Iron Deficiency and Anaemia: Why You're Always Tired, the Desi Foods That Help, and the Tea Mistake

In many Pakistani homes, being tired is treated as normal for women — the result of housework, children or 'weakness'. Sometimes it is. But a simple blood test often shows something fixable: low haemoglobin, low iron stores, or a vitamin deficiency. The usual home remedies — anaar juice, chukandar, a bowl of palak — are well meant but deliver surprisingly little iron.

How common is anaemia in Pakistan?

A 2017 analysis in BMJ Open of 11,751 blood samples from the National Nutrition Survey found that 50.4 percent of Pakistani women of reproductive age were anaemic. In the same women, 52.4 percent were low in vitamin B12 and 50.8 percent in folate. That matters: anaemia from B12 or folate deficiency, or from an inherited condition such as thalassaemia trait, will not improve with iron tablets — and taking iron you do not need is not harmless.

What are the symptoms of iron deficiency?

• Tiredness and low energy that sleep does not fix.
• Breathlessness or a racing heart on stairs or during exercise.
• Pale skin, inner eyelids or nails; brittle or spoon-shaped nails.
• Headaches, dizziness, feeling cold, poor concentration.
• Hair shedding.
• Restless legs at night, or cravings to chew ice, clay or raw rice (called pica).
• Workouts feeling much harder than they should.

Which blood tests do you need?

Ferritin rises with infection and inflammation, so a 'normal' result during an illness can hide low stores. Your doctor may also look for the cause of iron loss — heavy periods are the most common in women, but in men and older women, iron deficiency needs a check for bleeding from the stomach or bowel.

Can low iron make you tired without anaemia?

Yes. Iron stores can run low before haemoglobin falls. In a 2012 trial in the Canadian Medical Association Journal, 198 women aged 18 to 53 with unexplained fatigue, normal haemoglobin and ferritin below 50 µg/L took either 80 mg of iron a day or a placebo for 12 weeks. Fatigue scores fell by 47.7 percent with iron and by 28.8 percent with placebo. It also matters for training: a 2014 meta-analysis of 24 trials found iron supplements improved maximal aerobic fitness (VO2max) in women by about 2.35 mL/kg/min and lowered heart rate during submaximal exercise.

Which foods are high in iron?

Haem iron from meat, liver and fish is absorbed far better (roughly 15–35 percent) than the non-haem iron in plants (roughly 2–20 percent), according to the US National Institutes of Health. Adult women up to 50 need about 18 mg of iron a day; men and women over 50 need about 8 mg. A bowl of daal is a good source — the trick is helping your body absorb it.

Does tea block iron absorption?

Yes, strongly. In a 1999 study in the British Journal of Nutrition, black tea drunk with a bread meal reduced iron absorption by 79–94 percent, and adding milk made little or no difference. Coffee and many herbal teas did the same. Timing helps: in a 2017 trial in the American Journal of Clinical Nutrition, drinking tea one hour after a meal instead of with it cut the inhibition roughly in half, from 37.2 percent to 18.1 percent. For a nation that drinks doodh patti straight after lunch and dinner, this one change matters.

How to absorb more iron from desi food

• Move tea at least an hour away from main meals — have it mid-morning and mid-afternoon instead.
• Add vitamin C to iron-rich meals: lemon squeezed on daal or chana, tomatoes, a guava, orange or kinnow after lunch. Vitamin C counteracts the phytates in whole wheat and pulses that block iron (Hallberg 1989).
• Eat a small amount of meat, chicken or fish with plant foods — it improves absorption from the whole meal.
• Have kaleji once a week if you eat meat; it is the richest common source.
• Soaking daal and chana overnight, and sprouting moong or chana for chaat, reduces the phytates that block iron.
• Keep calcium supplements and large glasses of milk away from iron-rich meals and iron tablets.

How to take iron tablets

If a doctor confirms iron deficiency, tablets are usually needed — food alone refills empty stores slowly. A 2017 trial in The Lancet Haematology gave 40 iron-depleted women 60 mg of iron either every day for 14 days or every other day for 28 days. Every-other-day dosing was absorbed better: 21.8 percent of each dose versus 16.3 percent, and more iron in total from the same number of tablets. Daily doses raise a hormone, hepcidin, that blocks absorption of the next dose. Ask your doctor whether alternate-day dosing suits you.

• Take tablets on an empty stomach or with orange juice, not with tea, coffee, milk or calcium.
• Constipation, nausea and black stools are common; taking them with a little food or on alternate days often helps.
• Recheck haemoglobin and ferritin after about 8–12 weeks, and keep going until stores are refilled, not just until you feel better.
• Keep iron tablets locked away from children — an overdose can be fatal for a child.
• Do not take iron 'just in case' without a blood test, especially if anyone in your family has thalassaemia.

This article is general information, not medical advice. Anaemia has many causes, some of which need investigation — see a doctor for blood tests before taking iron, and urgently if you have black or bloody stools, very heavy bleeding, chest pain or fainting.