I’m Katie, a women’s functional health coach sharing what I've learned about gut health, hormones, nutrition and the nervous system - without making wellness more complicated than it needs to be.

For more, come say hi at @harayahealth on Instagram & TikTok.

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Justin and I split a steak on Saturday. I thought about hepcidin for the rest of the night.

Saturday was date night. If you live in London, I highly recommend "mu" in Haggerston: Japanese fusion, live jazz in the evenings, and food that was genuinely incredible.

As our main we ordered a steak to share, and somewhere between the first slice and the music, my brain went straight to iron. Yes, this is what date night looks like now that I'm training as a nutritional therapist (sorry, Justin).

My brain went here particularly because iron is one of those things we all think we understand.

Tired? Must be low iron.

Low iron? I need to go down a steak, or snag an iron tablet from the chemist.

However the above rationale, which unfortunately is perpetuated amongst loads of wellness influencers is over simplifying things (a friend even sent me one of these influencers over the weekend and asked if what she was saying was "legit"). So I thought I'd take a moment to explain what iron is, why your iron might be low, what it might feel like, and what to do about it.

The reason your iron is low decides what actually helps.

So let's start at the beginning.

Let's make that make sense

What iron actually does

Iron is the mineral your body uses to build haemoglobin, the protein in your red blood cells that carries oxygen around your body. Think delivery trucks. It's also involved in making energy inside your cells, and in how your brain and immune system work.

Your body keeps a stash. Ferritin is your savings account (stored iron), and the iron circulating in your blood is your current checking account. Your body can't make iron, and it's not great at getting rid of extra, so more isn't automatically better.

Why iron runs low

Iron is a bank balance, so there are three ways it drops: more going out, less coming in, or the bank doors are locked.

1. More going out: heavy periods. Every period is a small withdrawal. Around one in three women of reproductive age has heavy periods, which makes it one of the most common reasons for low iron in women like us. Your stores can run low well before your usual blood count changes, and that still counts.

That's also why "your bloods are fine" doesn't always close the case. Haemoglobin (the delivery truck count) and ferritin (the savings account) are different tests, and lab ranges vary. It's worth getting ferritin checked to better interpret your comprehensive labs.

2. Less coming in: absorption. Stomach acid helps get iron ready to be absorbed, so low stomach acid, H. pylori and long-term acid-reducing medication have all been linked with poorer absorption. (Hello, the PPI that ended up lowering my stomach acid. We've met.)

3. The doors locked: inflammation. Iron leaves storage and gets absorbed from the small intestine through exit doors called ferroportin. Hepcidin, a hormone made in your liver, is the bouncer. When there's ongoing inflammation (an infection, an autoimmune condition, a long-term illness), inflammatory signals turn hepcidin up, and the doors lock. The reason hepcidin closes the doors is because bacteria want iron too, so your body hides it from them to prevent further inflammation / infection.

Your ferritin (savings) can look healthy, and can even read high because it rises with inflammation as hepcidin blocks iron from entering bloodstream. That said - your current account is still empty.

What low iron can feel like

This is the frustrating bit: it's vague. Tiredness that a 12 hour night sleep can't fix. Getting breathless on stairs you used to bound up. Headaches, dizziness, a racing pulse, brittle nails, hair coming out in the shower, restless legs at night, feeling snappier than usual.

If that reads like half of every working woman's week, that's the point. These symptoms overlap with loads of other things, which is why they can't tell you what's going on. A blood test can tell you whether it's iron or something else entirely.

Speak to your GP if you're regularly exhausted, breathless or dizzy, or your periods get in the way of your life. Do the same if you notice blood in your poo, black stools, unexplained weight loss, a lasting change in bowel habit, or symptoms that wake you at night. And please don't start iron tablets on a hunch. A test will tell you what you're dealing with.

Why the cause decides the plan

Here's the punchline. "Just take iron" is not addressing the root cause of your low iron...

• If it's heavy periods, the bleeding itself is worth looking at, as well as replacing what's been lost.
• If it's absorption, your will want to find out what's getting in the way, whether that's coeliac disease, H. pylori, low stomach acid or medication.
• If it's inflammation, more iron may just queue outside the locked door. The focus moves to what's driving the inflammation.

Where iron does need replacing, that's usually done with your GP. Food still matters. It's one piece, not the whole plan. The right plan depends on your results, your history and your doctor, which is exactly why I can't hand you a one-size list in a newsletter.

Try this

Put something bright on your iron-rich plate. Lemon over the lentils, peppers in the wrap. Eat a kiwi after a meal as a sweet treat. Vitamin C helps your body absorb plant iron. If you can, give your tea or coffee an hour's gap from that meal too (as the tannins in coffee and tea compete for the same absorption pathway as iron).

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FOR REGULAR GIRLS 💩

Because good digestion deserves good food.

Salmon & Lentil Salad

Serves 2

• 2 salmon fillets (about 120–150g each)
• 1 tbsp olive oil
• 1 x 250g pouch cooked puy lentils (or a 400g tin, drained and rinsed)
• 250g cooked beetroot (not in vinegar), cut into wedges
• 1 small red onion, thinly sliced
• 80g rocket
• 1/2 avocado
• Juice of 1 lemon, plus a little zest
• Salt and pepper

Dressing

• 3 tbsp Greek yoghurt
• 1 tsp Dijon mustard
• 1 tbsp olive oil
• Half the lemon juice
• A splash of water to loosen

Instructions

1. Leave the sliced red onion in the other half of the lemon juice while you cook. It softens the bite.
2. Season the salmon. Heat the oil in a pan over a medium-high heat and cook the fillets skin-side down for 4–5 minutes, then flip for 2–3 minutes until cooked through.
3. Whisk the dressing ingredients together and season.
4. Warm the lentils in the pan or microwave, then toss with a spoonful of the dressing and the drained onion.
5. Pile the lentils, beetroot and rocket onto plates. Flake the salmon over the top and drizzle with the rest of the dressing.

Why your gut will thank you

That's five different plants in one bowl (lentils, beetroot, red onion, rocket, lemon), six if you count the mustard, and I do. Variety is what your gut microbiome tends to like. The lemon and rocket bring some vitamin C to help absorb the iron in the lentils. If lentils and your gut aren't friends yet, start with a smaller scoop and rinse them well. And beetroot can turn your wee or poo pink or red, which is harmless but startling. If you're ever unsure it's the beetroot, check with your GP.

Until next time,

Katie x

Big thank you from me for joining my little corner of the internet for women who want to understand their bodies better - from gut health and hormones to nutrition, stress and everything in between.

General information only. Not medical advice. Seek personalised medical care from your GP or specialist.