Iron deficiency

The symptoms of an iron deficiency vary, depending on its severity, as well as a person’s overall health.

For a mild or moderate iron deficiency, a person may not experience any noticeable symptoms.

Iron-deficiency anemia can cause symptoms that include:

• fatigue

• weakness

• dizziness

• headaches

• sensitivity to temperature

• cold hands and feet

• shortness of breath

• chest pain

• difficulty concentrating

• heart palpitations

• restless leg syndrome

• cravings for nonfood items, such as ice or dirt

There are also several physical signs of an iron deficiency to look out for, such as:

• brittle nails

• cracks at the sides of the mouth

• hair loss

• inflammation of the tongue

• abnormally pale or yellow skin

• irregular heartbeat or breathing

Iron deficiencies occur when an insufficient amount of iron is present in the blood.

There are several potential causes for a lack of iron, including the following:

• Diet

Iron is in many different types of foods, including fish, fortified cereals, beans, meat, and leafy green vegetables.

• Iron malabsorption

Some medical conditions and medications may prevent the body from absorbing iron properly, even when a person is eating plenty of iron-rich foods.

Conditions that can cause problems with iron absorption include:

• intestinal and digestive conditions, such as inflammatory bowel disease

• gastrointestinal surgery, such as gastric bypass surgery

• rare genetic mutations

• Blood loss

Hemoglobin is a protein in red blood cells. It contains most of the body’s iron. For this reason, blood loss can result in iron deficiencies and anemia.

Blood loss can be a result of injury, or too frequent blood tests or donations. But it can also occur with certain conditions or medications, including:

• internal bleeding from ulcers or colon cancer

• regular use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs)

• heavy menstrual periods

• urinary tract bleeding

• rare genetic conditions

• surgery

• Other conditions

Other conditions that may cause iron deficiency include:

• kidney failure

• congestive heart failure

• obesity

Iron is particularly important during periods of growth. For this reason, children and pregnant women have a higher risk of developing iron deficiency and anemia than others.

Here are 10 signs and symptoms of iron deficiency, starting with the most common.

1. Unusual tiredness

Feeling very tired is one of the most common symptoms of iron deficiency. This symptom is common in people who don’t have enough iron .

This fatigue happens because your body lacks the iron it needs to make a protein called hemoglobin, which helps carry oxygen around the body.

2. Paleness

Pale skin or pale coloring of the inside of the lower eyelids are other common signs of iron deficiency

The hemoglobin in red blood cells gives blood its red color, so low levels during iron deficiency make the blood less red. That’s why skin can lose its healthy color or warmth in people with iron deficiency.

This paleness in people with iron deficiency can appear all over the body, or it can be limited to one area (7). This includes the:

• face

• gums

• inside the lips or lower eyelids

• nails

This is often one of the first things doctors will look for as a sign of iron deficiency. However, it should be confirmed with a blood test.

Paleness is more commonly seen in moderate or severe cases of anemia

3. Shortness of breath

Hemoglobin enables your red blood cells to carry oxygen around your body.

When hemoglobin levels are low during iron deficiency, oxygen levels will also be low. This means your muscles won’t receive enough oxygen to do normal activities, such as walking

As a result, your breathing rate will increase as your body tries to get more oxygen. This is why shortness of breath is a common symptom.

If you find yourself out of breath doing normal, daily tasks that you used to find easy, such as walking, climbing stairs, or working out, iron deficiency could be to blame.

4. Headaches and dizziness

Iron deficiency may cause headaches, particularly in women

This symptom seems to be less common than others and often occurs with lightheadedness or dizziness

The link between iron deficiency and headaches is still unclear.

Headaches may occur because low levels of hemoglobin in red blood cells mean that not enough oxygen reaches the brain. As a result, blood vessels in the brain may swell, causing pressure and headaches.

Although there are many causes of headaches, frequent, recurrent headaches and dizziness could be a sign of iron deficiency.

5. Heart palpitations

Noticeable heartbeats, also known as heart palpitations, can be another symptom of iron deficiency anemia.

The association between iron deficiency, anemia, and heart problems is still being studied, but it may be related to oxygen supply.

Hemoglobin is the protein in red blood cells that helps transport oxygen around the body. In iron deficiency, low levels of hemoglobin mean the heart has to work extra hard to carry oxygen.

6. Dry and damaged hair and skin

Dry and damaged skin and hair can be signs of iron deficiency

Iron deficiency lowers the level of hemoglobin in the blood, which may reduce the amount of oxygen available to cells that cause hair growth

When skin and hair are deprived of oxygen, they can become dry and weak.

Iron deficiency is also associated with hair loss, and some research suggests it could be a cause

It’s completely normal for some hair to fall out during everyday washing and brushing. If you’re losing clumps or much more than normal, though, it may be related to iron deficiency.

7. Swelling and soreness of the tongue and mouth

Sometimes just looking inside or around your mouth can indicate whether you have iron deficiency anemia.

Signs include when your tongue becomes swollen, inflamed, pale, or strangely smooth .

Iron deficiency may also cause other symptoms around your . These include:

• dry mouth

• a burning feeling in your mouth

• sore red cracks at the corners of your mouth

• mouth ulcers

8. Restless legs

Iron deficiency has been linked to restless leg syndrome

Restless leg syndrome is a strong urge to move your legs at rest. It can also cause unpleasant and strange crawling or itchy sensations in your feet and legs.

It’s usually worse at night, meaning that you may find it difficult to sleep.

9. Brittle or spoon-shaped fingernails

A much less common symptom of iron deficiency is brittle or spoon-shaped fingernails. This condition is called koilonychia

Usually, the first sign is brittle nails that chip and crack easily.

In later stages of iron deficiency, spoon-shaped nails can occur where the middle of the nail dips and the edges are raised to give a rounded appearance like a spoon.

However, this is a rare side effect that occurs in only about 5% of people with iron deficiency . It’s usually only seen in severe cases of iron deficiency anemia.

10. Other potential signs

There are several other signs that your iron could be low. These tend to be less common and can be linked to many conditions other than iron deficiency.

Other signs of iron deficiency anemia include:

• Strange cravings. A hankering for strange foods or non-food items is called “pica.” It usually involves cravings to eat ice, clay, dirt, chalk, or paper and could be a sign of iron deficiency. It can also occur during pregnancy

• Feeling depressed. Iron deficiency anemia may be associated with depression in adults . Pregnant women with iron deficiency may also have a higher chance of developing depression.

• Cold hands and feet. Iron deficiency means less oxygen is being delivered to the hands and feet. Some people may feel the cold more easily in general or have cold hands and feet.

More frequent infections. Because iron is • needed for a healthy immune system, lack of it may increase your risk for infections

Eat iron-rich foods

If your doctor thinks your iron deficiency may be caused by a lack of iron in your diet, think about consuming more iron-rich foods, such as:

• red meat, such as beef , and poultry

• dark green, leafy vegetables, such as spinach and kale

• dried fruit, such as raisins and apricots

• peas, beans, and other pulses

• seafood

• iron-fortified foods

• seeds and nuts

Help boost your iron absorption

Importantly, eating vitamin C will help your body absorb iron better. Try to eat enough vitamin C-rich foods, such as fruits and vegetables

It may also help to avoid certain foods that, when eaten in large amounts, can keep your body from absorbing iron. These include tea, coffee, and foods high in calcium such as dairy products and calcium-fortified whole grain cereals.

Take iron supplements if your doctor recommends them

You should only take an iron supplement if your healthcare provider confirms that you’re iron deficient or are at risk for iron deficiency and can’t meet your needs through diet alone.

If you do take an iron supplement, try drinking orange juice with it to boost iron absorption or using a supplement that includes vitamin C.

Keep in mind that taking iron supplements may cause some side effects. These include:

• stomach pain

• constipation or diarrhea

• heartburn

• nausea or vomiting

• black stools

References… Written by Mary Jane Brown, PhD, RD (UK) — Medically reviewed by Jillian Kubala, MS, RD — Updated on October 26, 2020 Medically reviewed by J. Keith Fisher, M.D. — Written by Aaron Kandola on February 8, 2019

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