When should I get my iron tested and what can I do about low iron levels?

One of the more common nutrient deficiencies is iron. Risks for iron deficiency include menstruation, veganism or vegetarianism, malabsorptoin (celiac, gastric bypass for example or bleeding from a GI source (ulcer, malignancy). A routine blood panel may miss more mild cases, so it is important to consider testing a ferritin (in addition to a complete blood count) when you are suspicious for a low iron level. A common misconception in lab testing is that an iron level is the right test to look for iron deficiency - iron levels actually fluctuation quite a bit day to day and throughout the day, so while the iron level can help evaluate less straightforward cases of anemia for example, it is not a good stand alone screening test. The ferritin however can sometimes be falsely elevated so that is important to consider when choosing screening tests for iron deficiency.

Here are some symptom based reasons to consider testing a ferritin or more extensive iron panels:

  • Fatigue
  • Suboptimal exercise performance
  • Hair loss
  • Restless leg syndrome

What do I do if my ferritin is low?

The most common cause of low ferritin/low iron is menstruation, so women have to work harder to maintain iron rich diets to keep their ferritin up. Other causes of low iron are poor intake. In the US, most iron is consumed in the form of meat, with iron fortified bread and breakfast cereals making the rest of the lion’s share. If you tend not to eat meat or don’t eat iron fortified cereals and bread, you may need to consider an iron supplement. Below is a chart from the National Institutes of Health indicating daily iron intake needs by age, followed by a list of iron rich foods.

Age Male Female Pregnancy Lactation
Birth to 6 months 0.27 mg* 0.27 mg*    
7–12 months 11 mg 11 mg    
1–3 years 7 mg 7 mg    
4–8 years 10 mg 10 mg    
9–13 years 8 mg 8 mg    
14–18 years 11 mg 15 mg 27 mg 10 mg
19–50 years 8 mg 18 mg 27 mg 9 mg
51+ years 8 mg 8 mg    
Food Milligrams (mg) per serving Percent DV*
Breakfast cereals, fortified with 100% of the DV for iron, 1 serving 18 100
Oysters, eastern, cooked with moist heat, 3 ounces 8 44
White beans, canned, 1 cup 8 44
Beef liver, pan fried, 3 ounces 5 28
Lentils, boiled and drained, ½ cup 3 17
Spinach, boiled and drained, ½ cup 3 17
Tofu, firm, ½ cup 3 17
Chocolate, dark, 45%–69% cacao solids, 1 ounce 2 11
Kidney beans, canned, ½ cup 2 11
Sardines, Atlantic, canned in oil, drained solids with bone, 3 ounces 2 11
Chickpeas, boiled and drained, ½ cup 2 11
Tomatoes, canned, stewed, ½ cup 2 11
Beef, braised bottom round, trimmed to 1/8” fat, 3 ounces 2 11
Potato, baked, flesh and skin, 1 medium potato 2 11
Cashew nuts, oil roasted, 1 ounce (18 nuts) 2 11
Green peas, boiled, ½ cup 1 6
Chicken, roasted, meat and skin, 3 ounces 1 6
Rice, white, long grain, enriched, parboiled, drained, ½ cup 1 6
Bread, whole wheat, 1 slice 1 6
Bread, white, 1 slice 1 6
Raisins, seedless, ¼ cup 1 6
Spaghetti, whole wheat, cooked, 1 cup 1 6
Tuna, light, canned in water, 3 ounces 1 6
Turkey, roasted, breast meat and skin, 3 ounces 1 6
Nuts, pistachio, dry roasted, 1 ounce (49 nuts) 1 6
Broccoli, boiled and drained, ½ cup 1 6
Egg, hard boiled, 1 large 1 6
Rice, brown, long or medium grain, cooked, 1 cup 1 6
Cheese, cheddar, 1.5 ounces 0 0
Cantaloupe, diced, ½ cup 0 0
Mushrooms, white, sliced and stir-fried, ½ cup 0 0
Cheese, cottage, 2% milk fat, ½ cup 0 0
Milk, 1 cup 0 0

If you are struggling to keep your iron stores up through diet alone you can consider taking an iron supplement. 325mg of ferrous sulfate is a readily available, effective way to do that. Ferritin is pretty inexpensive so I have a low threshold to check when people have the above signs or symptoms.

DawnMD Lab Prices

Test Price
004598 Ferritin $5.38
005009 CBC With Differential/Platelet $3.82