The Iron Clinic

18/02/2026

Iron Deficiency in Men is unusual
The body is amazing it holds about 4000mg of iron and recycles 500mg of iron per month. There is no means to 'excrete' iron so the recycling accounts for >90% of iron needs. Consequently normal absorption pathways from the gut are pretty rubbish - just 2-3mg per day. This is why women are disproportionately affected as a baby requires >1000mg of iron and iron losses in blood from the menstrual cycle can be 25mg or much more in women with heavy periods.

In men that develop iron deficiency, often it can happen over months / years and there has to be a cause. Poor absorption from coeliac disease, atrophic gastritis or weight loss surgery. Or blood loss; gastritis, ulceration, inflammatory bowel disease, or polyps / cancer. So endoscopy and colonoscopy is indicated in most.

Here Dr Susan Jain and our ODP Nick, providing IV iron to a gentleman before his endoscopies. In the Uk an iron infusion is routine and a full treatment of 1000-1500mg can be administered in a comfortable safe environment in just 15-30 minutes

13/02/2026

Common symptoms of anaemia incl.:
🥱 Tiredness
😵‍💫 Dizziness or feeling light-headed
❄️ Cold hands and feet
😖 Headache
🫁 Shortness of breath, especially upon exertion
🫀 Irregular heartbeat

If you experience any of these symptoms without any apparent reason, you may have

11/02/2026

03/02/2026

Heavy Periods (Heavy Menstrual Bleeding) is very common. HMB affects 1 in 3 women and the most common cause for and . Despite this the UK NICE guidance does not advocate testing Ferritin. The reason? - because there are no data suggesting that HMB causes iron deficiency and that iron deficiency causes symptoms. To address this The Iron Clinic has launched a screening project to gather data to change UK guidance.

Please help us https://www.shineonwomenshealth.org/

Note: HMB is a symptom that can have many causes, but it is often the HMB that can impact a woman's quality of life - here is a simple guide to symptoms (any 2 means HMB): -
The need to double protect
To get up at night-time
Double protect
Worried about going outdoors one or two days of the week

Note a tampon or sanitary pad can hold 10-15 ml of fluid. So more than a dozen per cycle means you are losing more than 80ml of blood. That adds up to ONE LITRE of BLOOD per year!!! HMB needs treating!

That is a LOT of IROn i.e. 500mg. and a normal diet will not support those losses.
Iron Deficiency needs treating!

Iron is stored in Ferritin and Ferritin is the best marker of iron stores
Ferritin > 50 is normal
Ferritin < 30 is iron deficiency

Iron Deficiency causes symptoms that can be disabling.

Yet there is no charity, no central place to get good advice, no recognised source for information, nowhere for women to get help advice and direction!

We will soon be transitioning to the IRONliFE, a Charity headed by Prof Toby Richards to raise awareness for women about heavy menstrual bleeding and iron deficiency. To offer the correct medical advice to empower women to get the correct information in order to get the correct treatment and to stop the suffering of many. Please watch this space over the next few weeks.

27/01/2026

Your blood lives or dies by three nutrients: iron, folate, and vitamin B12.
This chart shows how they build every red blood cell you have.

🩸 Iron: You eat 10–20 mg a day but absorb only 3–15%.
Heme iron (meat) gets in easily. Non-heme (plants) struggles.
Vitamin C boosts absorption. Inflammation blocks it through hepcidin, trapping iron in storage.

🧬 Folate + B12: These two run the DNA synthesis machinery in your bone marrow.
Folate depletes in months. B12 lasts longer but needs intrinsic factor to be absorbed. Lose either and red blood cells enlarge but can’t divide.

♻️ Recycling: Your body reclaims ~25 mg of iron every day from old red cells

🔗 The triad:
Iron delivers oxygen.
Folate builds DNA.
B12 activates folate.
Break one link and oxygen transport collapses.

That’s why fatigue, pale skin, brain fog, or numbness often trace back to this same biochemical network.

Source: Color Atlas of Pathophysiology, Thieme.

18/01/2026

is all about low iron and the treatment is iron.
The article for the American College of Physicians is written by Tom D a lifelong expert and a friend and colleague with whom we wrote the Lancet haematology guidelines - much the same.

An interesting discussion we had was addressing some of the misconceptions (and sales from FB groups!).
1. Treatment with oral iron should be at 60-100mg elemental iron per day
2. Avoid taking multivitamins as these (Cu Zn Mg etc) compete on for absorption
3. Copper deficiency is very rare and seen in malabsorption secondary to bariatric surgery or reported in excess Zinc intake.

15/01/2026

Here is a talk by Prof Toby on his work over the last decade leading clinical trials on anaemia and iron deficiency in patients undergoing major surgery

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11/01/2026

Heavy periods affect 1 in 3 women and the commonest cause of - recognition is key as there can be very easy treatments that can change a woman’s life : here Emma a trustee of our charity SHINE gives her story to raise awareness

08/01/2026

what tablets do I take?
The main ingredient for an iron tablet is Iron sulphate / gluconate / fumarate / bisglycinate. These are termed 'iron salts' and there is no real difference between them. These ingredients are the basis of most iron tablets or liquids - the rest is marketing.

What dose?
The important bit: - its all about the amount of 'elemental iron' i.e. the dose:
If a 200mg tablet, you need to read the ingredients on the back to see the actual 'dose' of 'elemental iron it may be the dose is 65mg. The table here is very helpful.
Note there is a LOT of marketing but in reality little if any difference in the tablets, those promoting 'haem' iron professes better absorption but in reality when tested in clinical trials no benefit has been shown. So go with the well proven tablets - below.

WHAT DO YOU NEED
If your ferritin < 30 then you are 1000mg behind on iron in the body.
Treatment is 50-100mg elemental iron once a day. Most people tolerate this dose and one tablet a day is enough. The problem is that you only absorb about 10% of the dose so about 6-10mg per day - about 200mg -250mg per month. So you need a minimum of 6 months to get replenished (1000mg +)

If you do get side effects then stop for a few days then try half the dose or a tablet alternative days. Overall, while there may more absorbed per day as you are only taking half the dose the absorption per month is 150-200mg.

Struggling to find which iron tablets to choose? Checkout the information from Lifeblood Australia

06/01/2026

IRON and DIET
If iron deficient (Ferritin < 30) then you are 1000mg of iron behind
Diet alone will not suffice as normal absorption of iron is LOW.

One 325-mg ferrous sulfate tablet ≈ 13 mg absorbed iron
=🥩 3.3 lb steak = 🥬 18 lb spinach

Here 1Kg of spinach and there is more iron in Prof's left hand :-( !
( like or not those are the facts)
(Steak assumes ~25% heme absorption; spinach ~5% non-heme)

You cannot eat your way out of and do need treatment dose Oral iron tablets 200-300mg once a day (works out to about 200-240mg absorbed per month so you need 4-6 months treatment)

Food is important, but for iron deficiency, tablets are doing a very different job

04/01/2026

is common in pregnancy and about half of women become anaemic. A normal pregnancy requires about 1000mg of iron for normal baby growth (500mg in the last month when the baby doubles in size). This is a lot of iron and can use a mothers entire reserve stores of iron (held in Ferritin).

A Ferritin below 30 is iron deficiency and can lead to symptoms and anaemia.
Often mothers are advised to take oral iron - but is this enough?? - perhaps not!

A large clinical trial has shown IV iron infusion is better that iron tablets for both mother and baby - more details below: -

In this large clinical trial they compared IV iron infusions with oral iron for women with , not anaemic, at second trimester (11-20 weeks pregnant).
Intravenous iron for non-anaemic iron deficiency in pregnancy: a multicentre, two-arm, randomised controlled trial: The Lancet Haematology; Volume 13, Issue 1e22-e29 January 2026. DOI: 10.1016/S2352-3026(25)00315-1

600 mothers, average 26 years old (23-30) about 65kg (10) with Hb 11·8 (0·6) and Ferritin 14·8 (6·8) received either ORAL iron or IV IRON (1000mg)
Most mothers on ORAL iron had anaemia at delivery - few with IV iron - (Picture)

Haemoglobin at delivery 11·6 (0·5) 10·8 (0·7) 0·74 (0·64– 0·85)

04/01/2026

IRON DEFICIENCY IN PREGNANCY

Visit the post for more.