Heart palpitations, dry skin and soreness in the mouth aren’t necessarily symptoms you would associate with iron deficiency.
But they’re among the common signs you’re missing this essential nutrient – a condition affecting up to eight in 10 people worldwide, according to the World Health Organisation.
Iron is vital for transporting oxygen around the body and keeps the immune system healthy as well as reducing the risk of heart and lung conditions.
The UK Government’s Scientific Advisory Committee on Nutrition suggests women aged 35-49 years, girls aged 15-18, toddlers aged one to two, and men aged 65 and over are most at risk of not getting enough of the mineral.
And a rise in vegetarian and vegan diets could be partly to blame for the common condition, as it is easier for the body to absorb the iron found in meat.
Experts say another reason iron deficiency is so widespread – despite it being relatively easy to treat – is that doctors often miss its common symptoms.
Anna Magee speaks to leading nutritionist Greg Weatherhead for Healthista to find out how to spot nine tell-tale signs you might be in need of more iron:
Tiredness or exhaustion is a common effect of an iron deficiency because iron is necessary for the blood to carry oxygen around the body – muscles deprived of oxygen become tired much faster than those with a healthy supply
1. You’re always exhausted
This is one of the most common signs of iron deficiency because iron is responsible for the transportation of oxygen to all body tissues.
Too little iron in the body deprives the tissues of energy, leaving you exhausted as your body tries to take energy from wherever it can.
In fact, research published in the Danish Medical Journal in 2014 suggested that of patients that were critically iron deficient, almost half experienced physical tiredness as their key symptom.
The good news was that the same research found that supplementation with iron was significantly effective in relieving symptoms.
2. Shortness of breath
Those low levels also mean the body can’t transport enough oxygen to the muscles and tissues effectively and this can manifest as shortness of breath, during exercise or even everyday activities such as climbing stairs.
In fact, according to the NHS website, shortness of breath, along with pale skin, tiredness and heart palpitation is among the most common symptoms of iron deficiency.
3. You have pale skin (or a pale tongue)
Pale skin is quite typically associated with low iron levels and anaemia.
But even if your skin isn’t pale, there is another key check you can make – pull down your inner eyelid and take a look in the mirror.
‘Paleness in general, whether it’s the skin, nails, eyelids or any other area can indicate low iron levels,’ says Greg Weatherhead.
‘This is due to low levels of haemoglobin which carries oxygen from the lungs, which helps to give the blood its red colour.’
Having a pale tongue could be a sign of anaemia – critically low levels of iron – because iron helps to give blood its red colour so a lack of it can lead to the body being drained of colour
Iron is an essential part of haemoglobin which carries oxygen from the lungs, transporting it throughout the body.
Without enough iron, the body can’t make enough healthy oxygen-carrying red blood cells, leading to that tell-tale pallor.
If you’re still unsure, check out your tongue.
A study published in 2010 in the journal PLOS One found that tongue pallor was the most common indicator of iron deficiency anaemia, even more than facial pallor.
4. Restless Legs
Restless Leg Syndrome (RLS) is an overwhelming desire to move the legs and it’s something that usually gets worse in the evenings and at night.
It can cause an unpleasant crawling sensation in the feet, calves and thighs, and occasionally the arms are affected too.
While studies have confirmed that those with RLS often have difficulty absorbing the iron in their diets, a study published in 2009 in the journal Sleep Medicine found those with RLS who took iron orally for 12 weeks had significant improvements in their symptoms.
5. Headache and dizziness
The lack of haemoglobin in the blood that iron deficiency causes means not enough oxygen reaches the brain, causing its blood vessels to swell and create pressure, resulting in pain, explains Greg Weatherhead.
And, if you get menstrual migraines or headaches, research from 2010 suggests you might need to get your iron levels checked.
The study, from University Hospital, Zagreb, found that menstrual headaches and migraines were a common symptom in women who also had iron deficiency.
Low iron levels may also have an impact on our mental health, asserts Greg Weatherhead.
‘Anxiety, panic attacks, mood swings, depression and a lack of concentration can all be symptoms of iron deficiency too,’ he said.
6. Brittle nails
‘Low levels of iron can cause nails to become more brittle,’ says Greg Weatherhead.
‘This is usually accompanied by other symptoms such as fatigue and pale skin.’
‘The more serious iron deficiency anaemia has a more significant impact on our nails with them becoming concaved and looking as though they scoop away from the finger, like a spoon – this is a tell-tale sign of iron deficiency,’ says Weatherhead.
An iron deficiency can make finger and toe nails brittle – more likely to break – as well as making them become concave and looking as if they are bending away from the fingers
7. Heart palpitations
In cases of iron deficiency, the heart needs to work harder to transport oxygen around the body and this can result in heart palpitations – something that needs to be looked at by a doctor.
‘This can lead to irregular or fast heartbeats and even heart murmurs, an enlarged heart or in extreme cases heart failure,’ says Greg Weatherhead.
8. Swelling and soreness in the mouth
WHAT YOU SHOULD KNOW ABOUT IRON SUPPLEMENTS
If you find iron supplements confusing you’re not alone – you may have heard about absorption levels varying and that they can make you constipated.
‘There are two categories of iron supplements, those which contain the ferrous form of iron and those which contain the ferric form of iron,’ says leading nutritionist Greg Weatherhead.
Ferric iron is the oxidised form of iron which makes it less reactive.
‘This means it’s less likely than ferrous iron to act as a free radical and damage the cells once within the body,’ Weatherhead said.
One specific form of ferric iron known as ferric EDTA has been the subject of a large clinical trial demonstrating its superiority over other forms.
The trial, published in 2014 in the Tanzanian Journal of Health Research, showed how a 5mg supplement of this form of iron provided the same increase in haemoglobin concentration as a 10mg ferrous iron supplement.
What about side effects?
‘Any iron supplement which travels through the digestive system will have side effects such as abdominal discomfort, nausea, vomiting and constipation’ says Weatherhead.
‘The reason for this is that iron is hard on the digestive tract and only a fraction of the iron consumed will be absorbed, leaving the remaining iron to sit in the gut and cause irritation.
‘Ferrous forms of iron are also known to cause more side effects than the ferric forms of this compound’.
‘A sore, swollen or strangely smooth tongue can be a sign of iron deficiency anaemia,’ says Weatherhead.
‘Cracks on the corners of the mouth and ulcers can also be a sign.’
Inflammation of the tongue (known as glossitis) can be caused by iron deficiency.
Iron plays a crucial role in regulating cell growth and the production of red blood cells which carry oxygen around the body into tissues and muscles.
Low iron in the blood can result in a low level of a protein called myoglobin – this protein is responsible for carrying the oxygen to muscles including the tongue.
Due to a lack of oxygen, cells struggle to maintain their function, and this can cause the smooth appearance of the tongue as the papillae don’t develop as new cells regenerate.
9. Dry hair and skin
As skin and hair receive less oxygen from the blood because of iron deficiency, they can become dry and damaged, says Weatherhead.
In more severe cases this can result in hair loss, which affects an estimated eight million women in the UK.
What’s causing widespread iron deficiency?
‘The soaring rise in popularity of vegan and plant-based diets is one of the key factors behind why more and more people are finding themselves nutrient deficient,’ says leading nutritionist Greg Weatherhead.
‘While it does have its advantages such as lowering blood pressure and cholesterol, removing entire food groups from your diet also removes essential nutrients.
‘Fitness and lifestyle influencers have responsibility here as they encourage a wide variety of people to modify their diets to follow a healthier lifestyle,’ says Weatherhead.
‘Those that promote a vegan or vegetarian diet also have an obligation to highlight the importance of substitution rather than simply eliminating important food groups.
‘This is because meat is the only natural source of haem iron, which is considerably more absorbable than the non-haem iron found in plant sources.
Nutritionist Greg Weatherhead says more people turning to vegetarian and vegan diets could be fuelling the rise in iron deficiency because the iron in meat is easier for the body to absorb than iron in meat-free meals
‘What’s more, the amount of processed foods we consume means that the number of vitamins and minerals under-represented or omitted from our diet is on the increase,’ says Weatherhead.
How much iron do we need a day?
The British Dietetic Association’s recommended dietary allowance (RDA) of iron for women aged 19-50 years is 18mg. What does that mean in food terms?
‘This is the equivalent of over 1.6kg of turkey, 24 eggs or 1.2kg of kale per day,’ says Weatherhead.
This RDA for women increases to 27mg during pregnancy highlighting the vast increase in iron requirements during this time.
‘For men, men aged 19-50 years, the recommendation is 8mg daily which is almost 800g of turkey, approximately 11 eggs or just over 530g of kale per day,’ he said.
Symptoms of iron deficiency
‘Iron is essential to a vast number of processes within the body, meaning that the symptoms of deficiency can manifest themselves in number of different ways,’ Weatherhead explains.
Lack of energy, pallor and some mood symptoms might seem like obvious signs, but some are far less so.
One of the strangest symptoms of iron deficiency is the compulsion to eat non-food items, ranging from ice cubes to dirt and plaster, a condition called pica. It’s not understood (funny that) how iron deficiency causes this behaviour.
GPs can test iron levels whenever they deem necessary through a simple blood test.
This article originally appeared on Healthista and is being reproduced with their permission.