiency anaemia. For a long time the conclusion drawn from this was that there can be no iron deficiency without anaemia. In the 1980s a research group at what was then Ciba-Geigy even raised the suspicion of iron deficiency without anaemia in a scientific study. Unfortunately this work was forgotten. Looking back, it is hard to estimate how many people, young women above all, were wrongly diagnosed with depression when they were simply iron deficient.
‘Now I know what it feels like to be healthy. Before, I thought tiredness was a normal state.’ A patient after treatment with iron infusions
Causes of iron deficiency
- Heavy menstruation
- Growth
- Poor diet
- Bowel problems
- Injuries with major bleeding
- Major surgery
- Blood donation
- Extreme sport
- Kidney problems
- Bone marrow diseases
- Blood cancer and other tumours
Take the iron deficiency test
The more questions you answer with yes, the more likely iron deficiency becomes.
Do you suffer from tiredness bordering on exhaustion?
Do you have trouble concentrating or remembering things?
Do you suffer from headaches, dizziness or muscle tension?
Do you have pale skin or pale mucous membranes, or do you feel the cold easily?
Are you prone to hair loss or brittle nails?
Do you suffer from sleep disorders?
Do you have restless legs when falling asleep (restless legs syndrome)?
Do you tend towards a low or depressed mood?
Do you take medication: stomach protection, painkillers (NSAIDs)?
Do you do intensive sport (more than 12 hours of training per week)?
Are you vegetarian or vegan?
Do you have a chronic illness (e.g. rheumatism, heart failure)?
If you are a woman: are your periods heavy or long-lasting, or have you recently given birth?
Which of the two colours appeals to you more at the moment?
0 of 14 questions answered with yes
With three or more yes answers, we recommend having your ferritin level measured. The test does not replace a medical assessment; your answers stay on your device and are not transmitted.
Please bring the printout with you to an appointment at the SGK.
What the choice of colour tells us
In a practice study, female patients chose between Lüscher red and Lüscher blue before treatment with iron infusions. Those who preferred red responded markedly better to the treatment.
Our services at the Iron Centre of Seegarten Klinik
Iron deficiency can cause a wide range of distressing symptoms that considerably affect everyday life. At the Iron Centre of Seegarten Klinik we offer diagnostics, individually tailored treatment and follow-up care.
Diagnosing iron deficiency
We take a careful medical history with specific questions about typical symptoms, take a blood sample and analyse it in our own laboratory. We then explain iron deficiency to you and answer your questions.
How to prepare for the blood test
Iron from diet and preparations
The body absorbs only a small part of the iron supplied through the digestive tract, about 10% on average. And not all iron is the same:
- Haem iron from animal products (meat, fish, poultry) is present as Fe²⁺. It is absorbed independently of the pH of the stomach, at a rate of 15 to 35%; inhibitors have little effect on it.
- Non-haem iron from plant foods is present as Fe³⁺ and first has to be reduced. It needs an acidic environment and is absorbed at a rate of only 2 to 20%; inhibitors have a strong effect on it.
What matters is the right environment in the gastrointestinal tract. Absorption works best in an acidic environment.
- Inhibiting: black tea and coffee (tannins), wheat bran, cereals and soya (phytates), spinach (oxalate), dairy products and calcium salts, zinc (same absorption pathway), phosphates, cola, egg yolk, salicylates (aspirin), acid blockers and alkaline preparations, gastritis.
- Promoting: vitamin C, unsweetened lemon or apple juice, meat, poultry, fish.
| Iron-rich foods | Iron per 100 g |
|---|---|
| Pork liver | 18 mg |
| Pumpkin seeds | 12 mg |
| Dark chocolate | 12 mg |
| Tofu | 5.4 mg |
| Rolled oats | 4.5 mg |
| Lentils | 3.3 mg |
| Millet | 2.7 mg |
| Beef | 2.5 mg |
Oral iron preparations
Various preparations are available. They differ mainly in how well they are absorbed in the gut. Ferrous gluconate has proved to be absorbed particularly well. It is contained in Floradix, for example.
Iron absorption the natural way – a time-honoured trick with an apple
This simple method is particularly suitable for people who avoid animal sources of iron or tolerate iron preparations poorly. Pushing iron nails into an apple produces a natural iron compound that the body can absorb.
How it works:
- Use apples that are as sour as possible (e.g. Boskoop or Granny Smith).
- Push about 6 cleaned iron nails into the apple.
- Leave the apple to stand for about an hour.
- Remove the nails and eat the apple.
- Repeat the procedure every day.
The dark discolouration around the holes is harmless: it shows the reaction of iron with oxygen. After use, the nails should be cleaned with soap and dried well; they can be reused as often as you like.
Nails specially suited to this are available from us.
Despite every optimisation of the diet, many of those affected see no effect. In such cases an iron infusion is often the most effective solution.
Iron infusions
If iron tablets or syrups are not tolerated or are not effective enough, iron infusions become necessary, in children too.
With very low ferritin levels (e.g. below 20), a better diet and oral iron preparations hardly ever lead to prompt success.
Infusions generally take effect quickly, whereas oral iron preparations need months. They do not depend on absorption in the gut and do not have the typical side effects of iron tablets, such as constipation or stomach complaints.
How an iron infusion works
Once the ferritin level and the deficiency symptoms have been established, you will be given an infusion appointment as soon as possible. The infusion is medically supervised and takes 45 to 60 minutes.
Side effects
- Circulatory problems (rare)
- Dark urine (rare)
- If the preparation runs in beside the vein (extremely rare), the skin may remain discoloured for some time. This happens mainly when the arm is moved too vigorously during the infusion.
- Hypersensitivity reactions (very rare). This is why you stay for about 30 minutes of observation after the infusion.
- Low phosphate in the blood, mainly with high single doses; see “Why we replenish slowly”.
Planning a pregnancy and pregnancy
Women should only become pregnant with very well replenished iron stores. Have your ferritin measured as soon as you are planning a pregnancy. During pregnancy, iron infusions are only permitted from the second trimester (from week 13).
How much iron do you need? An estimate
With your laboratory values you can estimate for yourself how much iron you would need as an infusion. Enter what you know: ferritin is enough; with body weight and sTfR or haemoglobin, the estimate becomes more precise.
The calculation uses the formula your values allow. Ferritin only: (100 − ferritin) × 10 = mg of iron. Ferritin, sTfR and body weight, according to Beat Schaub: (1152 − (11 × ferritin) + (52 × sTfR)) × body weight / 60. Haemoglobin and body weight, Ganzoni formula: body weight × (15 − haemoglobin in g/dl) × 2.4 + 500 mg storage iron.
Transferrin saturation is not part of the calculation. If it is below 20 % with a ferritin of 100 ng/ml or more, the calculator points to possible iron deficiency.
This is an estimate. Whether and how much iron you receive is decided by the doctor after examination and laboratory tests.
Your entries stay on your device and are not transmitted.
Please bring the printout with you to an appointment at the SGK.
Why we replenish slowly
As an iron centre, we prefer slow replenishment: 200 mg per infusion at roughly weekly intervals instead of high single doses of 500 to 1000 mg. With high doses, ferritin is harder to control and overshoots. The clinical result can be worse, and the risk of hypophosphataemia (low phosphate in the blood) rises. Phosphate is important for forming our energy molecules, ATP, which is why the effect of the infusion can be reduced. The decision rests with the treating doctor. If rapid replenishment is necessary, you will be informed.
Where the formula falls short
- In anaemia: if haemoglobin is low, additional iron is needed for blood formation. In that case, enter haemoglobin and body weight; the Ganzoni formula includes this requirement.
- In inflammation: ferritin rises during inflammation even when the stores are empty. The calculation then underestimates the requirement. If you know your transferrin saturation, enter it: if it is low, the calculator will point this out.
- With a high result: the figure is the total requirement, not the amount of a single infusion. We spread it over infusions of 200 mg.
Follow-up and monitoring
Three to six weeks after the necessary series of infusions has been completed, the peak ferritin level is checked and we ask about the improvement in symptoms. The next steps are decided on the basis of this laboratory value and the course of the symptoms. The very individual ferritin ‘feel-good level’ is the yardstick for further maintenance iron infusions. Regular check-ups every three to six months help to secure the success of the treatment and to adjust it.
Why the Iron Centre of Seegarten Klinik?
Individual treatment based on a proven system
We take your symptoms seriously. Diagnostics and treatment follow a proven system and are tailored to you.
Short distances
Thanks to the clinic’s own laboratory, we can establish iron deficiency quickly and arrange a prompt infusion appointment.
Experience
Since the early 2000s we have been researching and treating iron deficiency in adults and in children from the age of 6, including complex cases.
If iron is not the cause
Should it turn out that your symptoms are not caused by iron deficiency, we offer conventional medical assessments and assessments in functional medicine, all under one roof. Bluttuning shows whether other micronutrients are lacking.
Experiences from the Iron Centre
Personal accounts from patients and case examples from our doctors. These are individual experiences; how a treatment works differs from person to person.
Read the reports
‘The 6 iron nails from you and your nutritional advice seem to have borne fruit! I had an appointment with the internist. He had my ferritin measured again. It is now at 40. I know people who took iron preparations for a year, but their ferritin level could not be raised that way.’ A patient
A patient who had suffered from severe depression for years had to be treated as a psychiatric inpatient because outpatient treatment was getting nowhere. During her stay in hospital the depression also proved resistant to treatment, so she was discharged again. Only after her very low iron stores had been replenished did the depression disappear, and further antidepressants were no longer needed. Case report by Dr. med. Peter Meyer
‘The whole medical team is exceptionally competent, warm and committed. You feel taken seriously, because everyone takes a great deal of time, listens attentively and responds individually to your concerns. I was particularly convinced by the holistic approach, in which causes are carefully analysed and not just symptoms treated. A big thank you to Dr. and Mrs Meyer and to the whole team! Our children received a comprehensive analysis which identified vitamin and mineral deficiencies. On that basis an individually tailored treatment was recommended, and that gives us a very good feeling. Appointments are given quickly, reminders are sent reliably and laboratory results arrive promptly too. The atmosphere in the clinic is also very pleasant. We feel very well looked after in every respect and recommend this clinic wholeheartedly.’ L. A.
‘I am absolutely delighted with the treatment by Dr. Meyer. The advice was extremely competent, and the treatments carried out really helped me a great deal; I feel much better. I particularly appreciate that I received not only medical care but also many valuable tips for my general well-being. The whole team, including Dr. Meyer, was very friendly and committed. I felt I was in excellent hands and can recommend the practice wholeheartedly.’ M. C.
One of our medical practice assistants had been trying to become pregnant for years. Because of polycystic ovary syndrome she had not had a period for more than ten years. After her iron reserves had been properly replenished for the first time, her periods returned and she went on to become the happy mother of two healthy children. Case report by Dr. med. Peter Meyer
‘Dear Dr. Stirum, I wanted to thank you in this way and tell you how well I have been feeling again since the iron infusion! I have more strength in training again and no longer feel exhausted so quickly (my pulse no longer goes through the roof straight away either). I suspect that my “feel-good threshold” is not necessarily 50 but more like 80. I do not eat meat, train 3 to 5 times a week and still have regular periods. Many thanks for your help and kind regards.’ A patient
“Only now, after the iron infusions, do I know what it is like to have enough iron. When I think back to how I was before, it now seems almost unbearable to me.” A patient
Frequently asked questions (FAQ) about iron deficiency
How is iron deficiency defined?
It is not the iron level but the ferritin level that matters. The normal range for ferritin runs from 10 to 300 nanograms per millilitre of blood. With such a wide range it is necessary to find the individual ferritin ‘feel-good level’. Experience shows that in most women the symptoms of iron deficiency only disappear in the upper part of the normal range. It therefore makes little sense to go only by the lower limit of normal for ferritin.
In medicine today one has to distinguish between a normal range and an ideal range. Ferritin is a prime example. At the Seegarten Klinik, patients with ferritin levels within the normal range, of up to 50 or even 70, have been raised to levels above 100, with great success. The ideal range lies between 100 and 150.
Why is the ferritin level so important in diagnosing iron deficiency?
The serum ferritin level is the most specific marker in the diagnosis of iron deficiency and correlates best with the clinical symptoms, not free iron. Ferritin is a protein that stores iron; a low ferritin level therefore usually indicates that the body’s iron stores are exhausted.
There are exceptions, however: in acute or chronic inflammation, such as flu, colitis or other inflammatory diseases, the ferritin level can be artificially raised, because in such situations the liver produces additional ferritin, regardless of the actual iron stores.
That is why we always assess the ferritin level in the overall context of your symptoms, laboratory values and medical history.
Further laboratory tests
The transferrin receptor (TfR) mediates the cellular uptake of transferrin-bound iron. Because iron deficiency increases receptor expression, and the plasma level of the soluble transferrin receptor (sTfR) correlates directly with this expression even during inflammation, the sTfR is particularly suited to diagnosing iron deficiency in inflammation and tumour diseases. The sTfR index (sTfR/log ferritin, sTfR-I) sharpens the method further.
| Hb, MCV | Ferritin | CRP | ALT (GPT) | sTfR | sTfR-I | |
|---|---|---|---|---|---|---|
| Iron deficiency only | ↓ | ↓ | Normal | Normal | ↑ | ↑ |
| Inflammation only | ↓ | ↑ | ↑ | Normal | Normal | Normal |
| Iron deficiency + inflammation | ↓ | ↑ / normal | ↑ | Normal | ↑ | ↑ |
| Iron deficiency + liver disease | ↓ | ↑ / normal | Normal | ↑ | Normal | Normal |
↓ decreased, ↑ increased
How does iron deficiency anaemia develop?
If the signs of incipient iron deficiency are ignored or not recognised, anaemia can develop when the ferritin level is very low, with additional symptoms such as shortness of breath and a racing heart. Severe bleeding from injuries or childbirth can also lead directly to anaemia.
Why don't iron-rich foods or tablets help my iron deficiency?
Many patients wonder why their iron levels do not rise despite an iron-rich diet or tablets. The reason often lies not in the iron intake but in iron absorption, that is, the body’s ability to take up iron in the gut at all.
How much iron the gut absorbs, and what inhibits or promotes absorption, is explained above under “Iron from diet and preparations”.
Which ferritin level applies in sport?
Anyone who does intensive sport needs more iron. Higher ferritin levels therefore apply to athletes:
| Ferritin (ng/ml) | Meaning |
|---|---|
| below 15 | Deficiency confirmed |
| below 30 | Deficiency likely |
| 30–50 | Suboptimal |
| 50–100 | Normal, but not optimal |
| above 100 | Optimal for endurance sport |
Is an iron infusion doping?
No, not automatically. Under the rules of the World Anti-Doping Agency (WADA), infusions of more than 100 ml within 12 hours are prohibited, except during hospital treatment, surgery or a clinical investigation. Otherwise a therapeutic use exemption is needed. What matters is therefore the volume of the infusion, not the amount of iron in milligrams.
Who pays for the iron infusion?
Health insurers usually cover an iron infusion if ferritin is below 30 nanograms per millilitre; some insurers only below 15. If the level is higher, the insurer usually does not cover the cost. If basic insurance pays, the deductible (franchise) and co-payment apply.
An infusion of 100 to 200 mg of iron costs about CHF 170 to 200. Higher doses, which are rare at our clinic, cost correspondingly more.
We will be glad to advise you in our consultation
- How iron deficiency can be detected.
- How you can optimise iron absorption naturally through your diet.
- How iron preparations in the form of tablets or infusions can help you.