10 Sep Iron Deficient But Not Anemic? A Simple Solution for Fatigue
This simple cause of chronic fatigue symptoms has a simple solution.
Even if you don’t have anemia, you could have an iron deficiency that is sapping your energy.
It is entirely possible, especially if you are a woman of reproductive age, to be iron deficient without becoming fully anemic. When you’re iron deficient but not anemic, you can still suffer from lower vitality, decreased immune function, poorer mental health, and impaired ability to perform physically and mentally.
Iron deficiency is one of hundreds of causes of anemia, the most common blood condition in North America. It affects about 3.5 million Americans alone. Anemia occurs when your blood can’t effectively carry oxygen to your cells. This develops when you have too few red blood cells or hemoglobin, the part of red blood cells that bind oxygen. When your cells can’t get the oxygen they need, you experience chronic fatigue symptoms such as weakness, lethargy, and feeling sleepy all the time.
Your doctor may not be ordering this best test
A study indicates that doctors may not be ordering the right test—and patients with chronic fatigue symptoms may therefore not be getting the right treatment—when it comes to iron deficiency.
The best way to see whether you have an iron deficiency is by measuring your level of ferritin, a protein found inside cells that stores iron so your body can use it later.
The amount of ferritin in your blood (serum ferritin level) is directly related to the amount of iron stored in your body. The lower the ferritin level, even within the “normal” range, the more likely it is that you do not have enough iron.
However, most doctors don’t order this test. Instead, they may order only what is known as a CBC, which stands for complete blood count, to check a patient’s red blood cell and hemoglobin levels. If the CBC, which is a simpler, less expensive test, comes back normal, the doctor may send the patient away without ordering a ferritin test and with no explanation for the patient’s fatigue.
Here’s what research shows about ferritin
In the recent double-blind, placebo-controlled study, French and Swiss researchers decided to check ferritin levels. They wanted to see whether iron supplementation would help women with fatigue symptoms who had either low or “borderline” ferritin levels (<50 mcg/L) but were not anemic (meaning they had normal hemoglobin levels, >12 g/dL).
Interestingly, the “normal” reference range for ferritin in women is typically 18 to 160 mcg/L, but the researchers considered any level below 50 mcg/L to be borderline low.
The researchers randomly assigned 198 women with unexplained fatigue to take either 80 milligrams of iron a day (as sustained-release ferrous sulfate) or a placebo. Over 12 weeks, women on iron supplements noticed a significant improvement in their fatigue. On average, scores on a standard measure of fatigue fell by nearly half – from about 25 to 13, on a scale of zero to 40 – among women getting the extra iron.
Those in the placebo group also improved, but not as much as those in the iron group. They concluded their study by stating that in “women with unexplained prolonged fatigue, iron deficiency should be considered when ferritin values are below 50 µg/L, even when hemoglobin values are above 12.0 g/dL.”
Why you should test first: too much iron is dangerous
Other studies have also shown that treatment of iron deficiency with either supplementation or a high iron diet results in improved mental health, increased energy, and decreased fatigue among women of childbearing age.
But please be aware that it would be a mistake for you to take iron supplements or multivitamins with iron – thinking it will help your fatigue – without knowing if you are iron deficient in the first place. Studies have shown that excessive iron increases Alzheimer’s risk and can lead to serious health problems such as liver and heart disease.
Different types of iron supplements make a difference
The ferrous sulfate used in the study cited above is the most commonly prescribed form of iron supplementation by conventional healthcare practitioners.
However, naturopathic physicians and other integrative healthcare practitioners trained in nutritional supplementation will often recommend other forms of supplemental iron which are better absorbed and cause less side effects:
- Iron amino acid chelates have been shown to be efficacious in treating iron deficiency with significantly less side effects. Ferrous glycinate chelate (also known as iron bis-glycinate chelate), for example, has been shown to be much more bioavailable than ferrous sulfate, and is associated with very few gastrointestinal symptoms.
- Iron from animal sources, such as beef liver, is known as heme iron and is up to 33% more absorbable in the body than non-heme iron. Quality supplements containing heme iron are obtained from animals raised with no chemical sprays, pesticides, or antibiotics from livestock feed.
- Also available are iron supplements complexed with whole-foods which contain iron that has been cultured in a matrix of fermented whole foods. Both heme iron from animal sources and whole food complexed iron are less constipating and easier to digest than ferrous sulfate. Research has also shown that a high-iron diet can be equally effective at increasing iron levels and treating chronic fatigue symptoms. Good vegetarian food sources of iron include asparagus, chard, spinach, romaine lettuce, blackstrap molasses, soybeans, tofu, lentils, mustard greens, collard greens, turnip greens, and leeks. Thyme, cumin, turmeric, and black pepper are also excellent sources. Vitamin C greatly helps you increase your absorption of plant food iron. Animal sources rich in iron include red meat, egg yolks, and liver.
- Using cast iron cookwareis another way to increase iron intake.
Conclusion
The conclusion to draw from this important study is that iron deficiency should always be considered as a possible underlying cause of your fatigue symptoms. However, because many doctors check only for anemia but not for low iron, this condition is commonly missed. Since too much iron is toxic and leads to serious health problems, you’ll want to absolutely know if you have low iron by checking your serum ferritin level before taking any iron supplements.
If your serum ferritin level is less than 50 mcg/L, I can recommend ideal iron sources to get your iron levels–and your energy–back to normal.
Resources:
[1] Patterson AJ, Brown WJ, Roberts DC. Dietary and supplement treatment of iron deficiency results in improvements in general health and fatigue in Australian women of childbearing age. J Am Coll Nutr. 2001 Aug;20(4):337-42.
[2] Vaucher P, Druais PL, Waldvogel S, Favrat B. Effect of iron supplementation on fatigue in nonanemic menstruating women with low ferritin: a randomized controlled trial. CMAJ. 2012 Jul 9. [Epub ahead of print] PubMed PMID: 22777991.
[3] Verdon F, et al. Iron supplementation for unexplained fatigue in non-anaemic women: double blind randomised placebo controlled trial. BMJ. 2003 May 24;326(7399):1124.
[4] Castellani RJ, Moreira PI, Perry G, Zhu X. The role of iron as a mediator of oxidative stress in Alzheimer disease. Biofactors. 2012 Mar-Apr;38(2):133-8.