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Conquer Iron Deficiency: Stages, Causes, and Effective Solutions

By Dr. Nicole Cain ND, MA

Key Points:

Is your doctor keeping an eye on your iron levels?

We’ve been talking a lot about iron deficiency and how it can worsen your anxiety, panic, and depression. Beyond its role in mental well-being, iron is just as essential for our overall health, as it produces hemoglobin and transports oxygen throughout our bodies.

Yet, iron deficiency often goes unnoticed in routine health screenings. In fact, one of the most common errors in healthcare is overlooking the early signs of iron deficiency, particularly low ferritin levels. This can lead to pre-anemia or ferritin deficiency, which, if caught early, can be managed before it escalates into severe anemia.

In this article, you’re going to learn about the importance of iron in your body, the stages of iron deficiency, and how to recognize the signs early on.

What is iron and why does your body need it?

Many of us recognize iron as the element that gives our blood its red color. But it’s just a part of its functions.  Iron plays a critical role in our overall health and survival, especially in how our bodies create hemoglobin — the molecule in our blood cells responsible for transporting oxygen to our organs, tissues, and every part of our body.

Iron carries oxygen throughout your body.

In simple terms, iron takes oxygen everywhere. This process is essential for our survival because it affects everything from our energy levels to our cognitive functions.

Did you know that almost all the iron on the earth comes from ore deposits in rocks that were formed nearly 1.8 billion years ago?

Iron is stored in your body in the form called ferritin.

To ensure we never run out of this resource, our bodies have come up with a mechanism to store iron in a protein called ferritin.

This storage system is essential because, although we need iron daily, our dietary intake can vary and we might not be able to take iron every day. If you’re not absorbing enough iron and storing it in ferritin as quickly as you’re breaking down ferritin and using it, you might begin to experience symptoms associated with low iron levels, such as:

However, keep in mind that too much iron in your body can be just as dangerous as too little. You can learn more about that at my instagram account: https://www.instagram.com/drnicolecain/?hl=en

What is the definition of iron deficiency?

The European Society of Cardiology guidelines define iron deficiency as ferritin under 100. To get the full picture of your iron status, you should include an iron panel with your CBC (including ferritin) every time you get your blood work done.

Let’s talk about the process of iron deficiency. It occurs in 3 stages.

The 3 stages of iron deficiency

Most doctors traditionally rely on a Complete Blood Count (CBC) to diagnose anemia. After running CBC, they just tell you whether you’re ‘anemic’ or not. And if the test shows that you’re not, they stop there, potentially missing the early signs of iron deficiency.

Generally, iron deficiency anemia starts when you use iron more rapidly than you’re absorbing it. But you can develop symptoms of anemia right away before you actually have iron deficiency anemia.

There are three phases of iron depletion before you develop iron deficiency anemia:

Stage 1 of Iron deficiency: Mild Deficiency or Storage Iron Deficiency

The first sign that you may be entering the stages of iron deficiency is a decrease in ferritin levels, which indicates a reduction in your body’s iron stores. Even though your CBC might show normal levels of red and white blood cells, your iron reserves could be dropping.

During this phase, intervention is especially effective, yet doctors often ignore it because you’re not ‘anemic’ yet.

Stage 2 of Iron deficiency: Marginal Deficiency

As the deficiency progresses, iron saturation — the amount of iron bound to proteins in the blood — starts to decrease. This stage often goes unnoticed because, once again, red blood cells, hemoglobin, and hematocrit are normal in the CBC, despite the body’s reduced ability to transfer iron effectively. This marginal deficiency signifies a worsening condition that requires attention before it escalates.

Stage 3 of Iron deficiency: Iron Deficiency Anemia

The final stage occurs when iron stores are completely exhausted. Ferritin goes down even more and hematocrit and hemoglobin are also dropping. This stage is characterized by typical anemia symptoms.

The Iron Essentials Primer

What is ferritin and why do you need to check your ferritin levels?

Pre-anemia or Ferritin deficiency starts right away, long before anemia is detectable through standard blood tests. But many people miss this diagnosis because they’re not testing their ferritin levels.

What level of ferritin is too low?

When ferritin levels drop below 75, symptoms of pre-anemia can already start affecting your well-being. This means that a ferritin of anything less than 75 is too low. But without checking ferritin levels, you may overlook the initial signs of iron deficiency, delay intervention, and potentially allow the condition to worsen into full-blown anemia.

Thus, instead of watch-and-wait for full anemia to develop, you should test ferritin to find out if you have iron deficiency before it evolves into a more serious condition.

Now, let’s make sure you’re getting the most accurate results when you run your iron panel, starting with what not to do first.

Avoid this before you test your iron levels:

Before you get your iron levels checked you should stop your iron supplements.

Taking iron supplementation causes your iron levels to transiently rise, and if you do not stop supplementation before you do your iron blood test, you will get what is called a “false positive.” A false positive in this instance refers to your iron levels appear higher than they actually are, because you just took iron. This is similar to the idea of why you are supposed to fast before doing a fasting glucose test.

Serum iron tests do not give accurate information about your overall iron status.

It’s important to note that serum iron tests, which measure the amount of iron present in your blood at the time of the test, isn’t a very accurate assessment of your overall levels of iron. This is because serum iron changes quickly, and your levels of iron in your blood may rise and drop throughout the day.

The most accurate test for iron is ferritin.

For a more accurate measure of your iron status, the ferritin test is recommended.

Ferritin levels give insight into the amount of stored iron in your body, which is indeed a clearer indication of whether you are truly iron deficient.

Now that you know what your iron levels are, let’s explore some of the reasons why your iron may be low.

What are the most common causes of iron deficiency?

Iron deficiency usually happens for two reasons:

What can we do to treat the root causes of low iron?

This is where root-cause testing for low iron comes into play. You may want to see a gastroenterologist to get a thorough work-up of your gut health, an endocrinologist to look at your sex hormones, or another sort of specialist to run appropriate diagnostic testing.

Functional testing for iron deficiency.

Functional testing for iron deficiency may also be valuable. Depending on what I suspect may be at the root of iron deficiency, I may order comprehensive stool testing including parasite testing, or DUTCH testing, or environmental toxin testing such as those that screen for mold, metals, glyphosate, solvents and other toxins that can interfere with gut and hormone health.

I often recommend my clients to do what they need to in order to get to the root cause of their low iron levels. That may involve seeing specialists and testing. In either case, you need to find out why.

After understanding the root cause of your iron deficiency, you have to replace your iron levels. Here are some of my favorite iron deficiency treatments.

How to get iron levels up:

When people figure out they have low ferritin levels, the first thing they usually try to do is to get the levels up by taking iron supplements.

However, when taken alone iron supplements can cause a lot of side effects– most commonly digestive upset and constipation.

The best supplements for iron deficiency: Heme vs Non-Heme Iron

Regardless of whether it’s in heme form (which is found in animal products and is generally better absorbed by the body) or non-heme form (which comes from plant sources), you will get more bang for your buck if you take iron with certain specific herbs, vitamins and minerals.

Herbs, supplements, and minerals to improve iron absorption.

Optimal iron absorption requires a healthy gut, and a variety of minerals and nutrients including the right ratios of zinc, copper, magnesium, vitamin C, and selenium.

Common mistakes in iron supplementation.

So, you finally got to the root cause of why you feel so awful and figured out that you need to take iron to get your ferritin levels up. But every time you take your iron, you feel even more sick – body aches, digestive upset, and a general worsening of your condition make you think that it’s not even worth it to boost your iron levels.

If this sounds familiar, then you should know that this reaction might be due to how your body handles the iron supplementation.

Why supplementation with iron may make you feel worse.

Iron is essential for your liver to make an enzyme your body uses for detoxification, called the cytochrome P450 enzyme. If you are chronically low on iron and have not been able to make enough cytochrome P450 to keep up with your detoxification needs, you will start to build up toxins. Then, as you start to build your iron levels back up, you’ll detox more, and that can make you feel worse.

Common signs that your body is detoxing that may show up when you start taking your iron supplement may include:

To avoid this, I always advise my clients to start their iron slowly at a low dose and work their way up depending on how they tolerate the iron supplement. Pairing iron supplementation with a detox can also be helpful depending on your unique needs.

Is an iron infusion right for you?

There are three key instances when you might talk with your doctor about if an iron infusion might be right for you.

If you’ve been low on iron and have had an iron infusion to get your levels normalized, quickly, you’ll probably agree that getting an iron infusion can be game changing.

An iron infusion is a therapy where iron and saline are delivered straight to your bloodstream. This is especially helpful for those with malabsorption and who cannot properly absorb and process iron, because an infusion bypasses the gut and goes straight into the blood.

Iron infusions are not right for everyone.

However, you should know that iron infusions are accompanied by specific side effects and it’s not suitable for everyone.

Who should consider an iron infusion

Typically, iron infusions are recommended for those who:

For most people, iron infusions are well-tolerated, and adverse reactions happen less than 4% of the time.

Concluding Remarks

Understanding the progressive stages of iron deficiency, from mild deficiency to iron deficiency anemia, is key for early detection and intervention. But it can feel overwhelming, especially if your doctor isn’t educated or supportive.

If you’re looking for more support regarding all things related to iron, iron deficiency, ferritin and all things anemia, I have created a handout containing all of this information and more. You can access it inside of the Holistic Wellness Collective today!

Recognizing pre-anemia or Ferritin deficiency early on through ferritin level testing can prevent the progression to full-blown anemia, combat anxiety and brain fog at the root, and help you to take back control over your health.

Check out the Holistic Wellness Collective to learn how to start supplementing your iron today.

This article is for educational purposes only and is not intended as medical advice. Whenever considering changing your protocol whether it includes a change of medications, supplements, diet or lifestyle, always speak with your primary care physician first.

Dr. Nicole Cain is an advocate for empowering people around the world to help themselves via her educational free resources, online courses, and membership group. You can receive the tools you need to find the root cause of your symptoms and feel healthy again.