Low iron in older adults: What to know and when to see the doctor

The human body is an incredible machine, and iron is an important fuel that keeps it running and performing well. However, the body does not make iron on its own, so proper nutrition is essential for its production.

Here, we’ll take a closer look at iron’s critical role in our bodies, how things change as our bodies age, and how to maintain healthy levels for a lifetime.

What iron does in the body

Iron is a mineral your body uses to create hemoglobin, which is a protein in our red blood cells that carries oxygen from the lungs to the rest of the body. Iron is also necessary for creating certain hormones. The delivery of oxygen-rich blood is tied to everything from strong nails and supple skin to good circulation, stamina and brain health.

Why older adults may be at increased risk for low iron

There are 5 common reasons that older adults in particular should pay attention to their iron levels:

1. Chronic inflammation, or as some experts call it, “inflamm-aging.” Later in life, ongoing low-grade inflammation from age-related conditions (like heart failure or arthritis or kidney disease) can cause the release of a liver hormone that blocks iron absorption.
2. The frequent, long-time use of aspirin or NSAIDs (Tylenol, Advil). This can lead to the development of ulcers, polyps, or other conditions that may contribute to slow but chronic internal bleeding which depletes iron supply.
3. Changes in diet. Many older adults do not get enough iron from healthy foods or supplements due to changes in their appetite, isolation (living alone and eating alone), financial constraints, or even dental problems. Being on a restricted diet due to other health issues can also contribute to low iron.
4. Decreased absorption. As you age, low stomach acid or changes in the lining of your gut may hinder your body’s ability to break down iron and absorb it for its oxygen messenger role.
5. Chronic or co-existing kidney disease. Older adults may experience health challenges related to failing kidneys, which may overlap with problems related to iron.

Sources: American Society of Hematology (ASH), National Library of Medicine, Medical News Today, Mayo Clinic

Symptoms of low iron that are not normal aging

If you’ve ever experienced these symptoms or remember an older relative who had them, don’t dismiss it as “normal aging.” These signs and symptoms of low iron should be addressed with your healthcare provider, as they may indicate your body needs some support with iron production or absorption:

• Cold hands or feet

• Brittle nails

• Pale skin

• Extreme fatigue or weakness

• Chest pain or fast heartbeat

• Headache, dizziness or lightheadedness

• Shortness of breath

• Tooth decay

• Cognitive decline or changes

• Restless legs

• Soreness or irritation of the tongue

• Strange cravings for ice, dirt or clay

• Odd smell cravings for rubber, detergent or cleaning agents

How to diagnose low iron levels through preventive care

Blood work is generally the first way to determine if your iron levels are low. Your provider is likely to order lab testing focused on red blood cell size and color, the levels of hemoglobin and hematocrit (blood volume composed of red blood cells), and ferritin, the protein that helps store iron in the body.

Sometimes further testing is needed to determine the cause of low iron, particularly if there are concerns about internal bleeding. An endoscopy, ultrasound or colonoscopy may be ordered to examine the source of the bleeding and make a plan for treatment or intervention.

Because internal bleeding (even small amounts released slowly) may occur without signs or symptoms, staying up to date on routine screenings like colonoscopies or other preventive care measures can catch things like an iron deficiency before symptoms show up or progress to a high-risk level.

How to support healthy iron levels

Since our body’s supply of iron is built up through ingestion, what we eat is perhaps the most significant and practical way to keep those levels in the right place.

ArchWell Health nutritionist, Laura O’Hara, breaks down the two different types of iron and examples of what foods provide them:

• Heme iron: Found in animal-based foods and is absorbed more efficiently. 

Examples: red meat, poultry, fish, oysters, canned sardines, canned tuna, and organ meats

• Non-heme iron: Found in plant-based foods. Absorption is more variable as it does not bind to hemoglobin or myoglobin.

Examples: beans, lentils, spinach, fortified cereals, nuts, seeds, dark chocolate

• Other examples of high iron foods: eggs, figs, dates, raisins, whole wheat or enriched breads, tofu, broccoli, potato

Want more iron inventory ideas? Access a long list of iron-rich foods to keep your pantry or refrigerator well-stocked, compliments of the US Department of Agriculture’s National Nutrient Database.

Also remember to stay active — keep that iron-rich blood pumping from your heart to your lungs to your brain and back again.

When to talk to your doctor about persistent symptoms or concerns

Low iron symptoms like brittle nails or cold hands might not seem too serious, but things can escalate quickly — sometimes without much warning. Also, persistent weakness, dizziness and fatigue could cause you to be off balance, which could lead to a fall/injury.

Talk to your primary care provider before taking an iron supplement, as too much of this important mineral in the body can cause problems. Iron can also interact with other medications in harmful ways.

If you’ve noticed any of the signs we’ve shared here, there’s no time like the present to get it checked out. Reach out to your doctor to share your concerns and determine the best next steps; sometimes it may be a simple diet fix, quick lab work or a vital change in medications.

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