I check 5 labs on the daily for women–cbc with diff, iron, tibc, % saturation, and ferritin. Iron deficiency is one of the most common nutrient deficiencies in the world, especially for women. You’ve probably heard of it in relation to fatigue and pale skin, but iron can also impact your mood, your motivation and your mental focus in ways that are easy to miss or misdiagnose if you don’t have it top of mind.
Here are 8 lesser known symptoms of iron deficiency that I see in the clinic
Symptoms that Mimic ADHD
Trouble focusing? Struggling with attention or mental fog? It might not be just a busy schedule, perimenopause or ADHD. Iron plays a key role in brain function.
Iron is critical for dopamine production, a neurotransmitter involved in attention and executive function. Several studies have shown that low serum ferritin (your iron storage level) is associated with ADHD-like symptoms. Low iron can reduce working memory and processing speed, making it hard to focus and organize your thoughts.
Clinical tip: If you or your child has been diagnosed with ADHD or has symptoms of ADHD, check your iron levels. Goal is to have a ferritin over 50 ng/ml.
Postpartum Depression and Anxiety
The emotional rollercoaster after birth? It’s real-but low iron can make it worse.
If you’re feeling anxious, teary, or emotionally flat after childbirth. It may not just be your hormones. Pregnancy, blood loss during and after delivery and breast feeding can drain your iron stores. Research shows that iron deficiency is linked to higher rates of postpartum depression and anxiety and replacing iron orally or IV if needed can improve those symptoms significantly. Iron is involved in the synthesis of serotonin and other mood-regulating chemicals, so it’s no surprise that low levels can tip your emotional balance. We can proactively treat iron deficiency after childbirth too by checking levels and replacing the iron to help prevent mood changes!
Decreased Exercise Performance
Are your workouts dragging lately? Iron may be the missing link-especially if you’re a runner, cyclist, or doing high-intensity interval training.
Iron helps deliver oxygen to your muscles. When it’s low, your body has to work harder just to maintain the same pace. Studies in female athletes show that even borderline iron deficiency (even before anemia occurs) can reduce endurance and increase fatigue.
Ferritin levels under 30 ng/ml are often associated with performance decline. Aim for a ferritin of 50-100 ng/ml if you’re training hard.
Unusual Cravings
You may have heard of people with iron deficiency craving ice, but I’ve definitely seen people craving salty things, chocolate, and even weirder things like dirt, clay and cornstarch.
Bizarre. . . yes. It’s the brain’s way of trying to compensate for the nutrient deficiency and the good thing is it disappears within weeks of iron repletion. Those insatiable cravings now satisfied can also help with weight loss for those that have iron deficiency.
Low Motivation
You know that feeling where you can’t make yourself care enough to do things? That gray-area feeling between physical fatigue and mental burnout?
Iron deficiency can blunt dopamine, disrupt thyroid function, and mess with mitochondrial energy production which is a perfect recipe for “meh” mode. This shows up in my practice with women who say, I’m not depressed, I’m just blah. They’ve lost their drive and can’t quite explain why.
Restless Legs at Night
Can’t get comfortable at bedtime because your legs are crawling or twitching? Restless legs syndrome is another under-recognized sign of low iron. Multiple studies link RLS to iron deficiency and treating it can significantly improve symptoms.
Hair thinning
Iron is essential for the production of hemoglobin, which helps carry oxygen to cells including those responsible for hair growth. When iron levels are low, the body prioritizes vital functions like oxygen delivery to organs over less critical processes like hair growth. This can lead to telogen effluvium, a condition where more hairs than usual enter the shedding phase of the hair cycle. While hair thinning can have multiple causes, correcting iron deficiency through diet or supplementation-if deficient-can often improve hair density over time.
So what should you do?
If any of these symptoms ring true it’s time to get your iron checked.
Ask for these labs:
- CBC (to check hemoglobin and red blood cells)-iron is one of the building blocks of red blood cells
- Ferritin (iron storage-ideally >50 ng/ml, or higher for certain symptoms
- Iron panel (serum iron, TIBC, transferrin saturation)
If your levels are low, treatment options include iron-rich foods, oral supplements (like ferrous sulfate, ferrous bisglycinate, or carbonyl iron) or in some cases IV iron.
Bottom Line:
These symptoms can creep up slowly and can impact your quality of life, but it is absolutely treatable and I love see these weird symptoms resolve when the iron level becomes normal.
