Ep. 85: Iron, Ferritin, and the Gut: What Your Labs Are Really Telling You

If you’ve ever been told your iron or ferritin is “low”  but no one can explain why then this episode is for you.

Iron issues are rarely just about your diet or supplements. They’re often a reflection of what’s happening in your gut. In this episode, Dr. Heather breaks down how stomach acid, infections like H. pylori, mineral balance, and inflammation all impact how your body absorbs and uses iron.

You’ll learn:
 ✅ The real difference between ferritin and serum iron (and why both matter)
 ✅ What high or low ferritin actually means and the hidden gut clues behind it
 ✅ How minerals like copper, zinc, and potassium influence iron utilization
 ✅ Why iron supplements can make symptoms worse if the root cause isn’t addressed
 ✅ Practical steps to rebuild your terrain for better energy, digestion, and balance

If your labs have never made sense or you’ve been stuck taking iron without feeling any better  this episode will help you see why.

Links Mentioned:

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Tune in to discover how your gut and minerals could be the missing link to finally balancing your iron and feeling like yourself again.

Transcript

Dr. Heather Finley: 0:03

Welcome to the Love Your Gut Podcast. I'm your host, Dr. Heather Finley, registered dietitian and gut health specialist. I understand the frustration of dealing with GI issues because I've been there and I spent over two decades searching for answers for my own gut issues of constipation, bloating, and stomach pain. I've dedicated my life to understanding and solving my own gut issues. And now I'm here to guide you. On this podcast, I'll help you identify the true root causes of your discomfort. So you can finally ditch your symptoms for good. My goal is to empower you with the knowledge and tools you need so that you can love your gut and it will love you right back. So if you're ready to learn a lot, gain a deeper understanding of your gut and find lasting relief. You are in the right place. Welcome to the love your gut podcast.

0:58

If you have been told your iron or your ferritin is low, but no one can explain why, and you keep taking iron, and every time you stop, your iron is low again, then this episode is for you. I cannot tell you how many clients come to me saying My doctor told me to take iron. But I still feel tired all the time, or I've been taking iron supplements for months and my ferritin hasn't budged, and now I'm taking iron and I'm so constipated and bloated even more than I was before. It is one of those frustrating cycles where you're trying to. Fix one problem and you accidentally create another. You want more energy, less hair shedding and better focus, but instead, you are battling sluggish digestion and discomfort. So here is the thing, if your iron or ferritin levels aren't improving, or if your iron supplements are making your gut worse, there is a clue that your iron might not be. An iron issue, it might be another issue all together. So today on the Love Your Gut podcast, we are unpacking. What your iron and your ferritin labs are really telling you how stomach acid, gut infections, and even mineral imbalances can play a role. Because when we zoom out and we look at the full picture, we often find that iron issues actually start in the gut and not just in your blood. So before we get into the gut side of things, I wanna take a minute to understand what your Iron Labs are actually showing you, because most people have seen these numbers. On their blood work, but have no idea what they actually really mean. So we're gonna use the analogy of your iron as kind of like your finances. So everybody's familiar with finances. I thought this might be a good analogy. Ferritin is like your savings account, so it's where your body stores iron for later use to make red blood cells support. Thyroid function, carry oxygen. Your serum iron, which you've probably seen on your blood work, is like your checking account. So that is the iron that's actively circulating and being used day to day. For all different types of things in your body. Then you have TIBC and transferrin saturation. These are more like direct deposits and like a bank transfer system. So they tell you how efficiently your body is moving iron between your accounts when everything is balanced and you have enough in savings, so your ferritin or enough in your checking your serum iron. And the transfers are working smoothly, so TIBC and transfer and saturation, everything is good, but when something goes wrong, whether it's stress or inflammation or poor absorption, these quote unquote accounts stop communicating well, and that's when you start to feel it. You start feeling fatigued. You start having brain fog, hair loss, brittle nails, shortness of breath. Maybe even GI symptoms. And so here are the most common three patterns that we see on labs. There's a lot more, but obviously this is just a podcast episode. So we're gonna keep it to three today, and I will probably record another episode on this. Especially if I get a lot of questions. So maybe you have low ferritin and normal serum iron, so this means that your checking account still looks okay, but your savings are empty, so you're drawing from your reserves faster than you can replace them, or you're spending basically what you're making. And this can be an early sign of depletion, sometimes hidden inflammation that's keeping you from storing iron properly. We see this quite a bit where ferritin is like. Nine 11, maybe even in the twenties, and it will not budge unless somebody is like getting an iron infusion or megadosing iron. But what I hope you understand by the end of today's episode is that getting an iron infusion or just. Mega dosing iron is not always gonna help you, and in fact, it could be making things worse. Another scenario that we'll see is high ferritin or normal to low serum iron, so maybe your ferritin is out of range. It's in like the three hundreds high, two hundreds. We see this quite a bit as well. This is like having a ton of money locked away that you can't access. So maybe this is like a retirement savings that you know you've got a lot of money, but you can't do anything with it. The body will raise ferritin in response to inflammation or infection as a protective move. It will hide iron away from other pathogens that love to feed on it. So your storage looks really high, but you're not actually using it. Efficiently. So maybe your serum iron is low and that's your body just doing what it was designed to do and is a sign that we need to look a little bit deeper. And then the third scenario is maybe you're just low across the board. Low ferritin, low serum iron, low saturation. This is true iron deficiency. It can come from blood loss, maybe heavy periods or gut bleeding. Poor dietary intake of iron, which this would be probably the least common cause.'cause you actually don't need. That much iron in your diet. If your iron recycling is working pretty well, malabsorption, maybe from low stomach acid or even infections that will interfere with iron recycling. So understanding which pattern you fall into can help us to determine how we are actually going to approach it. Because like I mentioned, supplementing iron when the issue is actually inflammation or infection can make things worse. So let's talk about the gut connection of iron and why Iron Labs will get out of whack. And here's where it all really starts to make sense. When we look at iron and ferritin levels, it's really easy to assume this is just about how much iron you're eating or that maybe you just need to supplement more. But that's really just the tip of the iceberg because the gut plays a massive role in how your body absorbs, uses, and even protects your iron, like in the example that I mentioned earlier. So let's start with the top of digestion, stomach acid, which if you've listened to any of my podcast episodes, I've probably talked about this at least in some of the episodes that you've listened to, you actually need a lot of stomach acid. To absorb iron and really all minerals, but especially the kind that comes from plant-based or non-heme sources. Without that iron just passes through without really ever getting fully utilized. And one of the biggest culprits behind low stomach acid is h pylori. H Pylori is the most common infection in the world. It's a bacterial infection that can damage the stomach lining and it can suppress acid production. So if you're low in ferritin and you're struggling to raise it depi, despite taking supplements, this could actually be why you keep. Adding more iron. But if digestion isn't working properly, it's like pouring water into a bucket with holes. It's just going straight through. So this is why a root cause approach matters so much, because if you only focus on this symptom. Oh, you have low iron. Oh, you're constipated. Oh, you're tired. And you just start patch treating all these symptoms and not looking to the reason behind them. You end up playing whack-a-mole with your health. And most of the time, 99% of the time when we start working with new clients, it's because they're sick of doing that. You improve one issue, another one pops up, and then you're still left guessing as to why you're feeling that way. So let's talk about the other side of the equation, which is. Pathogens that love iron, things like parasites, h pylori, and then even certain bacterial overgrowths thrive on iron. So your body does something super smart. It will hide it, it will lock it away in ferritin, almost like. Putting food in a high cabinet so that your toddler can't dump it out. That is why you might see high ferritin, but low serum iron when infection or inflammation is present. But if your ferritin is low, so your storage form of iron is low, that's a sign that your body's resources are. Tapped, it's trying to fight something off. It no longer has enough reserve to protect you and function optimally. We do see this happen during pregnancy when ferritin naturally drops because your body is prioritizing the baby and you have a lot of. Extra blood volume. It's called hemodilution, and you're sharing nutrients and increasing demand for iron and minerals. So low ferritin in pregnancy, doesn't always mean something's wrong. In fact, that was actually something that I dealt with in this last pregnancy. But it's a sign that your reserves are being heavily used and really need to be replenished. So full transparency. I've been on a ferritin iron journey. Self since giving birth. And thankfully things are improving but it is taking time. So there's inflammation, which is a huge player. When the body senses inflammation, it releases a hormone called hepcidin, and this blocks iron absorption and iron recycling. And so basically it's a defense mechanism to starve pathogens of iron, but unfortunately, it also starves you, and that's why inflammation driven iron issues often don't respond to supplementation until the inflammation itself is addressed. Let's move down further to the gut, to absorption and permeability. So if you have, quote unquote leaky gut or intestinal permeability or just poor digestion, you are simply not absorbing minerals. Well, the lining of your intestines is like a fine mesh. When it's healthy, it lets. Nutrients in it keeps toxins out, but when it's inflamed or permeable, that mesh will loosen and it will allow larger particles and inflammatory compounds to slip through. And this constant irritation just reduces your ability to absorb minerals like iron, like zinc, magnesium, all the other minerals that work for energy. And even detox and digestion. And then lastly, we can't forget motility and bile flow. So you need to be able to empty your bowels. You need bile to help digest fats. If you are constipated or you have sluggish digestion, your bile isn't flowing well and bile is your body's basically like dish washing detergent. It helps to emulsify fats, it sweeps out toxins. It even supports microbial balance. But the kicker here is that minerals are needed to move and make bile. So when you're depleted in things like copper or sodium or potassium, bile flow will slow, and that means that your detox pathways struggle and so does your digestion. And this sets the stage for issues like SIBO or candida or just that feeling of like stuckness that so many people describe. So while iron and ferritin might look like a blood problem on paper. It's really a reflection of your own gut environment, and that's cool because your body is just giving you clues for where to look. And iron is kind of that first clue. So low stomach acid, hidden infections, inflammation, permeability, poor bile flow. All of these will interfere with your ability to actually use iron. Now that we've talked about digestion and the guts role in iron absorption, let's zoom out a little more. Because iron does not work alone. It is not as simple. Like I mentioned as just taking iron, it's part of a bigger mineral network and when the rest of that network is off balance, your iron will move or be used properly no matter how much you supplement. So I wanna start with the one mineral that often gets most overlooked, which is. Copper. So copper is required to mobilize stored iron. So in simple terms, what this means is it allows the body to take iron out of storage, so out of ferritin and actually use it. And so if your copper is low, you can end up with ferritin that's stuck in storage. Iron is there, but your body cannot access it. When we see HTMA results for clients, I often look at a couple different patterns when it comes to copper. Number one is buried copper. This is when copper looks normal or even low on paper, but it's actually stored in the tissues rather than available for use. And so clients often show symptoms of both low copper and copper toxicity. Like fatigue or anxiety or histamine issues, or just stubborn low ferritin that won't budge. Another situation is overt copper. This is when copper is just truly unregulated and it can happen with estrogen dominance, sluggish liver. Poor detox, certain supplements, higher copper can suppress zinc, and then just throw off iron utilization leading to kind of that same feeling of like burnout that wired, tired energy, et cetera. And then the last one is low copper. So this is more straightforward. It's when the body genuinely doesn't have enough from either long-term depletion or birth control use, vegan diets, low stomach acid so many different things. Without enough copper, you can't make an enzyme called ceruloplasmin. And that is essential for transporting iron safely and efficiently. So ceruloplasmin is another marker that you can draw on blood work that will help you look at this whole iron picture. So when you start to see low ferritin or stubborn anemia, that won't improve with iron. Copper status is definitely something that you wanna check. And then next up is zinc. Zinc and copper work hand in hand, almost like siblings that share a room. So too much of one throws off the other, and you know how that can get a little bit crazy. So zinc is helpful for supporting immune health. It's also helpful for stomach acid production wound healing. I know many of us were mega dosing zinc during the pandemic, which my theory, I shared this at a conference I spoke at last weekend is my theory. We're seeing a lot of copper issues now, and I think a lot of that has to do with people, mega megadosing, zinc during the pandemic. But that's just my theory. I don't really have anything to back it up. But if you've developed some weird symptoms as a result. That could be part of it. Obviously part of a much bigger picture. But zinc cannot be too high because it will crowd out copper and limit iron utilization, which you certainly do not want, because then on the flip side, if copper is too high, it can suppress zinc, it can slow stomach acid, it can create this really bad cycle of poor digestion and poor nutrient absorption. The thing that I want you to hear about minerals, and this podcast of course is about minerals because it's about iron. But probably another podcast for another time is. Minerals are rarely about more. It's about balance. It's a symphony. You can't mega dose one and think that you're not gonna impact the whole symphony if the violinist is off. The whole thing sounds bad. So there are smaller but more important players as a part of this as well. But that's really what you wanna understand is we never want to just overdose or mega dose, one mineral. We have to look at how the whole thing is playing out together. I wanna focus on manganese and molybdenum really quick. These minerals are very minor minerals, but they do help to regulate oxidative stress, which is basically how well your body handles the byproducts of energy production. And so when these are off, especially if we see manganese really high on HTMA testing, it can signal that the body's under oxidative stress. Often from inflammation or just overall detox strain. Sometimes we'll see this in a chronic SIBO picture, and when that's happening, iron metabolism can get disrupted as well, because inflammation and oxidation are linked together. So this is where HTMA testing just gives us a much fuller picture than just blood work on, yes, your ferritin's low, or yes, your iron's low, whatever it might be, because we can see how the whole mineral system is working together. For example, let's say somebody has high calcium and magnesium that can indicate slower metabolism. Which means the body's oxygen delivery and energy production, which are both dependent on iron are reduced. Or if we see low sodium or potassium ratios, this can show that the adrenal patterns are under stress and that can affect things as well. Zinc and copper ratios, those are really important. And then even low cobalt is something that we see often. Which often reflects low stomach acid or B12 issues, which will further impair iron absorption. So when we look at minerals, we're not just looking at numbers on a chart. And that's the biggest difference is we're not just looking at like, okay, check your iron is normal, check your calcium's normal. We're seeing. How your body is managing energy and oxygen and inflammation behind the scenes. And then when we start rebalancing minerals, especially a lot of these minerals that have to do with iron, copper, and zinc and potassium, we see iron and ferritin improve without high dose supplementation. Obviously if we're addressing the gut as well, if there's something coming from that. So here is why supplementing isn't always the answer and why I think so many people get stuck because you're told your iron is low. Just take a supplement. So you go, you grab iron and you hope your energy comes. Back, but instead you're bloated, you're constipated, you have stomach pain, and then your labs are doing crazy stuff. So if that sounds familiar, you're definitely not alone. And the truth is that digestion and pathogens and inflammation could all be part of the picture, and your body needs to be able to use the iron that you're taking. And we don't also want to be adding more fuel to a fire that's still burning. So that can happen because iron can also be pretty irritating to the gut lining. When your digestion is already compromised, it can feed bacteria and pathogens, like I mentioned, especially if you have SIBO or parasites or h pylori. Those are common things that we see with clients we work with. So instead of solving the problem, you're just supplementing iron in increasing inflammation, making your constipation worse, and your body is still really struggling to absorb what it needs. Which is why we need to support the terrain of your gut. We need to improve digestion. We need to support gut motility. We need to clear infections. We need to rebalance minerals. We need to give the body all the tools that it needs. And this sounds really complicated, but. It really isn't when you're able to get the correct testing and get all the pieces of the puzzle laid out right in front of you and you have someone to walk you through exactly what to do, it really is fairly straightforward on, okay, here's the plan and kind of here's where we're headed. We're not navigating this in the dark and we know exactly what we need to do. So there, this is the difference between chasing your symptoms or band-aiding your symptoms, and actually addressing the system. When you rebuild the terrain, your body finally has what it needs and it becomes a lot easier. And then it's not a chronic problem, right? Like you're not having to. Constantly take mega doses of iron or constantly worry about this. So now that we've uncovered the why behind iron, let's talk about some functional clues, like just little patterns that help us connect the dots between your symptoms and your labs and what could be going on underneath. So low ferritin is a common one that we see. Maybe you notice you get bloated or nauseous after eating protein. If those two things are going on with you, and again, by the way, this is not diagnostic, consult your medical provider. All the legal things I'm supposed to say, I'm just pointing out some patterns. If you have low ferritin and you also get bloated or nauseous after eating, that is a big red flag for low stomach acid and possibly h pylori. So your body is. Probably, or possibly not breaking down food efficiently, which also could mean that's why you're not absorbing iron or other minerals very well. Maybe you have the opposite. You have high ferritin, but you still feel tired and inflamed. Maybe you have joint pain, acne that often points to inflammation or infection. And your mo, your body may be intentionally locking iron away to protect itself. So even though your ferritin looks high, you could be functionally iron deficient. Or just sequestering that iron away from some kind of infection. So navigating. The testing to look at that would be really helpful. And then let's say you have low iron and constipation. This is a sign of classic slow motility or mineral imbalances. We need minerals to help our gut contract, and that sluggishness can affect everything from bile flow to detox to nutrient absorption, which is why testing really matters because blood work alone is not gonna tell the full story. We want to see how your gut is functioning, how your minerals are balanced, not just what's floating around in your blood. That's why inside our programs we definitely use blood work. But whether you're working with our client in really any of our programs, we're gonna use a combination of testing GI Map, HTMA blood work to piece together the whole picture if you've got iron stuff going on, because we wanna see how all these systems are going together. So what can you actually do if your ferritin or iron numbers. Aren't where you want them to be, and maybe you're gonna jump into testing, but you want some actionable steps that you can do right now. The first step, of course, is to stop guessing, because Iron Balance is never just about taking more iron. It's about creating the right environment. And so while you're waiting on getting more answers on the whole picture, let's start with the top of digestion. Stomach acid support. If you're dealing with bloating, nausea, gas, burping, undigested food in your stool, low iron, you need to support your stomach acid most likely. So using things like digestive bitters, supporting minerals that drive stomach acid production like sodium and zinc, and. Always consult your health provider. In some cases you might need HCL. That's not my go-to, and I would not recommend that if you don't know if you have h pylori or not. When stomach acid is optimized, you're gonna absorb iron. You're gonna absorb B12 protein all without the digestive discomfort. Next is addressing infections before you push iron. So getting rid of parasites, h pylori, yeast overgrowth, and giving your body more iron can actually make you feel worse. So. Clearing the terrain is going to allow you to utilize and store iron properly. Also, looking at minerals, repleting minerals, and focusing on balancing minerals like copper and zinc and potassium and magnesium. So your body can utilize iron correctly. Copper will help mobilize it. So definitely looking at copper, whether it's on an HTMA or blood work and ideally both. Usually we're running a full Monty blood work panel, so we can look at ceruloplasmin and all of that as well, and balancing your minerals so that your body can recycle iron. Without the inflammation and constipation that comes with that. Another gentle option that I often use with clients and that I'm actually currently taking, I shared this on Instagram maybe a couple weeks ago and I got a bunch of questions about it, is lactoferrin. Lactoferrin is a bioactive and it helps to bind to iron safely. It supports immune function. It has mild antimicrobial properties and can help. Prevent pathogens from feeding on iron. So whether you have low or high lactoferrin can be good. It also acts as a prebiotic, which means it's gonna support the growth of beneficial gut bacteria and regulate how the body utilizes and stores iron. And this is really where personalization matters because there's no one size fits all. There's a reason your ferritin and your iron are off. For one person, it might be poor absorption for another, it might be copper for another. It might be an underlying infection. And so guessing on this. It's just gonna waste your time and waste your money and maybe actually make things worse, which is where functional testing is so powerful because you're not just throwing darts in the dark and instead you're finally gonna understand what's going on with your body. So just to wrap this up, if your ferritin or your iron labs have never made sense. Maybe they're low one year high the next, or maybe they're always low, and you just don't seem to, it doesn't match how you feel. It might not be your diet. It might not mean that you just need to eat more steak. It's usually other things that are going on. So learning to understand the connections between your digestion and your minerals and inflammation and your microbiome. You can start to see why iron might not be fixing your fatigue or what really the true. Portion of this is so of course, if you are ready to stop guessing and finally figure this out, that's exactly what we do inside of gut together. It's a custom one-on-one program. We're going to use functional testing like stool testing and HTMA, and we'd love to work with you. And then if this episode hit home, you definitely wanna join me live for my brand new webinar on October 19th. So we're gonna test out a Sunday webinar to see if that helps with work schedules and after school sports and all the things we're gonna be digging deeper into sibo and specifically why so many people stay stuck after multiple rounds of antimicrobials or antibiotics or diets. So even if you haven't been diagnosed with sibo, but you struggle with bloating or constipation or diarrhea. And no matter what you do, you're stuck. Make an effort to be there. It's gonna be good. I'm really excited about the updates that I am making to this webinar. And. It's gonna be fun, so make sure you can be there. I put a poll up on Instagram, so I think it's gonna be sometime in the afternoon, but TBD, we'll put all the link in the show notes for the time and all of that. But we'll talk about the role of slow motility infections, how to rebuild your gut so you can feel better for good. You can pre-register using the link in the show. And I can't wait to see you there because your gut matters and you feeling good matters too. So see you next time on the next episode of the Love Your Gut podcast. Thanks for joining.