Hypothyroidism and iron deficiency have more in common than you might think. From fatigue to hair loss, these two conditions can not only make you feel miserable. They are also intimately tied when it comes to your health. Here's what you need to know about hypothyroidism and how to raise iron levels.
Hypothyroidism is a condition in which you either don’t make enough thyroid hormone, you don’t convert it into its active form (T3) or you are not using it at the cellular level. That’s right, it’s not just about how well the thyroid itself functions.
Common Symptoms of Hypothyroidism
Symptoms of hypothyroidism includes fatigue, hair loss, cold intolerance, dry skin, depression, anxiety, constipation, and joint pain—to name a few. Similarly, women who are suffering from iron deficiency experience fatigue, can feel chilled, and experience hair loss. They may also experience restless leg syndrome, anxiety, and irregular heart beats.
In America, the majority of cases of hypothyroidism are due to an autoimmune condition known as Hashimoto’s thyroiditis. It’s quite common in women and risk for developing the condition increases with age.
When there is adequate T3 available to the cells in the stomach they produce hydrochloric acid (HCl), which helps in breaking down food and liberating nutrients for absorption. Without adequate stomach acid your body is unable to access the iron stores in the food you eat.
Your gut and thyroid are intimately connected!
Unless your doctor is monitoring your free T3, odds are you are among the many women without adequate T3, stomach acid or iron. Add that on top of the average 10-15 mg iron that may be lost during menses and you can find yourself iron deficient pretty quickly.
What’s worse is iron deficiency anemia makes periods heavier!
Testing for Iron Deficiency
I recommend 2 baseline tests: CBC and Ferritin.
CBC is an abbreviation for a complete blood count. It tells us what your white blood cells and red blood cells look like. A red blood cell that is small or a low hemoglobin or hematocrit are signs of iron deficiency.
Ferritin is the storage form of iron. I like to think of it as the savings account. Your red blood cells are the checking account and they are out spending iron. In women, we want to see that number above 50, but closer to the 70-90 range is ideal.
Hypothyroidism & Iron Deficiency? 4 Steps How to Raise Iron Levels
Test! Don’t Guess!
Getting your levels tested will help you understand your risk and if supplementation is necessary. Ask your doctor for a CBC and ferritin.
Your entire supply of red blood cells is completely replaced in about 4 months. This means that if you haven’t had these labs checked in the last 4 months and you are experiencing symptoms, it is time to see what your blood cells can tell you.
A complete thyroid panel, including TSH, free T4, free T3, anti-TPO, anti-Thyroglobulin, and Reverse T3 are necessary to understand your thyroid health.
Dial in Digestion.
There is definitely some testing to be done in this category. If you have hypothyroidism then I definitely recommend reading up on SIBO and talking to your doc about testing. The majority of hypothyroid women in my clinic are positive for SIBO when we test. Read more about my approach to SIBO here.
In the meantime, start by chewing your food really well. Like 30+ chews before you swallow kind of well. I know it sounds extreme, but this level of chewing will not only get your gut primed to do its job, it’ll also break down more of your food so your gut doesn’t have to work so hard.
For many women, the addition of hydrochloric acid and digestive enzymes will improve iron absorption and support overall better digestive health.
Note: If you're taking PPIs or Oral Contraceptives you are inhibiting your ability to absorb iron.
Increase Dietary Iron.
Sure spinach is full of iron, but you won’t be absorbing much of that if you don’t have adequate stomach acid. The iron found in leafy greens is not as bioavailable (meaning you can’t actually absorb it) as well as what is called heme sources of iron, which includes beef, chicken, pork, bison, venison and other meats.
Does this mean you shouldn’t bother trying to get iron from vegetables? Far from it!
Vegetables contain so much goodness beyond just iron that there is no way we can skip these in our diet. Instead, try combining your leafy greens with citrus, peppers and other vitamin C containing foods. Vitamin C enhances the absorption of iron so it is great to pair with any iron containing food.
Add some acid while you’re at it! Apple cider vinegar, balsamic vinegar and lemon juice can help start the digestive process going when it comes to make those mineral available to your gut for absorption.
In my clinical experience, I haven’t seen anything raise iron stores quite like liver. Eating grass fed, organic liver, beef heart and bone marrow are mega iron boosting foods.
In women who have heavy periods and are iron deficient we get them going on both an iron rich diet and supplementation due to the increased risk for anemia.
Iron sulfate at 325 mg daily is the most common prescription for women with iron deficiency anemia. Not all iron is equal and that iron sulfate your conventional practitioner recommended is not only highly absorbable (read – you poop most of it out), but it is terribly hard on your digestive tract—like not pooping for a few days kind of hard.
Instead, I recommend women take a form of iron called bisglycinate. This form is non-constipating, which is good news since that can be a key issue with hypothyroidism. It is also highly absorbable and won’t make you feel nauseous when you take it. This is also why it is commonly recommended for pregnant and breastfeeding women.
In patients who are struggling to increase their iron levels, I often recommend 1 cap daily of iron bisglycinate along with a vitamin C supplement to enhance absorption.
Although iron deficiency can be quite common in women with hypothyroidism, it is treatable and reversible!