Iron deficiency anemia is a surprisingly widespread condition. According to a 2021 study published in The Journal of Nutrition, American women are consuming nearly 10% less iron from their diet, while males are consuming about 7% less, leading to a concerning increase in iron deficiencies. The study's authors suggest that this trend may be due to a shift towards consuming less red meat and more lean proteins, such as chicken, which are lower in iron. Additionally, they note that many foods that were traditionally rich in iron, like beef, beans, and apricots, now contain less due to modern agricultural practices that have reduced iron levels in the soil. Individuals who avoid or limit their intake of fortified grains, including bread, breakfast cereal, and pasta, which contribute to about 50% of the iron in one's diet according to the National Institutes of Health (NIH), are also at risk of missing out on this essential nutrient. Laurie Tansman, M.S., RD, CDN, a clinical nutritionist at Mount Sinai Hospital in New York City, points out that those most vulnerable to iron deficiency anemia (IDA) are individuals with the highest iron requirements. The NIH states that premenopausal women need more than double the amount of iron compared to men due to menstrual blood loss. Pregnant women require over 50% more iron to support the developing fetus. Vegans and vegetarians are also at a higher risk of IDA because plant-based foods primarily contain non-heme iron, which is less absorbable than the type found in meat. Iron deficiency can be challenging to identify as its symptoms can develop gradually as iron levels decrease, especially as one progresses from mild deficiency to marginal deficiency and eventually to iron deficiency anemia, which is the most severe form. Thomas DeLoughery, M.D., M.A.C.P., FAWM, a professor of medicine, pathology, and pediatrics at Oregon Health and Science University, notes that he has seen individuals with iron deficiency anemia for years before it begins to affect their daily lives. It's easy to mistake the symptoms for other conditions, such as saying, "I'm naturally cold" or "Of course, I'm tired all the time with small children." Below is a list of subtle signs that may indicate iron deficiency, along with what to do about it and the best dietary choices for anemia.

1. Chronic Fatigue: Fatigue is one of the most common indicators of iron deficiency and can manifest even with a slight decrease in iron reserves, as reported by the National Heart, Lung, and Blood Institute. Identifying low iron as the cause of persistent fatigue can be difficult since it could be attributed to various factors. The most common causes of ongoing fatigue include sleep disorders, depression, and excessive stress, as per a 2021 review in Deutsches Ärzteblatt International. However, if your level of exhaustion has changed recently or is accompanied by other symptoms, it may be worth checking your iron levels.

2. Persistent Coldness: If you consistently experience cold hands and feet, it could be a sign of low iron. Iron is crucial for thyroid function, as indicated by a 2022 Cureus study. An iron deficiency can impair thyroid efficiency, and thyroid hormones regulate body temperature.

3. Shortness of Breath: Difficulty catching your breath, even with regular exercise, could be a sign of low iron. Iron aids in the transportation of oxygen throughout the body, and a deficiency can make it harder for your body to keep up with your cardiovascular routine, as discussed in a 2023 Nutrients review study.

4. Increased Irritability: Being more sensitive to annoyances may be a symptom of iron deficiency. While more research is needed, studies have shown that adolescents with iron deficiency or anemia exhibit greater irritability compared to their healthy counterparts, as reported in a 2020 Journal of Pediatric Hematology/Oncology study.

5. Hair Loss or Brittleness: Hair loss is a normal part of the hair growth cycle, with a daily shedding of 50 to 100 hairs being typical, according to the American Academy of Dermatology. However, excessive hair loss may signal low iron. Some women with hair loss are also iron deficient, and numerous studies have linked low iron levels with hair loss conditions like alopecia. A 2022 review study in Skin Appendage Disorders suggests that women with hair loss may benefit from increased iron levels.

6. Depression: Iron is essential for the production of neurotransmitters such as serotonin and dopamine. Low iron levels can affect these neurotransmitter levels, impacting mood and depression/anxiety symptoms, as per a 2023 Antioxidants review study.

7. Inflammatory Conditions: Conditions like celiac disease and inflammatory bowel disease (IBD) can interfere with nutrient absorption, specifically the absorption of iron from food in the small intestine. These conditions are inflammatory, and chronic inflammation can lead to the overproduction of a compound called hepcidin. Hepcidin helps maintain iron levels in the body when at healthy levels, as reviewed in a 2021 Clinica Chimica Acta study. However, excessive hepcidin can result in iron deficiency. If you have an inflammatory bowel condition, it may be prudent to discuss your iron levels with your doctor.

Addressing Iron Deficiency Anemia: If you suspect you might be iron deficient, a simple blood test by your doctor can easily confirm this. If the test shows low iron levels, it's crucial to work with a healthcare professional to determine the cause of the deficiency and develop a treatment plan to address it, while also considering any other conditions you may have. There are numerous dietary options that can help manage anemia. Here are some tips for those looking to increase their iron intake:

Pour a Bowl of Fortified Cereal: "I often recommend fortified breakfast cereals for patients with IDA," says Tansman. Check the label to see how much iron your cereal provides. "And if you're eating it with milk, drink the milk at the end," she adds. The added vitamins and minerals may be sprayed on top of the cereal and can wash off into the liquid, allowing you to get additional nutrients from drinking your milk.

Pair Plants with Vitamin C: Consuming vitamin C alongside iron-rich plant foods can aid in the absorption of the mineral, which is especially beneficial for vegans and vegetarians. Consider topping a spinach salad with vitamin C-rich tomatoes or strawberries, or adding bell peppers to a warm lentil salad.

Consider an Iron Supplement: If your diet is insufficient to increase your iron levels, you might want to consider an iron supplement, but always consult your healthcare provider first. "People often try to self-treat when they suspect they have anemia and can end up causing more harm than good," says Tansman. "Anemia can be caused by other deficiencies, and taking iron may mask the identification of the correct cause." Iron supplements are also known to cause constipation, so it's important to work with your doctor to mitigate this side effect.