Iron Deficiency: Botanical Treatment

The use of various forms of elemental iron have been a part of both folk and Western medical herbal tradition for at least the past few hundred years, whether in the form of iron nails stuck in apples to infuse the apples with iron for consumption by pioneer women, or the use of ferrum supplements by the Eclectic physicians. As stated earlier, side effects from iron supplements are common. For pregnant women who may be experiencing GI symptoms due to the pregnancy itself, such as nausea, vomiting, or constipation, regular elemental iron supplements may be intolerable. Although there is almost no evidence in the literature evaluating the efficacy or safety of herbs used as “iron tonics,” their use is popular amongst herbalists, midwives, and pregnant women (Table Botanical Treatment Strategies for Iron Deficiency Anemia). Clinical observation has demonstrated a high level of efficacy and minimal side effects (see Case History) with a limited number of botanical supplements. The herbs in this section are those most commonly used in contemporary midwifery and herbal practice.

Botanical Treatment Strategies for Iron Deficiency Anemia

Therapeutic GoalTherapeutic ActivityBotanical NameCommon Name
Provide dietary / supplemental ironIron tonicMedicago sativaAlfalfa
Rumex crispusYellow dock
Taraxacum officinaleDandelion root
Urtica dioicaNettles
Floradix Iron and Herbs
Liquid chlorophyll
Treat blood and yin deficiencyAngelica sinensisDong quai
Paeonia rubraPeony

Floradix Iron and Herbs

This product is a popular, easily assimilable source of elemental iron and iron-rich herbs, including aqueous extracts of carrot, nettle wort, spinach, kelp, blackberry, cherry, and beet root concentrates, among other herbal and food ingredients. A 2-tsp (10-mT) daily dose provides 100% of the daily dose of pyridoxine (vitamin B6), 125% cyanocobalamin (vitamin B12), and 10 mg (56%) of iron. Many of the herbs in the product have not been evaluated for use during pregnancy; however, no adverse outcomes from use of the product have been identified. Most women find Floradix palatable and easy to digest.


The leaf of the nettle plant, prepared as a strong infusion, is a popular tonic used by many herbalists for treating iron deficiency anemia, many of whom stand by it as one of their primary anemia treatments. The fresh leaves, which lose their sting when cooked, can also be eaten as an iron-rich green leafy vegetable, if one has access to them. The leaves are also rich in chlorophyll, for which they are commonly a commercial source, and a rich source of vitamin C. As with other herbs used for the treatment of iron deficiency anemia, the amount of iron in any given dose has not been quantified; however, pregnant women and midwives report good results with symptoms of anemia, particularly fatigue. It is rarely used as a singular treatment but rather as part of a protocol for anemia. It has been suggested, although not demonstrated, that the astringency of this herb might interfere with iron absorption. A 1975 review article by Farnsworth et al. reported that stinging nettle was a potential aborti-facient, and that its constituent 5-hydroxytryptamine was a uterine stimulant; however, frequent use of large doses of this herbal infusion in midwifery practice has demonstrated no evidence of such activity.

Dandelion-Yellow Dock Syrup for Iron Deficiency Anemia

Yellow dock root (Rumex crispus): ¼ ounce (14 g) Dandelion root (Taraxacum officinale): ½ ounce (14 g) Directions: Prepare a decoction by simmering both herbs (1 oz / 28 g total) in 4 cups of water, uncovered, until reduced to 1 cup. Strain the liquid thoroughly (discard the herb material) and add ¼ cup blackstrap molasses, mixing until blended. Cool to room temperature. Keep refrigerated. The product will keep for up to 2 weeks refrigerated. Dose: 1 to 2 tbl, up to twice daily depending upon the severity of the anemia.

Yellow Dock and Dandelion Root Iron Tonic

The use of yellow dock root, in combination with dandelion root, is perhaps one of the most popular Western herb tonics used by midwives. It is typically prepared as a syrup with blackstrap molasses (see recipe), itself rich in iron (and calcium), to be taken daily, usually in a 1- to 2-tbl dose. In this form it is easily digestible, though some women report mild nausea if taken on an empty stomach. Yellow dock is listed in Dr. Duke’s Phytochemical and Ethnobotanical Databases ( as an iron-containing herb; however, the amount of iron per any single dose of this herb is difficult to quantify and has not been evaluated in regard to its use as an iron supplement. The herb is touted by traditional herbalists, as is dandelion, not only for its iron content but also for its actions on the liver. It is believed to increase uptake of dietary iron. Neither the veracity of this claim nor possible mechanisms have been evaluated. The use of yellow dock as an iron tonic is presented in the 1918 edition of Remington’s Dispensatory of the United States of America: The roots of this plant are said to possess the power to take up the iron present in the soil, and fix it in the form of organic compounds of iron. By watering the plants with a solution of iron carbonate, roots are said to be obtained that contain 1.5% of iron. Rumex is said to give good results in the treatment of chlorosis and anemia. The authors gave the dried and powdered root during meals in doses of 15 to 45 grains (1 to 3 g), in view of their good results they regard it as a valuable iron medicine. Dock root is given in powder or in decoction. Note that yellow dock is sometimes considered contra-indicated in pregnancy because it is a mild anthra-quinone laxative; however, clinically it has not been observed to be associated with increased uterine activity. The gentle laxative effects (aperient) relieve anemia-associated constipation while building iron.


In 1915, Dr. Richard Willstatter, a German chemist, was awarded the Nobel Prize in Chemistry for elucidating the structure of chlorophyll. Willstatter observed that the chlorophyll molecule bears a striking resemblance to hemoglobin, except that its centerpiece is a single atom of magnesium rather than iron. Today, commercial liquid chlorophyll is derived mostly from alfalfa, and is popularly used to improve iron levels in iron deficiency anemia. No data evaluating the efficacy or safety of chlorophyll use during pregnancy have been identified. In fact, little data exists on the safety or efficacy of alfalfa, though some preliminary studies have suggested possible beneficial effects in lowering cholesterol. The herb may also have some hypoglycemic and antifungal effects. Alfalfa is considered to have minimal risk when used as a food source (e.g., a normal serving of alfalfa sprouts) during pregnancy and lactation. Animal studies (nonpregnant and lactating) have demonstrated no toxicity when alfalfa seeds or saponins are ingested in large quantities over an extended period of time (up to 6 weeks consumption of seeds and 8 weeks for saponins). However, the herb, particularly the seeds and seed products (e.g., alfalfa sprouts) are contraindicated in patients with systemic lupus erythematosus (SLE), in whom it has been reported to cause exacerbations and pancytopenia. The constituent thought to be responsible for this effect, 1-canavanine, is not present in the leaf; however, lupus-like syndrome has been reported with consumption of leaf-containing tablets. This may be caused by adulteration of leaf products with 1-canavanine-containing plant parts. Alfalfa contains the phytoestrogen coumestrol, which may have estrogenic properties. A 1975 paper by Farnsworthetal. on the antifertility effects of herbs stated that alfalfa has uterine stimulant activity; however, no other such findings have been reported in the literature or observed by clinical herbalists. Alfalfa is rich in vitamin K, and thus is contra-indicated with anticoagulant therapies (e.g., Warfarin) with which it may interfere. It may also interact with hypoglycemic drugs, lower blood glucose levels, interfere with lipid-lowering medications, and should not be taken with Thorazine. Clinically, liquid chlorophyll, combined with other iron-raising protocols, has been observed to rapidly improve hemoglobin more quickly than the protocol used alone, and without adverse effects (see Case History that follows).

Dong Quai and Peony

Blood deficiency, a traditional Chinese medicine diagnosis, akin to iron deficiency anemia, is characterized by fatigue, depression, dizziness, constipation with dry stools, and pale complexion. The traditional Chinese medical literature is replete with treatments for blood deficiency in pregnancy, prescriptions historically tailored to the unique needs of the individual woman. Herbs classically used to treat blood deficiency include dong quai and peony, the two primary ingredients in the classic dong quai and peony formula; however, the literature is scant in demonstrating hematopoeisis or improvements in iron status with its use. There is only a single case report in the literature of a hemodialysis patient who was anemic because of insufficient production of erythropoietin, who self-medicated with dong quai and peony decoction once weekly. The tea was prepared using approximately 12 g of dong quai and 52 g of shao yao decocted in three cups of water reduced to one cup by cooking. The patient was concurrently given recombinant human erythropoietin but appeared to be resistant to it. One month after starting the herbal tea, the hematocrit increased from 29.7% to 34.4%. Because of possible hormonal effects and anticoagu-lant / antiplatelet activity, the herb is listed in several Western sources as contraindicated in pregnancy. Data regarding the effect of dong quai preparations on the fetus are lacking. It is recommended that this herb be used in pregnancy only under qualified supervision, and in traditional herbal preparations used for pregnancy.