Scientists explained the inability to determine iron deficiency by skin
A trend is gaining popularity on social media, according to which iron deficiency can be determined by the appearance of the face: users associate low ferritin levels with dark circles under the eyes, pallor and grayish skin tone. However, a pronounced iron deficiency can indeed affect the appearance, but medicine does not distinguish a characteristic "person with low ferritin". About what skin changes may be associated with iron deficiency, who is at risk and why the problem can only be determined by a blood test, see the "Izvestia" article.
What is a "low ferritin face"?
The term "low ferritin face" is spreading on social media. This is what users call the alleged external signs of iron deficiency — primarily dark circles under the eyes, pale or grayish skin. Some authors say that after increasing ferritin levels, their complexion allegedly changed noticeably. The work was published in The Conversation magazine.
As Chloe Casey, a lecturer in nutrition and behavior at Bournemouth University, explains, ferritin is a protein that stores iron in the body. Therefore, a blood test for ferritin is used to assess the reserves of this element. Unlike iron itself, the level of which can fluctuate throughout the day, ferritin better reflects the amount of iron in the body's reserve.
Iron is necessary for the formation of hemoglobin, a protein of red blood cells that carries oxygen through the body. In addition, it is involved in growth, immune system function, and energy production. With a lack of iron, its reserves may first be depleted, and then, with a more pronounced deficiency, iron deficiency anemia develops, in which blood oxygen transport is disrupted.
According to the American Society of Hematology, iron deficiency is one of the most common conditions in the world and, according to the organization, affects about one in three people. However, many cases remain undetected: symptoms may persist for months or years before diagnosis.
Can iron deficiency change your appearance?
The popular trend has a definite medical basis. With severe iron deficiency, especially if it has already led to anemia, the skin can actually become paler. According to Casey, fatigue, a weaker immune system, mouth ulcers, brittle nails, and hair loss are also among the possible manifestations of iron deficiency.
The American Society of Hematology also lists a lack of energy, shortness of breath, rapid heartbeat, headache, and pale skin as possible symptoms of iron deficiency. With further development of the condition, iron deficiency anemia may occur, which already affects the blood's ability to carry oxygen.
At the same time, dark circles under the eyes, which are especially often noticed by the authors of the videos, cannot be considered a specific sign of low ferritin. The appearance can be affected by skin and facial features, sleep quality, stress, dehydration, hormonal changes and lack of other nutrients. Therefore, the same "tired" appearance can occur for completely different reasons.
There is some truth in the very notion that is spreading on social media, Casey notes.: severe iron deficiency, especially accompanied by anemia, can actually make a person look paler. However, this does not mean that low ferritin forms any characteristic set of facial features.
In a study published in the journal JAMA, researchers analyzed data from 3,490 girls and young women between the ages of 12 and 21. 39% of the participants had ferritin levels below 25 micrograms per liter, and 6% simultaneously had indicators corresponding to iron deficiency anemia according to the criteria used in the work. The researchers separately noted that iron deficiency may be present even in the absence of obvious symptoms.
Why can't a mirror replace a blood test?
The level of ferritin cannot be determined by the appearance of a person. Even if a person notices pallor, hair loss, constant fatigue, or dark circles under their eyes, these signs do not allow them to determine the cause. A blood test for ferritin is used to assess iron reserves, and if necessary, the doctor prescribes other tests, including a general blood test and iron metabolism.
It is especially important that iron deficiency may exist even before anemia develops. In this case, hemoglobin may remain within the normal range, although iron reserves are already depleted. Therefore, the absence of pronounced pallor or other noticeable changes in appearance does not automatically mean that there is nothing wrong with the iron level.
In September 2026, the American Society of Hematology released new clinical guidelines for the diagnosis of iron deficiency. They suggest higher ferritin thresholds for a number of patient groups. For adults, menstruating and pregnant people, the organization specifies a threshold of 30 nanograms per milliliter or lower, and for some high—risk groups - 50 nanograms per milliliter or lower. In inflammatory diseases, including some oncological and intestinal diseases, it is also suggested to take into account transferrin saturation, since inflammation can increase ferritin levels regardless of iron reserves.
This means that even the result of the analysis itself cannot be interpreted in isolation from the human condition. The doctor takes into account the symptoms, concomitant diseases and other blood parameters. Therefore, an attempt to determine a deficiency from a photo of a face or independently evaluate the result of one analysis may lead to incorrect conclusions.
Who is more likely to experience iron deficiency
Some groups do have an increased risk of iron deficiency. First of all, these are pregnant women, people with heavy menstruation, patients with inflammatory bowel diseases, as well as vegetarians and vegans. In these cases, a deficiency may occur due to increased body needs, regular blood loss, impaired nutrient absorption, or dietary patterns.
A separate group consists of teenagers and young women. During puberty, the body requires more iron due to growth, and after the onset of menstruation, regular blood loss is added to this. In a study of Swedish high school girls in 2025, published in Medical Xpress, iron deficiency was found in 38% of the participants. The highest risk was observed in girls who simultaneously followed a meat-restricted diet and reported heavy menstruation. Among vegans and vegetarians, deficiency was detected in almost 70% of cases.
Similar results were previously obtained by researchers from the University of Michigan, whose work was published in the journal JAMA Network. They analyzed national data on 3,490 girls aged 12 to 21 and found signs of iron deficiency in about four out of 10 participants. At the same time, some of the girls had a problem even before the onset of menstruation, which shows that blood loss alone during menstruation cannot explain the prevalence of deficiency.
Risk factors also include diseases of the gastrointestinal tract, surgery on the digestive system, regular blood donation and some chronic diseases. In these cases, the problem may be related not only to insufficient intake of iron from food, but also to blood loss or impaired absorption.
Is it possible to replenish iron with nutrition
If the reason for the shortage is insufficient iron intake, the diet plays an important role. Casey divides dietary sources of iron into heme and non-heme. The former are found in red meat, poultry and fish and are more easily absorbed by the body. The latter are found in lentils, leafy vegetables, oatmeal, chickpeas, tofu, and iron-fortified grain products.
Vitamin C helps the absorption of plant iron. Therefore, foods with iron can be combined with citrus fruits, sweet peppers, tomatoes and other sources of this vitamin. Tea and coffee, on the contrary, can interfere with the absorption of iron, so they are not recommended to be consumed directly with a meal if it is necessary to increase the intake of the element into the body.
At the same time, a pronounced or disease-caused deficiency cannot be reduced solely to the issue of nutrition. If iron is constantly being lost due to bleeding or is poorly absorbed, changing the diet alone may not be enough. In such cases, it is first necessary to determine the cause of the deficiency, and then choose a treatment.
If there is a confirmed shortage, the doctor may prescribe iron supplements. However, taking them yourself just for the sake of improving skin color or appearance is not worth it. As Casey notes, the popularization of such supplements on social media blurs the line between medical advice and marketing. Excess iron is toxic: even in relatively small amounts, drugs can cause nausea and diarrhea, and a significant overdose can lead to serious complications, including liver damage.
Thus, a change in skin color can indeed accompany a pronounced iron deficiency, but you should not look for a diagnosis in the mirror. If a person belongs to a risk group and at the same time is faced with constant fatigue, hair loss, unusual pallor or other symptoms, it is not the appearance that will help determine the cause, but an examination.
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