Fatigue, exercise intolerance, shortness of breath, feeling cold, easy bruising, restless legs ... all symptoms which can significantly and negatively impact someone's life, but also may be difficult for clinicians to track down a cause, as these symptoms can occur with a variety of conditions.
Clinicians are accustomed to looking for potential Iron Deficiency Anemia, which is a condition where your body does not have enough iron, which is required for your body to make red blood cells (one component of your blood). Although many individuals have Iron Deficiency Anemia, there is another condition which is even more common.
Iron Deficiency Without Anemia (Iron Deficiency) is the condition where the body does not have enough stored iron (ferritin). To diagnose or look for Iron Deficiency, clinicians need to order blood tests to look at ferritin levels.
An individual with Iron Deficiency may be experiencing symptoms such as those mentioned at the beginning of this blog, and although they may not have Iron Deficiency Anemia, they should be treated because their body does not have the iron stores it requires to function appropriately.
One difficulty with using labs to determine Iron Deficiency, is that an an individual may be on the low side of a "normal" level of ferritin (so not flagged by the lab used for the labwork), but their SYMPTOMS imply that for that person, they do not have enough iron stores and they are in need of more.
Another difficulty is determining what should be a "normal" level of ferritin. In one study, referenced below, low ferritin was defined as "absolute: ferritin < 100 μg/L."
In another study, it states, "...in clinical practice, when ferritin levels dip below 30 μg/L..." as the point where an individual then has Iron Deficiency.
Just to make things a bit more confusing, that same study also stated that "...100 μg/L [should be used] in states of chronic inflammation..."
And, since all that was confusing already, the "WHO defines low ferritin as levels <15 μg/L for adults..." In general, this number is considered to be far too low and many will have symptoms by the time they meet this definition.
Although many labs will use the WHO definition, and will not flag a result that is maybe at 19 μg/L and if the clinician (or patient) does not understand that this may very well be the cause of their many symptoms - the patient may not get the treatment they actually need and additional, unnecessary tests may be run.
If a patient has symptoms and has Iron Deficiency, they should be treated even if they do not have Iron Deficiency Anemia, a clinician's job is to look at the patient's case, lifestyle, symptoms, and labwork to create an overall picture and if that points to the patient needing additional iron, then that should be further looked into.
Iron Deficiency causes vary widely, some of which can be...
Diet - not consuming enough iron (vegan, no red meat, vegetarian, etc)
Blood Loss - donating blood, menstruation, bleeding ulcer, colon cancer or bleeding, surgery, H. pylori infection, nose bleeds, etc
Chronic Inflammation - athletes, autoimmune conditions, Celiac disease, Gluten Intolerance, Inflammatory Bowel Disease, etc
Increased Need - athletes, menstruation, pregnancy, children
Absorption Issues - digestion issues, taking medications which decrease the absorption of iron (heartburn medications are one!), H. pylori infection, Celiac disease, Gluten Intolerance, Inflammatory Bowel Disease, etc
Although not an exhaustive list of causes, it is obvious there are many potential reasons why someone may have Iron Deficiency. Interesting to note - some of these conditions can cause the same symptoms as Iron Deficiency, making regular lab work important in managing patient symptoms.
Iron Deficiency is important to screen for in those who are pregnant or considering pregnancy. During pregnancy, the fetus is dependent on the iron to help with proper brain and body development, and if this is lacking, it can have significant impacts such as low birth weight, born prematurely, but even later in life can have cognitive difficulties. These issues can result even if the baby has enough iron when born, but they develop Iron Deficiency post-birth.
Ultimately, if you, or someone you know, is having symptoms but has been told their "iron is normal," get your ferritin checked. Better yet - get your ferritin checked anyway, do not wait for symptoms.
Additionally, females in particular should be getting their ferritin checked regularly. This will let you (the patient) know what your "normal" is, but also can help with addressing Iron Deficiency if needed and before it becomes a bigger problem, again - do not wait for symptoms.
Sources: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8002799/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9745472/
This is not medical advice, always ask a chiropractor if chiropractic care is appropriate for you, and your preferred healthcare provider before making dietary, supplement, or lifestyle changes
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