“Just Take Iron and We’ll Watch It”

0:00Liz Roman: There’s so many people struggling with this, and your doctors are just gonna tell you that it’s normal.

0:06Becca Chilczenkowski: Just take iron.

0:07Liz Roman: Yeah, that too. Just take iron. We’re gonna watch it.

0:10Becca Chilczenkowski: And at the end of the day, guys, we have to understand that unfortunately, the doctors don’t have the tools or the capacity to dive deeply into this for you.

0:18Liz Roman: And it’s like, okay, did anybody look at how they’re doing with their cycles and the heavy bleeding?

0:23Becca Chilczenkowski: Because if you are even if you’re below a 50 of ferritin, you’re not feeling great. We’re not in a place where we’re gonna be growing hair well, and hair, you know, skin and nails are gonna be healthy, and energy and recovery and all of those things.

0:35Liz Roman: And there’s five different patterns that we’re gonna go through today and help you understand what your body and the pattern is trying to tell you. So women will have this miss for decades.

0:45Becca Chilczenkowski: And so you kind of have to fight for yourself and find your own answers sometimes.

0:48Liz Roman: Hello, and welcome back to the Health Revival Show. We’re talking all things iron anemia and low ferritin, because y’all don’t seem to get it yet. Mm-mm. No. There’s so many people struggling with this, and your doctors are just gonna tell you that it’s normal. Your ferritin is above a 15, and it’s not flagging low on your blood work, or even sometimes it is flagging low, and they’re like, “Oh, we’ll just keep an eye on it. We’ll just watch it.“

1:16Becca Chilczenkowski: Like- Just take iron

1:19Liz Roman: Yeah, that too. Just take iron, we’re gonna watch it, come back and let us know in three months. And it’s like, okay, did anybody look at how they’re doing with their cycles and the heavy bleeding? Because low iron, low ferritin can result in heavier menstrual periods and bleeds and clotting and all kinds of things. so that’s what we’re gonna get into today, and we’re gonna talk about the different patterns, because you would see this as one problem, and there’s five different patterns that we’re gonna go through today and help you understand what your body and the pattern is trying to tell you. If your body is looking for iron, if it’s sequestering iron because there’s an infection and it’s trying to protect you, it will lock it up. Or if you have a true anemia here and you really need to consider potentially an infusion, oral iron, a patch, sublingual, lactoferrin, all the types of things, and then we’ll also talk about hemochromatosis, at the end here and what iron overload is. And I don’t know if you’ve experienced this, Becca, but I have gotten several people who’s like, “Well, what about this pattern? What about this pattern?“ It’s like, these are the main five, and you need to look at the ranges, and so we’re gonna walk you through all of that today. If you wanna grab a pen and paper. If you’re watching us on YouTube, you can follow along. Also, we have a great guide that you can download for free and be able to go through this and understand your pattern, and then we’ll also share with you some of the things that we do and implement and things that you may want to watch out for and things that we don’t recommend doing, which is a lot of what your doctor’s gonna tell you to do.

2:54Becca Chilczenkowski: Yeah, and at the end of the day, guys, we have to understand that unfortunately, the doctors don’t have the tools or the capacity to dive deeply into this for you, and so that is why it is a Your options are take iron, come back later, or an iron infusion, which neither actually solve the problem of what’s going on at the root. So that’s what we wanna talk about today is where, where these patterns essentially originate from, what they look like on your blood work, tighter blood work ranges so that you know what you should be looking for versus what your LabCorp thing says. Because if you are even if you’re below a 50 of ferritin, you’re not feeling great. We’re not in a place where we’re gonna be growing hair well, and hair, you know, skin and nails are gonna be healthy, and energy and recovery and all of those things. And yes, timing of when you test this does matter because obviously if you just had a period, you’re gonna have lower iron. Like, don’t time it around that. Time it leading into your cycle, which is also about when you usually wanna get hormones tested if you’re testing hormones in a preme- premenopausal female and they’re having a normal cycle and consistent cycle, you usually wanna test around day 19 to 22 or so if you have that, like, 26 to 28-day cycle. So timing of when you test matters, and then trends matter, too. I would say that I see iron flip pretty frequently, and so if we see something kinda low, I’m looking for other patterns to go along with it. Ferritin’s a little bit more of a storage shedding, right? And then we’re looking at hemoglobin, we’re looking at hematocrit, and these other markers that give us clues into, like, true deficiencies that have reached other parts of the system, right?

What Each Marker on an Iron Panel Actually Measures

4:25Becca Chilczenkowski: So let’s first talk about what’s measuring what, and, you know, explain the markers that we’re looking at here. So Typically, we run four markers with an iron panel, and then we also run an additional marker that gives us insight into inflammation, a, a general insight, right? So serum iron is first. That’s obviously, like, what’s in your bloodstream right now of iron, your tank, you know? Ferritin is what’s in storage. What has your body been able to kind of put away into storage? And a big reminder here is that if your body is under chronic stress, if you are under chronic inflammation, it doesn’t have the capacity to put anything in storage. Like, you’re burning through things. It’s just keeping it what it can into circulation. So it’s a huge clue for a lot of people, if you have chronically low ferritin, a lot of times it’s a cellular problem. It’s a problem of what is going on that’s not allowing you to even put anything in storage because it’s so needed in actual circulation right now. So we’ll get into that, obviously. Total iron binding capacity is how hard your body is hunting for iron. Percent saturation is how much of the ride is actually occupied, so, like, how much of the little cars taking iron around are actually consumed with iron. And then CRP. We run CRP, HS-CRP, a little bit different, but same general idea, whether inflammation is kind of faking the numbers, because CRP measures IL-6, which is produced by the liver, and so the liver tends to be very heavily involved in iron, in sequestering of iron, in production and release of iron. So we’ll get into all of that. But those are the big numbers that we’re looking at. That’s what we’re gonna give kind of ideas around, in terms of, you know, ranges and what we wanna see. So now you understand what we’re looking for.

6:11Liz Roman: Yeah.

The Functional Ranges We Use, and Why They Are Tighter

6:12Liz Roman: So if you have your labs and you wanna get them out right now, I’m gonna take you through what our optimal ranges are. And again, this is very different than what you’re gonna see on a LabCorp or a Quest panel. So as Becca mentioned, your ferritin, which is your storage tank, if we are very low, we’re gonna feel exhausted. We’re gonna be depleted. We’re gonna have hair loss and low energy, brain fog. All kinds of things can be associated with low ferritin. But also on the flip side, if it’s really high, it can be an indicator of inflammation. So the functional range, and now I will say that functional ranges definitely vary. There are different schools of thoughts on this. I have been trained that over 100 is a sign of inflammation. I’ve also been trained that it can go up to 150 if we’re looking at the broader picture to say, “Okay, no, things are actually okay.“ I would say both of us would agree that a sweet spot for ferritin is in the ballpark of 80 to 120, even though a functional range that has been provided through various blood chemistry courses says 50 to 100 When we look at hair specifically, I wanna see at least an 80, and this is also for cycling females because we don’t wanna have those heavy periods. And when ferritin gets low, iron gets low, that is going to cause heavier bleeding, and we obviously don’t wanna do that. And heavier bleeding over long periods of time is going to deplete your iron stores as well. So 50 to 100, we would say really the sweet spot is 80 to 120. Beck, I don’t know if you have anything different there to share, but I don’t like that top end being so high, and I also think 100’s a bit too low. You have to look at, at the pattern and the trend and everything else, right? ’Cause we’ll also look at your hemoglobin, hematocrit, right, on your complete blood count. There’s some markers that can be indicative of anemia there. Serum iron, this is your total iron that you’re looking on your labs, 85 to 130. If we’re looking at transferrin, this is not one that we always run, but 200 to 350. This is the iron delivery driver. and so if your iron is high, this is your body kind of scrambling to move more iron. So think of that as your delivering driver. Transferrin saturation, so this is how full those delivery driver trucks are. If it’s low, there’s not enough iron being delivered, and this is a key deficiency marker as well. Then we have total iron binding capacity. So this is total seats on the bus, if you will, for iron. Lots of empty seats can point to a deficiency, so we would wanna see that somewhere between 250 and 400. And then we have UIBC as well, and this is unfilled seats, and if it’s high, there’s room to spare, so there’s a deficiency. So it’s kind of flip-flopped here. And low would be inflammation and overload. So you might see some of those other markers that we didn’t mention, ’cause typically on our panel it’s gonna be total iron, ferritin, binding capacity, and percent saturation. All right.

Pattern 1: The Empty Tank — True Iron Deficiency

9:07Liz Roman: So when we look at five anemia patterns that women show, I think this is really important to understand, and we’re gonna specifically for the first couple highlight the binding capacity because again, as Becca mentioned before, this is going to be telling us how hard your body is hunting for iron. So if we have, let’s go in the empty tank here, low iron, low ferritin, high binding capacity, and low percent saturation, this is your body asking for iron High total iron binding capacity is the tell that your body needs it. This is a true, you know, deficiency. The body is building more, drivers because there’s nothing left to haul essentially, so we need to find the leak. Is this heavy cycles? Is it malabsorption, so low stomach acid, need for vitamin C? All of those things in your gut microbiome are gonna be imperative to you absorbing the iron from your foods, but also thinking about things that would block iron absorption from those foods.

10:13Becca Chilczenkowski: Yeah,

10:13Liz Roman: absolutely. This can be … I also wanna say here, sometimes you don’t wanna ignore this if this is ongoing and there’s a lot of GI issues, because it could be an internal bleed in the GI tract or, like, an ulcer or something along those lines. So again, this is just a caveat. Like, these are patterns, but you may have further investigation to do.

Pattern 2: Normal Iron, Low Ferritin — A Conversion Problem

10:30Liz Roman: When we look at a low or normal binding capacity, this is gonna tell us that your body is not absorbing this. So we wanna think here in terms of, you know, thyroid. Iron builds thyroid hormone, and low thyroid means heavier periods and worse absorption as well. So this is gonna be a pattern of normal iron, low ferritin, normal binding capacity, and normal percent saturation. So the only thing in this pattern is that your ferritin is low, so we need to focus on your conversion. What helps conversion? Lactoferrin, vitamin C, stomach acid. And then we could argue things like folate and B12 and all the different B vitamins, but this is really where iron is moving fine, but you’re just not converting it and storing it. So for me, when I see this pattern, I’m gonna go and I’m gonna look at other patterns and trends on blood work to say how many markers indicate a gut infection or inflammation or malabsorption, right? Does she show other deficiency patterns in terms of a need for magnesium, a need for vitamin D, right? There’s a lot of things that we can see, and we talk about this in our, webinar series that we did, Labs Decoded, and that’s in our FitMom Society. So if you want to understand, this is one panel that we look at amongst many. If you wanna understand that, you can go to fitmomsociety.com. There’s a seven-day free trial. Access that. It’s an hour, five hours essentially, but it’s split up into, one-hour segments that you can go through the different panels, and you can understand all those other patterns and trends outside of this. So fitmomsociety.com. And pattern three.

Pattern 3: Anemia of Chronic Disease, Where Inflammation Locks Iron Away

12:11Becca Chilczenkowski: Yes. So pattern three is an anemia of chronic disease. So this is typically more of an inflammatory pattern. You have iron, but inflammation ultimately locks it inside a storage, and it’s an inflammation problem, not really an iron problem here. So here you’re gonna see ferritin is gonna be normal or high. Serum iron and saturation will be low. Total iron binding capacity and UIBC will be low. We will usually see CRP, and we also test ESR, sedimentation rate. Those are often elevated. We want sedimentation rate under a 10. Usually conventional’s not gonna flag it until it’s like a 25 or 30. We like it under a 10. CRP, again, is not the end-all be-all, because what CRP was designed to measure was it was designed to measure acute infections, injuries, and ultimately, you know, active large amounts of inflammation. If you have chronic low-grade inflammation, CRP might not be elevated, which is why we cannot lean on CRP by itself. We have to go off symptoms. We have to go off of other labs. And so CRP often is elevated, ESR is often elevated, but it might not be as much as you would think, right? Hemoglobin and hematocrit are often also low And in these situations, again, oral iron is not the fix here because it’s not the problem. You usually have an issue where the inflammation is going on, and so ferritin is an acute phase inflammatory response in the body, and so your ferritin is going up and up, and you feel exhausted, and you feel like, “Okay, maybe because my iron is low, that’s the answer.“ No, no, no. Iron is not low. Your body is responding to something. We have to figure out what it’s responding to, right? This is an inflammatory process, and so in these cases, this is where we would be looking at, like, potentially a GI map test if there’s nothing obvious going on. We would be looking at liver enzymes. We would be looking at our CBC. What’s going on with the immune system? Do we have, you know, elevated or low white blood cells? Do we have neutrophils, lymphocytes, monocytes, all of our different types of white blood cells, are they dysregulated? Is vitamin D low? How long has this been going on? What I will often see is that ferritin will go acutely high when it is somewhat of an active infection. When the infection is ongoing and the immune system becomes exhausted, we over time start to see ferritin drop low. And so it kind of is like an indication that something is currently pretty acute, is what I actually tend to see. And then we also look to the liver, because the liver plays a really large role in essentially ferritin levels. And so if the liver is very stressed, if we’re dealing with fatty liver, if we’re dealing with liver burden, detoxification issues, we will also, also often see this go elevated. Sometimes I’ll actually see ferritin go high and everything else is somewhat normal because it’s more of a liver problem than it is even an iron or ferritin problem.

Hepcidin: The Liver Hormone That Closes the Gate

14:57Liz Roman: Yeah, so let’s talk about that. So what’s happening in the liver is that we have hepcidin, which is iron gatekeeper, if you will, and this is a hormone actually made by the liver. Its job is to decide how much iron gets into your bloodstream and how much stays locked away in storage. And so when we have an acute infection or there’s a chronic infection and the body knows that these pathogens, because there’s a variety of pathogens that can feed off of iron, including parasites and candida, the body knows it’s going to sequester it. So what happens here is hepcidin goes up, and it shuts down a protein called ferroportin. Ferroportin is basically the door that allows your iron to move out of your intestines into your blood, out of the storage in your liver into your blood, and from macrophages that recycle old blood cells back into circulation. So if we have elevated hepcidin, that hormone from the liver, this is shutting down ferroportin, so things aren’t gonna go into transportation appropriately. We have less iron absorption and more trapped in storage. This is iron sequestration We’re going to see that ferritin high typically, and then everything else, like Becca was saying, normal. And so again, this is really important, and this is where we’re gonna look at all of those other markers that she mentioned in terms of the inflammatory markers, because those signals tell the liver to produce more hepcidin to lock iron up. So hepcidin is the iron gatekeeper. When inflammation rises, hepcidin rises as well and your body closes the gate. You absorb less iron from the gut, and you lock more inside storage. So again, this is really where, as you mentioned before earlier, Becca, it’s trends over time. We don’t wanna overreact to something, because typically we’ll see this when people start with us or after an infection. You know, like, hey, they just got the flu, 24-hour bug, whatever this is, which is kind of silly, guys. Like, really don’t do your labs close to being sick, because we are gonna see typically white blood cells are gonna be elevated. Other things are just gonna be off because there’s an active infection. Sometimes we’ll also see this with an injury, right? So injuries create inflammation in the body. It’s a healing response that we need. And so I like to see at least a week, if not longer, maybe two, away from an infection or an injury inflammation that’s, you know, again, more acute.

Pattern 4: B12 and Folate Anemia

17:19Becca Chilczenkowski: Mm-hmm. So the next trend is what’s called B12 folate anemia or macrocytic anemia, where red blood cells actually get too big but not enough, so there aren’t enough of them, and they grow in size. And this is not iron. It’s low B12 and folate and poor absorption issues. So you watch for kind of tingling and brain fog and memory changes. MCV is a big marker that we’ll look for. I actually see this, I would say, in more labs than not. Like MCV in almost all of my labs that I look at is high. So in this situation, a lot of times you will actually see red blood cells, hemoglobin, and hematocrit low. Iron and ferritin are normal. Homocysteine can be high. Sometimes it can also be low, too. This is like … This is a tricky one, ’cause homocysteine can be low when there’s a B12 folate need, and it can be high when there’s a trimethylglycine need. Like, it is kind of dependent. so homocysteine we want around, like a 7.2 or so. If it’s in the 8, 9, 10 plus, definitely a need for for B12 and folate. When it’s low though, a lot of times there’s deficiencies as well, so something to consider. And then MMA, if it is measured, a lot of times will be high. So in this situation, it’s a little bit different of an anemia, and still a problem. It will still reflect in red blood cells, hemoglobin, hematocrit, these different things, but it typically is not reflected in iron and ferritin. so just something to watch out for in terms of another trend that we will sometimes see. And then the fifth one is

18:53Liz Roman: It is important, though, to check your folate and check your B12. And by the way, guys, B12 also has a very wide range on- Yes … LabCorp. It’s, like, laughable. I had someone on Instagram the other day like, “Oh, my B12 is, like, 470-something.“ I was like, “Yeah, that’s great. That’s about half of where we wanna see it, around 900. 850 to 950 for B12 is what we wanna see. And here’s a caveat. You need to stop your B12 or all, you know, biotin, any B vitamins 72 hours or three days prior to your lab draw because it’s not only gonna throw your B12 off, and some people freak out, like, their B12 is 1,600. It’s like, okay, this is a water-soluble vitamin, and you took that. You didn’t, you know, pause it for three days before it’s going to show high. You’re gonna pee it out. Don’t freak out. It’s fine. Obviously, if you’re not taking B12 and B12 is elevated, that’s a different cause for concern, right, and you’re seeing that pattern. but I think this is wise to not only look at your iron panel with everything and your complete blood count with everything, the CRP, the homocysteine. Look at everything else, a full thyroid panel. All of it matters because it can really tell us a story that we can start to piece together, you know, that puzzle for you essentially. So a lot of times we talk about deficiency, we talk about low iron, low ferritin, all of that. And again, we’ve helped you now distinguish, do I have a true deficiency? Is my body locking iron up? Maybe there’s inflammation, infections going on here. Maybe it’s more of, you know, the B12, folate, anemia. There’s multiple patterns.

Pattern 5: Iron Overload and Hemochromatosis

20:26Liz Roman: But what about over like over, high iron, right? And so when we look at this and everything is spilling over, this is overloaded. That’s the word I was looking for. hemochromatosis. And so your body absorbs iron and it can’t stop. Now, there’s genetic factors here to this. and ferritin alone will totally miss this. You need to have that saturation. and that’s really gonna be the tell here. So if you’re looking at your iron saturation, hemochromatosis, like a true hemochromatosis, you’re gonna see that over 45%. You are likely going to see high iron, high ferritin, low total iron-binding capacity, but you can’t say this is hemochromatosis if you’re not looking at the saturation. So women will have this miss for decades. I remember, Becca, we won’t share the client’s name live, but we had a client with this pattern, and she was having a lot of heaviness in her legs. She was getting winded she-- when she would go up the stairs. And as soon as we had her go and donate blood, a lot of that improved. and so this is something that, you know, we do wanna watch out for. if you do have iron overload, and this is more genetic in your family, then there’s, you know, ways you need to watch how much iron, you know, rich foods you’re consuming. Not cooking in an iron skillet. the cast iron skillet, specifically when there’s acid added to it, like a tomato sauce, it’s going to leach more iron into your cooking. You would want to, you know, think about avoiding supplements that have iron in them and giving blood, donating blood, and also potentially using lactoferrin because that can help with transporting things appropriately, and helping your body process that. Lactoferrin also has a lot of great benefits though, even for your gut microbiome, the epithelial cells, healing up leaky gut. So if we’re seeing on labs high zonulin, high calprotectin, a lot of inflammation in the gut, lactoferrin can be really great, actually for most cases. Again, this is not medical advice. We would wanna evaluate this, you know, person to person.

Why We Avoid Oral Iron, and What We Use Instead

22:28Liz Roman: And then in our guide, so if you wanna click the link in the show notes for you know, our iron anemia guide, we do talk a little bit about why we avoid oral iron, and I’ll give it to you straight here. Simply, it can feed pathogens, and it’s very harsh on the gut. We can get into the debate about different types of iron and how that goes and, you know, sometimes there are situations where we do need oral iron, and in that situation, we would want iron that’s very gentle on the gut. We would wanna have it be paired with copper. Copper deficiency is a big thing with iron deficiency as well, and it really impacts your body’s ability to utilize the iron appropriately. So vitamin C, copper, stomach acid support, those are three big players when we’re seeing a true anemia, you know, iron anemia, ferritin is low, all of that. We want to make sure that we’re supporting your body. But on the flip side, if you have too much iron, right, then you have to go the opposite direction. and again, you would wanna obviously be partnering with your doctor or your practitioner for your individualized protocols here and how often you need to donate blood. I know at Vital Medical, our nurse practitioners and our partners there are fantastic with this, where we’ll have clients donate blood, lab, draw labs at about six weeks. Conversely, iron infusions, if that’s the case, I have a few of those right now where we truly needed to have, their iron anemia was gone that far, an infusion, then we’re checking again, typically at four weeks, this is what I’m sending them in for, and we’re monitoring symptoms between, and we’re still using things that are going to support them in terms of the oral iron strips, so the Kaave Melts. Those have folate in them and then iron, which is great, very gentle. It’s going sublingual through the tongue and just melts in your mouth, tastes like raspberry. I don’t personally love it. A lot of people haven’t complained about it. It’s not terrible, but it has a metallic taste to it. Mm-hmm. and then lactoferrin. So lactoferrin, I have a lot in a lot of my cases. I am starting it myself because I have a l- bit low ferritin, and everything else is fine, but I’m seeing my ferritin, I think it was 42. I don’t have heavy periods, but I wanna get ahead of this. I do see other markers that are depleted, and that has to do with previous stress of moving and all of that, not eating enough for sure, as I’m learning, as I’m retracking my food and all of that. But we often don’t realize how much we burn through when we are stressed. And so if you’re somebody who has this pattern and you, you know, kinda have this tendency to fall on that low side Here’s the real truth. You’re probably going to have to work hard to get this up and keep it up. Some people say, “Well, can’t we take, you know, just everything through food? And why do we have to use so many supplements?“ And I get it, but when you’re in a state of dysfunction, there’s a reason for a season. And when we know the person’s genetics, we know they’ve had a compromised gut for many years, maybe a lot of stress, trauma, dysregulation of nervous system, whatever it might be Then this is where supplements come to play to be supplemental to your diet. Yes, we take a diet first approach, and you should take a diet first approach. However, sometimes that’s not enough, and so you need to rebuild your stomach acid levels. We love the HCL Guard by HealthyGut or Betaine HCL and our stomach acid resource pack. We have a ton of different ways that you can support that with bitters and apple cider vinegar and all those things. I like to just keep it simple and take a capsule. Then you would wanna think about vitamin C, so vitamin C rich foods, vitamin C with your meals. So you could either take this in a liquid form, a powder form. I prefer buffered vitamin C. It’s easier on the gut. But for me personally, if you’ve watched my stories over the past almost three years now, I believe maybe… No, two years, going into my third year, we’ve taken camu camu every day. My son takes it as well. It’s great, source of natural vitamin C, naturally higher in iron, so I include for my iron anemia gals. Put it in your smoothies. Put it in your drink. You can use a camu camu powder. Those are very cheap and affordable. They do have, like, a little bit of a sour taste. Sometimes I just found that they were kinda chalky, so I opt to just keep the IO1 dropper in, and it’s just so easy. My kids don’t even notice that it’s going in their drinks.

Recheck at Four Weeks and Watch Your Cycle

26:48Liz Roman: so just remember there’s a lot of things that we can do here, and then it’s important that you recheck. So look at your labs, see the pattern, identify what you need, implement that, and take consistent action for at least four weeks. Recheck. Watch your menstrual cycles too. So if you are somebody who is having those really heavy bleeds, go into the guide and look at everything else we talk about related to your thyroid. Iodine’s a crucial player here because that regulates growth, and we know that typically when iron is low, we’re gonna see iodine deficiency and typically more on the slow hypothyroid, side. So Beck, I don’t know if you wanna add anything to that, but this is definitely a broader, complex picture, and sometimes we do have to work hard to get these stores up.

The Mitochondrial Piece: Why Low Ferritin Drains Your Energy

27:33Becca Chilczenkowski: Yeah, and I, I think the last piece that we haven’t expanded on too much is around how ferritin can a lot of times be because of mitochondrial and cell issues. So iron isn’t just for making red blood cells. Like, it’s required for the raw material inside of individual cells for jobs that have nothing to do with oxygen support. One of them is in the electron transport chain, which is basically how your cells make energy. And so if there is a lot of struggle happening at a cellular level due to, you know, immune based issues, chronic stress on the system, the iron is going to be essentially worked through, and mitochondria can’t run that chain efficiently. And so your cells make less energy regardless of what hemoglobin looks like, and that’s why people a lot of times don’t have hemoglobin and hematocrit issues, but, like, they’re exhausted, they have brain fog, they’re cold. Because if their ferritin’s low A lot of times it’s a cellular problem, not necessarily an iron and iron storage problem. And iron’s also a cofactor, which we didn’t talk too much about, but it’s a cofactor for enzymes outside the mitochondria that convert T4 to T3. So it’s needed for enzymes that essentially synthesize dopamine and serotonin, and low ferritin will contribute to sluggish thyroid conversion, low mood, low motivation. So it’s kind of this vicious cycle of, like, it affects a lot of different systems, and ferritin is a reserve. It’s not real-time measurement like iron is, you know? So it tends to drop well before your hemoglobin or MCV or these other markers, and the body prioritizes iron for hemoglobin production above almost everything else, so it will drain ferritin, essentially to protect red blood cell output. So we’re looking at iron, we’re looking at the gut, we’re looking at all these things, and that’s not wrong, but sometimes it gets to a place where we have to look at the cellular health and what ultimately is depleting the cellular health, which can be, you know, chronic viral, it can be GI issues, it can be chronic stress, it can be chronic undereating, right? There’s so many things that can stress out a system, and that’s a case-by-case basis of what we look for. But this was something that was really interesting that we kind of, came upon a little bit more recently on with the mitochondria being such a big piece of low ferritin and having to be addressed as well. but yeah, it’s why you have to look at things as a whole. You can’t just isolate an iron panel. You can’t just isolate ferritin. Like, you have to look at the entire system.

Why You Cannot Read an Iron Panel in Isolation

29:47Becca Chilczenkowski: It’s why we run so much blood work. It’s why we look at health history and dive deep into this with people. Because again, you’re just not gonna get it anywhere else. Like, we’ve had the … Liz and I had this conversation offline. People are like, “I learned more in this conversation than I’ve learned in months/years working with different doctors.“ And it’s, again, no fault to people. Like, some people, it’s just not their expertise. It’s not what they’ve learned. It’s not that they don’t have the time, right? I mean, I had a client a wh- a while ago, I remember, and she had a very clear hemochromatosis pattern, and I told her to go to her, her hematologist. Mm. And she came back and said the hematologist basically said, “We’re not gonna do anything until it gets worse.“ And so, you know, you kinda have to fight for yourself and find your own answers sometimes, which is what our team helps with. and so we advise, obviously, utilize things that are helping with, you know, not absorbing so much iron, like Liz went through, and then giving blood. Some people need to give blood every month, every other month. Like, sometimes it needs to be a little bit more regular, especially if it’s gotten kinda bad. but yeah, that heaviness, that leg heaviness, that feeling like you’re huffing and puffing, like, it almost feels like you’re working through quicksand, can be really common with hemochromatosis ’cause iron is very heavy on the system. When it gets too high, it stresses out the liver a ton. so yeah, it’s, we gotta find our own answers sometimes, and that’s what we do the podcast for. That’s what we try to help you guys with. and if you want those answers and you feel like you’re not getting them, go to the show notes, book a call with our team, set up a lab review with us. We’re more than happy to go through this all with you and help you understand what your patterns are.

Frequently Asked Questions

What ferritin level is actually too low?

Conventional labs often flag ferritin only below 15, and many women are told a result in the 20s or 30s is normal. Liz Roman and Becca Chilczenkowski of FitMom use a functional target of 80 to 120, and want at least 80 in women who still cycle or who are losing hair. Below 50, they say most women already feel the fatigue, hair shedding, and poor recovery.

Why is my ferritin still low even though I take iron?

Because in four of the five patterns FitMom sees, iron is not the limiting factor. Ferritin can stay low when inflammation raises hepcidin and locks iron in storage, when low stomach acid or a gut infection blocks absorption, when the deficiency is really B12 and folate, or when chronic stress burns iron in circulation faster than the body can store it. Adding oral iron does not address any of those.

What is hepcidin and why does it matter for low iron?

Hepcidin is a hormone made by the liver that decides how much iron enters your bloodstream. When inflammation or infection rises, hepcidin rises with it and shuts down ferroportin, the protein that moves iron out of the intestines, liver, and macrophages into circulation. The result is less absorption from food and more iron trapped in storage. Liz Roman calls hepcidin the iron gatekeeper.

What are the five anemia patterns on an iron panel?

FitMom groups them as: true deficiency, with low iron, low ferritin, high total iron binding capacity and low saturation; a conversion problem, with normal iron but low ferritin; anemia of chronic disease, with normal or high ferritin, low serum iron, low saturation and low binding capacity; B12 and folate anemia, with high MCV and normal iron; and iron overload, with high saturation.

When in my cycle should I test iron and ferritin?

Not right after a period, because blood loss drops the numbers and makes the result look worse than your baseline. Becca Chilczenkowski recommends testing leading into your cycle, around day 19 to 22 on a typical 26 to 28 day cycle, which is also the window used for hormone testing in a cycling woman. She also stresses reading trends across draws rather than reacting to one panel.

Why does low ferritin cause heavier periods?

It runs in both directions. Iron builds thyroid hormone, and low thyroid output leads to heavier bleeding and worse absorption, which then depletes iron stores further. Liz Roman describes this as a loop: low ferritin drives heavier bleeds, heavier bleeds drive ferritin lower. That is why FitMom wants at least 80 in a woman who is still cycling rather than the bottom of the lab range.

Can low ferritin cause fatigue even with normal hemoglobin?

Yes. Becca Chilczenkowski explains that iron is required inside the electron transport chain, which is how cells produce energy, and as a cofactor for enzymes that convert T4 to T3 and synthesise dopamine and serotonin. When ferritin is low, cells make less energy regardless of hemoglobin, which is why exhaustion, brain fog, feeling cold, and low motivation show up with a normal complete blood count.

How do you tell hemochromatosis from ordinary high ferritin?

By transferrin saturation, not ferritin. Liz Roman notes that a true hemochromatosis pattern shows saturation above 45 percent alongside high iron, high ferritin, and low total iron binding capacity, and that ferritin alone will miss it entirely. High ferritin with everything else normal is more often inflammation or a stressed liver. Symptoms can include heavy legs and getting winded on stairs.

Key Terms From This Episode

Ferritin

Your iron storage tank. It reflects reserves rather than what is circulating right now, so it drops well before hemoglobin or MCV do.

Serum iron

The iron actually in your bloodstream at the moment of the draw. FitMom's functional target is 85 to 130.

Total iron binding capacity (TIBC)

How hard your body is hunting for iron — described on the episode as the total seats on the bus. Lots of empty seats points to deficiency. Target 250 to 400.

UIBC

Unfilled iron binding capacity. High means room to spare and suggests deficiency; low points toward inflammation or overload.

Transferrin

The iron delivery driver. FitMom's range is 200 to 350. High transferrin means the body is scrambling to move more iron.

Transferrin saturation

How full the delivery trucks are. Low means not enough iron is being delivered; above 45 percent is the tell for true hemochromatosis.

Hepcidin

A hormone made by the liver that decides how much iron gets into the bloodstream. Inflammation raises it, and it closes the gate.

Ferroportin

The door hepcidin shuts. It moves iron out of the intestines, out of liver storage, and out of macrophages back into circulation.

Iron sequestration

The body deliberately locking iron away, usually because pathogens such as parasites and candida can feed off it.

Anemia of chronic disease

An inflammatory pattern where iron is present but locked in storage. Ferritin reads normal or high while serum iron and saturation read low.

CRP / hs-CRP

An inflammatory marker produced by the liver. It was designed to catch acute inflammation, so chronic low-grade inflammation can leave it normal.

ESR (sedimentation rate)

A second inflammatory marker. FitMom wants it under 10; conventional labs often do not flag it until 25 or 30.

MCV

Mean corpuscular volume — the average size of a red blood cell. High MCV points toward B12 and folate deficiency rather than iron.

Homocysteine

An amino acid marker tied to B vitamin status. FitMom targets around 7.2; 8 to 10-plus suggests a B12 and folate need.

MMA (methylmalonic acid)

A confirmatory B12 marker. It typically runs high when B12 is functionally low.

Lactoferrin

An iron-binding protein used to help transport iron appropriately. Also used to support the gut lining when zonulin and calprotectin are elevated.

Hemochromatosis

Iron overload with a genetic component — the body absorbs iron and cannot stop. Diagnosed on saturation, not ferritin.

Macrocytic anemia

Anemia where red blood cells grow too large but too few are made. Driven by B12 and folate, not iron.

Referenced In This Episode

• LabCorp reference ranges
• Quest Diagnostics reference ranges
• FitMom Society — the Labs Decoded webinar series referenced in this episode
• Book a Root Cause Discovery Call with the FitMom team