Iron, Anemia, Ferritin and Fatigue

Iron, B12, and Folic Acid

Iron, vitamin B12, and folic acid are very important components of overall health. They are each required to make red blood cells, which in turn carry oxygen throughout the body. Without adequate iron we can become anemic. Anemia causes fatigue and poor cognitive function.


Anemia is a common blood disorder, which is either a decreased number of red blood cells (RBCs) and/or poorly formed red blood cells. There are many different types of anemia, the most common types being iron deficiency, vitamin B12 deficiency, and folic acid deficiency anemias. Iron deficiency anemia shows up on your Complete Blood Count (CBC) as a low RBC count, low hematocrit (Hct), or low hemoglobin (Hgb). However, low iron status will show up long before anemia if ferritin is measured. B12 and folic acid deficiency anemias show up as unusually large red blood cells.


Ferritin is the form in which iron is stored in the tissues of the body, particularly the liver, spleen, and bone marrow. Ferritin is a protein complex that contains iron. Ferritin decreases long before iron deficiency anemia shows up on your CBC. Therefore measuring ferritin is the optimal way to determine your actual iron status. A satisfactory ferritin level is generally over 50 and not much higher than 200. A ferritin level less than 30 indicates iron deficiency, and less than 18 can indicate absent iron stores. If you do not adequately raise your ferritin level then you are much more susceptible to repeatedly becoming anemic and may have difficulty breaking out of a cycle of frequent anemia.

A high ferritin level may indicate the need for further testing in order to rule out iron overload.

Supplementing with Iron

Never take iron unless blood tests demonstrate that you are deficient in iron. Excess iron can cause symptoms similar to iron deficiency and can be very toxic, leading to liver damage.

If you have an iron deficiency on your CBC, this will generally respond fairly rapidly to iron supplementation. However, it can take 6-12 months to increase iron stores (ferritin) to an adequate level, depending upon how iron deficient you are. Therefore it is important to continue to take iron until you have raised your ferritin level to a satisfactory level, even though your CBC may be normal.

It is important to monitor your iron supplementation with follow-up blood tests to check your CBC and your ferritin. This is necessary to determine that the treatment is working, that you reach an adequate ferritin level, and that you do not take excess iron.

High Quality Iron vs. Low Quality Iron

Low quality iron supplements, such as iron oxide and iron sulfate, are poorly absorbed and often cause digestive problems such as an upset stomach and constipation. Fortunately, this is often avoidable.

High quality iron comes in the form of iron picolinate, iron glycinate, or iron citrate, which are much better absorbed and do not cause side effects. Liquid iron and time release iron capsules are also less likely to cause digestive upset. It is wise to include folic acid and vitamin B12 in your iron supplement, because these nutrients are also required to form RBCs.

Recommended Product: Ferrasorb by Thorne, Liquid Iron by NF