Why iron deficiency is more common—and more serious—than you think
One in three US adults don’t get enough iron, which has a major effect on getting oxygen around your body. Find out how this common deficiency can lead to more severe health issues if untreated.
Having enough energy to get through the day is hard enough for most of us. But for one in three American adults with an iron deficiency, daily life can be even more exhausting.
More than 2 billion people worldwide deal with some form of iron deficiency. Because the mineral is essential for several important biological functions, those with low levels of iron often report experiencing symptoms like tiredness, shortness of breath, dizziness, headaches, and even heart issues.
It’s a phenomenon that can affect men and women of all ages, but certain populations, including pregnant women, are affected disproportionately. Without treatment, iron deficiency can easily slide into anemia, or a lack of healthy red blood cells. Iron deficiency is the most common cause of anemia—a lack of iron causes a lack of hemoglobin, which slows red blood cell production.
Since this can lead to a number of adverse short and long-term health effects, those at risk should get screened for any changes in their iron levels, says Irogue Igbinosa, an instructor of maternal-fetal medicine at Stanford University who specializes in women’s reproductive health.
“Usually by the time people become anemic, that is reflective of an iron deficiency that has been going on for some time,” says Igbinosa. “You need energy to do life, and there's just so many ways that we're still discovering how that lack of iron can have an effect.”
Who is affected by iron deficiency and anemia?
Living with an iron deficiency can take an incredible toll on the body. Iron is vital for making hemoglobin, a protein necessary for red blood cells to be able to ferry oxygen around the body, so having low amounts of it means that your organs, muscles, and tissues can’t receive enough oxygen to operate at full strength.
While most humans absorb enough iron from the food they eat, diet doesn’t provide enough iron for everyone. Although the condition rarely causes death on its own, iron deficiency has been known to exacerbate other chronic illnesses like kidney or liver disease, as well as hinder recovery from infections and injuries, since the body needs oxygen to repair them.
Until puberty, men and women usually have the same recommended daily intake of iron (7 to 10 mg). But between the ages of 19 and 50, the recommended daily intake of iron for females shoots up to 18 mg, rises to 27 mg when pregnant, and later drops to 9 mg when breastfeeding. For men, depending on their age, they only require between 8 to 11 mg of iron throughout their lives.
Iron deficiency anemia typically occurs gradually, but women may develop it more frequently than men because the condition is worsened by the menstrual cycle, says Igbinosa. Blood loss caused by heavy or prolonged periods further depletes already limited iron holdings.
“If you don't have the minimum amount of iron you need, and then your body is undergoing something monthly that loses iron, then it's easy to see how one might become deficient over time,” she says. The absence of such an important building block can even cause changes to the brain, including a lack of concentration, memory problems, and mental health issues that might erringly be attributed to stress or other life factors.
Anemia can also make pregnancy more dangerous, as strained iron stores can impact the survival of both the mother and the child. Those who are prone to the condition and give birth might experience heavy bleeding or a higher risk of needing a cesarean delivery.
“Anemia really increases that risk of severe maternal morbidity,” says Igbinosa. “How much anemia contributes to that risk can vary by race and ethnicity.” For the infant, a mother’s anemia has also been associated with stillbirth, prematurity, low birth weight as well as neurodevelopmental delays later in life.
To date, research has shown that Black, Hispanic, and Indigenous women experience more prevalent rates of anemia than females of other races, and may deal with more issues after childbirth. Though it’s still not greatly understood why, this could likely be attributed to differences in their environment, predispositions to certain gynecological issues,or other social determinants of health, such as where they live, income, culture or access to a healthy and balanced diet, Igbinosa says.
Iron deficiency and heart health
While feeling weak or particularly sluggish may not on its own seem to warrant a visit to the doctor, leaving this issue untreated will certainly cause you some unnecessary grief down the road.
It’s vitally important to keep a close eye on those indicators, according to Biykem Bozkurt, a professor of medicine-cardiology at Baylor College of Medicine, “Even with functional iron deficiency, before it becomes anemia, there is evidence of adverse outcomes,” she says.
Combined with other comorbidities such as diabetes, high cholesterol, or hypertension, iron deficiencies serve to further punt up the risk of developing chronic illnesses. What’s more, symptoms similar to that of iron deficiency, such as a lack of energy and limited capacity for exercise and exertion, are some of the most notable markers of a growing heart issue.
“The heart is a pump that sends the blood to the body, but also to its own muscle,” says Bozkurt. “If, for example, there is a blockage and [someone] becomes iron deficient or anemic, the heart will have difficulty feeding.”
Generally, doctors study a patient’s cardiovascular fitness by measuring their peak oxygen uptake (VO2)the amount of oxygen the body can use during intense physical movement.
Iron availability affects how much hemoglobin a person has. The more hemoglobin, the more efficiently oxygen is distributed through the body. Since iron deficiency anemia interrupts the creation of hemoglobin, it can lead to a low VO2.
These values can also help predict a person’s risk of future cardiac disease. A hospitalized patient’s peak VO2 plays a role in evaluating what type of care they might receive, including determining eligibility for advanced life-saving measures such as a heart transplant.
Although such an outcome lies at just one end of the health spectrum, there has been evidence to show that regardless if a person has anemia or not, treating a heart failure patient’s iron deficiency improves both quality of life and hospital readmission rates, says Bozkurt.
Still, for those currently dealing with only mild symptoms of iron deficiency anemia at home, treatment happens to be a much more straightforward process, as experts note that either taking iron supplements or adopting an iron-rich diet can improve overall health. However, the best way to handle the need for any potential medication is to talk with your primary care physician to decide what may be the best plan for you to follow.
