Fatigued? Maybe It’s Iron Deficiency


During pregnancy a woman needs a little more of every nutrient to make a baby but her requirements for iron are even higher. A mother’s blood volume increases 50% during pregnancy. Since 70% of our body’s iron is found in our red blood cells, you can see that a pregnant women’s need for iron is greatly increased.

But it’s not just pregnant women that need more iron. According to the CDC iron deficiency anemia is the most common nutritional deficiency in the United States. It affects pregnant women, children, and men as well. It is most common in those with increased need for iron such as pregnant women, children and babies who are growing rapidly, anyone who has lost a lot of blood, and those who eat foods high in anti-nutrients such as whole grains, legumes, nuts, and unfermented soy, coffee, and chocolate (aka raw cacao).

Symptoms of Iron Deficiency Anemia

  • Fatigue
  • Feeling weak
  • Shortness of breath
  • Dizzy spells
  • Cold hands and feet
  • Itchy skin
  • Heart murmurs
  • Repeated infections such as colds
  • Restless leg syndrome
  • Disrupted sleep
The most common symptom of iron deficiency is fatigue, which occurs because the body does not have enough iron to carry oxygen to all the parts of the body. Iron deficiency is very common in children. Children who are fed cows milk at an early age or who are not breastfed are particularly susceptible.

Symptoms of Low Iron in Children

  • Poor appetite
  • Slowed growth and development
  • Behavioral problems

How to Quickly and Effectively Boost Iron

The solution given by doctors to boost iron and correct iron deficiency anemia is to take iron supplements and to increase iron containing foods in the diet. While popular, supplements are not the best route to take. Iron supplements often contribute to constipation by altering gut flora. They also don’t work very well; very little of the iron in a supplement is actually absorbed.

Increasing iron containing foods in the diet, then, is the way to go. But even here there are a couple caveats. Vegetarian sources of iron like spinach and kale do not contain heme iron which is the type best absorbed by the body. Heme iron is found in animal sources like liver, chicken, and beef. Eating heme iron and non-heme iron together increases the absorption of the non-heme iron. So eating beef with spinach would be a great way to get more iron in your blood.

To further the absorption of iron, you should also eat vitamin C. For a comprehensive list of iron containing foods, check the list at the bottom of this page.

Cooked Meat Reduces Iron Solubility

Iron needs to be soluble in order to be absorbed. Cooking greatly reduces solubility. Since people don’t generally eat meat raw, most of us aren’t absorbing all of the iron that we eat, as Roger Purchas of Massey University in New Zealand noted in his research on iron availability in meat.

” Comparisons of meat cooked to various final temperatures and for different times showed that much of the soluble-haem iron was quickly converted to an insoluble form with cooking, and with more severe cooking some of the haem iron was converted to the less desirable non-haem form. The extents to which these changes are reflected in a lower bioavailability remain to be determined. Interestingly the amount of iron lost in juices released during cooking was highest at a lower cooking temperature (60°C vs 80 or 98°C) apparently because the slower cooking meant the haem iron remained soluble for longer. This loss in cooking juices was up to 16 percent of the total iron in some cases, which suggests that devising ways of retaining the cooking juices from meat may be beneficial with respect to iron intakes.”

Traditional peoples all over the world eat some of their meats raw. The iron boost they receive from it may be one reason for this. I too eat much of my meat raw. The damaged iron may be one reason why I feel better when I eat raw meat.

While raw liver is super gross to most normal people out there, my favorite and most effective way to boost iron is by drinking a liver and lemon smoothie. Liver is very high in iron and the lemon adds vitamin C to help absorb it. The smoothie is not yummy, but it’s a fast way to get 1/4 lb of liver in your body relatively painlessly. I don’t like the taste or texture of liver, so anything to make it quick is ideal for me.

Disclaimer: Remember, unless you’re very confident in your stomach’s ability to kill germs, i.e. you have strong stomach acid, your immune system is strong, and you eat fermented foods and have a healthy gut, you should always eat only previously frozen grassfed and free range fresh meats raw. Personally, I don’t worry about it anymore. I started eating meat raw 5 or 6 years ago and am beyond confident that humans are perfectly well designed to handle raw meats. I’ve never been sick from hundreds of pounds of raw and undercooked meats and fish. In fact, exposure to bacteria only makes me stronger.

Iron Deficiency Blood Tests

Blood tests can be deceiving. A standard iron deficiency blood test can easily miss-diagnose anemia. While blood tests do test the levels of iron in the blood, if you eat a steak before the test, the test will show adequate iron. So it is important to pay attention to symptoms along with the results of a blood test.

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  1. I’ve heard you should not eat more than 4 oz. liver per week. My daughter who is healing from rheumatoid arthritis eats about 1 lobe raw liver 2 -3 times per week. We chop it up fine. She washes it down with raw milk. I also eat raw liver and I like mine mixed with cherry juice.

    Love the video, btw.

  2. I am still mainly breastfeeding my 2 year-old, so I make sure to consume 1oz of raw grassfed liver every day. I buy it frozen from my local health food store, then cut it into chunks the size of the tip of my pinky. I swallow six of those liver pills a day, (about 1oz) keeping the rest in the freezer until bedtime, then I pop the next day’s liver in the refrigerator. It thaws out overnight and keeps the rest of my liver fresh until I need it. I don’t ever get any liver-y taste or texture.

  3. Not sure I could stomach this smoothie — props to you for that!

    On the other hand, I love raw (non-organ) meat and seafood and they make me feel best, too. I prefer my rare burgers and sashimi, but remember this idea just in case I feel the need for an iron boost some day…

  4. Another good way to increase the iron in your food….cast iron cookware! I just bought my first cast iron sauce pan a couple of months ago.

    Now Peggy, I know you can’t handle cooked meat, but even if you can’t eat cooked meat, cooking your veggies in cast iron pots and pans is supposed to boost the iron content, especially if you cook foods with a high acid content like tomato sauce in it.

    • Hey Keoni! Nice to see you around. You know, I’ve been using cast iron for umm, well I can’t remember how many years! They are the perfect pan. I do eat cooked fish and I love cooked spinach. All that is done in cast iron. It probably does help to boost my iron. I’ve read that it can boost iron up to 80%. But regardless, on occasion, if I’m not careful to eat heme iron, I’ll feel the symptoms of low iron.

      • Plus, I think pregnancy just takes a lot out of you (literally) and extra measures are probably important to take. I’m going to try this. I have to figure out a way to get liver down. I’m already testing for low iron at 5 months pregnant even though I eat half raw (cooked on the outside) meats and use an iron skillet. My skin is itching like crazy, every where!

        • My iron got low while I was pregnant too. I was really good about eating liver early on, but once summer kicked in I got busy and careless. So for a couple of months I was not a happy camper! I started eating raw liver and raw beef and got my numbers up.

  5. Thanks for the tip about adding lemon juice for the Vitamin C. I am really grateful for your encouragement and information about eating raw meats!!!

    I too don’t like liver, but make myself take raw liver and raw heart (for the CoQ10/Ubiquinol for extra brain power and anti-aging) blended in a savory smoothie. I am on GAPS to heal my gut right now, so I blend a small quantity (like 2-3 tablespoons) of raw organs into warm meat/bone broth, cooked veggies, coconut oil, and add raw ginger, turmeric, and garlic to disguise the liver taste to a degree.

    I crave this smoothie about 2-3 days a week. It is harder to get it down more often than that. I make these smoothies taste relatively good, so I suspect that my body doesn’t need it more than that if I am reluctant to consume it. If I haven’t had one in a few days, then I slurp it down all at once without thinking about it, so most likely my body really needed it.

    Sometimes I will blend the organs with raw young coconut water and pulp, a banana, some pineapple or strawberries, a teaspoon of raw honey, egg yolk, nutmeg, cardamom, coconut oil, and cinnamon flavored fermented cod liver oil. This is even better tasting than the savory smoothie. It’s quite decadent actually. However I don’t always have a supply of coconuts on hand.

    • Is the savory smoothie like a soup? I mean do you drink it hot? I don’t think I would like to drink a luke warm liver tasting beverage. Actually, I do make my soups with organs. I usually take a bite or two for good measure but really I’m just hoping that some of the nutrients just leech into the soup.

      Years ago, before I knew I fructose was a problem for me, I used to make a liver fruit smoothie similar to what you describe. It was great!

      • Yes, the savory smoothie is like a blended soup. Sometimes I drink it warm, but today I had it cold, blended with greens, avocado, egg yolk, chicken broth, turmeric, ginger and garlic, and with lemon juice on your suggestion. I could not taste the organs at all. It was much better.

        • Is there any chance of you posting the quantities of each item for that smoothie? it sounds great!

  6. I suspect the younger of my twin boys is iron deficient, but there is no way in hell I can get him to drink this (he just turned 4) even though I can clearly see the benefits. It’s tough to even get him to eat spinach. What would you suggest for young children?Normally I hide things in things like meatloaf but that would mean it would have to be cooked… I may be able to bribe him in a couple years but right now that smoothie would end up splattered all over the kitchen if I tried to feed it to him.

    • Given his age and with fructose issues you probably won’t have much luck getting him to eat raw liver. Cooked meat does provide usable iron, it’s just that a lot of it goes unabsorbed. Just get him to eat more iron rich foods and make sure he’s not eating foods that inhibit iron absorption. Does he like soups? You can probably get away with adding all kinds of good stuff there. Puréeing it might help too.

      • My favorite way to have liver is lightly seared, so that it’s still raw on the inside, but looks cooked on the outside. Maybe that could help? I find it tastes better to me than fully raw or fully cooked liver.

        • It’s worth a try, but my taste buds are seriously rebellious when it comes to liver. I can learn to like just about any flavor and texture but the taste of liver (and any organ that I’ve tried) just isn’t getting any better.

    • He also has a fructose issue, so can’t use fruit to mask the taste…

  7. The lemon/liver smoothie actually sounds good to me. But, I don’t mind the taste or texture of raw liver. I’ve been making a smoothie in my nutribullet with raw liver, chard, coconut oil, coconut milk, lemon or lime wedge, raw vanilla powder, frozen wild huckleberries, raw cacao, and water. Am going to try without the cacao. Did not realize it was high in antinutrients. :(

    Thanks for giving me the courage to eat raw meat! After I first read your blog, I started eating some of my meat (and organs) raw and have noticed a big difference in how I feel.

  8. Peggy, do you think your tiredness from dairy could have something to do with decreased iron absorption?

    I’ve been consuming tons of raw dairy and have been getting that tiredness too, but it has improved so many things so drastically that I’m loathe to give it up.

    I guess I could just try to eat some raw liver and see if it helps. I eat it about once a week cooked and love it, but maybe I need to incorporate some raw in there too.

    Oooh! Maybe…. a liver ceviche? Put enough cilantro and chill in there and it might be not too bad.

    Otherwise the fruit smoothie and soup by RG sound pretty good.

    • Alexandra,

      I hadn’t thought of that! I really have no idea why dairy makes me so tired but I wouldn’t be surprised if it had something to do with nutrient deficiency. Magnesium gets out of balance with excess calcium too.

      Let me know how the liver ceviche turns out. That sounds interesting!

      • Magnesium was my first guess with the dairy, but I’ve been supplementing with transdermal magnesium and haven’t seen much of a difference. Granted, I’m not super-regular with it yet, so maybe it’ll just make a while. On the other hand, I know I had very low iron before, so clearly iron absorption is an issue for me regardless.

        I think it would be interesting to look into what dairy-heavy traditional cultures were/are eating to offset it. The Maasai consuming blood regularly comes to mind, but it’s not really a measure I can implement easily :P

        • Yeah, my iron has been low all my life due to undiagnosed celiac disease. Since eliminating gluten and going Primal I’ve never had the degree of symptoms that I used to (whoch, by the way, a doctor never did even consider was low iron) but occasionally, if I’m not careful, I’ll notice a few symptoms crop up again. I like to eat seafood a lot more than land animals.

          When I was doing dairy I was taking magnesium too, but it didn’t make any difference. I was still tired.

          I was watching a show the other day that featured some Tibetan people who are nomads on the plateau and basically sustain themselves on yak milk. I don’t think they drink blood. Wonder what they do and others who are not as “barbaric” as the Massai.

          • Yeah, one time after routine bloodwork my doctor was like, ‘your iron is getting a little low, here take this supplement.’ I checked the number afterwards and it was *rock bottom* for ‘normal’ values.

            Gee, thanks, all those years that I heard ‘no, it’s not your iron levels, they’re fine’ but was probably still barely above anemic and could have been working on it… Ugh.

            Needless to say, I don’t go for routine checkups anymore.

            Anyway, seafood is a good idea. Shellfish is high in iron, right? I do find it easier to cook and eat a bit of seafood for myself at breakfast and lunch than meat or liver.

            By the way, how often do you think liver needs to be eaten if it is cooked? I aim for twice a week, but usually only manage once, and it’s clearly not enough. I really love the taste of cooked liver, but there’s only so much of it you can have.

            And, is beef liver better than chicken or is there not a difference?

  9. All the meat that you buy at the store has been “previously frozen” so parasites are unlikely to be a problem. You probably have to go out of your way to get truly “fresh” meat.

  10. Interesting! Thank you! I’m 8 months pregnant & have been eating my liver cooked. I’m going to try raw next time (well, frozen uncooked) as it sounds like the iron & other nutrients are damaged in cooking.

    My favorite way to eat liver (I don’t love the taste, although it is tolerable) is by making liver “capsules” and keeping them in the freezer. I have a few every night. Basically, you just cut the liver up into small pill-size pieces and freeze them… then you swallow them like a pill (instead of having to chew & taste them!). The liver keeps for a long time this way too. I’ve been doing this with cooked liver, but again I’ll try frozen raw next time. (I first read about this trick on Chris Kresser’s website BTW.)

    My fingers are crossed that Whole Foods has grass fed liver in stock (they don’t always…).

    • Ah ha! I wondered where everybody got that idea.

    • I keep mine in the freezer, but thaw it out before taking it, just so it’s softer and easier to swallow. That way, I don’t have to take so many “pills”, because I can cut them into larger pieces. And if they have been placed on a paper towel for a minute and aren’t dripping with blood, I don’t get any taste at all.

  11. This has been my favorite liver recipe, though it’s cooked.


    We tend to make it as a meatloaf now, because it’s much easier than making meatballs. And we’ll use 1 # beef liver, 1# ground beef, and 1# ground pork or pork sausage, which makes 2 medium sized meat loaves. Delicious!

    I’ll keep the raw liver smoothie in mind in case intensive iron loading is needed.

  12. I always resented the time consuming nature of preparing my liver. I get a whole liver from the butcher since lambs liver is preferable over here, beef liver isn’t readily available and I have to order it in. Then, spending hours dividing and cutting it up – getting those gross slimy and chewy bits off. I had considered just throwing it in my food processor – and I do when I make meatloaf – but the thought of putting spoonfulls of liquefied liver into my mouth was too revolting. Since becoming pregnant, I only consume about 2 oz. of liver every other day, and eat a lambs kidney every day instead. I also eat a lambs heart every day or so, but I eat that flash fried as I’ve always like the taste of heart. Well, today, I made a liver and kidney smoothie with lime juice. I made it, and left it there, cleaning up. I knew I was stalling, so I put it in a wine glass, told myself bottoms up, and chugged it. It was down in about 4 gulps, less time than it takes to take the liver by spoon. And it wasn’t so bad. The texture was actually okay, and the trick is to continue breathing through your mouth for a minute afterwards until the taste leaves your mouth. THANK YOU PEGGY! I mean, it’s disgusting, but I value the time and energy you’ve helped me get back.

    • Forgot to say, I like how you put Don’t Trust Babylon in there – I love that song.

      • Thanks! I was trying to think of how to get around the copyright issue with music in youtube videos and then I thought, oh duh, I’ll just use the songs I write. :P

    • So glad to hear that you made it and found it tolerable! I figured out that opening my mouth is the key to not tasting it too. I don’t have to plug my nose anymore. ;)

  13. First of all, congratulations for the site which I just discovered.

    I have a question.. do you still recommend eating raw meat even if in my country (Italy) grass-fed meat isn’t available? Only corn-fed, unfortunately..


    • Gabriele, I’d be really surprised if you couldn’t find any grass fed meats anywhere in Italy, although it may be a drive… I not only don’t recommend eating grain fed, factory farmed meats raw but I don’t recommend eating them at all. On the other hand, if the meats out there are raised on pasture and supplemented with grain and are living in good, outdoor conditions, then go ahead.

  14. Regarding the mention of anti-nutrients in raw cacao — would roasted be a better option? Or is this one of those foods we should avoid entirely? Not sure I can quit chocolate completely, but if eaten in moderation, which form is the least damaging? Thanks!!

    • Cacao and coffee are generally fermented first and so the anti-nutrients break down. Cheap coffees (and cheap soy sauces) will skip that step. These days it’s cool to eat raw foods like cacao. Thing is, if it’s truly raw it might need to skip the fermentation step because the cacao can get pretty hot during fermentation.

  15. Hi Peggy,
    Just wanted to leave a note saying I have followed your advice and made myself a raw liver smoothie. I must admit it was tough getting it down and getting over the icky feel of raw liver, BUT I feel fabulous! I have been taking about an ounce or and ounce and a half with the juice of a full lemon and lots of sea salt for the past 5 days or so, and have been able to completely come off coffee and am down to just one green tea bag in the mornings(which I will wean off of soon). The best thing is that I don’t crave sugar like I used to. I have yet to find anything that will kill the bloody taste in my mouth after… Any advice as to how much raw liver is too much? I don’t want to overdo it. Thank you for all that you do!

  16. I tried raw liver for the first time last night (well, it had been frozen for 14 days, but not cooked). It actually tasted much better then cooked liver!!! Yippee! There was no metalic taste at all… it had kind of a sweet, bloody flavor with no aftertaste. I felt like a vampire eating it & was so surprised that it actually tasted good-ish. Seriously much better than cooked liver. It was the normal organic grass-fed (step 4) chicken liver that I buy from Whole Foods. I had also been feeling really tired all day yesterday (I’m 8 months pregnant) and it gave me a big energy boost. I ate it along side a glass of water with half a lemon squeezed in (I wasn’t mentally prepared for your smoothie!). Anyway, so glad I tried it “raw.”

  17. I just came to tell you that…. I hate you for this post :P I love you too, but now that it’s so easy to prepare, I have absolutely no reason NOT to take my liver and kidneys. Now, instead of averaging 80 grams once or twice per week, I have to take it every second day :( Baby loves you though :D

    • Congratulations and I am so happy for your baby. You are working hard to make him/here healthy! (Hey, by the way, I quit Facebook. In case you were wondering.)

      • I figured you had. I got sick of it and deactivated my account awhile back, but with all of my family in America, and the boys family too, facebook is the easiest way to keep up with them, and for them to feel like they are some part of the boys’ lives. The smoothies are getting easier and easier to take down. Something about things only being impossible until they are not.

        • Yeah, I’ve got three brothers over seas. It was nice to see pictures and stuff.

  18. Is eating the livers from pastured, organic chickens just as safe as eating them from organic, pastured cows?

    • I meant eating them raw

    • The safety of eating raw meats depends on your own immune system, although, the exposure to bacteria over time can help boost your immune system.

      For the most part, pastured chickens aren’t carrying disease like those cooped up in crowded pens are. So the safety is probably similar to pastured cows.

  19. I so need to do this, this 2nd pregnancy is killing me with exhaustion. I bought Floradix per my TCM teachers recommendation but I know your probably not big on “supplements”. This sounds legit. Does it matter if we use chicken as opposed to beef? Both have the iron right?

  20. Hi Peggy,
    I love your blog! I have had chronic low ferritin levels (like 2 – 9) for the past few years. When I took supplements they never seem to help (plus all the side effects), and even increasing my beef consumption and going Paleo hasn’t helped (it’s actually gone down more). I was thinking of going all meat and partial raw meat (grass fed/pastured) to see if it helps. With cutting out vegetables and fruits, are there any supplements you suggest or anything I should watch out for? I Googled “all meat diet” and a bunch of other terms to see if I could find info and didn’t find much. Any advice or resources you can point me to would be awesome!

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