This post contains affiliate links which means that if you make a purchase I will make a small commission, at no cost to you. Thank you for supporting my work.
As always, this blog is for educational purposes only. Please consult your doctor before trying anything new.
If you’ve been told your ferritin is low and you can’t seem to fix it no matter how much iron you take, you’re not alone. Many women find themselves trapped in the frustrating cycle of low ferritin, fatigue, and constipation, despite doing everything “right.” You’ve probably eaten more red meat, added spinach to every meal, or even received iron infusions, only to see your labs barely move. Maybe your doctor told you to take another round of iron supplements, but each time you do, you end up more bloated, constipated, and exhausted. The truth is, your iron problem might not be an iron problem at all. It might start in your gut or with your minerals.
When digestion, absorption, or inflammation issues are at play, the iron you eat or supplement with can’t actually be used by your body. Instead of fixing fatigue, it can make your gut symptoms worse. Lasting change in your iron levels comes from understanding why your ferritin is low in the first place.
Understanding What Ferritin Really Means
Think of your ferritin as your body’s savings account for iron. It stores extra iron for when your body needs to make red blood cells, support your thyroid, or carry oxygen. But when those savings start to run dry or when iron gets trapped and can’t be used you feel it. Fatigue, hair loss, brain fog, and shortness of breath are often the first clues.
Most people with iron issues related to ferritin fall into one of three main categories, and understanding which one you fall into can completely change the way you approach your symptoms.
Low ferritin with normal serum iron: This is one of the most common patterns we see. It means you still have enough iron circulating in your blood, but your storage levels are running on empty. It’s like having just enough cash in your checking account to get by, but your savings account is drained.
This pattern often stems from hidden inflammation, chronic stress, or sluggish metabolism. These factors that make it harder for your body to store iron properly. You might feel tired, foggy, or notice more hair shedding, even though your “iron” looks fine on paper.
Low across the board: When ferritin, serum iron, and saturation are all low, that’s a sign of true iron deficiency. The causes can vary including heavy periods, postpartum blood loss, a past surgery, poor absorption due to low stomach acid, or even a diet lacking enough bioavailable iron.
In this case, iron supplementation can help, but only if your gut is functioning well enough to absorb it. Without addressing digestion, that iron may pass right through unused and cause constipation or nausea along the way.
High ferritin with low serum iron: While less common, this pattern is equally important. It can point to chronic inflammation or an infection where your body is intentionally locking iron away to protect itself.
When pathogens like H. pylori or certain bacteria feed on iron, your immune system hides it in ferritin storage to keep them from thriving. This means your ferritin looks high, but your cells are still starved of usable iron.
If your ferritin won’t budge despite eating iron-rich foods, taking supplements, or even getting infusions, it’s time to look beyond the bloodwork and into your gut.
The Gut–Iron Connection
Iron absorption begins in your stomach, and one of the biggest reasons for low ferritin is low stomach acid. Without enough acid, iron, especially iron from plant-based foods just passes through unused.
One common culprit behind low stomach acid is H. pylori, a bacterial infection that suppresses acid production. When H. pylori is present, your iron supplements may do more harm than good, leading to constipation, bloating, and more fatigue.
Pathogens like H. pylori, parasites, and yeast can also feed on iron, forcing your body to “hide” it in ferritin stores to keep these bugs from thriving. So even if you’re eating enough iron, your body may be keeping it out of circulation for protection.
Inflammation compounds this problem. When your body senses inflammation, it releases a hormone called hepcidin, which blocks iron absorption and recycling. This defense mechanism protects you, but it also starves your cells of iron, keeping ferritin low despite your best efforts.
Mineral Imbalances That Impact Ferritin
Iron doesn’t work in isolation. Low ferritin often traces back to a deeper mineral imbalance, especially with copper and zinc.
Copper is needed to move iron out of storage so your body can actually use it. Without enough copper (common after birth control, stress, or vegan diets), iron can get trapped in ferritin. Zinc and copper also work closely together, meaning supplementing one without the other can throw the entire system off balance.
Other minerals like potassium, sodium, and magnesium are critical for motility, bile flow, and energy, all of which determine how well your body can absorb and recycle iron. Without balanced minerals, your gut and your cells stay stuck in a depleted loop.
What to Do If Your Ferritin Is Low
If your ferritin has been low for months or years and supplements haven’t helped, it’s time to stop guessing and get more robust data on why your ferritin is low. The answer is often in improving how your body absorbs, uses, and regulates it. This starts with rebuilding your gut terrain and creating the right environment for iron to actually do its job.
1. Start with digestion
Iron absorption begins in the stomach, and that process depends heavily on stomach acid. Without enough acid, even the most iron-rich meals or supplements will pass right through unused. Support this by slowing down at meals, chewing thoroughly, and incorporating foods that naturally stimulate stomach acid like bitter foods.
Digestive bitters before meals and mineral-rich foods (especially those containing sodium and zinc) can also make a big difference.
2. Address infections
Parasites, H. pylori, and yeast overgrowth are some of the most common hidden drivers of low ferritin. These pathogens either consume iron directly or trigger inflammation that prevents your body from using it.
Test for these infections and then clear them if they exist (by working with the gutTogether® team) using GI Map testing.
Rebuild with minerals
Copper, zinc, potassium, and magnesium are key players in the iron story. Copper helps move iron out of storage (ferritin) so your body can actually use it. Zinc supports stomach acid and immune function, while potassium and magnesium help regulate motility and bile flow which are two processes critical for mineral absorption and detoxification.
Without these cofactors, iron metabolism can’t function properly. Foods like shellfish, liver, pumpkin seeds, avocado, coconut water, and leafy greens are great ways to bring these minerals back into balance.
Don’t overlook whole-food sources of iron
Heme iron from animal foods, like grass-fed beef, bison, lamb, or oysters is the most absorbable form. If you eat plant-based, pairing non-heme iron sources (lentils, pumpkin seeds, spinach) with vitamin C–rich foods like citrus, bell peppers, or strawberries can enhance absorption. Avoid pairing iron-rich meals with coffee, tea, or high-calcium foods, which can block uptake.
Consider lactoferrin
This gentle bioactive protein naturally found in human milk binds to iron safely, supports immune health, and helps your body use iron efficiently without feeding pathogens. It also acts as a prebiotic, encouraging the growth of beneficial gut bacteria as your digestion heals. For many people, lactoferrin serves as a supportive bridge while they work on restoring gut balance and rebuilding mineral stores. This is my favorite lactoferrin supplement (use code DRHEATHER for a discount if you try this).
Low ferritin is your body’s way of signaling that something deeper is out of balance. When you identify and address those root causes: digestive function, mineral depletion, or hidden infections, your energy, focus, and hair growth often follow.
Supporting your Low Ferritin Long Term
The most overlooked reasons for low ferritin are often the most fixable ones: low stomach acid, hidden infections, inflammation, and mineral imbalances. When you rebuild your gut and restore your mineral balance, your ferritin can finally rise and so can your energy (YAY!)
If your ferritin numbers have never made sense or iron supplements make you feel worse, it’s time for a deeper look. Inside gutTogether, we use stool and mineral testing to uncover the root causes behind patterns like low ferritin so you can stop chasing supplements and start rebuilding your body from the inside out.
