How to Add More Iron in your Diet

Iron deficiency anemia is the most common nutritional deficiency worldwide, specifically affecting about 17% of the population over the age of 65 years. Anemia is a condition where your blood has fewer red blood cells than normal, and iron is an important mineral that helps maintain healthy blood. It is a major part of hemoglobin, a type of protein in red blood cells that carries oxygen from the lungs to the body. You can get plenty of iron through certain foods. 

Causes and Risk Factors for Low Iron

Older ages are associated with a higher risk of iron-deficiency anemia due to possible poor nutritional status and chronic inflammatory diseases that can lead to iron malabsorption, such as celiac disease, ulcerative colitis, or Crohn’s disease. Other chronic conditions that may affect red blood cells are ulcers, cancers, or liver and kidney disease. Another risk factor for iron malabsorption is a history of weight-loss surgery.

Without enough iron, the body experiences extreme fatigue because there are not enough red blood cells to transport oxygen. Other symptoms of iron-deficiency anemia include dry, damaged hair and skin; paler-than-normal skin; brittle or spoon-shaped fingernails; cold hands and feet; and shortness of breath.

Types of Iron: Heme vs. Non‑Heme

Iron comes in two forms:

• Heme iron: Found in animal-based foods and is absorbed more efficiently.
  • Examples: red meat, poultry, fish, oysters, canned sardines, canned tuna, and organ meats

• Non-heme iron: Found in plant-based foods. Absorption is more variable as it does not bind to hemoglobin or myoglobin.
  • Examples: beans, lentils, spinach, fortified cereals, nuts, seeds, dark chocolate

• Other examples of high iron foods: eggs, figs, dates, raisins, whole wheat or enriched breads, tofu, broccoli, potatoes

*Find a list of high iron foods with portion sizes and number of mg per serving here.

Although the absorption of heme iron is more efficient, keep in mind that too much intake of animal-based proteins may increase the risk of heart disease. Both animal and plant-based iron sources are essential for maintaining sufficient iron levels.

Pro Tip: Improve your iron absorption from plant-based foods by pairing them with vitamin C-rich foods, such as citrus fruits and bell peppers. Find a list of other high vitamin C foods to pair with iron-boosting foods here.

Daily Iron Intake and Iron Supplements for Older Adults

The Recommended Dietary Allowance (RDA) of iron for older adults (aged 51+) is 8 mg per day. For women, the RDA drops from 18 mg per day (aged 19-50 years) due to the end of menstruation occurring with menopause. While highly unlikely, consuming an excess amount of iron is unlikely to cause any harmful effects on health. The Tolerable Upper Intake Level (UL), or the maximum daily intake, is 45 mg daily for all males and females ages 14+.

Iron-deficiency anemia is diagnosed through a blood test, specifically measuring levels of ferritin and total iron-binding capacity (TIBC). It can be treated through diet and consuming high iron foods, but also through oral iron supplementation or iron infusions given intravenously (IV). Some possible side effects of iron supplementation are constipation, dark bowel movements, a metallic taste, diarrhea, or nausea and vomiting. Discuss with your provider which treatment may be right for you.

Foods and Medications That Affect Iron Absorption

• Heartburn medications (Tums, Pepcid, Omeprazole, Protonix)
  • Iron is best absorbed with acid in the stomach. If you take heartburn medication, it is recommended to take your iron supplement about 2 hours prior.

• NSAIDs (Advil, Motrin)
  • While helping manage pain and inflammation, they can also carry risks, such as stomach ulcers and bleeding, which can lead to iron-deficiency anemia. This can counteract the benefits you get from iron supplements. Ask your provider about pain-reliever alternatives.

• Dairy Products (milk, yogurt, cheese)
  • Rich in calcium, which is great for your bones, but calcium binds to iron in the stomach, preventing its absorption. Take iron either 2 hours before or 2 hours after consuming dairy products.

• Coffee and tea
  • While delicious, they contain certain chemicals called polyphenols and tannins that bind to iron. This goes for both caffeinated and decaffeinated coffee and tea. No need to go without, though - just make sure to wait to enjoy it about 2 hours after taking iron.

• Levothyroxine (Synthroid)
  • A common and effective treatment for hypothyroidism, however it will not fully absorb when taken too closely with iron. It is recommended to space these out by at least 4 hours, preferably iron in the morning and Levothyroxine in the evening.

• Bisphosphonates (Fosamax)
  • Used to prevent and treat Osteoporosis. Space at least two hours apart from an iron supplement.