Iron deficiency occurs when the body doesn’t have enough of the mineral iron. This leads to abnormally low levels of red blood cells.
That’s because iron is needed to make hemoglobin, a protein in red blood cells that enables them to carry oxygen around the body.
If your body doesn’t have enough hemoglobin, your tissues and muscles won’t get enough oxygen and be able to work effectively. This leads to a condition called anemia.
Although there are different types of anemia, iron-deficiency anemia is the most common worldwide (1).
Common causes of iron deficiency include inadequate iron intake due to poor diet or restrictive diets, inflammatory bowel disease, increased requirements during pregnancy and blood loss through heavy periods or internal bleeding.
Whatever the cause, iron deficiency can result in unpleasant symptoms that can affect your quality of life. These include poor health, concentration and work productivity (2).
Signs and symptoms of iron deficiency vary depending on the severity of the anemia, how quickly it develops, your age and current state of health.
In some cases, people experience no symptoms.
Here are 10 signs and symptoms of iron deficiency, starting with the most common.
This happens because your body needs iron to make a protein called hemoglobin, which is found in red blood cells. Hemoglobin helps carry oxygen around the body.
When your body doesn’t have enough hemoglobin, less oxygen reaches your tissues and muscles, depriving them of energy. In addition, your heart has to work harder to move more oxygen-rich blood around your body, which can make you tired (1).
Since tiredness is often considered a normal part of a busy, modern life, it’s difficult to diagnose iron deficiency with this symptom alone.
However, many people with iron deficiency experience low energy alongside weakness, feeling cranky, difficulty concentrating or poor productivity at work.
Summary: Fatigue is one of the most common signs of iron deficiency. This is due to less oxygen reaching body tissues, depriving them of energy.
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, rosy color 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, such as the face, gums, inside of the lips or lower eyelids and even the nails (8).
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 (6).
Paleness is more commonly seen in moderate or severe cases of anemia (9).If you pull your lower eyelid down, the inside layer should be a vibrant red color. If it is a very pale pink or yellow color, this may indicate that you have iron deficiency.
Summary: Paleness in general or in specific areas such as the face, lower inner eyelid or nails may be a sign of moderate or severe iron deficiency. This is caused by lower levels of hemoglobin, which gives blood its red color.
Hemoglobin enables your red blood cells to carry oxygen around the body.
When hemoglobin is low in your body during iron deficiency, oxygen levels will also be low. This means your muscles won’t get enough oxygen to do normal activities, such as walking (10).
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 (4).
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.
Summary: Shortness of breath is a symptom of iron deficiency, since low hemoglobin levels mean the body isn’t able to transport oxygen to muscles and tissues effectively.
Iron deficiency may cause headaches (11).
This symptom seems to be less common than others and is often coupled with lightheadedness or dizziness (4).
In iron deficiency, low levels of hemoglobin in red blood cells mean that not enough oxygen can reach the brain. As a result, blood vessels in the brain can swell, causing pressure and headaches (12).
Although there are many causes of headaches, frequent, recurrent headaches and dizziness could be a sign of iron deficiency.
Summary: Headaches and dizziness could be a sign of iron deficiency. The lack of hemoglobin means not enough oxygen reaches the brain, causing its blood vessels to swell and create pressure.
Noticeable heartbeats, also known as heart palpitations, can be another symptom of iron-deficiency anemia.
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.
In extreme cases, it can lead to an enlarged heart, heart murmur or heart failure (4).
However, these symptoms tend to be a lot less common. You would have to suffer from iron deficiency for a long time to experience them.
Summary: In cases of iron deficiency, the heart has to work extra hard to transport oxygen around the body. This can lead to irregular or fast heartbeats and even heart murmurs, an enlarged heart or heart failure.
Dry and damaged skin and hair can be signs of iron deficiency (4).
This is because when your body is iron deficient, it directs its limited oxygen to more important functions, such as organs and other bodily tissues.
When skin and hair are deprived of oxygen, it can become dry and weak.
It is completely normal for some hair to fall out during everyday washing and brushing, but if you are losing clumps or much more than normal, it may be due to iron deficiency.
Summary: Because skin and hair receive less oxygen from the blood during iron deficiency, they can become dry and damaged. In more severe cases, this can cause hair loss.
Sometimes just looking inside or around your mouth can give you an indication of whether you are suffering from iron-deficiency anemia.
Signs include when your tongue becomes swollen, inflamed, pale or strangely smooth (16).
Low hemoglobin in iron deficiency can cause the tongue to become pale, while lower levels of myoglobin can cause it to become sore, smooth and swollen.
Myoglobin is a protein in red blood cells that supports your muscles, such as the muscle that makes up the tongue (16).
Iron deficiency can also cause dry mouth, sore red cracks at the corners of the mouth or mouth ulcers (17).
Summary: A sore, swollen or strangely smooth tongue can be a sign of iron-deficiency anemia. Cracks on the corners of the mouth can also be a sign.
Iron deficiency has been linked to restless leg syndrome (18).
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 the feet and legs.
It is usually worse at night, meaning that sufferers may struggle to get much sleep.
The causes of restless leg syndrome are not fully understood.
However, up to 25% of people with restless leg syndrome are thought to have iron-deficiency anemia, and the lower the iron levels, the worse the symptoms (19).
Summary: People with iron-deficiency anemia have a higher chance of experiencing restless leg syndrome. This is a strong urge to move the legs when at rest.
This often starts with 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 and usually only seen in severe cases of iron-deficiency anemia.
Summary: Brittle or spoon-shaped nails can be an indicator of more severe iron-deficiency anemia.
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 (21).
- Feeling anxious: The lack of oxygen available to body tissues in iron deficiency may cause feelings of anxiety. However, this tends to improve or resolve as iron levels are corrected (22).
- 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 cause you to catch more illnesses than usual (23).
Summary: Other more generic signs of iron deficiency may include strange food cravings, feeling anxious, cold hands and feet and an increased risk of infections.
If you think you have iron-deficiency anemia, consider the following advice.
Talk to Your Doctor
If you think you’re showing signs or symptoms of iron deficiency, you should make an appointment to see your doctor. A simple blood test will confirm whether you have iron-deficiency anemia (3).
If your doctor confirms you have iron deficiency, you will likely be able to treat it fairly easily by increasing your intake of iron from your diet or with iron supplements (4).
The main aim of treatment is to restore hemoglobin levels to normal and replenish iron stores.
Try to ensure you are getting enough iron through real food in your diet. Only take supplements if your doctor recommends them.
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, pork and poultry
- Dark green, leafy vegetables, such as spinach and kale
- Dried fruit, such as raisins and apricots
- Peas, beans and other pulses
- Iron-fortified foods
- Seeds and nuts
Help Boost Your Iron Absorption
It may also be beneficial to avoid certain foods that can inhibit iron absorption when eaten in large amounts. These include tea and coffee and foods high in calcium such as dairy products and whole-grain cereals.
Take Iron Supplements If Your Doctor Recommends Them
Generally, you should only take an iron supplement as a last resort and if your doctor recommends it. This will likely be the case if you are unable to restore your iron levels through diet alone.
If you do take an iron supplement, try drinking orange juice with it to boost iron absorption.
Keep in mind that there are some unpleasant side effects of taking iron supplements. These include stomach pain, constipation or diarrhea, heartburn, nausea and black stools.
However, these side effects usually decrease over time and depend on the dose of iron you take.
Summary: If you think you have iron-deficiency anemia, talk to your doctor, who will likely recommend more iron-rich foods (plus vitamin C to increase your iron absorption) or possibly iron supplements.
Iron-deficiency anemia is the most common type of anemia worldwide.
Some people have obvious symptoms, while others experience none at all. This often depends on the severity of the anemia.
Common signs and symptoms include tiredness, pale skin, noticeable heartbeats, headaches and dizziness, feeling short of breath, dry and damaged hair and skin, sore or swollen tongue and mouth, restless legs and brittle or spoon-shaped nails.
If you think you have symptoms of iron deficiency, be sure to visit your doctor. Self-diagnosing is not recommended.
Luckily, most forms of iron deficiency can be treated fairly easily, usually through an iron-rich diet or iron supplements, if your doctor recommends them.