Should You Supplement With Iron?

Mar 8 / Drs. Bryan & Julie Walsh
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The short answer is, no.

Unless you need it, demonstrated by proper lab testing (which most people aren’t doing).

Iron is a somewhat paradoxical trace element. It is essential for almost every form of life, and in humans is necessary to synthesize ATP (energy) and DNA. However, it is also highly reactive, accepts and donates electrons with ease, and can quickly cause significant damage to fats, proteins, cells, or just about anything it comes into contact with.

Because of this, iron is tightly regulated in the body to ensure it is used for the right things, while not damaging the wrong things.

So should you take iron, even in a multivitamin?

Before answering this question, consider the following:


Numerous studies have demonstrated a connection between iron supplementation and a worsening of gut-related pathologies, as well as pathogenic bacteria and dysbiosis. 


Microbes love iron. It has been said that “iron is like chocolate for bacteria”. If someone has an infection of any type – fungal, viral, bacterial – it will likely get worse from increased iron availability. 


Excess iron is highly reactive and intracellular iron overload is associated with a number of different chronic conditions, including neurodegenerative disease.


Even in cases of what appears to be iron deficiency, the body might actually want low iron to protect it from other things. In these cases, even though iron appears to be low, taking it might subvert what the body wants, and make things worse. 
Some people do need iron and there are forms of iron that seem to be better tolerated, more effective, and with fewer side effects than the standard ferrous sulfate given by many doctors. Chelated forms of iron, such as iron bisglycinate, is one such form.

But the question remains...

Who Needs to Take Iron, And Who Doesn't? 

Many practitioners rely on serum ferritin, but this might be a mistake.

Serum ferritin can be unreliable and within the normal range in one-third of patients with anemia.

When trying to differentiate between iron deficiency anemia and anemia of chronic disease, transferrin and/or TIBC are far more valuable markers, as they are not impacted by inflammation and will tend to reflect intracellular iron levels better than ferritin. When transferrin is elevated, it is more likely to be due to iron deficiency and someone may benefit from increasing their iron intake. However, when anemia is present by transferrin is normal, or even low, it is because intracellular iron levels are often sufficient, and the anemia is more likely due to chronic disease or infection. An individual with this pattern would likely do better to avoid extra iron. 

How to Identify Iron Deficiency

There are advanced markers and calculations to even more accurately identify early iron deficiency, differentiate between iron deficiency and chronic disease, and therefore help practitioners decide who should receive iron, and who should not.


"This is incredible information Dr Walsh."


"Another outstanding presentation...
Thank you!"


You ground me from all the FM Hype out there, which is mostly messy, biased, and FOMO driven. Please keep doing what you're doing. Your work is benefiting so many patients around the globe. Truly blessed to be amongst your students. Much love ❤️