The 14 Signs of Iron Deficiency
Source: National Institute of Health and Care Excellence
Most people with an iron deficiency have 3 or more of these symptoms:
Panting, being breathless and feeling exhausted
This is the most common symptom that affects everyone with an iron deficiency, whether or not they have anaemia. You will get out of breath after the slightest physical exertion, including things like walking upstairs. You may even feel out of breath just from having an animated conversation!
Frequent headaches
The causes of headaches are countless, but iron deficiency can be one cause of this debilitating problem.
Restless leg syndrome
This uncontrollable need to keep fidgeting with your legs, even when you need to get to sleep, has various causes which include iron deficiency. (It can also be caused by a magnesium deficiency.)
Constant itching with no skin rash
The misery of relentless tingling and itching, which moves around the body, can reach the point where it never stops and is a major clause of sleep loss for some people with iron deficiency. Iron deficiency itching is worst on the legs and torso and may cause a frequent need to have your back scratched.
It becomes difficult to swallow food
You may choke when trying to swallow down food you’ve chewed, or you may even get it down but then it’s suddenly back in your mouth again, or even shooting out of your nose.
You suddenly hate red meat
Nobody knows why this happens to so many people with iron deficiency anaemia, but even people who used to love a slab of steak can unexpectedly find it nauseating if they develop an iron deficiency.
Constantly wanting to chew ice cubes
Medically, wanting to eat things that aren’t food is called pica and it’s often a sign of a nutritional deficiency. A few people with iron deficiency develop pica so bad that they want to eat mud, but chomping on ice cubes and risking broken teeth is surprisingly common in people with an iron deficiency.
Brain fog and difficulty concentrating
The lack of enough oxygen supply to the brain as a result of iron deficiency anaemia may mean you start finding things difficult when they used to be easy. You may notice the change in anything from suddenly dreading driving on motorways, to constantly postponing tasks that take a little concentration. Or you may simply find aspects of your job challenging when you used to find them easy. In elderly people, this symptom looks just like senile dementia and it's the reason anaemia is frequently overlooked in the elderly.
You tend to go dizzy
This is especially likely when you stand up suddenly, or while exercising. You may feel thumping heart palpitations and you may faint. This is connected with what doctors call “haemodynamic instability” which means your blood pressure and heart rate don’t react properly to what you’re doing. They should both go up when you’re exercising and go down when you’re sitting still, but with an iron deficiency they can go haywire.
Food starts losing its taste and may taste metallic
You will still be able to taste sugar, salt and a bitter taste, but you will often have a metallic taste in your mouth. You’re likely to go off foods you used to love because of this metallic taste. (This symptom can also be caused by a deficiency in zinc, vitamin B12 and a few other nutrients.)
Being irritable
A lot of people with iron deficiency generally feel as if people keep doing things just for the purpose of annoying them! You may be apathetic and resent being asked to do anything - which is hardly surprising since you are unwell and chronically exhausted.
Sore tongue and mouth
This will make your mouth feel generally tender inside and, if it’s severe, you can also start getting little cuts at the corners of your mouth that sting if you eat acidic foods like lemon or vinegar.
Ringing in the ears
Tinnitus from iron deficiency usually sounds like one continuous, high-pitched beep.
The hair, skin and nails disaster
You may get dry skin, dry and thinning hair or even start balding. Your fingernails may also start growing with ridges in them, or grow curving downwards over your fingertips.
Fact box: What's the difference between iron deficiency and anaemia?
Iron deficiency and anaemia are not the same thing. Iron deficiency may or may not lead to anaemia. It's actually possible to have a severe iron deficiency yet not be anaemic.
Anaemia means the blood can't carry as much oxygen as normal. This may be caused by having a low number of red blood cells, not enough haemoglobin inside the blood cells, or abnormally small, large or deformed blood cells. Anaemia has various causes including deficiencies in iron or vitamin B12, genetic diseases and some medicines.
Iron deficiency specifically means a lack of iron in the body, which is needed for making haemoglobin. It may or may not lead to anaemia.
What to Do if You Suspect You Have an Iron Deficiency
If you feel physically tired most of the time and have more than three other symptoms on this list, you should discuss the possibility of iron deficiency with your GP. If he or she thinks iron deficiency sounds possible, they will order a blood test.
Blood tests to check for iron deficiency and anaemia
- Complete Blood Count (CBC): Evaluates red blood cells (RBCs), hemoglobin, hematocrit, and mean corpuscular volume (MCV). Low hemoglobin or hematocrit levels indicate anaemia, while abnormally small red blood cells (low MCV) suggest iron deficiency.
- Serum Ferritin: Measures stored iron levels in the body. Low ferritin is a key indicator of iron deficiency.
- Serum Iron: Assesses the amount of iron in the bloodstream. Low levels suggest iron deficiency.
- Total Iron-Binding Capacity (TIBC): Measures how much transferrin (a protein that carries iron) is available. High TIBC often indicates iron deficiency.
- Transferrin Saturation: Calculates the percentage of transferrin carrying iron. Low levels suggest iron deficiency.
- Reticulocyte Count: Measures immature red blood cells. A low count may indicate insufficient production of RBCs due to iron deficiency.
Finding the cause
If an iron deficiency is confirmed, it’s important to find out what is causing it. One common cause is heavy periods in women (called dysmenorrhea) which is especially common around menopause. The most serious cause is undetected constant bleeding from the intestine, which can be an early warning sign of bowel cancer. It’s vital to have further tests to check for this - it may be caused by other bowel conditions which are less serious but still need to be diagnosed and treated.
Treating the iron deficiency
If you do turn out to have an iron deficiency or anaemia, you will need to be treated with high-dose iron supplements for several months to make a difference.
- The NHS prescribes a dose of 200 mg of iron sulphate a day, which delivers 65mg of elemental iron.
Iron supplements sold in shops and online contain 14mg of elemental iron, often in the form of iron bisglycinate. This is the dose that is safe to take every day, to keep iron topped up. However the NHS prescription dosage, which is four and a half times stronger, is necessary for people with a confirmed iron deficiency.
The best form of iron supplements
Whilst iron sulphate commonly causes diarrhoea or gas, iron bisglycinate causes few to no intestinal disturbances. For this reason, some people discuss with their doctor the possibility of switching to an appropriate dose of commercial supplements. It’s essential to understand you MUST NOT take over the recommended dose of any iron supplement unless you are explicitly told to do so by your doctor.
