Tiredness, difficulty concentrating or brittle nails: Symptoms like these are often linked to iron deficiency. As a trace element, iron plays a central role in the body, supporting functions like blood formation and oxygen transport. Find out what triggers a deficiency and when treatment is advisable.
Iron deficiency means the body’s iron stores have fallen below a healthy level. Iron is needed for functions that include the production of red blood cells and haemoglobin. If iron is lacking over a prolonged period, oxygen transport in the body can be impaired.
Common early signs include tiredness, reduced performance and difficulty concentrating. These symptoms are non-specific and can have other causes, which is why a blood test brings clarity.
A blood test measures ferritin, which provides information about iron stores. The CRP level is usually checked as well, to see whether inflammation may be a confounding factor.
As a guideline: A ferritin level below 15 nanograms per millilitre of blood (ng/ml) means iron stores are practically empty. In women of menstruating age, even a level below 50 ng/ml may be associated with symptoms such as persistent tiredness.
A low iron level on its own isn’t necessarily dangerous, but left untreated it can worsen and lead to more pronounced symptoms. Medical assessment is recommended, especially if symptoms persist.
Two forms are distinguished: In latent iron deficiency, iron stores are already reduced but the blood count is still normal. In iron deficiency anaemia, the blood pigment haemoglobin is also too low, impairing oxygen transport.
If iron deficiency has been confirmed, iron supplements in tablet form usually help. However, they should only be taken under medical supervision. If tablets don’t achieve the required effect, iron infusions may be considered. Iron-rich foods alone generally aren't enough to treat an existing deficiency, but they do help with prevention.
Iron is a vital trace element as it performs key functions in the body: It’s particularly important for producing the blood pigment haemoglobin, which ensures oxygen is transported around the body. Iron also supports the immune system and the production of certain neurotransmitters in the brain, along with other nervous system processes. A balanced iron status is therefore a basic prerequisite for energy, concentration and a well-functioning immune system.
Iron deficiency is diagnosed when the body’s iron reserves fall below a certain level. While severity levels can vary, the two best-known forms are:
How pronounced and how long-standing the deficiency is affects which symptoms appear. Common symptoms include:
Because these complaints are non-specific and can occur in other conditions too, it's worth having a blood test if symptoms persist. Only a root cause analysis, including a ferritin test, can reliably show whether iron deficiency is the problem.
Paleness arises because less haemoglobin is produced in iron deficiency, and haemoglobin is what gives skin its colour. On its own, though, paleness isn’t a reliable sign of iron deficiency, as it can also be caused by factors such as cold, circulatory problems or an individual’s natural skin tone.
Fatigue in iron deficiency occurs because less oxygen is being transported around the body. However, fatigue often has other causes – for example depression, kidney disease, thyroid dysfunction or chronic hepatitis. It's therefore important to have the root cause analysed by a medical professional before starting iron therapy.
Before, I was completely exhausted and went through really depressive phases – but I thought it was because I was juggling two small children with work and studies.
The most common causes of iron deficiency are increased iron requirements, recurrent blood loss (for example through menstruation), and inadequate iron intake due to an unbalanced diet. Requirements are higher, for instance, during growth phases and in pregnancy, when the body needs more iron to produce blood. Intensive sport also raises demand, as more iron is lost through sweat and micro-injuries. Other possible causes include:
The body can’t produce iron itself and relies on dietary intake. Iron requirements differ markedly according to gender and life stage:
Important: Because it’s scarcely possible to meet the increased iron requirement in pregnancy through diet alone, iron supplements are often prescribed for women during pregnancy or while breastfeeding.
A balance is needed between intake and loss – and there are simply some people who lose more. Menstruating women are one example.
Besides taking gender, age and pregnancy into account, there are also other groups of people with higher iron requirements or a greater risk of deficiency:
If you belong to one of these groups, it’s worth keeping a close eye on your iron level and having it checked by a doctor if needed.
To reliably determine the body’s iron levels, a blood test is carried out to check ferritin levels. This protein indicates how full the iron stores are. While there are no standard threshold values, a general guideline is: If ferritin is below 50 nanograms per millilitre of blood (ng/ml), symptoms can already occur; below 15 ng/ml, iron levels are too low. It’s not possible to state a single ferritin value that’s considered dangerous for everyone – but as a general principle, the lower the value, the more pronounced the deficiency tends to be.
For a reliable diagnosis, CRP should also be measured. This protein indicates acute inflammation and infections, which can artificially raise ferritin and distort the test result.
With just a small prick in the fingertip and a result within minutes, it’s no wonder iron self-tests from pharmacies remain popular. Most of these tests measure the person’s ferritin level, which gives an indication of the body’s iron stores. However, such tests are only reliable when the deficiency is severe. Inflammatory conditions can also skew the results, as ferritin levels may rise regardless of the actual iron status.
Self-tests therefore provide only a first indication and don’t replace a thorough diagnosis by a healthcare professional. If you’re experiencing recurring symptoms or are unsure, it’s best to discuss the next step with a doctor and have your iron status checked with a blood test.
As a rule, not every case of iron deficiency needs treatment. Treatment is primarily recommended when anaemia has been diagnosed – that is, when the haemoglobin concentration is too low. It’s important to note that low iron levels don’t necessarily cause symptoms.In the case of iron deficiency without anaemia, treatment makes sense mainly when symptoms occur. Options typically include tablets or infusions.
Iron tablets are usually better tolerated by the body, because the iron is supplied in several small doses over a longer period rather than the stores being completely re-filled in one or two sessions.
Iron infusions are generally a second option and are only considered if tablets cause gastrointestinal side effects or don’t produce the required ferritin rise. An iron infusion should always be medically supervised. In very rare cases, allergic reactions can occur.
Overdose through food alone is very unlikely. However, if iron supplements are accidentally taken in larger amounts than prescribed, acute iron poisoning can occur. Symptoms include nausea, vomiting, abdominal pain or diarrhoea and can be dangerous even in adults. In children, an overdose can be life-threatening. Iron tablets should therefore always be stored out of children’s reach. If too much iron is taken over a longer period, chronic iron overload can develop. This is when iron accumulates in organs such as the liver, heart or pancreas, potentially causing long-term damage.
To check whether treatment has worked, the medical practitioner will take another blood sample. In patients who take tablets, haemoglobin is checked after four weeks, while iron stores (ferritin) are measured no sooner than six to eight weeks. In patients treated with infusions, follow-up takes place at twelve weeks, because ferritin levels rise sharply immediately after treatment.
If you already have iron deficiency, it’s difficult to correct it with iron-rich foods alone – supplements are generally needed as well. For prevention, however, diet plays an important role, since iron is found in varying amounts in almost all foods.
Facts to note:
The amount of iron different foods provide varies considerably. The following overview shows the iron content of selected foods per 100 grams:
These figures show: Iron is found in both animal and plant foods. It’s important to remember that the body never absorbs all the iron contained in a food, only a fraction of it. Exactly how much depends on factors such as whether it’s haem iron (from animal sources, around 15–35% absorption) or non-haem iron (from plant sources, around 2–15% absorption).
The body also actively regulates absorption: When iron levels are low, significantly more iron is taken up from food than when stores are full. Daily iron requirements are around 10 to 15 milligrams, depending on age and gender. By regularly eating a varied, balanced diet, most people can meet their daily needs through food, depending on their individual circumstances.
Certain substances also affect how much iron the body can actually absorb. Some foods contain compounds that inhibit iron uptake in the gut:
Important: You don’t need to avoid a single inhibiting food altogether. Timing is what matters – if you avoid consuming coffee, tea or large amounts of dairy when eating iron-rich foods, you can significantly improve iron absorption. As a rule, a varied diet generally compensates well for the inhibiting effects of individual foods.
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