Getting Proper Iron Testing: You May Have Low Iron & Not Know It

The Hidden Risk of Iron Deficiency in Women

As menstruating women, we face a higher likelihood of experiencing low iron levels throughout our lives due to monthly blood loss. Your risk increases if you have heavy periods, are pregnant, or follow a vegetarian/vegan diet. However, I’ve seen many women outside these categories with surprisingly low iron levels and significant symptoms.

Iron is an essential mineral that plays a crucial role in transporting oxygen from our lungs to the rest of our body. Without adequate iron, our bodies can’t produce the healthy red blood cells needed to maintain energy and overall health.

Recognizing the Symptoms of Low Iron

Low iron levels can manifest in various ways:

• Fatigue, weakness, and shortness of breath
• Pale skin and cold hands/feet
• Unusual cravings for ice or non-food items (indicates significant deficiency)
• Headaches or lightheadedness
• Brittle nails and hair loss
• Inflammation or soreness of the tongue

If you’re experiencing any of these symptoms, it could indicate low iron levels. The best way to confirm is through proper testing that includes both hemoglobin AND ferritin.

Why Standard Iron Testing Often Fails

Many healthcare providers check hemoglobin levels but neglect ferritin testing. There’s a common misconception that normal hemoglobin means normal iron levels, but this isn’t accurate.

Hemoglobin is a protein in red blood cells that carries oxygen. Low hemoglobin indicates iron-deficiency anemia—meaning you don’t have enough red blood cells due to insufficient iron.

However, hemoglobin only tells us if you have the minimum amount of iron needed for survival: manufacturing red blood cells. It doesn’t reveal how much iron you actually have stored.

Ferritin measures your stored iron levels. I’ve seen many women continue suffering from symptoms (especially fatigue) with normal hemoglobin but low ferritin levels.

Understanding Your Iron Storage

Think of ferritin as your body’s gas tank. If it’s constantly near empty, you won’t get far before needing a refill. Optimal ferritin levels range from 50-100 micrograms per liter (mcg/L). Maintaining this range is particularly important when trying to conceive, ensuring optimal iron levels during pregnancy.

For comprehensive assessment, a complete iron panel can measure circulating iron and transportation between tissues. I recommend at minimum checking both hemoglobin and ferritin levels for all my patients.

Effective Strategies to Replenish Iron

Meeting daily iron needs through diet alone can be challenging. Women aged 19-50 need 18 mg daily (27 mg during pregnancy), yet common sources provide:

• 6 oz beef: 4 mg
• 1/2 cup tofu or spinach: 3 mg
• 3 oz beef liver: 5 mg
• 1 cup white beans: 8 mg

Practical Cooking Solutions

Cast iron pans and iron fish are excellent tools for boosting iron intake. Cooking acidic, moist foods in cast iron can increase iron content by 6-8 mg! Acidic foods include tomatoes, lemon, or spaghetti sauce. My favorite trick is wilting spinach with a drizzle of lemon juice.

For broth-based dishes or boiling, simply add an iron fish with a bit of lemon to naturally increase the iron content.

Maximizing Iron Absorption

Avoid taking iron with dairy—calcium blocks iron absorption. Instead, combine iron-rich foods or supplements with vitamin C sources (citrus fruits, bell peppers, broccoli) to enhance absorption.

Choosing the Right Supplements

Multivitamins containing 15-18 mg of iron can help meet daily needs. Recommended brands include:

• PhytoMulti with Iron (Metagenics)
• Multi for Women (MegaFood)
• Women’s Multivitamin (Innate Response)

Vegetarian and vegan women should absolutely take a daily multivitamin with approximately 18 mg of iron.

For those with low hemoglobin or ferritin needing higher supplementation, I recommend iron bisglycinate or iron chelate—gentler forms that cause less stomach upset. Supplements combining iron with vitamin C can further boost absorption.

Important Safety Considerations

Iron can be toxic in excess, so avoid oversupplementing. Have your ferritin levels checked regularly and stop supplementing once they normalize. If supplementation isn’t raising your ferritin levels, request a full iron panel to investigate further.

Medical Caution: In certain conditions like cancer, iron supplementation can be harmful. Always consult your doctor before starting iron supplements if you have medical conditions.

Understanding proper iron testing and supplementation can help you maintain optimal energy levels and overall health. By addressing both hemoglobin and ferritin levels, you can ensure your body has the iron stores needed to function at its best.