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. 

The Connection Between Ferritin and Hair Loss

Your hair follicles actually store ferritin. When your body is short on iron for its essential functions (such as red blood cell production), it will steal it from the ferritin stored in less essential parts of the body, such as the hair follicle. 

If your ferritin levels are sufficient, a single hair grows five years on average before falling out and being replaced. If ferritin is insufficient, this life cycle gets shorter. Low ferritin also affects the hair’s ability to grow, and may change the hair’s texture, rendering it weaker, more brittle, and more resistant to curl. 

The Connection Between Ferritin and Thyroid

Another major cause of hair loss is hypothyroidism. Iron is also one of the key nutrients required for conversion of T4 (inactive thyroid hormone produced by the thyroid) to T3 (active thyroid), and iron deficiency increases the body’s tendency to produce more of the inactive reverse T3, rather than the active T3 hormone. 

What this means is that it is possible for a patient with low ferritin to have hypothyroid symptoms (complete with hair loss) and yet appear “normal” according to the standard TSH and T4 thyroid labs.

Causes of Iron Deficiency

  • Decreased absorption and depletion. This can occur with proton pump inhibitors such as omeprazole, as well as prolonged ingestion of aspirin or NSAIDs. It can also occur with ingestion of too much coffee, black tea, manganese, fiber, calcium, magnesium, or phosphates (soda). This is why, if you take an iron supplement (see below), it’s important to do so on an empty stomach.
  • An hidden bleed. It’s always worth checking for this. Occult bleeds often show up in the GI tract, and screening may include a stool culture, colonoscopy, and/or an endoscopy.
  • Menstruation. Menses = iron loss, which means menstruating women are more likely to be at risk for ferritin-related hair loss. Women who bleed heavily are at even higher risk; if this is you, you’ll need to get your estrogen-to-progesterone ratio balanced as well.
  • SIBO. Overgrowth of gut flora in the intestines can also rob your body of iron, as certain bacteria use iron in their life cycles.

Adequate Ferritin Levels

Ferritin levels are considered normal for women between 10-120 ng/mL, and between 30-250 ng/mL for men. However, about 50-70 ng/mL are required to stop hair loss and for adequate hair regrowth. 

Iron in Food

One of several reasons I don’t tend to favor vegetarian and vegan diets is because iron deficiency is so common in these patients. Although iron can be found in plant-based foods such as nuts, raisins, prunes, and whole grains, it’s difficult to eat enough of these to achieve adequate iron intake, compared to usual portion sizes and iron concentrations in meat and poultry. I simply advocate choosing free range and grass fed meat sources over agriculture-industry meats.

Should You Supplement With Iron?

Definitely not unless you’ve been tested and are definitively low. Iron is one of those nutrients for which overdose is both possible and serious if it occurs. It’s also relatively hard to absorb, so it helps if it’s given on an empty stomach, in a non-constipating chelated form, along with certain other nutrients like Vitamin C that will aid in its absorption. 

It will take at least a few months and sometimes up to a year with ferritin at adequate levels before you are likely to see significant hair regrowth, so do your best to be patient.

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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