Man experiencing fatigue from iron deficiency falling asleep at desk

8 Common Signs of an Iron Deficiency

Medically reviewed on June 27, 2022 by Jordan Stachel, M.S., RDN, CPT. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

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Iron is one of the most important minerals in the body. It is necessary to produce hemoglobin, the protein found in red blood cells that transports oxygen throughout the body. While most people get enough iron through diet, certain underlying health problems and other lifestyle factors can keep you from properly absorbing enough of this nutrient, leading to iron deficiency [1].

Without enough iron in the system, red blood cells can’t make hemoglobin, resulting in a wide range of health problems. A lack of healthy red blood cells is known as “anemia,” which comes in various forms [2]. Knowing if you have iron deficiency anemia can help you take the right steps to replenish iron stores.

Iron deficiency won’t always show signs or symptoms in its early stages, or the symptoms can be so mild that you may not even notice them. However, as iron stores deplete, the signs and symptoms become more severe and hard to ignore [2]. This article will tell you how to know if you have an iron deficiency.

What are the signs of low iron levels?

Extreme Fatigue

Are you tired all the time? It’s not uncommon for anyone to feel tired every so often. Whether you had a bad night of sleep or went particularly hard during a workout, you can feel tired for just about any reason. However, if you’re experiencing persistent and unusual tiredness, you may have an iron deficiency regardless of your sleep time or activity level.

Remember, red blood cells need iron to create hemoglobin and transport oxygen throughout the body. Less hemoglobin in the blood means less oxygen in tissues and muscles, which deprives them of energy, making you feel tired. As you perform everyday activities, your iron stores get even further depleted. Your heart also must work harder to pump the few oxygen-rich cells that you do have throughout the body, which makes you even more tired [3].

Pale Complexion

Along with carrying oxygen, hemoglobin is what gives red blood cells their rich, red color. That redness is also what gives the skin its characteristic healthy glow. Less iron and hemoglobin can make blood less red. That can also cause the skin to look much paler in people who suffer from low iron levels [3].

That pallor can spread beyond just the skin. The gums, lips, nails, and lower eyelids can also become pale. The paleness can affect the whole body, or it can be isolated to one area. For people with darker complexions, the paleness may only be noticeable in the inside layer of the lower eyelid, which should normally be a vibrant red [3].

Feeling Cold

While everyone has their own personal temperature threshold, iron deficiency can cause the hands and feet to feel persistently cold, regardless of the weather or internal temperature. The blood transfers warmth and heat throughout the body and is one of the components for regulating internal temperature [4].

Iron deficiency anemia leaves fewer healthy red blood cells, which contributes to poor circulation. To adjust, the body may focus more of the existing healthy red blood cells to the core. This can leave your fingers and toes cold [5].

Shortness of breath

With less hemoglobin in the blood, you naturally end up with less oxygen circulating in the body. The lungs and muscles have less oxygen to work with, making even walking feel extremely difficult. As the body tries to refuel with more oxygen, you may experience shortness of breath more often. Breathing rate, in general, may increase, and simple tasks like washing the dishes or putting on clothes may leave you out of breath [3].

Damaged Hair and Skin

A lack of oxygen naturally means fewer nutrients reaching all the cells of the body, including the skin and hair. Without oxygen, the skin and hair can become dry and damaged [3].

Iron deficiency may also be responsible for hair loss in some people. This is particularly common in women, but it can potentially occur in all genders. Without iron, the body has a harder time getting oxygen to the cells responsible for stimulating hair growth in your follicles. Over time, hair may look less lush before eventually thinning and falling out. As iron stores get depleted, you may notice more of your scalp when your hair is wet. The process can look a lot like hormonal hair loss (better known as male or female pattern baldness) [6].

Craving Ice

One of the stranger symptoms of iron deficiency is a craving for ice. Medically known as “pagophagia,” this may result in you wanting to constantly chew ice cubes or ice chips. This is a form of pica, an eating disorder that broadly refers to wanting to chew or eat things that don’t have any intrinsic nutritional value.7 In less common forms of pica, iron deficiency may cause people to crave dirt or starch [5].

While there’s nothing inherently wrong with chewing ice (aside from potential damage to the teeth), it can point to other underlying problems even outside of iron deficiency. This can include excess stress, developmental disorders, and obsessive-compulsive disorder [7].

The exact reason why iron-deficient people crave ice still requires further research. At least one study suggests that chewing ice might increase alertness in people suffering from the general fatigue that comes with iron deficiency [7].

Restless Legs Syndrome

Restless leg syndrome, also known as “Willis-Ekborn disease,” is characterized by a constant and uncontrollable need to move the legs to dispel uncomfortable sensations in the legs. Moving the legs temporarily reduces unpleasant feelings that are commonly associated with iron deficiency. This occurs most often at night when you are sitting or lying down. The condition can get worse over time, and it can lead to sleep problems and depression [8].

The exact cause of restless legs syndrome is not well known, though some research suggests it may come from imbalances in dopamine. This neurotransmitter plays a role in controlling muscle movement [8]. However, there may be some link between restless legs syndrome and iron deficiency anemia. Studies show that about 25 percent of people with iron deficiency anemia also show symptoms of restless legs syndrome. Furthermore, restless legs syndrome is nine times more common among people with iron deficiency anemia [9].

Heart Palpitations

Heart palpitations are characterized by a fast, fluttering heartbeat that can feel like it’s noticeably pounding through the chest. Although heart palpitations are generally harmless, they can signify a more serious underlying heart condition [10].

The exact link between heart palpitations and iron deficiency still requires further study, but like with most other symptoms, it may lead to a lack of oxygen supply. Less oxygen means that the heart must beat even harder to pump the remaining oxygenated blood cells that you have. This can lead to an abnormal heartbeat or excessively fast heart rate [3].

There are a few different causes of iron deficiency. If you are experiencing any of these symptoms, it may be time to check your iron levels. Iron deficiency can be difficult to identify based on symptoms alone. If you think you might have low iron intake and/or are experiencing symptoms, be sure to talk with a healthcare provider.

What Causes Iron Deficiency?

What is Iron Deficiency Anemia?

What Does the Iron, TIBC, and Ferritin Panel test?

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1. Iron. NIH. URL. Accessed June 27, 2022.

2. Iron deficiency anemia. Symptoms and causes. Mayo Clinic. URL. Accessed June 27, 2022.

3. 14 Signs of Iron Deficiency Anemia. Healthline. URL. Accessed June 27, 2022.

4. Fasano, A., Sequeira, A. (2017). Blood and Heat Transfer. In: Hemomath. MS&A, vol 18. Springer, Cham. URL. Accessed June 27, 2022.

5. 5 symptoms of an iron deficiency. Piedmont. URL. Accessed June 27, 2022.

6. Iron Deficiency and Hair Loss: What You Need to Know. Hims and hers Health. URL. Accessed June 27, 2022.

7. Craving and chewing ice: A sign of anemia? Mayo Clinic. URL. Accessed June 27, 2022.

8. Restless legs syndrome. Mayo Clinic. URL. Accessed June 27, 2022.

9. Allen, Richard P et al. “The prevalence and impact of restless legs syndrome on patients with iron deficiency anemia.” American journal of hematology vol. 88,4 (2013): 261-4. URL. Accessed June 27, 2022.

10. Heart palpitations. Mayo Clinic. URL. Accessed June 27, 2022.

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