Integrative Nutrition: Herbal Therapies to Treat Iron-Deficiency Anemia
By Densie Webb PhD, RD
Today’s Dietitian
Vol. 24 No. 8 P. 14

Are they safe and effective?

Anemia affects approximately 3 million Americans and is most prevalent among premenopausal, menstruating women. While there are several types of anemia, the most common is iron-deficiency anemia, which comprises about 30% to 50% of all anemia cases. Iron-deficiency anemia occurs when hemoglobin, a protein responsible for carrying almost all of the oxygen through the blood, falls below a healthy range level (for men, 13.2 to 16.6 g/dL; for women, 11.6 to 15 g/dL). While hemolytic and aplastic anemia are more deadly, iron-deficiency anemia is the only type of anemia for which mortality rates increased between 1999 and 2018.1 When left untreated, iron-deficiency anemia has been associated with CVD, cognitive and functional impairments, and depression.

Iron supplements are the most commonly prescribed treatment for iron-deficiency anemia. However, constipation and diarrhea are common side effects. Nausea and vomiting also may occur with higher doses. Iron tablets can interact with other prescribed drugs, making them less effective, including tetracycline, penicillin, ciprofloxacin, and drugs used for Parkinson’s disease and seizures. In addition, medicines that reduce stomach acid will impair iron absorption, making iron supplements less effective.

Alternative herbal preparations and supplements are promoted for the treatment of iron-deficiency anemia, but efficacy is unclear, and safety varies. Sue-Ellen Anderson-Haynes, MS, RDN, CDCES, LDN, CPT, a national media spokesperson for the Academy of Nutrition and Dietetics and founder of the Massachusetts-based 360 Girls & Women®LLC, a holistic health and wellness company for girls and women, says, “For the dietitian, the risks and benefits should be ascertained before deciding to recommend herbs to clients as alternatives for improving iron status.” However, reliable information on herbal therapies for anemia is hard to come by. Here are a few of the herbs and herbal supplements said to help treat iron-deficiency anemia.

Dandelion — a perennial herb often considered a pesky weed but is used for a variety of health conditions in traditional Chinese medicine. The flowers, leaves, roots, and stems can be used in teas. Roasted dandelion root tea can smell like coffee, and it has a bitter taste, although adding honey can reduce the bitterness. Dandelion greens are a rich source of vitamins and minerals and are particularly high in iron (3.1 mg/31/2 oz), even more iron than spinach (1.5 mg/31/2 oz).2,3 A small mouse study found that treatment with a dandelion extract administered peritoneally for 20 days resulted in a significant increase in hemoglobin and red blood cell count compared with controls.2 Although dandelion has long been used in traditional Chinese medicine, there haven’t been any quality studies done on humans.4 Dandelion generally is considered safe, but some people who are allergic to ragweed, chrysanthemum, marigold, chamomile, yarrow, daisy, or iodine should avoid taking it.4 And since there are no well-controlled studies in humans, there’s no generally accepted recommended dosage of dandelion for the treatment of anemia.

Yellow Dock — a perennial plant considered a “wildflower,” can be found growing in many places around the world but is most commonly found in Serbia, Korea, and China. The root and fruits are used as medicine.5 Although yellow dock’s iron content isn’t significant enough to have an effect on iron status, the plant’s vitamin C content works with the body to better absorb nonheme iron. While there’s a lack of human clinical trials on yellow dock, some animal and lab-based studies highlight the various potential health benefits of yellow dock’s active constituents.6

Anyone who’s allergic to ragweed may be allergic to yellow dock.5 And since yellow dock contains oxalate that can bind with calcium and form crystals in the kidneys, individuals who have or have had kidney stones should check with their health care provider before taking it. The herb may interact with medications, including digoxin, diuretic drugs, and warfarin.7 Yellow dock traditionally has been used by adults in teas, alcohol extracts, and tinctures. But there isn’t enough reliable information to know what an appropriate dose may be for the treatment of anemia.

Seaweed — there are several types of edible seaweed, but kelp (also known as kombu) probably is most familiar to most Americans. Seaweeds are considered one of the most important plant sources of iron.8 Despite several kelp and seaweed supplements on the market, no research indicates an optimal dose for anemia or any other medical condition. According to Anderson-Haynes, if seaweed supplements are consumed in high doses, there may be a concern of contamination with heavy metals, such as arsenic and cadmium. But, she adds, if seaweed is eaten as part of the daily diet, it’s considered safe. Fresh edible seaweeds can be used in a variety of dishes, such as salads, soups, and noodle dishes.

Research on seaweed as a treatment for anemia is almost nonexistent. However, in one study in India, 500 adolescent girls aged 15 to 18 with moderate anemia were given a specially formulated seaweed dark chocolate for four months.8 The product was well accepted and resulted in a significant increase in hemoglobin, as well as serum iron and serum ferritin.

Stinging Nettle — an herb that has been used for more than 2,000 years as a natural remedy for a variety of conditions.9 True to its name, stinging nettle has fine hairs on the leaves and stems that contain irritating chemicals, which are released when the plant comes in contact with the skin. The plant is used in many forms, including teas, tinctures, fluid extracts, and creams.

According to the American Botanical Council, midwives have used nettles to treat anemia in pregnant women.10,11 The flowers of the plant are rich in iron.9

Despite these recommendations, according to Anderson-Haynes, stinging nettle is contraindicated for pregnant women because it can increase bleeding and uterine contractions. She also says it can interact with diuretics, blood pressure medications, blood thinners, and anti-inflammatory medications.12 Other possible interactions may increase or decrease the efficacy of angiotensin-converting enzyme inhibitors, beta-blockers, calcium channel blockers, and diabetes medications. 9 Stinging nettle also can cause gastrointestinal upset in some people.

Bottom Line
Dosing information and valid proof of efficacy are lacking for these herbs in the treatment of anemia. Anderson-Haynes offers this advice to consulting dietitians: “The pros and cons should be discussed with the patient in a way that’s easy to understand. If during counseling you become aware that the patient or client is taking herbal preparations, always communicate with their primary care provider about any teas, supplements, or any herbal treatments the patient is taking.”

If iron supplements aren’t tolerated or interfere with current medication, iron-rich foods, such as lentils, beans, kale, spinach, collard greens, pumpkin seeds, blackstrap molasses, and lean red meats are still the best approach. To boost absorption of nonheme iron from plant sources, recommend an increased intake of foods rich in vitamin C, such as oranges, melon, strawberries, bell peppers, tomatoes, broccoli, Brussels sprouts, cabbage, and cauliflower.

— Densie Webb, PhD, RD, is a freelance writer, editor, and industry consultant based in Austin, Texas.

References
1. Sun H, Weaver CM. Decreased iron intake parallels rising iron deficiency anemia and related mortality rates in the US population. J Nutr. 2021;151(7):1947-1955.

2. Modaresi M, Resalatpour N. The effect of Taraxacum officinale hydroalcoholic extract on blood cells in mice. Adv Hematol. 2012;2012:653412.

3. US Department of Agriculture, Agricultural Research Service. FoodData Central. https://fdc.nal.usda.gov. Updated October 1, 2019.

4. Complementary and alternative medicine: dandelion. St. Luke’s Hospital website. https://www.stlukes-stl.com/health-content/medicine/33/000236.htm. Accessed September 1, 2022.

5. Yellow dock uses, side effects, and more. WebMD website. www.webmd.com/vitamins/ai/ingredientmono-651/yellow-dock. Accessed September 2, 2022.

6. Mendicino S. 7 yellow dock benefits: dosage & safety. The Botanical Institute website. https://botanicalinstitute.org/yellow-dock/. Published July 1, 2022. Accessed August 31, 2022.

7. Yellow dock. RxList website. https://www.rxlist.com/yellow_dock/supplements.htm. Updated June 11, 2021. Accessed August 30, 2022.

8. Banu AT, Mageswari SU. Nutritional status and effect of seaweed chocolate on anemic adolescent girls. Food Sci Hum Wellness. 2015;4(1):28-34.

9. Said AAH, Otmani ISE, Derfoufi S, Benmoussa A. Highlights on nutritional and therapeutic value of stinging nettle (Urtica Dioica). Int J Pharm Pharm Sci. 2015;7(10):8-14.

10. Engels G, Brinkmann J. Stinging nettle. American Botanical Council website. https://www.herbalgram.org/resources/herbalgram/issues/110/table-of-contents/hg110-herbpro-stingingnettle/

11. Stinging nettle. In: Drugs and Lactation Database (LactMed) [Internet]. Bethesda, MD: National Library of Medicine; 2006. https://www.ncbi.nlm.nih.gov/books/NBK501777/. Accessed September 1, 2022.