Whether you’re running around constantly for yourself and your family, expecting a new baby, or just beginning to explore means of better caring for yourself, you may be painstakingly aware of how often you find yourself tired out, short of breath, or looking pale. Are you just having an off day, or could your fatigue be the sign of something more sinister?
For many women, these signs are just part of the strain of modern life and hint at a need to slow down and prioritize self-care. That said, they can also indicate iron deficiency, a condition that tends to impact women and young children and can lead to a variety of health issues. In fact, according to the National Institutes of Health (NIH),“infants, young children, teenaged girls, pregnant women, and premenopausal women are at risk of obtaining insufficient amounts” of iron, which means whether you’re a mother or kid free and loving it, knowing the signs of iron deficiency is critical.
It can be hard to keep track of all the nutrients and vitamins that we’re supposed to eat daily to keep our bodies running at optimum health, but being aware of whether or not you’re getting enough iron in your diet is especially important because the nutrient is critical for producing blood—which is literally your life force. Being iron deficient will leave you feeling zapped, tired, and sometimes even sick.
Luckily, once you know what to look for, it’s easy to tell whether you might be iron deficient and to take steps to ensure that you—and your children, if you have any littles—are getting enough iron to stay healthy. Here’s everything you need to know about iron’s role in your body, where the nutrient comes from, and how to make sure you are getting enough.
What is iron (and what does it do for the body)?
According to the NIH, iron is a mineral that is critical for bodily functions including making blood, maintaining a healthy metabolism, and supporting healthy growth. Iron’s most important function in the body is supporting the production of hemoglobin, a protein found in your blood that helps transfer oxygen from the lungs to your tissues.
Because your body cannot make iron itself, it is critical to get your recommended daily intake of iron from the foods you eat.
“Iron helps produce hemoglobin, which is the part of the red blood cell that transports oxygen to our brain, heart, muscle, and all tissues within the body,” explains Ehsan Ali, MD, a primary care physician in Beverly Hills. “With a low iron level, the body won’t have enough hemoglobin, which means oxygen is not being delivered to our cells properly. Having iron levels that are too low can be very dangerous.”
If you don’t have enough iron, your body can have a hard time producing hemoglobin. This means that oxygen will not circulate throughout your body as it should, which can leave you feeling tired and run-down.
“Low levels of oxygen can lead to symptoms such as fatigue, heavy periods, pale complexion, shortness of breath, problems regulating body temperature, headaches, pica, anxiety, brain fog, hair loss, and hypothyroidism,” says Rebecca Lee, a registered nurse from New York City.
Iron is important for more than just blood flow, however.
“Iron also helps convert blood sugar into energy, protects the immune system, and maintains normal cognitive function in children,” Lee explains.
How does iron function in the body (and what does being a woman have to do with it)?
For your body to stay healthy, you need to have adequate iron stores. Most of the iron in your body (about 70 percent of it) is stored in your blood and muscles according to a resource hosted by the University of California San Francisco Medical Center. Iron in your blood is concentrated in hemoglobin, the protein that helps deliver oxygen throughout the body, whereas iron in your muscles is found in myoglobin, the substance that stores and releases oxygen in your muscles during intense muscular activity.
In addition to the iron found in your blood and muscles, which is easily accessible to your body and helps keep everything functioning smoothly on a regular basis, you also have iron stores in your liver, spleen, and bone marrow. It is the amount in these stores that makes women particularly susceptible to iron deficiency. Whereas men have—on average—1,000 milligrams of iron stored in their bodies (which is enough to last up to three years!) women’s bodies store an average of just 300 milligrams of iron, which is only enough to last us about six months.
Because women have limited iron stores—and because we menstruate, gestate, and lactate, all of which put increased demands on our iron reserves—we’re at a significantly greater risk of developing iron deficiency.
What causes iron deficiency (and what does iron deficiency look like)?
Iron deficiency occurs when your body’s iron stores become depleted.
“Iron deficiency means a patient has low levels of iron,” explains Ali. “Common symptoms and signs are fatigue, tired feeling, and low energy. You may also notice your skin and nails starting to look very pale.”
Irony deficiency can happen in two ways, Lee explains. Either your body suddenly needs more iron, or your body is taking too little iron in because the foods you’re eating don’t contain adequate amounts of iron, or because you’re experiencing an issue with absorption.
Certain groups of individuals are at an increased risk for iron deficiency according to the NIH, including pregnant women and young children.
Pregnant Women
During a healthy pregnancy, a woman’s blood volume will increase by 50 percent to support the needs of the fetus and to prepare for blood loss during childbirth. Creating all that new blood means that the body needs more iron than ever before.
“During pregnancy, plasma volume and red cell mass expand due to dramatic increases in maternal red blood cell production,” explains Elizabeth Trattner, an acupuncture physician. “The amount of iron that women need increases during that time.”
Having insufficient iron levels during pregnancy can lead to health complications for mom and baby including low birth weight and central nervous system issues, which is why many healthcare providers carefully monitor iron levels in pregnant women. The NIH recommends that all pregnant women take a low-dose iron supplement, and iron is often included in prenatal vitamins.
If you’re pregnant or thinking about trying for a baby, it’s important to note that women who have low iron stores before pregnancy should work with their doctors to develop a more aggressive plan for increasing their iron levels during gestation. In addition to the toll iron deficiency can take on an expectant mother, pre-conception and early-pregnancy iron deficiency can actually result in brain abnormalities associated with slow language learning and behavioral issues that last long after a baby’s gestation period.
Infants and Toddlers
Like pregnant women, infants and toddlers are also at risk for iron deficiency, in part because they are growing so quickly.
“An increased iron need can be caused by a growth spurt, especially in growing infants and toddlers,” says Lee, noting that their picky eating habits don’t help. “It may be more difficult for them to obtain iron from their diet than older children and adults.”
Research cited by the NIH shows that 12 percent of infants and 8 percent of toddlers are iron deficient. Iron deficiency in the early stages of life can lead to cognitive delays and psychological effects including social withdrawal. Because the impacts of iron deficiency in infancy and early childhood can be irreversible, it’s essential for young children to get enough iron.
Breastmilk is a great source of iron, especially for children under 12 months old. That said, the American Academy of Pediatrics recommends that starting at four months of age, parents of breastfed infants begin giving them a 1 milligram per kilogram iron supplement every day until they are eating iron-supplemented foods like infant cereals. If your baby is breastfeeding, your pediatrician can help you determine the right supplement dosage based on their age and weight.
Most infant formulas sold in the U.S. already contain iron, so there is no need to supplement formula-fed infants.
A resource posted by MedlinePlus also points out that infants who drink cow’s milk instead of breast milk or iron-fortified formula are more likely to be iron deficient because cow’s milk contains less iron, can cause intestinal issues, and is much harder for the body to absorb than breast milk. Likewise, children who are over a year old whose diets contain too much cow’s milk and not enough nutrient-dense, iron-rich food are at an increased risk of iron deficiency.
According to the Mayo Clinic, the following symptoms can be signs of iron deficiency in children and may warrant a talk with their pediatrician:
- Pale skin
- Lethargy
- Slowed growth and development
- Poor appetite
- Abnormally rapid breathing
- Behavioral problems
- Frequent infections
- Unusual cravings for non-nutritive substances, like ice, dirt, or paint
So how much iron do I need to prevent iron deficiency (and where should it come from)?
Given all the factors that impact how women and children’s bodies rely on and store iron, it’s especially important that they ingest enough iron to prevent iron deficiency. That can be complicated, though, because iron isn’t the easiest mineral to absorb.
According to Lee, “Only about 10 percent of consumed iron is absorbed into the body.”
In order to get enough iron, the NIH recommends that women consume 18 milligrams of iron each day (although if you’re pregnant you’ll need to increase that to 27 milligrams). Women who have stopped menstruating only need about 8 milligrams of iron each day, while toddlers ages 1 to 3 need 7 milligrams and children ages 4 to 8 need 10 milligrams daily to prevent iron deficiency.
The most well-known way to get iron is by eating red meat, which can contain up to 5 milligrams of iron per serving. However, if you or your kiddo isn’t a fan of red meat, or you choose to steer clear of meat altogether, there’s no need to worry. There are many non-meat sources of iron that you can incorporate into your diet to ward off iron deficiency. Oysters and white beans both contain 8 milligrams of iron per serving, while a 3-ounce serving of dark chocolate can give you 7 milligrams.
In the United States, many cereals are also fortified with iron and can contain up to 100 percent of the recommended daily value in just one serving, making them an easy way to help kids (or yourself!) get the iron needed to prevent deficiency. This nutrition data resource ranks hundreds of ready-to-eat cereals based on their iron content. Note that cereals more aggressively marketed toward children—like Lucky Charms and Cocoa Puffs—are lower in the ranking, whereas quick oats and and bran flakes top the list.
Lee also suggests that eating foods that are rich in vitamin C can help increase iron absorption, which highlights the importance of a balanced, nutrient-rich diet.
Other Risk Factors for Iron Deficiency
While Lee’s assertion that iron deficiency typically occurs when someone suddenly needs more iron or isn’t getting enough, other conditions including cancer and gastrointestinal bleeding can increase a person’s risk for iron deficiency. However, the fact remains that iron deficiency is most common in women of childbearing age, for both biological and social reasons.
“Women in this age group seem to be low in body stores of iron for several reasons,” says Arielle Levitan, MD. “Firstly, they often do not consume large quantities of red meat. They also continually lose significant amounts of iron from having periods, pregnancies, and breastfeeding.”
It is especially important for women who are breastfeeding or who have heavy periods to be sure they are getting enough iron, and Levitan suggests supplementation as a valid means of addressing and preventing iron deficiency.
“Many women make the mistake of stopping a prenatal after giving birth,” she says. “This is a time when they may need it the most given bleeding during the birth, nursing, and months of giving up your own iron for the baby. Many women remain deficient into their menopausal years starting with pregnancy.”
Are anemia and iron deficiency the same thing?
You’ve probably heard of anemia, but even if you know someone who has it, you might not understand exactly what the condition is. According to Ali, anemia occurs when there are not enough red blood cells (which are made from hemoglobin) in the blood to transport oxygen throughout the body. Because iron helps with the production of hemoglobin, he notes that iron deficiency and anemia often go hand-in-hand, although that isn’t always the case.
Symptoms of anemia are similar to those of iron deficiency, including fatigue and pale coloring, according to another Mayo Clinic resource. Over time, if anemia is not treated, these conditions can get worse and grow to include chest pain, dizziness, and yellowing of the skin. If you think that you are suffering from anemia, it is important to speak with your doctor to identify the cause and develop a treatment plan.
I think I’m struggling with iron deficiency: What’s next?
Iron deficiency can be diagnosed by a blood test, and some medical researchers actually suggest that all young women should be tested for iron deficiency and anemia given their heightened risk for developing the conditions. That said, if you think you might not be getting enough iron, the first step is to try to increase your iron intake. Levitan says this can be done by eating more iron-rich foods like red meat, legumes, and spinach. For young kids, fortified cereals are a great way to boost iron intake.
If you’re still experiencing symptoms associated with iron deficiency, talk to your doctor about incorporating an iron supplement. Iron supplements are usually the first line of treatment for iron deficiency and even anemia, but it’s important to work with a healthcare provider to find the right one for you since iron supplements can have unpleasant side effects.
“Iron from supplements is generally used by your body very readily,” Levitan says. “The challenge tends to be finding a supplement without side effects. Many people find that vitamins containing iron are hard on the stomach and can cause stomach aches, constipation, and other side effects. Finding a supplement that you can tolerate is essential.”
Your doctor may also advise taking the supplement with vitamin C to increase your absorption.
In some extreme cases, doctors recommend iron deficient patients receive iron supplements via IV, but this is uncommon and typically limited to cases in which oral supplementation isn’t an option, for example when a patient has a serious gastrointestinal condition, is on dialysis, or has celiac disease.
I don’t think I have an iron deficiency, but could I be consuming too much iron?
Women under 50 are much more likely to be iron deficient than to have too much iron in their bodies, but it is important to note that according to the NIH, there are negative health consequences and serious risks associated with consuming too much iron.
Nausea, vomiting, and faintness are associated with over-supplementation, and iron overdoses can result in multi-system organ failure, coma, and death. The upper healthy limit of iron is 40 milligrams per day for children under 13 and 45 milligrams per day for adults. If you or a child accidentally ingests more than that, it is important to seek medical attention immediately.
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