We all have flat days. But if you are tired in a way that a good night’s sleep does not fix, running low on energy for weeks on end, and putting it down to a busy life, there may be a simpler explanation worth ruling out. Iron deficiency is one of the most common nutritional shortfalls in the world, and it is easy to miss because the main symptom, tiredness, is so easy to explain away.
The good news is that it is straightforward to check and very treatable once identified. Understanding what to look for is the first step.
Why low iron leaves you exhausted
Iron does an important job in the body. It helps make haemoglobin, the part of your red blood cells that carries oxygen from your lungs to the rest of your body. When iron runs low, your body cannot make enough healthy red blood cells, and less oxygen reaches your muscles, brain, and organs.
That is why the tiredness of iron deficiency feels different from ordinary fatigue. It is a deep, persistent lack of energy that rest does not seem to touch, because the issue is not how much you are sleeping. It is how well your blood is doing its job.
The signs that go beyond tiredness
Fatigue is the headline symptom, but iron deficiency often shows up in other ways too. Worth paying attention to:
- Unusual paleness, or pale skin inside the lower eyelids
- Shortness of breath or a racing heartbeat during everyday activity
- Feeling cold, particularly in the hands and feet
- Frequent headaches or feeling lightheaded
- Brittle nails, or noticeably more hair coming out than usual
- Poor concentration or a persistent foggy feeling
You will not necessarily have all of these, and having one does not confirm anything on its own. Together, though, and alongside ongoing tiredness, they are a reason to get checked.
What actually causes it
Iron deficiency comes down to one of three things: losing iron, not taking in enough, or not absorbing what you eat.
- Blood loss. This is one of the most common causes. Heavy menstrual periods are a frequent culprit, as is slow bleeding inside the body from conditions such as ulcers or haemorrhoids. Regular blood donation can also lower your iron stores over time.
- Not enough iron in your diet. Iron comes from foods like red meat, poultry, fish, beans, lentils, and dark leafy greens. A diet low in these, including some vegetarian and vegan eating patterns, can fall short without a little planning.
- Difficulty absorbing iron. Certain conditions, such as coeliac disease, affect how well the gut takes in iron from food.
- Pregnancy. The body needs considerably more iron during pregnancy, which is why it is monitored so carefully.
Who is most at risk
Some people need to be a little more alert to this than others. Women with heavy periods, pregnant women, regular blood donors, people following diets low in iron-rich foods, and anyone with a digestive condition that affects absorption all carry a higher risk. If any of these apply to you and you have been feeling persistently drained, it is worth a conversation with your doctor.
Why you should test, not guess
It is tempting to buy iron supplements off the shelf the moment you suspect low iron, but this is one to approach carefully. Too much iron can be harmful and can build up in the body, so supplementing without knowing your levels is not a good idea.
A simple blood test is all it takes to confirm whether iron is the problem and how low your levels really are. Just as importantly, your GP will want to understand why your iron is low, because occasionally low iron is the first clue to something else that needs attention. Treating the number without finding the cause only solves half the problem, which is part of why regular check-ups matter so much.
When to speak to your GP
If you have been unusually tired for more than a few weeks, or you recognise several of the signs above, it is worth getting your iron levels checked rather than pushing through and hoping it passes.
At Take Care Clinic in Lonehill, Johannesburg, our GPs can arrange a simple blood test, talk you through the results, and get to the bottom of what is behind your fatigue. If your energy has not been what it should be, feel free to book an appointment and let us help you find out why.
Frequently asked questions
Can you be low in iron without being anaemic?
Yes. Iron stores can run low well before full anaemia develops, and you can feel tired and run-down during that earlier stage. A blood test can pick this up before it worsens.
How is iron deficiency diagnosed?
Through a simple blood test that measures your iron levels, including a marker called ferritin, which reflects your iron stores. Your GP may run additional tests to find the underlying cause.
Should I just take iron supplements?
Not without checking first. Too much iron can be harmful, and the right approach depends on your actual levels and the reason they are low. Speak to your GP or pharmacist before starting any supplement.