Tired? Pale? What You Need to Know Before Taking B12 and Iron Supplements

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Tired? Pale? What You Need to Know Before Taking B12 and Iron Supplements

As a nutritionist, the most frequent question I get asked about is B12 and iron supplementation. Low levels of B12 and iron are more common than you’d think, especially among females. Additionally, even if your levels are considered ‘within the healthy range’, you may still be experiencing symptoms associated with deficiency.

For this reason, I’ve put together the most relevant information on deficiency symptoms, optimum levels, food sources and supplementation (both iron and B12 are notoriously poorly absorbed and difficult to obtain through diet alone and often need to be supplemented).

Many people know that too little iron results in anemia but a little known fact is that low B12 levels can also result in anemia. When your body is low in iron, your red blood cells become very small; and when your body is low in B12 (and folic acid) your red blood cells become too large. In both instances, your RBCs don’t function as they should.


How You Might Feel If Your Levels Are Low

Iron is so important because it plays a crucial role in the function of red blood cells and their ability to transport oxygen from the lungs to other tissues and carbon dioxide from tissues to the lungs. As well, iron plays an important job in DNA synthesis and energy production.

When your tissues and organs don’t get enough oxygen, and energy production is impaired, you end up feeling tired and looking pale. For females, who are at greater risk, low iron levels can also lead to excessive bleeding during that time of the month, making the problem even worse. Other issues include learning and memory retention problems and lowered immune function meaning constant sniffles.

What Should Your Iron Level Be?

When it comes to taking iron, I highly recommend getting your ferritin levels tested by your doctor before supplementing. Iron is one of the only supplements I frequently talk people out of taking. This is because excess iron can cause severe harm. This point is particularly important for males as they have no way of getting rid of excess iron, other than by donating blood.

Just like an iron railing oxidizes and rusts, the same thing happens to excess iron in your body. This oxidization creates free radicals which damage delicate cells and tissues. These include cells that make up the lining of arteries, which can lead to heart disease, as well as damage to DNA which can lead to many serious illnesses, including cancer.

Once you know your levels, you can supplement accordingly. The suggested iron range is between 10-300 ug/L. However, this is a very wide range and allows for many people with depleted iron to go untreated. To feel vibrant and support optimum health, your iron level should to be around 80-100 ug/L. 

Taking Iron Supplements

If you decide that iron supplementation is right for you, there are some great, non-constipating options available at the health food store. Your doctor will likely recommend FeraMAX iron supplementation. Unfortunately, many people find this form of iron very constipating. 

Iron is constipating because it is poorly absorbed and much of it ends up being excreted. All the extra iron in your poop causes it to harden. Generally, the better absorbed an iron supplement is, the less constipation you will experience. It’s a win-win!

My favourite iron supplements are Carbonyl Iron from Pure Lab, Iron Bisglycinate from CanPrev or New Roots and Blood Builder from Mega Foods. Blood Builder is a whole food supplement meaning that Mega Foods takes real food, dehydrates it, grinds it into a powder and presses it into tablets. This means that all of their supplements are very easy on the stomach, however I only recommend this option for someone who is not severely anemic as the dose is slightly lower. If you’re very low, opt for carbonyl or bisglycinate iron to start.

It can take anywhere from 6-12 months to get your iron levels up to optimum so don’t worry about overdoing it in the early days. I would recommend going back to your doctor after 3 months of supplementation to make sure you’re on the right track, the iron you’re taking is being well absorbed and your iron levels are going up.

Screen Shot 2016-05-17 at 4.13.12 PMEating Your Iron

Once you have achieved optimum iron levels, it is important to maintain these numbers in order to stay healthy. The recommended dietary intake* for iron is as follows:

Infants (7months to 10yrs) – 10mg per day
Males 11-18yrs – 12mg per day
Males 19yrs and older – 8mg per day
Females 11yrs and older – 18mg per day
Pregnant women – 27mg per day

Here are some food suggestions* to help you get your daily dose of iron:

Beef (90gr serving) – 2.7gr of iron
Cooked beans (100gr serving) – 2.3gr of iron
Prunes (100gr serving) – 1.8gr of iron
Chicken and turkey (90gr serving) – 1.6gr of iron
Cooked greens (75gr serving) – 1.5gr of iron
Peas (75gr serving) – 1.5gr of iron
Egg (1 medium egg) – 1.1gr of iron

Additionally, certain foods like tea, coffee, wheat bran and the overuse of antacids and calcium supplementation decrease iron absorption. If you are low in iron, you should avoid these items.


How You Might Feel If Your Levels Are Low

Anemia from low levels of B12 is referred to as pernicious anemia. Because of it’s affect on red blood cells, low levels of B12 also result in tiredness, weakness and pale skin tone.

Additionally, B12 (and all B vitamins) are involved in nerve function and mental wellbeing. Therefore, low levels of B12 can result in numbness and tingling as well as behavioural changes, depression, anxiety and memory loss.

What Should Your B12 Level Be?

According to ‘healthy’ ranges, your B12 should be between 220 pmol/L and 1100 pmol/L. This is a very wide range, and you may still experience symptoms even if your levels falls within this range.

In order to give your body what it needs, you should be around 800 pmol/L. Depending on how deficient you are, your doctor could recommend taking B12 shots or B12 orally. Oral B12 therapy has shown to be as effective as B12 shots, as long as the dosage is correct and you don’t forget to supplement daily.

Taking B12 SupplementsScreen Shot 2016-05-17 at 4.15.36 PM

If you opt to take B12 tablets, they come in 1000mcg, 2000mcg and 5000mcg per tablet. Depending on how deficient you are, you may want to start with 5000mcg for the first 4 weeks to get your levels up and continue with 1000mcg per day after that.

There are two very important things to remember when supplementing with B12 tablets:

The first is that the tablets must be taken sublingually. This means that rather than swallowing the pill, you must dissolve it under your tongue.

B12 is poorly absorbed in the gut so the best way to get a good dose is by absorbing it under your tongue, through your sublingual glands.

The second thing to consider is the type of B12. There are several options available on the shelf when it comes to the form of B12. Most commonly, you’ll find B12 in the form of cyanocobalamin. This is not the active form of B12. In this form cobalamin (B12) is bound to a cyanide molecule. Not good stuff and not well absorbed.

Instead, check the label on the back of the bottle to make sure you are getting methylcobalamin. This is the most active and absorbable form of B12.

It shouldn’t take too long for your B12 levels to rise, so you’ll want to book another visit with your doctor in 3 months to see how you’re doing. B12 is stored in the liver for up to 7 years so make sure to get your levels checked annually and adjust supplementation as needed.

In terms of brands, Natural Factors have some very good options.

Eating Your B12

B12 is most commonly found in animal foods like liver and kidneys. Unfortunately, since these foods have fallen out of popularity, the next best sources include eggs, fish and meat.

Vegans often struggle with low levels of B12 and while fermented foods like tempeh, miso and sea vegetables, have some B12, there is evidence that B12 in this form does not meet the body’s requirements and is unfortunately useless. Therefore, it is particularly important for vegans to get their B12 levels tested and supplement as needed.

If you have any further questions regarding B12 and iron, be sure to drop me a line! There’s nothing I love more than talking about your health.

**The content above is not intended to be a substitute for professional medical advice, diagnosis, or treatment. If you suspect you have a deficiency, please seek the advice of a qualified health provider.**

*Source: The Encyclopedia of Natural Medicine by Michael Murray



About the Author:

Kate Ortak is Certified Holistic Nutritionist and health writer. She is the founder of KO Nutrition Wellness. She focuses on clean living, healthy eating and detoxifying naturally through the Slim Down Detox program, her hands-on cooking classes, private nutritional counselling and her all-natural beauty line.


  1. Judy April 3, 2018 at 9:42 am - Reply

    My husband was just diagnosed with Barrett’s esophagus, the doctor has put him on iron. He seems to still tied , pale and also having charley horses in upper legs, he fingers lock up also. I thought maybe b12 could help . Any information you could give me would be greatly appreciated.

    • Kate April 17, 2018 at 9:21 am - Reply

      Hi Judy,
      I’m sorry to hear about your husband. I would recommend getting in touch with a Naturopathic Doctor who can properly evaluate your husband, get the full scope of his diagnosis and condition, as well as determine if there are any other deficiencies. Without much more information, I can’t provide any information unfortunately as the body is a complicated thing and there are likely multiple factors contributing to the way your husband feels.
      Best wishes,

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