Why is my iron low? UAE doctors explain the causes and who is most at risk

You’re sleeping enough. You’re eating well. You’re trying to take care of yourself. So why do you still feel exhausted? Why is your brain fog persisting, your hair shedding more than usual, and a simple flight of stairs suddenly leaving you drained?

It is easy to blame stress, and many people do. But doctors say these everyday complaints can sometimes be signs of a much more common issue: iron deficiency.

The challenge is that iron deficiency doesn't always show up in the way people expect. You don't need to have anaemia to feel its effects, and a routine blood test may not even pick it up.

The tricky thing about iron deficiency is that it hides in plain sight, slowly wearing down your energy.

Jamie Richards, Chief Wellbeing Officer at Valeo Health and a clinical psychoneuroimmunologist, says the decline is often so gradual that people struggle to recognise when something changed. "Iron deficiency rarely arrives overnight. Energy slowly fades. People often tell me they no longer feel like themselves, yet because the decline has been gradual, they struggle to identify exactly when it started."

Cue fatigue. A tad light-headed, accompanied by palpitations, shortness of breath, hair loss, burning or tingling sensations, headaches, dizziness, pale skin or even feeling unusually cold.

Moreover, they can be easy to dismiss, because they overlap with modern life, as Dr. Jomana AlFahham, Specialist Family Medicine at Medcare Medical Centre, says. "Many people attribute persistent tiredness, poor concentration or low energy to a busy lifestyle, stress or a lack of sleep, rather than considering an underlying medical cause."

She adds that in its early stages, iron deficiency may not cause obvious symptoms at all, and some people can already have depleted iron stores before routine blood tests detect anaemia.

Dr. Giovanni Leonetti, General Surgeon at Cornerstone Clinic, agrees, noting that many people mistake the slow decline for normal aging or everyday stress because the symptoms are so non-specific.

One of the biggest misconceptions is that iron deficiency and anaemia are interchangeable. The truth is, iron deficiency can be considered the beginning of the problem, and iron deficiency anaemia as the later stage.

Anaemia is a progressive condition, as Richards explains. It starts with iron deficiency, low stores and availability of iron. The next, more severe stage is iron deficiency anaemia, where this lack of iron eventually prevents your body from producing adequate haemoglobin.

That distinction matters because treating early iron deficiency is far easier than waiting until anaemia develops. Many people already experience symptoms even while their haemoglobin remains normal as iron supports much more than red blood cell production. "Iron plays an important role in energy production, brain function, muscle performance and supporting the immune system," adds Dr. AlFahham.

So, iron deficiency means that your body's iron reserves are running low, while anaemia means those depleted stores have progressed to the point where your body can no longer make enough healthy red blood cells.

In other words, you can feel awful long before you're officially anaemic.

Many people assume iron deficiency only becomes a problem once it develops into anaemia. But a 2021 review published in Clinical Medicine highlights an often-overlooked condition: iron deficiency without anaemia (IDWA), where the body's iron stores are depleted, but haemoglobin levels are still within the normal range.

The researchers found that iron deficiency anaemia affects around 1.2 billion people worldwide, while iron deficiency without anaemia is estimated to be at least twice as common. Yet it often goes undiagnosed because routine blood tests may only look at haemoglobin, missing the early warning signs.

The review explains that diagnosing iron deficiency requires looking beyond haemoglobin. Ferritin, a marker of the body's iron stores, is considered one of the most useful indicators, while transferrin saturation (TSAT) can provide additional information about how much iron is available for the body to use.

The researchers also highlight that iron deficiency can happen for many reasons, not just from a lack of iron-rich foods. The causes include increased needs during pregnancy or growth, blood loss from heavy periods or gastrointestinal issues, reduced absorption due to conditions such as coeliac disease, and long-term use of acid-reducing medications.

Certain groups may be particularly vulnerable, including pregnant women, children, vegetarians and vegans, athletes, and people with chronic inflammatory conditions.

This is why iron deficiency particularly tricky: The body can begin running low on its reserves before conventional blood tests flag a problem. The 2021 review on iron deficiency without anaemia warns that this overlooked stage is common, meaning many people may be experiencing the effects of low iron while assuming their symptoms are simply the result of a busy lifestyle, poor sleep or stress.

Persistent fatigue, brain fog, hair loss and low energy have become so common that many people automatically blame the stresses of daily life. The problem is that these symptoms are far from specific and can be linked to everything from thyroid disorders to other nutritional deficiencies, making it difficult to know when iron might actually be the underlying cause.

However, it's not enough to confirm iron deficiency. The only reliable way to determine whether iron deficiency is responsible is through appropriate blood tests, explains Dr. AlFahham. However, she notes that people should pay attention if they continue feeling exhausted despite getting enough rest or making healthy lifestyle changes, or if everyday activities that once felt easy suddenly leave them unusually tired or short of breath.

Furthermore, the relationship between iron deficiency and poor sleep can be misleading. "What came first, the chicken or the egg? Iron deficiency causes profound daytime fatigue, which can in turn lead to chronic insomnia, restless sleep and even restless leg syndrome. Blaming a lack of sleep or elevated stress is like shooting the messenger," Richards adds.

And so, what appears to be a sleep problem may actually be the consequence of depleted iron stores rather than the cause of the fatigue itself.

Leonetti adds that iron deficiency affects the body differently from ordinary burnout because it limits the oxygen reaching tissues. As iron stores become depleted, the brain and muscles receive less oxygen than they need to function efficiently, which can leave people feeling persistently drained, mentally sluggish and physically weaker. As these changes happen gradually, he says many people simply assume they are stressed, overworked or getting older, when the real issue may be an underlying iron deficiency that only a proper blood test can confirm.

At 23, a young woman sought medical help after months of symptoms she could no longer ignore: Headaches, nausea, irregular menstrual cycles and an unusual sensitivity to cold, describing her hands and feet as “always cold.”

According to a case report from the Kresser Institute, her symptoms initially appeared broad and could have pointed to several possible causes. She followed a mostly vegetarian diet with limited animal protein, frequently skipped meals because of nausea, and regularly used over-the-counter proton pump inhibitors (PPIs) for heartburn. medications that can reduce the stomach acid needed for iron absorption.

A detailed functional medicine assessment revealed the real issue: severe iron depletion. Blood tests showed low haemoglobin (11.2 g/dL), low ferritin (9 ng/mL), reduced serum iron and low transferrin saturation, alongside elevated total iron-binding capacity, a pattern consistent with iron deficiency anaemia. Tests also ruled out gastrointestinal bleeding as a cause.

The case authors concluded that her deficiency was most likely linked to a combination of low dietary iron intake and impaired absorption, with chronic PPI use potentially worsening the problem by limiting the stomach’s ability to process iron effectively.

Her treatment focused on addressing the root causes rather than simply replacing iron. She was advised to reduce PPI use, support digestive function, introduce more iron-rich foods such as beef, chicken liver, oysters and clams, and pair plant-based iron sources like lentils and spinach with vitamin C-rich foods to improve absorption.

The case drives home the point: Fatigue is not always a sign of stress or poor sleep. Sometimes, it is the body’s way of signalling that essential nutrients are running low.

Iron deficiency does not discriminate, but some people are more likely to develop it. Women of reproductive age are among the highest-risk groups, with heavy menstrual bleeding being one of the most common reasons their iron levels can fall.

And, pregnancy also dramatically increases iron requirements as the body supports both mother and baby. Teenagers face another challenge because rapid growth coincides with increased iron demands, while infants and children also require more iron during key developmental stages.

Plant-based eaters and endurance athletes also need to pay closer attention to their iron levels, albeit for very different reasons. Leonetti explains that while vegetarian and vegan diets can be rich in iron, they also tend to contain phytates and polyphenols, compounds that naturally reduce how much iron the body absorbs.

For athletes, the issue is often loss rather than intake. Richards says endurance exercise increases iron loss through sweat, microscopic bleeding and higher red blood cell turnover, while Leonetti highlights another lesser-known factor: "foot-strike hemolysis", where the repeated impact of running gradually breaks down red blood cells.

Additional higher-risk groups include:

Finally, iron deficiency in men and postmenopausal women should never be ignored, as it may signal an underlying source of gastrointestinal blood loss that requires investigation.

Many people assume iron deficiency simply means they aren't eating enough spinach or red meat. In reality, diet is often only part of the picture.

Richards says one increasingly common cause surprises many patients. He calls it the law of unintended consequences: "The one I come across most frequently is the increasingly common use of antacids or acid-blocking drugs, which lower the stomach acid needed to absorb iron."

Heavy menstrual bleeding, gastrointestinal bleeding, frequent blood donation, coeliac disease and bowel disorders are among the common contributors to iron deficiency. Beyond diet, experts point to chronic blood loss, medication side effects, impaired absorption, increased physiological demands and chronic inflammation as key causes.

Dr. AlFahham adds that stomach ulcers, haemorrhoids, Helicobacter pylori infection, pregnancy, breastfeeding and periods of rapid growth can also increase the risk.

Her key message is simple: correcting iron levels is only half the job — identifying and treating the underlying cause is equally important.

Iron deficiency should always be viewed as a sign that warrants further assessment. Identifying and treating the underlying cause is just as important as restoring healthy iron levels."

One of the biggest reasons iron deficiency slips through the cracks is because many routine blood tests aren't actually looking for it.

Richards explains that a standard complete blood count (CBC) often doesn't include iron markers. "A CBC can look completely normal even when your iron is low — 'a little information can be a dangerous thing.'" Furthermore, haemoglobin alone only identifies late-stage deficiency, as Dr. AlFahham agrees.

Instead, doctors say a full iron profile provides a much clearer picture.

This typically includes:

In some cases, additional tests such as C-reactive protein (CRP) help doctors interpret ferritin levels, since inflammation can make ferritin appear normal even when iron stores are low.

Richards sums it up with an analogy. "Haemoglobin typically only drops once deficiency has developed — testing it alone is 'locking the stable door after the horse has bolted.'"

Not necessarily. Experts strongly discourage self-prescribing iron simply because you're tired.

While iron supplements can be highly effective for genuine deficiency, taking them unnecessarily carries risks. Richards recommends a "test, treat and retest" approach.

"You test to discover a deficiency, treat the deficiency and then repeat the test to make sure the treatment has worked."

And, more isn't always better, as he warns. "We are saturated by high dose, poorly absorbed iron supplements, cheap, often ineffective, and prone to gastric side effects. Too much is often worse than not enough."

Instead, he says newer low-dose, better-absorbed formulations are often gentler and more effective. DR Leonetti also advises against blindly taking large doses, noting that excess iron can accumulate in organs and become toxic.

He recommends taking supplements on alternate days under medical supervision, choosing more easily absorbed formulations such as ferrous bisglycinate, and taking them one hour before meals with water or a vitamin C-rich drink for better absorption.

Nevertheless, check with your doctors first, as everyone is different.