Feeling Drained? Iron Deficiency Could Be Why

🩺 WELLNESS SPOTLIGHT: SIGNS AND SOLUTIONS FOR IRON DEFICIENCY

Over the course of this newsletter series, I've alluded to some of the health issues that I've personally struggled with. A few weeks ago, I mentioned my protracted bout with SIBO (Small Intestinal Bacterial Overgrowth), but what I didn't fully explain was the cascade of nutritional deficiencies that followed. SIBO doesn't just cause uncomfortable digestive symptoms—it creates a perfect storm for malabsorption of key vitamins and minerals as the bacterial overgrowth literally competes with your body for nutrients.

One of the unexpected consequences of my SIBO was developing iron deficiency—an unusual situation for a man, as we don't experience the regular iron loss that menstruating women do. At its lowest, my ferritin was 26 ng/mL, which as you'll learn today, is classified as "absolute iron deficiency." No wonder I was experiencing crushing fatigue, brain fog, heart palpitations, and watching my hair thin dramatically. My body was in full-on iron rationing mode!

The frustrating part? Multiple doctors missed it. "Your hemoglobin is normal," they'd say, dismissing my symptoms. It wasn't until I specifically requested ferritin testing and discovered online resources about non-anemic iron deficiency that I began to understand what was happening. My journey to recovery has been long—nearly two years of strategic supplementation—but the transformation in my energy, mental clarity, and overall health has been nothing short of remarkable.

What Exactly Is Ferritin? The Science You Need to Know

Let's start with the basics: Iron is essential for over 180 different biochemical processes in your body! As noted in medical literature, "in the human body, iron exists mainly in erythrocytes as the heme compound hemoglobin (approximately 2 g of iron in men and 1.5 g in women), to a lesser extent in storage compounds (ferritin and hemosiderin) and in muscle cells as myoglobin."

But what's ferritin? It's not just a number on your lab test—it's your body's brilliant safety mechanism.

When you consume and absorb iron, it circulates in your bloodstream (that's your serum iron on blood tests). But free-floating iron can be dangerous, so your body has a clever solution: it wraps excess iron in a protein casing called ferritin.

Ferritin is your safe storage of excess iron. If you don't have an excess of iron, there's nothing to store.

When your iron intake is insufficient, your body taps into these ferritin reserves. As reserves deplete, your body enters "rationing mode"—prioritizing which processes get the limited iron supply. Critical functions (like sending iron to bone marrow) get priority, while "non-essential" functions (like hair growth) get cut off.

That's why you can experience all the symptoms of anemia before you're actually anemic. According to research published by the American Society of Hematology, iron deficiency without anemia can cause significant symptoms when ferritin falls below 100 ng/mL, despite normal hemoglobin levels.

The Iron Panel: What All Those Numbers Mean

Your typical iron blood test includes several measurements that tell different parts of the story:

• Serum Iron: The active iron currently circulating in your bloodstream

• Transferrin: The protein that transports iron through your body

• TIBC (Total Iron Binding Capacity): How much iron your transferrin can potentially bind

• % Transferrin Saturation: The percentage of your transferrin currently carrying iron

• Ferritin: Your iron storage reserves

When your body senses iron deficiency, it produces more transferrin (raising your TIBC) in a desperate attempt to capture any iron that comes in. This is why many iron-deficient people have high transferrin/TIBC but low % saturation.

Dr. Soppi's research, published in multiple medical journals, confirms that "the non-anemia patients have often been extensively examined as in- and out-patients during many years and may be unable to work because of extreme fatigue... their quality of life is close to zero. The associated costs are also huge."

Iron 101: Heme vs. Non-Heme

Iron comes in two forms, and they're not created equal:

• Heme Iron: Found in animal products (red meat, poultry, fish). Your body absorbs this easily—about 35%! No special tricks needed.

• Non-Heme Iron: Found in plants and most supplements. Absorption rates? A measly 2-20%. This needs vitamin C as a wingman to be properly absorbed.

Calculating Your Iron Needs

Medical research indicates that for those dealing with iron deficiency, here's the formula:

1. Minimum Daily Intake for Non-Heme: Your weight (kg) × 2 mg

2. Maximum Daily Intake for Non-Heme: Your weight (kg) × 5 mg (cap at 400 mg)

3. Minimum Daily Intake for Heme: Your weight (kg) × 1.5 mg

4. Maximum Daily Intake for Heme: Your weight (kg) × 2 mg

Studies show the body typically cannot absorb more than 400 mg of iron daily, as transferrin becomes saturated and cannot safely transport additional iron.

The "Wait, That Causes Iron Deficiency?!" List

Low ferritin can be sneaky, and the causes might surprise you:

Blood Loss & Increased Demand

• Heavy periods (the #1 culprit for women!)

• Pregnancy and breastfeeding

• Endometrial polyps and fibroids

• Miscarriage and childbirth blood loss

Absorption Issues

• Low stomach acid (hello, antacids!)

• SIBO or H. pylori infection (competing for your iron!)

• Hypothyroidism (affects iron metabolism)

• Celiac or Crohn's disease

• Post-bariatric surgery (removal of parts of the gut involved in iron absorption)

• Medications like proton pump inhibitors and antacids

Diet & Timing

• Vegan/vegetarian diets (no heme iron)

• Taking iron with calcium or coffee (big no-no!)

• Appetite suppressants (reduce overall nutrient intake)

• Poor timing of supplements (taking iron with inhibitors)

Increased Bleeding

• Regular blood donation

• Bleeding disorders like hemophilia

• Gastrointestinal bleeding from ulcers, NSAIDs, or cancer

• Hookworm infections causing chronic blood loss

Iron Depletion

• Parasites and bacteria competing for iron

• High-dose vitamin supplements interfering with iron metabolism

• Turmeric, curcumin, quercetin (may chelate iron)

• Hyperoxaluria (high oxalate levels binding iron)

Rare Causes

• Genetic mutations affecting iron metabolism

• Premature birth leading to nutritional deficiencies

• Nutritional deficiencies during pregnancy affecting fetal iron stores

What You Need to Know About Labs

Here's why your doctor might be missing your iron deficiency:

• Ferritin is your iron storage protein and the MOST specific indicator of iron status

• Under 30 µg/L: This is ABSOLUTE iron deficiency, according to multiple peer-reviewed studies. No questions asked!

• Under 100 ng/mL: Research shows you can have symptoms even without anemia

• Goal: Clinical research suggests at least 125 ng/mL, up to 200 ng/mL for those who've been deficient a long time

Measuring iron in the blood is like counting the cash in your wallet on payday—it shows only what's immediately available, fluctuating with each meal. But your body's true wealth lies in ferritin, the vast bank account where your iron savings are stored away in tissues and organs. While a quick glance at your wallet might suggest financial health, it reveals nothing of your accumulated savings or long-term security. Similarly, normal serum iron levels can mask a dangerously depleted ferritin reserve—the body's iron emergency fund that has been slowly draining for months.

Absolute Iron Deficiency = ferritin 30 and below. This is an ABSOLUTE. No questions asked.

Remember: Normal iron panel ≠ normal ferritin. This is why so many doctors miss the diagnosis!

Treating Iron Deficiency The Smart Way

Getting your iron levels back up isn't just about popping supplements. Here's the evidence-based strategy:

1. Dosage: Medical guidelines recommend 150-200 mg of elemental iron per day, or 2-5 mg/kg body weight

2. Timing Matters: Take iron supplements on an empty stomach, ideally in the morning and early afternoon

3. Power Couple: Take 1,000+ mg of Vitamin C with each iron dose to enhance absorption

4. Managing Cofactors: Vitamin C enhances iron absorption; calcium, magnesium, coffee, tea, and proton pump inhibitors inhibit it

5. Medication Interactions: Take thyroid hormones in the morning and iron supplements later in the day to avoid interference

6. Avoid the Blockers: Don't take iron with milk, calcium, magnesium, coffee, or tea

7. Monitor Progress: Check ferritin levels every 3-6 months

8. Symptom Tracking: Note improvements in energy and overall well-being

Dietary Considerations

Research supports integrating these dietary habits for better iron status:

• Heme Iron Sources: Red meat, poultry, and fish provide the most bioavailable form of iron

• Non-Heme Iron Sources: Legumes, beans, spinach, and fortified cereals

• Vitamin C-Rich Foods: Pair iron-rich meals with citrus fruits or bell peppers to enhance absorption

• Limit Inhibitors: Avoid coffee and tea during meals to improve iron absorption

Hepcidin: The Body’s Iron Gatekeeper

Hepcidin is a hormone produced by the liver that plays a crucial role in regulating iron levels in the body. It works by limiting the absorption of iron from the gut, primarily by inhibiting the uptake of iron. While hepcidin's effect on heme iron is less pronounced, it still influences overall iron balance.

However, vitamin C can counteract hepcidin's inhibitory effects by enhancing iron absorption. Vitamin C has been shown to directly inhibit hepcidin expression with doses of 500 mg every second day. Vitamin C also helps reduce ferric iron to ferrous iron, which is more soluble and better absorbed.

Beyond Tired: The Strange Symptoms of Iron Deficiency

Some strange symptoms include:

• Irresistible urges to eat ice, clay, or even lick concrete floors (a condition called pica)

• Cravings for rice cakes because "the crunching sound when eating gave satisfaction"

• Nail clubbing (rare but documented)

• Cognitive symptoms like memory lapses and reduced mental awareness

Understanding Your Iron Safety

When supplementing with iron, it's important to understand safety markers. Here's what the research tells us:

• % Transferrin Saturation: This is your key safety marker. When supplementing, this will naturally rise, but should ideally stay below 70-80%

• Monitoring: Get blood work while taking supplements to see how much transferrin is in use

• Splitting Doses: For doses higher than 150 mg, split into 2-3 doses throughout the day to avoid saturating transferrin

• Blood Work Timing: If testing for safety of dose, take iron 1-2 hours before blood draw; if testing baseline status, avoid supplements for 24 hours

The Path Forward

If you suspect iron deficiency, don't let anyone dismiss your symptoms. Get your ferritin tested—not just a standard iron panel. Research consistently shows you can have normal hemoglobin and still be iron deficient!

Iron deficiency treatment isn't a quick fix. Your body may need months or even years to fully recover and stop rationing iron. But with persistence and the right approach, you can get back to feeling like yourself again.

💡HEALTHY HACKS: TOP 5 SCIENTIFICALLY SUPPORTED CAFFEINE ALTERNATIVES FOR ENERGY

1. Rhodiola

Introduction: Rhodiola rosea, an adaptogenic herb, enhances mental and physical energy by reducing stress and boosting cellular energy production.
Evidence:

• De Bock et al. (2004, Int. J. Sport Nutr. Exerc. Metab.) found 200 mg Rhodiola improved endurance exercise capacity by 10–15%.

• Hung et al. (2011, Phytomedicine) showed Rhodiola reduced mental fatigue and improved cognitive performance under stress.
  Actionable Tips: Take 200–400 mg Rhodiola (3% rosavins, 1% salidroside) 1–2 times daily, 15–30 minutes before meals. Cycle use (3 weeks on, 1 week off) to maintain efficacy. Avoid evening doses to prevent sleep disruption.

2. L-Tyrosine

Introduction: L-Tyrosine, an amino acid, supports dopamine and norepinephrine synthesis, improving focus and energy during stress or fatigue.
Evidence:

• Jongkees et al. (2015, J. Clin. Psychopharmacol.) found 2 g L-Tyrosine enhanced cognitive performance under stress.

• O'Brien et al. (2011, Med. Sci. Sports Exerc.) showed L-Tyrosine extended cycling endurance in heat by 15–20%.
  Actionable Tips: Take 500–2,000 mg L-Tyrosine capsules 30–60 minutes before demanding tasks. Pair with a light meal to avoid stomach upset. Avoid late-day use to prevent overstimulation.

3. Panax Ginseng

Introduction: Panax ginseng, a traditional adaptogen, reduces fatigue and boosts energy by supporting mitochondrial function and stress response.
Evidence:

• Kim et al. (2013, J. Ginseng Res.) found 2 g daily ginseng reduced fatigue and improved energy in 12 weeks.

• Etemadifar et al. (2019, J. Altern. Complement. Med.) showed ginseng improved physical and cognitive function in chronic fatigue patients.
  Actionable Tips: Take 200–400 mg Panax ginseng (4–7% ginsenosides) 1–2 times daily with food. Start with a lower dose to assess tolerance. Avoid combining with caffeine to prevent overstimulation.

4. Protein-Based Smoothies

Introduction: Protein-rich smoothies with chia seeds or nut butter stabilize blood sugar, promoting sustained energy and alertness.
Evidence:

• Paddon-Jones et al. (2008, Am. J. Clin. Nutr.) showed protein intake enhanced cognitive function and alertness.

• Blom et al. (2006, Appetite) found protein-rich meals reduced energy dips compared to carb-heavy meals.
  Actionable Tips: Blend 20–30 g protein powder, 1 tbsp chia seeds, or 1–2 tbsp nut butter with fruit and water or milk. Consume mid-morning or post-workout for steady energy. Add spinach for micronutrients.

5. Cordyceps

Introduction: Cordyceps, a medicinal mushroom, enhances energy by boosting ATP production and oxygen utilization, ideal for physical performance.
Evidence:

• Chen et al. (2010, J. Altern. Complement. Med.) found Cordyceps improved exercise capacity by 10% in healthy adults.

• Hirsch et al. (2017, Nutrients) showed 1–3 g daily Cordyceps reduced fatigue and improved aerobic performance.
  Actionable Tips: Take 1–3 g Cordyceps (7% cordycepic acid) capsules daily, ideally before exercise or morning tasks. Alternatively, add 1 tsp Cordyceps powder to smoothies or tea. Consult a doctor if on immunosuppressants.

Honorable Mentions

• Maca: Promising for energy and stamina but needs more robust human studies to confirm effects.

• Zynamite: Shows potential for cognitive and physical energy but requires further research due to limited studies.

💊 SUPPLEMENT SAVVY: MAXIMIZING YOUR BODY’S IRON ABSORPTION

Iron exists in two distinct forms, and your body has clear preferences between them. Heme iron, found in animal products, is absorbed at rates of 15-35%, while plant-based non-heme iron typically achieves only 2-20% absorption. This significant difference isn't just a scientific curiosity—it has real implications for your health and energy levels.

The Science Behind Absorption Efficiency

Research consistently demonstrates that heme iron's molecular structure allows it to bypass many of the absorption barriers that limit non-heme iron. This efficiency advantage becomes particularly important for individuals with increased iron needs, including athletes, pregnant women, and those with iron deficiency. Your body's ability to utilize iron directly impacts oxygen transport, energy production, and cognitive function.

Strategic Supplementation Options

For those seeking to optimize iron levels, heme iron supplements like Iron Repair Simply Heme offer a targeted approach. With 20mg of heme iron per serving, this supplement provides the absorption benefits of animal-based iron in a convenient form. Clinical evidence suggests that heme iron supplementation can effectively raise iron levels with fewer of the digestive side effects often associated with traditional iron supplements.

Iron Repair Simply Heme is the only heme supplement on the market offering 20 mg of iron in every dose. Use The Iron Protocol’s discount code 10Protocol at checkout for a 10% discount. Please note that some of these are affiliate links.

🎶 BETTER HABITS: USING MUSIC TO ENHANCE DIGESTION

Did you know the sounds you experience while eating can nourish your body as much as the food on your plate? Harnessing music’s power can transform your meals into a digestion-boosting, stress-soothing ritual.

Evidence:
• Frontiers in Psychology (2021): Calming music stimulates the vagus nerve, improving digestion and reducing bloating.
• Journal of Neuroscience (2023): Low-frequency binaural beats lower cortisol, aiding gut efficiency.

Actionable Tips:
• Play soft classical music or nature sounds at low volume during meals.
• Start a 20-min playlist 2–3 min before eating to relax your body.
• Try theta-range (4-8 Hz) binaural beats for stress relief. Find free tracks on YouTube or Spotify.
• Skip loud, fast music to avoid slowing digestion.
• For snacks, eat in silence to focus on chewing well.

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See you next week! 👋