Iron Deficiency in India: Why It Is So Common and What It Does

What iron does in the body

Iron is a core component of haemoglobin, the protein in red blood cells that carries oxygen from the lungs to every tissue in the body. When iron stores fall, the body cannot produce enough functional haemoglobin, and tissues receive less oxygen than they need.

This is why the symptoms are so diffuse — fatigue, breathlessness, poor concentration — rather than localised to any one organ.

Why deficiency is so widespread here

Several factors compound one another in the Indian context:

• •Predominantly plant-based diets supply non-haem iron, which the body absorbs far less efficiently than the haem iron in animal foods
• •Tea and coffee taken with or immediately after meals contain polyphenols that markedly reduce iron absorption
• •Phytates in whole grains and legumes — otherwise healthy foods — also bind iron and limit uptake
• •Menstrual blood loss creates a recurring monthly demand in women of reproductive age
• •Pregnancy sharply increases requirements
• •Intestinal worm infestation, still common in some regions, causes chronic low-grade blood loss

Signs worth taking seriously

Early iron deficiency is often silent. As it progresses, common features include persistent tiredness disproportionate to activity, breathlessness on mild exertion such as climbing stairs, pallor of the skin, inner eyelids and nail beds, frequent headaches, poor concentration, hair fall, and brittle or spoon-shaped nails.

An unusual but well-recognised sign is pica — a craving to eat non-food substances such as ice, chalk or mud. In children, iron deficiency can affect attention and school performance before any obvious physical sign appears.

Improving iron from the diet

Dietary change alone cannot correct an established deficiency quickly, but it supports recovery and helps prevent recurrence:

• •Pair iron-containing foods with a source of vitamin C — lemon, amla, guava, tomato or citrus — which substantially improves absorption of plant iron
• •Move tea and coffee to at least an hour away from meals
• •Include iron-rich foods such as ragi, bajra, green leafy vegetables, dates, jaggery, sesame and legumes
• •Soaking, sprouting and fermenting grains and pulses reduces their phytate content
• •Cooking in cast-iron vessels can modestly increase the iron content of food

Why you should not self-prescribe iron

This is the most important point in this article. Iron supplementation should follow a blood test and medical advice, never guesswork.

Fatigue has many causes besides iron deficiency — thyroid disorders, vitamin B12 deficiency, diabetes, chronic infection and others — and treating the wrong one delays the correct diagnosis. More seriously, iron deficiency in an adult male or a post-menopausal woman can be the first sign of bleeding in the digestive tract, which requires investigation rather than supplementation.

Excess iron is also harmful. The body has no efficient way to excrete it, and conditions such as haemochromatosis or thalassaemia trait can cause dangerous accumulation. Iron preparations are additionally a leading cause of accidental poisoning in young children and must be stored out of reach.

A doctor will typically order a complete blood count and ferritin before deciding whether supplementation is appropriate, at what dose, and for how long.

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