Low Iron in Pregnancy?

A bio energetic approach

At the time of writing this I am 35 weeks pregnant, and I am faced with a very common challenge in pregnancy: Am I actually low in iron if my test results say I am low in iron? And if I am, what can I do about it (that isn't iron supplementation)?

I'm going to share some insights from the bio energetic approach / Dr Ray Peat / Pro-Metabolic Approach that differs from the mainstream approach of iron. I'll share my test results and how I am interpreting them, as well as what I am doing about it. I think this offers some value to women to make a more informed decision about how they want to approach this scenario in pregnancy - or at the very least offers an alterative perspective to engage with.

Disclaimer - I am not a nutrition expert. I hold no nutrition or medical qualifications. I am someone who has been intentional about my health for many years. I read A LOT and I deep dive into topics, and while I hold no formal qualification - I am fortunate in my connections to experts who I can soundboard with, and from all my reading I have narrowed down the sources I choose to turn to such that I am not caught up in the mainstream thought without questioning it or completely overwhelmed by all the information out there. And that is what I share with you in this blog - a layman, but well-read and informed, perspective thanks to the information I am able to get from experts who do hold qualifications.

Nothing in my blog or website is ever medical advice. Read this information and apply your mind or consult your experts to take what serves you and leave what doesn't. See my disclaimers page for more if you want to.

Am I low in iron?

I recently received back my standard pregnancy blood work that indicates that I am low in iron by mainstream interpretations of iron - but am I low in iron?

P.S. I only did this blood work in my 3rd trimester. Next time I will do it early and then repeat it now to see what my normal is outside of 3rd trimester. But I didn't do this and I only have my blood work from this pregnancy and my previous pregnancy to compare.

Let's have a look at the 3 most common metrics used to determine if someone is low iron in pregnancy - Hemoglobin, Ferritin and Hematocrit.

The three blood measures of iron:

Hemoglobin

Hemoglobin measures the amount of the oxygen‑carrying protein in red blood cells. It reflects how well your blood can transport oxygen from your lungs to the rest of your body. Low hemoglobin usually indicates anemia, while high levels can point to dehydration or other conditions.

Normal range according to my Alberta (Canada) health records: 120 - 160 g/l

Ferritin

Ferritin measures the amount of stored iron in the body. It acts as a reserve supply, showing how much iron is available for making new red blood cells and supporting metabolic processes. Low ferritin suggests depleted iron stores, while high ferritin can signal inflammation or iron overload.

Normal range according to my Alberta (Canada) health records: 20 - 300 ug/L

Hematocrit

Hematocrit measures the percentage of blood volume made up of red blood cells. It’s expressed as a proportion: for example, a hematocrit of 40% means 40% of your blood volume is red blood cells. Low hematocrit indicates anemia or dilution from increased plasma volume, while high hematocrit can suggest dehydration or excessive red cell production.

Normal range according to my Alberta (Canada) health records: 0.36 - 0.48 L/L

My results and how I am interpreting them?

Note: I have not consulted my midwife on my blood results - she is awesome, but currently on holiday in Australia and will only be back when I am 38 weeks pregnant. I will consult the backup midwives I see during my routine appointments.

Hemoglobin

Normal range according to my Alberta (Canada) health records: 120 - 160 g/l

Mine is currently: 119 and therefore flagged as abnormal.

My previous pregnancy mine was: 112, 114 and 109 (this final was 4 weeks before Elba was born)

Is this actually low?

Here is a quote from Loren from Innate Fertility "Hemoglobin production stays the same while blood volume rises. The space between these two grows naturally during pregnancy."

While my blood work has indicated the below 120 is low - it generally accepted that low hemoglobin due to the natural change that happens in pregnancy is only below 110g/l. Hemoglobin will naturally drop in pregnancy.

Innate Fertility has a good article that expands on hemoglobin and the book Real Food for Pregnancy by Lily Nichols is also a generally useful source (it forms part of my books I recommend people read in preconception or in pregnancy). It doesn't respond to the question at hand directly, but an interesting article by Dr Ray Peat titled "Iron's Dangers" is an interesting read to get a different perspective on iron.

To conclude without going into much more detail - I am not concerned about 119 hemoglobin, and I don't consider this to be an indicator of low iron in my pregnancy, however, there is more to the picture.

Hematocrit

Normal range according to my Alberta (Canada) health records: 0.36 - 0.48 L/L

My current level: 0.37 L/L - therefore considered normal but just just.

My previous levels have all been around 0.36 and one of them was 0.35 L/L.

So far, the two metrics are pointing to me not having low iron - but then...

Ferritin

Normal range according to my Alberta (Canada) health records: 20 - 300 ug/L

My current level is: 10 ug/L - so definitely flagged as abnormal.

In my previous pregnancy it was 12 u/L, but I was around 32 weeks pregnant then and not 35 weeks.

Is this a concern?

A valuable perspective to consider is that "low ferritin in pregnancy is often normal and protective, not pathology" and that it is important that ferritin be considered in the context of our general health (most specifically - thyroid because it regulates iron absorption, iron transportation, ferritin synthesis and red blood cell production). An excellent IG post by ForeverhealthyLLC provides so much value on this topic (make sure to read the comments as well).

Big thing to consider: Ferritin in isolation is not a good metric to use (in my opinion) to decide to supplement iron or not. I think it is important to consider whether we are experiencing symptoms of low iron (although they may be subtle and hard to feel in the context of general pregnancy discomfort), how is our thyroid (usually based on measure of TSH, but probably more valuable is basal body temperature and pulses - I typically only do BBT), and if you're doing extensive blood work or other tests then I am sure more information from other metrics is helpful. I am not doing that.

I have a blog post on Basal Body Temperature that may be useful, but for a deeper understanding of how it is an indicator of our health / metabolic rate - I recommend the course I created with two other experts where we have a discussion on symptoms from our cycle (Coming home to Yourself - Only $24.99 for a lot of compiled information), but also I have a whole module on BBT and/or the book by Kate Deering called How to Heal your metabolism.

How am I interpreting my results?

The short answer - as a little bit low in iron, but I am not panicking about it, and I am not planning on taking an iron supplement.

Iron is not straight forward and again, ferritin should not be considered in isolation, but sometimes we also work with what we have. I am not going to do more extensive testing now. I am going to observe symptoms and address what I have to work with. That being said I get that it is helpful to have some kind of threshold information - so for that purpose alone I share that based on my sound boarding with Jacqui (who I created Coming Home to Yourself with) I am considering this low iron, but not necessarily anemic and also not panicking about it. The threshold for low, based on sound boarding, I am using is below 15.

Why do we care what Jacqui has to say? You can read her credentials on her website, but I feel so fortunate to have her as part of my community. She is an expert on these things (women's nutrition, pregnancy nutrition, iron, etc) and even gave a very valuable talk at a big midwife conference on how iron is misunderstood and interpreted.

In context of how I feel - I definitely feel lower energy, but it's hard to say how much of that is due to just being much heavier in pregnancy. My thyroid health before TTC was good (measured by my BBT and other metrics) and it is still good. Considering my diet and sound boarding with Jacqui I realized a few things that I can increase.

Why I want to increase my iron?

I am not overly concerned about it, but it is still very important to take seriously - for birth and the amount of blood lost in birth. I am having a home birth again. Last time I was just shy of being considered as hemorrhaging. I lost a lot of blood and felt pretty weak after birth and for a few days after (very pale, some shaking, etc). It was considered fine, and no intervention was taken except to down some mineral rich drinks and I took lots of desiccated organ supplements. But fine (as in not a medical issue) isn't exactly the bar I am going for, and I'd rather be more than fine.

Another reason is that, while too much iron is a concern, iron is still very important for us for post-partum and for our developing baby and too low iron is also a concern. I want to ensure there is sufficient iron (and that it is moving around - to state it very basically) for me and for my baby.

Therefore, I am taking action to improve my iron based off my results.

What to do to improve iron?

I am not supplementing iron - personal choice, but I cite Loren from Innate Fertility "Supplementation of iron ..... all deplete the body of copper. Copper is critical to new blood production, blood homeostasis, microcirculation function, vascular structural integrity and wound healing. Low levels of copper in the liver have been associated with more and longer hemorrhaging" (so the very thing people take iron supplements for - the risk can be increased by supplement) and also "It’s important to remember that pregnant women absorb iron 9X better than men. If it was really only about iron, we wouldn’t have any anemia issues during pregnancy."

Remember iron is not to be considered in isolation - Also look to prolactin, estrogen, thyroid, and stress hormones (see the post by ForeverhealthyLLC).

From their recommendations - I have already done most of those things for years and therefore I will be not expanding on them much in this blog, except for this short-ish list:

1. My thyroid is good, but because I like supporting my body I have for years taken desiccated thyroid gland supplement. A small dose twice a day.

2. I drink lots of milk, juice, honey and eat lots of fruit.

3. My protein can be better - see what I am doing about his.

4. I do sunlight (although it is hard in Canadian winter - I also do red light), rest and adequate sugar (I know shocking that sugar is recommended - but it is prometabolic and the issue is if your body can process it not that "sugar is bad" - sorry if I lost you here I know that super contrary to the mainstream view of health).

5. I do regular meals - 3 a day plus snacks. Proper balanced meals. I don't eat junk food.

6. I eat enough carb

7. I stay warm

8. I avoid PUFAs (polyunsaturated fats) and have for years now - p.s. see my SIMPLY product line for low to no PUFA products.

9. I do decent calcium, but see below how I will improve this

10. I consume desiccated oyster daily (I don't like fresh oyster)

11. I consume liver and other organ meats, but see below how I will improve this

12. I drink 1 coffee daily (yes - I know shocking that caffeine is also considered healthy in specific context) with milk and honey (and only ever after food).

13. I get adequate Vit A (retinol) because of my organ meat consumption. Please consider too much Vit A is harmful and the difference between real food Vit A and synthetic supplementation of Vit A - especially for pregnancy.

14. I consume egg daily - I add yolks to my milky dfrinks

15. I consume grass-fed dairy every day

16. I consume collagen and gelatin daily

17. I eat raw carrot salads regularly - see my post about this.

Now that I've covered things I do (I do more than this, but that was from the list given by ForeverHealthyLLC - subscribe to my website if you want more updates on healthy things I incorporate through different phases) - Let's talk about the new things I am going to be doing.

New things I am doing to address my iron (and general health, because it isn't in isolation)

More focus on Lactoferrin

Random note: If you're worried about iron and babies, and breastfeeding or getting pressure to supplement breastfed baby with iron. This is a great video on that topic. It is also on lactoferrin but in breastmilk.

Here is some copy pasted information to give an overview of Lactoferrin to get a basic understanding:

What Lactoferrin Does for Iron

• Iron binding and absorption: Lactoferrin binds iron and makes it more bioavailable, improving absorption in the gut.

• Iron recycling: It helps recycle iron that would otherwise be lost through cell turnover, maintaining iron balance.

• Gentle alternative to supplements: Unlike ferrous sulfate or other iron pills, lactoferrin is better tolerated, with fewer gastrointestinal side effects such as constipation or nausea.

• Supports hemoglobin and ferritin: Clinical studies show lactoferrin can improve serum iron, ferritin, and hemoglobin levels more effectively than some standard iron formulas.

• Anti‑inflammatory and antimicrobial: Beyond iron, lactoferrin reduces inflammation and protects against infections, which can contribute to anemia of chronic disease.

Lactoferrin has been shown to normalize iron homeostasis in pregnant women, improving anemia without the side effects of conventional iron therapy.

Instead of directly focusing on just "increase iron" - my main focus is actually increase lactoferrin (along with iron).

For many months now I have consumed bovine colostrum powder daily (for me and my toddler). I have purchased these in Canada - Wellness extract & Organika. Colostrum is one of the richest natural sources of lactoferrin (see how that ties in with breastfeeding mentioned above). I don't have access to fresh cow colostrum anymore and therefore I take it in powdered form.

While consuming this daily was great in general, we've seen now I probably need more focus on lactoferrin, and I don't just want to up my colostrum powder. So here are two new things I am doing:

1. Direct supplementation of lactoferrin (iron bound one) - I am limited for choice in which supplement to take here in Canada. This is the one I have gone with and am currently taking. I shared the Amazon link, but I know lots of people are hesitant to buy supplements from Amazon. I get that - this one is also the one sold in the health shops in Canada and the brand seems to be a reputable brand. This is the first supplement I have ordered from them.

I am taking it when I take desiccated organs (see details below). So far, I am only taking one a day of the lactoferrin, because I am also doing other things to increase lactoferrin.

2. Whey Protein - some sources don't acknowledge it as a good source of lactoferrin, but my sound boarding says it is - therefore I am bringing it in. When I bought it this weekend it was a real frustration finding a pure one - seriously check the labels. I settled for a naturally flavoured one typically don't consume artificially or "naturally" flavoured things), but I have since found a better one that I will buy when mine is done and I would rather share the link for this one. Grassfed with nothing added.

And that is what I am doing to increase my lactoferrin - as part of my effort to increase iron. So here is what I am doing to increase iron.

Spleen

When I was pregnant with Elba I went and bought spleen from the butcher. I ended up not consuming it, but I should have. I got it because spleen is an excellent source of iron in a highly bioavailable form (it's not about if something is a high source - it's whether we can use it or not).

I will go back to the butcher and get some spleen, but for ease I am also supplementing desiccated spleen. Desiccated spleen is not as easy to find compared to other desiccated organs, so often it is taken as a general organ supplement like this one. The link is to the supplement I will take postpartum.

Currently I am taking a desiccated spleen (only - no other organs) one from New Roots. It's not an ideal one, because it contains more things than I like to have in my supplements. I aim for literally just what I need / want and this one has some addition things (I don't mind the added Vit C because this does help with iron absorption, it's more the silicon dioxide and peppermint flavour? that's my issue). Anyways for now it will do, but if you can get a better spleen supplement I'd say get that or go with the organ blend I linked above. Or better - eat spleen.

The above mentioned are the explicit things I am bringing in, here are some more general things I am doing:

Organ meats: We're increasing them in general. We were great at regularly consuming all sorts of organ meat - heart, liver, kidney, etc. But in summer and spring we consumed les because we ate a lot lighter. So we're getting back to our usual - steak and kidney pie (I make it from scratch with a sourdough pie dough), chicken liver pate - see my recipe (chicken liver is a great source of iron), ground beef with 30% organ meat, just plain beef liver bits, and even pork liver pate (we don't usually eat pork liver, but it is the highest source of iron of all the animal livers).

Calcium: My calcium intake is pretty good, but it can be better. I was consuming pearl powder regularly, but my source of it has dried up so now I am using less (plus it is expensive). We're back to doing eggshells. We did this a few years ago and then stopped, but now we are back. Basically, saving eggshells from eating egg (we do egg daily so we have a lot) and then baking them, and then grinding them down to a powder. It is a very cheap and easy source of calcium.

Lots of bone broth: This is a usual for us for winter, end of pregnancy and postpartum time. Ian (my husband) is making broth every few days for us to have an abundance of it. He also adds in seaweed for iodine because our diet is a little low in iodine since living inland and not having as much seafood). Lily Nichols (from Real Food for Pregnancy) has a good article on iodine for fertility, pregnancy and breastfeeding. I started increasing my iodine a few months ago now because I experienced what appeared to be fibrocystic breasts / lumpy breasts in pregnancy - having not experienced this before). I started incorporating kelp flakes daily and it seemed to resolve what I was experiencing (was getting random lumps that came and went in both breasts, sometimes uncomfortable) within 2 to 3 days. I assume it was the kelp, but I also did red light daily and pomegranate extract.

Again - feel free to subscribe to read more about the different health things I do if it offers some useful insight or ideas for you.

Concluding remarks

And this brings us to the end of my current approach to my iron and general health as I near the end of pregnancy (or not, because who knows when this baby will come :) ). I will share any updates here on my website - general, but also specific to iron situation and how birth goes.

I will also be sharing a few Youtube videos before baby comes on our prep for our usual things - home birth, cloth diapering, elimination communication, cosleeping, first 40 days, etc. I already have many videos on these topics on my channel from doing it with Elba, but I'll be sharing how we prep for baby #2.

AND - please check out my amazing postpartum care box! I highly recommend getting this for yourself or for any mom as her postpartum gift. These are the items I made for myself and for friends because I think they are perfect and supportive.

Lastly - I will be detailing my first 40 days here. I will write details of every single day as I experience them in terms of honouring the first 40 days, what I am doing health wise and what I am experiencing as I recover from birth and care for my littles. Subscribe below if you want to be a part of that journey with me.

Thanks for the read! I hope there was some value in my share.

Carmen - link to my IG (I mostly make stories and not posts).

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