Suffering from weird and sometimes scary medical symptoms? Check your iron.
My “heart attack” was a symptom of iron deficiency, an overlooked condition affecting more than 20% of the global population. Here’s what I’m doing about it.
Before we begin I am not a medical expert. In fact I like to think we’re walking around with magical cotton candy insides rather than blood and guts. None of what follows is advice. I also don’t believe supplements are cures. Most are garbage, IMHO. Okay, allons-y!
My French emergency department adventure was over. Finding out that I didn’t have a heart attack was a great relief. But then I faced the challenge of figuring out what the hell was going on. I didn’t believe it was just stress that caused my heart attack symptoms. So naturally I went to Google.
“Google says we are all dying, all the time,” the French nurse said as he had checked my vitals that night in the Emergency Department. “Do not Google.”
I nodded my head in agreement and casually glanced down at the results for “heart attack symptoms, women.” Women’s heart attacks are not like the ones men get in the movies. Female heart attacks are subtle. Chest pain is a common sign but some women simply feel a discomfort in their chest, according to the American Heart Association. Here is the full symptom list:
Pain or pressure in the lower chest or upper abdomen
Jaw, neck or upper back pain
Nausea or vomiting
Shortness of breath
Fainting
Indigestion
Extreme fatigue
I had every symptom on the list but no medical evidence of heart attack.
When I got home from the hospital I tried to sleep, to not stress per doctor’s orders. Unable to do either and in the dark, literally and figuratively, in the glow of my iPhone, I had an epiphany. I searched “iron deficiency, anemia, heart” and I found what I was looking for.
Iron deficiency and anaemia are among the most frequently observed simultaneous conditions in people experiencing heart failure, according to a 2022 study titled Iron Deficiency in Heart Failure: Mechanisms and Pathophysiology. I didn’t have heart failure but it felt like I was heading in that direction. The study finds heart failure and iron deficiency often occur simultaneously and iron deficiency may even be a cause of the heart failure. More studies are needed to determine if this is causation or correlation.
Among the lists of iron deficiency and anemia symptoms heart issues are consistently at the top. But this line from a clinical case report struck me:
“One should always consider iron deficiency (without anemia) as the cause of persisting, unexplained unspecific, often severe, symptoms.”
Although “anemia” and “iron deficient” are sometimes used interchangeably they are different. You can be one without the other.
You are anemic1 when your blood lacks hemoglobin, a protein in red blood cells that carries oxygen to organs and tissues and moves carbon dioxide back into the lungs. Iron deficiency happens when your body lacks iron. Iron deficiency with anemia means you lack both iron and hemoglobin.
I learned that people can be anemic because of inadequate iron (microcytic anemia) or low vitamin B-12 levels (pernicious anemia). Anemia is currently diagnosed with a hemoglobin value of between 7.0 to 9.9 g/deciliter of blood. I’m putting the numbers here in case you’re reading this with your blood test results sitting nearby. Anemia can be caused by a number of issues. Women with menorrhagia, aka heavy menstrual bleeding, are some of the most susceptible to microcytic anemia.
Iron deficiency without anaemia the most common mineral deficiency in the world, affecting more than 20% of the world’s population, mostly women and children. An estimated 10 to 20 percent of people who menstruate have iron deficiency. Iron deficiency is also famous for its “unexplained, non-specific symptoms.”
Here’s a list of some of those symptoms compiled by Dr. Esa Soppi who has spent more than 30 years as an internist with a special interest in hematology:
“Fatigue, brain fog, muscle and joint pains, weight gain, headache, dyspnoea, palpitations, sometimes associated with sleep disturbances, arrhythmia, lump in the throat or difficulty in swallowing, and restless legs.”
Dr. Soppi also points out that many people who complain of these symptoms are treated for “hypothyroidism, chronic fatigue syndrome, fibromyalgia, chronic Lyme disease, burnout, and overtraining.” Iron deficiency, solved with a mineral, overlooked in favor of conditions that require medication. Some people, eh hem, are told they need to stress less.
The heart-related symptoms of both iron deficiency and anemia kept jumping out at me.
In an article from Texas Medical Institute titled “10 Symptoms of Anemia You Shouldn’t Ignore” was symptom number two: Chest Pains and Palpitations.
“A rapid heartbeat and palpitations along with feelings of anxiety (due to a deprived sympathetic nervous system) may be connected to a lack of oxygen in the blood.
A consistently rapid heart rate is not good for your heart or for the rest of your body. When there’s a low level of oxygen in the blood, the heart works extra hard to compensate. This puts a lot of pressure on the heart, which can cause it to beat faster, irregularly, and experience pain.
Untreated anemia can exacerbate underlying cardiovascular issues. Extreme cases can lead to an enlarged heart, heart murmurs, or even heart failure.”
I was either iron deficient or anemic or both. As a vegetarian I knew my diet could be an issue but I eat very healthily and I’m mindful of iron (and B vitamins!). Besides no one else in my vegetarian family had symptoms of iron deficiency. BUT my periods have gotten worse in the past two years, lasting seven days and coming like clockwork every 28 days. I suspected that these devastating periods had started to add up and my heart was begging for help.
Self diagnosed and armed with translated Googled evidence, the next day I ate a plate of broccoli and lentils for breakfast and went to our French family practice doctor who listened to my theory. He agreed with me, ordering a battery of blood tests, a pelvic MRI to rule out cysts and a mammogram because “pourquoi pas,” why not?
The first step was to find out if I was iron deficient and/or anemic. Along with a biochemical test I took a Complete Blood Count to measure the number of red blood cells in my blood sample, a.k.a. hematocrit, and protein in those blood cells that carry oxygen to my organs, a.k.a. hemoglobin. Healthy adult hemoglobin for women is between 12 to 16 grams per 100ml of blood. Healthy hematocrit for women is between 37% and 50%. I was 13.8 g/100ml for hemoglobin and 42% hematocrit. Pretty much right in the middle. It appeared I did not have anemia.2
But then I got my ferritin results. Ferritin is a blood protein that contains iron. Low ferritin indicates low iron stores. The range of healthy levels of ferritin depends on the doctor you’re seeing but most believe a healthy ferritin range is between 20 to 120. Just skimming the results of a search for “healthy ferritin range” will show how varied the thinking is on what is healthy ferritin. My ferritin was a 19.
A fantastic resource to help interpret your bloodwork at home and enjoy reading about other people’s weird symptoms is called The Iron Protocol. The Iron Protocol defines absolute iron deficiency as ferritin 30 and below. At 19 I was absolutely iron deficient. I wanted to start treating my deficiency immediately.
I got a prescription for iron supplements. Two things surprised me about being prescribed iron. First I was absolutely shocked that my doctor didn’t tell me to "just eat meat." Most French people are concerned that I don't eat meat. Many Americans are, too. My American doctor once told me to stop being vegetarian and eat grass-fed buffalo whenever I started my period. The French doctor believed I needed more daily iron than I could possibly eat and a sustained amount at that.
The second surprise was that he wasn’t sure exactly how much iron I needed to take. The daily RDA in America is 15mg. Iron is a mineral of which you can absolutely take too much. Children can overdose on it. There are also a mind-blowing amount of different iron supplements. My doctor told me to take 25mg of elemental iron per day but I was already taking 25mg daily when I was having my heart issues. I needed more.
Based on guidelines from the American Society of Hematology I learned that most people with iron deficiency need 150-200 mg per day of elemental iron. There’s a calculation you can do: 2 to 5 mg of iron per kilogram of body weight per day. I would need at least 108mg to 200mg of iron a day to dig myself out of my deficiency.
Afraid of taking too much I started on the low range of 100mg of iron per day and ramped up to 200mg daily along with a massive amount of vitamin C. Within a couple of days of taking iron my heart stopped hurting. Within a week I was less tired. It felt like my “on” switch was flipped. If I missed a dose of iron I could feel it. A month later my hair started growing. A lot.3 My fingernails stopped breaking and grew in smoother. I fell asleep quickly and stayed asleep. It sounds like a miracle but it shows how lack of iron was affecting my whole body.
It is recommended that oral iron be taken for at least three months with a ferritin test follow-up after one month. If the oral iron doesn’t work or causes miserable gastro side effects some people respond well to intravenous iron. After two months of taking 200mg of daily iron with no negative side effects my ferritin is 46. I am on the right track.
I probably would have come to this same conclusion in America but it would have taken more time and more money. I think there’s a good chance I may have been diagnosed and treated for other illnesses. Here in Bayonne, France, I went to a doctor who listened to my concerns and agreed with my self assessment.4 He then sent me to two more doctors, an OBGYN and a radiologist. Each visit cost less than 50 euros. Each of the doctors spent more than 15 minutes with me. My blood tests were less than 70 euros total and I got them same-day, walking only a block from my house. With the iron prescription I get a weeks-worth of high quality vegetarian iron supplements for less than 2 euros.
I was so relieved that the solution to my health crisis was a mineral and not a prescription drug. I am a firm believer in modern medicine and am skeptical about nutrition as a cure but I now wonder how many people suffer from lack of iron and are put on much harsher drugs instead. The reality is that most people with iron deficiency won’t get treatment at all.
“Under the existing [World Health Organization] guidelines, doctors detect people only with the more severe forms of iron deficiency,” explains Dr. Gary M. Brittenham in the article “Are We Underestimating the Prevalence of Iron Deficiency?” by Columbia University Irving Medical Center. “But they are neglecting many women and children with mild-to-moderate iron deficiency who are not anemic but still have ill effects from the lack of iron.”
Dr. Brittenham’s 2021 study suggests raising the iron deficiency threshold of ferritin from 15 to 25 for women and from 12 to 20 for children. Even at this higher ferritin range physiological changes are happening in the blood. Being diagnosed and treated for low iron could help millions of people avoid miserable, scary symptoms. At ferritin 19 I thought I was dying. At ferritin 46 I feel alive.
For the next chapter I will describe the adventure of figuring out the root cause of my iron deficiency how to stop it, along with some tips about how to navigate French doctors offices.
For more background on all those numbers checkout the American Society of Hematology. The symptoms of iron-deficient anemia include:
Being pale or having yellow "sallow" skin
Unexplained fatigue or lack of energy
Shortness of breath or chest pain, especially with activity
Unexplained generalized weakness
Rapid heartbeat
Pounding or "whooshing" in the ears
Headache, especially with activity
Brittle nails or hair loss
The “whooshing” in the ears stunned me. After years of this symptom I had stoped noticing the whoosh that would come and go. I assumed it was an age thing. It also disappeared with iron so it appears it may also be a symptom of iron deficiency.
I was really excited about this because if your blood shows you may have anemia the next step is sometimes a bone marrow test and then IV drips of iron. As my pediatrician once said “avoid anemia because it is truly hell.” Not for this lady made of cotton candy, thank you very much!
Yay for head hair but boo for leg hair. But I’ll take it!
There’s an illness in France called Heavy Leg Syndrome. It doesn’t exist in America. When French women complain to their doctors about their “heavy legs” they are treated for it. Doctors believe women are suffering and they help them. I believe this shows that French doctors are more inclined to treat a person’s symptoms regardless of what textbooks say. I certainly benefited from this mentality when I showed up with my self diagnosis of iron deficiency.