Iron & HHT




What is iron?

Iron is a mineral vital to the proper function of haemoglobin, a protein needed to transport oxygen in the blood.

Certain individuals, like children and teens, menstruating or pregnant women, and athletic individuals, are at an increased risk of iron deficiency. HHT also increases your risk of iron deficiency. A shortage of iron in the blood can lead to a range of serious health problems, including iron deficiency anaemia.

Symptoms of iron deficiency anaemia include fatigue, lack of energy, pale skin, depressed immune function, and reduced mental performance.

How much iron do I need? 

The average daily foods and supplements:

  • in children aged 2–11 years: is 13-15mg
  • in children and teens aged 12–19 years: day 16mg/day
  • in men: and 1–20 mg/day
  • in women older than 19: 17–18 mg/day
  • in pregnant women is 14mg/day

It is recommended that you talk with your doctor. He/she will advise you if you should take your iron daily or on alternate days.

Necessary iron daily per category of population and per mg



However, people who have chronic bleeding and have low levels of iron in their bodies need more iron than this. Every individual is unique, so talk to your doctor about your own personal needs.

How does my body absorb iron?

Iron enters the stomach where it is exposed to stomach acid and changed into a form that allows it to be absorbed. The portion of the small intestine called the duodenum is the chief area where iron absorption takes place.

Heme-iron (from meat) is more easily absorbed by the body. Because vegetarians only consume non-Heme iron, they are at a higher risk for iron deficiency. But other factors (eg Calcium) influence how your body absorbs iron as well. If you are deficient in iron, your body will absorb more of it from food than it would if you had good iron stores.

Increase your intake and absorption of iron:

Consume iron with a source of vitamin C. Many fruits, vegetables, and juices are good sources of vitamin C, including citrus fruits and juices, strawberries, broccoli, peppers, and tomatoes.

Meat aids absorption of non-heme iron, e.g. beef in chili will help you absorb the iron in kidney beans.

Where is iron found?

There are two types of iron found in foods.

Heme iron is found only in animal sources, such as beef, chicken, turkey and in shellfish eg Oysters & Shrimp.

Non-Heme iron is found in animal & plant sources. Plant Sources include pumpkin seeds, tofu, soybeans, lentils, and legumes, nuts, eggs, baked beans, blackstrap molasses.

Some fruits and vegetables e.g. cooked spinach, dried fruits like apricots, cooked green peas, and tomato sauce are all other good sources of non-heme iron.

For more information about sources of iron, talk to your dietician

Iron medications

Since people with HHT often need extra iron, your doctor might recommend iron replacement therapy. Iron is available in capsule, tablet, chewable tablet, and liquid form.

Take your iron pills on an empty stomach, which means 2 hours after the last meal or 1 hour before eating. If you experience stomach cramps, nausea, or diarrhea when taking iron, you may take it with a small amount of food.

Vitamin C helps you absorb iron so you can take your iron pill with a glass of orange juice.

Don’t drink milk or take calcium supplements or antacids at the same time as your iron – wait at least 2 hours before taking your iron after consuming these.

Avoid the following foods when consuming your iron pills, because they decrease absorption:

  • Foods containing phytates: e.g. legumes, rice, whole grains
  • Foods containing polyphenols: e.g. coffee, tea, red wine, oregano
  • Foods containing vegetable proteins: e.g. soybeans
  • Foods containing calcium: e.g. dairy products

Ask your doctor or pharmacist about your other medications. Some antibiotics (e.g. tetracycline, penicillin, etc…) and other drugs don’t work as well if you take them at the same time as iron – wait at least two hours in between. Also, if you take acid suppressant medications (e.g. ranitidine, omeprazole, pantoprazole and others), talk to your doctor or pharmacist about what time of day to take your different pills.

Iron supplements can sometimes cause constipation

Here are some tips to help with this:

  • Aim for 25-35 grams of fibre per day, but increase slowly by adding 1-2 high fibre foods per day (e.g. whole grains, fruits, vegetables, bran cereal). Be sure to drink 6 to 8 cups of fluid per day as you increase your fibre.
  • Some evidence suggests that probiotics might help with constipation. Some probiotic yogurts also contain added fibre (e.g. some types of Activia brand yogurt)
  • If by consuming more fibre and fluid is not helping, ask your doctor about a laxative or stool softener


Diarrhea, nausea, or vomiting sometimes occur with high doses of iron supplements. This can be managed by taking iron in smaller doses throughout the day. Talk to your doctor about adjusting your iron rather than just stopping. Black stools are normal when taking iron supplements, but if you notice blood in your stool or have cramps or sharp pains in your abdomen, talk to your doctor immediately.

Iron Deficiency in HHT

Iron deficiency is a common and important manifestation of HHT. Lack of iron makes it harder to produce red blood cells (RBCs), has symptoms similar to anemia, and makes anemia more likely to occur with active bleeding as the body will not have the necessary iron available to replace the lost RBCs. Approximately 50% of patients with HHT develop anemia. However, many patients can be iron deficient but not anaemic.

There are many iron-rich foods that can help increase iron absorption. An iron-rich diet can help offset iron deficiencies, but it’s also important to know which foods can prevent iron from being absorbed. Learn more with this inclusive factsheet from CureHHT