A while ago my hair started falling out in handfuls. I was tired in a way sleep didn't fix. I had my bloods done, and my GP told me everything was within range.
It was. When I sat down and went through the numbers myself, my iron was sitting low inside the "normal" range, low enough to explain exactly how I felt.
If you've had iron studies come back "fine" and you still feel flat, this one's for you.
What's in an iron study?
Iron studies aren't one number. They're a group of markers that each tell a different part of the story:
Ferritin: your iron stores. Think of it as the savings account.
Serum iron: the iron circulating in your blood right now. It swings a lot day to day, so on its own it isn't very reliable.
Transferrin: the protein that carries iron around your body.
Transferrin saturation: how full those carriers are.
Haemoglobin is often reported alongside, in your full blood count. It's the iron-containing part of your red blood cells.
Why "normal" ferritin can still be too low for you
Lab reference ranges for ferritin are wide, and the lower cut-off varies between labs. Some won't flag ferritin as low until it drops well into the teens or twenties.
The problem is that symptoms often start well before you hit that cut-off. Your stores can be running down for months, sometimes years, while every test says "normal."
As a naturopath, I look at results against optimal ranges as well as lab ranges.
These aren't diagnostic cut-offs, and they're not a reason to start supplementing on your own. They're a lens for asking better questions.
Low iron symptoms that are easy to brush off
Tiredness that doesn't lift with rest
Hair shedding or thinning
Breathlessness on stairs, or a racing heart
Feeling cold, especially hands and feet
Brain fog and poor concentration
Restless legs at night
Brittle nails, pale skin, or cravings for ice
Most of these have a socially acceptable excuse sitting right next to them. Busy. Stressed. Getting older. That's what makes low iron so easy to miss.
Not all low iron is the same
This is the part that surprises people most. Iron can be low because you're not getting enough in, because you're not absorbing it, or because you're losing it, through heavy periods for example. Sometimes ferritin can even look higher than it really is when there's inflammation in the body.
Each of those needs a completely different approach. That's why simply taking more iron doesn't work for everyone, and why some people end up back at square one six months later.
Get the free iron guide
I've written a free guide that walks through the different types of iron deficiency, the root causes worth looking into, and the blood test ranges to compare your results against.
Download the free iron guide →
Want someone to look at your results with you? Book a consult. And if you haven't had iron studies done yet, start with What blood tests should I ask my GP for?
This article is general information only and isn't a substitute for advice from your own health practitioner. Don't start iron supplements without testing and guidance, as too much iron can cause harm.