Updated: Aug 24
Iron deficiency is one of the most common things I see in my clinic and for many people, it's been an ongoing issue over years, or even decades! 'Yeah I've always had pretty low iron' - I hear that sentence often.
Despite iron supplementation, iron infusions, increasing dietary iron intake etc., people consistently still have issues with lower iron levels because they haven't addressed the cause of the problem and their GP or specialist often has never suggesting doing so either.
Heavy menstrual bleeding, digestive issues that mean the breakdown of food and/or absorption of nutrients is compromised (which may also include absorption of nutrients from supplementation), low dietary intake, higher consumption of things like caffeine that compromise absorption of nutrients like iron, gastrointestinal parasites and so on.
The other thing I hear a lot is, 'I had my iron tested and it was fine'. Ferritin levels are generally the best indicator of iron status because that's our iron storage protein. References ranges suggest that a ferritin level as low as 20ug/L is 'fine', but if you have a ferritin level lower than around 50ug/L, you may not necessarily have anaemia, but will likely still be experiencing symptoms of lower iron and that certainly won't make you feel like you're 'fine'.
You have to remember that the reference ranges that are used are an average of the results taken by that lab. Often its people that aren't feeling well that are getting blood tests done, so what's considered normal, most certainly isn't optimal.
Ferritin is also related to zinc and protein intake and metabolism, not just iron, so there are several things to consider. Levels can also be raised in acute infections and therefore give a false high result. You also need to consider other results like transferrin, and also haemoglobin which is a protein found in red blood cells and will give an indication of true available iron, and MCV which tells you whether your blood cells are smaller or larger than normal.
GP's can be great at determining whether disease is present or ruling out bigger issues, but further investigation into your blood results can give you much more information about why you might not be feeling 100%, even though your results are within range and seem 'fine'.
In saying all of that, sometimes you may not have had a blood test or your results aren't available. Your body will give you plenty of signs that low iron may be a problem:
Restless legs - particularly at night. Feeling like you need to stretch them or keep them moving.
Feeling cold all the time.
Pale skin and pale around the mucous membranes of the eyes.
Feeling breathless without much physical exertion.
A sore tongue.
Thin, flakey finger nails.
Low energy levels.
Getting sick frequently.
There are many others and you may not have all of these, but this is a big part of the puzzle. For example, you may have a couple of these symptoms, some digestive issues and fairly heavy periods, you can be pretty sure that lower than optimal iron levels may be a problem you you.
What can you do about it?
Taking an iron supplement might be part of the solution, increasing dietary iron intake or reducing caffeine near meals or supplementation. But ultimately you need to address the cause. Improve digestive function and absorption of nutrients, address potential oestogen dominance and hormone clearance that may be causing heavy bleeding, and so on. The solution will be different for everyone.
What are the best iron supplements?
The iron supplements that you get from pharmacies are generally poorly absorbed and often lead to further digestive issues like constipation. The type of iron that you want to be taking in most instances will be Iron Bisglycinate which is an amino acid chelate. Around 25mg daily is good for most people and this form of iron means you avoid the common digestive side effects that you get with poorer quality forms of iron.
As with anything, there is always a cause. If you're having issues with low iron levels there will be a reason for it.