7 Signs That You Could Have an Iron Deficiency

You often wake up tired, even after a good night’s sleep. You continually reach for a sweater, even when it’s not all that cold. And your fingernails are looking a little funny lately…

Could low iron levels be the culprit?

Family medicine physician David Brill, DO, explains why your body needs iron, what symptoms may signal a deficiency and when to talk to a healthcare provider.

What is iron, and why is it important?

Iron is a mineral that your body uses to make hemoglobin, an important protein in red blood cells.

“Hemoglobin helps your blood carry oxygen throughout your body,” Dr. Brill explains. “But if you don’t get enough iron, your hemoglobin levels drop, which can limit oxygen flow.”

Iron deficiency is the most common cause of anemia, which is when you have low levels of healthy red blood cells (aka iron-deficiency anemia). You can have an iron deficiency without anemia, but a lack of iron is often the first step toward developing this blood disorder.

So, why does it happen? That depends. Lots of factors can cause you to have lower levels of iron in your body, and some people are at a higher risk than others.

“Causes of an iron deficiency can range from diet to illness,” Dr. Brill says. “Other factors to consider are age, sex and medical history.”

Signs of an iron deficiency

Here are six signs that you may be dealing with low iron levels.

1. Pale or yellow skin

The hemoglobin in red blood cells is ... well, red. And if you don’t have enough hemoglobin because of low iron, it can start to affect the color in your face.

“Iron deficiency may cause you to appear pale, especially on your face, lips and inner eyelids,” Dr. Brill says. “You may also notice a yellowish color in your complexion that wasn’t there before.”

It’s also important to know that Black women are at a high risk of developing iron-deficiency anemia. But paleness and yellowing may not be as noticeable on darker skin, so other symptoms may be more obvious.

2. Constant fatigue and weakness

It’s one thing to feel tired. But fatigue related to iron deficiency is on another level.

“If you constantly feel exhausted with no clear cause, even after getting enough rest, it could be a sign of low iron levels,” Dr. Brill states.

You may also feel a general weakness in your body, like you don’t have the energy to do things you usually can.

3. Shortness of breath

Oxygen is essential for breathing, and iron is essential for transporting oxygen through your body. So, low iron levels can affect your ability to breathe normally.

“Low iron levels can reduce oxygen delivery to your tissue, leading to shortness of breath,” Dr. Brill explains. “It may be especially obvious during physical activity, or even just doing everyday tasks.”

Anyone can have low iron. But athletes (and female athletes, in particular) are at especially high risk. So, if you’re noticing that you’re much more out of breath than usual during workouts, it could be a signal that your iron levels are low — especially if you’re having other symptoms, too.

4. Chills

Iron-deficiency anemia causes poor blood circulation, which can affect the way you feel temperatures. When you don’t get enough oxygen to your limbs, it can make you feel very cold.

“In particular, people with anemia often experience chills or a constant feeling of being cold,” Dr. Brill notes. “It’s common to feel cold with low iron, especially in your hands and feet.”

5. Craving ice or non-food items

Feeling like you want to chomp on chunks of ice? Sometimes, iron deficiency can cause this strange craving. It can even compel you to want to eat non-food items, like dirt or hair, a condition known as pica.

“Pica can have a lot of causes, but low iron levels can be one of them,” Dr. Brill reports. “Researchers still aren’t sure exactly why.”

Chewing on ice (pagophagia) can damage your teeth and cause jaw pain. So, if you’re a chronic ice chewer or have developed a sudden craving for it, a healthcare provider may want to do bloodwork to check your iron levels.

6. Nail changes

Iron deficiency can cause changes to your fingernails and toenails, making them feel soft or brittle.

It can also cause “spoon nails” (koilonychia), which is when your nails become flat and indented, like spoons, instead of growing straight. Though there are other possible causes, it’s most commonly a sign of iron deficiency anemia.

7. Hair loss

While it’s not as common as other symptoms, iron deficiency can also contribute to hair loss (telogen effluvium), particularly in women.

Your hair needs oxygen to grow, and your body needs iron to fuel the process that carries oxygen to your scalp. When iron levels drop, your body directs its attention away from functions that it considers nonessential, like hair growth.

When to see a doctor

If you think you’re experiencing signs of low iron, talk to a healthcare provider. They can identify iron deficiency with blood tests, but that’s only part of the evaluation. They’ll also want to discuss your lifestyle habits, family medical history and other factors that may explain why your iron levels are low.

“A good history and physical exam are tools that no amount of technology can beat,” Dr. Brill notes. “Then, if tests confirm the diagnosis, I typically recommend having annual lab screenings done so that your provider can compare changes over time.”

Remember: There is a variety of causes of low iron, from diet to other medical conditions. Oftentimes, it can be treated by adding more iron-rich foods to your diet and, in some cases, starting an iron supplement or IV iron infusions.

But other times, an iron deficiency can be a sign of a more serious medical condition, so it’s always best to talk to a provider.

“Your provider will take into account the cause and the severity of your symptoms to figure out the treatment that’s right for you,” Dr. Brill says. “There’s no quick fix, but we can often help you start feeling better within a few months.”