When Your Iron Levels Are "Good" But You Still Feel Bad


If you are like many of my patients, you have had your blood tested, told that your iron levels are fine and that it is not the cause of your symptoms. In todays post I am going to cover the ins and outs of iron levels, and why even if you have been told they are fine, that that may not be the case

Why is Iron Important?

Hemoglobin (Hb) is a protein within your red blood cells, that helps to transport iron around your body. Hb is the bus that picks up iron and drops it off where is needed (brain, heart, muscles etc.)

Ferritin- refers to your body’s iron stores. When your Hb is low, your body has to dip into its iron stores


With iron, as with most things in the body, there is a “Goldilocks” effect

Too little iron= bad

Too much iron= bad

You need it to be just right


Iron excess, called hemochromatosis, is not very common in women between the ages of 14-50 because of menstruation. To be throughout, I should add that you could have hemochromatosis if you have an IUD that stops/reduces your period).

What is most common in women, I see multiple cases of it most weeks in my practice, is low iron or iron deficiency.

Low Iron/Iron Deficiency


Causes of Low Iron

  • Heavy Periods
  • Iron intake not adequate via diet and/or supplementation
  • Iron is not being absorbed
  • Postpartum


  • Heavy periods- losing more than 2 TBSP (30 ml/1 oz), 9 or more saturated regular tampons, of blood over the duration of your period puts you at risk for low iron
  • Iron intake via diet/supplementation

Many women do not consume enough iron. The recommended daily intake for women is 18 mg. If you are not meeting this need via your diet, you should consider supplementation (more about this later)


Food Sources of Iron

Heme Iron

3.5 mg/serving= 3 oz of beef/chicken liver, mussels or oysters

2.1 mg/serving= 3 oz of beef or sardines

0.6 mg/serving= 3 oz chicken, turkey or ham


Non Heme Iron

3.5 mg/serving= fortified cereal, 1 cup of beans, ½ cup of tofu

0.7mg/serving= 1 oz of nuts, 1 medium broccoli stalk, 1 cup spinach, 1 cup pasta


As you can see, it is challenging to get enough iron through the diet.


  • Absorption

If you have digestive issues, you may not absorb iron well. Eating iron rich foods or taking a supplement at the same time as having tea or coffee can also reduce the amount of iron you are able to absorb. Tea and coffee contain tannins, which bind to the iron and result in it not being absorbed. You can increase the amount of iron your body will absorb, by having vitamin C at the same time as iron


  • Postpartum

Many women struggle with low hemoglobin or ferritin in pregnancy, so you are already starting from a spot of lower iron. All birth, even if it is textbook, involves quite a bit of blood loss (we lose iron via the blood). On top of this breastfeeding is another demand on the body that can further reduce iron stores. Studies have shown that 30% of postpartum women are anemic, but this is likely much lower than the real number because women are not having their hemoglobin and ferritin levels checked routinely postpartum


Symptoms of Iron Deficiency

-Unrelenting Fatigue- does not get better form sleeping more

-Shortness of Breath doing things that don’t normally cause that like walking up a flight of stairs

-Hair Loss- From all over the head, not forming bald spots

-Brain Fog/Difficulty Concentrating

-Palpitations- feeling of skipped heart beats or the awareness of your heart beating “weird”


-Restless Leg Syndrome


Why You Get Told That You Are Fine

Your hemoglobin should be over 121 g/L (Canadian units) or 12.1 g/dL (American units).

Most labs report a ferritin of 12 as being normal, but most women have symptoms of iron deficiency if their ferritin is under 30. You need your ferritin to be 40 for proper hair growth, and ideally you want your ferritin levels to be between 60-70.


Iron Supplementation

Many women that I see in my practice already know that they have low iron but have had bad experiences/side effects with supplementing with iron in the past, namely constipation and GI upset.


Iron comes in many different forms. It may be as simple as trying another form of iron that works better for you. In my practice, I have the best results at increasing iron levels without causing side effects by using Carbonyl Iron.  Another tip with iron supplementation is to take twice the dose, every other day. Studies have shown that having a “24 hour holiday” increased iron absorption and decreases. Side effects. Iron is best taken every other night at dinner


I hope you found this post helpful.


Dr Alexis


Dr Alexis sees patients via telemedicine and is currently accepting new patients. Click here to book your appointment




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