"Normal" Iron but Still Exhausted? what your labs don’t tell you
You’re exhausted, dragging yourself through the day with heavy limbs and heavier eyelids. You finally get your bloodwork done, hoping for answers… but everything comes back “normal.”
In particular, your iron.
So why do you still feel like something is off?
As a Naturopathic doctor, I’m here to tell you: there’s more to iron than ferritin. And there’s a big difference between normal and optimal.
What Is Ferritin?
Most conventional bloodwork screens for ferritin, a protein that stores iron in the liver. It’s helpful — but it’s not the whole picture.
Ferritin shows us what’s in storage, not what’s actively circulating or being used. Even then, the cutoff for “normal” ferritin on most lab reports is shockingly low. Most labs won’t flag ferritin as low until it’s under 30 — but optimal ferritin levels for menstruating women are closer to 60–80.
Let’s put it this way: the standard lab range might help classify you as deficient, but it won’t help you feel your best.
When Ferritin is Too High
Now, what if your ferritin is over 100? That doesn’t necessarily mean your iron is stellar — in fact, it might mean the opposite.
Ferritin is also an acute phase reactant, meaning it rises in response to inflammation. If your ferritin is high, your body may be fighting something off or dealing with stress in the liver. In that case, it becomes unreliable as a marker of your true iron status, and we need to look elsewhere for answers.
The Full Iron Panel: What You Actually Need
To get the full story, we may need to look at more than just ferritin. A complete iron panel can reveal what’s happening with your iron transport, availability, and usage.
Here’s what we typically look at in a full iron panel:
Serum Iron – Iron that’s currently circulating in your bloodstream.
TIBC (Total Iron-Binding Capacity) – Think of this as the number of seats on the bus that carries iron around.
Transferrin Saturation – This tells us how full that bus is. Low saturation = not enough iron there to be transported.
CBC (Complete Blood Count) – Shows us if your red blood cells (which carry oxygen) are being impacted by your iron status.
When any of these markers are off — even if ferritin looks “normal” — it can explain symptoms of iron deficiency.
Symptoms of Iron Deficiency: It's Not Just Fatigue
Common Symptoms of Iron Deficiency:
Fatigue and weakness
Dizziness or lightheadedness
Pale skin
Heart palpitations
Shortness of breath
Cold hands and feet
Sneaky Symptoms of Iron Deficiency:
Hair thinning or hair loss
Restless legs at night
Brain fog and poor focus
Headaches
Brittle nails
Craving ice or non-foods (yes, that’s a thing — and it’s called pica!)
You Deserve Better Than "Normal"
If you’ve been told your iron is fine, but you’re still exhausted, dizzy, or losing hair — you’re not crazy, and you’re not alone.
As a Naturopathic doctor, I’m not just here to flag deficiencies — I want to help you reach optimal health. That means digging deeper, interpreting lab markers in context, and connecting the dots between your symptoms and your biochemistry.
If no one’s ever run a full iron panel for you… it might be time.
