Iron can make all the difference between your being energetic and exhausted. Yet this important mineral, responsible for many vital functions within the body, turns out to be the nutrient that we most often lack. (1)

Despite an abundance of iron-fortified foods among a subset of the population, including breastfed infants, menstruating or pregnant women, vegans and vegetarians, and people on medications that cause internal bleeding or interfere with iron absorption, iron deficiency is surprisingly common. (2)

Why is iron essential?

Hemoglobin, the substance in red blood cells that transports oxygen from the lungs to muscles, organs and the brain, depends on iron to function. (3) Iron is critical for both mental and physical performance. Without enough iron, the body can’t make enough oxygen-rich red blood cells, and thus can’t get enough oxygen. This lack of red blood cells is called iron deficiency anemia.

four people running together outdoors

Not being able to muster the energy to exercise is a common symptom of iron deficiency.

In addition to being responsible for overall oxygen distribution, iron is a part of many enzymes used in a wide variety of cell functions. Iron is also necessary to maintain healthy cells, skin, hair, and nails. (4)

An iron deficiency can drastically affect our various organs and bodily functions that are necessary for survival. One of it’s more deleterious effects is fatigue—the lack of oxygen makes us winded and chronically tired. Iron deficiency ranks as one of the most common nutritional deficiencies in the world, impacting more than 25 percent of people worldwide. (5)

Did you know?
According to the National Heart, Lung, and Blood Institute, an estimated 20 percent of women of childbearing age have iron-deficiency anemia, the most commonly diagnosed blood disorder. (6)

Pregnant women are even more likely to have iron-deficiency anemia because they require greater amounts of blood to support their growing babies. The World Health Organization estimates nearly all women are to some degree iron deficient. (7)

Signs and symptoms of iron deficiency

Because the symptoms of iron deficiency are not exclusive to this one disorder, many who suffer from it may not even be aware that they have it. In fact, a person may not exhibit any noticeable symptoms at all until iron deficiency anemia sets in. Anemia can be subtle, gradually worsening over time. One tell-tale sign is having difficulty exercising—even if you are relatively fit.

As iron deficiency anemia progresses, symptoms may include (8):

  • Fatigue
  • Irritability
  • Dizziness
  • Headaches
  • Grumpiness
  • Trouble concentrating
  • Brittle nails
  • Restless legs syndrome
  • Slow cognitive development (children)
  • Glossitis (inflamed tongue)
  • Hair loss
  • Pale skin
  • Short attention span
  • Shortness of breath
  • Cold hands and feet
  • Rapid heartbeat
  • Poor appetite
  • Unusual cravings (such as for ice or dirt)

Causes of iron deficiency

A lack of iron implies at least one of two main causes, each of which can itself be the result of a number of factors:

Increased need for iron

Children, with their rapid growth spurts, require more iron than adult men. Menstruating women and pregnant women require the highest amount of iron. (9) Women who are pregnant need more iron because the growing fetus puts extra demand on their iron intake.

dad measuring daughter's height on wall

Children, with their rapid growth spurts, may experience iron deficiencies.

Any loss of blood is also a loss of iron. Blood loss could be the result of regularly donating blood, heavy menstrual flow, or even certain gastrointestinal conditions that might cause bleeding (such as ulcers or hemorrhoids). Even taking too many pain relievers such as aspirin can cause intestinal bleeding. (10)

Decreased intake or absorption of iron

There are several factors that could interfere with your ability to absorb iron. The four most common reasons for a decreased iron intake are as follows:

  • Vegetarian and vegan diets are typically low in iron. In addition, the type of iron available in plant foods, called non-heme iron, is not absorbed as easily as the heme iron found in meats, fish, and poultry. (11)
  • Certain substances in foods (such as calcium, polyphenols, and phytates) can actually inhibit iron absorption. (12) For those with a varied diet, the amount of inhibition is negligible. If you don’t have a well-balanced diet, however, you should pay attention to certain combinations of food that can reduce iron absorption and put you at a risk for deficiency.
  • Excessive consumption of antacids has also been found to decrease the amount of iron that one is able to absorb. (13) Keep in mind that if you are taking these antacids to control another condition, you will need to deal with it in treatment.
  • Crohn’s and celiac disease are intestinal disorders that can prevent the body from properly absorbing all types of nutrients, including iron. (14)

Because young children, menstruating adolescent females and pregnant women are already at a higher risk for iron deficiency than most others, it is especially important to ensure that they are not subject to any additional risk from some of these other factors. In other words, if you are pregnant and vegetarian, you need to take extra special care to monitor your iron intake and compensate for your increased need and potentially decreased intake.

Prevention of iron deficiency

The best way to avoid iron deficiency is to maintain a healthy, well-balanced diet with good sources of iron included in your diet. This should include fortified foods, lean meats, fish, fresh and dried fruits, vegetables, beans, eggs, nuts, whole grains, and fat-free dairy products. (15)

Make every effort to avoid unhealthy fats and cholesterol, as well as excessive salt and sugary foods. When eating non-meat sources of iron (fruits, veggies, beans), try to pair foods that are high in vitamin C with them. Vitamin C makes plant-based iron easier for your body to absorb. (16)

woman squeezing oranges for orange juice

Foods containing high levels of vitamin C, such as oranges, are great to consume with plant-based iron foods.

Those at greater risk for iron deficiency should consult with their doctor about whether iron supplementation or iron-fortified foods might be necessary. It can be hard to hone in on iron deficiency because the symptoms could also be indicative of a gamut of other kinds of medical conditions.

The key is to always listen to your body and see your healthcare practitioner if in doubt. While we all experience fatigue and irritability, exhaustion coupled with brittle nails and hair loss should be enough of a red flag for you to make an appointment and get yourself checked. Don’t wait until it’s too late and critical bodily functions have begun to break down.

How is iron deficiency detected?

Blood tests and even a complete blood count (CBC) may be necessary to determine how much iron is present in your blood before a thorough diagnosis can be made. While there are several additional blood tests designed to detect anemia, a complete blood count test is usually sufficient to confirm whether you have iron-deficiency anemia. (17)

Treatment for iron deficiency

Treatment for iron deficiency (and related anemia) depends on your age, health and the overall severity of your condition. Typically, iron supplements are advised in the short term—expect several months to allow iron levels to return to normal. Most people with anemia take 150 to 200 milligrams (mg) each day, but your practitioner will assess your iron levels and advise accordingly. (18)

Because vitamin C improves iron absorption, many doctors recommend that you take 250 mg of vitamin C with iron tablets. (19) During the time your body’s iron stores are being replenished, you’ll be asked to return for follow-ups and will be monitored for improvement in your hemoglobin levels.

If your diet is the culprit for the deficiency, you may be put on a special diet that is heavy in iron-rich foods and vitamin C. For patients whose intestines don’t absorb iron well, iron injections, blood transfusions, and even intravenous iron therapy may be suggested.

Do iron supplements have side effects?

Possible side effects from iron supplements are nausea, vomiting, diarrhea, dark stools, or constipation. (20) If you do suffer from constipation, adding extra fiber and bulky foods to your diet may provide relief. You can also try taking supplements with food to minimize gastric distress. It is always best to consult with your healthcare practitioner before taking any type of supplements.

Can you overdo iron?

More iron is definitely not better—high levels of iron can be toxic. (21) The problem with too much stored iron is that, short of bleeding, the body can’t easily get rid of it. If you don’t menstruate or frequently donate blood, excess iron gets stored in the liver, heart, and pancreas, where it can cause organ failure and other chronic diseases.
Adults shouldn’t exceed more than 45 mg of iron a day without close medical supervision. Although rare, some people have an inherited condition called hemochromatosis that means their bodies don’t naturally regulate their iron absorption. (22)

The bottom line

Although iron deficiency can be subtle, especially at first, it’s well worth paying attention to. Left unchecked, it can lead to anemia, severe fatigue, and a range of other debilitating conditions. Always check in with your healthcare practitioner to know more about conditions such as iron deficiency.

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