Anemia in Women: Causes and Nutritional Treatment

Quick AnswerAnemia is very common in women due to menstruation and pregnancy. Treatment depends on cause: increase iron from food (red meat, lentils, spinach), take vitamin C to boost absorption, avoid tea and coffee with meals, and iron supplements if needed. Normal hemoglobin for women: 12-16 g/dL.What is Anemia?

Anemia means blood doesn't contain enough healthy red blood cells or hemoglobin to carry oxygen to body tissues. Result: you feel tired, weak, and constantly exhausted.

Women are more prone to anemia than men, especially during reproductive years. In my clinic, I see women daily suffering from anemia symptoms without realizing it, believing constant fatigue is "normal" due to life pressures.Common Anemia SymptomsConstant fatigue and exhaustion even with adequate restPale skin and lipsShortness of breath with simple movementHeart palpitations or rapid heartbeatDizziness and headacheCold hands and feetPoor concentration and memoryHair lossWeak and brittle nailsCraving strange things (ice, chalk, dirt) - PicaTypes of Anemia and Causes in Women1. Iron Deficiency Anemia (Most Common)

Represents 90% of anemia cases in women. Iron is essential for hemoglobin production.

Main Causes:Heavy menstruation: Losing more than 80 ml blood monthlyPregnancy and breastfeeding: Fetus draws iron reservesDietary iron deficiency: Not eating enough iron-rich foodsMalabsorption: Intestinal diseases, bariatric surgeryInternal bleeding: Stomach ulcer, hemorrhoids2. Vitamin B12 Deficiency Anemia

Vitamin B12 is essential for producing healthy red blood cells.

Causes:Strict vegetarian dietMalabsorption (pernicious anemia)Stomach surgeriesCertain medications (metformin)3. Folate Deficiency Anemia

Folate is essential for DNA and red blood cell production.

Causes:Diet poor in leafy vegetablesPregnancy (increased needs)Certain medicationsAlcohol abuseDr. Mai's Tip: If you suffer from constant fatigue, don't ignore it. A simple blood test reveals anemia and determines its type. Early diagnosis makes treatment easier.Required Tests

To diagnose anemia and determine cause, you'll need these tests:Basic Tests:Complete Blood Count (CBC): Measures hemoglobin, red blood cell count, and sizeIron stores (Ferritin): Measures body iron reservesSerum Iron: Free iron levelTIBC: Blood's capacity to carry ironAdditional Tests as Needed:Vitamin B12FolateKidney functionThyroid function

Normal Hemoglobin Values:Non-pregnant women: 12-16 g/dLPregnant: 11-14 g/dLMen: 13.5-17.5 g/dL

Normal Ferritin: 15-150 ng/mL (ideal: above 30)Nutritional Treatment for Iron Deficiency AnemiaDaily Iron NeedsWomen (18-50 years): 18 mg dailyPregnant: 27 mg dailyBreastfeeding: 9-10 mg dailyAfter menopause: 8 mg dailyTwo Types of Iron in Food

1. Heme Iron - from animal sourcesAbsorbed at 15-35%Not affected by absorption inhibitorsBest source for fast treatment

Best Heme Iron Sources:FoodAmountIron (mg)Beef liver100g6.5Red meat (steak)100g2.6Chicken (dark meat)100g1.3Tuna fish100g1.0Oysters100g7-8

2. Non-heme Iron - from plant sourcesAbsorbed at only 2-10%Heavily affected by absorption enhancers and inhibitorsVery important for vegetarians

Best Non-heme Iron Sources:FoodAmountIron (mg)Cooked lentils1 cup6.6Cooked spinach1 cup6.4Black beans1 cup3.6Chickpeas1 cup4.7Cooked quinoa1 cup2.8Egg1 large1.0Oatmeal1 cup dry4.0Iron Absorption Enhancers1. Vitamin C (Most Important!)

Vitamin C increases non-heme iron absorption by up to 300%!

How to Use It:Eat vitamin C source with every iron-rich mealExample: lentils with orange juice or tomatoesExample: spinach with lemon juice

Rich Vitamin C Sources:Oranges, grapefruit, lemonsBell peppers (red and green)Strawberries, kiwiBroccoli, tomatoesGuava2. Amino Acids

Animal protein improves plant iron absorption.

Example: Eat lentils with small piece of chicken3. Fermented Foods

Fermentation reduces phytates that inhibit iron absorption.

Examples: Sourdough bread, miso, tempehIron Absorption Inhibitors (Avoid!)1. Tea and CoffeeContain tannins that prevent iron absorption by up to 60%.Solution: Don't drink tea or coffee 2 hours before or after mealsDrink them between meals only2. CalciumCompetes with iron for absorption.Solution: Don't take calcium supplements with iron supplementsDistribute them at different times of day3. PhytatesFound in whole grains and legumes.Solution: Soak legumes before cookingEat vitamin C with whole grains4. OxalatesFound in spinach, chocolate, nuts.Solution: Cooking spinach reduces oxalatesVary iron sourcesDaily Meal Plan for Treating AnemiaSample Full Day (Iron-Rich)

Breakfast (7:30 AM):Cup cooked oatmeal with milk1 tbsp molasses (iron-rich)Half cup strawberries10 almondsGlass fresh orange juice (vitamin C)

Snack (10:30 AM):2 boiled eggsRed bell pepper slices

Lunch (1:00 PM):120g red meat or liver (once weekly)Cup brown rice or quinoa2 cups cooked spinach with lemon (vitamin C)Green salad with tomatoes and peppersGlass guava or orange juice

Snack (4:00 PM):Hummus with tahini (3 tbsp)Cucumber and carrotsFresh lemon juice

Dinner (7:00 PM):Cup lentil soup with lemon100g grilled chicken or fishCup cooked broccoliGreen saladWhole grain bread

Before Bed:Glass milk (2 hours after dinner)Or handful of nutsImportant Note: Don't drink tea or coffee with meals! Drink them at least 2 hours later.Iron Supplements

If iron level is very low, food alone may not be enough. You'll need iron supplements.Types of Iron Supplements

1. Ferrous Iron - better absorbed:Ferrous Sulfate (cheapest and most common)Ferrous FumarateFerrous Gluconate (fewer side effects)

2. Ferric Iron - fewer side effects:Iron Bisglycinate (best tolerated)Iron Polysaccharide ComplexHow to Take Iron SupplementsDose: Usually 60-120 mg elemental iron daily (per doctor's recommendation)Timing: On empty stomach (1 hour before breakfast or 2 hours after last meal before bed)With what: Glass orange juice or water with vitamin CAvoid: Taking with tea, coffee, milk, or antacidsDuration: At least 3-6 months even after symptom improvement (to build reserves)Side Effects and How to Handle ThemConstipation: Drink more water, increase fiber, try different iron typeNausea: Take with little food, or before bedDark/black stool: Completely normal, don't worryMetallic taste: Try coated tabletsDr. Mai's Tip: Don't stop iron supplements as soon as symptoms improve! Building iron stores takes 3-6 months. Continue per doctor's recommendation and repeat tests.Nutritional Treatment for B12 and Folate Deficiency AnemiaVitamin B12

Daily Needs: 2.4 mcg

B12 Sources (found only in animal sources):Beef liver (100g = 60 mcg)Oysters (6 pieces = 20 mcg)Salmon fish (100g = 3 mcg)Red meat (100g = 2 mcg)Egg (1 egg = 0.6 mcg)Milk (1 cup = 1.2 mcg)Fortified plant foods (breakfast cereals, plant milk)

For Vegetarians: Must take daily B12 supplements (1000 mcg) or periodic injectionsFolate

Daily Needs: 400 mcg (600 for pregnant)

Rich Folate Sources:Dark leafy greens (spinach, kale)Legumes (lentils, beans, chickpeas)Broccoli, asparagusAvocadoOrangeBeef liverFortified breakfast cerealsWhen to See Doctor Immediately?

See your doctor or nutritionist if:Severe fatigue affecting daily lifeShortness of breath even at restPersistent heart palpitationsSevere dizziness or faintingSevere cold extremitiesNoticeable hair lossHave very heavy menstruationPregnant or planning pregnancyStrict vegetarianSuffering from Anemia and Need a Customized Treatment Plan?Dr. Mai Obeid - Clinical Nutritionist Specialized in Treating Anemia and Women's Health📱 WhatsApp: +961 81 337 132Frequently Asked QuestionsHow Long Does Anemia Treatment Take?Symptoms improve within 2-4 weeks of starting treatment (you'll feel more energetic). Hemoglobin rises within 4-8 weeks. But building iron stores takes 3-6 months. So don't stop supplements early! Recheck ferritin after 3 months.Can Anemia Be Treated with Food Only Without Supplements?Depends on anemia severity. If mild (hemoglobin 11-11.9) and ferritin above 15, yes food treatment works within 3-4 months. But if hemoglobin below 10 or ferritin very low, you'll need supplements for faster treatment. Food excellent for prevention and maintenance, but supplements faster for treatment.Why Do Iron Supplements Cause Constipation?Iron slows intestinal movement and absorbs water. Solution: drink 8-10 glasses water daily, increase fiber (vegetables, fruits, whole grains), move more. If constipation persists, try Iron Bisglycinate (less constipating) or take supplement before bed. Can also take mild laxative with doctor's approval.Do I Need to Eat Liver?Liver is very rich in iron and B12, but not necessary. If you like it, eat once weekly (100g). If you don't like it, get iron from other red meats, fish, legumes. Liver prohibited for pregnant in large amounts (very rich in vitamin A). Options are multiple!I'm Vegetarian, How Do I Get Enough Iron?Focus on: lentils, beans, chickpeas, spinach, quinoa, oatmeal, tahini, pumpkin seeds. Most important: eat vitamin C with every meal (orange juice, tomatoes, peppers, lemon). Soak legumes before cooking. Avoid tea and coffee with meals. You'll likely need iron supplement, and definitely B12 supplement (not found in plants). Test levels every 6 months.Can I Take Iron with Multivitamins?Yes, but carefully. Avoid taking with calcium, magnesium, and zinc at same time (they compete for absorption). Best: take iron supplement morning on empty stomach with vitamin C, and multivitamins evening with food. Or use separate iron supplement with higher dose instead of multivitamins.My Period is Very Heavy, What Should I Do?Heavy period is main cause of anemia. If you change pad every hour, or period longer than 7 days, see gynecologist immediately. Cause may be: fibroids, hormonal imbalance, clotting problems. Treatment may include: birth control, medications, or simple surgery. Meanwhile, increase iron in food and take periodic iron supplements.Medical Disclaimer: The information provided in this article is for educational purposes only and does not replace consultation with a doctor or nutritionist. Anemia has multiple causes requiring accurate medical diagnosis. Don't start any supplements without tests and doctor's approval. Excess iron is dangerous and can damage organs. This content does not constitute medical advice and should not be relied upon as a substitute for professional consultation.