Why Mom Burnout Might Actually Be Low Ferritin

Your ferritin might be lower than your doctor tested for. If you've been told your labs are "normal" but you still feel exhausted, this episode names the thing most annual exams miss: low iron stores.

Sara breaks down why ferritin matters more than hemoglobin for tired women, why the standard reference range of 15 ng/mL is far below where most women actually feel well, why heme iron from animal foods absorbs two to three times more efficiently than plant iron, and what you can do at your next annual physical to actually get the number you need.

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Transcript

Speaker 0:00

If you're a mom over 40 and you feel wrecked every afternoon, you've asked your doctor about it, they ran your labs and told you everything looks fine. This episode is for you. There's a blood test most doctors don't run. Even when they do, the range they compare it to is set so low you could be running on fumes and still be called normal. That blood test is ferritin. Today we're gonna talk about why that happens, why moms are especially vulnerable, what to ask your doctor, and what to actually do about it.  Welcome to Wild is Wise. I'm Sara Estes, a former private investigator who ditched the high stress legal life after a major health crisis. I rebuilt my health from the ground up through nutrition and functional medicine and now I'm here to uncover the truth about women's wellness and translate it so you can make informed decisions about your health. On this podcast, we break down women's nutrition and physiology with real research and actionable tips, And here's the core philosophy: what's found in nature is often exactly what our biology is wired to thrive on. We get nerdy with the science, but keep it practical for everyday life. If you're ready to understand what your body actually needs, you're in the right place. As always, this podcast is educational, not medical advice. Please talk to your healthcare provider before making any changes. Let's jump in. Most annual physicals check hemoglobin. Hemoglobin measures how much iron is in your blood right now, doing its job, carrying oxygen to your cells. If hemoglobin is low, your doctor calls it anemia. That part is well understood. But hemoglobin is only half of the picture. Ferritin measures how much iron is stored in your body, your reserves. Think of hemoglobin as the cash in your wallet and ferritin as your savings account. You can have cash in your wallet and an empty savings account. You can have normal hemoglobin and basically no iron in the reserve. And when that happens, your body is pulling from empty all day and you feel it. This condition has a name. It's called iron deficiency without anemia. And there's a 2021 paper published in the journal Clinical Medicine titled Very Directly Iron Deficiency Without Anemia: A Diagnosis That Matters. The authors laid out how common this is, how real the symptoms are, and how consistently it gets missed because standard blood work is not asking the right question. Women lose iron every single month through menstruation. Pregnancy demands enormous amounts of iron for the baby. Postpartum, you're still rebuilding from blood loss during birth. Breastfeeding costs more iron, and perimenopause brings heavier and less predictable cycles for a lot of women, which means more, not less. Stack all of these on top of each other, you can get decades of steady, invisible iron depletion without any single event being dramatic enough to flag. And if you're also running a household, you're doing physical work with small children, sleeping poorly, and trying to hold everything together, you're burning through iron faster than any sedentary man would. This is why people most likely to have suboptimal ferritin are exactly the same people, most likely to be told it's just stress, or it's just being a mom, or it's just getting older. It might not be any of those things. Or at least it's not only one of those things. It's often iron. Here's what suboptimal ferritin actually looks like: not textbook anemia, not a hospital visit, just your life, but harder. Exhaustion that doesn't lift with rest, brain fog that makes you reread the same email three times over, hair shedding, especially around the crown and the temples, more than what you're used to finding in the shower drain. Cold hands and cold feet, even in a warm house, shortness of breath, climbing a flight of stairs that used to be nothing, a racing heart when you stand up too fast from the couch, unusual food cravings, sometimes for ice, sometimes for starch, sometimes for things that aren't even food, brittle nails, sometimes with vertical ridges, restless legs at night that make it hard to fall asleep. Here's the thing none of those symptoms on their own are specific enough to point a finger at iron. That's the whole problem. They get distributed across six different diagnoses if they get diagnosed at all, and nobody ever pulls the one string that would unravel all of them at once. And here's where the story gets a little frustrating. Your lab report has a ferritin reference range that typically starts around 15 nanograms per milliliter. So if your ferritin comes back at, let's say 18, your result stays in range and your doctor tells you you're fine. But here's what the actual research is showing. In January of 2025, researchers published a review in the journal Diagnostics titled Defining Global Thresholds for Serum Ferritin. And they looked at exactly this question: what ferritin level actually corresponds to a real physiological impact, not just what's the floor before you collapse. And what they found is that when ferritin drops below 50, women are already showing measurable impairment in thyroid hormone conversion, dopamine synthesis, and energy metabolism. That is not a wellness opinion, that's peer-reviewed finding published earlier this year in a medical journal. Functional medical practitioners and a growing body of literature consider ferritin levels below 50 to be suboptimal. And for women who are active, menstruating, or recovering from any kind of iron-demanding phase of life, levels of 70 to 100 are where most people actually feel well. So in range doesn't mean optimal. In range means you are not currently in a medical emergency. The space between medical emergency and actually feeling well is enormous. And that space is where most hired women live for years without anyone noticing. Okay, let's talk about food. There are two forms of iron in your diet: heme iron and non-heme iron. Heme iron is found in animal foods. Think of meat, fish, shellfish, organ meats. Non-heme iron is the kind you find in plants: spinach, beans, lentils, fortified cereals, tofu, that kind of thing. Your body absorbs heme iron at roughly 15 to 35%. Non-heme iron is closer to 2 to 20%. That's a big difference. Researchers in the American Journal of Clinical Nutrition have reviewed this across dozens of trials, and the pattern holds. Heme iron is two to three times more bioavailable than non-heme. And even though heme iron makes up a smaller portion of the average diet, it ends up accounting for far more of what actually gets absorbed into the bloodstream. This is why, if you ask a hematologist what to eat for iron, the answer is likely beef liver, clams, oysters, and red meat, not spinach. Popeye was wrong, or at least he was oversold. The strongest per serving sources on the planet are beef liver, clams, and oysters. If you're not eating those regularly, and most of us aren't, you're relying on either supplementation or fortified foods. And both of those have their own absorption issues that we're about to talk about. Here's the part that nobody tells you non-hame iron absorption, the plant-based iron, is fragile. And a lot of the things you put next to your iron-rich foods are actively blocking them from being absorbed. Coffee polyphenols bind iron in the gut. Tannins do the same thing, even more aggressively. Calcium, whether you're getting it from dairy, from a supplement, interferes. Phytates in whole grains and legumes reduce absorption. Oxalates in spinach and chard reduce it too, which means, interestingly, that spinach is not even a great source of iron for you because the oxalates in the spinach are partly blocking the iron that's already in the spinach. Now, here's a study that will change how you schedule your meals. In 2017, researchers in the American Journal of Clinical Nutrition ran a controlled trial on healthy UK women using a stable iron isotope, which is essentially a tracer. So they could measure exactly how much non-heme iron the women absorbed under different conditions. When the women drank tea alongside an iron-rich meal, absorption was cut by more than a third. But when there was a one-hour gap between the meal and the tea, most of that inhibition disappeared. One hour was all it took. So the fix is timing. Wait at least an hour between an iron-rich food and your coffee or tea. Don't take a calcium supplement alongside an iron-rich meal. And if you're gonna eat plant iron, pair it with a source of vitamin C because vitamin C is the one thing that actually reverses most of these blockers. Asorbic acid converts iron to a form your body can absorb. So squeeze lemon on your spinach, eat some bell pepper with your beans, or have an orange alongside your morning eggs. That is a strategic play. And if you're taking an iron supplement, the protocol is pretty clear. Try taking it on an empty stomach with vitamin C and not right next to your coffee. Here's what to actually do at your next annual. Ask for a ferritin test. Don't assume that it's included. It's usually not. Ask specifically for it by name. Ask for a full iron panel, not just a CBC. That means ferritin, serum iron, transferrin saturation, and total iron binding capacity. You want the full picture, not just one number. When your results come back, ask for the actual number, not the word normal, not in range, the number. Because if that number is below 50, you need to know. And the flag on the printout isn't going to tell you. If your doctor pushes back, and some will, you can say something like, I'd like to optimize, not just pass the floor. Most doctors will respect that framing. And if you genuinely can't get cooperation, direct to consumer labs like Lab Core on Demand or Quest Demand will run a ferritin test for about like 40 or 50 bucks without a prescription. You've got to advocate. This is your body, and this is a number that deeply affects how you feel every single day. I want to zoom out for a second because this is bigger than ferritin. The reason I'm spending a whole episode on one lab value is that ferritin is a case study and something that runs through almost every single symptom that women over 40 get dismissed for. Normal range was built for survival. It was not built to tell you whether or not you can thrive. Your exhaustion probably has a name. It's just that nobody has given that name to you yet. And low ferritin is a very, very common name for that exhaustion. So if you take one thing from this episode, let it be this. Your body is telling you something. Listen to it. Get tested. And if the results come back in range, ask for the actual number. This is actually one of the reasons I built Sarenova. Our first supplement, Formula No. 06, is a grass-fed beef liver and beef intestine blend, two of the richest whole sources of heme iron on the planet. If you want on the wait list, it's at sarenova.com. Founding member pricing locks in for anyone on that list before we open. And enough said on that. All right, that is it for this episode of Wild is Wise. Thank you so much for being here and for listening. I hope this information was helpful and useful for you. And look, if this episode gave you a piece of your own exhaustion bag, send it to a friend. The women in your life who are running on fumes need to hear this before their next annual physical. Until next time, stay wild, stay wise. I'll see you next week.