I have many clients who come to me with low iron levels and, despite their best efforts, which often include iron supplements, they can’t seem to increase them.
There is often a lot of detective work required to get a true picture of why you have low iron (or ferritin). Iron supplements may help in the short term, but for some people, iron levels drift back down again because the underlying patterns and imbalances that may be contributing haven’t been addressed.
Low iron and low ferritin should always be investigated with your GP too, as there are medical causes, such as blood loss, that need to be ruled out. Please don’t stop any iron your doctor has prescribed without talking to them first.
Here are some of the factors that may be contributing to low ferritin, and that we like to consider.
Gut Health
Hepcidin is a hormone that regulates iron balance. Its job is to reduce iron absorption when the body senses there is enough iron stored. Inflammation also increases hepcidin. This means that when there is ongoing inflammation, including in the gut, hepcidin may stay raised and iron absorption may be reduced, even when your ferritin is low. To help keep hepcidin levels within range, we want to support healthy stomach acid, a healthy intestinal lining (including the brush border of the gut), healthy digestive enzymes and low levels of inflammation.
Unabsorbed iron may also affect the gut microbiome, because some unfriendly bacteria thrive on iron, and it may add to intestinal inflammation. When the body senses too much iron, the immune system may respond by moving iron into storage in the tissues, to keep it away from potential infections.
Copper Dysregulation May Contribute to Iron Issues
Copper and iron work closely together. The body needs copper in the right, usable form to move iron around the body and help it be used to make haemoglobin. When copper is out of balance, or is biounavailable (stored in a form the body can’t use well), iron may not be used as well as it should be.
In clinic, I see many clients with signs of biounavailable copper. We can be exposed to copper in many ways: the contraceptive pill and the copper IUD, drinking water from taps with copper pipes, and even before birth, as copper crosses the placenta during pregnancy. Vegetarian diets are often high in copper, and many products in our environment contain xenoestrogens, chemicals that mimic oestrogen, which may also influence copper balance.
Healthy adrenal function is also important, as it helps the body make a copper-binding protein called ceruloplasmin. Ceruloplasmin is needed to help move copper out to the body. If ceruloplasmin is low, copper may be pushed into storage and become biounavailable. Retinol, the animal form of vitamin A found in foods such as liver, eggs and butter, is thought to play a role in making ceruloplasmin, so we often look at whether your diet includes enough of these foods.
Copper imbalances and adrenal stress may be part of the picture behind your iron issue.
What Else Can Help Support Iron Levels?
In clinic, we use Hair Tissue Mineral Analysis (HTMA), which measures minerals and mineral ratios in a small hair sample. All minerals need to be within certain ratios to work at their best. When it comes to iron, I like to look closely at copper, zinc, sodium, potassium and molybdenum, along with the ratios practitioners associate with adrenal activity. I also consider B12 and liver function through your health history and other testing. HTMA is not a diagnostic test, but it gives us useful information to read alongside your blood tests. Working on all systems in the body is key.
Support your gut health. In clinic, we often use a comprehensive stool test called Microba. It looks at a range of intestinal markers, parasites, and beneficial and unfriendly bacteria, and the balance required for a healthy gut.
We also look at stomach acid, to make sure you are digesting and absorbing nutrients from your food. Healthy stomach acid helps the body absorb iron.
Be mindful of how much of your iron comes from iron-fortified processed foods, such as some grains, cereals and flours. Iron is one of the most abundant elements on Earth, and we can also be exposed to it through some contraceptive pills, supplements and the pots and pans we cook with.
By exploring the underlying patterns and imbalances that may be contributing to your iron issues, we can build a much clearer picture of your health. Working on the body as a whole, and from different angles, is at the heart of how I support my clients.
If you’d like to understand what may be affecting your iron levels, book a free 30-minute phone call.