Iron Deficiency a Common Problem for U.S. Teens and Young Adults

Tired young woman rubbing her eyes while working at her computer.

According to research published on June 27th in the Journal of the American Medical Association[1], based on analysis of a nationally representative sample of nearly two decades of data, nearly 39% of females in the United States aged 12 to 21 have an iron deficiency.

Researchers Angela Weyand M.D. and colleagues from the University of Michigan examined iron deficiency using data from the National Health and Nutrition Examination Survey[2] of 3,490 participants. They found that the overall prevalence of deficiency was as high as 77.5% when using a 50-μg/L ferritin cutoff. This was not entirely due to menstruation, as more than 27% of not yet menstruating individuals were also deficient, even when using a stricter 25-μg/L cutoff.

Iron is an essential mineral used in every cell of the body, including to make ATP, the energy currency of our cells, and collagen, the structure underlying our bones, hair, skin, and nails. It is also critical to make hemoglobin, a protein in red blood cells that carries oxygen from the lungs to the rest of the body, and myoglobin, a protein in muscle cells that allows them to store the oxygen needed for energy.

The researchers found that more than a third of study participants were iron-deficient using an average including the strictest definition of deficiency, and yet 84% did not meet the criteria for anemia, the most advanced stage of iron depletion. Because iron is used across the body, non-anemic iron deficiency[3] is in itself a serious issue, one that can cause a variety of unpleasant symptoms, including:

  • Cold hands and feet
  • Difficulty concentrating and focusing
  • Frequent headaches
  • Fatigue, both mental and physical
  • Pale or olive-toned skin or dark under-eyes
  • Shortness of breath or inability to exercise
  • Brittle nails, dry skin
  • Hair that is very dry or falling out
  • Pica (unusual cravings for ice or dirt)
  • Irritability, low mood
  • Muscle weakness or heavy legs
  • Dizziness, heart palpitations

These symptoms often progress as deficiency worsens and are usually noticeable by the time anemia sets in. People with an iron deficiency may, however, not notice any symptoms because they often get used to living with the effects of being low in iron. If you suspect your iron levels are low, the only way to truly know is by having your doctor run a blood test.

Who is at risk for low iron? The researchers found that iron deficiency and iron-deficiency anemia were both associated with being non-White or of Hispanic ethnicity, and menstruation. In particular, those with heavy menstrual periods often lose significant amounts of blood and may benefit from extra dietary iron.

Other groups at risk of not getting enough:

  • Athletes, due to physical exertion, have increased iron loss and reduced iron absorption. Things like gastro-intestinal micro-bleeds, foot- strike hemolysis, post-exercise hepcidin bursts and exercise induced inflammation contribute to the issue.
  • Those who are picky eaters or who restrict their food intake or eat mostly plant-based, including those with anorexia or bulimia and vegetarians and vegans. Many plant foods have iron that may not be easily absorbed due to compounds in food, such as fiber, that can bind iron.
  • Pregnant folks need more iron because they are making extra blood for their needs as well as the physical and mental growth of their developing babies. People who have had surgery or accidents or who give blood often clearly have higher needs for iron as well.
  • Those with digestive system conditions such as celiac disease, GERD, or ulcers, and people who use certain medications including antacids and antihistamines may have reduced iron absorption.

Getting enough daily iron can help prevent deficiency. The amount of iron a person needs varies by age and sex. According to the NIH recommendations[4], healthy females should get an average of 18 mg iron in their diet per day – more than double that of males. Upwards of 27 mg per day is needed during pregnancy and around 11 mg after menopause.

It is generally recommended to get the needed iron primarily by eating iron-rich foods, which could include seafood such as clams and oysters, dark meat and organ meats, seeds such as pumpkin seeds, sprouted lentils, molasses, raisins and prunes, and products made with iron-fortified flours. However, heavy tea, red wine and coffee drinkers can have a harder time raising iron levels since tannins in these drinks often impacts iron absorption – in some cases reducing it up to 80%!

Due to all these factors, as well as genetics, once a person is iron deficient, it often doesn’t resolve without effort and supplementation, possibly even with a combination of different forms of iron to maximize absorption. For more information about iron supplementation, contact Flora Product Information at or by calling 1-888-436-6697.

[1]  Angela C. Weyand et al, Prevalence of Iron Deficiency and Iron-Deficiency Anemia in US Females Aged 12-21 Years, 2003-2020, JAMA (2023). DOI: 10.1001/jama.2023.8020


[3] Esa T. Soppi, Iron deficiency without anemia – a clinical challenge. Clin Case Rep. 2018 Jun; 6(6): 1082–1086. DOI: 10.15761/CCRR.1000456