Iron supplementation: is it only problematic if your levels are too high?

I always said I would never take iron supplements because of the Alzheimer’s studies, but my numbers are low – ferritin 10, iron 37, % Sat only 11. (TIBC normal at 327.)

I have had crippling fatigue and brain fog and assume it’s related (though there may be numerous causes) and am initiating a 65 mg iron pill (325 ferrous sulfate) daily. However, my doctor doesn’t have much guidance on dosage or length, other than we can check back in a few months. For someone interested in long-term neurological health, is there anything special I should keep in mind w/r/t iron supplementation, like timespan, dosing, or type? (I’m a late 20s female.)

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We’ve had some discussions on iron here. I recommend you review them, if you have not already. I’m not sure if the discussions would be different for a young female or not. Perhaps someone with more knowledge in this area can jump in the discussion.

  1. Iron: an underrated factor in aging
  2. Rapamycin and Iron Levels

Thank you. Yeah, that’s part of what I’ve been mulling. 2-43 is a huge range. On the one hand if your iron is too low you’re not circulating blood well enough to your brain I think, especially if you’re having fatigue and brain fog.

I also question to some degree the iron/inflammation causality and whether iron deposits found in the brain and/or high ferritin associated with various disease isn’t just a symptomatic effect of general inflammation, but that’s a somewhat separate topic.

If it were me I would test sooner than a few months once you have stabilised any intervention.

One of the key things, of course, is blood loss which is the main reason that iron leaves the body. You could try to assess how much iron you are losing that way and use that to guide supplementation as you will be getting some in food.


I have a similar situation. Low ferritin and hemoglobin (though not that low) - but TIBC is normal which suggests iron intake is good and the problem is elsewhere - but digging has produced nothing definitive or useful. Yes to fatigue etc. It’s frustrating! I’ve been low level anemic most of my life and have tried extra iron in the past with no change.

My feeling, with normal TIBC (and normal iron intake - not vegetarian for example), is to NOT supplement extra iron - but if you do I’d like to know if it makes a difference. I’m currently taking B12. If it helps I’ll let you know.

I have had surgery (couple years ago now) removing about a third of my left femur (a cancer - chondrosarcoma - inside the bone) and therefore lost a not insignificant amount of marrow. But the only change that might be related is that my ferritin is lower than before. All the other numbers are typical of the last 30 years or so.

I had the same issue. Male, non-vegetarian but 10 years of ferritin 5-50 but asymptomatic. Became slightly anaemic. MCV normal. Investigated but no cause found. The thing that persuaded me to take iron supplements was that my RCDW tanked to 17 which concerned me as it is a metric within the Morgan-Levine calculator. Two months of iron and ferritin now 110 and seems to be maintaining. Waiting to retest my FBC and RCDW but I suspect the latter needs a while for the cells to regularise. Of course there are those papers that running low iron is better for longevity….

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Younger women, however, tend to have quite regular blood loss and that may indicate a need for additional iron (and copper possibly).

I think it is the case that low ferritin is good for longevity, but that is not necessarily just linked to iron levels. However, people can end up too low. As with many things there is likely to be a sweet spot.

I think you’re right John. My only problem is that they wouldnt let me do my quarterly blood donation as I was slightly anaemic. Blood letting - another good thing for longevity.

My ferritin has come right down (from 300-400 to 50-100). I do weekly blood tests, but that is only 10-20ml a week of blood so I don’t think that is the primary cause.

Consider whether you have chronic fatigue syndrome/myalgic encephalitis. I have that as well as had extremely low iron when tested .

I mean, I wouldn’t be diagnosed with CFS because I have numerous other conditions that cause fatigue including an autoimmune disease, but I definitely have chronic fatigue and share some features of CFS.

Did you try supplementing iron and did it help you?

If you’re not anemic, I would not be taking a supplement. Iron is also toxic at high doses, so careful around children who might get into it.


Hi Darlie:

I agree only take iron when absolutely proven it is deficient and you know the source.
Your iron markers are low for sure but what are your hgb and hct levels? Are you truly anemic?
It is very rare unless chronic bleeding, GI pathogen (we all used to have parasites) or genetic red cell disorder. I have seen it twice in young woman with heavy periods, runners and vegan. Even then they still were low in copper, magnesium and sodium.

Other chemistry markers to gauge metabolic/mitochondrial function.
Uric Acid
It is also important to know RBC mag, serum copper, ceruloplasmin and vitamin A.

Are you lean? Do you know your visceral fat levels?
Take rapamycin?

We regularly work with woman and athletes who think they are low iron and actually are overload and iron is bound in the tissue. These are the makers we check.

Optimal mitochondrial function depends on:

  1. The body’s ability to create more efficient energy from oxygen and food.

  2. Reduction of the damaging exhaust (free radicals) produced in the mitochondria as a natural by-product of the metabolic process.

The goal is to restore and strengthen your mitochondrial function. Ideally, your mitochondria should work like Tesla cars–powerful and quiet without generating any exhaust–not like diesel trucks that struggle to make it up a hill, spewing noxious exhaust along the way.

Here are the key steps to optimal mitochondrial energy production:

  1. Increase bioavailable copper in order to…

  2. Decrease unbound iron and…

  3. Decrease magnesium loss (burn rate) which…

  4. Protect the reduction-oxidation reactions from creating excess reactive oxygen species
    (ROS) and the resulting inflammation which is common denominator of all modern, chronic disease (including heart disease, diabetes, cancer, cognitive decline and accelerated aging).

It’s that simple. But it’s easier said than done in today’s world because:

  • Copper deficiency is a modern epidemic due to soil mismanagement, synthetic fertilizers, the overuse of glyphosate (copper chelating chemicals), and many other factors.

The excess intake of iron in our modern diet (in combination with copper deficiency) has led to a widespread, modern epidemic of toxic iron-tissue overload which consequently leads to a massive increase in oxidative stress and inflammation.

  • Magnesium is constantly being depleted in the body due to physical and mental stress and it is not being adequately replaced in the modern diet. Magnesium deficiency reduces the body’s innate ability to properly utilize oxygen resulting in diminished energy (ATP) production.

For an overview of the topic, I highly recommend this engaging YouTube interview with Morley Robbins and Paul Saladino, M.D.


Hi, thank you for the insight! I will think this over some more. Sounds like I should get a copper test done and supplement if that is low at least.

I’m not anemic in my numbers, but I do believe the iron deficiency (or whatever it is that manifests like this) is related to my fatigue because in the last few months it’s been severe and out of the ordinary or different from my “normal” chronic fatigue.

Not a runner or vegan, I don’t know what lean/visceral fat would mean but my bmi is 18. I wouldn’t say I have heavy periods, though no idea what the comparison point would be (anyway, they’re the same as always and I’ve never had low ferritin before). The only thing I could think of is that in December/Jan, I was on a supplement that made me bleed too much and my gums would bleed like a solid tablespoon a night for a bit. Not sure if that’s enough to affect iron stores.

Mag I got a few months ago and was high (not alarmingly so, just definitely not low) and I supplement 260-320 mg/day.

Is the dietary iron overload you’re thinking of from high muscle meat consumption, or supplementation? I do eat meat daily (a fair amount) and legumes with iron but I don’t eat anything that’s fortified like cereals or breads anyway.

Edit – AST 18, ALT 21, uric acid 4.4, RBC 4.38, HGB 12.5, hematocrit 38 think that’s all I got from what you asked, my other basic labs were normal

Sodium I also supplement due to POTS, I take 1-2g supplemental sodium and double salt all my food.
and no not on rapamycin

Alcohol can deplete copper as well.

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I don’t drink but good to know.

There is also a conflict between Molybdenum supplementation and copper which argues to supplement at different times, but very few people supplement in Molybdenum although it is in some foods and perhaps it is best to avoid copper supplementation when eating foods high in Molybdenum although probably they are not high enough to matter.

A ferritin level of 10 is definitely too low and could be one of the causes of your fatigue. I would get it to at least 30. Low iron can be just as harmful as high iron through different mechanisms of action.


I stand corrected. Maybe iron is indicated in your case.

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