6 Signs You May Be Iron-Deficient

You often wake up tired, even after a good night’s sleep. You always feel cold and reach for a sweater, no matter the temperature. Your nails are looking a little dry lately, despite using moisturizer.

While your mind may go to iron deficiency to explain these symptoms, you’re still unsure. But it’s true: Low iron levels can cause some of these reactions.

But what might cause low iron levels?

“Causes of an iron deficiency can range from poor diet to a serious illness,” says family medicine physician David Brill, DO. “Other factors to consider are your age, gender and medical history.”

It can be difficult to determine whether your symptoms are due to an iron deficiency, as headaches, chills and fatigue can occur for various reasons. But Dr. Brill shares some signs of iron deficiency and how to get properly diagnosed.

Why is iron important?

Your body uses iron, a mineral, to make hemoglobin. This helps your blood carry oxygen throughout your body. If you aren’t getting enough iron, your hemoglobin levels drop and this can limit oxygen flow. This is what ultimately causes iron-deficiency anemia — the most common type of anemia.

How to tell if you may be iron-deficient

If you show up at the doctor’s office looking pale, especially around the eyes, and complaining of constant chills and exhaustion, your provider is likely to test for iron deficiency. Here are six signs to watch for:

1. Pale or yellow skin

You look in the mirror and feel like you’re a bit paler than usual. Iron deficiency may cause you to appear pale, especially on your face, lips and inner eyelids.

This is because the hemoglobin in our red blood cells is, well, red. If you don’t have enough hemoglobin (because of low iron), this can affect the color in your face.

You may also notice a yellowish color in your complexion that wasn’t there before.

2. Constant fatigue and weakness

Being tired occasionally is one thing, but if you’re experiencing fatigue related to iron deficiency, it will feel like exhaustion on another level. You may also feel a general weakness in your body, like you don’t have the energy to do things you usually can. If you constantly feel exhausted with no clear cause — even after getting enough rest — it could be a sign of low iron levels.

3. Shortness of breath

As iron is tied to how oxygen moves in our body, it’s no surprise that your breathing can be affected by iron deficiency. Iron is essential for oxygen transport in the body.

Low iron levels can reduce oxygen delivery to tissues, leading to shortness of breath, especially during physical activity.

If you find yourself out of breath while doing everyday tasks, this may be a sign of low iron.

4. Chills

You used to handle the cold just fine. But lately, you find yourself shivering when the air conditioner is on or when the temperature drops.

Because iron-deficiency anemia causes poor blood circulation, this can affect the way you feel the temperature. In particular, people with anemia often experience chills or a constant feeling of being cold. It’s common to feel cold with low iron, especially in your hands and feet.

5. Craving ice or non-food items

This is a strange one, but it does happen! In some cases, people with iron deficiency may experience cravings for non-food items such as ice, dirt or even hair. This condition, also known as pica, can have a lot of causes, but low iron levels can be one of them.

6. Brittle nails or hair loss

Iron deficiency can cause brittle or spoon-shaped nails (koilonychia). And although not as common as other symptoms, iron deficiency can also contribute to hair loss, particularly in women and people assigned female at birth (AFAB).

What to do if you think your iron is low

If you think you’ve been experiencing signs of iron deficiency, the best thing to do is to talk to a healthcare provider. Blood tests can identify an iron deficiency, but that’s only part of the evaluation during an office visit.

“We always want to listen to what you tell us,” Dr. Brill states. “A good history and physical exam are tools that no amount of technology can beat.” Lab tests then confirm the diagnosis. “I would recommend annual lab screenings so we have a trail to look back on if there are any changes with time,” he adds.

How is iron deficiency treated?

Your healthcare provider will first determine what’s causing your iron deficiency. Treatment will then focus on both the low iron levels and the underlying cause.

For example, if your diet is the culprit, they may recommend changing to or adding more iron-rich foods to what you eat daily. Dr. Brill recommends working in food with a good source of iron like:

• Quinoa (one serving has 5 milligrams, or about 1/3, of your daily iron)
• Spinach (squeeze on some citrus, like lemon, to help release the iron)
• Red meat
• Oysters
• Peanut butter
• Pumpkin or squash seeds
• Kidney beans and lentils

Your doctor also may recommend an iron supplement available without a prescription.

“There are pros and cons for every type of treatment,” Dr. Brill points out. “We take into account the cause and the severity of your symptoms. If the severity is life-threatening, we can do a blood transfusion. This, however, is not the answer for everyone.”

Who’s most at risk?

People who may be at higher risk of developing iron deficiency include:

• Women and people AFAB. “By far, women are more at risk of iron deficiency, which can start with the onset of menstrual cycles,” Dr. Brill notes. Women are also at a greater risk of autoimmune disorders and hypothyroidism, which may cause anemia.
• Older adults. As you age, your appetite typically decreases. And meager meals may lack good sources of iron.
• People taking certain medicines. Medicines and treatments that can rob your body of iron include blood thinners, such as aspirin, or prescription medicine, like Coumadin® (warfarin). Chemotherapy and other cancer-targeted therapies can also strip away iron.

The bottom line

Your body can send you a message about iron deficiency in a lot of ways. Whether you’re experiencing persistent chills, constant fatigue or shortness of breath, these could all be signs that your body isn’t getting enough iron.

Typically, iron deficiency can be treated through changes in diet or by taking iron supplements. But sometimes, it can be a sign of a more serious medical condition, so it’s always best to talk to a healthcare provider.