Love Your Gut, hosted by Dr. Heather Finley, is helping thousands of women get to the root cause of their symptoms and redefine their gut health. After years of struggling with her own health issues, Dr. Heather Finley completed a doctorate in Clinical Nutrition and has been on a mission ever since to help women find life changing and lasting solutions for their digestive issues. She’s the doctor everyone comes to after every other treatment, regimen, and protocol has failed them. Dr. Heather Finley provides real results with her cutting edge holistic methodology and she’s giving you the inside scoop on how to finally heal every week. It’s time to love your gut, so your gut will love you back.
Ep. 113: Why Your Iron Is Stuck & Ferritin Is High (And How Your Thyroid & Liver Play A Role) [PART 2: Iront & Ferritin series]
•Heather Finley
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Most people assume low ferritin means they need more iron. But what about the woman whose ferritin is actually high and she still feels exhausted, is still losing hair, and is still bloated every single day? That's the case this episode is built around, and it's one of the most important iron stories Heather has ever told (because it goes WAY beyond iron)
This is Part 2 of a three-part series on iron, and it covers what happens after iron is absorbed and why it can still fail to reach the cells that need it. Dr. Heather walks through the case of her client Danielle who came to gutTogether eating clean, exercising consistently, and taking a carefully curated supplement stack and still couldn't figure out why her body felt so depleted.
In this episode:
Why a high ferritin doesn't automatically mean your body is iron replete and what elevated ferritin with low iron saturation actually signals
What ceruloplasmin is, why it's the missing link in most iron conversations, and how copper status determines whether iron can move at all
How long-term zinc supplementation without copper awareness quietly undermines iron transport
Why the body deliberately sequesters iron during infection and dysbiosis
The thyroid-iron connection: how sluggish T3 conversion creates functional iron deficiency even when labs look "normal"
Why the answer wasn't more iron and what actually started moving the needle
The interesting turn of events that contributed to a last minute addition to the episode
Next week: Part 3 covers iron storage and what has to be in place for ferritin to actually build and stay built, and why some women do everything right and still can't get above 30
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Dr. Heather Finley
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.
If you have not listened to part one of this series yet, I'd encourage you to go back and start there. It's all about iron absorption and features our client, Ashley, whose case is a really powerful illustration of why just taking more iron doesn't always move the needle. But today's episode is for a slightly different person. Most people who find this podcast are searching for answers about low ferritin, low numbers, low iron, numbers that just won't budge no matter what they do, and part one is very much for that person. But today's episode is a little different, and I hope you'll stick around. This is for the women whose ferritin came back high or normal, the one who was basically told, "You're fine. Your iron is actually elevated," but yet you're still exhausted every afternoon, losing your hair, bloated every single day, running and lifting consistently, eating clean, doing everything that you're supposed to be doing, but you still don't feel okay. So Danielle, our client, came to us exactly like that, and her case is just so interesting when you actually really break it down, so I'm really, really excited to share that with you today. Here's the thing I want you to hold onto going into this episode, is that ferritin is just one marker. It's one data point. A high ferritin doesn't mean your body is using iron well. It actually might mean the opposite, and today I'm gonna show you why. So let's get right into it. Danielle is a client of ours who is just active in a way that most people would probably be tired thinking about it. She is running. She's lifting weights. She does all the right things. She has a carefully curated supplement stack. But she came to Gut Together because something had progressively been getting worse for years, and nobody had been able to explain it. So her symptoms were daily bloating that started at lunch and just built throughout the day, meal by meal, until nighttime she just wanted to be in sweats. Who can relate? So many people. She had foul-smelling gas after meals that was so embarrassing it was starting to affect her social life. She told us she was avoiding certain situations because of it. And then she also had that fatigue wall, where she just felt exhausted by 2:00 or 3:00 PM every day, brain fog where she'd read something and immediately forget what she said. Her hair was thinning and shedding, and that had been going on for about five years. So when she came to us, she had already eliminated dairy. She cut heavily back on gluten. She had tried probiotics. She said she craved salty foods. She wasn't sleeping very well. She had trouble falling asleep. She was waking up tired. She would get that, like, second wind at night. And she had actually never seen a doctor for her digestive symptoms. She was looking for someone who could actually connect the dots, and this is really actually uncommon for the client that we see. Typically, people have worked with multiple practitioners at the time that they work with us, and that was not the case for Danielle. She had described in her intake form in a way that just stuck out to me. She said, "It feels like my body has forgotten how to digest food." So let's go back to where her story really started. She said that it started in 2019 on a missions trip, and she picked up something while she was on this missions trip. Her stomach was upset for months afterwards. Her digestion never quite fully recovered. And then in 2020, she had a full hysterectomy. She felt like her energy levels never bounced back after the surgery. She had been on HRT, bioidentical estrogen, tes- testosterone, which had helped, but the digestion, the fatigue, the hair loss, like, all of that persisted. She said that she had been experiencing hormonal issues since her teens and years of infertility. She had endometriosis diagnosed years and years ago. And all of that, the hormonal history combined with a gut that hadn't been the same for seven years and a surgery that further depleted her, added up to the picture of someone whose symptoms had slowly just been building over time. So this is a woman who lived a really healthy lifestyle, and she felt like she s- was not feeling the way that her lifestyle habits should reflect. So when we actually got lab data back on Danielle, the number s- that stood out to me immediately was her ferritin. And her ferritin was actually high. It was extremely elevated. I believe it was in the 200s. So most practitioners, and honestly, most of conventional medicine, would look at this and be like, "Well, yeah, you have plenty of iron. Your ferritin's elevated. That's not causing your fatigue. That's not causing your hair loss." But the interesting part was actually what the rest of her panel showed. Her iron was actually low. It was 77. She had some other markers that were low as well. Her ceruloplasmin was low. We're gonna talk a little bit about what that means. Her magnesium was low. Her TSH was actually elevated, so she was kinda trending towards this, like, subclinical hypothyroid picture. So the full picture here, in summary, is her ferritin was elevated, her actual iron was below optimal, her saturation was low, her ceruloplasmin was low, her thyroid was under stress, and her magnesium was low. So this is the teaching moment that this entire episode is focused on, is that ferritin and iron are not the same thing. Ferritin is a storage protein. It tells you how much iron the body has tucked away, but it does not tell you how much iron is circulating, or being transported, or being delivered to the cells that actually need it. So a high ferritin with a low saturation and low ceruloplasmin, which ceruloplasmin is what helps to transport iron, is not a sign of abundance. It's a sign that iron is stuck now in the wrong place, and that's why this episode is focused on transport. So the body is holding onto iron, but it's not moving it. It's not loading it onto the transport system. It's not getting it to where it needs to be, into tissues and cells, where it actually creates energy. So I wanna walk you through how iron transport actually works, because I think that this will help it to make sense. So in last episode, part one, we talked about iron absorption, which has to happen for iron from food or supplements to actually make it to your bloodstream. So that's step one. But step one is not the finish line. So once iron is absorbed into the bloodstream, it still has a journey to make. It has to be loaded onto a transport protein. It has to be moved through circulation. It has to be delivered to cells, and tissues, and mitochondria. That is transport. And transport failing is completely different from absorption failing. That's why this requires its own episode. So the key players here are transferrin. That's the protein that carries iron through the blood. You can think of it like the bus route. Ceruloplasmin is a copper-dependent protein that functions like the loading dock. It helps iron to get loaded onto transferrin so that it can actually travel. When ceruloplasmin is not doing its job, iron absorbed into the bloodstream doesn't go anywhere useful. It's just circulating. It accumulates. It gets shunted into storage, and ferritin can rise. Iron is the passenger. Transferrin is the bus. Ceruloplasmin helps iron get on the bus. So when ceruloplasmin is low or not functioning, the bus is running, but nobody's getting on. And that's what ferritin-- and that's when ferritin keeps building at the station. So this is what was happening for Danielle. Her ferritin was not high because she was, like, in this state of overabundance of iron, but it's just because the iron had nowhere to go. So the transport system was backed up. And the reason the transport system was backed up comes down to one mineral that almost nobody is talking enough about. And it really is more than one mineral, but the one mineral that I wanna focus on today, and that is copper. So copper, ceruloplasmin is a copper-dependent protein. You cannot properly activate it without copper. So this is where Danielle's supplement history becomes one of the most significant parts of her case. She was taking a ton of zinc every day. She was also taking iron every other day. She was taking high doses of vitamin D, a multivitamin, vitamin C, fish oil, magnesium, like normal supplements that people would take, right? She wasn't randomly taking it. She was thinking about, you know, these are the things that people talk about. This is what I'm taking. But zinc and copper have an inverse relationship in the body. So as zinc goes up, copper tends to come down. And this isn't a problem with short-term zinc supplementation at reasonable doses, but long-term zinc without attention to copper is quietly gonna deplete copper over time. And when copper goes down, ceruloplasmin activation goes down, and then iron transport starts to break down. So where it gets interesting and where standard lab interpretation would completely miss what's happening is Danielle's serum copper came back at one sixteen, which is the normal reference range. So you could look at that and say, "Oh, that's completely fine." But her ceruloplasmin was twenty-eight. It was suboptimal. So the gap between normal serum copper, low ceruloplasmin is what tells the story. You have to have-- you, you can have copper present in the blood and still have poor copper utilization, especially in the presence of chronic gut dysfunction, liver stress, ongoing inflammation. So the copper is circulating, but it's not being converted into that protein, ceruloplasmin. And that's the difference between having copper and using copper. So something that we needed to dig into even farther, and that can be something that easily falls through the cracks. So I wanna say something just directly here for anyone who's gonna go home and immediately just order a copper supplement. Please don't. Copper and zinc have this seesaw relationship like I mentioned, so pushing one up without understanding where the other one is, is creating a whole new issue. So the answer is never to just megadose a single mineral in isolation, especially copper or zinc. The answer is to understand the whole picture, and that's where the combo of a Full Monty and an HTMA can be so helpful. So let's focus then also on what the gut can inform about a case like this. When we got GI map testing back, there was another layer to the picture that I don't wanna skip because it also explains something really important about why ferritin can be elevated, and that is that H. pylori came back. She also had some other gut infections Her occult blood, which actually measures hidden blood in the stool, was high, like well above the reference range. So that occult blood finding and alongside just having pathogens was pretty significant. There was active irritation and micro-bleeding happening, which means she was both losing iron and dealing with pathogens that were competing for that iron that she had. So the body can become very protective of iron during infection or inflammation. Okay, I'm actually jumping in here the week that this podcast is being released to add a little snippet here because we got some updated information that I just thought was so helpful to add. So what I wanna add here is I mentioned that her GI map showed blood in her stool. Now, when blood is high on a GI map, it doesn't always mean that something bad is wrong. It can be high from hemorrhoids. It can be high sometimes if somebody's on their period, et cetera. However, hers was high enough in combination with several other markers that we encouraged her to go to a GI doctor and get a colonoscopy. And the reason that I'm jumping in here today to add this very important information is that she ended up going to the GI Getting a colonoscopy and they found a polyp that was bleeding. And I am just so glad that this client not only pursued testing for her ferritin issues, but also was open to being referred and getting some additional testing because her doctor had told her that if she had let this go on, that it could have turned cancerous. And so I do not share this to scare you or to share that anybody that has low ferritin or high ferritin has polyps. That is not the case. But if you start with testing, that shows that there could be something significant going on, and we're always going to refer you to someone to get proper workup and make sure that we're not missing anything. So I just thought that that was so important for me to come in and add a little two-minute snippet here of kind of just some updated information. Obviously, this client was just so thankful so, so thankful that they were able to address it, that she has this knowledge, that she went ahead and pursued this testing, that she went ahead and then went forward with the colonoscopy, even though she wasn't yet quite of, like, colonoscopy age. So all that to say, like, sometimes-- and I know I get messages like that-- this on Instagram all the time, like, "Do you think I should just go straight to the GI?" If you're having active bleeding that you're seeing and you know it's not hemorrhoids, you know it's not fissures, yes, go. If you have some severe symptoms, please go. Don't mess around with that, especially as someone who has family history of colon cancer. I don't mess around with that kind of stuff. But this is where maybe some testing that's less invasive than a colonoscopy can be really helpful to just see are there signs that that could be helpful. So I just wanted to add that little snippet here because I thought it was so important and just give a little bit more context as to this specific situation. But now back to the rest of the episode that was already recorded Pathogens, bacteria, H. pylori, fungus, they need iron to survive and replicate. And iron is essentially fuel for microbial overgrowth. So when the body detects a threat, it responds by sequestering iron. It pulls iron out of active circulation, and it locks it into storage and makes it less available for the pathogens trying to use it. The body is just doing what it knows to do to protect itself. This is a survival mechanism. It's the body doing what it's designed to do. But the side effect is that ferritin rises, and not in a sign of abundance, but more of a defensive response. So that iron gets hidden, and then now we have this person walking around with an elevated ferritin and low saturation, and they still feel exhausted, but it's really easy to get written off because it doesn't look like a standard low ferritin case. But that iron is just, like, locked in a vault that it can't get out of. Iron is like gasoline during any kind of microbial conflict. The body doesn't wanna hand it over to the enemy, so it hides it, and it's hiding it. It shows up as elevated ferritin. Also worth noting is that there were just several other things that were competing for attention on her GI map. But before she even started working with us, Danielle had made a really smart adjustment on her own. She had switched from raw salads to cooked vegetables and noticed that this helped her digestive function. And her digestive system simply just didn't have the capacity to break down raw fiber foods at that point. Reducing that burden just gave her more room. It's one small thing, but it's worth mentioning because it was so just wise of her to, like, tune in to that, and that's what her body needed at the time. Now, the thyroid piece of Danielle's picture is something that I wanna spend a few minutes on because it explains a lot of the symptoms that didn't make sense on the surface, and that was that her TSH was elevated. Her antibodies were negative, so that was good. But functionally, a TSH that's elevated combined with just some other wonky thyroid labs- Are showing that the thyroid is struggling. And why does this matter for iron? Because thyroid function and iron transport are very interconnected. So poor iron transport is going to impair thyroid conversion, and a sluggish thyroid is going to impair cellular energy needed to use iron effectively. So when T3 is low, in some cases, your cells don't have the energy to run the different processes that move iron into the mitochondria, that convert oxygen, that generate ATP. So she was kinda stuck in a loop of, like, gut infections driving this iron sequestration, low ceruloplasmin, which was impairing transport, suboptimal thyroid slowing the cellular metabolism, and then all of it was feeding back on itself. So her, her cells were functionally iron deficient even though her storage was overly full. So that is what I mean when I say you can feel iron deficient before you actually become iron deficient. You might have a lot of the symptoms because the body isn't quite there yet, but it's showing up the same. So what actually helped her? The answer was not more iron. She was already taking iron every other day. Adding more would have continued to provide fuel for the infections that were competing for it and done nothing to address why her body couldn't move the iron it already had. So what we did instead, we had to address the gut infections in the right sequence. We had to start with reducing that inflammatory burden before going after pathogens directly. We had to support her liver because ceruloplasmin is produced in the liver, and liver stress was likely a contributor to why her copper wasn't being properly converted. We had to back off the zinc. We had to support minerals across the board through food and targeted supplementation and just slowly build that mineral foundation back that her body needed. And then we expanded and built on the dietary shift she had already made toward cooked and warmed foods, just reducing overall digestive burden so her gut could function more normally Then we also had to support thyroid conversion, both through minerals and making sure she was eating enough carbohydrates because her diet was fairly low carb, and that pattern can constri- contribute to sluggish T3 conversion over time. So this is the sequence error that people can get stuck in, is that they see a high ferritin and they stop looking, or they assume that labs are normal and they never quite get to the transport question. They never ask whether iron is being moved or why that might be. So Danielle is still an active case, and I wanted to use her as an example because we got a message from her the other day that was just so encouraging. What she said verbatim was, "I am honestly feeling so much better. I can't believe it. The minerals and supplements you have me taking are creating a drastic difference in how my body is feeling. The bloat and gas have dramatically improved, and my bowels are completely different as well. I can tell that my body is digesting food more normally again." So this is from somebody in the middle of the process, watching her body come back online in real time, and the reason it's working isn't because we gave her more iron. It's because we figured out why her body couldn't move the iron it already had and are working on addressing that. So a few things that I want you to leave with this episode knowing is ferritin alone does not tell the whole iron story. A high ferritin does not automatically mean your body needs iron. It can mean iron is stuck. It's sequestered by inflammation, infection. Maybe it's unable to move, like ceruloplasmin in this case. And that iron saturation, ceruloplasmin, transferrin, they all are just gonna give us a much more complete picture. These are the labs that we run. We don't wanna just run a ferritin. It's like checking your fridge to see if it's stocked, but not making sure that, like, all the ingredients actually go together, if that makes sense. So you can have normal copper, you can still have poor copper utilization. We wanna look at zinc supplementation without overdoing zinc because of how it affects copper, especially at higher doses And then that the gut and iron are really connected. Pathogens are gonna compete for iron. Inflammation is gonna signal the body to sequester iron. A gut that isn't functioning well is not a separate issue from your iron issues. They're all a part of the same system. And then lastly, that the thyroid and iron are intertwined. So if you have thyroid issues, it's very common that you might also have iron issues. They affect each other. They can show up as the same cluster of symptoms: fatigue, brain fog, feeling cold, hair loss. And then the most important thing is sometimes the problem isn't that you don't have iron, it's that your body doesn't know how to move it. So before you go, if you have been listening to this series and thinking, "I actually need to understand which step is the problem for me," that is exactly what I'm gonna cover in my upcoming webinar on May 31st. This is a live webinar. I would love to have you there. It was so popular the last time I ran it. You will also get access to our ferritin troubleshooting guide. We're gonna walk through all three steps together: iron transport, absorption, and storage, and I'll walk you through the testing that actually shows where your system is breaking down. The link to register is in the show notes. And then make sure you come back next week for part three. It's the final episode in the series. We're going into storage. W- what has to be in place for ferritin to actually build and stay built. So I will see you next week on the next episode of the Love Your Gut podcast. Thanks for jumping on.
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