August 12, 2026

The story of AI

in Articles

We thought it might be nice to write a blog on what AI is and without any hype and without any doom. Where AI came from and how it actually works.

What is AI?

Artificial intelligence, or AI, refers to computer systems that are designed to perform tasks that would normally be associated with "human intelligence" such as recognising speech, translating languages, solving problems or generating text. Chances are, you've already been using AI for years without even realising it.

When your phone predicts the next word you're typing
When Netflix recommends a programme
When Google Maps reroutes you around traffic
When your email filters out spam, that's all AI

The type of AI that has become famous over the past few years is called a Large Language Model (LLM).

Instead of memorising answers like a giant encyclopaedia, these models learn patterns from enormous amounts of text, including books, websites, scientific papers and publicly available information. When you ask a question, they use those patterns to generate what they predict is the most helpful response.

But that is all it is. This is one of the most important things to understand about AI. It doesn't think the way you do or felt pain or ever been hungry. It doesn't know who you are unless you tell it. It generates responses based on patterns it has learned.

And that's why AI can be incredibly helpful, but it also should never replace your own judgement or the advice from a qualified healthcare practitioner.

A short history

1950

The mathematician Alan Turing published a paper called "Computing Machinery and Intelligence", which asked the now-famous question, "Can machines think?". He proposed what became known as the Turing Test: if a person could not tell whether they were talking to a human or a machine, the machine could be said to be intelligent. This paper is considered the beginning of AI as a serious idea.

1966

A researcher at MIT called Joseph Weizenbaum created ELIZA, one of the first chatbots. It mimicked a psychotherapist by rephrasing whatever you said back to you as a question. If you typed: "I'm feeling anxious today." ELIZA might reply "Why do you think you're feeling anxious?". It was simple, and yet people using it began to open up to it as if it were a real person. Weizenbaum was reportedly unsettled by how easily humans formed emotional bonds with a machine. Nearly sixty years later, we are seeing exactly the same thing with modern AI chatbots.

1997

When the computer beats the chess champion. IBM's chess-playing computer Deep Blue defeated the reigning world champion Garry Kasparov. For many people, this was the moment they realised computers could outperform humans in tasks once thought to require uniquely human intelligence.

2017

A group of Google researchers published a paper called "Attention Is All You Need", which introduced a new AI architecture called the transformer. Instead of reading one word after another like older computer systems, transformers learnt to understand the relationships between all the words in a sentence at the same time and today, almost every modern AI chatbot including ChatGPT, Claude, Gemini and Microsoft Copilot is built using this breakthrough.

2022

On 30 November 2022, OpenAI released a chatbot called ChatGPT. Within five days, it reached one million users. Within two months, it had reached 100 million users, making it the fastest-growing consumer application in history at the time. To put that into perspective, we researched that Instagram took around two and a half years to reach the same number. By early 2026, ChatGPT had grown to around 900 million weekly active users, showing just how rapidly AI has become part of everyday life.

What are people actually using AI for?

If you are new to AI these are some examples that it is being used for:

Summarising a long document into three bullet points
Helping a child understand tricky maths homework
Suggesting recipe ideas for whatever is left in the fridge
Translating a menu on holiday
Preparing questions to ask a doctor before an appointment
Explaining a medical or scientific term in plain language
Brainstorming a birthday present

Here are a few real examples we tried, to give you a sense of what that looks like in practice.

A screenshot of an AI conversation asking what to make with eggs, oats, rice, oil, half an onion and tomatoes, with the AI suggesting three dinner options: shakshuka, tomato and egg fried rice, and savoury oats with a fried egg

An everyday example, turning what you have in the fridge into three dinner ideas in seconds.

A screenshot of an AI conversation asking to explain glycation in plain language, with the AI describing it as excess sugar sticking to proteins or fats in your body, almost like caramelising them

A learning example, using AI to make a tricky word easier to picture.

For example, you could ask AI to explain what fibre is or summarise a scientific paper on vitamin D. But if you ask whether you need vitamin D, that's a question that still requires your medical history, blood tests and advice from your healthcare professional.

The exciting bit and the slightly worrying bit

One of the reasons AI feels so remarkable is that it can appear to "understand" us. You can ask it to explain a blood test, rewrite a difficult email, plan a week's meals or even help you understand a research paper. Often, the answers sound thoughtful, confident and surprisingly human. But there is something important to remember. AI is designed to produce the most likely answer based on patterns in the information it has learned from.

It does not independently verify every fact before it responds, and it can occasionally produce information that is inaccurate or outdated while sounding completely convincing. This is sometimes called an AI hallucination. For example it might invent a paper that doesn't exist or give a wrong date for an event. It is one of the reasons we always recommend checking important medical, legal or financial information with trusted sources.

Will AI replace us?

If history can tell us anything is that technology, rather than eliminating jobs, usually changes them.

Calculators did not replace mathematicians.

GPS did not replace pilots.

The internet didn't replace teachers.

Instead, they changed how people worked.

The same is likely to happen with AI. Many repetitive tasks may become faster, allowing professionals to spend more time doing the things that require human judgement, empathy, creativity and experience.

Which AI should you use?

You may have heard names like ChatGPT, Claude, Gemini and Copilot. Our IT colleague explained it to us that the different types are like different makes of cars.

ChatGPT (OpenAI) is for everyday questions, writing, brainstorming ideas, learning new topics, explaining complex concepts and coding. It is one of the most widely used AI assistants in the world.

Claude (Anthropic) is known for writing and working with long documents. Many people enjoy using Claude for reports, creative writing and detailed analysis.

Gemini (Google) is Google's AI assistant that works closely with Gmail, Google Docs and other Google services. It is particularly useful for people already using Google.

Microsoft Copilot is built into Microsoft Word, Excel, Outlook and Teams. Copilot is designed to improve productivity by helping users draft documents, analyse spreadsheets and summarise meetings.

Our thoughts

AI isn't magic, it isn't alive and it is not perfect. But it could be one of the most important tools humanity has ever built. Like the internet before it, it will almost certainly change the way we learn, work and solve problems.

Use it to learn. Use it to save time. Use it to explore ideas. But for important decisions, especially those involving your health, keep asking questions, keep thinking critically and keep speaking to trusted professionals.

Technology will continue to evolve.
Human judgement will always matter.

If you have any questions or want to learn more, please contact our team at admin@sallyanncreed.co.za ❤

This article is for educational purposes only and is not intended to diagnose, treat or replace medical, legal or financial advice. AI tools can be a useful starting point for learning, but important decisions, especially those relating to your health, should always be discussed with a qualified professional.

August 12, 2026

The story of AI

Have you noticed that "AI" seems to have appeared everywhere? It is on our phones, in our search results, even being used in some of the tools we use for work. Depending on who you ask, it is either the greatest invention since the internet, or the beginning of the end. We don't think either is quite true. We thought it might be nice to write a blog on what AI is and without any hype and without any doom. Where AI came from and how it actually works. What is AI? Artificial intelligence, or AI, refers to computer systems that are designed to perform tasks that would normally be associated with "human intelligence" such as recognising speech, translating languages, solving problems or generating text. Chances are, you've already been using AI for years without even realising it. When your phone predicts the next word you're typing When Netflix recommends a programme When Google Maps reroutes you around traffic When your email filters out spam, that's all AI The type of AI that has become famous over the past few years is called a Large Language Model (LLM). Instead of memorising answers like a giant encyclopaedia, these models learn patterns from enormous amounts of text, including books, websites, scientific papers and publicly available information. When you ask a question, they use those patterns to generate what they predict is the most helpful response. But that is all it is. This is one of the most important things to understand about AI. It doesn't think the way you do or felt pain or ever been hungry. It doesn't know who you are unless you tell it. It generates responses based on patterns it has learned. And that's why AI can be incredibly helpful, but it also should never replace your own judgement or the advice from a qualified healthcare practitioner. A short history 1950 The mathematician Alan Turing published a paper called "Computing Machinery and Intelligence", which asked the now-famous question, "Can machines think?". He proposed what became known as the Turing Test: if a person could not tell whether they were talking to a human or a machine, the machine could be said to be intelligent. This paper is considered the beginning of AI as a serious idea. 1966 A researcher at MIT called Joseph Weizenbaum created ELIZA, one of the first chatbots. It mimicked a psychotherapist by rephrasing whatever you said back to you as a question. If you typed: "I'm feeling anxious today." ELIZA might reply "Why do you think you're feeling anxious?". It was simple, and yet people using it began to open up to it as if it were a real person. Weizenbaum was reportedly unsettled by how easily humans formed emotional bonds with a machine. Nearly sixty years later, we are seeing exactly the same thing with modern AI chatbots. 1997 When the computer beats the chess champion. IBM's chess-playing computer Deep Blue defeated the reigning world champion Garry Kasparov. For many people, this was the moment they realised computers could outperform humans in tasks once thought to require uniquely human intelligence. 2017 A group of Google researchers published a paper called "Attention Is All You Need", which introduced a new AI architecture called the transformer. Instead of reading one word after another like older computer systems, transformers learnt to understand the relationships between all the words in a sentence at the same time and today, almost every modern AI chatbot including ChatGPT, Claude, Gemini and Microsoft Copilot is built using this breakthrough. 2022 On 30 November 2022, OpenAI released a chatbot called ChatGPT. Within five days, it reached one million users. Within two months, it had reached 100 million users, making it the fastest-growing consumer application in history at the time. To put that into perspective, we researched that Instagram took around two and a half years to reach the same number. By early 2026, ChatGPT had grown to around 900 million weekly active users, showing just how rapidly AI has become part of everyday life. What are people actually using AI for? If you are new to AI these are some examples that it is being used for: Summarising a long document into three bullet points Helping a child understand tricky maths homework Suggesting recipe ideas for whatever is left in the fridge Translating a menu on holiday Preparing questions to ask a doctor before an appointment Explaining a medical or scientific term in plain language Brainstorming a birthday present Here are a few real examples we tried, to give you a sense of what that looks like in practice. An everyday example, turning what you have in the fridge into three dinner ideas in seconds. A learning example, using AI to make a tricky word easier to picture. For example, you could ask AI to explain what fibre is or summarise a scientific paper on vitamin D. But if you ask whether you need vitamin D, that's a question that still requires your medical history, blood tests and advice from your healthcare professional. The exciting bit and the slightly worrying bit One of the reasons AI feels so remarkable is that it can appear to "understand" us. You can ask it to explain a blood test, rewrite a difficult email, plan a week's meals or even help you understand a research paper. Often, the answers sound thoughtful, confident and surprisingly human. But there is something important to remember. AI is designed to produce the most likely answer based on patterns in the information it has learned from. It does not independently verify every fact before it responds, and it can occasionally produce information that is inaccurate or outdated while sounding completely convincing. This is sometimes called an AI hallucination. For example it might invent a paper that doesn't exist or give a wrong date for an event. It is one of the reasons we always recommend checking important medical, legal or financial information with trusted sources. Will AI replace us? If history can tell us anything is that technology, rather than eliminating jobs, usually changes them. Calculators did not replace mathematicians. GPS did not replace pilots. The internet didn't replace teachers. Instead, they changed how people worked. The same is likely to happen with AI. Many repetitive tasks may become faster, allowing professionals to spend more time doing the things that require human judgement, empathy, creativity and experience. Which AI should you use? You may have heard names like ChatGPT, Claude, Gemini and Copilot. Our IT colleague explained it to us that the different types are like different makes of cars. ChatGPT (OpenAI) is for everyday questions, writing, brainstorming ideas, learning new topics, explaining complex concepts and coding. It is one of the most widely used AI assistants in the world. Claude (Anthropic) is known for writing and working with long documents. Many people enjoy using Claude for reports, creative writing and detailed analysis. Gemini (Google) is Google's AI assistant that works closely with Gmail, Google Docs and other Google services. It is particularly useful for people already using Google. Microsoft Copilot is built into Microsoft Word, Excel, Outlook and Teams. Copilot is designed to improve productivity by helping users draft documents, analyse spreadsheets and summarise meetings. Our thoughts AI isn't magic, it isn't alive and it is not perfect. But it could be one of the most important tools humanity has ever built. Like the internet before it, it will almost certainly change the way we learn, work and solve problems. Use it to learn. Use it to save time. Use it to explore ideas. But for important decisions, especially those involving your health, keep asking questions, keep thinking critically and keep speaking to trusted professionals. Technology will continue to evolve.Human judgement will always matter. If you have any questions or want to learn more, please contact our team at admin@sallyanncreed.co.za ❤ This article is for educational purposes only and is not intended to diagnose, treat or replace medical, legal or financial advice. AI tools can be a useful starting point for learning, but important decisions, especially those relating to your health, should always be discussed with a qualified professional.

August 5, 2026

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.

August 5, 2026

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.

July 20, 2026

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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