Iron and Iron Deficiency: Why Most People *Aren't* Deficient

Written by: SphynxCatVP
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Some people take iron because they feel tired and "run down" all the time, and they believe that they have anemia and thus, need to take iron. In the vampire community, I have seen people automatically dish out the advice "Oh, you're a vampire? You need iron!"

Both of these assumptions are - as long as the person is otherwise in good health - very often, WRONG!

In reality there are somewhere around a dozen different types of anemias, only ONE of which is caused by iron deficiency, and close to twenty other ailments that have similar symptoms. Anemia essentially means that there is a problem with the body's production of red blood cells, or RBC's - problems in RBC production can happen for many MANY reasons. Taking iron supplements - when there is no iron deficiency to begin with - will NOT fix the problem. Sometimes it will make the existing problem worse - or create additional problems if the body cannot get rid of the excess iron in a timely manner.

This article will explain more about iron deficiency and the blood test items that need to be checked to verify the presence of an actual iron deficiency. This article makes the assumption that the reader is in their late teens or adulthood, and is in reasonably good health.



Complete Blood Count (sometimes done "with differential", sometimes without.) This is one part of routine bloodwork run by most doctors. The "differential" part refers to the examination of a blood smear on a slide by a lab tech. (This is sometimes called a "peripheral smear".)


Complete/Comprehensive Metabolic Panel. This the other part of routine bloodwork run by most doctors. There is a less 'complete' version, I believe termed as just "metabolic panel" - the CMP tracks 14 or so different items, the smaller MP tracks just 7 or 8 items.


(part of the CBC)

Hematocrit - This is the red blood cell count, which is low in various types of anemia and in cases of blood loss (either externally obvious or internally not-so-obvious.)


(part of the CBC)

Hemoglobin. This carries oxygen in the blood. Red blood cells made improperly carry less oxygen.


(part of the CBC)

These three items all reflect the sheer volume of red blood cells in a sample, as well as how much hemoglobin is in them.


Smaller than normal red blood cells; growth is stunted for various reasons, including iron deficiency. This is seen on a differential smear, but can be hinted at with other bloodwork items as well.


(part of the CBC)

Red cell Distribution Width - this reflects the variation in size of red blood cells. Some variation is routinely expected, but in cases of anemia, the size variance will be greater than normal.


Indicates quality of bone marrow production vs. state of health. Reticulocytes are too high in anemia with normal bone marrow production ability or too low if there's an impairment of the bone marrow production ability in addition to the anemia.

What is iron deficiency?

Iron deficiency simply is an indicator that the body has low iron stores. This can be due to blood loss, poor diet, or an inability to absorb enough iron from foods.

Always remember that iron deficiency is a SYMPTOM of a disease process, not the actual disease itself. Many doctors (especially those who see a lot of low-income patients, or have a very crowded practice) see a low HCT on bloodwork and assume the patient is iron deficient, when this is not always the case. The actual cause of the iron deficiency has to be found and treated - and differentiated from other diseases with similar symptoms, otherwise the problem will keep getting worse.

Iron deficiency usually develops over time if the body doesn't have enough iron to build healthy red blood cells. Without enough dietary iron (or without proper absorption in the stomach or GI tract) the body starts using the iron it has stored. When that runs out, the body cannot produce as many red blood cells (hence the lowered HCT) and the red blood cells that are made will have less hemoglobin than normal (hence a lowered HGB.) The bone marrow - if working properly - will attempt to produce more red cells in order to compensate (shown by a higher reticulocyte count)

How is it diagnosed?

Symptoms of iron deficiency show that body tissues are not getting as much oxygen as they should. These symptoms do overlap with many other health conditions, but acute AND chronic (yes, even cancer!) which is why it's absolutely critical to be certain what the actual cause is. Some of these symptoms include:

  • Chest pain
  • Chronic fatigue
  • Depression
  • Dizziness
  • Headaches
  • Shortness of breath
  • Sleepiness
  • Twitching muscles
  • Weakness

Iron deficiency can be suggested (but so can other reasons for lack of blood cell production) by the following items on a routine CBC:

  • low HCT
  • low HGB (hemoglobin)
  • Microcytes
  • high RDW
  • Low MCV, MCH or MCHC
  • Differential smear may also show poikilocytosis (variation in shape) and anisocytosis (variation in size)

Iron deficiency needs to be verified with the following items - these are DIFFERENT bloodwork items, not included on a CBC or a CMP:

  • Serum Iron
  • TIBC (total iron-binding capacity)
  • UIBC (unsaturated iron-binding capacity)
  • Serum ferritin
  • Reticulocyte count
  • Transferrin saturation

What causes iron deficiency?

  • Chronic Internal bleeding (bleeding ulcers, bloody diarrhea, etc.)
  • Chronic illness (cancer, Crohn's disease, Celiac Syndrome, etc.)
  • Copper deficiency (rare)
  • External hemorrhage (rectal bleeding due to hemorrhoids, accident/trauma, etc.)
  • Medications that reduce stomach acid (ulcer medications, etc.)

Who should take iron supplements?

Anyone who demonstrates an iron deficiency on specific bloodwork, as talked about above.

Possibly children (because they're growing) or menstruating women of reproductive age (because they shed blood due to their monthly cycles) IF they don't have a lot of meat in their diet OR they have a malabsorption problem.

For men, iron supplementation is not only generally unnecessary, but not recommended (it can lead to side effects and overload symptoms) for men with a meat-heavy diet. Iron tends to accumulate in the liver first (which can cause jaundice - yellowing of skin and eyes) and contributes to certain types of cancers.

Dietary sources

Meat, fish, eggs, spinach and other dark leafy greens, dried fruits, dried beans, nuts, vitamin C taken with iron (helps absorption), regularly cooking in cast iron pots and pans (especially cooking acidic foods like tomatoes), liver, bone marrow, stinging nettle tea.

One person also suggested a bit of iron (plain iron, not coated with anything else) stuck in a lemon, and then make lemonade with it the next tday, will also add iron to the diet. (Most iron nails in the hardware store are coated with something that's probably not safe for digestion... you may need to visit a metal shop to get plain iron.)

Things that impair absorption

Aspirin (Acetacylic Acid) and aspirin derivatives, antacids, cholesterol busters, drugs for urinary stones, too little acid production (if the patient is taking any anti-ulcer medications), calcium, phosphates, diary products (because milk has calcium), egg whites, phytates/phosphorus in beans, tannins in tea/coffee. Separate these from iron supplementation by 8-9 hours.

Iron overload/toxicity symptoms

Initial overload side effects are due to the corrosive nature of iron in large doses on tissues in the stomach and GI tract, and include:

  • Abdominal pain
  • Diarrhea
  • Nausea
  • Vomiting

Interestingly, these are also listed as common side effects on every over-the-counter iron supplement, along with the additional effects of black tarry fecal matter and occasional constipation.

If overloading of iron continues, it may progress to cellular and organ toxicity, and also include (in addition to above):

  • Fatigue, weakness
  • Impaired blood production (too much iron crowds out other necessary ingredients)
  • Joint pain
  • Lack of energy
  • Loss of sex drive
  • Organ damage starting first with: Liver, kidneys, heart, and/or endocrine system.
  • Liver damage due to iron overload may, due to oxidative stress, cause an excess of porphyrins and lead to the acquired form of Porphyria Cutanea Tarda.