Episode 14: Why Mom Burnout Might Actually Be Low Ferritin
Your ferritin levels might be lower than your doctor tested for.
If you've been told your labs are "normal" but you still feel exhausted, this episode names the thing most annual exams miss: low iron stores.
Sara breaks down why ferritin matters more than hemoglobin for tired women, why the standard reference range of 15 ng/mL is far below where most women actually feel well, why heme iron from animal foods absorbs two to three times more efficiently than plant iron, and what you can do at your next annual physical to actually get the number you need.
Topics covered: the difference between ferritin and hemoglobin, iron deficiency without anemia, why women are most vulnerable, the symptoms that hide in normal bloodwork, heme versus non-heme iron, the foods and drinks that block iron absorption, and exactly what to ask your doctor.
Key Takeaways
Ferritin and hemoglobin are not the same thing.
You can have normal hemoglobin and still have low iron stores.“Normal” doesn’t always mean optimal.
A lab range can look acceptable even when symptoms are still showing up.Heme iron is absorbed more efficiently than non-heme iron.
Food form matters when iron stores are depleted.Tea, coffee, and calcium can interfere with absorption.
Timing around meals can make a real difference.Ask for ferritin and a full iron panel.
Do not settle for “your labs are normal.”
Research Mentioned
This episode is an educational translation of the following peer-reviewed research. Click any citation to read the original paper.
1. Al-Naseem A, Sallam A, Choudhury S, Thachil J. "Iron deficiency without anaemia: a diagnosis that matters." Clinical Medicine (London), 2021. 21(2):107–113. doi:10.7861/clinmed.2020-0582
2. Cancado RD, Leite LAC, Muñoz M. "Defining Global Thresholds for Serum Ferritin: A Challenging Mission in Establishing the Iron Deficiency Diagnosis in This Era of Striving for Health Equity." Diagnostics (Basel), 2025. 15(3):289. doi:10.3390/diagnostics15030289
3. Ahmad Fuzi SF, Koller D, Bruggraber S, Pereira DI, Dainty JR, Mushtaq S. "A 1-h time interval between a meal containing iron and consumption of tea attenuates the inhibitory effects on iron absorption: a controlled trial in a cohort of healthy UK women using a stable iron isotope." American Journal of Clinical Nutrition, 2017. 106(6):1413–1421. doi:10.3945/ajcn.117.161364
Links Mentioned
Full Digest article: sarenova.com/digest/why-mom-burnout-might-actually-be-low-ferritin
Sarenova Founding Member waitlist: sarenova.com
Wild is Wise podcast archive: wildiswise.com
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If you're a mom over forty, and you feel wrecked every afternoon, and you've asked your doctor about it, and they ran your labs and told you everything looks fine, this episode is for you.
There's a blood test most doctors don't run. And even when they do, the range they compare it to is set so low that you could be running on fumes and still be called normal.
That blood test is ferritin. Today we are going to talk about why that happens, why moms are especially vulnerable, what to ask your doctor, and what to actually do about it.
[INTRO]
Welcome to WILD IS Wise. I'm Sarah Estes, a former private investigator who ditched the high stress legal life after a major health crisis. I rebuilt my health from the ground up through nutrition and functional medicine
[00:00:49] and now I'm here to uncover the truth about women's wellness and translate it so you can make informed decisions about your health. On this podcast, we break down women's nutrition and [00:01:00] physiology with real research and actionable tips, and here's the core philosophy, what's found in nature is often exactly what our biology is wired to thrive on. We get nerdy with the science, but keep it practical for everyday life. If you're ready to understand what your body actually needs, you're in the right place. As always, this podcast is educational, not medical advice.
[00:01:21] Please talk to your healthcare provider before making any changes.
[00:01:23] Alright, let's jump in.
Most annual physicals check hemoglobin. Hemoglobin measures how much iron is in your blood right now, doing its job, carrying oxygen to your cells. If hemoglobin is low, your doctor calls it anemia. That part is well-understood.But hemoglobin is only half of the picture. Ferritin measures how much iron is stored in your body. Your reserves.
Think of hemoglobin as the cash in your wallet, and ferritin as your savings account. You can have cash in your wallet and an empty savings account. You can have normal hemoglobin and basically no iron in reserve. And when that happens, your body is pulling from empty all day. And you feel it.
This condition has a name. It's called iron deficiency without anemia. And there's a 2021 paper published in the journal Clinical Medicine titled, very directly, "Iron Deficiency Without Anaemia: A Diagnosis That Matters." The authors laid out how common this is, how real the symptoms are, and how consistently it gets missed by standard bloodwork. Because standard bloodwork is not asking the right question.
Women lose iron every single month through menstruation. Pregnancy demands enormous amounts of iron for the baby. Postpartum, you're still rebuilding from blood loss during birth. Breastfeeding costs more iron. And perimenopause brings heavier and less predictable cycles for a lot of women, which means more loss, not less.
Stack all of those on top of each other. You can get decades of steady, invisible iron depletion without any single event being dramatic enough to flag. And if you're also running a household, doing physical work with small children, sleeping poorly, and trying to hold everything together, you're burning through iron faster than a sedentary man would.
This is why the people most likely to have suboptimal ferritin are exactly the same people most likely to be told it's just stress. Or it's just being a mom. Or it's just getting older.
It's not any of those things. Or at least it's not only those things. It's often iron.
Here's what suboptimal ferritin actually looks like. Not textbook anemia. Not a hospital visit. Just your life, but harder.
Exhaustion that doesn't lift with rest. Brain fog that makes you reread the same email three times. Hair shedding, especially around the crown and the temples, more than what you're used to finding in the shower drain. Cold hands and cold feet even in a warm house. Shortness of breath climbing a flight of stairs that used to be nothing. A racing heart when you stand up too fast from the couch. Unusual food cravings, sometimes for ice, sometimes for starch, sometimes for things that aren't even food. Brittle nails, sometimes with little vertical ridges. Restless legs at night that make it hard to fall asleep.
Here's the thing. None of those symptoms, on their own, are specific enough to point a finger at iron. That's the whole problem. They get distributed across six different diagnoses, if they get diagnosed at all, and nobody ever pulls the one string that would unravel all of them at once.
And here's where the story gets frustrating.
Your lab report has a ferritin reference range that typically starts around fifteen nanograms per milliliter. So if your ferritin comes back at eighteen, your result says "in range," and your doctor tells you you're fine.
But here's what the actual research is showing. In January of 2025, researchers published a review in the journal Diagnostics titled "Defining Global Thresholds for Serum Ferritin." And they looked at exactly this question. What ferritin level actually corresponds to real physiological impact, not just what's the floor before you collapse. And what they found is that when ferritin drops below fifty, women are already showing measurable impairment in thyroid hormone conversion, dopamine synthesis, and energy metabolism. That's not a wellness opinion. That's a peer-reviewed finding, published earlier this year, in a medical journal.
Functional medicine practitioners, and a growing body of literature, consider ferritin levels below fifty to be suboptimal. And for women who are active, menstruating, or recovering from any kind of iron-demanding phase of life, levels of seventy to a hundred are where most people actually feel well.
So "in range" doesn't mean optimal. "In range" means you are not currently in a medical emergency. The space between medical emergency and actually feeling well is enormous. And that space is where most tired women live for years without anyone noticing.
Okay. Let's talk about food.
There are two forms of iron in your diet. Heme iron and non-heme iron. Heme iron is found in animal foods. Meat, fish, shellfish, organ meats. Non-heme iron is the kind you find in plants. Spinach, beans, lentils, fortified cereals, tofu.
Your body absorbs heme iron at roughly fifteen to thirty-five percent. Non-heme iron is closer to two to twenty percent. Researchers in the American Journal of Clinical Nutrition have reviewed this across dozens of trials and the pattern holds. Heme iron is two to three times more bioavailable than non-heme. And even though heme iron makes up a smaller portion of the average diet, it ends up accounting for far more of what actually gets absorbed into your bloodstream.
This is why, if you ask a hematologist what to eat for iron, the answer is beef liver, clams, oysters, and red meat. Not spinach. Popeye was wrong. Or at least he was oversold.
The strongest per-serving sources on the planet are beef liver, clams, and oysters. If you're not eating those regularly, and most of us aren't, you're relying on either supplementation or fortified foods, and both of those have their own absorption issues that we're about to talk about.
Here's the part nobody tells you.
Non-heme iron absorption, the plant-based iron, is fragile. And a lot of the things you put next to your iron-rich foods are actively blocking them from being absorbed.
Coffee polyphenols (POL-ee-FEE-nols) bind iron in the gut. Tea tannins do the same thing, even more aggressively. Calcium, whether you're getting it from dairy or from a supplement, interferes. Phytates (FYE-tates) in whole grains and legumes reduce absorption. Oxalates (OX-ah-lates) in spinach and chard reduce it too. Which means, interestingly, that spinach is not even a great source of iron for you, because the oxalates in the spinach are partly blocking the iron that's already in the spinach.
Now here's a study that will change how you schedule your meals. In 2017, researchers in the American Journal of Clinical Nutrition ran a controlled trial on healthy UK women using a stable iron isotope. Which is essentially a tracer, so they could measure exactly how much non-heme iron the women absorbed under different conditions. When the women drank tea alongside an iron-rich meal, absorption was cut by more than a third. But when there was a one-hour gap between the meal and the tea, most of that inhibition disappeared. One hour was all it took.
So the fix is timing. Wait at least an hour between iron-rich food and your coffee or your tea. Don't take a calcium supplement alongside an iron-rich meal. And if you're going to eat plant iron, pair it with a source of vitamin C, because vitamin C is the one thing that actually reverses most of these blockers. Ascorbic acid converts iron to a form your body can absorb. So squeeze lemon on your spinach. Eat bell pepper with your beans. Have an orange alongside your morning eggs.
And if you're taking an iron supplement, the protocol is clear. Take it on an empty stomach. With vitamin C. And not next to your coffee.
So here's what to actually do at your next annual.
Ask for a ferritin test. Don't assume it's included. It's usually not. Ask specifically for it by name.
Ask for a full iron panel, not just a CBC. That means ferritin, serum iron, transferrin (trans-FAIR-in) saturation, and total iron binding capacity. You want the full picture, not just one number.
When your results come back, ask for the actual number. Not the word "normal." Not "in range." The number. Because if that number is below fifty, you need to know. And the flag on the printout isn't going to tell you.
If your doctor pushes back, and some will, you can say something like, "I'd like to optimize, not just pass the floor." Most doctors will respect that framing. And if you genuinely can't get cooperation, direct-to-consumer lab services like Labcorp OnDemand or Quest Direct will run a ferritin test for about forty or fifty dollars without a prescription.
Advocate. This is your body. And this is a number that deeply affects how you feel every single day.
I want to zoom out for a second, because this is bigger than ferritin.
The reason I'm spending a whole episode on one lab value is that ferritin is a case study in something that runs through almost every single symptom that women over forty get dismissed for. "Normal range" was built for survival. It was not built to tell you whether or not you can thrive.
Your exhaustion probably has a name. It's just that nobody has given that name to you yet. And low ferritin is a very, very common name for that exhaustion.
So if you take one thing from this episode, let it be this. Your body is telling you something. Listen to it. Get tested. And if the results come back "in range," ask for the actual number.
This is, actually, one of the reasons I built Sarenova.
Formula No. 06 is grass-fed beef liver and beef intestine. Two of the richest whole-food sources of heme iron on the planet.
If you want on the waitlist, it's at sarenova.com. Founding Member pricing locks in for anyone on the list before we open. Enough said on that.
If this episode gave you a piece of your own exhaustion back, send it to a friend. The women in your life who are running on fumes need to hear this before their next annual physical.
Until next time. Stay wild. Stay wise. I'll see you next week.
Frequently Asked Questions
Q: What is the optimal ferritin level for women?
Standard lab ranges list anything above 15 ng/mL as “normal,” but peer-reviewed research shows women often experience measurable impairment below 50 ng/mL, including reduced thyroid hormone conversion and dopamine synthesis. For active women, menstruating women, and those recovering from pregnancy, optimal ferritin is generally 70 to 100 ng/mL.
Q: Can you have low iron with normal hemoglobin?
Yes. This condition is called iron deficiency without anemia and it is widely documented in peer-reviewed research. Hemoglobin measures iron currently circulating in your blood, while ferritin measures iron stored in your body. You can have normal hemoglobin and critically low ferritin at the same time, which is one of the most common reasons exhausted women are told they are “fine.”
Q: What blocks iron absorption?
Coffee polyphenols, tea tannins, calcium, phytates in whole grains, and oxalates in spinach and chard all inhibit non-heme iron absorption. Research shows tea consumed with an iron-rich meal can cut absorption by more than a third, and a calcium-containing meal can roughly halve iron absorption. A one-hour gap between iron-rich food and these blockers largely restores absorption.
Q: What should I ask my doctor to check for iron deficiency?
Ask for a full iron panel, not just a complete blood count. The full panel includes ferritin, serum iron, transferrin saturation, and total iron binding capacity. Request the actual ferritin number rather than the word “normal,” because if the value is below 50 ng/mL you may still be experiencing suboptimal iron stores even if your doctor says the result is in range.
Q: Is heme iron better than non-heme iron?
Heme iron, which comes from animal foods like meat, fish, and organ meats, is absorbed at 15 to 35 percent. Non-heme iron, which comes from plants like spinach, beans, and fortified cereals, is absorbed at 2 to 20 percent. Heme iron is two to three times more bioavailable, which is why whole-food sources such as beef liver, clams, and oysters are considered the most efficient dietary iron sources for women with low ferritin.