Low Iron and Ferritin—Causes and Symptoms

Can low iron be the cause of your fatigue, brain fog, and other symptoms? I will talk about that, how to find out if you have an iron deficiency, and what to do about it.

My name is Dr. Tom Rofrano from the Natural Medicine Clinic in Palm Beach Gardens, Florida. I’ve had the opportunity to see over 100,000 patient visits over the last 35 years. Many of whom have had thyroid and gut issues. 

A common issue that I see is deficiencies, commonly patients with iron deficiency. What are the symptoms of low iron or low ferritin: lack of concentration, fatigue, weakness, shortness of breath, heart palpitations, hair loss, decreased thyroid function, and oftentimes, digestive symptoms including IBS. There are many other symptoms as well. For kids decreased growth and development, ADHD, and anxiety.

Testing for Iron Deficiency

In testing for iron deficiency, you don’t want to just check your iron stores. You want your doctor to look at serum iron, total iron-binding capacity (TIBC), percent saturation and ferritin. Ferritin is a storage protein that can reflect your body’s stores of iron. Iron level is just a brief view in your serum and ferritin reflects your body’s stores. The ferritin lab ranges are 10 to 150 ng/ml for females and 20 to 400 for males, which is a huge range. I like to see optimal ferritin levels in the 60 to 90 ng/ml range. 

A woman at the level of 20 can have major symptoms even though you’re considered within the normal range. Then we look at other things as well. You don’t want to just look at iron levels. You also want to check at the minimum, a CBC, comprehensive metabolic panel, thyroid TSH, T3, T4, lipids. I also like to check several other factors including B12, folic acid, vitamin D and magnesium. You want to get a more complete picture. 

If you want a more complete list, on page 104 of my book I give a comprehensive health panel, which has 27 different items. You can look at that if you’d like. But at the minimum, I would do those listed above.

Causes of Low Deficiency

What are the most common causes of an iron deficiency? Decreased intake, increased blood loss due to menstruation in women, internal bleeding as in an ulcer, or decreased iron absorption. I also see gluten sensitivity and other food reactions with people who are iron deficient.

Infections including gut infections, parasites, yeast, and bacteria can cause malabsorption. Leaky gut is another cause of malabsorption. It’s usually not just one thing but often multiple things are involved. 

Just to give an example:  a 37-year-old woman came to me with symptoms of fatigue, weakness, and shortness of breath. She was too exhausted to even exercise. She also had digestive symptoms of nausea, vomiting and abdominal pain. 

She had seen doctors including another functional medicine doctor. He did more testing, found her ferritin level was low as well as vitamin D. He treated for those, but she was still feeling terrible. When she came in, I did more comprehensive testing and found she had gluten sensitivity and other food reactions. She had infections including yeast, intestinal bacteria, and H-Pylori, a stomach bacteria that was causing the heartburn, nausea and abdominal pain.

Treatment of Iron Deficiency

She also had leaky gut and other things as well, including multiple deficiencies, not just iron. So what are the solutions for that? Just taking iron supplementation on your own is not typically the best solution. You need to make sure you’re taking the right kind. I prefer iron glycinate. It’s highly absorbable and is designed not to cause constipation or gut reactions.

You also need to take the right amount. I use 29 milligrams of Iron Glycinate. For this patient, her ferritin was at 17 so I prescribed two pills twice a day because one just wasn’t enough. You do the right amount depending on what your levels are. Taking vitamin C, C-Bioflavanoids 500 as she did, is helpful with iron because it helps increase absorption. If you have low iron, most commonly you have other deficiencies as well. It’s rarely just iron.

As I said, she was also low in vitamin D plus many other nutrients that we checked. I will typically recommend Functional Five™, which is a multivitamin, fish oil, vitamin D, magnesium, and probiotics that help with absorption and gut health. B12 and folic acid are common deficiencies I see as well as digestive enzymes. In her case, she needed stomach enzymes, including HCL. It helps absorb iron from foods and helps you break down your foods and absorb them better. 

Diet for Low Iron and Low Ferritin

On top of that, I will use the FreeDiet®, because most people I see who are iron deficient are also gluten sensitive, which contributes to malabsorption. I put our patients on the FreeDiet®, which is not only free of gluten but gluten, grains, sugar, yeast, dairy eggs, soy, legumes, nightshades, and processed foods. These are the foods most commonly responsible for inflammation, leaky gut, and other chronic health issues.

If you’d like a free copy of the FreeDiet® phase 1 food chart, you can click here.

I put her on the FreeDiet® along with supplements and in four weeks her ferritin went from 17 to 89 ng/ml. Equally as great was that most of her symptoms resolved. She had more energy. Her digestive issues cleared up, the nausea was gone, and her brain fog lifted. She was able to start exercising again!

It’s amazing what can happen when you find out the underlying causes and are provided the right solutions. It’s also important to follow up. So you test. You find out your deficiencies. You take iron for a while according to protocol. then you want to get retested. 

When your levels are good, it doesn’t necessarily mean you stop taking the iron. Your physician can adjust the dosage accordingly or you may be able to stop taking it. It depends on a lot of factors. You want to follow up to make sure that you are consistently on the right track.

Contact Us

If you would like help personally, call us at 561-627-5800 or email us at info@nmcwellness.com. We would love to help. To learn more about functional iron deficiency treatment or iron therapy please reach out.


  • Excellent. Very informative. Thank you.

  • Hi Dr Rofrano, thank you for sharing your expertise–very informative! I’ve consistently checked low in ferritin the last few yrs. (hovering around 29) but having apparently normal iron levels otherwise. I’ve also been borderline hypothyroid with an elevated TSH. A few questions:

    1. Is ferritin truly the gold standard for the need for iron supplementation? Are there any instances/conditions where this is not the case?

    2. What do you think of bovine spleen to raise ferritin? I’ve tried iron supplements in the past (they were supposed to be the “safe” natural kind) and got weird symptoms–not gastro–but feeling spacey and depth perception/visual disturbances.

    3. I’ve read that for a man to have low ferritin is rare and internal bleeding should be ruled out. What’s your take–what would cause iron deficiency in a 34 yr old man? FYI, I do have chronic health issues, particularly lyme disease (diagnosed at 19) and pectus excavatum (rib cage compressing heart and lungs). I also have chronic fungal infections on the skin and possibly the digestive tract (near constant abdominal swelling/bloating).

    Thank you for your time!

  • Very helpful and informative !
    Thank you

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