Feeling Foggy And Drained? A Common Mineral Shortage Could Be To Blame

Treating the problem can make a real difference, though it may require speaking up for yourself.

What if your exhaustion is caused by more than family stress, work demands and social commitments? Those factors can certainly leave people tired, but iron deficiency — which affects roughly one-third of women who menstruate — may also be behind the problem.

“Many people think [iron is] just another vitamin, like you just didn’t take your iron, or you didn’t get enough in your diet, but it’s totally not that. Iron is a very important mineral ... that’s involved with every cell in the body utilizing energy,” said Dr. Steven Fein, a hematologist and owner of HemeOnCall, women’s health centers that treat iron deficiency, abnormal blood counts and more hematology issues.

“Your muscles cannot contract without iron. Your brain cannot think without iron,” he explained.

The condition is especially common among premenopausal women. “We think that about 30 million U.S. women have iron deficiency,” Fein said.

Iron deficiency can lead to a range of problems, including iron deficiency anemia. “You can imagine it like a spectrum where iron deficiency without anemia is the milder version, and then if you get to a point where you have iron deficiency anemia ... if you get to that point where you’re that severe, then the symptoms are all the worse — more fatigue, more tiredness,” Fein said.

About 15% of American women have iron deficiency anemia, and another 15 or 20% have iron deficiency without anemia, according to Fein.

“Anemia ... means that the iron is low enough that the bone marrow has essentially failed to keep up. It needs iron to make red blood cells, and it just can’t make enough because it doesn’t have the right supplies,” explained Dr. Joseph Shatzel, a classical hematologist and associate professor in the school of medicine at Oregon Health and Science University.

Neither iron deficiency nor iron deficiency anemia should be dismissed, since both can cause health problems. Doctors can diagnose them with blood tests.

Getting diagnosed, however, may take some self-advocacy. “We do not have a routine recommendation in the U.S. to screen for iron deficiency,” Shatzel said. As a result, the issue often goes unaddressed.

Here’s what to know about iron deficiency and iron deficiency anemia, including the signs you should raise with your doctor:

Fatigue and brain fog are among the most common symptoms of iron deficiency and iron deficiency anemia.

Women are often carrying the mental load of caring for children, partners and parents, while also handling essential tasks around the home. That can certainly contribute to fatigue and low mood. But iron deficiency can also play a role.

The most common symptom of iron deficiency and iron deficiency anemia is fatigue, “but difficulty concentrating, or poor concentration, that sort of mental fog ... is well noted,” Shatzel explained.

Signs of iron deficiency can also include poor memory and mood changes, Fein added. Research also shows that low iron may worsen depression and anxiety. People may have trouble catching their breath after exercise or climbing stairs, according to Fein. It can also cause dizziness or lightheadedness.

“Sometimes, people have weird cravings like chewing ice or craving ice,” said Fein, who noted that restless leg syndrome is also reported. Hair thinning is another indicator, according to Shatzel.

People who menstruate are especially vulnerable because of blood loss.

“Every time you have a menstrual cycle ... you lose blood. Blood is really your main store of iron,” said Shatzel, noting that it only takes a small amount of blood loss to trigger the problem.

The body absorbs iron slowly by design, “because if you do get excessive iron, that can be a health risk as well,” Shatzel explained.

“Probably about half of the women who have low iron have heavy periods that they don’t even realize a lot of the time,” Fein said.

Other causes include inflammatory bowel disease and Crohn’s disease, Fein noted. The issue can also signal colon cancer, a gastric ulcer or even Celiac disease, according to Shatzel. These conditions can affect both men and women, though in men the underlying cause is often more serious.

There has also been an increase in gastric bypass weight-loss surgery, “which causes iron deficiency on purpose by causing malabsorption of all nutrients,” Fein said.

Still, the problem is most often seen in women with periods and bleeding disorders, Fein added.

Iron deficiency and iron deficiency anemia are also common during pregnancy and can cause complications.

Iron deficiency and iron deficiency anemia are also common, and often underdiagnosed, in pregnant people, according to both experts, which can be especially dangerous.

Research shows that iron deficiency can cause complications in pregnancy for both the mother and the baby, Shatzel noted. These include preterm birth, low birth weight and developmental delays. If mothers are already fatigued from low iron, they may be less able to push, leading to more C-sections, Fein said. C-sections are riskier than vaginal delivery.

“And this is a public health problem that affects Black people disproportionately, because it turns out that half of [pregnant] Black people have iron deficiency, and a third of non-Black [pregnant] people have iron deficiency,” Fein added.

Treating low iron can improve everyday life.

Bringing iron levels back into a healthy range not only helps the body function properly, but can also improve overall well-being.

Treatment usually comes in one of two forms: oral iron pills or IV therapy, Shatzel explained. The best option depends on the individual. A doctor can help determine the right approach, though experts say IV iron is often more effective.

If the condition goes untreated, blood transfusions may be needed in rare cases, Shatzel said.

It is also important to address the underlying cause of iron deficiency, which for many women is heavy periods and may improve with birth control or other medical treatments, according to Shatzel. Because low iron can also stem from gastrointestinal issues, GI testing is sometimes needed to determine the best plan.

“I think the biggest thing in the general population is the quality of life. It’s pretty clear people feel better when they’re not anemic and their iron is at a good level,” Shatzel said.

Iron deficiency can leave people tired, distracted and anxious, making it harder to get through everyday life, whether that means spending time with loved ones, working or going for a hike.

With normal iron levels, athletic performance may improve, making a run, dance class or HIIT session feel less exhausting. You may also have more energy at work, Fein said, since heavy periods, tiredness and brain fog can lead to missed work and difficulty focusing on tasks.

“At the very least, it’s a quality of life issue for all these women,” Fein said. “And not only that, it’s a gender inequality issue to the point [where] a woman may not be able to function well at work. They may not get the job promotion or the salary that they deserve because they have this [issue], whereas men do not have this problem.”

“My general sense of this is that it hasn’t really been as important as it should be to the medical community because this is a very common thing that the majority of people suffering from are women,” Shatzel said.

If you menstruate and deal with brain fog, fatigue or other symptoms linked to iron deficiency and iron deficiency anemia, it may be worth discussing testing with your doctor. It could be an important step toward feeling better and living more comfortably.