Iron Physiology 101

Most of us know that low iron makes you tired. This is because you have to have iron in order to make enough hemoglobin, which is the part of your red blood cells that binds and transports oxygen. There are several forms of anemia, but one of the most common is iron deficiency anemia. Too little iron leads to too little oxygen, which leads to exhaustion.

But there are several steps in the iron pathway before red blood cell count and size begins to decline, indicative of full-blown anemia. Ferritin, which is the storage form of iron, can be an early indication of a problem. It’s also chronically low in quite a few of my patients.

How Ferritin Gets Depleted

Like almost everything else, the process starts in your gut. It has to, because that’s where you absorb your nutrients. Or at least it’s where you’re supposed to.

Your gut is a teeming ecosystem of bacteria, most of which are helpful to you (called probiotics). They assist you in breaking down any undigested food particles, and they keep your gut lining strong, preventing intestinal permeability or invasion of pathogens. These probiotics also secrete acid, which makes iron soluble and able to be absorbed through your digestive tract.

But suppose those bacteria get killed off. This can happen from: 

So now iron can’t get absorbed—and as a bonus, the opportunistic fungal organism called candida starts to overgrow. Candida may cause or result from increased intestinal permeability, which means candida and any overgrowth of dysbiotic (bad) intestinal flora now come in contact with the bloodstream.

Next stop: the liver (that’s where your blood gets filtered). In response to the inflammation of intestinal permeability, the liver now secretes the antimicrobial hormone hepcidin, which reduces iron transport in the gut. Why does it do this? Because most microbes also require iron. Sequestering iron is one of your body’s strategies to cripple the enemy. The problem is, if you do have long-term overgrowth of dysbiotic flora and/or candida, not only will those continue to trigger hepcidin, lowering your absorption of iron, but they will also snatch up the iron you do have for their own life cycles.

Thus, as soon as you stop supplementing with iron, your ferritin levels plunge again.

What To Do About It

If your ferritin is low, you will need to supplement with iron for a few months to get your levels back up (but make sure you test your levels first; you don’t want to take iron if you don’t need it, as it can be a pro-oxidant in that case). But also make sure you identify and treat the underlying cause.

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If you have the opportunity to see a naturopathic doctor, please do so. It is always best to have someone to coordinate your care. However, if you have had your ferritin tested, if it is below 70 and if you are losing hair, I recommend this form of iron: it is gentler on the stomach and easier to absorb. Always re-check your ferritin levels in another 3 months.

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