If you’re new here, quick catch up: My ferritin came back at a 9 in early June. My doctor said I was fine because the rest of my panel looked “normal”. It wasn’t fine, it was a trend that had been falling for almost a year, and nobody caught it because nobody looked at the trend, they looked at one number in isolation. If you missed that one, start here.
Since then I’ve been doing what I always do, get curious, and share it with you as I go. This is that update, and it’s also me widening the lens a bit, because I hear from just as many of you with HIGH ferritin as low.
The good news is that I am sleeping better - energy is better - digestion is better & still no hair loss (YAY) - and I am going to share what I have been doing with you here in case there are any clues there for you.
In this article I will share exactly what I have found - what I have been doing - a list of Labs to check with your provider - HCL & Enzymes Protocol & Estrogen Clearance Quiz and Cheat Sheet.
Before we start:
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Quick note before I go further, because these are not the same problem and I don’t want to blur them together. Low ferritin usually means your iron stores are actually running low. High ferritin usually means something else entirely, it’s an inflammation marker as much as an iron marker, so a high number can point to active inflammation, iron overload conditions like hemochromatosis, liver involvement, or several other things that have nothing to do with iron deficiency at all.
AND - this article is not medical advice & for informational purposes only.
In other words - I’m not collapsing those into one article. (I will be doing a deep dive with my friend Chris - who is my master lab reader - here on Substack - so stay tuned).
What I do think applies to both is this: Before you chase a rare root cause, before you land in a Facebook group with someone who’s positive it’s copper dysregulation or mold or parasites, there are two things worth ruling out first. They were my two, and they might not be yours…..but I think they’re a smart place for almost everyone to start looking.
I already know what’s coming in the comments: Someone’s going to tell me it’s actually copper dysregulation. Someone else is going to say it’s mold. Someone else is going to swear it’s parasites, or heavy metals, minerals, or adrenal fatigue, or whatever their one root cause is. And here’s the thing, they might be right, for them. I’m not saying those aren’t real.
I’m saying I’ve watched enough people online build an entire framework around the one root cause that fixed their body, and then apply it to everyone. That’s not how this works. Most people aren’t dealing with one thing, they’re dealing with two or three things stacked on top of each other.
I’m definitely not claiming absorption and estrogen clearance are THE answer for everyone. I’m saying they’re two of the easiest, most overlooked places to start looking, no matter what else ends up being part of your picture.
So yes, this is all complex. Low ferritin alone can come from EBV, SIBO, H. pylori, fibroids, celiac, heavy bleeding, chronic under eating, and a dozen other things I’m not going to list here (which is why it is imperative for you to potentially dig deeper than “just take iron”). High ferritin has its own separate list, and typically there is no one single root cause and I am not telling you there is.
But I also don’t think complexity means we can’t talk about starting places. For some people this really will be layered and take months to untangle with a practitioner. For other people, the answer might be sitting inside one or two basic levers nobody ever asked them to check, and both of those things can be true at once.
My answer is not your answer, and please don’t read this and skip your workup. Read this and potentially add two more things to what you’re already looking at (PS - this is not medical advice).
One, absorption. Are you actually absorbing what you eat?
I already wrote about this piece, low stomach acid and how it blocks iron absorption even when your intake looks fine on paper. I did an HCl challenge, confirmed I needed support, and added HCl before protein meals along with digestive enzymes. Low stomach acid is common, underdiagnosed, and completely invisible on standard bloodwork, which is exactly why it gets skipped.
I will add my HCL & Enzymes protocol that I give to my clients and students as a starting place (which also tells you who should NOT do this challenge) - in the paid section below.
Two, estrogen clearance: Does your body have what it needs to clear the estrogen you make. (This is complex - and more than just “estrogen” & I have a full quiz, symptom checklist & cheat sheet below in the paid section).
This is the piece I think a lot of people skip entirely because it doesn’t feel connected to iron at all on the surface, but here’s the thread.
When I dug into my gut testing again alongside my labs, one thing stood out. I was low, close to nothing, in lactobacillus, one of the gut bacteria your body actually needs to help clear excess estrogen. When it’s missing, estrogen doesn’t clear the way it should, and it can build up relative to progesterone.
Yes - I have a few genetic predispositions to have a hard time clearing estrogen to start with (include a gene that makes me more likely to aromatase other hormones into estrogen) - but these genes never became an issue for me until I got into my 40’s & started managing a ton of crazy stress.
Genetics are not your destiny….but when mitochondria are stressed - they are more likely to be expressed.
I went back and looked at my own bloodwork on day 20 of my cycle and my estrogen was out of range compared to my progesterone. IMPORTANT: One lab draw isn’t a diagnosis, but it lined up with what I’d actually been feeling in my body.
SYMPTOMS: I’ve had two separate episodes, one in February and one in June, of very painful, swollen breasts right before my period (They were actually so bad that I went and paid for my own breast ultrasound & everything came back clear….but that’s how painful it was). I’ve also had heavy cycles for about a year now & have been connecting those to stress.
So I started supporting clearance directly. I added a stabilized sulforaphane, one of the better studied compounds for supporting healthy estrogen metabolism (important note if you go looking, most sulforaphane supplements on the market don’t actually contain sulforaphane, they contain a precursor your gut has to convert, and that conversion is unreliable for a lot of people).
I also started having coconut kefir from Fermenting Fairy (my code there is SARAHK) pretty much daily to help rebuild lactobacillus. I’m keeping it coconut based and keeping regular dairy on the lower side for now, mostly as a precaution while I’m still working on absorption, not because I think dairy itself is “bad”.
I changed my diet (more on my personal meal plan below).
This month, for the first time in about a year, I had a completely normal cycle. No pain, no clotting, none of the usual issues. I’m not saying that’s fixed or proven, one cycle isn’t a study. But it’s the first real data point that’s made me feel like I’m pulling on the right thread.
You don’t need a Dutch test - gut test - or a full hormone panel to start noticing this side either (although if you have the finanical means - these can be helpful).
Look at your own symptom pattern first. Painful or swollen breasts before your period, heavy or clotty cycles, carrying weight in the hips and thighs, again - even in menopause when you’re not cycling anymore, these are all worth paying attention to. If you’re still cycling, fibroids and heavy bleeding belong on that list too.
I’ve also been a lot more conscientious with my actual nutrition, not just supplements. Getting adequate protein at meals, adding in things like carrots and other resistant starch, apples, lamb, seafood, and salmon roe, along with the rest of it.
Part of that is keeping my blood sugar balanced & staying fueled (crucial for detox - sleep & ferritin in general), part of it is just making sure I’m getting enough protein in general, and part of it is feeding my microbiome what it actually needs to clear estrogen. All of it works together, and none of it is one silver bullet on its own.
I’m stacking a lot at once, which means I won’t know exactly what did what until I retest. But for transparency, here’s everything currently in play (reminder - this is MY protocol & might not be right for you for many reasons):
- HCl before protein meals and digestive enzymes with meals, for absorption
- Spleen (I recently switched to 3 Arrows) with Vitamin C & my methylated B’s away from coffee and dairy
- Coconut kefir daily, for lactobacillus and estrogen clearance (Code sarahk if you want to try the one I love)
- Stabilized sulforaphane, for estrogen clearance (code SARAHK if you want to try this one)
- Keeping dairy on the lower side as a precaution while I rebuild absorption
- Eating a lot more red meat again (lamb & beef), on purpose, after realizing I’d basically stopped reaching for it without noticing (click here to see photos of my most recent meals - but I have to warn you the comments are CRAZY)
- Way less coffee, one cup, always after breakfast
- Isotonic minerals - more bananas (B6 is crucial here) - more carbs in general - more potassium (OJ has been a hero for me here!)
- Castor oil packs - regularly - these have been a game changer for my sleep & they are a very gentle way to support the liver.
- Magnesium baths 3 times per week
How this is working: My digestion is better - My sleep is better - My energy is noticeably better, and I still haven’t lost real hair through any of this, which I think comes down to the hair products I’ve been consistent with rather than anything ferritin related. That part is speculative, I want to be honest about that every time I mention it. (I also did a post on this & how I think my other habits like sun exposure & mineral repletion have been helping - click here to read).
I’ll retest my full panel at the end of August and I will absolutely share the numbers, good or bad. I am also still waiting on the full report from a pelvic ultrasound I got - but the lab tech said it was “nothing remarkable”…..which is good news (I am guessing?).
Next up, I’m sitting down with my friend Chris, who helps people read and understand their own bloodwork as part of educational consultations, for a real deep dive. We’re going to go through all the different types of low ferritin and high ferritin, the other markers worth looking at on a full panel, and what those numbers actually mean beyond just “normal” or “not normal.” This is the one to be subscribed for, so make sure you are if you want it landing in your inbox.
A quick note: none of this is medical advice. I’m a health coach sharing my own n=1 investigation, working alongside people helping me read my data. Please don’t start HCl, add supplements, or change your diet based on my story alone. Work with someone who can actually look at your labs and your symptoms.
- My full recommended labs list for ferritin and absorption, the exact one I bring to my own appointments
- My HCl and enzymes protocol, the one I give every Blueprint client that needs it
- My estrogen clearance checklist and quiz, to help you figure out if this might be part of your picture before you spend money on testing
Thank you for following along with this one in real time. More soon. 💛
Upgrade to Paid to get the goodies & I will also have a paid zoom meeting for paid subscribers next week on August 11 if you want to ask me questions! (zoom link will be sent out on Monday).
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