Written by Denise Schipani
In the past year, a bizarre trend circulated on TikTok: Users were posting videos “proving” that they had iron-deficiency anemia by rubbing a ring across their forehead. If the metal left a telltale dark streak, it somehow showed that the person was low on iron.
That test, of course, was useless. (Best speculation is that the rings were dragging through makeup and creating dark streaks.) “I’ve never heard of this myth, but if you have symptoms of iron deficiency, you should speak to a doctor because it could be serious,” says Susan Besser, M.D., an internist and family medicine physician with Mercy Personal Physicians at Overlea in Baltimore. What are the signs to watch out for, how do you test for iron deficiency, and what complications can it lead to? Read on.
Related article: The Four Benefits of Nutritional Metals on The Body
What is Iron Deficiency?
Iron is a mineral your body needs to perform some vital functions, chiefly producing hemoglobin, the component of your blood that ferries oxygen around your body. Without enough iron, you produce less hemoglobin, and your blood is less effective at circulating oxygen.[2, 3] In the United States, about 10% of women of childbearing age are iron deficient; in men, rates are far lower. About 9% of children between ages 1 and 3 have an iron deficiency.
Normally, your body absorbs iron from the foods you eat and stores any excess in your liver until it’s needed. When those stores run low for a prolonged period of time, the result is iron-deficiency anemia.[3, 4, 5] This can happen if:
- You’re losing more red blood cells than your body can replace. This may be due to heavy periods, but it may also be a sign of a more serious condition, such as some types of gastrointestinal cancer that cause internal bleeding.[5, 6]
- Your body isn’t effectively absorbing iron. Inflammatory bowel conditions, such as Crohn’s disease and celiac disease, may interfere with the normal absorption of iron from food. They may also cause blood loss from intestinal bleeding.
- You’re not eating enough iron-containing foods. This is more common among vegetarians, as meat is a major source of dietary iron.[5, 8]
- Your iron needs change. If become pregnant, for example, you’ll need almost twice as much iron as before to make enough blood cells to support the growing fetus.[9, 10]
Recognize the Signs of Iron-Deficiency Anemia
Though in most cases anemia will leave you tired and weak, it can cause more serious problems, says Dr. Besser.” Your heart, in particular, must work harder to compensate for a lack of healthy red blood cells, which can lead to heart damage over time. In pregnant women, iron-deficiency anemia may lead to premature birth or low birth weight babies. Look out for one or more of the following symptoms:[2, 9]
Iron-Deficiency Anemia Sign #1: Pale skin
If you have enough iron and are making enough hemoglobin, oxygen-rich blood circulating close to your skin’s surface gives your skin its normal tone.[2, 9] Low iron stores may make you appear paler, says Dr. Besser, an effect that can also show up in pale nail beds.[2, 11]
Iron-Deficiency Anemia Sign #2: Chest pain, rapid heartbeat, or shortness of breath
When your hemoglobin levels are low, your muscles aren’t being fed by oxygen-rich blood and you feel tired and weak as a result. This causes your heart to pump faster and you to breathe harder. That’s your body’s attempt to push whatever oxygenated blood it can around your body, Dr. Besser explains. As part of that same struggle, iron-deficiency anemia can also provoke dizziness and lightheadedness.[2,12,13]
Iron-Deficiency Anemia Sign #3: Cold Hands and Feet
Again, thanks to a dearth of oxygen-rich blood, your fingers, toes, hands, and feet may get less circulation, as your body tries to preserve oxygen for vital organs.[2,13]
Iron-Deficiency Anemia Sign #4: Hair Loss
It’s normal to lose 50 to 100 strands of hair a day. But if you find more than is typical for you in your brush or shower drain, take note. As hair follicles get less oxygen, they may go dormant, causing hair to drop out.[2,14]
Related article: Hair Falling Out? Here Are 4 Health-Related Reasons Why
Iron-Deficiency Anemia Sign #5: Unusual cravings
Anemia can spur a condition called pica, which may lead people to crave (and even consume) non-nutritive substances, such as ice, dirt, or starch. Pica can also be caused by malnutrition. It’s your body’s way of trying to correct a significant deficiency in one or more nutrients or minerals, including iron.[2,15]
When to Get Tested for Iron-Deficiency Anemia
If you have any of these symptoms or are concerned, talk to your health care provider about getting tested (or test from the comfort of your home).[2,16] “Iron-deficiency anemia is diagnosed with blood testing, starting with a complete blood count, or CBC,” says Dr. Besser. A CBC assesses levels of all types of blood cells (red, white, and platelets).[2,17] “This test will show if you’re anemic, but not necessarily why, as iron-deficiency anemia is just one type.” If iron-deficiency is suspected, the test you need is for ferritin, TIBC, and iron levels, she says.[2, 18, 19]
How Anemia is Treated
If testing reveals that you have iron-deficiency anemia, treatment will depend on the cause. “You want to understand the reason you have iron-deficiency anemia so you can address any medical issues,” says Dr. Bresser. If Crohn’s disease, celiac disease, or gastrointestinal cancer is suspected, for example, you should be referred to a specialist.[2, 7] If your anemia is due to insufficient iron in your food, your provider might recommend diet changes.[2, 8, 20]
Iron needs change across your lifespan. Young children need more iron than adults do, and women need more than men, especially during childbearing years and pregnancy.[10,12,21] Vegetarians may need to pay more attention to getting iron from plant-based foods than meat-eaters do. That’s because the body more readily absorbs iron from meat than from plant-based sources (beans, legumes, and iron-fortified bread or cereals).[2,8,20,21] While increasing your dietary sources of iron may be a smart idea, don’t take matters into your own hands and assume that if you just eat more iron-rich foods, you’re fine. The best path to bringing your anemia under control is by partnering with your health care provider.[2,3]
Susan Besser, M.D., Mercy Personal Physicians
Iron Deficiency Anemia / Matthew J. Warner; Muhammad T. Kamran/ August 10, 2020
Conference of Hemoglobin: The Role of Iron In Hemoglobin Synthesis/Clement A. Finch
American Society of Hematology/Iron-Deficiency Anemia: https://www.hematology.org/education/patients/anemia/iron-deficiency
Medline Plus/Iron Deficiency Anemia: https://medlineplus.gov/ency/article/000584.htm
Crohn’s & Colitis Foundation/Anemia: https://www.crohnscolitisfoundation.org/emr/emr-ibd-education-tool/anemia
American Journal of Lifestyle Medicine/Iron Status of Vegetarian Adults/ v. 12 (6) Nov-Dec 2018
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6367879/#:~:text=Vegetarians have a high prevalence,true for premenopausal vegetarian women.
U.S. Department of Health & Human Resources/Office of Women’s Health/Iron-deficiency Anemia
NIH/Iron Fact Sheet for Consumers: https://ods.od.nih.gov/factsheets/Iron-Consumer/
Medical News Today/What to Know About Skin Paleness
Medically Reviewed by Dr. Payal Kohli, MD, FACC; Written by Zawn Villines on June 26, 2019
National Heart, Lung, and Blood Institute/Iron-Deficiency Anemia
https://www.nhlbi.nih.gov/health-topics/iron-deficiency-anemia#:~:text=People with mild or moderate,and severity of the condition.
National Eating Disorders Association: https://www.nationaleatingdisorders.org/learn/by-eating-disorder/other/pica
Medline Plus/Complete Blood Count
Labs Tests Online/Transferrin and Iron-binding Capacity
Medline Plus/Iron Tests
Academy of Nutrition and Dietetics/ Foods to Fight Iron Deficiency
By Caroline Kaufman, MS, RDN Published January 23, 2020
UCSF Patient Education/Anemia and Pregnancy: https://www.ucsfhealth.org/education/anemia-and-pregnancy