All You Need To Know About Iron Deficiency: Symptoms, Treatment, And Impact On Your Health
Iron is an essential mineral necessary for hemoglobin production, oxygen transportation, immune system support, and many other functions in the body. Sadly, iron deficiency is one of the most common forms of malnutrition in the world. Learn about the symptoms of iron deficiency and its impact on health.
Iron deficiency is one of the most prevalent nutrient deficiencies in the world. The World Health Organization estimates that around 40% of young children and 30% of women have anemia caused by a lack of iron. Lacking this essential mineral can have serious effects on your physical and cognitive health.
What is iron deficiency?
Iron is an essential mineral necessary for your body’s optimal functioning.
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Iron’s role in the body:
- Oxygen transport: Iron helps to make hemoglobin, the protein in red blood cells that carries oxygen from the lungs to tissues throughout the body.
- Cellular energy production: Iron is essential for the electron transport chain in mitochondria, the cell’s powerhouse.
- DNA synthesis: DNA synthesis and repair requires iron to work properly.
- Muscle function: Iron is a component of myoglobin, a protein that stores oxygen in muscle tissues.
- Immune system support: Immune cells need iron to function and produce cytokines.
- Proper brain function: The brain needs iron to produce neurotransmitters.
Heme and non-heme iron
We normally get iron from the food we eat, mainly animal products. The iron we can absorb comes in two types: heme and non-heme iron.
Heme iron is part of hemoglobin and myoglobin molecules. The body absorbs and uses it more easily. Heme iron comes from animal foods like red meat, organ meats, poultry, fish, and seafood.
Non-heme iron is not absorbed as well and can be affected by other foods that limit its absorption, like calcium. You can get non-heme iron from plants, grains, legumes, seeds, and nuts. Some processed foods, such as bread, cereal, and plant milk, are fortified with iron.
You can even get iron from your iron cookware. For instance, if you use a cast iron skillet, some iron molecules can leach into the food you cook. You might also find cooking accessories, such as Lucky Iron Fish, made for this exact purpose. The fish is made from iron, and you need to add it to your foods when cooking to let your food absorb some of that iron.
How does iron deficiency start?
Simply put, iron deficiency starts when you don’t consume enough foods that contain the mineral, lose blood, or can’t absorb iron from foods. Many people confuse iron deficiency with anemia. While iron deficiency is one of the most common reasons for anemia, called iron-deficiency anemia, the condition can exist on its own. Other conditions like vitamin B12 or B9 deficiency, cancer, HIV, and trauma can also cause anemia.
Reasons for iron deficiency
- You don’t consume enough foods or supplements containing the mineral
- Iron absorption isn’t working the way it’s supposed to
- You have gastrointestinal disorders like celiac disease or inflammatory bowel disease
- Certain medications can interfere with iron absorption, such as antacids or calcium supplements
- You are pregnant
- You’re going through periods of rapid growth (infancy, adolescence)
- You’re an athlete or exercise a lot
- You can lose iron through blood loss, such as heavy menstrual periods, gastrointestinal bleeding (e.g., ulcers, colorectal cancer), or frequent blood donation
- Some chronic conditions like chronic kidney disease, cancer, and chronic heart failure might cause deficiency
- Parasitic infections like hookworm can also impair iron absorption
Stages of iron deficiency
Usually, iron deficiency starts gradually and develops over months or years, unless you lose a lot of blood or have other health issues that cause faster depletion of the element.
Typically, it goes through four stages:
Iron depletion
- The body's iron stores (primarily in the liver) begin to decrease
- At this point, there’s no immediate effect on red blood cell production
- Serum ferritin levels fall
Iron-deficient erythropoiesis
- Iron stores are depleted
- Iron supply to the bone marrow for red blood cell production becomes insufficient
- Transferrin saturation decreases
- Slight increase in red blood cell distribution width (RDW)
Iron deficiency anemia
- At this stage, hemoglobin production is affected
- Red blood cells become smaller (microcytic) and paler (hypochromic)
- Hemoglobin and hematocrit levels fall below the normal range
- Anemia symptoms start
Severe iron deficiency anemia
- A significant drop in hemoglobin levels
- More noticeable symptoms
- It might cause long-term health complications, such as damage to the organs, heart problems, and chronic fatigue
Iron deficiency symptoms and signs to look for
At the first stage of iron deficiency, you might not notice any signs. However, as your nutritional needs aren’t met, you might begin to experience the typical symptoms.
First signs of iron deficiency:
- Fatigue and weakness
- Pale skin in the lower eyelids, gums, and nail beds
- Shortness of breath and getting tired after short physical activity
- Headaches
- Dizziness, particularly when standing up quickly
- Cold hands and feet
If you ignore the warning signs, deficiency might progress to more serious symptoms such as:
- Brittle nails and nail ridges
- Hair loss
- Craving for non-edible items, such as ice, dirt, or clay (also called pica)
- Restless legs syndrome
- Difficulty concentrating and brain fog
- Getting sick more often and taking longer to recover
- Tongue inflammation or soreness
- Rapid heartbeat, especially with mild activity
In extreme cases, you might start experiencing more severe symptoms such as:
- Extreme fatigue and weakness, where you can’t do your daily activities
- Very pale skin, especially noticeable in the face, nail beds, and mucous membranes
- Chest pain
- Tachycardia or palpitations
- Dizziness that leads to fainting
- More frequent and intense headaches
- Difficulty concentrating, memory problems, and irritability
- Cracks at the corners of the mouth
- Koilonychia (spoon-shaped nails)
- Cold intolerance
- Frequent infections and slow wound healing
- Children with severe iron deficiency might have delayed development and behavioral issues
- Pregnant women deficient in iron have an increased risk of premature birth and low birth weight
Who is at risk of iron deficiency?
In general, reproductive-age women and children have the highest risk of developing iron deficiency.
- Women of childbearing age are more prone to iron deficiency because of monthly bleeding.
- Pregnant women have an increased need for iron as their blood volume increases by around 50%. They also need extra iron to support the developing fetus and placenta. After giving birth, women might also need to take iron supplements if they lose a lot of blood during labor.
- Infants and young children need to consume enough iron-rich foods to support their fast growth and cognitive development.
- Vegetarians and vegans are at risk of deficiency as they don’t consume enough heme iron. As it’s more difficult to absorb iron from plants, they might not meet their recommended iron intake.
- Athletes have a higher risk of iron deficiency because intensive training increases red blood cell production which needs extra iron to produce hemoglobin. Athletes also lose more iron through sweat and sport-induced injury.
- People with certain medical conditions like gastrointestinal bleeds, severe food allergies, and some autoimmune diseases might have a hard time absorbing iron even if they consume enough of it through food.
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How is iron deficiency diagnosed?
A simple blood test can usually show the warning signs of iron deficiency. However, most people learn about their iron deficiency through routine checkups when it’s already developed into anemia.
If you notice iron deficiency symptoms, you can request a blood test to check your mineral levels.
A blood test checks for:
- Complete blood count (CBC)
- Serum ferritin (the most sensitive test for iron stores)
- Serum iron which measures the amount of circulating iron
- Total iron-binding capacity (TIBC), which indicates the blood's capacity to bind transferrin with iron
How to treat iron deficiency?
Most iron deficiency stages can be treated by changing your diet or supplementing. However, if a health condition you have depletes iron, then treatment depends on the underlying cause.
Ways to treat iron deficiency:
- Increase your intake of iron-rich foods such as beef, lamb, pork, chicken, oysters, sardines, tuna, liver, kidney, and other animal products. Sources of plant-based iron are legumes (beans, lentils, chickpeas), tofu and tempeh, spinach and other dark leafy greens, quinoa, pumpkin seeds, and fortified foods.
- Combine iron sources with vitamin C to enhance absorption.
- Avoid foods and drinks that inhibit iron absorption, such as foods high in calcium, tea, coffee, and alcohol.
- Take iron supplements. Many supplement forms are available, such as ferrous sulfate or ferrous gluconate. It’s best to take iron supplements between meals for better absorption together with vitamin C.
- Intravenous iron might be necessary in severe cases or when you can’t tolerate oral supplements.
- Treat underlying causes such as heavy menstrual bleeding, gastrointestinal bleeding, and malabsorption issues.
Living with iron deficiency
While iron deficiency is common, it can have serious effects on your health and well-being. The best way to diagnose and treat iron deficiency is to consult with your doctor and ask them to test for iron deficiency. Once you know whether you have it or not, you can make the necessary changes.
Remember:
- The first signs of iron deficiency are fatigue, pale skin, shortness of breath, headaches, dizziness, and cold hands and feet.
- To prevent iron deficiency, eat a whole and balanced diet.
- To test for iron deficiency, request a blood test that includes a complete blood count, serum ferritin, serum iron, and total iron-binding capacity.
We hope that this article helps you understand iron deficiency better and live a healthy and balanced life.
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