So you’ve been told you have an iron deficiency. Or iron deficiency anaemia. This might feel like a straight forward issue of having enough iron or not, but really there is a deeper story to be told. Beyond the mere numbers your doctor is looking at lies the intricate dance of iron metabolism where balance is key.
Getting a truly accurate iron status assessment requires careful preparation and comprehensive analysis, yet often this essential information is overlooked by the medical community. And as a result, women are left grappling with inaccurately prescribed iron supplements that may go on cause their own unforeseen problems.
First of all, what is iron?
Most women are aware that iron is an essential mineral responsible for carrying oxygen around the body. Without enough iron and the ability to use the iron you’ve got, you can feel weak, tired, pale and brain dead. Too much iron leads to damaged tissues and damaged organs, and can worsen symptoms of inflammatory diseases (like endometriosis or Inflammatory Bowel Disease). The key is to have just enough iron, and to make sure your body is able to use it.
How to get your iron levels checked accurately
Getting an accurate read on your iron status is essential to understanding your overall health. The test itself requires preparation to ensure precise results – and unfortunately most doctors are not communicating this preparation to their patients prior to testing.
To get accurate results, follow these steps first:
1. Fast from all food & beverages (excepting water) for 5-12 hours. Interestingly anything taken in before AND after this period can lead to misleadingly high iron levels.
2. Avoid alcohol, iron fortified foods, iron supplements & cooking with cast iron cookware in the 24 hours prior to testing.
3. Strenuous exercise should be avoided 24 hours prior to testing. Moderate exercise should be avoided just before doing the test as well.
What you need to know about the current iron testing methods
The main issue with just using a standard iron panel on blood tests is that it overlooks your overall iron metabolism, and fails to consider other factors that may be influencing your results. This means that if your GP solely relies on ferritin as the best marker for iron deficiency anaemia (which unfortunately happens frequently), they might end up giving you inaccurate results.
If you want your GP to assess your iron levels effectively, first ask them to test the entire iron panel.
This includes your:
1. Transferrin: This protein binds to iron and transports it around the blood, and is the best indicator of how hungry your body actually is for more iron.
2. Saturation: This indicates how much iron is attached to the transferrin and whether it reaching where it is required (or not).
3. Serum iron: This provides insight into how much iron is in circulation at the time of the blood test, and finally…
4. Ferritin: The primary iron storage protein that is found in the liver & bone marrow, that shows the amount of iron waiting to be used by the transferrin. However by the time ferritin appears in the blood (where it’s being measured), iron has been released and can be already breaking down organ cells. Inflammation can also increase ferritin in the blood, making it an excellent marker for your overall inflammation.
For an even more accurate assessment of your iron status, it’s also a good idea for your doctor to measure your haemoglobin alongside your iron panel, as haemoglobin is where 70% of your iron is stored (thus provides you with a much better idea of your actual iron levels).
Once your iron panel has been checked, other influences need to then be considered in order to read the results accurately
There is a list of things that can make your iron panel results look falsely high or low. Which means they all need to be considered when interpreting the results.
What could be making your iron status look normal or falsely high
• Inflammation that stems from disease states, strenuous exercise, obesity & the regular consumption of alcohol. Your doctor can also measure your inflammation by ordering a sensitive CRP with the blood test.
• Liver disease, which can be assessed by a Liver Function blood test.
What could be making you look iron deficient when in fact you’re not
• Moderate exercise before testing.
• A copper deficiency, which can hinder iron absorption and usage, and can then manifest symptoms resembling an iron deficiency (despite normal iron levels).
• A vitamin A deficiency, which can affect the regulation of iron metabolism genes, and the production of certain proteins (like ferritin) that play a role in iron storage and transport.
• A magnesium deficiency, as magnesium supports the absorption, transportation and use of iron. It is also required to incorporate iron into haemoglobin, where 70% of your iron is stored.
• Active bacterial infections + bacterial overloads, which are known to use iron to support their growth & survival.
• A genetic mutation called C282Y HFE. People who have copies of this gene from both their mum and dad experience increased iron absorption, causing iron to accumulate in the tissues (where it’s not measured) leading to iron overload & increased inflammation. This can present like an iron deficiency despite having excess stored in the tissues (on a blood test it will present as low ferritin & low transferrin – and your family members often will receive similar results despite adequate intakes of iron).
When evaluating a woman’s overall iron status, consideration must also be given to the high oestrogen states connected to pregnancy, Hormone Replacement Therapy (HRT) & the Oral Contraceptive Pill (OCP). Oestrogen acts as a signal to the body to increase iron uptake as iron is crucial to the healthy development of the foetus during pregnancy. This means if you take HRT or the OCP, your higher oestrogen state could be sending false signals to the body for a higher iron intake (that you don’t need).
As you have now read, it is crucial to find the right balance of iron as both iron deficiency and iron excess can profoundly impact your health. To find that balance, you must first know where you are actually starting from, and that begins with accurate assessment. A woman’s iron status must be measured in context to her entire nutritional biochemistry and overall health. That is the bare minimum standard you should expect from any health practitioner. Finding a health professional who understands testing nuances and these nutritional interconnections is essential if you want a comprehensive understanding of your overall iron status and metabolism. Empowering yourself with knowledge about how iron tests are performed allows you to make an informed decision, avoiding unnecessary supplementation when it’s not needed, and receiving the appropriate treatment when it is. Embracing this holistic approach can help you attain the balance of iron your body truly needs. And when you find that balance, you will start to feel well again.
Is your doctor looking at your blood work, telling you everything is ‘normal’ despite the fact you have clear symptoms? If this sounds like you, book a consultation with me today where I can translate your results for you in context to your symptoms and biological individuality. For more information please contact me via my booking page.
Warm regards,
