Fatigue in Older Adults? It’s Probably Not Low Iron


Decades ago, TV commercials for Geritol cautioned viewers about “iron-poor, tired blood,” helping to create a misconception that if you feel worn-out and fatigued, you could reverse it by taking an iron supplement.

However, if your body’s iron supply is not truly depleted, taking a lot of extra iron may not solve the problem and, in fact, could cause new problems, like gastrointestinal discomfort, constipation and impeded ability to absorb some medications.

In older adults, fatigue is not usually due to a lack of iron. “Most of it has to do with deconditioning, side-effects of certain medications or lack of overall fitness,” says Richard M. Dupee, MD, a primary care physician and geriatrician at Tufts Medical Center. “Reconditioning improves not just the overall feeling of well-being, but it also improves also your overall health.”

Iron and Anemia: Blood cells need iron to make hemoglobin, the molecule that ferries oxygen through the blood. If you don’t have enough iron in your system, your red blood cell count will be low.

In the general population, certain groups are at risk of iron deficiency and the more severe anemia caused by low intakes or excessive loss—mainly of concern in adolescent and premenopausal women.

Anemia also becomes more prevalent with aging. Based on data from a large national health survey, about 10% of American men and women age 65 and older may have anemia. It has a variety of causes, including conditions such as gastrointestinal bleeding, impaired ability to absorb iron, and inadequate intakes of other nutrients such as folic acid and vitamin B12.

However, Dupee says, the most common cause in older people is an impaired capacity of bone marrow to make enough red cells. In that case, you may have plenty of iron but just can’t use it effectively.

Another cause of anemia in older adults is inflammation associated with chronic diseases such as rheumatoid arthritis, inflammatory bowel disease, and some blood cancers. This persistent inflammation interferes with the absorption of iron in the gut.

“You have to treat the inflammation and then the anemia gets better,” Dupee says. “So, the solution in these cases is obviously not an iron supplement.”

In about 15% of cases of anemia in seniors, the condition stems from iron deficiency, although the problem rarely arises from inadequate dietary intake. That’s thanks to the many foods fortified with iron and the general availability of naturally iron-rich food.

“If it’s true iron deficiency, then this person’s got a problem that needs attention,” Dupee says.

Getting Enough Iron: The National Academy of Sciences’ Recommended Dietary Allowance for iron in generally healthy adult men and postmenopausal women is 8 milligrams (mg) per day from food and/or supplements. Women of childbearing age have higher requirements—18 mg per day for women age 19 to 50.

Animal foods are the best sources ofthe type of iron that the body absorbs most readily, called heme iron. Foods rich in heme iron include lean red meat, beef and chicken liver, dark meat poultry andseafood.

But you don’t need to start eating meat just to get iron, especially if you take a daily multivitamin. “A lot of people don’t eat red meat anymore but we have not seen an increase in iron deficiency as a result of it,” Dupee says.

People who eat little or no meat can obtain sufficient iron from grain products, which are enriched in iron, and plant foods, such as leafy greens and beans, although they may need to eat relatively more of these sources to compensate for the decreased absorption of non-heme iron.

Exercise, Not Iron: If you feel fatigued, Dupee recommends working with your doctor to find the root cause, rather than immediately turning to iron supplements. A healthy overall dietary pattern provides ample iron.

“In cases of fatigue, there is sometimes an underlying depression in older adults, but primarily it’s because they’re not getting enough exercise, although be sure to talk with your doctor about your medications,” Dupee says.

Take Charge!

The following foods, as part of a healthy overall dietary pattern, are good sources of iron to meet the requirements of most older adults:

-Iron-fortified foods, like breakfast cereals and enriched grain products.
-Animal foods containing heme iron including beef or calf liver and heart, dark-meat poultry, eggs, pork, salmon and sardines.
-Plant foods, including legumes (white beans, chickpeas), lentils, leafy greens, tofu, nuts and dark chocolate.


  1. Most people who eat a well balanced whole food plant based diet are not iron deficient needing only to supplement B12. High saturated fat organ and red meats are not needed and are detrimental to health. I have never been anemic, nor my wife, 20 years into a plant based diet. We exercise 1.5-2 hours per day and that does help prevent chronic fatigue.

  2. One of the hidden benefits of Geritol was its alcohol content. It made people “feel” good initially. Also, why it is no longer on the market.


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