I recently helped a patient who came to see me for what he believed was high iron. He actually had iron deficiency anemia caused by too much therapeutic phlebotomy.
Phlebotomy (or blood donation) can be helpful for:
- Iron overload
- High hemoglobin
- Thickened blood from testosterone replacement therapy (TRT)
But it also carries risks—especially when overdone. Today, you’ll learn how to determine whether you need phlebotomy, how often to do it, and how this patient restored his health.
My name is Dr. Tom Rofrano from the Natural Medicine Clinic in Palm Beach Gardens, Florida, and author of the FreeDiet®. I’ve been blessed to have seen over 100,000 patient visits over the last 39 years, many involving gut, thyroid, and ferritin issues.
The Problem: Misinterpreting Hemoglobin as Iron
This patient came in with:
- High iron (or so he thought)
- Joint pain
- Inflammation
- Fatigue
- Poor muscle endurance
- Weight gain
- High blood pressure
- Bloating, gas, heartburn, constipation
He had been doing testosterone injections twice weekly for years, and his doctor told him to donate blood regularly because TRT can raise hemoglobin and thicken the blood.
So he donated blood every two weeks for two months, checking only his hemoglobin.
Here’s the issue:
- Hemoglobin is NOT the same as iron.
- Hemoglobin contains iron, but measuring hemoglobin alone does not tell you whether your iron stores are high or low.
- Many people are told, “Your hemoglobin is low, so your iron is low,” but this is not always accurate.
When I ran a full blood panel, it turned out he had iron deficiency anemia, including:
- Low red blood cells
- Low hemoglobin
- Low iron
- Low saturation
- Low ferritin (14)
He also had markers of metabolic syndrome:
- High glucose
- High A1C
- High uric acid
- High insulin
- High inflammatory markers
and more.
The Minimum Tests You Need Before Donating Blood
Before deciding whether you need phlebotomy—and how often—you must get the right tests.
Minimum Initial Tests
- CBC
- Comprehensive metabolic panel
- Ferritin
- Serum iron, iron saturation, and TIBC
- Lipids
- TSH
- CRP
- LDH
- GGT
- Insulin
- A1C
- Uric acid
- Free T4
- Free T3
These help determine whether you truly have high ferritin or iron overload.
Minimum Follow-up Tests to Determine Phlebotomy Frequency
Instead of checking hemoglobin alone, you need:
- CBC
- Comprehensive metabolic panel
- Ferritin
- Iron saturation
- TIBC
This prevents the common mistake of over-donating and becoming anemic—exactly what happened to this patient.
How We Restored His Iron Levels and Overall Health
After reviewing his full results—including deficiencies, toxins, infections, food reactions, and hormonal imbalance—I put him on a specific anti-inflammatory diet and targeted supplements.
Results After 8 Weeks
- Anemia resolved
- Ferritin normalized
- Energy improved
- Inflammation decreased
Results Over the Following Months
The following improved to optimal levels:
- Glucose
- A1C
- Insulin
- Uric acid
- HDL
- Homocysteine
He also:
- Lost 20 lbs
- No longer needed blood pressure medication
- Stopped testosterone injections
- Had testosterone levels in the 500s naturally within six months
- Experienced less pain and inflammation
- Saw major improvement in gut symptoms
The FreeDiet®: The Foundation of His Recovery
The diet I put him on is called the FreeDiet®, an anti-inflammatory plan I developed years ago while healing my own autoimmune Hashimoto’s, rheumatoid arthritis, IBS, fatigue, skin issues, and other chronic health problems.
The FreeDiet® is free of:
- Gluten
- Grains
- Sugar
- Yeast
- Dairy
- Eggs
- Soy
- Legumes
- Nightshades
- Processed foods
These are the foods most commonly responsible for inflammation, gut issues, thyroid dysfunction, and chronic health problems.
He also had additional food allergies that we addressed.
Supplements That Supported His Recovery
He took the Functional Five, the foundational supplements I find most people need:
- Multivitamin
- Fish oil
- Vitamin D with K
- Magnesium
- Probiotic
Additional support included:
- Gut-supportive supplements
- Curcumin
- CardioMetaboliX (berberine + alpha-lipoic acid)
- Resveratrol + Quercetin
- Other nutrients he tested low in
The Takeaway: Don’t Assume High Ferritin Means Iron Overload
If you have high ferritin or high hemoglobin, don’t assume it’s iron overload and rush to donate blood.
Get the proper testing first.
When you uncover the root causes and are provided the right solutions, I believe almost anyone can get better.
Go here if you would like a free copy of the FreeDiet® phase 1 food chart.
