You might be more tired than usual and needing extra sleep.
Sometimes, an hour or so after lunch, fatigue sets in and hangs on, leading you to another cup of coffee or a sweet treat to perk you up.
One reason you feel exhausted often could be because you’re low on iron. It’s a very common condition.
Who’s at highest risk of an iron deficiency
Those most often low in iron are:
- People who are menstruating: Losing blood every month can take a toll if you’re not eating enough iron-rich foods to replenish your iron supply, especially if you have heavier periods.
- Older adults: When you’re older, you can sometimes lose small amounts of blood from your stomach or intestines. Aspirin, blood thinners and more fragile tissue in your digestive tract can all add to your risk of bleeding. And you might not notice it for a while.
One in three women of reproductive age are iron-deficient, according to the American Society of Hematology.
Among older adults, the rate is between 1 in 10 and 1 in 20 people.
Men ages 18 to 65 are the least likely to be low on iron – closer to 1 in 30.
At any age, not having enough iron can affect not only your energy level, but also your mood and how easily you can concentrate and sleep.
Signs of being low in iron
- Cravings for items that aren’t food, most often ice
- Problems with focus and memory
- Brittle nails
- Hair loss
- Restless legs syndrome or a worsening of the syndrome
- Pale skin
Iron deficiency versus anemia
It’s possible to be iron-deficient and not have anemia, which is a more severe condition when your blood lacks enough healthy red blood cells or hemoglobin. Hemoglobin is a protein in your red blood cells that carries oxygen from your lungs to various parts of your body.
Your body will try to save iron for making red blood cells and hemoglobin because that’s essential for delivering oxygen. So, your body depletes stored iron before it draws from the iron used to make red blood cells.
As a result, your body’s iron stores could be low without it affecting your red blood cells and their ability to carry oxygen.
An iron deficiency is three times more common than anemia.
Causes of an iron deficiency
Iron deficiency causes can include:
- Heavy menstrual bleeding
- Gastrointestinal bleeding especially in older adults; it may be too slight to notice
- Chronic use of aspirin and blood thinners
- Problems in the digestive tract, including fragile or abnormal blood vessels in the intestines
- Colon cancer that causes bleeding
- Poor iron absorption, including after bariatric surgery or with uncontrolled celiac disease
- Long-term antacid use, such as omeprazole or pantoprazole, which reduces stomach acid and may decrease iron absorption
- Pregnancy (the pregnant person must supply iron to the baby)
- A vegan diet, particularly when combined with increased iron loss or needs
- Frequent intense exercise, especially long-distance running
- Bleeding disorders such as hemophilia, Von Willebrand disease and hereditary hemorrhagic telangiectasia
An iron deficiency usually has an underlying cause, and figuring it out is as important as replacing the iron.
What blood tests for iron are measuring
Ferritin: A protein that stores iron inside our cells that live in your liver, spleen and bone marrow.
What it tests: How much iron reserves are in your body. This is the best blood test to screen for an iron deficiency.
Complete blood count (CBC): Red and white blood cells, platelets and hemoglobin.
What it tests: Whether an iron deficiency has progressed to anemia. An iron deficiency can also cause a rise in platelet count.
Serum iron: The amount of iron circulating in the blood at the moment it’s tested.
What it tests: The serum iron level is a snapshot of your iron level and represents less than 1% of your body’s iron. It will go up if you’ve just eaten food high in iron, such as a hamburger.
Transferrin saturation (TSAT): The percentage of transferrin that’s loaded with iron. Transferrin is the protein that transports iron in your blood. The protein is like a shuttle that carries iron between your gut and your bone marrow and the tissues in general.
What it tests: A TSAT shows how much iron is available for your body to use.
Total iron-binding capacity (TIBC): The blood’s capacity to bind and transport iron.
What it tests: This measures how hungry your body is for iron. If your body is low in iron, this number will often go up.
Types and sources of iron
- Heme iron comes from meat and seafood, such as tuna or salmon. Heme iron is more easily absorbed by the body than non-heme iron.
- Non-heme iron comes from plant-based sources such as beans, pumpkin seeds, almonds.
Are iron supplements enough to address low iron?
For most people, oral iron supplements are enough to give their body enough iron.
The most common daily supplement amount is 325 mg tablets of ferrous sulfate containing 65 mg of pure iron. If having that amount of iron upsets your stomach, you can instead take supplements containing lower doses of pure iron, such as 36 mg or 25 mg daily.
Sometimes just taking a supplement is not enough. Intravenous iron is given if you:
- Have a high intolerance to iron supplements.
- Are very anemic and need a large amount of iron.
- Can’t absorb the iron because of bariatric surgery or celiac disease.
How should you take an iron supplement
It’s best to take iron on an empty stomach two hours before or after you eat. If that upsets your stomach, try having the iron pill with food.
Calcium does the opposite. It blocks iron from being absorbed in the body. Because of this, try not to take your iron supplement within two hours of having any food that has calcium, such as yogurt or milk.
How long over-the-counter iron supplements take to work
It depends on the rate that you’re losing iron. A lot of people will see some improvement in their symptoms and the amount of hemoglobin in their red blood cells within four weeks of starting an iron supplement. Fully replenishing your body’s iron supply will take three to six months.
Our bodies are built to keep all the iron we get from the food eat. If you become iron-deficient, it means something isn’t right. Reach out to your healthcare provider to find out why. The solution may be as easy as changing your diet to include more iron-rich foods and taking an iron supplement.
