6 Signs You’re Not Getting Enough Iron

Though it mostly goes unnoticed, iron has a very important job: it carries oxygen through our bodies, which helps us produce energy and get rid of carbon dioxide. Like we said—IMPORTANT!

If you’re not getting enough iron or your body is struggling to absorb the iron you are already consuming, you could have iron-deficiency anemia. In the United States, 5.6 percent of the population are at least mildly anemic, according to the journal PLoS One. Additionally, an estimated 1.5 percent of Americans are moderately to severely anemic.

However, certain populations are more at risk for low iron than others, says Brittany Poulson, R.D.N. “People at higher risk of iron-deficiency anemia include women of childbearing age (due to blood loss during menstruation), infants and children, pregnant women, vegetarians (meat is a great source of dietary iron), and people who donate blood often,” she says.

Low iron levels can be caused by a wide variety of factors, including a lack of iron in your diet, an underlying health condition that makes it difficult for your body to absorb iron (like certain intestinal diseases), and pregnancy, according to Poulson. Heavy menstrual periods are one of the most common culprits for women of reproductive age.

The trouble is, many people aren’t aware that they aren’t getting enough iron—until they don’t quite feel like themselves. If you’re experiencing any of the following six symptoms, it’s worth a trip to your doctor to find out if you’ve got iron deficiency going on behind the scenes.

#1. Extreme Fatigue

Feeling tired is one of the most common symptoms associated with low iron, according to dietitian Vanessa Rissetto, R.D.

“Fatigue [can] happen because your body doesn’t have enough red blood cells to carry oxygen to its many parts,” she says. “Also, the red blood cells your body makes have less hemoglobin than normal—and hemoglobin is an iron-rich protein in red blood cells.”

But here’s the thing: This isn’t your run-of-the-mill “I need more coffee” tiredness. We’re talking about a bone-deep exhaustion that doesn’t improve even after a full night’s sleep. You might feel like you’re moving through molasses, struggling to get through your normal daily activities.

Why Iron Deficiency Fatigue Feels Different

What makes iron-deficiency fatigue unique is that it happens even before you become anemic. Your body has iron-dependent proteins in your muscles that help produce energy—when these run low, you feel it throughout your entire body. Research shows that iron supplementation can significantly improve fatigue in people who are iron deficient but not yet anemic.

It’s worth noting that fatigue is not the same as sleeplessness. With fatigue, you generally feel lethargic, both mentally and physically—like you have no energy at all. You might find yourself:

• Needing to sit down frequently during tasks that used to be easy
• Feeling winded after climbing a single flight of stairs
• Struggling to concentrate or finish thoughts
• Canceling plans because you just don’t have the energy

If this sounds familiar and you can’t pinpoint another reason (like a new baby keeping you up at night), it’s worth asking your doctor about checking your iron levels—specifically your ferritin, which measures your iron stores.

#2. Excessive Weakness

If you’re not getting enough iron, you may also notice that you’re feeling weak, especially in your muscles, according to Rissetto. This could be due to a lack of oxygen. When you don’t have enough red blood cells, you’re likely not transporting an adequate amount of oxygen to your cells, organs, and body parts.

Think about it this way: Your muscles need oxygen to work properly. When iron is low, it’s like trying to run an engine without enough fuel. You might notice this weakness when you’re:

• Carrying groceries that used to feel manageable
• Doing your regular workout routine
• Simply standing for extended periods
• Trying to open jars or lift everyday objects

Accompanied by weakness, you may also notice you are feeling dizzy or lightheaded, according to Poulson. Some people describe it as feeling “shaky” or unstable on their feet, particularly when they stand up quickly. This happens because your brain isn’t getting enough oxygen-rich blood, causing that woozy sensation.

When Weakness Affects Your Workouts

For athletes and active individuals, this weakness can be particularly frustrating. You might find that your usual running pace feels impossible, or that weights you normally lift seem suddenly heavier. Recent research shows that even in non-anemic athletes, low iron can reduce exercise performance and increase fatigue during training.

#3. Loss of Appetite

Are you suddenly finding yourself skipping meals? This could be another sign that you’re not getting enough iron. “If there is decreased oxygenation to the stomach, it can make you feel less hungry,” says Rissetto. “Less action means less interest in food.”

Your digestive system needs oxygen to function properly—when it’s not getting enough, it basically slows down. Food might seem less appealing, or you might feel full after just a few bites. Some people notice that they’re forgetting to eat simply because the usual hunger signals aren’t kicking in.

If your appetite has markedly changed, do speak with your medical care provider. It’s especially important to mention this if you’re also experiencing other symptoms on this list, as loss of appetite combined with low iron can create a frustrating cycle where you’re not eating the iron-rich foods your body needs.

#4. Spoon-shaped Nails

Yep, the physical appearance of our nails can indicate underlying health conditions. If you’re not getting enough iron, you could develop koilonychia, a condition caused by anemia that gives nails a thin, spoon-shaped appearance.

This symptom usually shows up in more severe or long-standing iron deficiency. Your nails might start to:

• Become thin and brittle, breaking easily
• Develop ridges or grooves
• Curve upward at the edges, creating a concave “spoon” shape
• Look pale instead of their normal pink color

Other Nail and Hair Changes to Watch For

Beyond spoon nails, you might notice increased hair shedding or thinning. Iron plays a role in the growth cycle of your hair follicles, so when levels drop, your hair can enter a resting phase and fall out more than usual. Some people notice more hair in the shower drain or on their brush—if you’re seeing this along with brittle nails, it’s worth getting your iron checked.

#5. Cold Hands and Feet

Some people are prone to having cold hands and feet because of their natural body temperature. However, if you’re experiencing it out of the blue, it could be one more clue you need more iron in your diet. This is also caused by the lack of oxygen moving throughout your body.

Here’s what’s happening: When your body doesn’t have enough iron, it prioritizes sending oxygen-rich blood to your vital organs—your heart, brain, and lungs. That means your extremities (hands and feet) get less blood flow and feel cold as a result.

You might notice:

• Your hands and feet feel cold even in warm rooms
• You’re reaching for socks and gloves more than usual
• Your fingers and toes look paler than normal
• People comment that your hands feel unusually cold when you shake hands

This isn’t the same as having naturally cool extremities or being sensitive to air conditioning. We’re talking about a noticeable change where you’re cold when others around you are comfortable, or where you need extra layers even in mild weather.

The Connection to Circulation

Interestingly, about 40 percent of people with restless leg syndrome—that irresistible urge to move your legs, especially at night—are iron deficient. If you’re experiencing cold extremities along with restless legs that keep you up at night, iron deficiency might be the common thread.

#6. Pale Skin

If you’re suddenly struck with a look of pallor, you may want to have your iron levels checked, according to Poulson. This isn’t the same as having a fair complexion, of course, which is dependent on the melanin in your skin. If your skin is looking lighter, or unusually less colorful (like your cheeks have lost their color, for example), talk to your doctor.

Where to Look for Pallor

The easiest place to check is the inside of your lower eyelid. Gently pull it down and look in the mirror—it should be a vibrant, reddish-pink color. If it looks pale pink or almost white, that’s a potential sign of low iron. You can also check:

• The nail beds (should be pink, not pale)
• The palms of your hands
• Your gums and inside of your mouth
• Your face, especially if you notice you’ve lost your usual “glow”

People around you might comment that you “look tired” or ask if you’re feeling okay, even on days when you feel relatively normal. That’s often because they’re picking up on the subtle pallor that comes with iron deficiency.

Unusual Cravings: The Ice Connection

Here’s one of the weirdest signs of iron deficiency: cravings for ice or other non-food items. This condition, called pica, affects 40 to 50 percent of people with iron deficiency. The most common form is pagophagia—the compulsive urge to chew ice.

If you find yourself constantly crunching ice cubes, filling cups with ice just to eat it, or even seeking out specific types of ice (like the soft pellet ice from certain restaurants), this could be your body’s strange way of signaling low iron. Some people also crave starch, clay, dirt, or paper. While scientists aren’t entirely sure why this happens, one theory suggests that chewing ice might temporarily boost alertness in iron-deficient individuals by increasing blood flow to the brain.

Treating Low Iron

If you find you’re not getting enough iron, you should, first and foremost, focus on improving your diet. “Excellent sources of iron-rich foods include lean beef, liver, and dark chicken and turkey meat,” says Poulson. “Other sources include turkey, chicken, pork, fish, beans, peas, lentils, iron-enriched grains, spinach, collard greens, prunes and raisins.”

Understanding Heme vs. Non-Heme Iron

Not all iron is created equal when it comes to how well your body can use it. There are two types:

Heme iron comes from animal sources and is more easily absorbed by your body—typically 15 to 35 percent absorption. You’ll find it in:

• Red meat (beef, lamb, pork)
• Poultry (especially dark meat)
• Fish and seafood
• Organ meats like liver

Non-heme iron comes from plant sources and is less readily absorbed—usually only 2 to 20 percent. Good sources include:

• Beans and lentils
• Tofu and tempeh
• Dark leafy greens like spinach and kale
• Fortified cereals and grains
• Nuts and seeds

If you’re vegetarian or vegan, you’re not out of luck—you just need to be strategic about maximizing absorption.

The Vitamin C Trick

Pro tip: It’s beneficial to eat iron-rich foods (from plant sources) alongside foods that are high in vitamin C, since this essential vitamin aids our bodies in the absorption of iron.

Here’s how to put this into practice:

• Add strawberries or oranges to your iron-fortified cereal
• Squeeze lemon juice over spinach or lentils
• Have bell peppers with your bean dishes
• Drink orange juice with your iron supplement

On the flip side, certain foods and drinks can actually block iron absorption. Try to avoid having these at the same time as iron-rich meals:

• Coffee and tea (the tannins interfere with absorption)
• Dairy products (calcium competes with iron)
• Foods high in phytates like whole grains (when eaten with iron sources)

This doesn’t mean you can’t enjoy your morning coffee—just try to space it out from your iron-rich breakfast by a couple of hours.

Considering Supplementation

If a change in diet is not enough, iron supplementation should be your next step. You may want to avoid consuming dairy, coffee, tea, chocolate, or high-fiber foods when taking iron supplements, as components of these foods may bind to the iron and reduce its absorption. Talk with your doctor about appropriate dosages before beginning supplementation.

When it comes to iron supplements, you have options. The most common forms you’ll see are:

• Ferrous sulfate – The traditional, most affordable option, but it can cause stomach upset
• Ferrous gluconate – Gentler on the stomach than sulfate
• Iron bisglycinate – A chelated form that tends to be the most easily tolerated with fewer digestive side effects

What to Expect When Taking Iron

It’s important to have realistic expectations. You probably won’t feel like a new person overnight. Most people start noticing improved energy within 2 to 3 weeks, but it can take 8 to 12 weeks for your iron stores to fully replenish. Your doctor will likely want to recheck your blood work after a few months to make sure your levels are improving.

Common side effects of iron supplements include:

• Constipation (try increasing water and fiber intake)
• Dark or black stools (this is normal and harmless)
• Nausea (taking iron with a small amount of food can help)
• Stomach discomfort

Some strategies that might help:

• Start with a lower dose and gradually increase
• Take your supplement every other day instead of daily (recent research suggests this might actually improve absorption while reducing side effects)
• Try taking it with a small snack, though not dairy
• Consider a liquid or chewable form if pills bother your stomach

The Vitamin Shoppe’s Auto Delivery program can help you stay consistent with supplementation—you’ll save 10% on every order and never run out during your treatment period, which is especially helpful since iron repletion takes several months of consistent use.

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