Iron Deficiency Anemia: Are You at Risk?

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Iron Deficiency Anemia: Are You at Risk?

Iron deficiency anemia may not be something that you think too much about unless you have this condition. But more and more people in the United States aren’t getting enough iron in their diets, at least, based on a study in the 2021 July issue of The Journal of Nutrition. Are you at risk of anemia? And if so, what can you do about it?

What is iron deficiency anemia?

Iron deficiency anemia occurs when you don’t have enough iron in your body. This is a common type of anemia in which the blood doesn’t have enough healthy red blood cells. Red blood cells carry oxygen to the tissues in your body.

If you don’t have enough iron in your body, you can’t make enough hemoglobin, which is a protein that carries oxygen. When your tissues don’t get enough oxygen, you may feel weak, tired, and short of breath.

What causes iron deficiency anemia?

There are several possible causes of anemia, including:

Blood loss

When you lose blood, you lose some iron. Women are at risk of anemia because they lose blood during menstruation, particularly if blood loss is heavy. Blood loss from an ulcer, a colon polyp or colon cancer, or urinary tract bleeding can cause anemia, as can stomach bleeding from taking too much aspirin or other over-the-counter pain relievers. Certain genetic conditions can cause bleeding in the colon, leading to anemia. And an injury or surgery that results in a lot of blood loss can lead to anemia, as well.

Not getting enough iron in the diet

Some people become iron-deficient due to not getting the recommended daily amounts of iron. Adult men need 8 milligrams (mg) of iron daily; women ages 19 to 50 years need 18 mg daily, and women 51 year or older need 8 mg of iron daily. Following a restrictive diet can mean that you aren’t getting enough iron in your diet.

Problems absorbing iron

You might be getting enough iron in your diet, but you may have a problem absorbing it. Certain conditions and medications make it harder for your body to absorb iron and this can lead to anemia. Ulcerative colitis, Crohn’s disease, celiac disease, and Helicobacter pylori infection put you at risk for anemia. You can also be at risk for anemia if you’ve had weight-loss surgery, such as gastric bypass. And there are certain rare genetic conditions that block the intestines from absorbing iron.

End-stage kidney failure

If you are receiving dialysis, you may have blood loss which can lead to anemia. Also, people with chronic kidney disease may be taking medicines, such as blood thinners and proton pump inhibitors that lead to bleeding or affect iron absorption.


Pregnant women are at risk for anemia due to an increase in blood volume and because their iron stores provide a source of hemoglobin for the growing fetus.

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Who’s at risk for iron deficiency anemia?

Certain factors can increase your risk for anemia, including:


Infants, children between ages 1 and 2, teens, and adults over the age of 65 are at risk for anemia.


Girls and women between the ages of 14 and 50 need more iron than boys and men due to menstruation, pregnancy, and breastfeeding.

Family history

People with Von Willebrand disease, an inherited disorder that affects the blood’s ability to clot, and people with hemophilia may be at risk for anemia.


Vegetarian and vegan eating patterns that limit iron-rich foods can raise the risk of anemia, as can frequent blood donations, and endurance activities. Endurance athletes can become iron deficient due to a loss of iron in the digestive tract, as well as through hemolysis, a breakdown of red blood cells.


People with diabetes may have a higher risk of anemia than those without diabetes if they also have kidney disease or heart failure.

What are the symptoms of iron deficiency anemia?

Common symptoms of anemia are:

  • Feeling very tired
  • Weakness
  • Coldness in the hands and feet
  • Dizziness
  • Chest pain
  • Headache
  • Irregular heartbeat
  • Shortness of breath
  • Pica (cravings for nonfood items, such as ice, dirt, or starch
  • Sore tongue
  • Brittle nails
  • Poor appetite

What are the complications of iron deficiency anemia?

If not diagnosed or treated, anemia can lead to several health problems, such as:

Heart problems

The heart must pump harder to move blood through the body. This may lead to arrhythmias, a heart murmur, or heart failure.

Mental health issues

Anemia is linked with a higher rate of depression, anxiety, and sleep disorders.


Iron plays a role in a healthy immune system; a lack of iron can mean a higher risk of infections.

Pregnancy issues

Anemia increases the risk of a preterm delivery or having a baby with a low birth weight.

Growth problems in children

Infants and children who do not get enough iron are susceptible to delayed growth and development, as well as anemia.

How is iron deficiency anemia diagnosed?

Anemia may be diagnosed during a regular physical exam, or you may go to your doctor with signs or symptoms of anemia. Your doctor will likely do a physical exam to check for bleeding, irregular heartbeat, or shortness of breath.

You will likely have blood tests that check a complete blood count (CBC), which includes hematocrit (the percentage of blood volume make up by red blood cells), and hemoglobin. Your iron and ferritin levels may be checked, too. Ferritin is a protein that helps store iron in your body.

If the results of your blood tests indicate that you have iron deficiency anemia, your doctor may order other tests to determine the cause of the anemia. These tests include:

  • Endoscopy to check for bleeding in the esophagus, stomach, and first part of the small intestine.
  • Colonoscopy to check for bleeding or signs of cancer in the colon.
  • Fecal occult blood test to check for blood in the stool that may indicate bleeding in part of the digestive tract.
  • Ultrasound to check, in women, for uterine fibroids that may be causing excessive bleeding.

How is iron deficiency anemia treated?

If you’re diagnosed with anemia, your doctor will treat this in a number of ways, depending on the severity of the anemia.

Iron supplements

Iron is given in an oral form once or up to several times a day to increase iron levels in the body. It usually takes three to six months to replenish your iron stores. If you have side effects from the supplement, such as upset stomach, diarrhea, constipation, or a metallic taste in your mouth, let your doctor know, as they may prescribe a different type of supplement. For severe cases of anemia, you may need intravenous iron therapy or a blood transfusion.

Dietary measures

Your doctor will likely also recommend that you increase your intake of iron from food sources. Iron-rich foods include lean red meat, salmon, eggs, dried beans, dried fruits, and dark-green leafy vegetables. You can get enough iron if you follow a vegetarian or vegan eating plan; if you need help, ask your doctor to refer you to a dietitian. Also, eat foods high in vitamin C, such as citrus fruits, strawberries, peppers, and tomatoes, to help your body absorb iron from foods.

Treatment may also include identifying the underlying cause for the anemia and providing appropriate treatment, such as a blood transfusion or surgery to stop any bleeding.

Pay attention to any signs or symptoms of iron deficiency anemia, and let your doctor know if you have them. Anemia may worsen diabetes complications such as heart disease, kidney disease, and eye problems. It can also delay healing of wounds and foot ulcers.

Want to learn more about iron? Read “The Nuts and Bolts of Dietary Iron.”

Amy Campbell, MS, RD, LDN, CDCES

Amy Campbell, MS, RD, LDN, CDCES

Amy Campbell, MS, RD, LDN, CDCES on social media

A Registered Dietitian and Certified Diabetes Educator at Good Measures, LLC, where she is a CDE manager for a virtual diabetes program. Campbell is the author of Staying Healthy with Diabetes: Nutrition & Meal Planning, a co-author of 16 Myths of a Diabetic Diet, and has written for  publications including Diabetes Self-Management, Diabetes Spectrum, Clinical Diabetes, the Diabetes Research & Wellness Foundation’s newsletter,, and

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