These days, most of us experience, or know someone who experiences, unexplained fatigue. Maybe workouts feel harder to get through despite a good night’s rest, and the snooze button gets played on repeat. One possible symptom of iron deficiency, also known as anemia, is fatigue. Now, just because you’re tired doesn’t mean you’re deficient, but for women in particular, iron deficiency could be to blame.
Why is Iron Important?
Iron is a metal that plays many roles in the body. It is primarily used to make two important proteins, called hemoglobin and myoglobin. Hemoglobin is a protein found in red blood cells that helps carry oxygen throughout the body. Myoglobin, a similar protein found in muscles, which provides oxygen to the muscles. Iron is also used to make hormones and maintain healthy connective tissues. As you probably already know, getting oxygen where it needs to go inside the body is a pretty important job. Without iron our bodies are not able to carry oxygen correctly, leaving many organs and tissues at risk (1).
If you eat a varied diet it is likely that you are getting enough iron. But, sometimes people develop anemia because they are losing too much blood regularly, not because they aren’t eating enough iron. In these situations, the diet simply can’t keep up with the need for iron.
The people most at risk for iron deficiency include:
– Women with heavy periods
– Pregnant women
– Blood donors
– Infants, particularly those born prematurely
– People with a chronic illness, such as cancer or digestive disorders
– Those with poor iron intake due to restrictive diets
All of these conditions can lead to anemia, but a blood test is required to determine if the anemia is caused by iron. There are several different kinds of anemia caused by a lack of other nutrients, but iron deficiency anemia is the most common (2).
Iron Deficiency Symptoms
Obvious symptoms don’t always appear right away. If you suspect an iron deficiency, check these symptoms to know if you should speak to your doctor for further testing:
Fatigue
The most common symptom of iron deficiency is fatigue. When anemia develops, the body won’t make properly formed red blood cells. These cells cannot carry oxygen to the body, making you feel exhausted even when you sleep enough (3).
Frequent Illness
A poorly functioning immune system may be a sign of iron deficiency. The immune system needs iron to fight off infections.
Pale Skin
Healthy hemoglobin, red in color, gives the skin a healthy, rosy glow. When the body lacks hemoglobin, skin looks pale, particularly around the eyes, lips and gums (4).
Frequent Headaches or Migraines
Anemia has been linked to more frequent headaches, particularly around the time of a woman’s menstrual cycle. The headache, frequently accompanied by dizziness or lightheadedness, (5) is caused by lack of oxygen reaching the brain due to low hemoglobin and deficient iron.
Inability to Concentrate and Poor Memory
If the brain cannot get enough oxygen due to iron deficiency, memory and concentration suffer. Your brain needs oxygen to function correctly!
Always Feeling Cold
When iron levels are low, the body spares oxygen, prioritizing it for the most important organs. The hands and feet get the shaft on this one (which may explain those tingly cold extremities!). People with anemia feel cold in the hands and feet, or, just cold all the time.
When the body is deficient in iron, it uses the oxygen it has to keep more important organs functioning. This means it slows the oxygen normally used to keep hair and nails healthy because they’re less important. When hair and nails don’t have enough oxygen, they dry out and crack. If the iron deficiency becomes severe, hair falls out and nails may become spoon-shaped and brittle (6).
Soreness and Swelling of the Tongue
One sign of severe anemia is a swollen, painful, pale, or smooth tongue. This is caused by low levels of hemoglobin and myoglobin, making the tongue lose its color and shape (7). The tongue can look shiny or be abnormally smooth.
A Craving for Non-Food Items
Extreme deficiency can cause cravings for non-food items like chalk, clay, dirt, or paper. This condition is called “pica” and commonly occurs in pregnant women with iron deficiency (8).
Shortness of Breath
If your body does not have enough hemoglobin to carry oxygen, anemia can lead to shortness of breath. You may get out of breath easily by just walking. The shortness of breath is the body’s way to get more oxygen. If you feel breathless with just a little bit of physical activity, speak to your doctor about your symptoms right away (9).
Iron deficiency impacts how you feel significantly, and in many different ways. However, many of these symptoms present with other vitamin deficiencies. Therefore, if you experience symptoms mentioned here, ask for a blood test to give you a specific diagnosis.
How Much Iron Do I Need?
Iron needs depend on age and gender. People who follow plant-based diets may need more iron than the following recommendations because iron isn’t as readily absorbed from plant sources (10).
Iron recommendations for adults:
Men (ages 19-50): 8 mg/day
Women (ages 19-50): 18 mg/day
Adults over age 51: 8 mg/day
Pregnant women: 27 mg/day
Breastfeeding women: 9 mg/day
Men need significantly less iron than women, and the needs of women drop after menopause to match that of men. Women of childbearing age are most at risk for iron deficiency due to monthly blood losses. Even with an increased need, most people eating a varied diet meet their daily iron needs without significant effort. But, if you experience any type of blood loss (such as heavy periods) or become pregnant, you may need to increase your intake. So if you do have a deficiency, what do you do?
Treating Iron Deficiency
The only way to know if you truly have an iron deficiency is with a blood test. A few common tests used to diagnose anemia include (11):
– Complete Blood Count (CBC): test used to evaluate the amount of hemoglobin in your blood, and the number and size of your red blood cells. This is the most common test used.
– Blood iron level and serum ferritin: evaluates the amount of iron stores in your body.
– Levels of vitamin B12 and other vitamins: doctors run these tests to rule out other types of anemia not related to iron, since many of the symptoms overlap.
Even if you decide to not get tested for iron deficiency, it doesn’t hurt to eat high iron foods to see if it makes you feel better. On the other hand, you don’t want to take iron supplements without a doctor’s recommendation.
If you want to try eating more iron, try a variety of foods containing it. The type of food impacts iron absorption. There are two kinds of iron: heme and non-heme. Heme iron (better absorbed) comes from animal foods. Animal foods contain a special protein that helps with iron absorption.
Sources of Heme Iron Include:
– Liver and organ meats
– Oysters
– Beef
– Chicken
– Turkey
Non-heme iron, found in plant foods and iron-fortified products, is not well absorbed, meaning you must eat more of them to meet daily needs. In addition, many plants contain certain types of fiber that bind to iron, preventing it from absorbing effectively.
Plant-based sources of non-heme iron include:
– Spinach
– Cashews
– Broccoli
– Dark chocolate
– Tofu
– Beans and legumes
– Iron-fortified cereals and grains
A healthy diet includes a variety of heme and non-heme sources of iron.
Foods containing vitamin C help iron absorption. Foods high in vitamin C include: strawberries, peppers, citrus fruit and tomatoes. An example of an iron boosting meal would be a steak salad over spinach with tomatoes. This provides a source of heme and non-heme iron as well as vitamin C (and tastes dang delicious!).
Foods that Block
Several foods prevent the absorption of iron: coffee, tea, whole grains and high calcium foods like milk top the list. You don’t need to avoid these foods completely to get your iron levels up, but avoid consuming them with high iron food or your iron supplement. So with your spinach salad, drink water instead of coffee or milk.
Best Practices
Without an official diagnosis of anemia, don’t take iron supplements unless recommended by a doctor. Iron supplements can cause stomach discomfort, such as nausea and constipation. Too much iron also interferes with zinc absorption, another important mineral for your health.
If your doctor recommends an iron supplement, they come in many different forms: ferrous sulfate, ferrous gluconate, ferric citrate and ferric sulfate. Each of these supplements contain different amounts of iron. Your doctor should tell you which supplement to look for and how much to take. The amount you need depends on your blood test results and the specific cause of the anemia. Unless you have an underlying medical condition or follow a very restrictive diet, iron supplementation is usually not needed long-term.
Some multivitamins do contain a bit of iron. Taking a multi that has a bit of iron is fine for women between 19-50 years old, but should be avoided for men.
Iron deficiencies can make you feel unmotivated and lethargic. If you feel bit lethargic lately, try eating a few high iron foods to see if things improve. There’s really no downside, because many of these foods not only contain a lot of iron, but they’re full of nutrients and minerals. Women under 50, vegans and pregnant women need to pay close attention to their daily needs. When in doubt, become your own detective (something we teach in the 131 Method).
References
- https://ods.od.nih.gov/factsheets/Iron-Consumer/
- https://www.ncbi.nlm.nih.gov/pubmed/25946282
- https://www.ncbi.nlm.nih.gov/pubmed/24814598
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1497067/
- https://www.ncbi.nlm.nih.gov/pubmed/21830449
- https://www.ncbi.nlm.nih.gov/pubmed/10565636
- https://www.ncbi.nlm.nih.gov/pubmed/24388269
- https://www.ncbi.nlm.nih.gov/pubmed/2106702
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3999603/
- https://academic.oup.com/ajcn/article/78/3/633S/4690005
- https://www.webmd.com/a-to-z-guides/understanding-anemia-treatment#1
