Do you feel lethargic often and get tired easily?
If so, these may signs you have iron deficiency.
According to the World Health Organization (WHO), iron deficiency is the most common nutritional disorder in the world. Unlike most nutritional disorders, the lack of iron is also prevalent in developed countries like the United States.
Based on the WHO’s statistics, 2 billion of the world’s 7 billion people suffer from this disorder.
The good news is, it is very easy to treat.
Read how you can spot symptoms of iron deficiency, check whether you have it and fix the problem.
What is Iron Deficiency?
Iron deficiency occurs when the body doesn’t get enough of the trace mineral iron. This can either be because their diet does not contain enough iron rich foods, their body isn’t absorbing the iron they’re consuming, or a few other reasons like those we mention below.
Iron plays a very important part in keeping the body healthy.
It is a necessary component in the formation of hemoglobin, which is a protein that’s found in our red blood cells. Hemoglobin is what allows our blood to carry oxygen to all our organs. Without it, our organs will not be able to function properly.
While majority (around 2/3) of our iron intake is used for hemoglobin, some of it is used for other functions too. These include:
- Myoglobin. Myoglobin is a cousin of hemoglobin. This protein though, is found in the muscles instead of the blood. Myoglobin, which allows our muscles to contract and work properly, requires iron.
- Energy production. Some iron is also used by the body to convert nutrients from food into Adenosine triphosphate or ATP, which is the form of energy the body’s cells can use.
According to the National Institutes of Health Office is Dietary Supplements,
- Adult males ages 19 and older need 8 mg of iron daily.
- Women of child bearing age, between 19 and 50 years old require 18 mg of iron/day. Beyond the age of 50, the recommended dietary allowance goes down to 8 mg per day.
The body’s iron requirement also changes as we age.
But throughout our lives we continuously need the replenish our bodies with iron to make oxygen rich hemoglobin for our red blood cells. Our red blood cells have an average lifespan of around 4 months (120 days), then die. This means there’s always a need to replace dying RBC cells with new ones every few months.
Because iron deficiency ultimately presents itself in iron deficiency anemia, which is when the body has low levels of hemoglobin. Many people use the 2 terms interchangeably.
What Causes Iron Deficiency?
When the body lacks iron, there are typically 4 potential causes to this:
1. Insufficient iron intake
This can occur is your diet doesn’t contain enough iron. You may not get enough iron through diet, and also don’t take iron supplements.
This is more common in individuals who don’t eat meat like vegetarians and vegans.
The reason is meat and seafood contain heme iron which is well absorbed by the body. Non-meat sources of iron like green leafy vegetables and grains contain non-heme iron. Unfortunately, this type of iron isn’t as well absorbed by the body.
To compare, the National Institutes of Health’s Office of Dietary Supplements notes that our bodies absorb between 14% and 18% of iron from mixed diets. Mixed diets include vegetables, meat and seafood.
A vegetarian diet meanwhile, which is rich in non-heme iron, has around 5% to 12% iron bioavailability.
Young infants who rely solely on breastmilk for nutrition are also prone to iron deficiency. This is because breast milk is not a good source of iron.
2. Increase in the body’s demand for iron
When the body suddenly increases its rate of growth, the bigger mass requires more supply or iron. And if the body’s iron stores aren’t enough, or you don’t increase your intake, it may lead to iron deficiency.
This type of iron deficiency can happen in children and young teens going through adolescence. During these periods, the body is growing rapidly and the demand may outstrip the body’s iron supply.
Another instance this happens is with pregnant moms. Here, the body needs enough iron for the growing fetus and the demand increases as the unborn child grows.
3. Iron is not absorbed properly by the body
When we consume iron, it goes down your esophagus and into our stomachs. The acid in the stomach breaks down the food and turns the various nutrients and minerals, including iron, into something the body can absorb.
Once the stomach acid does its job, iron and a few other nutrients like magnesium, zinc and calcium, are absorbed by the duodenum. The duodenum is the first, and shortest section of the small intestine which does most of our body’s nutrient absorption.
That said, there are 2 possible locations where iron absorption can be affected:
- In the stomach: If your body isn’t making enough stomach acid, it won’t be able to break the food down well enough for the duodenum to do its job. This can happen if you’re taking certain drugs to reduce stomach acidity. One example are Proton Pump Inhibitors (PPI), a type of drug used to treat acid reflux (heartburn). These medicines lower acid levels in our stomachs to reduce the symptoms of acid reflux. However in doing so, they can also interfere with absorption of some minerals. This is why some medications warn you not to take them with antacids or calcium supplements.
- In the duodenum: Here, there’s probably a problem in the duodenum’s absorption capability. Patients who suffer from Celiac disease are one example. Celiac disease is a condition where the individual is gluten intolerant. And whenever they consume food containing gluten, it causes inflammation and damaging of the lining of the duodenum. Over time, the ability of the duodenum to absorb nutrients decreases as there are fewer healthy cells to do so.
4. Blood Loss
If you’re getting enough iron through your diet or from supplements, and have no problems with absorption, one possible problem could be you’re losing blood.
Iron that’s processed by the body is used in hemoglobin which is the oxygen carrying component present in red blood cells.
If you are losing blood, for example with an open wound, the blood loss and continuous production of it by your body to make up for the loss, depletes your iron levels.
This is one reason why women of child bearing age need to get more iron. They lose blood during menstruation.
Other instances where you may have low iron due to blood loss is if you suffer from peptic ulcers or other conditions that cause some sort of internal bleeding. Individuals who suffer from bleeding stools for example, due to colon cancer or other health issues are also more likely to be deficient on iron.
One final possible cause of iron deficiency due to blood loss is if you donate blood regularly.
Symptoms of Iron Deficiency
You Get Tired Easily
One of the tell-tale signs of iron deficiency is when you get tired easily.
Everyone gets tired when we do a lot of work or exercise vigorously. But when your body doesn’t get enough iron, even the simplest of things can wear you out and make you gasp for breath.
Activities like walking up a flight of stairs or doing 1 or 2 sets of a single low intensity exercise can get you feeling unusually exhausted.
When you have iron deficiency, you eventually become anemic as there isn’t enough iron to produce hemoglobin. This causes your blood to carry lower than optimal amounts of oxygen to your organs making you tire easily.
This is why people who are anemic suffer shortness of breath as well.
Feel Exhausted All the Time and Weakness
The effects of being iron deficient isn’t limited to feeling winded after doing light activity, it can also extend to having a general feeling of lack of energy or unexplained fatigue on a regular basis.
If that weak and tired feeling doesn’t go away even after a couple of nights of good sleep, it can mean you have anemia that’s caused by a lack of iron in your system.
A study by Australian researchers found that iron deficiency results in increased fatigue as well as decreased health.
You feel sluggish all the time is because your body’s cells aren’t getting enough oxygen, resulting in low energy levels.
Aside from feeling exhausted, you’ll also feel weaker. Physical tasks you can normally do like lifting boxes can also become more difficult and tiring. The lack of iron, also affects our muscles as it is needed for myoglobin.
Your Skin Becomes Pale (Pallor)
When we bleed, our blood has a dark red color.
What gives it this red color is iron combining with oxygen to form hemoglobin. Without iron, or the lack of it, turns red blood cells into a pale color.
Because our red blood cells are paler, and there isn’t as much of them circulating through the blood vessels in our bodies, our outer skin color also loses it pinkish hue. This makes our skin color look pale.
This pale complexion is usually easier for people to notice compared to some of the other symptoms of iron deficiency anemia. For people who have naturally pale looking skin, it can be harder to detect the difference in skin tone.
One other method doctors do to check for anemia when they have their suspicion is by looking at the bottom of your eyelids. This area normally has very red color. When you lack iron it loses that dark red color and becomes much lighter.
You May Have a Fast Heartbeat
The human body is a very complex system that has a number of ways to check and balance anything that isn’t going right.
When the body doesn’t have enough hemoglobin, the heart realizes that the organs aren’t getting sufficient oxygen to function properly and stay healthy.
This makes the heart work overtime to try to compensate for the lack of oxygen by pumping more blood. With more blood, it hopes to provide enough oxygen.
When this happens, you experience a more rapid than normal heart rate.
This is the same concept used by the lungs above, when it works harder to produce more oxygen for the blood to carry. This is why people suffering from anemia often have shortness of breath even when not doing anything strenuous.
If the heart keeps this pace for a long time (many years), the extra stress can lead to irregular heartbeat or an enlargement of the heart muscle.
Feeling Dizzy or Lightheaded
The brain is just like any other organ in the body, it requires oxygen to function. When you suffer from iron deficiency, the lack of oxygen makes the brain function as suboptimal levels.
This can make you feel dizzy or lightheaded when you move quickly like stand up from a chair. As the anemia it gets worse, the dizziness happens more and more.
The lack of oxygen also makes it difficult to focus when working or studying. Some people also suffer headaches.
Your Hands and Feet are Cold to the Touch
Like the other symptoms in our list, having cold hands and feet can be a sign of some other condition or be caused by something other than iron deficiency.
However, one of the causes of you having hands and feet that always feel cold is anemia. Our hands and feet are where blood has to travel the farthest to get. This makes them prone to poor circulation more than most of our other organs and body parts.
When we suffer from anemia, the lack of blood becomes more prominent in our extremities. Not getting the regular amount of blood circulation also makes the temperature in our feet and hands go down.
You Easily Feel Cold
Aside from having colder extremities, those who are deficient in iron also feel cold easily. Not having enough blood circulating through the body makes us feel more prone to cold temperature.
This can mean feeling cold in a lightly air conditioned room in the middle of summer or always requiring a jacket when everyone else is wearing t-shirts because of the weather.
Some people naturally have a low threshold to colder temperature, which means that one needs to “know their body” to tell if they’re abnormally feeling cold or if it’s the environment causing the coldness.
Lack of Iron Weakens Your Immune System
Without sufficient iron, you can get sick more often as your immune system isn’t functioning at its best. Iron’s role in bringing oxygen rich hemoglobin to our body’s organs includes blood delivery to the spleen.
The spleen is located in the upper section of our abdomen, and its main role is to purify blood and help the body recognize as well as mount an attack on bacteria, viruses and other pathogens that may be harmful to the body.
Lack of oxygen delivery to the spleen makes it function at less than optimal levels. This is also true for the rest of our lymphatic system. This ultimately affects our immune system’s production of infection fighting white blood cells.
When you suffer from anemia, the tired feeling and being exhausted all the time also takes its toll on the body, making the immune system weaker and less able to fight infection.
You Have Restless Leg Syndrome
Restless leg syndrome is a nervous system condition that gives you the urge to move your legs. It causes an uncomfortable sensation in the lower extremities like the feeling of “pins and needles”, itchiness or throbbing. This sensation makes it difficult to get a full night of sleep.
For some people it also makes them have the need to keep moving their legs when seated down, all the time.
You’re Losing Hair
According to the American Academy of Dermatology (AAD), we lose an average of 50 to 100 hairs each day. This is the normal rate of shedding.
When you lose more than that amount of hair of a daily basis, there’s a likely chance that there is some underlying health condition that’s causing it.
Iron deficiency is one of the possible causes for excessive shedding of hair. This study shows how lack of iron in the body affects our hair growth.
Our hair is part of our skin and require oxygen from our blood to grow and stay healthy. Lack of oxygen causes hair to fall out and not grow back.
When the body lacks iron, and suffers anemia, it will try to make as efficient use of the red blood cells and oxygen it has. This means focusing more oxygen in the vital organs to keep them functioning properly. As a result, the extremities, along with our hair gets a lower share of oxygen.
You Have Brittle and Spoon Shaped Nails
Just like our eyes, our nails offer a lot of information about our current health status. The shape, color and texture of our nails can tell us a lot.
Our body’s iron status affects our nails just as it does our skin and hair.
Nails that are brittle, break easily and are shaped like spoons can indicate a problem with iron deficiency. Spoon shaped nails have the middle portion of the nail sunk in. So when you feel the top of the nail, it will feel like the curved section of a spoon.
One other indicator of anemia is pale or white nail beds. The nail bed is the layer of skin underneath our fingernails and toe nails. Because our nails are translucent, you can see the color of your nail bed.
Normal colored nail beds have a red/pinkish hue. But when you have iron deficiency anemia this layer become pale or white colored.
Addressing Iron Deficiency
Because many of the symptoms above can be cause by other health conditions, it is always important to go see your primary care physician if you experience any of the symptoms above.
That said, if your doctor suspects you have iron deficiency or anemia because of it, they will ask you do have a few laboratory tests done. These test are very simple, diagnostic tests that require blood being drawn.
Tests to Diagnose Iron Deficiency & Iron Deficiency Anemia
The following are some laboratory tests that your doctor will probably order to help determine if you have anemia and/or iron deficiency.
Complete Blood Count (CBC): This is one of the standard tests that are included in your annual medical checkup. It tells you the amount and makeup of your blood cells. The CBC tells you your:
- Hemoglobin: is the amount of the hemoglobin protein that’s present in the blood. Hemoglobin is the part of the red blood cells, and the component that carries oxygen to the body’s cells. A low level means you are anemic.
- Hermatorcit: is the percentage of red blood cells in your blood’s volume.
- Red Blood Cell count: tells you how many red blood cells you have. Red blood cells are what carry oxygen (hemoglobin) to your organs.
In addition to these, the CBC also includes your white blood cell numbers and its components, as well as your platelet count.
Serum Iron: this test tells you how much iron is in circulating in your body (in hemoglobin). While the CBC test above is a good indicator of anemia, this test along with the next one below quickly tells you if your body has enough iron. Together it can diagnose if you have anemia, and if the anemia is caused by a lack of iron or something else.
Serum Ferritin: In contrast to serum iron which tells you how much iron is circulating in your blood, this test tells you how much iron is stored by your body. Around 40% to 50% of the iron is in hemoglobin which is circulating in the blood. The rest is stored in cells, most of which is in the spleen, liver and bone marrow.
Treatment for Iron Deficiency and Anemia
If the tests above determine that your body needs more iron, there are a few treatments available to alleviate the situation. The good news is that they’re fairly simple to do
The most common recommendation will be to increase your iron intake from food. This means consuming more iron rich foods, especially those that contain heme iron which the body absorbs well. If you are vegan or vegetarian, then choosing rich plant sources of iron works just as well.
Foods Rich in Heme Iron
Foods Rich in Non-Heme Iron
In most circumstances, your doctor will likely prescribe you an iron supplement as well. These table contain larger doses of iron that can quickly boost your body’s iron levels.