Tomato (Solanum lycopersicum L): Lycopene

 Understanding Iron Deficiency through physiological symptoms

Prof Yamini Bhusan Tripathi, PhD biochemistry, Former Dean Faculty of Ayurveda and CEO Yamini Innovations (MSME for R and D), Varanasi, India

03-06-2025

Iron deficiency is one of the most common and impactful nutritional deficiencies worldwide. Very often it is overlooked, though it is affecting approximately 2 billion people globally, it can silently sap energy, impair daily functioning, and worsen chronic illnesses if left unaddressed.

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🧬 What is Iron Deficiency?

Iron plays a vital role in producing haemoglobin, the protein in red blood cells that carries oxygen throughout the body. When iron levels are low, the body’s oxygen-carrying capacity is reduced, leading to iron-deficiency anaemia — a condition that affects around 1.2 billion people globally (Zhou et al., 2024). However, not all iron deficiency leads to anaemia, in the beginning. They may show the symptoms of non-anaemic iron deficiency, impairing several physical and mental functions.

Its Common Symptoms may include:

• Persistent fatigue
• Irritability or depression
• Difficulty with concentration
• Restless legs syndrome (affecting 32%-40%)
• Pica – craving non-food substances like dirt or ice (seen in 40%-50% of cases)
• Breathlessness, dizziness, or lightheadedness
• Poor exercise tolerance
• In chronic cases: worsening of heart failure

These symptoms can vary widely based on age, underlying health conditions (like CKD, IBD, heart failure), and how quickly iron levels decline.

Iron deficiency can induce a higher Risk to people:

• Reproductive-age women (38% may have non-anaemic deficiency; 13% anaemia)
• Pregnant women (up to 84% may be iron-deficient in the third trimester)
• People with chronic conditions like Chronic kidney disease (24%-85%), Inflammatory bowel disease (13%-90%), Heart failure (37%-61%), Cancer (18%-82%), Individuals taking NSAIDs regularly, People who’ve had bariatric surgery or suffer from celiac disease

 

Diagnosis: Don’t Just Guess

Fatigue isn’t always just from “stress” or “age.” Testing for iron deficiency is recommended if you have any symptoms listed above and having 

• Heavy menstrual bleeding
• Pregnancy
• Chronic inflammatory diseases

Recommended Tests:

• Serum ferritin: <30 ng/mL suggests iron deficiency (in the absence of inflammation)
• Transferrin saturation: <20% is also indicative of low iron

 Treatment Options must be based on the recommendations of a clinician, but for understanding to common people it may a Oral Iron Supplements (Ferrous sulfate 325 mg/day or on alternate days, when taken on an empty stomach for absorption, but with food if causing GI upset) or Intravenous Iron for those people who cannot tolerate oral iron, or have poor absorption (e.g., after bariatric surgery or due to celiac disease) or suffering with chronic inflammatory conditions or under pregnancy. Under Ayurveda, Lauh Bhasma, Mandur Bhasma, Navayas Lauh, Punarnavadi Mandur, Dhatri Lauh, Tapyadi Lauh, Draksharishta, Kumaryasava, Arvindasava are some of the common preparations for oral use.

 Food supplements: The animal-based sources of iron (like red meat and liver) contain heme iron—which is more easily absorbed by the body; many plant-based (non-heme) iron sources can still be effective, especially when combined with vitamin C, which enhances absorption.

Vegetables like Spinach (Palak), Amaranth leaves (Chaulai), Fenugreek leaves (Methi), Beetroot, Broccoli, Sweet potatoes, Kale are important. Fruits like Dried apricots, Raisins (Kishmish). Prunes (Sookha Aalu Bukhara), Dates (Khajoor), Mulberries (Shahtoot), Figs (Anjeer) – dried, Black currants, Watermelon, Pomegranate (Anar), Jackfruit (Kathal), Guava, Avocado, Custard apple (Sitaphal), Lychee (Litchi), Strawberries are good sources. Many of them are not very rich in iron content, but the presence of other minerals and Vitamin C makes them a better source.

Tips to gat maximum benefits of these supplements are to pair these fruits with:

• Good source of Vitamin C (ascorbic acid). It converts ferric iron (Fe³⁺) into ferrous iron (Fe²⁺), which is better absorbed in the gut.
• The soaked dry fruits (like anjeer, raisins) also help in tits better digestion and absorption.
• Avoid tea/coffee, milk before or after consuming these fruits. Basically, Calcium competes with iron absorption, which is very high in milk. Even 200–300 mg of calcium (the amount in a glass of milk or cup of curd) can significantly reduce iron absorption. It affects both heme (animal-based) and non-heme (plant-based) iron, but the effect is more pronounced on non-heme iron (plant-based supplements). Other iron-absorbing inhibitors are Tannins, Phytates (phytic acid), Polyphenols, Oxalates, and high-fibre foods. Thus, while choosing food combinations, which is known as “Incompatible diet (Virrudh ahar in Ayurveda), should be given importance. For example, cooking spinach curry with curd (high in calcium) is not good as it reduces the iron absorption. Instead, pair spinach with lemon juice or tomatoes to aid absorption.

 

The Bottom Line: Iron deficiency is not just a women’s health issue—it’s a global health challenge with far-reaching effects on energy, cognition, and chronic disease outcomes. Fortunately, it is both detectable and treatable.

👉 If you're experiencing unexplained fatigue, difficulty focusing, or symptoms like restless legs or pica, consider asking your doctor for iron tests.

 

📚 Scientific Reference:

• Zhou AY, Kaul DR, Trinquart L, et al. Iron Deficiency and Iron-Deficiency Anemia: A Review. JAMA. 2024;331(16):1471–1481. doi:10.1001/jama.2024.3195
• Charak Samhita
• Google search and Chat GPT for draft modifications.