Iron Metabolism Explained

One of our most frequent inquiries is the extra large topic of ‘iron metabolism’. Which truly is fair enough.. it’s such a complex topic and it really is very nuanced, so it can become very confusing too, especially if you have a current iron deficiency haha (IYKYK). From years in clinical practice, here’s everything we have learnt about iron metabolism and iron's role in health and vitality when it comes to energy, clarity, stamina, mental health and immune function.

Common signs of iron deficiency and anaemia

Firstly, let's unpack what it means to have low iron. Some common symptoms of iron deficiency and anaemia include fatigue, tiring easily, pale skin, breathlessness, orthostatic hypotension, frequent headaches, racing heart, heart palpitations, mouth ulcers, brittle nails and hair loss.

Recognising iron deficiency or anaemia can be done through a blood test, by having a full “iron studies” panel. Of course, you need your healthcare practitioner to interpret these levels correctly - a holistic practitioner (such as a Clinical Nutritionist or Naturopath or Functional Medicine Dr) is ideal here, as this is someone who is going to review using ‘optimal’ health ranges rather than Western Medical reference ranges, and also take into consideration your stage and phase of life, as pregnancy bloods are not comparable to a non-pregnant female.

Understanding your iron results

But in very simple terms, this is what our iron studies markers mean:

• Ferritin: indicates your iron storage, but is not the only important indicator of an iron deficiency. It is also an acute phase reactant, meaning it can rise due to infection, injury, or inflammation
• Serum iron: shows how much iron is getting absorbed through your gut, reflective of generally the previous 48 hours of iron intake through diet
• Transferrin: indicates how hungry your body is for iron, as it binds and carries iron through the body
• Transferrin saturation: measures the % of transferrin that is actively carrying iron, ready to deliver iron to tissue
• Total iron binding capacity (TIBC): measures your blood’s ability to attach to iron and carry it throughout the body, highlighting available binding sites, as it shows how much unused carrying capacity your blood has for iron

Additional, but highly recommended, markers to look at when assessing iron:

• Haemoglobin: a protein found in red blood cells that indicates how well your blood is transporting oxygen through your body
• MCV: shows size of cell, indicating possible iron, B12 or folate deficiencies
• B12, folate, copper, magnesium and vitamin A: all have a role in iron metabolism as they are a nutritional cofactor for either iron absorption, transport, storage or regulation.

It is important to note that haemoglobin must be tested to determine a true iron deficiency, especially in pregnancy due to haemodilution that occurs. It is natural for your ferritin to reduce in pregnancy, and it is not the only indicator of an iron deficiency. If your haemoglobin levels are below 105 g/L during pregnancy, then that is time to absolutely take action to increase your overall ferritin levels.

If your ferritin is low, and your haemoglobin is okay, you likely need support with iron metabolism via the various cofactors we discuss below.

So let’s say you get your blood test back from your practitioner and it says you are low in ferritin, anaemic, or perhaps you have been getting repeat tests indicating a recurring suboptimal theme or deficiency. There are a few things to consider here to understand WHY this is happening. We can supplement, transfuse, and test until the cows come home, but your iron won’t hold if you do not understand WHY it is happening.

What's possibly causing your iron deficiency?

For some people, this can look like a low dietary intake of food-based, bioavailable iron, a damaged gut lining hindering nutrient/iron absorption, possible bacterial or parasitic infection utilising iron as a fuel source and preventing absorption and increasing inflammation of the gut lining, internal bleeding depleting iron stores, poor quality iron supplements taken incorrectly, or lack of nutritional cofactors necessary for iron metabolism, including absorption and transportation around the body.

So if this is you… here are a couple of points to consider when trying to investigate and resolve the iron issue.

• Ensuring you are meeting your nutritional requirements through dietary intake: Including iron-rich foods of both heme and non-heme sources such as grass-fed red meat and organs (lamb, goat, kangaroo, beef, liver, spleen), legumes (beans, peas, lentils), seafood (sardines and octopus), some grains (quinoa, millet, amaranth), organic dried apricots and plums, nuts (pine nuts, cashews, almonds), seeds (chia, flax and poppy), cacao powder, pasture-raised egg yolk, dark leafy greens.
• Ensure you are including nutritional cofactors: If you have deficiencies or low intake of the nutritional factors required for optimal iron metabolism, your iron will not be absorbed or utilised efficiently. Cofactors include B12, folate, vitamin A, copper, B2, glycine and magnesium. Vitamin A mobilises stored iron, copper transports iron via ceruloplasmin, B2 supports iron enzymes, folate and B12 help to make red blood cells, while B6 and glycine help to make haem. Magnesium is also critical for indirectly enhancing haemoglobin levels by helping maintain healthy red blood cells and supporting the enzymes involved in iron regulation within tissue.
  *If you are supplementing a synthetic form from your practitioner, it is ideal to include these cofactors necessary for iron metabolism, whether this is in the same supplement or through dietary intake. If you choose to supplement with a synthetic, ensure it is of great quality and at a therapeutic dose (more is not always better). Due to hepcidin’s ability to block the absorption of excessive amounts of iron, taking a therapeutic dose every second day is ideal, and absolutely no more than 40 mg per dose. It is preferably taken on an empty stomach, away from any coffee, calcium, and zinc supplements.
• Investigate digestive function, gut microbiome, and integrity of the gut lining: A functional stool test is a great option here to get a full look at the gut microbiome, digestive function, and help identify possible imbalances such as low stomach acid, poor bile flow, poor digestive enzyme capacity, gut inflammation, and more. If not affordable, a simple MSC PCR testing can be done by your GP to investigate possible pathogens. Coeliac testing done by your GP can also be a valuable step here. If testing isn’t doable entirely, including foods to support healing your gut lining is a great option, such as bone broth, bone marrow, small fatty fish, beef liver, cod liver oil, and polyphenol-rich foods like wild blueberries and pomegranate. The probiotic strain Lactobacillus plantarum 299v can also help prevent iron deficiency and assist with iron absorption. Ensuring your fermented food or probiotic contains this in times of true iron deficiency can be a really beneficial action step.
• Rule out internal bleeding: This could look like a colonoscopy or endoscopy, CT scan, or stool testing with your GP, whilst paying attention to any blood that may be passed in bowel movements.
• Consider the food-first approach: Beef liver works because it respects natural human physiology. It contains haem iron in small amounts, but more importantly, it contains the necessary nutritional cofactors to support iron metabolism: vitamin A, copper, B12, folate and riboflavin. Beef liver supports the entire metabolism process, and choosing this cofactor approach makes a very small amount of iron go a very, very long way.
  When more iron is needed when correcting a deficiency or supporting cases of higher demand (heavy cycles, athletes, pregnancy, postpartum, growing children), that’s where beef spleen can be great. Beef spleen is naturally much richer in haem iron. It has a lower content of nutritional cofactors (although high B12!), but pairs perfectly alongside beef liver for this reason.
  Non-haem sources of iron, such as beans and lentils, contain phytates that block iron absorption. To remove phytates, soaking your grains and legumes in water with a dash of kefir or apple cider vinegar is ideal and makes them much easier to digest too. Non-haem iron also benefits from being paired with vitamin C to increase absorption, such as lemon juice.

And if your ferritin just keeps dropping…

If your infusion never lasts, if synthetic supplements make you constipated and hardly make your ferritin budge, or if your ferritin rises but you still feel totally exhausted, then it’s time to ask:

Because restoring metabolism requires an entirely different approach to just trying to force the numbers up.

And remember, we have an online clinic of health professionals ready to support you!

With so much love,

Our founder, Sheridan and Jessie, our in-house nutritionist.