Many people who experience symptoms of iron deficiency seek medical help and are told that their blood tests look normal. Despite this, fatigue, brain fog, and low energy persist. How is that possible?
A common issue is that the focus is often placed on hemoglobin levels, which reflect the blood’s ability to transport oxygen but say little about the body’s iron stores. Iron deficiency often begins long before hemoglobin levels fall, and low iron stores can cause symptoms even when hemoglobin remains within the reference range.
Many women have ferritin levels around 20–30 µg/L, which may be considered normal according to some guidelines. However, research shows that symptoms of iron deficiency can occur at ferritin levels below 50 µg/L. This means that you can experience clear signs of iron deficiency even if your blood tests do not technically indicate anemia.
If you recognize these symptoms but are told that everything looks fine, it may be worth discussing your ferritin levels and what is truly optimal for your well-being.
Symptoms of suboptimal iron levels
These symptoms often develop gradually and can be subtle. Many people experience them without linking them directly to iron status, as hemoglobin levels may still be within the normal range.
- Mild fatigue and low energy.
- Reduced concentration and brain fog. Difficulty staying focused throughout the day.
- Cold hands and feet.
- Reduced physical endurance. Running, walking, or exercise may feel more demanding than usual.
- Increased cravings for caffeine and sugar. The body attempts to compensate for low energy levels.
- Increased susceptibility to infections. Colds and minor infections may occur more frequently.
A person who consumes an iron-poor diet may have low ferritin levels, for example 20–30 µg/L, while still having normal hemoglobin levels.
Symptoms of iron deficiency anemia
In iron deficiency anemia, iron deficiency is so advanced that the body can no longer produce sufficient hemoglobin, leading to reduced oxygen supply to the tissues. Symptoms become more pronounced and can significantly affect daily life.
- Severe fatigue and exhaustion. Everything feels like an effort.
- Dizziness and a feeling of weakness, especially when standing up quickly.
- Heart palpitations and shortness of breath. The heart rate increases to compensate for the lack of oxygen.
- Headaches and migraines.
- Pale skin and pale mucous membranes. Often clearly visible on the inside of the eyelids.
- Hair loss and brittle nails. The body prioritizes oxygen delivery to vital organs.
- Cravings for unusual substances, known as pica. This may include cravings for ice or soil.
A person with ferritin levels below 15 µg/L and low hemoglobin, below 120 g/L in women, often feels exhausted, becomes easily short of breath, and may struggle to cope with everyday life. They are often told that they look pale and may experience recurrent dizziness.
