Iron Deficiency With (or Without) Anemia: The Silent Drain on Your Energy and Life
“I realized something was off when I felt my heart pounding in my chest just taking the laundry up the stairs — and yet I could still force my way through a workout.”
That’s how I first noticed I was iron deficient. Not anemic. Just low enough to feel… not right. A bit more tired. A little foggier. A tad more winded than usual. But like many women — professionals, caregivers, athletes (yes, even if your “event” is squeezing in a spin class before school drop-off) — I had adapted. I assumed it was just stress, busy-ness, or poor sleep.
And that’s the thing about iron deficiency with or without anemia: it’s incredibly common, often missed, and quietly chips away at your quality of life.
What Is Iron Deficiency Without Anemia?
Most people associate iron deficiency with anemia — low hemoglobin that shows up on routine blood work. But you can have iron stores that are too low long before your hemoglobin drops.
Ferritin is the blood marker that reflects your stored iron. Even with normal hemoglobin, a ferritin under 50 µg/L can cause symptoms — especially in menstruating women, vegans/vegetarians, and people who regularly exercise.
In some conditions (like hairloss), specialists even suggest aiming for ferritin levels above 50 in symptomatic individuals before dismissing iron as a non-issue.
Symptoms That Might Be Iron Deficiency
Fatigue or energy crashes
Breathlessness (especially on stairs or mild exertion)
Exercise intolerance or recovery issues
Hair thinning or loss
Brain fog or low concentration
Cold hands and feet
Frequent headaches
Restless legs or difficulty sleeping
Sound familiar?
Why It’s Missed So Often
Your CBC is normal – so the doctor says you’re fine.
Fatigue is blamed on stress, parenting, hormones, or poor sleep.
Your diet looks “healthy” – especially if it’s plant-based or gluten-free.
You’re functional: You still work out, parent, work full-time. (That doesn’t mean you’re not depleted.)
You have inflammation - which can cause your ferritin level to go up even though you don’t have enough iron
Who’s at Risk?
Menstruating women, especially with heavy periods
Vegans and vegetarians — plant-based iron is harder to absorb
Endurance athletes or active individuals — running and high-impact exercise can increase iron loss
People with gut conditions like celiac, IBD, or long-term acid suppression therapy
Frequent blood donors
What to Test
Ask for:
Ferritin
Iron, TIBC, and transferrin saturation
CBC - which includes hemoglobin (to rule out anemia)
Note: Ferritin is also an acute-phase reactant, so if you’re sick or inflamed, it might be falsely elevated. That’s why context and interpretation matter.
Can You Fix It With Food?
Occasionally — but probably not.
If your ferritin is low, diet alone usually isn’t enough to replete your stores. That’s where iron supplements come in — and choosing the right form matters (more on that in a future post!).
The Takeaway
If you’re feeling off — more tired than usual, a little breathless, like you’ve lost your edge — don’t write it off.
Ask for your iron panel. Not just a CBC
Your energy, brain, breath, and mood might thank you.