I held my friend's hand as we walked one morning. Hers were freezing. Mine felt warm against them.

"I always have cold hands," she said.

"You know that's a sign of low iron, right?"

She rolled her eyes at me. "Is everything related to low iron?"

Not everything, no. But the night before, she'd told me her hair was coming out in the shower. She'd nodded off in three of her classes. She'd been getting headaches, and felt dizzy when she stood up too fast. And it all seemed to get worse around her period.

None of those things on its own means much. Together, they were worth a blood test.

She wasn't keen at first. But she did decide to get tested. Her ferritin (stored iron) came back at 16, and her results were described as suggestive of iron deficiency. Australia's pathology college recommends treating anything under 30µg/L as iron deficiency. 

If some of that sounds familiar, here’s what's worth knowing.

What does "low iron" actually mean?

Iron's main job is helping your red blood cells carry oxygen around your body. When you don’t have enough, your cells get less oxygen than they'd like, and you feel it.

Low iron doesn't happen all at once. It usually runs down in stages:

1. Your stores drop first. Your body keeps a reserve of iron, mostly in a protein called ferritin. When you use more iron than you take in, it draws on that reserve.
2. Then there's not enough to go around. Once the reserve is low, there’s less iron available to make healthy red blood cells.
3. Eventually, iron deficiency anemia. This is where your red blood cells themselves are affected, and it shows up on a standard blood test.

Here's the part that catches people out: you can feel the effects of low iron well before you're anaemic. Plenty of people are told their blood count is "fine" when their iron stores are running on empty.

 

The common signs of low iron

Everyone’s different, and you might have one or two of these or a whole handful.

• Tiredness that sleep doesn’t fix. The big one. Not "I had a late night" tired, but the kind that's there when you wake up.
• Getting breathless easily. Puffing on the stairs, or finding exercise much harder than it used to be.
• Cold hands and feet. Especially if you're always the one reaching for a jumper.
• Pale skin. A useful place to look is the inside of your lower eyelids, which is usually a healthy pink.
• Headaches, or feeling dizzy or lightheaded.
• Brain fog. Trouble concentrating, losing your train of thought, reading the same line three times.
• Hair shedding. More hair in the brush or the shower drain. The research on this one is still catching up, but it's one of the things people notice most.
• Brittle nails, or nails that start to curve up at the edges like a spoon.
• Restless legs. That creepy-crawly urge to move your legs, usually when you're trying to fall asleep.
• Craving ice. Wanting to chew ice is a surprisingly specific sign. Some people crave other odd things too, like dirt or chalk.
• Your heart pounding or racing, particularly when you exert yourself.

Nearly every one of these can have another cause. Tiredness, headaches and hair loss have dozens of possible explanations, from thyroid issues to stress to a new baby. That's exactly why symptoms are a reason to get checked out, and aren't a diagnosis on their own.

Why so many women are low in iron

The World Health Organisation describes iron deficiency as the most common nutritional deficiency in the world. It can affect anyone, but some people are much more likely to run low:

• Anyone with periods, and especially heavy ones. This loss of iron every month adds up.
• Pregnancy and the months after birth. Blood volume increases by 50% during pregnancy, and iron is needed to make more red blood cells. The baby is also building its own iron stores.
• Vegetarian and vegan diets. Plant iron is harder for the body to absorb than the iron in animal products
• Teenagers who are growing fast and often eating unpredictably.
• Regular blood donors. Every donation takes iron with it.
• Endurance athletes who lose iron through sweat and effort.
• People with digestive issues like celiac disease or Crohn’s. This can affect iron absorption.

When to see a doctor sooner rather than later

Most of the time, low iron is something to sort out with your GP. But some things are worth acting on quickly:

• Very heavy periods, flooding, or periods that last longer than seven days.
• Black or bloody stools.
• Chest pain, fainting, or breathlessness at rest
• If you're a man or you've been through menopause, and your iron is low. Since you're not losing iron through periods, the doctor will want to find out where the iron is going.

Your symptoms can't tell you. A blood test can.

This is the most useful thing in this whole article, so I'll say it plainly: the only way to know for sure if you have low iron is to get a blood test.

Ask the GP for iron studies, usually alongside a full blood count. Iron studies look at a few different things:

• Ferritin, your stored iron. Usually the first thing to drop.
• Serum iron, how much iron is circulating in the blood right now.
• Transferrin and transferrin saturation, which show how much iron is being carried around the body.

A couple of things worth knowing:

• Ask what your numbers are, not just whether they're "normal". Reference ranges are wide, and there's a big difference between the bottom and the top of normal. The doctor can talk through what your numbers mean.
• Ferritin can look normal when you're unwell. It rises with infection and inflammation, so if you’ve been sick recently, it’s worth mentioning.

There are also a few simple things you can do to get an accurate result, like the time of day you test. I've written about which blood test to ask for, and how to prepare for it here.

Why not just take iron and see?

It's tempting. It was my friend's first instinct too: skip the blood test and just try something.

But too much iron can be dangerous and the body has a hard time getting rid of it. Haemochromatosis is a condition where the body stores too much iron. It's a common genetic condition and many people don't know they have it. High-dose iron is the last thing those people need.

A blood test first means you know what you’re working with, and it gives you a baseline to compare against later.

Getting more iron from food

Food is where iron is meant to come from, and it's the place to start for most people.

• Animal foods carry heme iron, the form your body absorbs most easily. Liver is the richest source and chicken liver has more iron than beef liver. Red meat, chicken, fish and eggs all contribute too.
• Plant foods like lentils, chickpeas, tofu, leafy greens and pumpkin seeds carry non-heme iron. It's absorbed less easily, so pairing with vitamin C-rich foods (like a squeeze of lemon) can help.
• Tea and coffee can reduce iron absorption. Having them between meals rather than with meals makes a difference.

If you've been prescribed iron tablets and wondered why food-form iron is talked about so differently, I've written about what's actually different between an iron tablet and wholefood iron here. 

Where Vitality Pills fit in

I created Vitality Pills after my own experience with low iron. I was vegetarian for 15 years, and I still don't eat red meat after 25 years. I know what it's like to need a good source of iron that isn't steak.

Liver is one of the most nourishing foods there is. Vitality Pills are simply 100% organic chicken liver: properly cooked, gently dehydrated and then put into capsules. That means iron in its food form, along with the vitamin B12, folate, copper and protein that come with it naturally.

They tend to suit:

• People who want more iron-rich food in their day but aren't wanting to cook liver
• Vegetarians and former vegetarians stepping back towards animal products
• People who can't take beef liver, whether because of Alpha-Gal Syndrome, religious reasons, or just personal preference
• Anyone who'd rather take a food than a mineral compound.

If you're on a specific iron dose from your doctor, have a chat with them before you change anything. 

The short version

• Low iron is common, especially for women.
• The signs are real but vague: tiredness, breathlessness, cold hands, hair shedding, restless legs and more.
• Symptoms are a reason to get checked out. Ask for full iron studies.
• Men and post-menopausal women with low iron should see their GP to try and find the cause.
• Don't start high doses of iron without a blood test. Too much iron is dangerous.
• Food comes first. If cooking liver isn’t your thing, our organic chicken liver capsules are the original organic chicken liver capsules in Australia. They've been made in small batches since 2013.

About the author

Kirrah Stewart holds a Bachelor of Clinical Science, majoring in Complementary Medicine (Nutrition and Herbal Medicine). She is a former doula with over 15 years' experience supporting families through pregnancy, birth and postpartum. She is the founder of Vitality Pills, the original organic chicken liver capsules in Australia.

 

This article is general information only and is not a substitute for medical advice. If you think you may be low in iron, please see your GP or a qualified health practitioner. If you're pregnant, breastfeeding, taking prescribed iron, or managing a health condition, talk to your practitioner about your individual needs.