- Old Town Scottsdale: (480) 949-9333
- Camelback & 101: (623) 777-1720
- Camelback: (623) 777-1720
- Scottsdale: (480) 949-9333
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Old Town Scottsdale:
Camelback & 101:
Old Town Scottsdale:
Camelback & 101:
The signs of iron deficiency that patients most often miss are the quiet ones: craving ice, brittle nails, hair shedding, restless legs at night, cold hands and feet, and a tiredness that sleep does not fix. Many people blame these changes on stress, age, or a busy schedule. A simple blood test can show whether low iron is the real cause, and treatment is usually straightforward once it is found.
At Phoenix Internal Medicine, we see iron deficiency in adults of every age. It often turns up during an annual physical or a visit for fatigue.
Iron is a mineral your body uses to make hemoglobin. Hemoglobin is the protein in red blood cells that carries oxygen from your lungs to every tissue in your body. Without enough iron, your body cannot make enough healthy red blood cells.
Iron deficiency develops in stages. First, your body uses up its stored iron, measured by a blood marker called ferritin. Next, the iron available in your blood drops. Finally, if the shortage continues, your hemoglobin falls and you develop iron deficiency anemia.
This slow progression is why symptoms are easy to miss. You can have low iron stores for months before your hemoglobin drops. During that time, you may feel off without knowing why. Some people have symptoms even when their red blood cell counts still look normal. You lose more iron than you take in, your body cannot absorb iron well, or your body needs more iron than usual.
Common causes include:
Blood loss. Heavy menstrual periods are one of the most frequent causes in women. Slow bleeding in the stomach or intestines is another, and it often causes no pain.
Low dietary intake. Diets low in meat, poultry, and fish can make it harder to get enough iron. Plant sources of iron are absorbed less easily.
Poor absorption. Celiac disease, inflammatory bowel conditions, and weight loss surgery can reduce how much iron your gut absorbs. Long-term use of acid-reducing medications may also play a role.
Higher needs. Pregnancy increases the body’s demand for iron.
Frequent blood donation. Regular donors can slowly drain their iron stores.
Regular use of certain pain relievers. Frequent use of anti-inflammatory pain medicines can irritate the stomach lining and cause small amounts of bleeding.
Our Medication Management reviews look for prescriptions and over-the-counter products that may affect iron levels.
Fatigue is the most common symptom of iron deficiency. It is also the one patients most often dismiss. When your tissues receive less oxygen, your body has to work harder to do everyday tasks.
Iron-related fatigue tends to feel different from normal tiredness. A full night of sleep does not seem to help. Climbing stairs, carrying groceries, or finishing a workout may feel harder than it used to. Many patients say they feel worn down by early afternoon.
Fatigue has many possible causes, including thyroid disorders, sleep problems, blood sugar issues, and hormone changes. We evaluate fatigue and low energy by looking at the full picture, and checking iron is often part of that work.
Hemoglobin gives blood its red color. When hemoglobin drops, skin can look paler than usual. This may be easier to see on the inside of the lower eyelids, the gums, or the nail beds than on the face.
Shortness of breath is another sign. With fewer red blood cells carrying oxygen, your body may breathe faster to keep up. You might notice it while walking up a hill or doing chores you once handled easily.
Shortness of breath can also signal heart or lung problems. Any new or worsening breathlessness deserves a medical evaluation.
Low iron can reduce oxygen delivery to the brain. This may cause headaches that seem to come without a clear trigger. Some people also feel lightheaded, especially when they stand up quickly.
These symptoms are easy to link to dehydration, which is a real concern in the Phoenix heat. If you drink enough water and still feel dizzy or have frequent headaches, low iron is worth considering.
When oxygen levels in the blood are low, the heart pumps faster to move more blood through the body. Some people feel this as a racing, pounding, or fluttering heartbeat.
Palpitations from iron deficiency often show up during light activity or even at rest. Over time, a heart that works harder to make up for anemia can come under strain. For patients with existing heart conditions, correcting low iron is an important part of heart disease management.
Iron is needed by muscles and by the brain. Low levels can leave your arms and legs feeling heavy or weak. Exercise may feel harder, and recovery may take longer.
Many patients also describe trouble focusing, slower thinking, or a sense of mental fog. They may forget small tasks or lose their train of thought more often. These changes are easy to blame on stress or poor sleep, which is one reason iron deficiency often goes unnoticed.
Pica is the urge to eat things that are not food. With iron deficiency, the most common craving is ice. This specific craving is called pagophagia. Some people chew several cups of ice a day and think of it as a harmless habit.
Other pica cravings may include clay, dirt, chalk, paper, or raw starch. Patients sometimes feel embarrassed to mention these cravings. We encourage you to bring them up. A strong, ongoing craving for ice is one of the clearest clues of low iron, and it often fades once iron levels are restored.
Your nails and hair need a steady supply of nutrients to grow. When iron is low, nails may become thin, brittle, or ridged. They may crack or chip easily. In more advanced cases, nails can curve inward and take on a spoon-like shape.
Hair loss is another overlooked sign. Low iron stores can cause increased shedding across the scalp rather than in one patch. Many women notice more hair in the shower drain or on their brush before any other symptom appears. Because hair loss can also come from thyroid problems or hormone shifts, we may check several lab values at the same time.
Restless legs syndrome causes an uncomfortable urge to move your legs. It is usually worse in the evening or at night when you are sitting or lying still. People describe a crawling, tingling, or pulling feeling deep in the legs.
Low iron stores are a known contributor to restless legs. This symptom can disrupt sleep and make daytime fatigue even worse. If you struggle with sleep issues and restless legs, checking your ferritin level is a reasonable step.
Feeling cold when others are comfortable can be a sign of iron deficiency. Reduced oxygen delivery and changes in circulation can leave your hands and feet chilly.
In a warm climate, this symptom can stand out. If you find yourself reaching for a sweater in an air-conditioned room when no one else is, mention it at your next visit. Cold intolerance is also common with an underactive thyroid, so we often evaluate both.
Some people with low iron crave specific foods rather than non-food items. Cravings for crunchy foods, salty snacks, or certain textures are sometimes reported.
Other overlooked mouth-related signs include a sore or swollen tongue, a smooth and pale tongue surface, and cracks at the corners of the mouth. These small changes are easy to ignore. Together with other symptoms, they can point toward low iron.
Anyone can develop iron deficiency.
Patients who have had weight loss surgery
Frequent blood donors
People who regularly take anti-inflammatory pain relievers
Adults with chronic kidney disease or heart failure
Older adults, who may have lower intake or slow, hidden blood loss
In men and in women after menopause, iron deficiency is less common. When it does appear, it needs a careful look for a source of blood loss, often in the digestive tract. Finding that source early matters.
Catching iron deficiency early has real benefits. Symptoms can improve once iron is restored. Treating low iron stores before anemia develops is often simpler than treating advanced anemia.
Early detection also helps uncover the cause. Iron deficiency is a sign that something is pulling iron out of balance. In some cases, that cause is easy to fix, such as a diet change. In others, it may point to a digestive condition that needs further evaluation.
Seek prompt care if you notice symptoms of low iron that last more than a few weeks. Go to an emergency room or call 911 if you have chest pain, fainting, severe shortness of breath, or black or bloody stools.
Iron deficiency is diagnosed with blood tests. Symptoms alone cannot confirm it, because so many conditions cause similar feelings. Common tests include:
Complete blood count. This measures hemoglobin, red blood cell count, and the size of red blood cells. Iron deficiency often causes smaller, paler red blood cells.
Ferritin. This reflects your stored iron. A low ferritin level is one of the most useful markers for iron deficiency.
Serum iron and iron-binding capacity. These show how much iron is moving in your blood and how much your body is trying to hold onto.
Transferrin saturation. This shows how much of your blood’s iron-carrying protein is actually carrying iron.
Ferritin can rise during inflammation or infection. This can make iron levels look better than they are. Reading the full panel together gives a clearer answer.
Both of our offices provide on-site phlebotomy. That means your blood can be drawn during your visit, which supports faster results and quicker follow-up. Learn more about our Blood Tests & Lab Work.
Depending on your results and history, we may also check vitamin B12, folate, thyroid function, kidney function, or celiac markers. If a source of blood loss is suspected, we coordinate Referrals to Specialists and review the findings with you.
Many cases of iron deficiency are found during routine visits. An annual physical gives us a chance to ask about energy, diet, menstrual history, sleep, and medications. It is also a natural time to order lab work when something seems off.
Regular Preventive Care & Screenings help track trends over time. A slow drop in hemoglobin across several years can be just as meaningful as one low result. Keeping your care with one primary care team makes those trends easier to spot.
Colon cancer screening is also part of preventive care for adults in the recommended age range. This matters for iron deficiency, because slow bleeding in the colon can be a hidden cause.
Treatment depends on how low your iron is, what is causing it, and how well your body handles supplements. Our board-certified internists, Dr. Punnaiah Marella, MD and Dr. Shantipriya Siripurapu, MD, work alongside our physician assistants to build a plan that fits your health history.
Common approaches include:
Oral iron supplements. These are the most common first step. Many people take iron once a day or every other day. Taking iron with a source of vitamin C may improve absorption.
Timing tips. Iron absorbs better when it is not taken with calcium, dairy, coffee, or tea. Some medications, including certain thyroid medicines and antacids, should be spaced apart from iron.
Managing side effects. Constipation, nausea, and dark stools are common with oral iron. Adjusting the dose, the schedule, or the type of supplement often helps.
Treating the cause. If heavy periods, a digestive condition, or a medication is driving the problem, addressing it is key to long-term success.
Intravenous iron. For patients who cannot absorb or tolerate oral iron, or who need faster correction, IV iron may be considered through coordinated specialty care.
Iron levels take time to rebuild. Hemoglobin may begin to improve within a few weeks. Refilling your stored iron often takes several months. Do not stop treatment early just because you feel better.
Avoid starting high-dose iron on your own without testing. Too much iron can build up in the body and cause harm, and some people have conditions that make them store iron too easily.
Once your iron is back in range, a few habits can help keep it there:
Eat iron-rich foods. Lean red meat, poultry, fish, beans, lentils, tofu, spinach, and iron-fortified cereals are good sources.
Pair plant iron with vitamin C. Foods such as citrus, bell peppers, tomatoes, and strawberries help your body absorb iron from plant sources.
Watch the timing of coffee and tea. Drinking them between meals rather than with meals may improve iron absorption.
Address ongoing blood loss. Heavy periods and digestive conditions often need continued management.
Follow up on labs. Periodic ferritin and blood count checks help catch a drop before symptoms return.
Patients in our Weight Loss Support program and those with a history of weight loss surgery may need closer monitoring, since diet changes and absorption issues can affect iron.
Reach out to your primary care provider if you notice any of the following:
Fatigue that lasts more than two to three weeks without a clear reason
A strong or ongoing craving for ice or non-food items
New hair shedding, brittle nails, or restless legs
Shortness of breath or a racing heart with light activity
Very heavy menstrual periods
Symptoms that return after finishing iron treatment
Side effects from iron supplements that make it hard to continue
We see adults 18 and older at our Camelback & 101 office in Phoenix, AZ and our Old Town Scottsdale office. Bring a list of your symptoms, your medications, and any supplements you take to your visit. This helps us connect the details and choose the right tests.
Iron deficiency often hides behind symptoms that feel ordinary: tiredness, cold hands, brittle nails, hair shedding, restless legs, and a habit of chewing ice. Knowing the signs of iron deficiency: what patients often miss can help you speak up sooner. A simple blood panel can confirm the diagnosis, and treatment usually works well once the cause is found. Our team at Phoenix Internal Medicine uses on-site lab work, careful review of your history, and coordinated follow-up to help restore your iron and your energy.
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Phoenix Internal Medicine
October 16, 2026
Scottsdale:
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