Iron and fatigue: why hemoglobin is normal but you have no energy

With each menstrual period, 15-30 mg of iron is lost; with heavy periods, twice as much. From food, 10-15% of the iron from meat and 2-5% from plants is absorbed. If there is little red meat on the plate and periods are heavy, the deficit accumulates over the years. Add pregnancy and breastfeeding, when iron is transferred to the baby, and it becomes clear why deficiency in women is the norm rather than the exception. Heavy periods can themselves be a sign of hypothyroidism—if you suspect it, get that checked too.

Fatigue unrelated to sleep. Shortness of breath during exertion that used to be easy. Hair loss, brittle nails, cracks at the corners of the mouth. Icy hands and feet. Restless legs syndrome at night. Craving ice, chalk, or uncooked grains. Paleness, dizziness when standing up. Workouts are not going well, and recovery takes a long time. Fasting is difficult to tolerate, and you constantly feel drawn to food. If you have two or three of these symptoms, a ferritin test is essential.

A low-carbohydrate diet is one of the best for iron: meat, liver, and seafood are its foundation. Beef liver once a week — 6-9 mg per 100 g, the best source. Red meat 3-4 times a week. Shellfish, mussels. Vitamin C on the same plate — bell pepper, herbs, lemon — doubles absorption. Coffee and tea — not until at least an hour after a meal containing iron: tannins block absorption. Calcium and dairy — separately as well.

With ferritin below 15-20, food won't make up for the losses — supplements are needed, and this is a doctor's decision: dose, form, duration. Iron bisglycinate is better tolerated than sulfate. Taking it every other day is absorbed better than taking it daily. Check again in 3 months. And most importantly — look for the cause: heavy periods, hypothyroidism, stomach problems, hidden losses. A supplement without addressing the cause is like pouring water into a sieve. How this is related to hair loss — in a separate article.