How to manage iron-deficiency anemia

AllisonMS, RDN, CDN

We depend on food and dietary supplementation for our iron supply because our bodies don’t produce it on our own.

There are two types of dietary iron: 1) heme iron from animal-based foods like meat, fish and poultry, and 2) non-heme iron from plant-based foods such as nuts, fruits, vegetables, tofu and fortified cereals and grains.

Heme and nonheme iron are absorbed by the body differently : iron from animal-based foods is generally better absorbed than iron from plant-based foods, but combining the latter with a source of vitamin C can help improve absorption. If you’re a vegetarian or vegan, this is particularly important. (For a complete list of vitamin c-rich foods read Getting enough vitamin C? Myself? My baby? My toddler?).

Other foods we eat in conjunction with iron can impact absorption too. For example, the calcium in dairy products and the tannins in coffee and tea can prevent absorption of both types of iron. If you’re iron-deficient, chat with the Happy Mama Mentors who can help you determine how to meet your needs and maximize your body’s absorption of this important mineral.

Iron needs change depending on our life stage. An adult woman should consume 18mg/day, whereas a pregnant woman should consume 27mg/day to support fetal growth and to meet the body’s increased need due to higher blood volume and oxygen demand.

So how do you know if you’re getting enough iron? A simple blood test can determine whether you have iron deficiency anemia (IDA), the official name for too little dietary iron. Testing is done routinely during pregnancy, most commonly at the first prenatal visit and again around the beginning of the third trimester (although each healthcare provider may have her own schedule for testing).

Some physical symptoms of IDA to look out for include: feeling persistently fatigued despite adequate sleep, heart palpitations and looking pale.

The women most at risk for IDA are those who have a multiples pregnancy, had a short recovery time after the last pregnancy, had IDA in a previous pregnancy, or have a history of poor nutritional and/or socioeconomic status. Additionally, any pregnant woman who is vomiting frequently due to morning sickness (which interferes with the proper absorption of dietary nutrients), can become low in iron.

Many pregnant women have insufficient iron stores to meet the demands of pregnancy. In fact,

17-31% of pregnant women in North America have IDA and it accounts for 75-95% of all anemia cases in pregnant women.

You can prevent IDA during your pregnancy by taking the recommended 27mg iron daily (the amount in most prenatal supplements) in addition to eating a diet that includes iron-rich foods. (Studies have shown that taking a prenatal vitamin alone reduced the risk of maternal anemia by 70% and iron deficiency by 57%.)

Prevention of IDA is important during all stages of pregnancy as it assures optimal health for you and your child.

What to Do

Incorporate iron-rich foods at every meal and snack

Eat plenty of iron-rich plant-based foods such as beans, dark leafy greens, dried fruit (such as raisins and apricots), iron-fortified whole grains, green peas, pastas and cereals (look for ones with less than 4g sugar and more than 4g fiber).

If you eat animal foods, choose lean protein sources like seafood and poultry as well as heme-rich lean red meat and pork.

For example, reach for these iron-rich foods:

  • Lentils (6.6 mg iron in 1 cup serving)
  • Oatmeal (10 mg iron in 1 cup serving)
  • Soybeans (8 mg iron in 1 cup serving)
  • Spinach (3.2 mg iron in 1 cup serving)
  • Lean ground beef (3.9 mg iron in 3 ounce serving)
  • Dark meat turkey (2.3 mg iron in 3.5 ounce serving)
  • Roasted chicken breast (1.1 mg iron in 3 ounce serving)

Get the most out of your iron-rich foods and supplements with food pairings

Pair iron-rich plant-based foods with vegetables and fruits that are rich in vitamin C, such as broccoli, grapefruit, kiwi, leafy greens, melons, oranges, peppers, strawberries, tangerines and tomatoes to maximize absorption.

Avoid eating dairy products high in calcium (yogurt, milk, cheese, cottage cheese) or drinking coffee and tea when you’re eating high-iron foods and supplements as these may inhibit iron absorption.

If you take a separate iron supplement in addition to your prenatal, take it at a different time of the day because your prenatal likely contains calcium.

Try these meal and snack ideas that are loaded with iron (and other important nutrients!):


  • Kale salad with grilled chicken and dried fruit of your choice, top with broccoli, chickpeas, and/or lentils. Try a homemade dressing of ½ clove minced garlic combined with olive oil, pepper and lemon juice
  • Vegetarian taco salad with spinach, mixed greens, brown rice, black or pinto beans and salsa. Add cilantro if you like!
  • Healthy Picadillo (beef hash, use lean beef. Or opt for ground turkey or chicken) with yellow, green and red bell peppers, carrots, tomatoes, golden raisins and green olives
  • Lentil soup with added spinach
  • Lettuce cups with tofu topped with veggies of your choice and guacamole


  • Dried fruit (like raisins and apricots)
  • Pumpkin seeds (try adding to your cereal along with strawberries for a boost of vitamin C)
  • Raw broccoli and tahini dip
  • Chickpea salad or roasted chickpeas
  • Oatmeal topped with apples (look for a brand of oats high in iron)

Take your prenatal vitamin as directed by your healthcare provider

And check the nutrition facts label on any supplements you take to determine iron levels.

Speak with your healthcare provider if your iron supplement is causing nausea or upset stomach

Iron is best absorbed on an empty stomach. However, supplemental iron may cause nausea, and taking it on an empty stomach might make nausea even worse. If this is your experience, it may be possible to take smaller doses of iron throughout the day with food to ease any discomfort. Or try a different form of supplemental iron, such as liquid instead of a pill.

As always, emphasize a diet rich in fiber to combat any iron-induced constipation

Because supplemental iron may also cause constipation, a diet rich in fiber (think fruits, vegetables, whole grains, nuts and seeds) with plenty of water and physical activity is more important than ever. As you add in more fiber, be sure to also drink enough fluids to prevent more constipation. During pregnancy, your goal is to drink 10 (8 oz) cups of fluid per day to meet your needs and breastfeeding moms need around 13 (8 oz) cups per day.

If you suspect iron deficiency anemia, ask your healthcare provider for a blood test

If you are diagnosed with IDA, your healthcare provider can provide guidance in increasing your amount of supplemental iron. And a Happy Family Milk Mentor can help you create a meal plan to increase iron-rich foods.