Iron Poor Blood is a difficult thing to define, however, it should be defined better in the medical world so that medical practitioners have an objective measurement of low iron stores when they have not yet progressed to anemia.
Iron Deficiency Anemia, is defined as when iron stores become so low that the Hemoglobin and Hematocrit blood levels finally drop below the normal range. Unfortunately, in cases of chronic anemia from things like low dietary iron intake and menstruation, low hemoglobin and hematocrit levels are a very late sign that only develops after many years of low iron stores.
Without a way to define iron poor blood, medical practitioners often overlook this serious issue when it has been shown to cause Symptoms of Iron Deficiency such as fatigue and brain fog in adults, and learning disability and attention problems in children. By not having a good definition of low iron stores, or the ability to recognize and intervene in those people sensitive to low levels of iron, many people go around with chronic health complaints for years that could be remedied with a simple vitamin supplement if doctors were to recognize and intervene in this condition.
Iron Poor Blood versus Anemia
As we mentioned, anemia is a condition that occurs when the hemoglobin and hematocrit blood tests dip below the normal range. This might occur years or even decades after iron intake is too low to meet the needs of the person. But other blood tests, namely serum iron and ferritin levels can be extremely useful in determining if iron intake is too low to meet someone’s needs such that they are on the way to eventually becoming anemic.
“[S]erum ferritin is the focal point of the
laboratory detection of iron deficiency.
[They] provide a reliable index of body iron
stores in healthy individuals”
Iron deficiency: definition and diagnosis
Notice that the study above states that serum ferritin should be the ‘focal point’ of any measurements of iron deficiency, however, it’s rarely used to detect iron deficiency… unless anemia is already present.
So, it’s a ‘Catch 22’; doctors won’t do serum iron and ferritin levels until you have anemia, but symptoms of iron deficiency can occur long before someone ever develops anemia. This can be particularly problematic in vulnerable populations such as vegetarians (see the page Iron from Spinach) and those who don’t get much vitamin D (see the page Why Do Doctors Keep African-Americans Anemic?) So, someone might suffer from Iron Deficiency Symptoms for many years while their doctor tells them they are fine… simply because they fail to do a simple blood test.
Even if they did do iron and ferritin levels, there is no treatable disease called ‘Iron Poor Blood’ or ‘Iron Deficiency’ without anemia. Therefore, even if you had levels of iron and ferritin below the definition above, it’s unlikely that you will find a doctor to treat such a problem, even if you have many Iron Deficiency Symptoms. It’s a frustrating position for a patient to be in.
I know because I suffered from iron deficiency from heavy menstruation for decades before I finally discovered this problem myself. Once I did, I felt that it was important to share my research with the world so that others did not have to go through decades of suffering with easily remedied health problems simply because their doctors fail to understand the importance of iron and ferritin.
Iron Deficiency is Extremely Serious, even Without Anemia
It’s important to understand this distinction of iron poor blood without having anemia, because if someone does not have anemia, few doctors will do further testing, but the consequences can be serious.
In fact, there are several studies looking at the consequences of iron deficiency without the requisite decrease in hemoglobin (Hgb) and hematocrit (Hct) levels In other words, they did not have anemia because they had normal hemoglobin and hematocrit levels in their blood. Unfortunately, few primary doctors would ever actually discover this condition because they simple do not do iron levels unless the Hgb and Hct are low.
- Teenagers with iron deficiency, but without anemia, have lower standardized test scores. 1
- Teens with anemia do more poorly in fitness tests 2
- Infants with iron deficiency, but not anemia, scored worse on behavior and learning tests 3
- Women with unexplained fatigue and low iron stores, but without anemia, improved with iron supplementation. 4
- Disturbingly, when iron is low, higher levels of other ‘heavy metals’, such as: Lead, cadmium, and manganese are absorbed by the body instead. Indeed, one study showed that children with lower iron levels had higher lead levels, which could be the explanation for some cognitive and behavioral issues seen in children with iron deficiency anemia. 5
These studies should be alarming to the entire medical world. Children are suffering from lower test scores and behavioral issues simply due to lack of an easily replaced nutrient! But doctors do not do iron blood tests or Ferritin Levels UNLESS someone has abnormally low hemoglobin and hematocrit levels, but those low blood levels are late signs of anemia.
How many children, particularly teenage girls, are we shortchanging on their cognitive abilities simply because parents and even doctors are not educated well enough to understand the importance of iron and its effects on learning ability? Even in industrialized countries, the rate of actual iron deficiency anemia in young, white, seemingly healthy omnivorous children, has been reported as high as 10% 6, and up to 20% in vegetarian populations. How many more are iron deficient, but without anemia, that go undiagnosed?
Vegetarians and Vegans Have Iron Poor Blood
Vegetarians and vegans actually have low rates of anemia, probably because of the tightly controlled Hepcidin feedback loop that increases iron absorption when iron levels are low, but, as we point out on the Spinach from Iron page, they are quite low in iron and hence vegans and vegetarians do tend to have very borderline Low Ferritin Levels and low iron levels, just not to the point of anemia. Also, since vegetarians generally get less Vitamin D than omnivores (and vegans get even less), it could also be that they have less iron stores due to the Vitamin D and Iron connection, as well.
These decreased iron stores are significantly different in vegetarians versus omnivores. One study reported ferritin levels of:
- Vegetarians 35 ug/l
- Omnivores 72 ug/l
Again, as was pointed out above, just not having anemia does not mean that health is optimal, and having low levels of iron have been linked to fatigue and brain fog, as well as inattention and learning difficulties in children. So, close monitoring of ferritin and iron levels in vegetarians and vegans is suggested, and iron replacement is recommended when ferritin and iron levels are below OPTIMAL levels, not just when anemia is present.
The Benefits of Iron Poor Blood
On the flip-side of the negatives of having iron poor blood, there are actually some benefits as well. These benefits should be weighed against the negatives that may occur with iron deficiency when someone is considering supplementation, but usually, if one is experiencing Iron Deficiency Symptoms, they would want to supplement to at least a level where their negative symptoms abate. Remember, iron is extremely toxic and supplementing unnecessarily can be dangerous. Always supplement only to the lowest levels that alleviate symptoms and no more.
But back to the benefits of having low blood iron levels. The main benefits of having low iron is that it protects from heart disease, which is one of the reasons why men experience higher rates of heart disease than women, but that women ‘catch up’ and get higher levels of heart disease after menopause when they stop menstruating regularly.
An interesting benefit of low serum iron levels is that it decreases insulin resistance, thus decreasing the risk of getting diabetes. Lower iron stores may be one of the reasons vegetarians have lower rates of diabetes 10. The evidence is so compelling that those with insulin resistance and higher than average iron stores might consider donating blood on a regular basis in order to decrease their chance of becoming diabetic. Being a humanitarian and getting health benefits at the same time is a double good reason to give blood.
What’s the Optimal Blood Iron Level
While there are benefits to having iron poor blood, anyone with health problems such as fatigue, brain fog, attention, or learning issues will want to seriously consider getting blood tests for serum iron and serum ferritin and correcting their levels up to the optimal range.
Unfortunately, there are few studies on what the ‘optimal’ range of iron is. We do know that women complaining of fatigue improved by taking iron supplements if their iron levels were below 50 ug/dl.
In the study Efficacy of oral iron therapy in patients receiving recombinant human erythropoietin, they define ‘adequate iron levels’, as ‘transferrin saturation greater than 20%, serum ferritin greater than 100 ng/mL, and serum iron greater than 80 µg/dL.’
For clarity, here is what they consider iron poor blood, iron deficiency, or ‘inadequate iron levels’:
- Transferrin saturation less than 20%
- Ferritin level less than 100 ng/ml
- Serum Iron less than 80 µg/dL
In the experience of many clinicians who treat iron deficiency, patients with fatigue or brain fog often don’t feel better until their iron levels are above 80 µg/dL. This comports well with the definitions above.
In our Blood Chemistry Analysis software, it uses the optimal reference range of iron as being between 85-130 ug/dl and the optimal range of ferritin to be between 30-70 ng/ml. From the research and from our clinical and personal experience, we believe that the ranges in the Blood Chemistry Analysis Software to be a range that we find to be beneficial for the most number of people. Additionally, if you are already taking iron, consider changing to the Best Iron Supplements on the market. Highly absorbable and with almost no side effects, these are truly a game changer for those who need to take iron.
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- Iron Deficiency and Cognitive Achievement Among School-Aged Children and Adolescents in the United States ↩
- Iron-deficiency anaemia and physical performance in adolescent girls from different ethnic backgrounds ↩
- Effect of Iron Therapy on Behavior Performance in Nonanemic, Iron-Deficient Infants ↩
- Iron supplementation for unexplained fatigue in non-anaemic women: double blind randomised placebo controlled trial ↩
- Association between iron deficiency and blood lead level in a longitudinal analysis of children followed in an urban primary care clinic ↩
- See the study above entitled Iron-deficiency anaemia and physical performance in adolescent girls from different ethnic backgrounds ↩
- Low iron status and enhanced insulin sensitivity in lacto-ovo vegetarians ↩
- A Vegetarian Diet Rich in Soybean Products Compromises Iron Status in Young Students1 ↩
- Dietary intake and iron status of Australian vegetarian women ↩
- see study above entitled Low iron status and enhanced insulin sensitivity in lacto-ovo vegetarians ↩