Do you often feel tired, even after getting a full night's sleep? Or perhaps you have noticed increased hair fall, brittle nails, frequent headaches or breathlessness during activities that never used to feel exhausting.
It is easy to dismiss these changes as stress, a hectic routine or simply not getting enough rest. But sometimes, they could be your body's way of signalling something else: iron deficiency.
Iron deficiency is one of the most common nutritional deficiencies worldwide. And here's something worth knowing: you can have low iron stores before developing iron-deficiency anaemia, which means the early signs may be easy to overlook. [NIH] [NIH]
So, let's understand what happens when your body does not get enough iron, the early symptoms to look out for, what causes iron deficiency and how to improve your iron levels.
What is iron deficiency, and why does your body need iron?
Iron is an essential mineral that helps your body produce haemoglobin, a protein in red blood cells that carries oxygen from your lungs to the rest of your body.
It also plays an important role in energy production, immune function and normal cognitive performance.
When your iron intake is inadequate, your body initially uses its stored iron to maintain normal functions. As these stores become depleted, haemoglobin production can eventually decline, resulting in iron-deficiency anaemia. [NIH] [NIH]
This distinction matters:
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Iron deficiency: Your body's iron stores are low, even if haemoglobin levels are still normal.
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Iron-deficiency anaemia: Iron deficiency has progressed to the point where your body cannot produce enough healthy haemoglobin to meet its oxygen-carrying needs. [NIH]
In other words, you do not necessarily have to be anaemic to experience symptoms of low iron.
7 early signs and symptoms of iron deficiency
Iron deficiency does not always announce itself dramatically. Sometimes, the symptoms are subtle enough to blend into your everyday routine.
Here are seven signs worth paying attention to.
1. Persistent fatigue and low energy
Feeling tired occasionally is normal. But if you constantly feel exhausted despite adequate sleep, low iron could be one possible explanation.
Iron helps haemoglobin transport oxygen to your tissues. When iron deficiency progresses, reduced oxygen delivery can contribute to fatigue, weakness and reduced physical endurance. [NIH]
2. Increased hair fall
Noticing more hair strands on your pillow, shower drain or hairbrush?
Iron plays a role in normal cellular growth and development, including the hair follicle cycle. Low iron stores have been associated with hair loss, particularly in some people experiencing diffuse hair shedding.
However, hair fall has several possible causes, including hormonal changes, thyroid conditions and nutritional deficiencies. Low ferritin alone does not establish the cause. [NIH] [NIH]
3. Brittle or spoon-shaped nails
Your nails can sometimes reveal nutritional problems.
Iron deficiency may cause brittle nails that break easily. In more pronounced cases, it can lead to koilonychia, a condition where nails become thin and concave, developing a spoon-like appearance.
This is not usually an early or common sign, but it is worth investigating when it occurs alongside other symptoms. [NIH]
4. Frequent headaches and difficulty concentrating
Do you find yourself struggling to focus or experiencing recurring headaches?
Iron deficiency anaemia can affect oxygen delivery to the brain and is associated with headaches, dizziness and difficulty concentrating.
These symptoms are non-specific, though, and can also be linked to dehydration, sleep disturbances and several other conditions. [NIH] [NIH]
5. Breathlessness during everyday activities
If climbing stairs or walking at your usual pace suddenly leaves you breathless, pay attention.
When haemoglobin levels fall, your blood carries less oxygen. Your heart and lungs may have to work harder to compensate, causing breathlessness, particularly during physical activity.
Sudden or severe breathlessness requires prompt medical attention. [NIH] [NIH]
6. Unusual cravings for non-food items
This is one of the more unusual signs of iron deficiency.
Some people develop pica, a condition characterised by cravings for substances that are not food, such as ice, soil, clay or chalk.
A particularly recognised form is pagophagia, which involves repeatedly craving or chewing ice. Pica can occur with iron deficiency, sometimes even before anaemia becomes apparent. [NIH]
7. Restless legs and unusual sensations
Do your legs feel uncomfortable, especially when you are trying to sleep or sit still?
Iron deficiency is associated with restless legs syndrome, which can cause an uncomfortable urge to move the legs, often accompanied by crawling, tingling or pulling sensations.
Iron levels in the brain may influence dopamine-related pathways involved in movement. However, restless legs can have other causes too. [NIH] [NIH]
What causes iron deficiency?
Recognising the symptoms is one part of the picture. Understanding why your iron levels are dropping is equally important.
Here are some common iron deficiency causes:
|
Cause |
How it contributes to iron deficiency |
|
Inadequate dietary iron |
Not consuming enough iron-rich foods can gradually deplete iron stores. |
|
Heavy menstrual bleeding |
Regular blood loss increases the amount of iron your body needs to replace. |
|
Pregnancy |
Iron requirements increase to support maternal blood volume and foetal development. |
|
Poor iron absorption |
Conditions such as coeliac disease and certain gastrointestinal disorders can interfere with iron absorption. |
|
Blood loss |
Gastrointestinal bleeding, ulcers and other sources of blood loss can reduce iron levels. |
|
Increased requirements |
Growth during childhood and adolescence can increase the body's iron needs. |
It is important not to assume that low iron is always caused by an inadequate diet. In adults, particularly men and postmenopausal women, unexplained iron deficiency may require investigation for gastrointestinal blood loss. [NIH] [NIH]
How to check iron deficiency: Which blood tests should you take?
If you recognise some of these symptoms, the next step is not to start taking iron supplements immediately. It is to understand whether your iron levels are actually low.
A few blood tests can help establish this:
|
Blood test |
What it tells you |
|
Complete Blood Count (CBC) |
Measures haemoglobin, red blood cell count and other blood parameters. |
|
Serum Ferritin |
Measures stored iron and can identify depleted iron stores before anaemia develops. |
|
Serum Iron |
Measures the amount of circulating iron in your blood. |
|
Total Iron Binding Capacity (TIBC) |
Helps assess how much iron your blood can transport. |
|
Transferrin Saturation |
Indicates the proportion of iron-binding sites occupied by iron. |
One important distinction: A normal haemoglobin result does not necessarily mean your iron stores are adequate. Ferritin can become low before haemoglobin levels fall. Ferritin can also appear elevated during inflammation, so results need to be interpreted in context. [NIH] [NIH]
How to improve iron deficiency naturally
If your iron stores are low, improving your dietary intake is a good starting point. Here are some practical ways to make your meals more iron-conscious.
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Include iron-rich foods: Add rajma, chana, lentils, pumpkin seeds, sesame seeds and leafy greens to your meals.
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Pair iron with vitamin C: Combine dal with lemon, have guava after meals or add capsicum to your salads. Vitamin C improves non-haem iron absorption.
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Be mindful of tea and coffee: Their polyphenols can interfere with iron absorption. Avoid having them alongside iron-rich meals.
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Include haem iron sources: If you consume animal foods, meat, fish and poultry provide haem iron, which is generally more readily absorbed than plant-based iron.
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Prioritise dietary variety: Eating a combination of iron-containing foods regularly is more useful than relying on a single food source. [NIH]
Can iron supplements help overcome iron deficiency?
If dietary changes alone are not enough to replenish iron stores, supplementation may be recommended based on your iron levels and underlying cause. PubMed | PubMed
Two options to consider:
1. Liposomal iron supplements: Use a lipid-based delivery system to encapsulate iron, potentially improving iron delivery and gastrointestinal tolerability. Evidence varies across formulations.
2. Iron melts: Offer a convenient, portable format for on-the-go supplementation. Their effectiveness depends on the elemental iron content and formulation.
A note on supplementation: Choose an iron supplement based on its elemental iron dosage and your individual requirements. Consult a healthcare professional before starting supplementation, and monitor your iron levels through follow-up blood tests.
The bottom line
Iron deficiency can develop gradually, and its early symptoms are often mistaken for everyday fatigue or stress. Pay attention to persistent changes, get the right blood tests and address the underlying cause rather than relying on symptoms alone.
Key takeaways
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Iron deficiency can occur even when haemoglobin levels are normal.
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Persistent fatigue, hair fall, brittle nails and difficulty concentrating can be possible signs of low iron.
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Heavy menstrual bleeding, inadequate dietary intake, pregnancy and poor iron absorption are common causes.
-
A CBC and serum ferritin test can help identify iron deficiency and iron-deficiency anaemia.
-
Iron-rich foods, vitamin C pairings and appropriate supplementation can help restore iron levels.
FAQs
1. What are the first signs of iron deficiency?
Persistent fatigue, reduced energy, difficulty concentrating, headaches and reduced exercise tolerance can be early symptoms. Some people have no noticeable symptoms initially.
2. What are the 5 weird signs of iron deficiency?
Some less commonly recognised signs include craving ice (pagophagia), restless legs, spoon-shaped nails, a sore tongue and unusual food cravings or pica.
3. Can you have iron deficiency without anaemia?
Yes. Iron stores can become depleted before haemoglobin levels fall. This is known as iron deficiency without anaemia.
4. Does iron deficiency cause hair fall?
Low iron stores have been associated with diffuse hair shedding in some individuals. However, hair loss can have several other causes, so testing and clinical assessment are important.
5. What causes iron deficiency in women?
Heavy menstrual bleeding, pregnancy, inadequate dietary iron intake and conditions affecting iron absorption are common causes.
6. How do you check iron deficiency in a blood test?
A CBC and serum ferritin test are commonly used. Additional tests, such as serum iron, TIBC and transferrin saturation, may help establish the diagnosis.
7. What is the difference between iron deficiency and iron-deficiency anaemia?
Iron deficiency means your body's iron stores are low. Iron-deficiency anaemia occurs when the deficiency becomes severe enough to reduce haemoglobin production.
8. How can I improve iron deficiency through food?
Include lentils, beans, leafy greens, seeds and other iron-rich foods. Pair plant-based iron sources with vitamin C-rich foods to improve absorption.
9. Are liposomal iron supplements effective?
Liposomal iron formulations are designed to improve iron delivery and may offer better gastrointestinal tolerability in some people. Their effectiveness depends on the formulation and individual response.
10. Are iron melts a good alternative to iron tablets?
Iron melts offer a convenient alternative for people who prefer a portable supplement format. However, their suitability depends on the elemental iron dose, formulation and individual iron requirements.
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