Iron Need

Authored by Chris McDermott, APRN, practicing with autonomous authority in Florida

Introduction

Iron is one of the most essential nutrients for maintaining human health, yet iron deficiency remains the most widespread nutritional deficiency globally. It impacts individuals across all age groups and can cause a cascade of physiological consequences—many of which are misattributed or missed altogether in routine care. Functional medicine focuses on identifying the root causes of iron depletion and restoring optimal levels through precise diagnostics and personalized treatment strategies.

At Intercoastal Health, we take a patient-centered, biomarker-based approach to evaluating and managing iron need—whether it’s subtle insufficiency or overt anemia. Understanding your body’s iron status is a key step in improving energy levels, mental clarity, immune defense, and overall vitality.

Why Iron Matters

Iron plays a central role in multiple biochemical and cellular processes. Most notably, it is required for the synthesis of hemoglobin, the protein in red blood cells responsible for transporting oxygen to every tissue in the body. But its role extends beyond oxygen delivery.
Iron also supports:

• Cellular energy production (mitochondrial function)
  
• Neurological development and neurotransmitter synthesis
  
• Thyroid hormone metabolism
  
• Immune system regulation, particularly in the function of T-cells and macrophages
  
  

When iron is depleted, even slightly, your body begins to conserve its stores—often manifesting in subtle symptoms long before traditional laboratory ranges fall below normal.

Symptoms of Iron Deficiency

Iron deficiency can present with a wide range of nonspecific symptoms, which often makes it difficult to diagnose without appropriate testing. Common symptoms include:

• Persistent fatigue, even after adequate rest
  
• Pale skin and mucous membranes, especially the inner eyelids and nails
  
• Shortness of breath, particularly with exertion
  
• Dizziness or lightheadedness
  
• Cold hands and feet
  
• Rapid or irregular heartbeat (tachycardia)
  
• Brittle nails or hair thinning
  
• Headaches or concentration difficulties
  
• Irritability or mood changes
  
• Pica: Craving non-nutritive substances like ice, dirt, or starch
  
• Glossitis: Soreness or inflammation of the tongue
  
• Poor appetite, especially in children
  
• Increased susceptibility to infections
  
• In children and adolescents, impaired growth, learning difficulties, and behavioral concerns
  
  

Diagnostic Evaluation: Functional Biomarkers We Use

At Intercoastal Health, we employ a comprehensive panel of iron-related biomarkers to identify deficiency at various stages—before it progresses to anemia.

1. Complete Blood Count (CBC)
   Evaluates hemoglobin, hematocrit, and red blood cell indices (MCV, MCH, RDW) to detect anemia.
   
2. Serum Ferritin
   Primary marker for iron stores; low ferritin often appears before changes in hemoglobin levels. (Iron deficiency is a common disorder in general population and independently predicts all-cause mortality: results from the Gutenberg Health Study – PubMed)
   
3. Serum Iron and Total Iron-Binding Capacity ([TIBC])
   Reflects the amount of circulating iron and the capacity of transferrin to bind and transport iron.
   
4. Transferrin Saturation
   The percentage of transferrin occupied by iron; optimal levels are 25–35%.
   
5. Reticulocyte Hemoglobin Content (CHr)
   Assesses the amount of iron available for newly forming red blood cells—a valuable early marker of functional iron insufficiency.
   
   

Causes of Iron Deficiency: Root-Cause Identification

Functional medicine emphasizes addressing the why behind a biomarker abnormality. Iron depletion can result from a variety of dietary, physiological, and pathological factors:

1. Inadequate Dietary Intake
   Vegetarian or vegan diets lacking in heme iron sources; poor intake of red meat, organ meats, shellfish, and leafy greens; insufficient vitamin C to aid absorption.
   
2. Increased Physiological Demand
   Pregnancy and lactation; adolescence (rapid growth); high-intensity training in athletes (“sports anemia”).
   
3. Impaired Absorption
   Celiac Disease, Crohn’s Disease, or gastric bypass surgery; low stomach acid; excessive calcium or zinc intake.
   
4. Chronic Blood Loss
   Heavy menstrual periods, gastrointestinal bleeding from ulcers or polyps, frequent blood donations, occult blood loss from NSAID use.
   
   

Functional Ranges vs. Standard Ranges

Interfering Factors in Lab Interpretation

Accurate interpretation of iron studies requires awareness of confounding variables:

• Inflammation: Elevates ferritin levels, masking deficiency (check CRP or ESR)
  
• Recent Illness or Infection: May distort iron metabolism temporarily
  
• Supplement Use: Recent iron supplementation can artificially elevate serum iron
  
• Menstrual Cycle: Ferritin levels can fluctuate with hormonal changes
  
• Vitamin Deficiencies: B12 and folate status can impact red cell indices
  
  

Medications That Impact Iron Status

May Decrease Absorption: Proton Pump Inhibitors, antacids, calcium supplements, certain antibiotics (tetracyclines, fluoroquinolones), NSAIDs (GI bleeding risk).
May Improve Availability: Vitamin C supplementation; erythropoietin in clinical settings.

Functional Medicine Approach to Iron Restoration

1. Nutritional Strategies:
   
   • Iron-rich foods: grass-fed red meats, liver, shellfish; spinach, lentils, pumpkin seeds; vitamin C–rich fruits and vegetables.
     
   • Avoid pairing iron-rich meals with calcium supplements, tea, or coffee.
     
2. Targeted Supplementation:
   
   • Iron bisglycinate or heme iron polypeptide with vitamin C co-administration; monitor for GI side effects.
     
3. Addressing Underlying Triggers:
   
   • Investigate GI blood loss (stool occult blood tests, endoscopy), manage heavy menstrual flow, treat malabsorption (celiac, SIBO), reduce medication-induced issues.
     
     

Monitoring and Follow-Up

• Recheck iron studies every 8–12 weeks after starting treatment.
  
• Continue supplementation for at least 3 months after normalization to replenish tissue stores.
  
• Avoid long-term unsupervised iron use due to risk of oxidative stress and overload.