Getting Proper Iron Testing: You may have low iron & not know It

As menstruating women, we are more likely to experience low iron levels throughout our life since blood is lost each month with our menstrual cycles. You are at a higher risk are if you have heavier periods, are pregnant, or following a vegetarian/vegan diet. But I have seen plenty of women who don’t fall into those categories with quite low iron levels and very bothersome symptoms!

​Iron is a mineral that is essential for our bodies to function properly, and it plays a key role in carrying oxygen from our lungs to the rest of our bodies. Without enough iron, our bodies can’t produce the red blood cells we need to stay healthy and energized.

How does my body feel when I have low iron levels? 

These are some of the symptoms you may feel:

  • Fatigue, weakness, shortness of breath
  • Pale skin, cold hands/feet
  • Craving for chewing on ice or other non-food items (this usually shows up when you are quite deficient!)
  • Headaches or lightheadedness
  • Brittle nails
  • Hair loss
  • Inflammation/soreness of the tongue

If you’re experiencing any of these symptoms that may be a sign that you have low iron levels. The best way to confirm this is to get tested for both hemoglobin AND ferritin. Many healthcare providers will typically check hemoglobin levels and neglect checking for ferritin. In addition, unfortunately, many people and healthcare providers alike assume if hemoglobin levels are normal that means your iron levels are also normal. However, that is not the case. Here’s why…

Hemoglobin is a protein in red blood cells that carries oxygen. When the body doesn’t have enough iron, it can’t produce enough healthy red blood cells. With the lower amount of red blood cells, you have lower amounts of hemoglobin. This is why low hemoglobin levels tell us that someone has iron-deficiency anemia.

In case I lost you, to recap: anemia means you don’t have enough red-blood cells. So, iron-deficiency anemia means you don’t have enough red blood cells because you don’t have enough iron. In summary, hemoglobin tells us if you have the minimum amount of iron needed to do an essential function for survival: manufacturing red blood cells.

Now, this is where it gets more nuanced. Although hemoglobin tells us whether you have anemia, it does NOT tell us how much iron you actually have. Remember, hemoglobin is just measuring red blood cells, so it’s an indirect measurement of iron. To measure how much iron levels you have stored in your tissues, you have to measure ferritin. The storage form of iron is ferritin, and I have seen plenty of women continue to suffer from the symptoms above (especially fatigue!) with normal hemoglobin levels, but upon further investigation they had low ferritin levels (low storage iron). Why does that matter?

Think of ferritin like the gas tank of your car, if it’s constantly close to empty, you won’t make it so far until you need another refill. That is why you want to make sure your storage levels of iron are also filled up to provide the energy and oxygenation your body needs! Optimal levels of ferritin to aim for are between 50-100 micrograms per liter (mcg/L). This can be measured in a blood test. Being in this optimal range is especially important while trying to conceive so you have optimal iron levels during pregnancy. 

You can also get a complete iron panel where you not only measure hemoglobin and ferritin but also get a direct measurement of how much iron is circulating in your blood and how much is being transported around between your tissues. I order more comprehensive panels like this on a case-by-case basis; in the least I make sure I always check all my patients’ hemoglobin and ferritin levels.

I have low hemoglobin or low ferritin; how do I replenish my iron levels?

It can be difficult sometimes to meet all your iron needs through diet alone. Women ages 19-50 need 18 mg of iron a day (in pregnancy it’s 27mg!). Six oz of beef only provides 4 mg, 1/2 cup of tofu or spinach provide 3 mg, 3 oz of beef liver provides 5 mg, and 1 cup of white beans provide 8 mg of iron. So how can we get the iron we need?

That is why I like to use cast iron pans and the iron fish routinely in my cooking, because it’s an effortless way of getting more iron into your daily foods. When cooking acidic foods with moisture in a cast iron pan the iron content in your food jumps up 6-8mg! Acidic foods include tomatoes, lemon, or spaghetti sauce. My favorite trick is to just drizzle some lemon juice in with my cooking (like wilting spinach with a drizzle of lemon). If you are cooking something that is broth based or requires boiling, just dump the iron fish in the pot with a drizzle of lemon and viola, you’ll get more iron with your dish.

Don’t take your iron with dairy

Yes! Calcium (which is high in dairy products), blocks iron absorption. On the other hand, vitamin C, commonly found in acidic foods, is what helps boost iron absorption. So, try to have your iron rich meals/supplements in different times than your diary rich foods.

What to look for in iron supplements & multivitamins

Another way to reach your daily iron needs is to use a multivitamin that contains 15-18 mg of iron. Some brands I typically recommend to my patients are PhytoMulti with Iron (Metagenics), Multi for Women (MegaFood), or Women’s Multivitamin (Innate Response). This is especially crucial if you are vegetarian or vegan, you must take a daily multi that has about 18 mg of iron. If you have low hemoglobin or ferritin levels and need higher iron supplementation my favorite iron supplements are in the form of iron bisglycinate or iron chelate – those are gentler forms of iron on the stomach that usually cause less stomach upset.

I also like supplements that combine iron and vitamin C together to boost iron absorption into your cells. You can also eat citrus fruits (they’re high in vitamin C) with your iron supplement to get the same effect! It’s also important to note that too much iron can be toxic, so you don’t want to over supplement. Make sure to get your ferritin levels routinely checked and stop supplementing once they have returned to normal. In some rarer instances some people may find that they are supplementing with iron, but their ferritin is not budging at all, in those cases make sure to request a full iron panel with your doctor to get a better picture of what is going on.

CAUTION: In some conditions like cancer or other cases iron supplementation can do more harm than good, if you have a medical condition, please make sure to consult with your doctor before adding in iron.

Leave a comment below if you find any of these suggestions helpful or if you have any questions about iron needs!

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