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The many faces of sugar
Understanding the family of carbohydrates behind your everyday food If you have already read our piece on sugar metabolism →, you will know how a mouthful of food travels through the body and becomes energy. Sugar is not a single substance, it is a whole family of carbohydrates, some naturally in fruit and dairy, some added to processed foods, some hidden inside grains and vegetables, some tied up in fibre. Each type behaves a little differently once inside your body. Some rush in quickly, others drift in slowly and some are not digested at all. This blog is here for you to understand sugars a little better, and without a single wagging finger. Meet the family When we say "sugar", we are really talking about a family of carbohydrates. They differ in size, meaning how many sugar units are joined together, and that changes how they are digested, absorbed and used for energy. There are three broad groups. Monosaccharides: single sugars These are the simplest sugars. One unit only, small enough to be absorbed straight into your bloodstream without further digestion. Glucose: the sugar your body ultimately uses for fuel. Most carbohydrates end up as glucose after digestion. Found in small amounts in honey and fruit. Fructose: the natural sugar in fruit and honey. Handled a little differently by the body, taking a detour through the liver before it can be used. Galactose: usually found alongside glucose in lactose (milk sugar). Disaccharides: pairs of sugars Two monosaccharides linked together. Your body needs to snip them apart before they can be absorbed. Sucrose = glucose + fructose. This is table sugar, and what you will find in sweetened drinks, sauces, biscuits and most sweet treats. Lactose = glucose + galactose. The natural sugar in milk, yoghurt and cheeses. Maltose = glucose + glucose. Forms during starch breakdown, and shows up in malted products, some cereals and beers. Polysaccharides: long chains of sugars Many sugar units linked together in long chains. Some of them we digest, and some of them we do not, which is where things get really interesting. Starch: the storage form of glucose in plants. Found in grains, potatoes, maize, rice, oats and legumes. Digested into glucose over time. Glycogen: the storage form of glucose in animals and humans. Held in the liver and muscles as a back up energy reserve. Fibre: long chains of sugars that we do not digest at all. Fibre is technically a polysaccharide, but its magic is that we cannot digest it. Which sounds like a failure until you understand what it actually does inside us. Soluble fibre forms a soft gel in your gut. It slows digestion, feeds your gut microbes, and helps flatten the rise in blood sugar after a meal. Found in oats, psyllium, and the pectin in apples and citrus. Insoluble fibre adds bulk to your stool and keeps things moving nicely. Found in wheat bran and vegetable skins. Resistant starch is a special kind of starch that behaves like fibre. It resists digestion in the small intestine, then arrives in your large intestine to feed your gut microbes. Found in slightly underripe bananas, legumes, and in rice or potatoes that have been cooked and then cooled. Fibre and resistant starch slow glucose absorption, feed your microbes, and help you feel full for longer. Why the packaging matters Here is one of the most important and exciting ideas in modern nutrition. The same sugar can behave completely differently depending on the "packaging" it comes in. Take an apple. It contains fructose and glucose, roughly the same sugars you would find in a fizzy drink. But when you eat an apple, those sugars are locked inside the fruit's cell walls. They are surrounded by fibre, water, vitamins and antioxidants. The sugars moves out slowly as your body breaks the fruit down. Your blood sugar rises gently. Your body handles it much easier. Now take the same apple, blend it into juice and strain out the fibre. Suddenly the same sugars are free, unbound and ready to hit your bloodstream almost immediately. The cell walls are gone. The fibre is gone. The fruit is gone, in a sense. This concept is called the food matrix, and it is why nutrition scientists increasingly say that how the food is structured is also very important along side what a food contains. An apple is not the same as apple juice. A whole grain is not the same as refined flour. The sugars may look similar on paper, but the packaging is completely different, and your body responds accordingly. What this means for your plate Once you understand the family of sugars and the power of the food matrix, here are a few practical takeaways. Whole fruit is not the same as fruit juice. Enjoy your fruit whole, with the skin where possible. Save juice for occasional treats. Whole grains carry their own fibre. Oats, brown rice, wholewheat bread, quinoa and barley all release their sugars more slowly than their refined cousins. Choose them more often. Cooked-and-cooled starches. Cooking rice or potatoes and then cooling them (even briefly) creates resistant starch, which behaves more like fibre than glucose! Read labels for free sugars. Anything ending in "-ose" (sucrose, glucose, fructose, dextrose, maltose) is a form of sugar. So are syrups, honey, agave, and fruit juice concentrates. Give your fibre some love. Most South Africans eat far less fibre than recommended. Aim for 25 to 30 grams a day, from a variety of vegetables, legumes, whole grains, nuts, seeds and fruit. A note on the "healthy" sugars Our ethos at Sally-Ann Creed® is centred on education, not fearmongering. We do not want to promote restriction or label foods as "good" or "bad", or even simply "healthy" and "unhealthy". However, it is helpful to understand that some sugars marketed as more natural or healthier can still affect blood glucose in a similar way to ordinary table sugar. Honey, coconut sugar, maple syrup and agave may differ slightly in taste, processing and micronutrient content, but they are still sources of added sugar. This does not mean that you need to avoid them completely. It means that they are best enjoyed mindfully and in context, rather than assumed to have no effect on blood sugar. The graph below provides an example of this. This blood-glucose curve from one participant in a study compared the same amounts of honey and glucose. In this example, honey produced a lower glucose response than pure glucose (not table sugar), and both caused a considerable rise in blood glucose. As always if you have any questions or want to learn more, please contact our dietitian at dietitian@sallyanncreed.co.za ❤ This article is for educational purposes only and is not intended to diagnose, treat or replace medical advice. If you have any concerns about your blood sugar, metabolic health, or are managing a chronic condition such as diabetes, please consult a qualified healthcare practitioner before making significant changes to your diet, exercise routine or medication. References 1. Gonzalez JT. Are all sugars equal? Role of the food source in physiological responses to sugars with an emphasis on fruit and fruit juice. European Journal of Nutrition. 2024;63(5):1435–1451. 2. Capuano E, Janssen AEM. Food matrix and macronutrient digestion. Annual Review of Food Science and Technology. 2021;12:193–212. 3. Xiong K, Wang J, Kang T, Xu F, Ma A. Effects of resistant starch on glycaemic control: a systematic review and meta-analysis. British Journal of Nutrition. 2021;125(11):1260–1269. 4. Abdulrhman M, El Hefnawy M, Ali R, Abou El-Goud A. Honey and type 1 diabetes mellitus. In: Liu CP, editor. Type 1 Diabetes: Complications, Pathogenesis, and Alternative Treatments. IntechOpen; 2011.
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Sugar metabolism
What your blood sugar has to do with your energy, your focus, and that afternoon crash There is a moment many of us know quite well. It is somewhere between 2 and 4 in the afternoon. Lunch was two hours ago, the emails are still coming in, and your brain, which was doing quite well earlier, seems to have slowed and clock out. Your eyelids feel heavy, your motivation dips. And almost without thinking, you find yourself walking towards the coffee machine, or the biscuit tin, or both. If this sounds familiar, welcome. You are not weak-willed. You could be riding a rollercoaster you never signed up for, and it has a name. Blood sugar. More precisely, the rise, the crash, and the rebound that happens inside you every time you eat. This blog is here to explain what is actually going on, why it matters more than most of us realise, and what you can do about it. A quick word on sugar itself Before we follow a mouthful of food on its journey, a very quick note. "Sugar" is not a single substance. It is a whole family of carbohydrates, some naturally in fruit and dairy, others added to processed foods, others hidden inside starches, others tied up in fibre. Each type behaves a little differently once inside your body. If you would like to understand the different types of sugar, where they come from and how they compare, we have written a companion piece: The many faces of sugar → For now, know this: whatever type of sugar or starch you eat, your body eventually breaks most of it down into one small molecule called glucose. And glucose is where the real story begins. So why should we care? Managing your blood sugar is one of the most powerful things you can do for your everyday wellbeing. Supporting healthy glucose regulation may help with appetite and everyday energy patterns and is an important part of long-term metabolic health. Every cell in your body needs a steady supply of fuel. Your brain is a demanding customer, and under usual circumstances glucose is its main source of fuel. When your glucose supply arrives in steady waves, your cells are happy! When it arrives in sudden peaks followed by dramatic troughs, your body has to work much harder to keep up. You have almost certainly felt this happening. The heavy-limbed feeling after a big pasta lunch. The mid-morning crash after a breakfast of just coffee and toast. The strange irritability that arrives when you have gone too long without eating. The journey of a mouthful of food To understand blood sugar properly, it helps to follow a mouthful of food on its actual journey through the body. Let us take a slice of wholegrain toast with a little honey, and follow it from your first bite to the moment its energy is put to work. More on step 6 Once inside your cells, glucose has three possible fates. First, it can be used immediately for energy. Your cells break glucose down further inside tiny power stations called mitochondria, producing ATP, the actual currency of energy in your body. Every heartbeat, every thought, every breath is powered by ATP. Second, it can be stored for later. Your liver and muscles store extra glucose in the form of glycogen, essentially the body's short-term battery, as it is held in reserve for when you need energy quickly. We use this in exercise for example, which is why many athletes choose to do carb-loading (which is when they consume a larger amount of carbs before a race) to maximize their glycogen storage. Third, if there is more glucose than your body needs right now, and your glycogen stores are already full, your liver converts the excess into fatty acids, which are then transported to your adipose (fat) tissue and stored for the long term. This is your body's natural way of "saving fuel" for if there is scarcity, an incredibly clever design that once kept our ancestors alive through winters, but which does not always serve us well in a world of constant, easy food. As insulin does its work, your blood sugar level gradually falls back towards where it started. In a well-functioning system, this happens gently, over a couple of hours. Your energy stays steady, your focus stays clear, and you feel neither jittery nor sleepy. Understanding your blood sugar is not about fear or restriction at all. It is about noticing the patterns in your own energy, your own hunger, your own focus, and making choices that support your body rather than fight against it. The rollercoaster is optional. Most of us are just riding it because no one told us there was another way. Now you hopefully know. What you can do to help this curve Build balanced plates. Combine carbohydrates with protein, fibre and healthy fats at every meal. Protein and fat slow down the release of glucose from the small intestine, so instead of a sharp peak you get a gentle wave. A slice of toast with butter and eggs is a very different glucose story from a slice of toast alone. Choose less refined carbohydrates more often. Sweet potato with the skin on. Brown rice or lentils rather than white rice. Wholegrain bread rather than white. These foods still give you carbohydrates, but they release the glucose slowly and steadily. Move after meals. A ten-minute walk after eating is actually a great tool for managing post-meal glucose. When your muscles contract during movement, they take up glucose from the blood directly, without needing as much insulin to do so. It does not have to be exercise. Even tidying the kitchen counts. Do not skip meals then overeat. For some people, long gaps followed by a large carbohydrate-rich meal may produce a greater post-meal glucose response. Regular, moderate meals keep the rollercoaster more steady. Eat your vegetables and protein first. There is a growing body of research showing that eating fibre and protein before the starchier carbohydrates within the same meal can reduce the glucose response to that meal. Sleep and stress matter. Some studies have actually shown that poor sleep and high stress can both raise blood sugar the next day. Protecting your rest and your nervous system is not separate from your metabolic health. As always if you have any questions or want to learn more, please contact our dietitian at dietitian@sallyanncreed.co.za ❤ This article is for educational purposes only and is not intended to diagnose, treat or replace medical advice. If you have any concerns about your blood sugar, metabolic health, or are managing a chronic condition such as diabetes, please consult a qualified healthcare practitioner before making significant changes to your diet, exercise routine or medication. References 1. Wyatt P, Berry SE, Finlayson G, et al. Postprandial glycaemic dips predict appetite and energy intake in healthy individuals. Nature Metabolism. 2021;3:523–529. 2. Berry SE, Valdes AM, Drew DA, et al. Human postprandial responses to food and potential for precision nutrition. Nature Medicine. 2020;26:964–973. 3. Engeroff T, Groneberg DA, Niederer D, et al. After dinner rest a while, after supper walk a mile? A systematic review with meta-analysis on the acute postprandial glycaemic response to exercise before and after meal ingestion in healthy subjects and patients with impaired glucose tolerance. Sports Medicine. 2023;53:849–869.
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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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