One Out, One In #4: iron “for energy” → ferritin first

One you drop. One you take instead.

3. Tiredness is not a diagnosis. Iron deficiency is one cause. Iron overload is another.

2. The body cannot dump surplus iron. Park unsupervised iron sold for energy.

1. Ferritin first (typically with an FBC). The IN is a test, not a bottle.

Fatigue has many owners. Iron deficiency is one. Hereditary haemochromatosis is another: RACGP puts C282Y homozygosity at about one in 200 people of northern-European background. Healthdirect: the body “has no way of getting rid of excess iron — any excess is stored in your organs and joints.”

So an unsupervised “energy” iron is not a harmless vitamin.

The Australian listed bottles we opened are not the US 65 mg iron-only pill. They are 5–24 mg elemental, and they say so themselves: not for the treatment of iron deficiency.

The therapeutic AU tablets (Ferro-grad 105 mg, Maltofer 100 mg) sit behind a diagnosed-deficiency fence. They are not the Chemist Warehouse energy gummy, and they are not this letter’s IN.

High-dose supplemental iron (45 mg or more) commonly means nausea and constipation. Treating actual iron-deficiency anaemia often goes above the adult upper level (45 mg) — that is GP territory, historically 100–200 mg elemental, not a DIY.

The fatigue trials that exist (Verdon 2003; Vaucher 2012) enrolled non-anaemic women who already had low or borderline ferritin. There is no good trial of extra iron in tired people whose stores are already fine. Absence of evidence plus haemochromatosis risk is the honest line — not a fake negative study.

Men and post-menopausal women taking iron “for energy” with no labs are exactly who this issue is for. They are more often iron-replete.

Park the energy iron if you bought it because you were tired and nobody drew blood. Keep it only if a clinician already put you on iron for a real deficiency or a pregnancy protocol.

Ask the GP for iron studies, typically with a full blood count.

NIH ODS: serum ferritin is “currently the most efficient and cost-effective test for diagnosing iron deficiency.” On that sheet, below 30 µg/L suggests deficiency and below 10 µg/L suggests iron-deficiency anaemia. Inflammation can raise ferritin and hide a shortage. Those are ODS numbers. The GP reads them. We will not print a hair/energy “target” of 40 vs 70.

If stores are low, replacement is a GP dose, form, and follow-up — Ferro-grad / Maltofer / whatever they choose — not a 24 mg “high strength” gummy. Bisglycinate may be easier on the gut (one pregnancy review, very low certainty). That is a form footnote if replacement is already indicated. It is not the swap.

If stores are not low, park the unsupervised iron. Vitamin C helps food non-haem iron go in. That is not a reason to start a pill.

Do not swap sulfate for bisglycinate as the story. Do not start iron from this email.

“I’ve been taking iron because I’m tired. Can we check ferritin (and a full blood count) before I keep taking it, and only replace iron if the stores are actually low?”

If you have been told you have haemochromatosis or high ferritin:

“I’ve been taking an iron supplement for energy. I know I should park extra iron — can we confirm my latest ferritin and transferrin saturation so I’m not adding to the load?”

If you are pregnant and already on prescribed prenatal iron: do not park it via this letter. Ask the obstetrician or GP about the dose.