Iron Deficient Anemia
Most people have iron dysregulation NOT iron deficiency or iron anemia, which is actually very rare.
First, what does iron do? It carries oxygen through the blood to cells so that it can used by mitochondria. Iron is not designed to be in storage. 80% of the iron in your body is found in hemoglobin and myoglobin (bound to proteins), which is in constant circulation. Iron is actually meant to be recycled. In fact, less than 10% of iron is found in ferritin and that is meant to be inside the cell, not in the blood!
Excess stored iron is not a good thing. Ferritin is stored in your tissues. When you get a blood test for ferritin it's only measuring what is circulating in the blood at that time. If you have high ferritin (>100 ng/mL) on a blood test that can actually an indicator of inflammation.
If your doctor has diagnosed you with iron deficiency or anemia based solely on your ferritin level, this is a problem. It’s similar to diagnosing you with hypothyroidism by only looking at your TSH level. Iron anemia is much more complicated than that and you need to also look at other cofactors that are required for proper iron homeostasis.
Cofactors Needed for Iron Recycling
In order to regulate and recycle iron there are several important nutrients and cofactors required. I see these almost always missed in lab testing and many doctors don't know how to interpret these in relation to iron regulation.
Bio-available Copper
Regulates the amount of iron in the body and activates oxygen in the mitochondria turning it into water. Required for iron absorption in the gut. Copper deficiency is a known root cause of anemia.
Vitamin A (Retinol)
Retinol is a requirement for building blood, especially hemoglobin. Retinol is the active form of vitamin A and only found in animal products. Yes, beta carotene can be converted to retinol, but it takes A LOT of beta carotene and about 30% of the population has a genetic variant that impacts this metabolic pathway.
Magnesium
Magnesium is critical for thousands of metabolic pathways including mitochondrial function and also needed to make red blood cells and hemoglobin. Magnesium deficiency can actually be a root cause of anemia.
Ceruloplasmin
Think of ceruloplasmin as a taxi for iron. It’s a copper dependent protein that when low leads to high amounts of unbound iron being stored in the tissues, especially the liver. If you are low in ceruloplasmin then you are low in bioavailable copper.
Recommended Lab Testing
I recommend a full iron panel including transferrin, saturation, and TIBC, as well as retinol (vitamin A), RBC magnesium, zinc, copper, and ceruloplasmin. Remember “in range” does not always mean optimal. Work with a functional or holistic health practitioner who understands the ideal range for these and how to optimize iron recycling.