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Diet and Nutrition

Borderline anemia with normal iron



During my recent physical, hemoglobin reading was 11.9 and HCt was 34.1. I am definitely experiencing the fatigue associated with low levels, even though I recognize that these are very borderline. Additional tests revealed that my iron levels were normal. I am scheduled to return in 30 days for a new reading. Meanwhile, is there anything that can be done to improve my energy levels?


Thanks for your question. Iron deficiency is an interesting disorder because it is the most common nutrient deficiency worldwide. There are 3 stages of deficiency, and anemia is the last. Most people assume if they are iron deficient, they are anemic. Not true. Your doctor will first test a serum ferritin level. Ferritin is the storage form of iron. If this level is low, your bone marrow stores of iron are low. The second stage occurs when your ferritin levels are further depleted, and circulating iron is also low. In order to evaluate circulating iron, your physician may check FEP (free erythrocyte protoporphyrrin) which is used to form hemoglobin. A serum transferrin level may also be ordered. Transferrin is a protein that carries iron in the blood. If the FEP and transferrin are increased, it is a sign of iron deficiency. The body is trying to overcompensate by increasing the available circulating iron. In the third stage, serum ferritin is very low and hemoglobin is low. This is the last stage of iron deficiency known as iron deficiency anemia. Iron is needed to transport oxygen in the body, and also plays a role in normal metabolism and immunity. Typical symptoms of iron deficiency anemia include paleness, fatigue, low vitality and decreased tolerance to cold temps. In addition, you may feel less able to concentrate, learn and do work. Based on your hemoglobin and hematocrit levels, I am assuming you are a female. I do not know if you are truly iron deficient, but iron deficiency is the most common nutrient deficiency among women. In order to get adequate iron in your diet, choose foods high in iron daily:

* red meat, fish, chicken, pork, liver * foods fortified with iron (breads & cereals) * dark green leafy vegetables * dried beans (kidney beans, lentils, etc.) * eggs * dried fruit (dates, raisins, prunes)

The iron in animal foods is better absorbed than iron from vegetables or fortified foods. If you are vegetarian, try to include a food high in vitamin C when you eat non-animal forms of iron. Vegetarian chili (made with dried beans, tomatoes and peppers) is a good source of iron for vegetarians. Your other option is to take a vitamin with iron, or iron supplements. If you take iron, try to take it on an empty stomach for better absorption. Do not take it along with calcium supplements (they compete for the same binding site in the intestine). Finally, you may just be tired for other reasons. Are you getting adequate sleep? Are you depressed or stressed for any reason? Have you recently started new medication, or recently begun exercising? Are you taking on too many tasks and not relaxing enough? Are you pregnant? Only you can answer these questions. I hope this information was helpful. Take Care!

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Response by:

Lisa Cicciarello Andrews, MEd, RD, LD Lisa Cicciarello Andrews, MEd, RD, LD
Adjunct Faculty
University of Cincinnati