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[This post was originally published in 2018 and has received some major updates.]

When working to address autoimmunity, including both Hashimoto’s and alopecia, it’s important to consider nutritional deficiencies. While mainstream/allopathic medicine tends to focus on thyroid lab values or antibodies for example, in the nutrition community, we also know that nutrient deficiencies play a huge role in hormonal imbalances and can even contribute to related symptoms.

Low iron—and more specifically, low ferritin (your iron storage protein)—is common in the hypothyroid and Hashimoto’s community. And the hair loss/alopecia community. It’s said to be deficient in roughly 50 percent of women in their childbearing years and up to a whopping 80 percent who are pregnant or recently postpartum.

Many have iron-deficient anemia and don’t know it because the symptoms can overlap with those of low thyroid function: fatigue, mood swings, hair loss, inadequate levels of B vitamins, heart palpitations, breathlessness, muscle aches and pains, and brain fog. It can also lead to elevated Reverse T3, which can act against T3, our “big daddy” thyroid hormone.

To add insult to injury, low iron and ferritin can inhibit thyroid function. This is why many holistic/functional medicine doctors include iron and ferritin in a basic thyroid panel.

[For more specifics on the iron/thyroid relationship, you can check out my post, Your Thyroid + Iron, which is part of my 10-part Minerals and Your Thyroid series. You can also find adaptations of these Minerals posts in the chapter of my Essential Thyroid Cookbook called “The Nutritional Heavy Hitters.”]

If you’ve had your iron levels tested (hemoglobin, serum ferritin, or total iron binding capacity (TIBC)) and they were low (see functional ranges below), chances are you were prescribed iron or told to buy over-the-counter ferrous sulfate. 

While this may seem like the obvious solution, there can be some downsides with iron supplementation. But I don’t believe it’s all bad and the end of this post offers some effective products for safely raising iron and ferritin.

Firstly, it’s notorious for causing an upset stomach/nausea, even when taken with food. It can also cause constipation, which can affect the gut microbiome, where beneficial bacteria may not thrive because of the toxic accumulation of waste. 

Secondly, this approach doesn’t address why someone may have low iron to begin with. Keep in mind, you can have adequate iron levels with low ferritin and vice versa!

The health of our digestive environment, our food choices, and our hydrochloric acid (HCl) levels have a direct impact on how much iron we’re able to absorb.

If you’re prone to indigestion, acid reflux, heartburn, or gut infections (bacterial, fungal, etc.), these could be indicators that you lack the HCl needed to metabolize and absorb iron. (Hydrochloric acid also helps with amino acid/protein metabolism.) 

Go here for my post, What Does Acid Have to Do With Alopecia? but don’t let the title turn you away if you don’t have alopecia—it covers the iron and ferritin/HCl/H. pylori trifecta. I’m not saying that everyone with low HCl and low iron/ferritin has H. pylori!

Iron/Ferritin and Hair Loss

Ferritin maximizes hair’s anagen or growing phase and encourages it to grow to full length. 

Anemia and low ferritin are chronic in the hair loss community. It’s a harsh but known phenomenon…the body will pull iron from our follicles/hair and conserve it for more vital processes. In other words, it takes ferritin that’s stored in non-essential tissue, like the hair bulb, and distributes it to essential tissue…an unfair leeching mechanism.

Effectively Increasing Both Iron and Ferritin

By making some smart dietary choices, and possibly taking some supplementation, you can increase your iron and ferritin levels without having to resort to harsh iron drops or pills. In fact, much of the iron supplementation on the market doesn’t raise ferritin, which leaves people at risk of iron toxicity while they wait for the ferritin to increase.

Firstly, consider your digestive health. Again, we need adequate levels of HCl to absorbiron, whether it’s from food or supplementation.

You can rely on acidic foods and drinks such as raw apple cider vinegar or other fermented foods such as kimchi, raw sauerkraut, or kombucha (before meals) to stimulate HCI production. While these foods have benefits beyond supporting HCl levels, please know that they’re problematic for those with histamine/mast cell issues. But that doesn’t mean that they’re off limits forever! (Stabilizing mast cells is something I work with clients on in my health coaching practice. I know it sounds weird and daunting, but it’s really not that complicated.)

Obviously, you want to ensure you’re eating enough iron-rich foods. See a full list of iron-rich foods at the end of this post, but know that meat, especially red and organ meat, is a rich source of heme iron. Heme iron (from meat and fish) comprises 40 percent of the iron in meat products and is very bio-available. 

I know…liver.

You don’t have to come out of the chute eating pâté. You can always start with small amounts of chicken livers that tend to be the mildest. It can easily be blended into ground meats to make burgers, meatloaf, and sautés, along with spices and flavorings, without affecting the flavor profile of the meal. 

Leafy greens, nuts and seeds, mushrooms, and even potato skins are non-heme iron sources, which isn’t absorbed as well and makes up the remaining 60 percent of iron in meat and fish. To that end, the iron found in plant-based foods isn’t metabolized like iron from animal products. 

Two Possible Absorption Considerations

It’s important to know that there are substances found in some foods that may prevent iron absorption. For example, phytic acid found in grains, beans, and legumes, can bind with iron, making it somewhat unavailable to the body. 

For someone who’s not anemic, moderate amounts of phytic acid aren’t likely an issue. But for those who are anemic, it may be problematic. To get around it, buy soaked, sprouted, or fermented grains, beans, and legumes, or learn how to do this yourself at home. If you have my Essential Thyroid Cookbook, the Pantry Staples and Ingredients chapter has whole sections dedicated to grains and legumes and how to properly prepare. (There’s also the chapter, Why This is Not Another Paleo or AIP Cookbook, explaining why I don’t believe that grains and legumes are entirely off limits for those with autoimmunity.)

In general, don’t buy rice or beans and cook them directly from the package. Soak first in a bowl of acidic water overnight, drain and rinse to remove a portion of the phytic acid, then cook normally.

Additionally, there are other naturally-occurring food chemicals that can also bind with iron…oxalates.

Oxalates are tiny calcium crystals found in plant foods. For most people, oxalates pose no issue and they’re safely eliminated in urine or bowel movements. 

For others, especially those who have an altered gut microbiome, digestive diseases such as Crohn’s or Celiac, altered kidney function, or who have gene mutations that make them susceptible to oxalate sensitivity, oxalates can end up being a problem. 

Unfortunately, there’s no effective way to completely remove oxalates from the foods we eat, although boiling high oxalate foods such as potatoes, beans, beets, spinach, and chard can reduce levels. 

To Supplement or Not?

Iron supplementation can be beneficial. As mentioned, iron drops and pills do pose temporary risks such as digestive upset and constipation, but there are a few other options.

It’s important to speak with your medical provider about any iron supplementation. There are well-documented risks of both high-dose and long-term use. (1, 2)

Additionally, never try to raise iron or ferritin unless you’re known to be deficient.

Functional ranges are:

- Iron: 85–130 μg/dL (the conventional medicine community tends to use the low end of the range as 30-40 μg/dL)
- Ferritin: 80–90 ng/mL (the conventional medicine community tends to use the low end of the range as 10 ng/mL—oh my goodness)
- TIBC (total iron binding capacity): 250–350 μg/dL

Remember, you can have adequate iron levels with low ferritin and vice versa! Don’t let anyone tell you that simply getting your iron tested without the accompanying ferritin is sufficient.

You can find information below on ordering your own labs. You’ll want to re-measure your levels in about 2-3 months to ensure that you’re supplementing enough—and not over-supplementing!

Also see below for how to order these supplements. But read the above paragraph again!

1. Desiccated liver by Vital Proteins: If the thought of eating it doesn’t agree with you, you can also take it in the form of encapsulated liver. I feel that this is one of the bestways to raise both iron and ferritin. 
2. OptiFerin C by Pure Encapsulations: This is my favorite way to raise ferritin specifically. It’s iron bisglycinate and includes Ester-C, a natural, non-acidic water-soluble form of Vitamin C that aids in absorption and also supports the immune system.
3. Blood Builder by MegaFood: This is what I occasionally take. It’s a food-based iron supplement, along with Vitamin C for absorption and also B12 and folate. Like OptiFerin C, it’s iron bisglycinate, so it can help with increasing ferritin as well.

4. Lactobacillus plantarum (probiotic strain): It can help to increase iron absorption by a whopping 50 percent. L. plantarum can be found in many probiotic products, but my favorite is Ortho Biotic by Ortho Molecular.

5. Ferrochel: This is also a highly bioavailable form of iron and is non-constipating.

6. Floradix: This is plant-based, so it’s very easy to absorb and is non-constipating.

Important note about Floradix: It’s in a juice base (look at that label) and can throw blood sugar off unless taken with food. Many in the functional medicine community don’t recommend it for this reason, but it’s been used widely in the hair loss community and many hail the benefits of Floradix for raising not only iron, but also ferritin.

If you’re trying to improve your iron levels based on testing, just remember it starts with your gut health and the foods you’re consuming. Work to heal low stomach acid and/or leaky gut, then put an emphasis on iron-rich foods and perhaps, depending on your situation, limit foods that contain naturally occurring substances that bind with iron. 

Foods rich in iron include: spinach, Swiss chard, turnip greens, collard greens, mustard greens, beet greens, romaine lettuce, asparagus, bok choy, sea vegetables, organ meats, bage, sauerkraut, kimchi, leeks, potatoes (skin on), beef, chicken (dark meat), lamb, oysters, tuna, shrimp, clams, mussels, tempeh, natto, miso, peanuts, adzuki beans, garbanzo beans, lima beans, lentils, yogurt, kefir, cumin, parsley, turmeric, basil, oregano, thyme, sesame seeds, pumpkin seeds, almonds, hazelnuts, cashews, amaranth, buckwheat, millet, oats, quinoa, chili peppers, chili powder, blackstrap molasses, and dark chocolate.

Acquiring Your Own Labs

You can go here to order. You’ll find a standalone Ferritin kit in the Featured Tests. If you use the Search function and type in ‘iron,’ you’ll find ‘Iron Panel’ that includes iron, TIBC, and ferritin. In the U.S., this testing is widely available except in the states of NY, NJ, and RI. Any tests involving a blood draw require a visit to your local health service.

Ordering Supplements

You can go here to set up a Fullscript account. If you’re in Canada, use this link.

After you log in, click on “Go to Catalogue” at the top and then ‘Jill Grunewald’s Dispensary Favorites.’ You’ll find categories of some of my favorite supplements there. Or you can use the Search function to look for anything else you need. 

Again, supplementation has its considerations. But many supplement with iron safely and effectively. You want to ensure that you maximize absorption so that you don’t end up supplementing longterm, only to wreck your gut and spin your wheels.