Recognizing the Signs of Iron Deficiency

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If you have felt increasingly tired and are having trouble concentrating, perhaps a good nap is in order. However, if over time you also feel it is impossible to keep warm, your tongue is becoming bright red, and your nails are turning pale, it’s time to get your iron checked.

The mineral iron is essential for a properly functioning body. It can be found in every human cell, and holds the responsibility of carrying oxygen throughout our blood supply. Further proving its worth, iron aids in DNA synthesis and is a key element in energy production.2 Since iron has a large presence in our system, when we are lacking sufficient amounts, symptoms of deficiency can manifest in many ways and affect multiple organs.

Despite the importance of this mineral, iron continues to remain the most prevalent nutrient deficiency in the U.S., and the leading cause of anemia — a condition when an individual has a depleted number of red blood cells or hemoglobin.1 This is of particular concern in women and young children who are experiencing growth spurts.

For medical professionals, this means becoming more attuned to the signs and symptoms that iron deficiency can cause:

Pallor of the mucous membranes: This is most evident in the face and palms of the hands. Assess for pale (less vibrant) colored tongue, lips, palms or skin under the eyelids.

Glossitis: Inflammation of the tongue, causing it to become bright red and swollen. The finger-like projections on the tongue’s surface may disappear, instead leaving the tongue smooth.

Koilonychias or brittle nails: Without sufficient amount of iron, the body has difficulty getting the nutrients to the farthest points on our limbs, including the fingernails and toenails, making them pale, weak and easy to break. Koilonychias is an extreme case when the nail begins to spoon, or become concave in shape.

A Nutrition-Focused Physical Examination should be performed on all individuals meeting with a dietitian — however, circumstance and heredity may put some people more at risk then others. The following individuals should be carefully examined for signs and symptoms of iron deficiency:3

  • Women who menstruate, particularly if menstrual periods are heavy
  • Women who are pregnant, breastfeeding or have recently given birth
  • Any individual who underwent surgery where blood was lost
  • Anyone who has experienced physical trauma
  • Persons with a gastrointestinal disease, such as Crohn’s, Celiac, Irritable Bowel or Ulcerative Colitis
  • Persons with Peptic Ulcer disease
  • Persons who underwent gastric bypass
  • Vegetarians or vegans who do not include iron-rich dietary choices

If one or all of these physical signs of iron deficiency are present, the medical team should be informed and laboratory tests ordered to confirm these findings. If an underlying medical condition is the cause, the team should be made aware to address the issue. Adding iron-rich and fortified foods to the diet is a safe initial form of treatment. Depending on the extremity of the deficiency, iron supplementation may also be required for repletion.

Having keen knowledge of the human body’s utilization of vitamins and minerals, and the potential consequences when deficiency is present, confirms the importance of the registered dietitian’s role in the medical team.

1. CDC: Iron and Iron Deficiency
2. NCBI: Mechanisms of heme iron absorption: Current questions and controversies
3. American Society of Hematology:Iron-Deficiency Anemia

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Bethany Oxender
Bethany Oxender, MS, RDN, is a clinical dietitian based in Ann Arbor, MI, specializing in weight management. Follow her on Twitter or Instagram and read her blog, Bethany Grey.