Iron deficiency without anemia vs. Iron deficiency with anemia

What is the difference between iron deficiency without anemia and iron deficiency with anemia? Iron deficiency is when you do not have enough iron. This is best demonstrated via a blood ferritin test. 

Ferritin is the storage depot for iron. A ferritin below 30 is generally considered iron deficiency.  Most people will feel their best with a ferritin above 70.

What is anemia?

Anemia is caused by a lack of hemoglobin.  You will find this on a blood test called a CBC or Complete Blood Count, it is usually the 3rd number down on a CBC test. Hemoglobin is crucial for health as it is a protein charged with transporting oxygen to cells and removing carbon dioxide from the body. 

Why iron deficiency is commonly overlooked

If you have a deficiency of iron and hemoglobin, we call it iron deficiency anemia. In my experience, iron deficiency is far more common than iron deficiency anemia. 

Unfortunately, because of this, many patients will go years without receiving proper treatment. They come into their doctor complaining about a litany of symptoms that all sound like iron deficiency anemia but upon running the CBC, the hemoglobin comes back in normal range. Patients are then passed off as depressed or stressed out.

SIBO and iron deficiency anemia

This is an example of a patient who had iron deficiency anemia and upon supplementation with a hydrolyzed whole protein supplement saw her anemia clear up and her ferritin increase over an 8 week time frame.

I would also note that due to SIBO, this patient was anemic and unable to eat more than 3-4 different foods. 

She had not tried supplementing with iron in years because the side effects were too great and exacerbated her SIBO symptoms. Thankfully the right type of iron made all the difference and she is experiencing a massive increase in quality of life.

Lab tests to run

This report is another patient who did not have iron deficiency anemia but did have iron deficiency and was experiencing all the symptoms of anemia, however she had been told she was not iron deficient for years because her CBC was still normal. 

Upon supplementation with iron she saw a dramatic increase in energy and overall well-being and of course an increase in ferritin as well.

The key is to make sure you are looking at both iron deficiency by getting your ferritin levels checked and anemia by getting your CBC checked. 

The reason you can have all of the symptoms of iron deficiency anemia but your complete blood count demonstrates a normal hemoglobin is because red blood cells turnover every 3-4 months, so even though your iron is low this will not have manifested in the hemoglobin of red blood cells. 

Iron is necessary for creating hemoglobin, so as there is less iron available, that slowly trickles down to hemoglobin creation but this may take 6 months to a year for the anemia portion to manifest on a CBC. 

Remember, Anemia is the symptom of iron deficiency, iron deficiency is the actual disease. 

Once your hemoglobin shows up low, you have been iron deficient for a significant amount of time.  

Please do not lose hope.  There are doctors out there who will listen and will be willing to check off one more box on your lab request to get ferritin checked. For more information on optimizing iron levels, check out this post Iron Infusions: Harmful or Helpful?

Have you experienced iron deficiency or iron deficiency anemia? I’d love to hear about it in the comments below.

1 thought on “Iron deficiency without anemia vs. Iron deficiency with anemia

  1. Amy Zibman

    I have been labeled anemic with B Thalassemia anemia and have been taking methylated folate but can’t find a B Complex without folic acid unfortunately. This has been a roadblock. I also have SIBO (been treating naturally and very limited diet, so most likely nutrition deficiencies as well) and have MTHFR deficiency, so, absorption and detox issues. I just recently have been told I have low ferritin now… I do NOT want an iron infusion either. Too many roadblocks and just want to heal my gut improve nutrition and digestion and have more energy again.


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