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  • Writer's pictureDr. Melissa Adams

Iron Deficiency Without Anemia - Low Ferritin

Updated: May 20

Woman sitting on a bed with her knees drawn up, her elbows on her knees, and her hands on her head, with her reflection in a nearby mirror

Fatigue is a concern and a significant issue for many individuals, it is also one that can have a wide variety of causes - often having more than one cause for an individual.

Menstruating individuals have a unique susceptibility to iron deficiency, in fact, 10-20% of them have iron deficiency but may not meet the actual definition for Iron Deficiency Anemia (IDA). Due to these individuals not meeting the textbook definition for IDA, they may be missed and not receive the appropriate treatment despite having iron deficiency (but not full blown IDA) they are often suffering in their daily life especially with fatigue.

Other individuals at higher risk include those with Celiac Disease (especially if they aren't following a strict gluten free diet), Irritable Bowel Syndrome (IBS/IBD), vegans and vegetarians, athletes, pregnancy, accidents, surgeries, and even those donating blood.

An individual with potentially a wide range of symptoms (often including severe, unrelenting fatigue) should always be evaluated for low iron and low ferritin. What's the difference?

Ferritin is the iron that your body has in storage. Typically, if someone has low ferritin ... IDA is on the way, OR may never actually show up, but many symptoms of IDA may be present ... including that pesky, unexplained fatigue.

Part of the confusion and potential problem with lab tests is the varied opinions of what is "normal," and what level is considered "deficient."

The below article demonstrates this, although the WHO considers "low ferritin" to be below 15μg/L for women (this is what is on most lab reports), CLINICALLY, ferritin should be considered "low," and treated appropriately if below 30μg/L. From the article below, "The ferritin level should be controlled regularly during and after the iron administration with a sustained target ferritin of more than 100 μg/L."

This means, there are individuals who should be treated for low ferritin, but are not receiving the appropriate treatment because the numbers on their labwork are not being interpreted properly - thus continuing their suffering.

Some potential symptoms of iron deficiency ...

"...fatigue, brain fog, muscle and joint pains, weight gain, headache, dyspnoea, palpitations, sometimes associated with sleep disturbances, arrhythmia, lump in the throat or difficulty in swallowing, and restless legs. ... Weakness, fatigue, difficulty in concentrating, and poor work productivity are nonspecific symptoms ascribed to low delivery of oxygen to body tissues..."

You can imagine the lengthy list of potential diagnoses these individuals may receive, when in reality they may "just" have iron deficiency. Some diagnoses people have received which were incorrect include - fibromyalgia, sub-clinical hypothyroidism, migraine syndromes, chronic fatigue syndrome, depression or other mental health diagnosis ... the list is seemingly endless.

If these issues sound like something you or a loved one may be dealing with, if you are searching for answers but haven't yet found them ... keep searching and take this research with you.

YOU must be your own biggest advocate, the world of labwork interpretation is not as black and white as we often think! Symptoms must be taken into account along with your labwork. The solution for iron deficiency can be fairly simple but does require follow ups and may require dietary changes (very strict ones if you need to be gluten free but it's worth it!)

This is not medical advice, please consult with your PCP or other appropriate provider before making lifestyle, supplement, medication, or dietary changes


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