Do you have fatigue even after getting adequate sleep? It’s expected to feel fatigued when you aren’t sleeping a sufficient amount, but constant fatigue may indicate there is an underlying medical problem. Constant fatigue is one symptom of anemia, as are irritability and difficulty concentrating.
Typically, your physician will order screening labs to assess your iron status when you endorse fatigue. However, these labs may not catch early iron depletion and a potential cause of your fatigue may not be found. Testing ferritin, your storage form of iron, can detect this early state of iron depletion.
Your body requires iron in order to transport oxygen within your red blood cells. Your body has about 3,000-4,000mg of iron (about the weight of a packet of sugar) and this is split about half and half for use within red blood cells and in storage cells called ferritin.
The focus of most studies that look for iron deficiency is your hemoglobin (iron carrying protein in red blood cells) and hematocrit (the volume % of red blood cells in blood). These tests are done to look for anemia, or a low red blood cell count. Given that nearly all of your cells require oxygen to function, it’s more important for iron to be used in red blood cells to carry oxygen than it is for iron to be stored in ferritin.
In order to keep your hemoglobin and hematocrit at appropriate levels your body will first draw from iron stores in ferritin when you are deficient in iron. There are symptoms of a low ferritin count that can mimic anemia, but if you haven’t lost enough iron to affect your hemoglobin and hematocrit, your doctor will find that your “anemia labs” are normal even though your symptoms may be coming from a total body lack of iron.
If you have insufficient ferritin, you could feel:
- Constantly fatigued
- Inability to concentrate
- Decreased memory
- Hair loss
- Restless leg syndrome
Even if your physician finds that your hemoglobin/hematocrit are normal, ask them to consider a ferritin test if you have the symptoms above.
- Insufficient meat and lack of iron containing plants
- Low caloric intake relative to needs (children, pregnant women, elderly)
- Celiac disease
- Excessive food which reduce absorption (cows’ milk or tea)
- Lack of stomach acid (taking reflux medicines or after partial stomach removal)
- Menstrual bleeding
- Gastrointestinal losses (Ulcer, Inflammatory bowel disease, NSAID use, hemorrhoids)
- Increase intake or iron rich foods (beef liver, beef, blackstrap molasses, lima beans, turkey dark meat, soybeans, kidney beans, broccoli raw, spinach raw)
- Increase Vitamin C with iron to enhance absorption (citrus fruits, tomatoes)
- Limit intake of tea or coffee for the three hours prior to a meal including iron
If the above treatments fail, please consider a discussion with your physician about iron supplementation.
- Ferritin is an acute phase reactant and the level is unreliable for iron status in the following situations: acute or chronic inflammation, chronic kidney disease, heart failure, liver disease, malignancy and hyperthyroidism.