Low Iron or Anemia?

Dec 02 , 2022

Low Iron or Anemia?

Anemia and low iron are often confused. It is important to understand the difference before taking supplements.

Think of it this way:

  • Anemia is caused by lack of Hemoglobin.
  • Iron Deficiency is caused by lack of Iron.
  • Iron Deficiency with Anemia is caused by both a lack of Iron AND a lack of Hemoglobin.
  • Iron Deficiency without Anemia is the same thing as Iron Deficiency and is caused by lack of Iron, but Hemoglobin is still normal.

You can have Anemia (low hemoglobin) without having iron deficiency. That’s because anemia can be caused by issues other than low iron including infection, inflammation or blood loss. Anemia (low hemoglobin) can be detected through a finger stick blood test and is what they test before you donate blood.

Likewise, you can have iron deficiency without having Anemia. Your iron can be low, even severely low, without yet reaching the point where your hemoglobin starts to drop. Iron levels are detected through a blood test for ferritin.

Ferritin is a blood protein and is the main storage protein for iron. Ferritin is, therefore, a good indicator of how much iron is stored within your body. Approximately one-quarter of the total iron in the body is stored as ferritin. Ferritin has a vital function in the absorption, storage and release of iron. Most ferritin is found in the liver but it can also be present in the spleen, bone marrow and muscles. 

Ferritin is therefore the best indicator of iron deficiency. By assessing the levels of ferritin in the body, you can clearly identify whether you might be iron deficient or even have levels that are raised. If a Ferritin test comes back showing a risk of iron deficiency, further tests may be suggested by a medical professional, including a test for iron itself. 

What are normal ferritin levels? 

The range for normal ferritin levels varies due to age and is different for women. It also seems to vary depending on the laboratory or the country doing the testing. A general guide in NZ is a reading under 15 ng/ml is low if you are younger than 19, and for anyone over 20 a reading under 20 is low. The upper limit can be up to 300/400 (though less for women, children and teens). We have Ferritin test kits available in the store, they wont give you an exact reading, just an positive result if your level is less than 30 ng/ml (which in other countries is considered low)

Low ferritin levels - symptoms 

If you have low ferritin levels, you MAY experience symptoms including: 

Pale skin        Fatigue        Very low energy levels    Headaches        Difficulty breathing    Dry skin and hair    Restless leg syndrome     Increased heartbeat 

Iron deficiency usually occurs because of increased requirements or pressure on the body. For example: High-performance sport. Vegetarian/vegan diet with limited iron supply, Pregnancy or Increased blood loss e.g. menstruation 

Up to 20% of menstruating women are iron deficient and up to 5% have iron deficiency anaemia.  In females, iron status is largely dependent on menstrual blood loss. In Europe, the amount of blood loss resulting from menstruation is on average 30 ml per day which is equivalent to a 0.45mg daily loss of iron. 

High ferritin levels  

It is also possible for excess iron to occur, too.   Symptoms of high levels of ferritin include fatigue, abdominal pain, unexplained weight loss, joint pain and weakness.  The ferritin test is used in combination with other tests to check for iron overload.

Improving Iron Nutrition 

There are two types of iron; haem and non-haem. Haem iron is found in animal products like meat, fish and poultry. Non-haem iron is found in foods such as green leafy vegetables, cereals and legumes.  There are certain dietary components which can enhance iron absorption, too, such as vitamin C. 

Because dietary iron can be poorly absorbed the body has a clever way of conserving its iron stores. When our red blood cells are broken down, the body reabsorbs the iron released from them to boost iron stores. The usual 1-2 milligram daily loss of iron is usually replenished by the absorption from dietary sources in the small intestine. 

In summary it is important to include iron rich foods in our everyday diet. It is also a good idea to get tested before adding supplements for iron as it is also possible for ferritin levels to become too high. It is interesting to note that whilst researching this topic we found a paper that reported that when the body gets flooded with iron it releases more of the hormone hepcidin, which suppresses iron absorption.  In one study women were getting iron every day or every other day for 14 days. The total absorption in the everyday iron group was 131mg versus 175mg in the alternate-day group.

(as this article was written using many references we have left them out, to save space, but you can contact us for more info)