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

Iron deficiency anemia is—surprisingly—not uncommon. Americans are consuming nearly 10% less iron, on average, compared to two decades ago, leading to an alarming rise in deficiencies, according to a 2021 study published in The Journal of Nutrition. Why? The researchers say it may stem from an effort to eat healthier— people shifting away from red meat and toward leaner proteins like chicken, which are lower in the mineral. They also point out that many typically iron-rich foods, such as beef, beans and apricots, pack less of it than they used to, 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. Premenopausal women need more than twice as much iron as men due to blood loss from menstruation. And pregnant women need 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. Asa result, they may need nearly double the RDA of iron compared to omnivores, according to the National Institutes of Health.

The thing about iron deficiency is that it isn't the easiest to ID, unless, of course, you get your blood levels measured. 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 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.

This is the most common symptom of iron deficiency—and, in fact, it can appear with even a mild dip in iron stores. But also, it's pretty hard to notice. Not only is it hard to get the recommended amount of sleep but life usually has us being pulled in different directions (between work, kids, your significant other and a social calendar) that feeling tired is, unfortunately, all too common.

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.

An intolerance to cold temperatures is another common symptom of iron-deficiency anemia and also sometimes simply just iron deficiency. 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 your endurance seems to be slipping, despite keeping up with your 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 a bit more "sensitive" to annoyances is a symptom you often see listed with iron deficiency. And there is some research (although it's limited) that suggests you could be more anxious. For example, in one study, the parents and teachers of kids who were severely and chronically iron deficient in infancy reported an increased concern about the kids' anxiety (among other behaviors) years after their iron deficiency was remedied.

5. Your hair is thinning or noticeably more brittle.

It's women who say they lose their hair with iron deficiency, according to research. But perhaps that's because it's not all that common for men to have low iron stores. Because your hair is constantly growing, it depends on a healthy blood supply and when you're low on iron you're shorting your hair a key nutrient.

6. You're depressed.

Iron has a role in making dopamine—a chemical that sends signals from your body to your brain and plays a big role in your mental wellbeing. In depression, dopamine levels are low. Also, research suggests that iron deficiency is about 15 percent more common in depressed people and a few studies have found that supplementing with iron decreased 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. But they're also inflammatory conditions 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 fairly easy to test: the best measure is a simple blood test administered by your doctor. Plus, 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 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.