So many women walk through our clinic doors complaining of fatigue, weakness, hair loss, and anxiety. My goal as a naturopathic doctor is to determine the WHY. These symptoms are often due to low ferritin.

Ferritin is the storage form of iron. It’s the earliest, most sensitive indicator of adequate iron stores.

Iron is a mineral important for oxygen transport, energy production, red blood cell synthesis. When levels are low, you can experience hair loss, fatigue, poor exercise tolerance, restless legs, anxiety, and shortness of breath.

Too often, low ferritin is missed since it is not part of routine blood-work.

Here are 3 reasons why your ferritin might be low:

1. Blood loss. My first question when women complain of fatigue is “Do you have heavy periods?” Menorrhagia (or heavy menstrual bleeding) is one of the most common causes of iron deficiency anemia. If you can’t go more than 2 hours in between changing a pad or a tampon and you regularly see clots, it is very likely you are tapping into your iron stores and your ferritin may be low.
2. Lack of iron-rich foods in your diet. If you are vegetarian or just don’t eat a lot of meat, your ferritin may be low.
3. Poor absorption. You may eat iron-rich foods, but are you absorbing the iron? If you have a history of IBS, your absorption of minerals may be compromised. Inflammation in the small intestine in particular, often found with small intestine bacterial overgrowth (SIBO), is associated with poor absorption of nutrients such as iron, B12, and zinc. Additionally, if you have a history of acid reflux or GERD and you take antacids to suppress stomach acid, your absorption will be compromised. We need stomach acid to help us absorb nutrients.

Test- Don’t Guess

If you struggle with exhaustion, shortness of breath, hair loss, restless legs, and/or mood disturbances (notably anxiety), ask your doctor to test not only your iron but also your ferritin. Optimal levels of ferritin are between 40-50. If you are low, we can discuss best sources of iron to include in your diet, well-absorbed forms of supplemental iron, and ways to improve gut absorption of iron. It’s always best to test (not guess!) when it comes to supplementing with iron as too much iron can be inflammatory.

Editor’s Note: The information in this article is intended for your educational use only. Always seek the advice of your physician or other qualified health practitioners with any questions you may have regarding a medical condition and before undertaking any diet, supplement, fitness, or other health program.