Understanding iron saturation and why it’s important

Rachael Kraus, Maurice Beer M.D.
January 21st, 2022 · 6 min read
Medically Verified
In this article:
  • What is iron saturation?
  • What causes iron deficiencies?
  • Signs and symptoms of low iron saturation (iron-deficiency anemia)
  • Signs and symptoms of high iron saturation (hemochromatosis)
  • How to monitor your iron levels
  • What should you do if you have low iron?
There are several different factors involved in having healthy iron levels, one of which is iron saturation. Even though your body is usually pretty good at regulating iron stores, imbalances are common; this is why it’s important to monitor your own iron levels.

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Takeaways:
  • While serum iron levels can tell you how much total iron is in your blood, iron saturation tells you how much you’re actually absorbing.
  • When people discuss anemia (low iron) or hemochromatosis (high iron), they’re actually talking about iron saturation more than total iron levels in the blood.
  • The symptoms of iron imbalance are pretty obvious in extreme cases, but blood tests can help you catch potential problems before they become serious. 

What is iron saturation?

Checking your iron levels isn’t as simple as testing the total iron in your bloodstream; in fact, it’s common to have more than one test done to determine how healthy your iron stores are. And, as you may have already guessed, iron saturation is usually included in those tests.
Your body does a lot of work to make sure the iron you consume (through food or supplements) is properly transported to your organs. But how can you tell how much of that iron is actually getting absorbed? That’s right - by checking iron saturation.
Here’s how it works: once the iron gets to the bloodstream, it’ll encounter a blood protein called transferrin. A certain percentage of the iron in your blood will bind to the transferrin, and then get transported to your organs. If your iron saturation is getting tested, the results should be within a reference range of 15% to 50% for men, and 10% to 45% for women.
That said, sometimes low saturation doesn’t mean low iron --- they are often, but not always correlated.

What causes iron deficiencies?

Iron is one of those things that your body can’t produce on its own, so it has to come from an external source. Eating a diet full of iron-rich foods is best since the iron you get from food is easier to absorb, but it’s also possible to correct an iron deficiency with supplements. An iron deficiency usually happens due to four different reasons:
  • Inadequate dietary iron intake
  • Excessive blood loss from heavy menstruation, injury, or internal bleeding
  • Pregnancy and childbirth
  • Disorders that reduce or prevent iron absorption
If you’re experiencing any of these things, you won’t necessarily see signs of low iron right away; since your body keeps iron stores in reserve, you can potentially live off of them for months. Think of it as having a backup generator for when the power goes out - it’s supposed to get you through the blackout, but it’s only a good solution if the power comes back on before the generator runs out of fuel.
Most people probably think they’re doing alright with their iron intake, but a lot of them would be wrong - about a third of people worldwide are deficient in iron. The tricky thing is, you can be low in iron even if you’re still eating some iron-rich foods. Living on Doritos and jelly beans would cause an iron deficiency for sure, but what if you’ve decided to limit your red meat consumption without upping your iron intake from other sources? Even with what looks like a fairly “balanced” diet, you may have accidentally set yourself up for an iron deficiency.

Signs and symptoms of low iron saturation (iron-deficiency anemia)

An iron deficiency can be tricky to catch if you’re just keeping an eye out for symptoms, mainly because they overlap with so many other conditions. You could be tired and brain-foggy from low iron saturation…or from a vitamin D deficiency, or from hypothyroidism, or from dozens of other causes. Even so, noticing the symptoms can be the first step in figuring out the bigger picture. The symptoms below are all typical for pretty advanced cases of iron deficiency, but they can start showing up in a more mild form well before you’ve developed official iron-deficiency anemia.
  • Fatigue
  • Weakness
  • Brain fog
  • Pale skin, lips, and tongue
  • Dark circles under the eyes
  • Difficulty taking a full breath
  • A tingling sensation in the legs
  • Elevated or irregular heart rate
  • Inability to stay warm
  • Brittle nails
  • Headaches
  • A swollen or sore tongue
As you can see, low iron saturation is a condition that can seriously disrupt your life. Some people describe developing anemia as “hitting a wall” - they thought they were fine, until they weren’t.
If you’re suddenly wondering what your iron saturation levels really look like, here’s something to consider: some people are more susceptible to anemia than others. People who have periods are more at risk than the ones who don’t, but the level of menstrual flow also plays a big part in iron depletion. Those who suffer from Crohn’s disease often experience internal blood loss, meaning they’d need more iron than the average person to maintain healthy iron saturation levels. Vegan and vegetarian diets lack most of the foods that are highest in bioavailable iron, which elevates the risk of eventually developing iron-deficiency anemia. You get the picture - iron deficiency can happen to just about anyone, especially if they don’t know what to look out for.

Signs and symptoms of high iron saturation (hemochromatosis)

While it’s much rarer than low iron saturation, hemochromatosis can be just as destructive. The body’s iron stores are carefully regulated, but most of the regulation involves keeping levels high enough for you to function; there aren’t any biological mechanisms for getting rid of excess iron. If your iron saturation becomes too high, your only options are medically administered bloodletting or expensive chelation therapy.
Just in case you aren’t already intimidated enough, here’s a list of hemochromatosis symptoms:
  • Fatigue
  • Weakness
  • Brain fog
  • Gray or bronze skin
  • Liver failure
  • Heart failure
  • Low libido or impotence
  • Diabetes
  • Joint pain
  • Abdominal discomfort
Did you notice anything familiar about this list? There are a few symptoms in common with low iron saturation. It just goes to show that you can’t diagnose yourself based on symptoms alone - in order to really know what’s up, you need lab testing. Fortunately, hemochromatosis is usually only seen in people who are genetically predisposed to it, or in people who take too many iron supplements. If you’re starting to wonder if your iron levels are off, chances are they’re too low, not too high.

How to monitor your iron levels

Symptoms can tell you that an iron imbalance may exist, but they won’t tell you what your actual levels are - for that, you need lab tests. Typically, lab testing is ordered by a doctor after they identify symptoms of low or high iron; however, you don’t necessarily have to go through a doctor in order to get accurate data on your own iron saturation levels. You could get at-home lab tests done instead, which involves a lot less hassle than going the traditional route. Base’s lab tests even come with expert, personalized advice that interprets the data for you, as well as providing a common-sense action plan to help you achieve your health goals.
An initial test can identify low iron stores, but if you want to actually monitor your progress, you should consider getting tested every three months or so. Not only will you be able to see your iron saturation levels moving into the healthy range, but you’ll be able to tell when it’s time to maintain, rather than continuing to boost your numbers. 

What should you do if you have low iron?

Say you get your iron levels tested, and the results show a deficiency. What’s the next step? The obvious move would be to increase your dietary iron intake (or start taking an iron supplement), but there are a few other strategies that can help your iron stores increase even faster.
  • Organ meats like liver, heart, and kidneys are among the absolute best sources of heme iron (the easiest form for your body to absorb), but if you don’t feel like taking those on, stick with red meats, chicken, fish, and shellfish. Remember, the best dietary plans aren’t just nutritionally balanced; they’re the ones that are sustainable for you personally
  • Vegans or vegetarians can get non-heme iron from plant sources like kale, spinach, dandelion greens, and beet greens.
  • Eat foods high in vitamin C to boost iron absorption - lemons, oranges, strawberries, and kiwi are all great choices.
  • Avoid or reduce consumption of foods that are high in phytic acid, such as legumes, seeds, nuts, and grains. Phytic acid binds to iron and prevents your body from absorbing it as effectively.
Even if you don’t see any signs of serious iron deficiency, you could still be experiencing it - that’s how it sneaks up on you. It doesn’t have to be that way, though! If you use lab testing to catch a developing imbalance before it turns into something more severe, you can nip it in the bud and enjoy the benefits of being a healthier you.
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