Iron deficiency is not uncommon, but can be difficult to identify. Here are some sneaky iron deficiency anemia symptoms to look out for.

Iron deficiency anemia is—surprisingly—not uncommon. Female Americans are consuming nearly 10% less iron and males are consuming about 7% less compared to two decades ago. According to a 2021 study published in The Journal of Nutrition , this drop is leading to an alarming rise in deficiencies. Why? The researchers say it may stem from an effort to eat healthier. The study found that the intake of red meat dropped while leaner proteins, like chicken, increased which are lower in iron. They also point out that many typically iron-rich foods, such as beef, beans and apricots, contain less due to modern farming practices that have decreased levels of iron in the soil.

Those most at risk for iron deficiency anemia (IDA) are people whose iron requirements are the highest, says Laurie Tansman, M.S., RD, CDN, a clinical nutritionist at Mount Sinai Hospital in New York City. According to the National Institutes of Health , premenopausal women need more than twice as much iron as men due to blood loss from menstruation. And pregnant women need over 50% more iron than usual to accommodate the developing baby's needs. Vegans and vegetarians also have a greater risk of IDA because plants contain mostly non-heme iron, which is not as readily absorbed as the type found in meat.

The thing about iron deficiency is that it isn't the easiest to identify. The symptoms can come on slowly as your iron levels begin (and continue) to dip—especially as you move from mildly deficient to marginally deficient to iron-deficiency anemia , which is the most severe.

"I have seen people have iron-deficiency anemia for years before it starts to inhibit their day-to-day life," says Thomas DeLoughery, MD, MACP, FAWM, professor of medicine, pathology and pediatrics at Oregon Health and Science University.

Read the list of sneaky signs below, and you'll realize it's easy to blame the symptoms on something else (for example: "I'm cold-blooded" or "I have small children, of course I'm tired all the time"). Here's what to look for if you think you might have iron deficiency—plus, what to do about it and the best diet choices for anemia.

1. You're tired all the time.

Fatigue is one of the most common symptoms of iron deficiency and can appear with even a mild dip in iron stores. Unfortunately, pinpointing low iron as the culprit if you're tired is difficult since that feeling could be due to a multitude of reasons. According to a 2021 review , the most common causes of persistent fatigue are sleep disorders and sleep-related disorders of breathing, depression and excessive stress.

Still, if your level of exhaustion has changed recently, or it's accompanied by one of these other symptoms, your iron levels could be low and worth getting checked.

2. You're cold, even when others aren't.

If you find that your hands and feet are constantly cold, you may be dealing with low iron. One possible explanation is that your thyroid needs iron to function , so a lack of iron hinders thyroid efficiency, and thyroid hormones help regulate your body temperature.

3. You're easily short of breath.

If you struggle to catch your breath, despite keeping up with regular workouts , it could be that you're low in iron. Iron helps to shuttle oxygen throughout your body and without enough of it, it's harder for your body to keep up with your cardio routine.

4. Your irritability or anxiousness has ramped up.

Being more "sensitive" to annoyances is a symptom you may see listed with iron deficiency. While additional research is needed, a 2020 study on adolescents with iron deficiency or iron deficiency anemia found that they dealt with greater irritability compared to their healthy peers.

5. Your hair is thinning or noticeably more brittle.

Our hair is constantly going through a growth cycle, and shedding hair is a normal part of that process. If you're losing about 50 to 100 hairs per day, you're in the clear, but anything beyond that may be a red flag for low iron.

According to a 2019 review , iron and other nutrients play an important yet unclear role in normal hair development. Most women with hair loss are also iron deficient, and many studies have linked low levels of iron with hair loss conditions such as alopecia.

6. You're depressed.

Iron has a role in making dopamine—a chemical that sends signals from your body to your brain. In depression , dopamine levels are low. A 2018 study on older adults found that those with depressive symptoms were more likely to have anemia than those without depression.

woman laying in bed looking exhaustedd
Credit: Getty / Martin Dimitrov

7. You have celiac disease or IBD.

Both celiac disease and IBD can hinder nutrient absorption and specifically, how much iron is absorbed from food in your small intestine. These conditions are considered inflammatory, and chronic inflammation encourages the overproduction of a compound called hepcidin . At "healthy" levels, hepcidin helps your body maintain a just-right level of iron. But too much hepcidin can lead to iron deficiency. So if you have an inflammatory bowel condition, you may want to talk to your doctor about your iron levels.

What to Do if You Have Iron Deficiency Anemia

If you think you could be iron deficient, the good news is it's relatively easy to test via a simple blood test administered by your doctor. If the test indicates you do have low iron, it's important to work with a medical professional to find out why you are iron deficient, create a course of treatment to remedy the deficiency and also be mindful of other conditions you may have. Plus, there are plenty of diet choices that can help manage anemia. Here are a few tips for those looking to boost their iron intake.

Pour a Bowl of Cereal

"I routinely recommend fortified breakfast cereals for patients who have IDA," says Tansman. Read the label to see how much iron your pick provides. "And if you're eating it with milk, drink the milk at the end," she adds. The added vitamins and minerals are sprayed on top of the cereal and can wash off into the liquid.

Pair Plants Smartly

Consuming vitamin C along with iron-rich plant foods aids in the absorption of the mineral—and that can be particularly helpful for vegans and vegetarians. So top a spinach salad with vitamin C-rich tomatoes or strawberries or toss bell peppers into a warm lentil salad .

Consider a Supplement

If your diet isn't enough to get your levels up, you might want to take an iron supplement—but get your health care provider's OK first. "People often try to self-treat when they suspect they have anemia and end up doing 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 be constipating, so you'll want to work with your doctor to counteract that side effect.