Feeling tired or run-down could have any number of causes. But a common one is iron-deficiency anemia. It affects 25% of the world’s population, especially women of childbearing age, according to the World Health Organization.

What’s anemia, you ask? This condition happens when you can’t make enough healthy red blood cells. Those red blood cells contain the hemoglobin that carries oxygen throughout your body. Low iron and anemia are linked. Your body relies on iron to make hemoglobin, so when iron is low, you can become anemic. Your cells don’t receive enough oxygen, and you feel tired.

“The most frequent symptom of iron-deficiency anemia is fatigue,” says Kathryn Boling, MD, a family doctor at Mercy Medical Center in Baltimore. “But there are lots of reasons why you might be tired. You could have a virus or some other low-grade infection. You could have thyroid problems, or you could just need more sleep.

In other words, don’t just assume you’re anemic. The only way to know for certain is with a blood test. But to decide if you need one, it helps to think like a doctor. Here are the signs to look for, along with tips for boosting your iron. (And if you need help affording your medication, Optum Perks can help. Download our app for coupons you can use at pharmacies nationwide.)

Symptoms of low iron levels

For some people, anemia symptoms come on quickly. For others, they sneak up gradually. “Sometimes, it happens over a long period of time,” says Dr. Boling. “With some conditions, you might be losing microscopic blood cells, and you don’t notice any symptoms at first. But little by little, you might start to find that it’s hard to walk as far as usual. Or you might feel tired and out of breath.”

Depending on the cause of anemia, iron levels could fall to dangerously low levels. This could happen if you were losing blood from gastrointestinal bleeding, for instance. You might even feel dizzy or pass out.

These are the symptoms most often linked with anemia:

  • Extreme fatigue
  • Weakness
  • Pale skin
  • Shortness of breath
  • Dizziness or lightheadedness
  • Cold hands and feet
  • Brittle nails
  • Unusual food cravings

Other anemia risk factors

With iron-deficiency anemia, the basic cause is always the same: low iron in your blood. But your doctor will want to know why the problem exists. The questions you’ll likely be asked include:

Are you pregnant, or did you recently give birth? Your unborn baby needs hemoglobin too. The extra demand might have sapped your supply. It’s also possible that you lost a lot of blood while giving birth.

How’s your diet? One of your best sources of iron comes from the foods you eat. (More on that below.) If you haven’t been eating well, your iron levels could be dipping. Poor diet and heavy menstruation are the most common causes of iron-deficiency anemia in women, says Dr. Boling.

Do you have tummy troubles? Gastrointestinal problems, such as Crohn’s or celiac disease, may limit your ability to absorb nutrients from food. Other possible digestive causes: ulcers, polyps or colon cancer.

Have you recently donated blood? That’s a good thing. But if you do it too often, or if your blood donations are too close together, your iron levels could decline.

Are your menstrual periods heavy? Extra blood loss can deplete your iron supplies.

For men, fatigue may also be the result of low testosterone. Learn more about low T and its treatment here.

Next step: your doctor’s assessment

Your doctor will examine your complexion to see if you’re looking pale. “I’ll also pull down the patient’s lower eyelid,” says Dr. Boling. She’s looking for deep pink or red coloring. “If it’s much lighter, that could be a sign of anemia,” she says. “Pale gums can be another clue.”

The explanation: Hemoglobin gives your blood its bright red color. When levels dip, you can lose your rosy glow.

If your doctor suspects iron-deficiency anemia, it’s time to roll up a sleeve. You’ll have blood drawn for a simple test called a complete blood count, or CBC. The lab report will show your levels of iron and other minerals. The number, size and shape of the red blood cells in your sample will also be examined.

Treating low-iron anemia

If your doctor decides you have an iron deficiency, treatment is the next step. Here’s what you can expect.

Iron supplements
Iron tablets can really help,” says Dr. Boling. “But like all medications, they may have side effects.” Gastrointestinal upset is the most common. “For people who can’t tolerate the tablets, we can do an intravenous iron infusion in the office,” she says.

A word of caution: “Never take iron supplements without your doctor’s advice,” Dr. Boling warns, “unless it’s part of your multivitamin and you’re a younger woman.” Too much can lead to organ damage.

Diet
Food is medicine, and what you eat has a big impact on your health. “Nutrition is a great way to boost your iron,” says Dr. Boling. These foods are among the best sources:

  • Meat (beef, pork and lamb; liver and dark meat has the most iron)
  • Poultry (chicken and turkey)
  • Leafy green vegetables (kale, spinach, broccoli and brussels sprouts)
  • Beans (including peas and lima beans)
  • Iron-fortified pasta, rice and cereal

Optum Perks can help you save money on prescription supplements. Just download our discount card and show it to your pharmacist at check out.

Additional Sources
Anemia overview: The Mayo Clinic
Iron-deficiency anemia stat: JAMA Network Open. (2020.) “The Efficacy and Safety of Vitamin C for Iron Supplementation in Adult Patients With Iron Deficiency Anemia: A Randomized Clinical Trial.”