Like so many things in life, iron deficiency can sneak up on you. For one, many of the symptoms are pretty general, so it’s easy to assume they’re something else. And two, many of those symptoms can appear so gradually that you might not notice them at first.
But despite iron deficiency’s sometimes elusive symptoms, the condition is surprisingly common—especially among women. In fact, one recent study suggests that moderate iron deficiency among premenopausal women in the United States might even be as high as 30 percent.
That’s a pretty high number—unnecessarily so. After all, iron makes up 5 percent of the earth’s crust and is one of the most plentiful minerals around. And, if you’re eating a balanced diet—one that includes dark leafy greens, legumes, red meat, poultry, eggs, fish, whole grains, nuts, and dried fruit—it should be fairly easy to consume enough iron through diet alone.
What does iron do?
“Iron is one of the most important nutrients in our diets, since it helps different proteins deliver oxygen throughout our body,” explains Jacey Folkers, DC, B.Sc.Ed, of Joi Women’s Wellness. Specifically, those proteins are hemoglobin and myoglobin, which carry oxygen to the lungs and muscles through red blood cells. When our red blood cells don’t have enough oxygen, iron deficiency anemia—the most common type of anemia in the world—can occur. “This deficiency can impact health and factors related to aging such as muscle strength, energy levels, and cognitive abilities,” says Anant Vinjamoori, M.D and Chief Medical Officer at Modern Age. “It’s essential to maintain a balanced iron level.”
Who is at risk for iron deficiency?
As mentioned, iron deficiency is especially common among women who menstruate—but it can affect anyone, including men, the elderly, and children. “Iron deficiency anemia is most often caused by either increased blood loss—commonly seen in women post-childbirth, women who are menstruating, someone undergoing surgery, or someone experiencing bleeding in the gastrointestinal (GI) tract,” explains Christy Evans, M.D., a Board Certified ObGyn at Almond ObGyn. Additionally, she says iron deficiency can be the result of reduced iron absorption, commonly associated with digestive disorders like celiacs, ulcerative colitis, Crohn’s disease, and H-pylori infection. Or, it can be caused by chronic conditions that result in chronic inflammation, like heart disease and obesity.
And, it can even result from everyday stuff you might not think about, like regularly using medications like aspirin or ibuprofen, or simply drinking too much coffee and alcohol—both of which can prevent the body from absorbing vital nutrients.
What are the signs of iron deficiency?
Here’s where things get tricky. Iron deficiency can definitely cause symptoms—but many of them are so common that they could easily be attributed to other things like not drinking enough water, being deficient in Vitamin B12, or hormonal fluctuations. “Signs of iron deficiency, although not exclusive to this condition, include persistent fatigue and weakness, reduced energy levels, difficulty breathing or shortness of breath during physical activities, headaches, dizziness, and cognitive changes,” explains Vinjamoori. Other symptoms—like cold hands, cold feet, and pale skin—could easily be attributed to climate, lifestyle, or weather. Worse, many of these symptoms aren’t even apparent, especially early on. “Some women with mild iron deficiency will have no symptoms at all,” says Evans.
Still, there are a few tell-tale signs to look out for. “As the body becomes more deficient in iron and anemia worsens, the signs and symptoms intensify,” explains Folkers. “Our bodies can do some pretty weird things when we’re severely low in iron.” Beyond the common symptoms, he says there are the five unusual signs of iron deficiency to watch out for.
1. An inflamed tongue
This one is serious, because it can make chewing and swallowing difficult, which in turn can make consuming enough nutrients all the more challenging. So, watch out for any tongue swelling, soreness, or changes in the way foods taste. And, don’t forget to look at your entire mouth—just as iron deficiency can cause pale skin due to lack of oxygen, it can cause pale gums, too.
2. Brittle nails
“Although they may seem unrelated to the rest of our body, our nails can actually say a lot about our health,” says Dr. Folkers. Therefore, having weak and brittle nails, can definitely be a sign of a nutrient deficiency. A condition called koilonychia, which causes the nails to grow concave like spoons, can also be indicative of insufficient of iron.
3. Dry, cracked lips and mouth
If no amount of lip balm or hydration seems to fix your chapped lips, beware. “People with iron deficiency may experience a specific type of cracking called angular cheilitis, which affects the corners of your mouth,” says Dr. Folkers. “Treating angular cheilitis on its own with cream or ointment won’t help: you need to treat the underlying iron deficiency to keep the cracking from coming back again and again.”
4. Odd cravings
If you suddenly have a hankering for substances that should definitely never be eaten—like dirt, clay, paint chips, charcoal, ashes, hair, fabric, cardboard, or cleaning supplies—it’s time to order some bloodwork. Craving non-food substances is a condition called Pica, and while it can sometimes be brought on by stress, anxiety, or other mental health issues, it’s also a sign of anemia. And it’s not just limited to cravings for the completely inedible: wanting to chew ice or even cornstarch can also be signs of anemia-induced Pica.
5. Hair loss
Tresses looking thinner or less shiny than usual? This could be a sign of iron deficiency, especially when it develops into anemia, which according to some studies, can negatively affect hair health. Luckily, this is reversible. “When hair follicles don’t get enough oxygen, they go into a resting stage, and hair falls out and doesn’t grow back until anemia is improved,” says Folkers.
How to fix iron deficiency
If you’re experiencing any of the above symptoms or suspect you have an iron deficiency, it’s important to get yourself checked to determine the underlying issues. And, don’t wait. As Dr. Vinjamoori says, “addressing iron deficiency is crucial for overall health, preventing age-related diseases, and ensuring optimal cognitive function throughout the aging process.
Luckily, treatment for iron deficiency is fairly routine. For severe iron deficiency, your doctor may prescribe iron supplements or intravenous iron therapy. For low to moderate deficiency, they will most likely encourage you to increase your intake of foods that are rich in iron, like spinach, broccoli, kale, sardines, eggs, poultry, and red meat.
They might also recommend improving your entire diet to include a range of healthy foods that ensure your body absorbs every nutrients it needs. Nayan Patel, PharmD, of Auro Wellness points out that our systems are meant to work synergistically, so it’s really important to look at our health holistically. For example, he recommends taking a vitamin C supplement along with your iron supplement. Vinjamoori agrees: “Enhancing iron absorption from plant sources with vitamin C-rich foods is vital, so getting nutritional guidance is definitely key.”
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