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Are you iron deficient?
Tiredness has become so normalised it is almost a personality trait. But persistent fatigue, particularly in women, is one of the most common early signs of one of the most under-diagnosed deficiencies in the world. Anaemia affects around one in three women globally, and iron deficiency is one of the leading contributors. Closer to home, a South African review found that between 1997 and 2021, anaemia prevalence in women of reproductive age ranged from 22% to 44%, while iron deficiency ranged from 7.7% to 19%. Yet most cases go undetected because the symptoms develop slowly, testing is not always comprehensive, and some laboratory cut-offs may not yet reflect newer guidance around earlier-stage deficiency. 1 in 3 Women globally are affected by anaemia 44% Peak anaemia prevalence in SA women of reproductive age (1997–2021) We talk about fatigue, joke about it, push through it — and rarely stop to ask what it is actually telling us. Symptom checker Before we go into the stages of iron deficiency, risks and testing — here is a symptom guide to help you recognise what to look for. Important: This checklist is for informational purposes only and does not constitute medical advice or a diagnosis. Please consult a qualified healthcare practitioner before starting any supplementation. Signs and symptoms to look for Energy and cognition Persistent fatigue, especially that mid-afternoon wall Brain fog and poor concentration Reduced exercise tolerance — things that used to feel easy suddenly don't Light-headedness or dizziness on standing Hair, skin and nails Increased hair shedding, particularly around the temples and parting Brittle, ridged or spoon-shaped nails (koilonychia) Dry, pale and dull complexion that no amount of moisturiser quite fixes Cracks at the corners of the mouth (angular cheilitis) Pale lower inner eyelids Heart, breath and circulation Shortness of breath on stairs or hills that never used to feel hard Heart palpitations or a noticeably faster heartbeat at rest Cold hands and feet, even when the rest of you feels warm Mood, sleep and nervous system Restless legs at night or that uncomfortable urge to move them just as you settle Anxiety, irritability or low mood without an obvious cause Poor sleep quality — waking unrefreshed despite the hours Less well-known signs Cravings for ice (pagophagia) or non-food items like soil or clay (pica) A smooth, sore or unusually red tongue (atrophic glossitis) More frequent colds and infections than usual Difficulty regulating body temperature There are three stages, not one Most people think of iron deficiency as something you either have or don't. But iron deficiency develops in three distinct stages — and most of us never hear about the first two. Stage1 Depleted iron stores The body's iron reserves (stored as ferritin) are running low, but blood iron and haemoglobin still look normal on a standard full blood count. Symptoms — particularly fatigue, hair shedding, poor concentration and reduced exercise tolerance — can already begin here. Most lab reports will still print "normal" at this stage. Stage2 Iron deficiency without anaemia (IDWA) Iron stores are low and circulating iron may be reduced, but haemoglobin has not yet dropped below the anaemia range. Symptoms can become more noticeable here — even though a person may not yet be classified as anaemic. Stage3 Iron deficiency anaemia (IDA) Haemoglobin has dropped below the normal range and the body cannot produce enough healthy, oxygen-carrying red blood cells. This is the most severe stage and the one most healthcare systems still focus on for diagnosis. By the time you reach it, you have usually been deficient for months or even years. Who is at higher risk? Menstruating women. Heavy periods (menorrhagia) are one of the most common causes of iron deficiency in women under 50. Pregnant and postpartum women. Iron needs nearly double in pregnancy as the body builds blood volume for two. Plant-based eaters. Iron from plant foods (non-haem iron) is less bioavailable than iron from animal foods, and compounds like phytates, polyphenols and tannins can reduce absorption further. Athletes and endurance trainers. Higher demands, increased losses through sweat and foot-strike haemolysis all deplete iron stores faster. Women with PMOS (formerly PCOS) or endometriosis due to chronic blood loss and hormonal factors. People with low stomach acid or on PPIs. Stomach acid is essential for converting dietary iron to its absorbable form. Long-term acid-suppressing medications — and age-related decline in stomach acid — can reduce iron uptake significantly. People with gut inflammation. Coeliac disease, inflammatory bowel disease and other gut conditions that affect absorption increase the risk. Anyone with hidden blood loss. Haemorrhoids, ulcers and undiagnosed digestive bleeding can quietly deplete iron over months without obvious symptoms. How to test for iron deficiency If you suspect you might be low in iron, please see your doctor and request a blood test. The most useful is a full iron panel (sometimes called iron studies) — not just a haemoglobin or full blood count alone. A full iron panel usually includes: Ferritin — the storage form of iron. This gives the earliest warning of deficiency and is the most important single marker to request. Serum iron — the iron currently circulating in your blood. Highly variable hour to hour, so should always be interpreted alongside the others. Transferrin saturation (TSAT) — the percentage of your iron-transport protein actually carrying iron. A TSAT below 20% is strongly suggestive of iron deficiency. Full blood count (FBC) — particularly haemoglobin (Hb) and mean corpuscular volume (MCV). A low MCV is a classic finding in iron deficiency anaemia. C-reactive protein (CRP) — a measure of inflammation. If ferritin looks "normal" but CRP is elevated, your true iron stores may be considerably lower than the number suggests. Total iron binding capacity (TIBC) — how much iron your blood is capable of carrying. Typically rises when iron stores are low. Haematocrit (PCV) — the percentage of your blood volume made up by red blood cells. Lower than normal indicates anaemia. Why ferritin alone is not always enough Ferritin is an "acute-phase reactant" — it rises in response to inflammation, infection, liver issues, alcohol intake, obesity and even strenuous exercise. Someone who is genuinely iron-deficient can show a perfectly normal ferritin number if there is background inflammation. For many years, the standard cut-off for iron deficiency was a ferritin below 12–15 µg/L. Many labs have since updated their lower reference range to 30 µg/L, and the American Society of Hematology moved in the same direction in its 2025 draft recommendations — particularly for menstruating and pregnant individuals. If your ferritin comes back in the 15–30 µg/L range and your doctor says your iron is fine, it is reasonable to ask whether the newer thresholds are being applied — particularly if you are symptomatic. The South African picture A 2025 Cape Town birth cohort study found that iron deficiency may be far more common than standard blood tests suggest. When researchers adjusted ferritin for inflammation, iron deficiency estimates rose to as high as 55% in pregnant women and 47% in postnatal women. The numbers varied depending on the method used, but the takeaway was clear: in South African women, iron deficiency is easy to miss. A note on self-supplementing If you recognise yourself in several of the signs above, please do not start a high-dose iron supplement before testing. There are two important reasons. First: some people have iron overload conditions (such as haemochromatosis) where additional iron is harmful. Without testing, you cannot know which side of the line you are on. Second: many symptoms of iron deficiency overlap with other conditions — thyroid issues, B12 deficiency, vitamin D deficiency, sleep disorders and depression. Testing helps make sure you are addressing the right thing. Want to go deeper? We've written a follow-up piece on how iron actually works in the body, why the form of iron matters so much, and what to look for in a well-formulated supplement. Read on the blog This article is for educational purposes only and is not intended to diagnose, treat or replace medical advice. Iron deficiency, like all health concerns, should be assessed and managed in consultation with a qualified healthcare practitioner. Please do not begin iron supplementation without prior testing. References Ringshaw JE, Zieff MR, Williams S, et al. Iron deficiency anaemia in mothers and infants with high inflammatory burden: Prevalence and profile in a South African birth cohort. PLOS Global Public Health. 2025;5(7). Link Turawa E, Awotiwon O, Dhansay MA, et al. Prevalence of Anaemia, Iron Deficiency, and Iron Deficiency Anaemia in Women of Reproductive Age and Children under 5 Years of Age in South Africa (1997–2021). Int J Environ Res Public Health. 2021;18(23):12799. Link An audit of the iron status of patients at Chris Hani Baragwanath Academic Hospital, Johannesburg. 2024. Link British Society for Haematology. Identification and management of preoperative anaemia in adults. Br J Haematol. 2024;205(1):88–99. Link Rethinking ferritin thresholds: towards a physiological-based definition of iron deficiency. The Lancet Global Health. 2025. Link
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Iron, simplified
How much iron you need, where to find it in food, what helps your body absorb it and what to consider when food alone is not quite enough. Iron is one of the most common nutrient deficiencies in the world, and one of the most frustrating to correct. Not because iron itself is difficult to find — it is present in plenty of foods — but because not all iron is the same. Different forms behave very differently in the body. The cofactors that help iron work are often missing from supplements, and the side effects of poorly designed iron products are often what stop people from continuing long enough to feel a difference. This guide is here to simplify iron: how much you need, where to find it and how to absorb it more effectively. Why iron matters Iron is involved in more body processes than most of us realise. It is not simply a “blood mineral”. In one sentence, iron helps carry oxygen around your body — but it does much more than that. Oxygen transport: Iron sits at the centre of haemoglobin, the protein in red blood cells that carries oxygen from the lungs to the rest of the body. When iron is depleted, tissues may receive less oxygen than they need, contributing to tiredness and reduced exercise tolerance. Energy production: Your cells use iron to produce ATP, the body’s energy currency. Low iron can therefore affect the amount of energy your cells can generate. Brain function: Iron is needed for neurotransmitter production and normal nerve function. Low iron may affect concentration, mood and sleep. Immune function: Iron is required for the development and activity of immune cells, including those involved in fighting infection. Hair, skin and nails: Hair follicles, skin cells and nail beds are metabolically active tissues, which is why they may show early signs of iron depletion, such as increased hair shedding or brittle nails. Pregnancy and fetal development: Iron requirements rise significantly during pregnancy to support increased blood volume, placental development and the baby’s growth and brain development. How much iron do you need each day? Your iron needs change considerably across your life. Menstruation and pregnancy increase requirements, while needs generally fall after menopause. Life stage Daily iron need Children 9–13 years 8 mg Adolescent girls 14–18 years 15 mg Adolescent boys 14–18 years 11 mg Women 19–50 years 18 mg Men 19+ years 8 mg Pregnant women 27 mg Breastfeeding women 9–10 mg Women and men 51+ years 8 mg Keep in mind These are general international guidelines. Individual needs may differ according to menstrual blood loss, pregnancy, dietary pattern, athletic load, gut health, medications and existing iron status. A healthcare practitioner can help tailor recommendations to the individual. Two types of iron Haem iron comes from animal foods. It is generally absorbed more efficiently — approximately 15–35% — and is less affected by other foods eaten at the same meal. Non-haem iron comes from plant foods and many supplements. It is less readily absorbed — approximately 2–20% — and is more strongly influenced by what is eaten or drunk alongside it. The lower absorption of plant-based iron does not mean that a plant-based diet cannot meet iron needs. It simply means that food pairing and preparation methods become especially important. Iron-rich foods to add to your plate Haem sources of iron Food Iron per 100 g Beef liver 6–13 mg Biltong Approx. 6–9 mg Beef steak, rump 2.4–3.6 mg Sardines 2.9 mg Beef mince 2.7 mg Eggs 2.2 mg Lamb leg, roasted 1.8 mg Chicken, dark meat 1.3 mg Non-haem sources of iron Food Iron per 100 g Sesame seeds 10.4 mg Pumpkin seeds 8–9 mg Dark chocolate, 70%+ 7 mg Sunflower seeds 6.4 mg Cashew nuts 6 mg Dried figs 3.9 mg Dried apricots 3.4 mg Lentils, cooked 3.3 mg Almonds 3 mg Chickpeas, cooked 2 mg Spinach, cooked 1.6–3 mg Tofu, steamed 1.2–3 mg A useful food-pairing trick Eating haem and non-haem foods together — for example, beef stew with lentils or chicken with chickpeas — can improve the absorption of plant-based iron. What helps your body absorb iron? Vitamin C: Vitamin C helps convert non-haem iron into a more absorbable form. Pair iron-rich meals with citrus, peppers, berries, tomatoes or another vitamin C-rich food. Vitamin A and beta-carotene: Found in carrots, butternut, sweet potato, peppers and dark leafy greens, these nutrients may support iron absorption and metabolism. Pairing haem with non-haem iron: A small amount of meat, fish or poultry eaten with beans, lentils or leafy greens may improve plant-iron absorption. Soaking, sprouting and fermenting: These preparation methods can reduce phytates in beans, grains, nuts and seeds, making more iron available for absorption. Cooking in cast iron: Cast-iron cookware may transfer small amounts of iron to food, particularly when preparing acidic dishes such as tomato-based sauces. What can reduce iron absorption? Tea and coffee: Tannins and polyphenols can substantially reduce non-haem iron absorption when consumed with an iron-rich meal. Try separating tea or coffee from iron-rich meals and supplements by at least one to two hours. Calcium and dairy: Calcium may reduce iron absorption when taken at the same time. Consider separating calcium supplements and large dairy servings from an iron supplement. Phytates: These compounds are found in legumes, whole grains, nuts and seeds. The foods remain nutritious, but preparation methods such as soaking, sprouting and fermenting can help reduce phytate content. Antacids and proton-pump inhibitors: Long-term acid-suppressing medication may reduce the stomach acidity required for optimal iron absorption. Certain medicines: Iron can interact with levothyroxine and some antibiotics. These medicines generally need to be separated from iron by several hours according to the prescriber’s or pharmacist’s instructions. Sally-Ann Creed® Gentle Daily Iron Our Gentle Daily Iron has been designed with three considerations in mind: the form of iron, the supporting cofactors and everyday tolerability. Each capsule provides 22 mg Elemental iron Provided as ferrous bisglycinate, a well-tolerated form of iron. 100 mg Vitamin C Included to support the absorption of non-haem iron. 1 mg Copper Contributes to normal iron transport in the body. Ferrous bisglycinate has been studied for its ability to support iron status and may be better tolerated by some people than certain conventional iron salts. The formula is intended to provide thoughtful daily support without an unnecessarily high dose. How to take it well Timing: Iron is often best absorbed on an empty stomach, approximately one hour before or two hours after a meal. If it causes discomfort, ferrous bisglycinate may be taken with a small amount of food. Avoid pairing it with: Tea, coffee, dairy products, calcium supplements or antacids at the same time. Pair it with: A vitamin C-rich food or drink, although the product already contains vitamin C. Be patient: Correcting low iron stores can take several months. Some people may notice an improvement in symptoms within four to six weeks, but response varies. Retest: When supplementation begins because of confirmed low ferritin or anaemia, follow-up blood testing is important. Your healthcare practitioner can advise on the appropriate interval. Testing matters. We recommend assessing iron status — ideally with iron studies that include ferritin and transferrin saturation, interpreted alongside the full blood count and markers of inflammation where relevant — before beginning supplementation. This is particularly important for anyone with a condition that affects iron metabolism, unexplained anaemia, ongoing blood loss or a risk of iron overload. This article is for educational purposes only and is not intended to diagnose, treat or replace medical advice. Iron supplementation should ideally follow blood testing and be discussed with a qualified healthcare practitioner. If you are pregnant, breastfeeding, taking prescription medication or living with a chronic health condition, please consult your doctor before beginning any new supplement. References British Dietetic Association. Iron Food Fact Sheet. September 2017, reviewed. View source Fischer JA, Cherian AM, Bone JN, Karakochuk CD. The effects of oral ferrous bisglycinate supplementation on haemoglobin and ferritin concentrations in adults and children: a systematic review and meta-analysis of randomised controlled trials. Nutrition Reviews. 2023;81(8):904–920. View source Bumrungpert A, Pavadhgul P, Piromsawasdi T, Mozafari MR. Efficacy and safety of ferrous bisglycinate and folinic acid in the control of iron deficiency in pregnant women: a randomised controlled trial. Nutrients. 2022;14(3):452. View source Ringshaw JE, Zieff MR, Williams S, et al. Iron deficiency anaemia in mothers and infants with high inflammatory burden: prevalence and profile in a South African birth cohort. PLOS Global Public Health. 2025;5(7):e0004174. View source Henriksen C, Arnesen EK. Copper, a scoping review for Nordic Nutrition Recommendations 2023. Food & Nutrition Research. 2023;67. View source Helman SL, Zhou J, Fuqua BK, et al. The biology of mammalian multi-copper ferroxidases. Biometals. 2023;36(2):263–281. View source
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How to read a clinical study
Learning to read a clinical study, even at a very basic level, transforms how you make decisions about your own health. You stop being at the mercy of headlines, and you start being able to judge what you read for yourself.
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Things you need to know about female hair loss
Losing hair is distressing in a way that goes beyond vanity, it can feel like your body is signalling that something is off. The good news is that in most cases, there are addressable reasons and once you find them things can most certainly improve. Hair loss in women is rarely caused by just one thing. It is worth approaching it with curiosity rather than panic, and always asking: what might my body be trying to show me? Common reasons women lose hair Nutrition first Low protein intake is one of the most overlooked contributors, particularly in women who eat very little animal protein or have been restricting calories. Hair is made almost entirely of protein, and your body will deprioritise hair growth when resources are limited. Low-fat diets are similarly problematic, as healthy fats are essential for hormone health and scalp integrity. Iron, B12 and nutrient stores Anaemia and low ferritin are among the most common and most correctable causes of hair shedding. If you have heavy periods, feel exhausted or eat little to no meat, this is worth looking into, especially if you have pale inner eyelids. Ask your doctor for ferritin, a full blood count including haemoglobin and C-reactive protein (to rule out infection, which can show raised ferritin levels), as well as vitamin B12 and not just a general iron test. Thyroid and hormones Thyroid changes, including raised thyroid antibodies, are a common and often missed cause of hair loss. Hormonal shifts including perimenopause, menopause, PCOS (also now referred to as PMOS) or changes in contraception, also play a significant role. Hormones in birth control can affect hair both during use and after stopping. Blood sugar and insulin In PCOS/PMOS-type patterns, high insulin and androgen levels (androgens are male sex hormones that women also produce naturally; in excess, they can shrink the hair follicle and shorten its growth cycle) directly affect the hair follicle. Addressing blood sugar regulation is an important and often underestimated part of the picture. Stress, sleep and life events The body treats hair as non-essential during periods of high stress, illness, poor sleep or major life upheaval. Shedding that follows a difficult period by two to four months is very common and is usually temporary. If you experienced a stressful event, illness or surgery and noticed hair loss some weeks later, this is likely the reason. Inflammation A diet high in sugar, ultra-processed foods and inflammatory oils can affect hair follicle health over time. This is one area where dietary change can really move the needle. Your hair routine matters too Not all hair loss starts from within. Sometimes the answers are closer to the surface. Heat styling Repeated use of blow dryers, straighteners and curling irons at high temperatures weakens the hair shaft over time, leading to breakage that can look a lot like shedding. The hair is not falling from the root, it is breaking along the shaft. Lowering the heat setting, using a heat protectant and allowing your hair to air dry where possible makes a real difference over time. Tight hairstyles High buns, tight ponytails, braids, cornrows and extensions that pull continuously on the hairline or scalp can cause a specific type of hair loss called traction alopecia. The follicle is repeatedly stressed by tension until it eventually stops producing hair. If you regularly wear your hair tightly pulled and notice thinning around the hairline or temples, this is worth reconsidering. Caught early, it is reversible. Left long enough, the follicle damage can become permanent. Aggressive brushing Brushing wet hair causes significantly more breakage than brushing dry hair, as wet hair is elastic and far more vulnerable to mechanical stress. If you brush immediately after washing, switching to a wide-tooth comb and working from ends to roots rather than roots to ends can noticeably reduce breakage over time. Hair products and chemical treatments Frequent colouring, bleaching, perming and chemical relaxing all weaken the hair shaft. Sulfate-heavy shampoos can strip the scalp of its natural oils, disrupting the environment the follicle depends on. Overuse of dry shampoo, particularly as a substitute for washing, can clog follicles and impair scalp health over time. This does not mean you cannot colour your hair. It means spacing treatments, choosing gentler formulations and giving your scalp the care it needs in between. A food-first foundation Before anything else, make sure you are eating enough. Enough protein, enough healthy fat, enough colour and variety in your vegetables. Skipping food groups, under-eating or over-restricting carbohydrates can all contribute to hair loss and no supplement will fully compensate for an inadequate diet. Prioritise whole, nutrient-dense food before reaching for anything else. It is the foundation everything else builds on. Supplements worth considering These are not quick fixes and individual needs vary. But where diet alone is not enough, or where specific deficiencies are confirmed, the following can meaningfully support hair health: Pure Hydrolysed Collagen: provides the amino acids that support the scalp, skin and connective tissue. One of the most impactful additions for many women, particularly those whose protein intake is insufficient. Biotin (B7): a B vitamin that supports keratin production. Worth considering where intake or status is low. Magnesium Citrate or Chelated Magnesium Premium: supports stress resilience, nerve health and insulin regulation. Chronically low magnesium affects many systems that indirectly impact hair. Zinc Picolinate: supports normal hair growth, skin, immune function and tissue repair. Berberine Complex: particularly useful where blood sugar imbalance and insulin resistance are part of the picture, as is often the case in PCOS or PMOS-type patterns. Gentle Daily Iron: worth considering if your ferritin is confirmed low. Iron deficiency is one of the most common and most correctable causes of hair shedding in women Omega-3: healthy fats are not optional when it comes to hair health. Omega-3 fatty acids support scalp health, reduce inflammation around the hair follicle and play a role in the hormonal environment that hair growth depends on. If your diet is low in oily fish such as sardines, mackerel or salmon, or seeds such as chia and walnuts, a supplement with good DHA and EPA levels is worth adding. One last thing Hair growth takes time. Even when you are doing everything right, it can take three to six months before you notice regrowth, because hair grows in cycles, and the follicle needs time to recover. Be patient with the process. And always remember, worsening or sudden hair loss deserves your time to investigate. The information above is supportive, but works best alongside an accurate understanding of what is actually driving the shedding. Blood tests, history and a conversation with your doctor or a caring health professional are always where to start. Hair’s to you! ❤ References 1. Thamotharan N, Harikumar MV, Sundaram M, Swaminathan A, Rangarajan S. Assessment of Serum Ferritin Levels in Female Patients With Telogen Effluvium. Cureus. 2025. doi:10.7759/cureus.100249. pmc.ncbi.nlm.nih.gov/articles/PMC12839778 2. Larrondo J, McMichael AJ. Traction Alopecia. JAMA Dermatology. 2023;159(6):676. doi:10.1001/jamadermatol.2022.6298. 3. Sunil M, Zacharia M. Clinical profile of female patients with chronic telogen effluvium and its association with serum ferritin level. Asian Journal of Medical Sciences. 2024;15(12):98–102. doi:10.3126/ajms.v15i12.70630. 4. Karadag AS, Bilgili SG, Onder S, et al. A comprehensive investigation of biochemical status in patients with telogen effluvium: Analysis of Hb, ferritin, vitamin B12, vitamin D, thyroid function tests, zinc, copper, biotin, and selenium levels. Journal of Cosmetic Dermatology. 2024. pmc.ncbi.nlm.nih.gov/articles/PMC11626366 This article is for educational purposes only and is not intended to replace medical advice. If you are experiencing hair loss, please consult a qualified healthcare practitioner who can investigate the underlying cause and advise accordingly.
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How to grow a useful veggie patch
How to grow a useful veggie patch Growing your own food doesn’t have to start with a big garden or a perfectly planned patch. It can start with a few herbs on the windowsill, a tomato plant on the veranda or chives regrowing in an old container. Something quite extraordinary happens You slow down. You get your hands in the soil. You watch something you planted turn into something you eat. And in that — which takes just minutes a day — you get back something modern life has slightly stripped away: a real sense of connection to the earth and to what nourishes you. You don’t need a large garden, perfect weather, or a green thumb handed down through generations. You need a little space, a little patience and the right starting knowledge. 4.2% decrease in relative stress levels was associated with daily gardening compared with never gardening. Chalmin-Pui et al (2021) — survey of more than 6,000 adults A comprehensive 2024 meta-analysis reviewed 40 studies and found a significant, positive effect on wellbeing, quality of life and health status. Research from Michigan State University found that growing food increases vegetable and fibre consumption, encourages physical activity, and lowers perceived stress and anxiety. And here is a particularly wonderful part: growing food outdoors exposes you to Mycobacterium vaccae, a naturally occurring soil bacterium that research suggests may stimulate serotonin production in the brain. Quite literally — dirt is good for you. No garden? No problem A veggie patch is whatever space you have Here are the best ways to grow useful food, wherever you are. Apartment / Indoors Windowsill & indoor growing A sunny windowsill is a surprisingly productive space. Focus on compact, fast-growing plants in shallow containers. Water from the bottom and check moisture in hot South African summers. Good for: microgreens, basil, chives, lettuce, spring onions, spinach Balcony / Patio Balcony container garden Larger containers (20L+) allow stronger root systems. Railing planters use vertical space beautifully. Wind can be challenging on higher floors — choose bushy, compact varieties. Good for: pepper, tomatoes, kale, beetroot, radish, baby marrow, beans Garden / Backyard Raised bed or wooden box Easy to control soil, excellent drainage, and the defined space makes crop rotation simple. Even a 1.2m × 2.4m bed produces a remarkable amount of food. Warms up faster in spring. Good for: beans, carrots, garlic, leeks, broccoli, sweet potato, peppers, tomatoes Upcycled / Creative Tin cans & upcycled containers Growing food with almost zero budget. Anything that holds soil and has drainage potential becomes a vessel. Tins heat up quickly and suit heat-loving herbs beautifully. Good for: mint, parsley, coriander, chillies, strawberries, lettuce, spinach Flexible Grow bags Fabric grow bags air-prune roots naturally and drain well. Portable — move them to follow the sun. Perfect for renters or anyone wanting flexibility without permanent structures. Good for: potatoes, tomatoes, baby marrow, aubergine, cucumbers, lettuce Garden Straight into soil The simplest way, if you have access. Healthy soil is key — enrich regularly with compost. South Africa’s climate allows year-round growing in many regions with seasonal crop rotation. Good for: almost everything, with good compost and consistent watering Getting started The steps 1 Choose your space Before you choose plants, choose your spot. How many hours of direct sunlight does it get? Most vegetables need at least 6 hours. Herbs can manage with 4. 2 Start with good soil This is the most important investment you’ll make. A rich, well-draining compost-based potting mix is everything. 3 Pick a few plants to start Resist the urge to grow everything at once. Choose what you eat, and choose easy wins like lettuce, cherry tomatoes, herbs. Early success builds confidence and keeps you coming back. 4 Water consistently, not excessively Most new gardeners over-water. Push your finger 2cm into the soil — if it’s moist, leave it. Water at the base of the plant, not on the leaves. Morning is ideal. 5 Feed fortnightly if needed Container-grown plants need regular feeding as nutrients leach out with watering. A liquid seaweed or fish emulsion fertiliser every two weeks during the growing season makes a huge difference to yield and flavour. 6 Harvest regularly The more you harvest, the more the plant produces. Pick lettuce leaves from the outside in. Snip herbs regularly. Most important of all Gardening should bring back a little slice of childhood — good bacteria on our hands, sunshine, nutrition and confidence. You don’t need to start with 36 plants and a plan to never visit the grocery store again. Grow one pepper. Decide what’s for dinner based on that. That is the whole point. Favourite YouTube channels from our team ▶ Simon Akeroyd — youtube.com/c/SimonAkeroyd ▶ Gerald’s Veg — youtube.com/@GeraldsVeg References Chalmin-Pui LS et al. Why garden? Attitudes and the perceived health benefits of home gardening. Cities. 2021;112. Panțiru I et al. The impact of gardening on well-being, mental health, and quality of life: an umbrella review and meta-analysis. Syst Rev. 2024;13(1):45. Alaimo K et al. Caretaking, accomplishment and connection to nature: the gardening triad. People Nat. 2024;6:2014–2028.
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Could low stomach acid be affecting your digestion?
Walk into any pharmacy and you'll see an entire aisle dedicated to one idea: that you have too much stomach acid. Antacids. Acid blockers. Proton pump inhibitors (PPIs) sold over the counter and prescribed by the millions and for many people, they can bring much-needed relief. But there is a narrative that acid is the villain. Suppress it, and everything gets better. Except, like most things in health, the story is more complicated than that. Stomach acid is not the enemy. It is one of the most carefully regulated and biologically expensive secretions the body produces. We need it to digest protein, absorb nutrients, activate enzymes and defend against the microbes that arrive on every bite of food. And while reflux and acid-related irritation are real and most certainly worth treating, there is another side most people have never heard of: stomach acid that is too low. It is called hypochlorhydria when production is reduced, and achlorhydria when it is essentially absent. And the reason it is rarely discussed is not that it is rare. It is because the symptoms look almost identical to the ones we have been taught to blame on the opposite problem. What stomach acid actually does Before talking about what happens when it is low, we should discuss what it does when it is working properly. The stomach maintains a remarkably acidic environment, with a pH between roughly 1.5 and 3.5. That's more acidic than vinegar, on par with lemon juice and a hundred thousand times more acidic than the blood that surrounds it. This acidity does five essential jobs: It unfolds dietary proteins so that digestive enzymes can begin breaking them down into amino acids. It activates pepsin, the main protein-digesting enzyme. Pepsin is released in an inactive form called pepsinogen, and it only becomes active in the presence of acid. It releases nutrients from food. Vitamin B12 must be cleaved from animal protein before the body can use it, and that cleavage depends on acid. Iron, calcium, magnesium and zinc absorption are also influenced by an adequately acidic stomach. It provides a defensive barrier against the bacteria, viruses and parasites that arrive in food and drink, reducing the chance of gastrointestinal infection and bacterial overgrowth further down the digestive tract. It signals the next stage of digestion. When acidic stomach contents move into the small intestine, that acidity triggers the release of bile from the gallbladder and digestive enzymes from the pancreas. Suppress acid for long enough and any of these processes can falter. Why low stomach acid is more common than we think A long-held assumption that gastric acid declines steadily with age has been re-examined in recent years. In healthy adults without underlying disease, acid production actually holds up fairly well into older age. The reason it becomes more common in older people is not age itself, but the accumulated conditions and medications that come with it. The most common contributors to low stomach acid include: Long-term use of acid-suppressing medication, particularly PPIs (omeprazole, lansoprazole and others). These were designed for short-term use, but are frequently taken for years without review. Helicobacter pylori is a bacterium that colonises the stomach lining and can suppress acid secretion over time. It is one of the most common chronic infections in the world. Autoimmune gastritis (also called autoimmune atrophic gastritis), a condition where the immune system mistakenly attacks the cells that make stomach acid (called parietal cells). Because these same cells also produce something called intrinsic factor, a small molecule the body needs to absorb vitamin B12 from food, this condition is closely tied to B12 deficiency and pernicious anaemia (a type of anaemia caused by not being able to absorb B12 properly). Previous gastric surgery, including procedures for weight loss or ulcers. The symptoms (and why they are confusing) The symptoms of low stomach acid overlap almost entirely with the symptoms of too much. Both can cause: Bloating after meals Excessive burping Feeling full quickly Nausea Poor tolerance of protein-rich meals A heaviness or sluggishness after eating Undigested food in the stool Recurrent low iron or B12 on blood tests This is why self-diagnosis is unreliable, and why the standard response "I have indigestion, I'll take an antacid" can sometimes work against you. If reduced acid is part of the picture, suppressing it further may worsen digestion, even if it offers short-term symptomatic relief. How do you actually know if you have low stomach acid? This is one of the harder questions in this whole topic, because there is no single easy test that gives a definitive answer outside of a hospital setting. The baking soda burp test (the traditional at-home version) This is the test that circulates widely online and has been around for decades. The idea is simple chemistry. Mix a quarter teaspoon of baking soda (sodium bicarbonate) into 100–150 ml of cold water and drink it first thing in the morning, on an empty stomach. When sodium bicarbonate meets hydrochloric acid in the stomach, the two react to produce carbon dioxide gas, which causes you to burp. The theory is that if you burp within roughly three minutes you have adequate stomach acid, and if you do not burp at all (or only burp after five or more minutes) your stomach acid may be low. The baking soda test has never been formally validated against a gold-standard medical test and the results are easily influenced by things that have nothing to do with stomach acid such as swallowed air, what you ate the night before, gastric motility, body position and natural fluctuations in stomach pH throughout the day. That said, it is harmless to try and may offer a rough, suggestive clue, particularly if repeated over three to five consecutive mornings and the pattern is consistent. Treat it as a curiosity, not a diagnosis. The Heidelberg pH test Is considered the gold standard for measuring gastric acid. It involves swallowing a small capsule that transmits pH readings from inside the stomach. It is not widely available, and is expensive when accessed privately. Normal Abnormal (low acid) Heidelberg pH test results. In a healthy stomach (left), pH drops sharply after a meal as acid is released. With low stomach acid (right), the pH stays at around 6, indicating little to no acid is being secreted.Source: The Functional Gut Clinic Endoscopy with biopsy Is the definitive test for atrophic gastritis and autoimmune gastritis. A gastroenterologist passes a thin camera into the stomach and takes small tissue samples for analysis. Blood tests Can support the diagnosis and a useful one is serum gastrin (which rises when stomach acid is low, as the body tries to stimulate more production), pepsinogen I and II and the pepsinogen I to II ratio. For suspected autoimmune gastritis, the relevant blood markers are anti-parietal cell antibodies and anti-intrinsic factor antibodies. Indirect markers Indirect markers in routine bloodwork can also raise suspicion: persistently low ferritin, low vitamin B12, low magnesium, or unexplained iron deficiency anaemia. Helicobacter pylori testing Is straightforward and important. It can be done with a non-invasive breath test, stool antigen test, blood test or via biopsy during endoscopy. If positive, it is treatable with a short course of combination antibiotic therapy. A note on reflux Reflux happens when stomach contents move upward into the oesophagus. The oesophagus is not built for acid exposure, so even a normal amount of stomach acid in the wrong place can burn. The crucial point is that reflux is not always a problem of how much acid is being produced. It is often a problem of where the acid is going. The lower oesophageal sphincter, the valve between the stomach and oesophagus, can become weak or relax inappropriately due to hiatus hernia, abdominal pressure, pregnancy, certain foods, smoking, alcohol, obesity or delayed gastric emptying. The acid escapes upward not because there is too much of it, but because the door is not closing properly. This matters because aggressive long-term acid suppression treats the symptom while leaving the underlying mechanical problem untouched, and may introduce new problems of its own. Habits that support healthy digestion Whatever the underlying picture, certain habits support healthy digestion regardless of whether your acid is high, low or perfectly normal: Eat slowly and chew thoroughly. Digestion begins in the mouth. The mechanical breakdown of food and the signalling that prepares the stomach both depend on this first step. Eat in a calm state where possible. The digestive system runs on the parasympathetic nervous system, the "rest and digest" branch. Eating in a rushed, stressed state genuinely impairs digestive function. Include adequate protein. Protein stimulates gastric acid secretion. Eating protein at most meals supports the digestive cascade. Avoid large, heavy meals close to bedtime. Particularly important if you are reflux-prone, since lying flat with a full stomach makes reflux far more likely. Notice your triggers. Alcohol, peppermint, chocolate, deep-fried foods, very spicy foods, coffee and carbonated drinks are common reflux triggers. Triggers are personal. Get the right tests if symptoms persist. If you have ongoing fatigue, hair loss, mouth ulcers, weakness, numbness or tingling, ask your doctor to check iron, ferritin, vitamin B12 and other relevant markers. These can reveal a digestive problem hiding upstream. Be cautious with DIY acid supplements. Supplements designed to replace stomach acid typically contain Betaine Hydrochloride paired with pepsin, taken at the beginning of each meal. Clinically, people often report improvements in bloating, reflux and stool consistency within a few days of starting it. However, this is not a supplement to use casually, particularly if you have reflux, gastritis, ulcers, Barrett's oesophagus or are on anti-inflammatory medication, steroids or blood thinners. It is best used only under the guidance of a qualified practitioner. Try traditional acid-stimulating foods. Cabbage, both fresh and fermented, can be a stimulant of stomach acid production. A small helping of fresh cabbage salad, cabbage juice, or sauerkraut at the start of a meal can be a food-first way to prepare the stomach for what's about to arrive. Bitter greens like rocket and chicory work similarly, as does a small glass of warm lemon water or apple cider vinegar diluted in water before meals. Stomach acid is not the enemy. A healthy digestive system depends on it being present in the right amount, in the right place, at the right time. If your symptoms are persistent, recurring, or not improving with what you have tried, the most useful thing you can do is investigate properly rather than guess. Sometimes the answer is less acid. Sometimes it is more. And sometimes the answer has very little to do with acid at all. The body is not asking us to silence it. It is asking us to listen more carefully. References 1. Maideen NMP. Adverse Effects Associated with Long-Term Use of Proton Pump Inhibitors. Chonnam Medical Journal. 2023;59(2):115–127. pmc.ncbi.nlm.nih.gov/articles/PMC10248387 2. Bhatnagar MS, Choudhari S, Pawar D, Sharma A. Long-Term Use of Proton-Pump Inhibitors: Unravelling the Safety Puzzle. Cureus. 2024;16(1):e52773. pmc.ncbi.nlm.nih.gov/articles/PMC10882567 3. Shahid MS, Ahmed N, Kamal Z, et al. A Systematic Review of Long-Term Use of Proton Pump Inhibitors (PPIs) in Older Adults on Polypharmacy: Do PPIs Deplete Nutrients? Cureus. 2025;17(8):e90888. pmc.ncbi.nlm.nih.gov/articles/PMC12456669 4. Vavallo M, Cingolani S, Cozza G, Schiavone FP, Dottori L, Palumbo C, Lahner E. Autoimmune Gastritis and Hypochlorhydria: Known Concepts from a New Perspective. International Journal of Molecular Sciences. 2024;25(13):6818. pmc.ncbi.nlm.nih.gov/articles/PMC11241626 5. Li P, Zhu W, Ding J, Lei F. Study of Helicobacter pylori infection in patients with chronic atrophic gastritis and its relationship with lifestyle habits and dietary nutrient intake. Medicine (Baltimore). 2024;103(2):e36518. ncbi.nlm.nih.gov/pmc/articles/PMC10783413
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