More people are low in iron than in any other micronutrient, according to the American Society of Hematology. Many individuals live with symptoms such as fatigue, weakness, and brain fog for months or years before a deficiency is identified, reports BritPanorama.
Nearly one-third of adults in the United States may experience iron deficiency, as highlighted by a 2024 study. Routine screenings among children and pregnant women, who face a higher risk, may miss more than 70% of cases.
Social media discussions have led some people to self-diagnose based on visible signs like dark under-eye circles and pale skin. Influencers label this appearance as “ferritin face,” a term derived from the protein that stores iron in the body.
Dr. Ariela Marshall, an associate professor of medicine at the University of Minnesota, emphasized that iron deficiency is common, prevalent, and often goes unrecognized. New diagnostic recommendations, released by ASH in September, aim to improve early detection and treatment for patients.
The difference between iron deficiency and anemia
Anemia occurs when there are insufficient red blood cells to transport oxygen to the body’s organs and tissues. Patients may experience fatigue, dizziness, shortness of breath, and symptoms like cold extremities and hair loss.
Lack of iron is a frequent cause of anemia, as iron is vital for creating hemoglobin, the molecule responsible for oxygen transport in the blood. A deficiency in iron can lead to a shortage of red blood cells when ferritin levels drop.
However, someone can be iron deficient without experiencing anemia, which may still manifest in similar symptoms. Low iron levels may also contribute to conditions like restless leg syndrome and pica, where individuals crave nonfood items, although the reasons for these behaviors remain unclear.
Dr. Jacquelyn Powers, section chief of hematology at Texas Children’s Hospital, noted, “The symptoms of iron deficiency can be very subtle, or they can be attributed to many different things,” underscoring that medical professionals might overlook the need for iron lab tests.
What the new iron testing guidelines say
The iron levels in blood can fluctuate based on recent dietary intake, making it an unreliable metric for diagnosing deficiency. Ferritin tests are regarded as the gold standard, yet until recently, there has been no universally accepted threshold for determining iron deficiency.
The World Health Organization recommends a ferritin concentration of below 15 ng/mL for diagnosing iron deficiency in children and adults, but this threshold has been challenged, with experts arguing it may overlook individuals who have slightly higher but still insufficient iron levels.
Current guidelines from ASH propose cutoffs of 20 ng/mL or less for children, 30 ng/mL for most adults, and 50 ng/mL for those with additional risk factors like heavy menstrual bleeding. Adults experiencing inflammatory issues are set at a limit of 100 ng/mL, alongside a recommendation for additional tests like transferrin saturation.
Marshall stated that one goal of the guidelines is to stress the importance of testing for iron deficiency regardless of anemia presence, as early interventions can prevent complications and address more subtle symptoms.
Who should be tested for iron deficiency?
Individuals manifesting a variety of symptoms, such as fatigue and cognitive cloudiness, or cravings for nonfood items, may need testing. Marshall observed, “Somebody can have all of those. They can have one of them. They can have none of them.”
While online posts indicate signs of iron deficiency, such as pale skin and hair loss, both Powers and Marshall caution against diagnosing low iron from selfies alone.
Although restrictive diets might contribute to insufficient iron intake, Marshall noted that more prevalent causes in the United States include blood loss and digestive disorders. Women, particularly those with heavy menstrual bleeding, are more susceptible to iron deficiency than men.
Children and pregnant women also rank higher in risk due to their increased iron requirements for growth and development, with iron deficiency rates rising in pregnant individuals as gestation progresses.
Chronic gastrointestinal issues, such as irritable bowel syndrome and Celiac disease, may impair iron absorption from food, while gastrointestinal blood loss can signal significant health issues, including colon cancer.
Endurance athletes typically have heightened iron needs and may experience fatigue during exercise when deficient. For those who maintain a healthy lifestyle but remain fatigued, testing for ferritin could be a prudent step; effective supplementation can deliver noticeable improvements.
Iron supplementation can yield symptom relief in a matter of weeks or months, reinforcing the connection between low iron levels and health concerns. However, identifying the root cause of deficiency remains crucial, Marshall stressed.
The ongoing challenges of iron deficiency merit continued examination, revealing a complex interplay between diet, health status, and the importance of proactive healthcare measures.
