Struggling With Low Iron? Why Your Gut Might Be Part of the Problem
Chronic low iron is something I see a lot in my patients. They will often say “it’s always been like that” or “I just can’t maintain my iron levels” but no one has ever offered them an explanation as to why. It has almost become so common (especially for women) that it is just accepted.
Now there is a really obvious reason why iron would be low in women (and that is menstruation), and in kids (fussy eaters) but that isn’t always the end of the story. The function of your gut and your overall gut health play a really important part in iron absorption.
Firstly what does low iron feel like?
The most common and noticeable signs of iron deficiency are:
Fatigue and lethargy
Pale Skin
General weakness
Shortness of breath
Heart palpitations
Iron is required to make haemoglobin, the protein in red blood cells responsible for carrying oxygen around the body. Iron deficiency can occur before haemoglobin falls below the normal range. When iron deficiency is severe enough to reduce haemoglobin, this is known as iron deficiency anaemia.
There are other signs and symptoms that can arise from low iron such as:
Brain + Dopamine
Iron is required for the production and function of dopamine in the brain. This means that when iron is low, symptoms of low dopamine can appear or worsen, such as:
brain fog
low mood
low motivation
and in some people, restless leg syndrome
Thyroid
Iron is also required for the activity of thyroid peroxidase, an enzyme involved in thyroid hormone synthesis. Iron deficiency may therefore affect thyroid function, particularly in people who are already vulnerable to thyroid dysfunction.
brain fog
dry skin
cold extremities
low mood
fatigue
What I look for in an iron test
When I assess iron, I don’t stop at ferritin. Looking at the full picture helps reveal whether your body is truly getting what it needs.
Here’s what information you get from a full iron panel:
Ferritin – your iron storage. Iron is stored in the liver. As it is an acute phase reactant, it can be falsely elevated by inflammation or illness, so it’s not reliable on its own.
Serum Iron – how much iron is circulating in your blood right now
Transferrin – shows how “hungry” your body is for iron. You might have normal ferritin, but if transferrin is high, your body is still craving more.
Transferrin Saturation – how much iron is bound to transferrin and being delivered to your tissues. A low level can mean your body isn’t getting enough iron where it’s needed.
When I am assessing someone’s need for iron I look at their ferritin but also their transferrin and transferrin saturation as this gives me a clearer picture of their iron needs.
So what does the gut have to do with all of this?
Your gut needs to be functioning well in order to absorb iron. Iron is such a fickle little mineral. It actually can make it quite difficult to absorb. The form of iron you consume, what you eat alongside it, your gastric environment and the health of your small intestine can all influence how much iron ultimately gets absorbed.
Your gastric environment and the health of the small intestine also influence iron absorption. For example, long-term use of acid-suppressing medications can reduce gastric acidity, which may affect the absorption of non-heme iron.
Inflammation can also affect iron absorption through a hormone called hepcidin. Hepcidin is one of the body's key regulators of iron. When inflammation increases hepcidin, it can reduce the amount of iron absorbed from the intestine and restrict the release of stored iron into the circulation.
This means that sometimes the issue isn't simply “not eating enough iron” the body may not be absorbing or utilising iron effectively.
Iron is primarily absorbed in the small intestine, so conditions that affect the small intestine including inflammation, altered gut function and SIBO, may also influence nutrient absorption and iron metabolism.
What to do next?
If you're struggling with low iron that keeps coming back, it may be worth looking beyond your dietary iron intake and considering whether absorption, inflammation or gut health could be contributing.
If you'd like to know whether naturopathy might be the right fit for you, I offer a free discovery call where we can chat about the process and answer any questions you have. Please note that individual health advice isn't provided during the call.
Lisa x
Book a gut health consultation to uncover what’s really driving your low iron and start feeling comfortable in your body again.
Disclaimer: The information in this blog is for general educational purposes only and is not intended to replace individual medical or naturopathic advice. Please consult your healthcare practitioner before making changes to your diet, lifestyle, or supplements.
