Ep. 99: Why Iron Wasn’t the Answer for My Low Ferritin

If you’ve been told to “just take iron” for low ferritin and it either didn’t work or made you feel worse, this episode is for you.

In this episode, I’m sharing my personal postpartum ferritin story and walking through why iron alone wasn’t the answer for me… or for so many of the clients I work with.

Low ferritin is one of the most misunderstood labs I see. And for most people, it’s not about iron intake. It’s about whether the body is actually ready to absorb, use, recycle, and store iron.

In this episode, we zoom out and talk about the systems that control ferritin, including digestion, motility, minerals, and liver support.

I also cover:

• Why ferritin often stays low even when you’re taking iron
• How postpartum depletion changes how the body handles iron
• Why iron can worsen constipation, bloating, and nausea
• The role of digestion, motility, and mineral balance in ferritin
• Why constipation is often a cause, not a side effect
• How the liver influences iron storage and regulation
• Why ferritin is usually a signal, not the root problem

This episode is especially for you if:

• You’re postpartum or have a history of heavy periods
• You struggle with constipation or slow digestion
• You don’t tolerate iron well
• Your labs are “normal” but you still feel exhausted
• Ferritin only improves while you’re actively taking iron

I’m hosting a free training called Why Iron Isn’t Enough

👉 Learn more and register here

Still dealing with bloating, constipation, or SIBO that keeps coming back?
Join my upcoming live training SIBO Unlocked on March 22, where I’ll walk you through why antibiotics, supplements, and elimination diets often fail—and what actually needs to be addressed for lasting gut healing.
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Transcript

Dr. Heather Finley 0:51

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.

1:43

If there was a way that you could improve your ferritin above 20 and actually keep it there without wrecking your digestion, you'd wanna know more about that, right? Because if you're listening to this, you likely saw the title of this podcast episode and thought, how do I fix my ferritin? There's a good chance you've already done what you were told to do. You've taken iron. You've taken vitamin C, you've cooked with a cast iron skillet. You've maybe even gotten iron infusions. You've stayed consistent. You've been patient, and either your ferritin didn't move at all. Or it stayed up only as long as you were taking the iron and now maybe you're dealing with constipation or bloating or nausea or that just uncomfortable feeling that something is off. So I want you to know how familiar that feels, because that is the exact experience that led me to record this episode. We have seen an uptick over the last couple years of women with iron issues, and what I mean by iron issues is low ferritin, wonky iron labs, as well as high ferritin. So don't automatically turn this episode off if you have high ferritin because part of this is applicable to you as well. I also dealt with low ferritin earlier last year as well. I shared in an email recently that I never expected to go viral for this. I started talking about ferritin on Instagram because it's something that we have seen a lot in this past year. And maybe it's one of those things like once you're looking for it, you know, once you have a certain car, you see that car all the time. And that definitely could be the case. But when I was postpartum with my last baby, I had previously during pregnancy, had low ferritin and I wasn't that worried about it because. Low ferritin during pregnancy can be a normal thing. If you follow Morley Robbins or any of his work. He talks a lot about this, just the hemodilution that can happen during pregnancy. So in previous pregnancies, my ferritin hadn't ever dropped as low as it did this one, but it would just rebound, go right back to normal. No big deal. Well, about six months postpartum, I got some Iron Labs drawn and I'm like, oh my gosh, my ferritin is nine. And to be honest, I actually didn't feel that bad. I was experiencing the normal postpartum, like hair loss and little bits of fatigue if I had a rough night's sleep. But to be honest. My third postpartum was my best postpartum, and I attribute a lot of that to how I prepared for pregnancy as well as mineral repletion and mineral support in postpartum, and just the boundaries that I had in place. There's, there's so many pieces of that, but. My ferritin was a nine, and I knew that, especially as someone with hypothyroidism and a history of gut issues, that I was not gonna mess around with that. And I was going to look into it because I knew that there was probably a reason that it was nine and it wasn't just hanging out at nine because it wanted to. So I started my own iron journey and going down all these rabbit holes. Meanwhile, we were seeing tons of women with the exact same issues, and so they would have their ferritin run, came back low. Their doctor would tell them, you need to take iron, but we're looking at all these iron panels, and I'm like, your iron is fine. Why is your ferritin low? And that's what I wanna talk about today. Uh, because you can take iron, but likely your ferritin issue is not an iron issue. You can do everything that you're supposed to take iron, pair it with vitamin C, you know, eat iron rich foods. Your body actually doesn't need that much iron every single day in order to keep your iron levels up. So. If your ferritin is barely moving or it's only staying up while you're actively taking iron or getting iron infusions, you have to look deeper. So I, when I had my ferritin of nine. I, like I said, I actually did not feel that bad. I didn't have the exhaustion that a lot of women have when their ferritin is so low. Probably because I was already taking so much mineral support. But what did change after my ferritin popped up, which spoiler alert, I never took iron. Is I felt even better. My digestion was better, my energy was better, my sleep was better. My thyroid actually is the best that it's ever been since fixing this whole thing. And that just shows you that this is a whole body approach. This is not just a, you have this, take this problem. Any health issue, whether you have low iron or something else. You have to look at the whole body, because what happens is if you're just. Patch treating things, you're usually playing whack-a-mole. You're creating one, fixing one problem, creating another. Your digestion's now slow because you're taking iron. Maybe your meals start to feel heavy. Maybe you're getting constipated, your bloating and suddenly something that was supposed to help you feel better, makes it feel like your body's working harder, and that's what makes this whole thing so confusing, especially if most of your labs are normal, but it's just your ferritin that's not. So here I was postpartum taking care of a newborn, two other kids running a business. My labs were decently okay. It was just the ferritin that was low. But I had to look a little bit deeper to see what story my body was telling me, and that's where I just wanna pause and say something really important. Low ferritin is one of the most misunderstood labs that I see and that we see in our practice. And for most people, it's. Not because they're not taking enough iron. I think I've said that like a hundred times already. It's be not because you're doing something wrong, and it's definitely not because your ferritin just is gonna be nine forever. I was in contact with a woman the other day whose ferritin was a two, and she's like, I, I need help. Like I gotta look into some other stuff. And so she's gonna work with our team. What finally shifts things for me and for so many of our clients was understanding this. One principle is that ferritin improves when the system improves, not when you just take more iron, not when you push harder. It's when you improve the systems that control how ferritin is actually supported. So for me, that meant stepping back and looking at three things together, not in isolation. So number one, the gut, number two, minerals and number three. My liver now, I was already really supporting minerals. I was doing HTMA testing, I was taking a custom blend. I was doing all the things I could to support minerals and that wasn't actually increasing my ferritin very much. So it made me wanna look even deeper into my gut and my liver and maybe possibly tweaking some mineral support. So we have to look at how all those three things are working together. That's usually the moment where clients are like, oh, I never knew that my gut and my liver and my minerals had anything to do with my ferritin. And that's really. An important piece is because when you understand why something isn't working, you stop blaming yourself for some of these things that you feel like you know should be fixed by now. So I just want you to hear that. If you've been doing everything you were told, you're taking iron, doing all this stuff, then we're gonna go through some of those systems and understand why you're still stuck. So let's walk through the big picture. Let's first talk about why iron is hard on digestion and how constipation and slow motility will actually make progress worse. Uh, why minerals matter. A lot more than people realize and why ferritin is just a signal, not the root problem. Just like constipation. Constipation is just a signal that there's something going on. It's not actually the real problem. So I'm not gonna give you a checklist or a protocol today because that's gonna be so individual. There's so many things that you can do for iron and ferritin. But by the end of this episode, I want you to understand why what you've tried hasn't worked and. What a different approach for you could be. So let's first talk about why iron is hard on the gut. That doesn't mean that iron is bad, it just means iron is demanding. In any season of depletion, whether you are a runner, whether you are postpartum, whether you are really stressed, the body is already doing a lot of work you can think of your body like a factory iron is that raw material that's coming in through the front door. But for that iron to be useful, the factory has to be staffed. It has to be powered. It has to be organized, it has to be moving. And so if the conveyor belt is jammed, if the lights are flickering, if the workers are on strike, bringing in more raw material doesn't fix the problem. It just creates more clutter, right? And that's what a lot of people are doing with their ferritin. They keep sending in iron and not actually making the factory work as a team, making sure the factory is using the resources appropriately. Uh, iron is not a light switch. It's like a relay race, right? It has to be absorbed, it has to be handed off, it has to be reused and then stored at the right time. So if you are a runner and you have low ferritin, which is a really common thing, uh, you know that if you're doing a relay race, if you drop the baton, the race is gonna stall, right? So at a very high level, iron has three jobs, absorption. Recycling and regulation, and most people are only focused on absorption, and even that honestly gets a little bit oversimplified. Ferritin is storage, so storage is only gonna happen when the body feels safe enough to actually save it. So you can think of ferritin, kind of like your savings account, right? Iron is the income, but income alone doesn't grow savings. What if your expenses are high, you're spending way more than you're making. That would be if inflammation is present. If stress is constant, if you're, there's a lot of stress strain on your body. Your body can't save anything. It's gonna spend money, right? You're making X amount per month, but your rent is really high. Your car payment's really high. You have an unexpected expense. All of a sudden, there's nothing left in the bucket. So for me. Specifically postpartum is already a really high expense season, so that makes sense why my body wasn't prioritizing storage, especially if digestion or movement weren't fully online, right? This is where digestion really came into focus for me, which sounds ironic because I'm a GI dietician, but I wasn't actually really having a ton of GI issues. Uh, most people think that digestion is one step. You eat food, you absorb nutrients, but it's actually a sequence, and iron is one of the most demanding nutrients to move through that sequence. It's like the assembly line, right? Each station has a job. If one station slows down, the whole line at the factory is gonna back up, right? So if stomach acid is low or irritated, iron doesn't move forward well, when enzymes in bile are sluggish, digestion is gonna feel incomplete when transit time slows. Iron is gonna sit longer than it should, and that's when symptoms can show up. If food feels heavy, bloating builds, iron can be nauseating constipating, et cetera. So that's where you can experience some of these side effects if you're supplementing with iron and the whole system isn't working, and constipation can really become a keystone symptom that you're experiencing. It's uncomfortable of course, but it's also one of the important clues in this ferritin conversation is that you have, your gut has to be moving your gut has to be eliminating, and we don't need motility to be slow. Because then the recycling of iron slows, and when recycling slows, the side effects will increase, and your storage becomes less efficient. So that's often a reason that iron isn't working. The reason that, or one of the reasons that I changed how I approached my own recovery is because I knew that. The, there was more to the picture than just minerals or like taking more iron, like I said. So you can easily be like, well, I don't know, my ferritin's just stuck low. But there's always something else that you can explore. You know, I had seen this doctor and she's like, you need to get an iron infusion. And I'm like, I don't know. I wanna try some other things first, because I, I definitely think that there's more. Um, to explore because like I said, I wasn't feeling that bad, but I knew that eventually I would, my hair would start to fall out. My energy would drop, my, my thyroid would be affected, my gut could be affected. And it would slowly kinda start to be that trickle effect. So then there are. The mineral piece. These are kind of the quiet drivers. I think iron gets a lot of attention, but minerals are like the stage crew. Like I said, I was already on good mineral support. I was on a custom blend based on my minerals, magnesium, sodium, potassium, copper, et cetera. These minerals Aren. Adding more iron to your body, they're actually enabling your body to use it. They help your digestion to move. They support nervous system regulation. They signal whether the body is ready to do more work. So minerals are like a symphony. We have to be robust in our mineral approach versus=just focusing on one mineral. I have gone viral several times posting about iron on Instagram, and it's funny, the comments that I'll get like, just take copper or just to zinc or this, and I'm like, no, no, no, no, no. We don't wanna mega dose one mineral because then again, we're playing whack-a-mole, right? We're fixing one problem causing another. So we really wanna look robustly. How is this mineral system working and how is one thing playing into another? And that's where the iron recycling system comes in. Your body wants to recycle iron, but recycling iron in the body requires calm and coordination and trust. And when your digestion is sluggish, when your motility is slow, minerals are depleted. Iron can get locked in the body. Instead of stored or reused. So most people with low ferritin actually do have iron in their system, like their hematocrit, hemoglobin, et cetera might actually be fine, or their serum iron might be fine. So this matters whether you're postpartum, whether you deal with chronic constipation, whether you have a history of gut issues, whether you don't tolerate iron, et cetera. Just knowing, what is the crux of the issue? Your body is asking for a different order of operations. Okay. And the last piece that I wanna talk about is liver health and iron. This is a, a really commonly missed piece, and it's one system that quietly plays a really big role in ferritin that it doesn't get enough attention. Your liver is basically like a traffic controller for iron. It helps to decide when iron gets stored, when it gets released, when it gets recycled. Ferritin itself, is the storage marker, but storage is not gonna be automatic. It's gonna be regulated, and the liver is a big part of that decision making process. So the important reframe or thing to think about here is that. If the liver is under strain or overwhelmed or backed up, the body is gonna become much more conservative with iron, not necessarily because something is wrong, but because the body is being protective. So the liver is juggling jobs, hormone clearance, detox, blood sugar regulation, bile production, inflammation. And when that load is heavy, your iron storage drops down to the priority list, which is why iron or ferritin often stays low, even when iron intake is fine. It's not that iron isn't coming in, it's that the body doesn't feel confident enough that it can protect it and manage it. Uh, your livers like the manager of that factory if the warehouse is already full. Or maybe it's understaffed. Or disorganized, it's not going to accept more inventory, right? It's going to pause storage until things are moving again, which is why sluggish digestion and slow bile flow matter so much. If you've listened to any of my podcasts on liver and gallbladder, you know that I'm obsessed with bile, and it is the MVP of digestion. Your bile matters so much for your liver health as well as your iron, health, and the gut. And the liver are deeply connected. So if bile flow is sluggish and elimination is slow, iron handling is not gonna be as efficient. And that could be what's keeping you stuck. So you're adding in iron without realizing that liver function and digestion is what's gonna create those conditions for ferritin to rise and stay there. So ferritin is not going to improve when the body is forcing it. It's going to improve when it feels supported enough to store. So if you're nodding your head and thinking like, oh, this is. So interesting. And how do I fix this? That is exactly what I'm gonna go over in my training called Why Iron Isn't Enough. We're gonna dig into all of this. You're gonna learn how to fix these three key systems because improving your ferritin requires looking at all of them and. It's gonna be a great training. I am so excited. When you come live, you're gonna get my ferritin PDF guide that has tons of links and supplements and resources and testing and all that. At the end, I'll share how our team can support you. this would be a great webinar to come to if you currently have chronically low ferritin or if you're a practitioner and your clients are struggling with this. So if iron hasn't worked for you. We're gonna talk about that. It's on February 15th. It is at 3:00 PM Central. There will be a recording if you can't come live, but I would love to see you there so we can continue this iron conversation and how to fix your ferritin for good. Thanks for joining for.