Anaemia (anemia) is a condition in which the number of red blood cells, or the amount of haemoglobin in them, is lower than normal. Because haemoglobin carries oxygen around the body, organs and the brain receive less of it, and you feel tired and weak. It is very common: about one in four people worldwide has some form of anaemia, especially women, children and pregnant women.
Common symptoms
- Ongoing tiredness and weakness
- Pale skin and pale inner eyelids and gums
- Dizziness, headache or cold hands and feet
- Shortness of breath or a fast heartbeat on little effort
- Brittle nails, hair thinning or sore tongue
- Craving for ice, clay or starch (pica), a sign of iron deficiency
- Restless legs and trouble concentrating
Mild anaemia may cause no symptoms, so it is often found in a routine blood test.
Common causes
- Iron deficiency, the most common cause worldwide, often from low intake, heavy periods or blood loss (for example from ulcers or piles).
- Low vitamin B12 or folate, for example in some vegetarian diets, older age or digestive diseases such as celiac disease.
- Chronic illness or inflammation, kidney disease and some infections.
- Pregnancy, when the body needs more iron for the baby.
- Inherited conditions, such as thalassaemia or sickle cell disease.
- Poor absorption, after stomach surgery or from conditions such as Crohn’s disease.
Who is at higher risk?
- Women with heavy periods, and pregnant women
- Infants, toddlers and teenage girls
- Vegetarians and vegans who do not plan their iron and B12
- People who donate blood often
- Older adults and people with chronic disease
Foods that help
- Iron (heme, best absorbed): red meat, liver, chicken and fish.
- Iron (non-heme, from plants): lentils, chickpeas, beans, tofu, spinach, dried apricots, raisins, pumpkin seeds, whole grains and fortified cereals.
- Vitamin C with iron meals: lemon, orange, peppers, tomato and parsley help the body absorb plant iron. Squeeze lemon on a lentil dish or have fruit with a meal.
- B12: meat, fish, eggs, dairy and fortified foods. Vegans need a B12 supplement or fortified foods.
- Folate: leafy greens, legumes, citrus and fortified grains.
Things that block iron absorption
- Tea and coffee drunk with meals; have them at least an hour before or after meals.
- Large amounts of calcium (dairy or supplements) at the same time as iron.
- Very high amounts of bran or phytates in unsoaked legumes; soaking and cooking beans and lentils helps.
- Some antacids and medicines
A sample iron-rich day
- Breakfast: eggs with whole-grain toast and an orange
- Lunch: lentil soup, such as our red lentil soup with lemon, with lemon juice squeezed in
- Snack: dried apricots and pumpkin seeds
- Dinner: chicken or beef with a tomato and parsley salad (iron plus vitamin C), or ghormeh sabzi, rich in herbs, beans and meat
Cooking in a cast-iron pan can also add small amounts of iron to food.
How anaemia is diagnosed
A simple blood test (complete blood count) measures haemoglobin and red cell size, and a ferritin test shows your iron stores. Further tests check B12, folate and the cause of any bleeding. Do not guess the type: treatment depends on the cause.
Treatment
- Iron deficiency: diet changes and, if advised by a doctor, iron tablets, usually taken every day or every other day for 3 months or more. Iron can cause constipation, dark stools and stomach upset; taking it with a little vitamin C and on alternate days can help.
- B12 or folate deficiency: supplements or injections.
- Treating the underlying cause, such as heavy periods, ulcers or kidney disease.
- Severe cases may need iron by infusion or a blood transfusion.
When to see a doctor
Do not guess. A simple blood test shows the type of anaemia. Take iron supplements only if a doctor advises them, because too much iron is harmful, especially for children (keep tablets out of reach). Seek care quickly for chest pain, fainting, severe breathlessness or black or bloody stools. See our guides to foods that support immunity and mushrooms for more food ideas.
This article is general information, not medical advice.
