7 weird symptoms that may be a sign of an iron deficiency, according to a vegetarian dietitian

I’ve been a vegetarian for more than a decade, and I’ve struggled with iron deficiency anemia throughout that time, due to an underlying condition. Iron deficiency is not a given for vegetarians, but it is common.

If you think you may be iron deficient, ask your doctor for a simple blood test. Here are common iron deficiency symptoms that prove you may not be eating enough iron on a vegetarian diet.

What is iron?

Iron is a mineral that is necessary for hemoglobin, a protein that transports oxygen to the lungs for breathing and muscles for movement.

During exercise, the body sends blood to the working muscles to maintain energy levels.

The recommended daily intake for iron is 18 milligrams (mg). This is a bit more difficult to achieve on a plant-based diet because iron from plants is not absorbed as well as iron from animals.

There are two types of iron:

1. Heme iron: This is the iron found in meat, such as chicken, beef, pork and seafood. It comes from the blood of those animals, and heme iron is more easily absorbed by the body.
2. Non-heme iron: This iron is found in plant sources and animal byproducts, such grains, fortified cereals, beans, nuts, seeds, vegetables and dairy. Non-heme iron is not as well absorbed by the body, and you need more of it to meet your iron needs.

Can vegans and vegetarians get enough iron from food?

Vegans and vegetarians can get enough iron through food alone. There are plenty of iron-rich foods for plant-based eaters. Many veggies have iron, but you may need to eat more of them to get enough.

The National Institute for Healthy (NIH) recommends that vegetarians eat 1.8 times more iron than meat-eaters, which is about 32 grams. It never hurts to add more iron-rich foods to your plant-based diet.

You can also increase your absorption of plant-based iron by paying attention to the foods you eat together. Vitamin C enhances the absorption of iron, so eating those two nutrients together can help you body absorb this important nutrient. For example, pair iron-rich oats with Vitamin C rich strawberries.

Conversely, calcium decreases the absorption of iron. Therefore, you want to be mindful of eating foods that are high in calcium with iron-rich foods.

If you’re a vegan or vegetarian and you’re worried about other nutrients you may be missing out on, make sure you check out these articles:

• Vegan & Vegetarian Sources of B12
• 12 Best Plant-Based Sources of Calcium
• 8 Best Vegan Proteins For Athletes

Signs of an iron deficiency

If you aren’t sure if you’re getting enough iron, watch out for these signs and symptoms.

Chewing on ice  

Medical experts aren’t sure why this happens, but people with iron deficiency experience something called PICA– the desire to eat things with non-nutritive properties, such as ice, clay, dirt or paper. If you notice a strong desire to chew ice, definitely report this symptom to your doctor.

Extreme exhaustion 

Iron carries oxygen throughout the body. When people are iron deficient, they don’t get enough oxygen throughout their body and often feel very fatigued. This is a very hard symptom to recognize because most people feel tired daily.  

But if you are iron deficient, the exhaustion is extreme and may affect your daily life.  For example, you may be too tired to go out to dinner with friends or feel completely exhausted after a full night of sleep.

Feeling cold

If you notice that you are cold all the time, chances are you may not have enough iron in your diet. Since iron carries oxygen throughout the body to the extremities, it also helps keep the body warm. Without enough iron, you may have poor circulation, which can cause you to feel cold.

Brittle nails

People with iron deficiency may have abnormally shaped fingernails. The nail becomes thin and brittle, and it has raised ridges and curves inward.

Pale skin

Iron deficiency means a lack of healthy red blood cells, so people with iron deficiency may be very pale. That said, pale skin does not always correlate to an iron deficiency. If your skin color changes over time and you experience other symptoms on this list, talk to your doctor.

Lightheadedness and headaches

The lack of oxygen circulating in the body can cause problems with your brain. If enough oxygen does not get to the brain, you may experience a lightheaded feeling and/or headaches.

Restless leg syndrome

While sitting or laying down, you may suddenly feel an inexplicable aching in your legs or the overwhelming urge to get up and move your legs. It’s not all in your head, and it may be restless leg syndrome.

A lack of iron in the brain can cause this symptom, and it’s very persistent. Restless leg syndrome often occurs at night or may even wake you up from sleep.

What causes iron deficiency? 

If you’re experiencing any of these symptoms, you may wonder why this is happening. These are usually the main culprits for iron deficiency:

1. Not eating enough iron. Quite simply, vegetarians and vegans are at higher risk for iron deficiency because the iron in plants is not absorbed as well as the iron in meat.
2. Not absorbing iron properly. People with gastrointestinal disorders may have problems absorbing nutrients. If you have an undiagnosed case of Celiac or Crohn’s Disease, this could cause an iron deficiency.
3. Heavy bleeding, from heavy menstrual cycles or internal bleeding. A loss of blood equals a loss of iron. It’s as simple as that.

What to do about iron deficiency

If you think you have an iron deficiency, the first thing to do is talk to your doctor. They can do a simple blood draw to check your iron levels. If your doctor detects an iron deficiency, they may tell you to take an iron supplement.

Luckily, people who are deficient in iron absorb 20-30% of dietary iron compared with the 5-10% absorbed by those without iron deficiency. If there aren’t any problems in your digestive tract, you will absorb the supplements easily and the problem will be rectified.

But you should NOT take an iron supplement if you don’t need it. Too much iron in the blood can be toxic.

It also never hurts to eat more iron rich foods. And, pairing iron-rich foods with Vitamin C foods can enhance the absorption of iron.  Tea and coffee, or foods with tannins, decrease the absorption of iron.