Tired and Washed Out? Maybe You’re Iron Deficient

chronic fatigue syndrome

chronic-fatigueTrue story: a patient of mine in her mid-thirties came to my office complaining she was tired–more tired than she had ever felt in her whole life. I looked at her carefully and, from appearances, nothing seemed wrong. She was an active woman who regularly ran 3 to 5 miles three times a week. She had a hectic job as an attorney constantly back and forth between the office and the courthouse. Of course she had stress.

Who in New York City doesn’t have stress?

But this patient felt like this is stress she could handle — as she always had. Her fatigue was now affecting her mood. She started staying in on the weekends and cutting back on her exercising.

I examined her for all the signs of anemia, which is a low red blood cell count, but nothing was abnormal. I then ordered blood studies to check for typical causes of being tired: anemia, thyroid dysfunction or metabolic disorder. Her thyroid tests were normal, and her blood counts showed normal levels for her red and white cells. Her iron level was normal, as well.

But then the Ah, ha!

I gave her the test that gives insight into a true low body iron storage — her serum ferritin level was extremely low at 10 (a normal count is above 50). My patient was clearly iron deficient and this explained her fatigue and weakness. I wasn’t surprised, women of child-bearing age (menstruating) lose blood that can be significantly alter their iron level. In addition, running can cause women and men to lose iron stores. The double-whammy of being a woman runner had set her up for this condition. The good news is that this can be treated and prevented with proper attention to your diet.

Iron is an essential mineral that is required for normal red blood cell formation. The classic foods that are a good source of iron are: red meats(not the white meats like chicken and turkey), lentils, spinach and raisins. Also, cooking in a iron pot is also an excellent way to get more of this mineral in your body. You can of course get iron in a supplement form, however it isn’t always absorbed best that way and for many patients it can be very constipating.

Final thoughts: why didn’t this patient’s blood show she was anemic or low in serum iron? The answer is that these two blood studies don’t always become abnormal until the patient isseverely iron deficient.

In the past, I was a strict vegetarian and my serum ferritin was low from lack of iron. Initially, I loaded up on lentil soup with spinach–and it’s still one of my favorites. If, unlike me, you don’t want to indulge in a lamb chop a few times a month, then try my winter lentil soup recipe.

Lentils are slow burning complex carbohydrates, which is important for you active folks. This member of the legume family increases your energy by replenishing your iron stores–1 cup gives you 36% of your daily recommended intake. Unlike red meat, another source of iron, lentils are not rich in fat and calories. Give it a try.


  • 4 leeks – sliced into 1/4 inch pieces and cut in half
  • 1 bunch kale or spinach — about 3 cups
  • 1 tablespoon olive oil
  • 3 1/2 cups of diced tomatoes, drained, or two 14 oz cans (we like Muir Organics)
  • 3 cups of water
  • 3 cups of vegetable broth
  • 2 sweet potatoes, peeled and diced
  • 1/2 cup lentils — black or brown
  • 1 tablespoon chopped fresh thyme leaves
  • 1 bay leaf
  • 2 teaspoons sea salt
  • 1/4 teaspoon freshly ground black pepper
  • parmesan cheese (for topping)

Place leeks in a large bowl of cold water to clean. Drain in colander.

Stem kale (if using) and chop leaves. There is no need to stem baby spinach (if using).

Heat the oil in a saucepan over medium heat. Add the leeks and cook for 3 minutes. Add the tomatoes and cook for another 5 minutes. Add the water and broth and bring to a boil. Stir in the kale or spinach, sweet potatoes, lentils, thyme, salt, pepper, and bay leaf. Simmer until the lentils are tender, about 30 minutes. Remove bay leaf and discard. Serve topped with a little parmesan, if you choose. Enjoy!

Dr. Dean Mitchell
Mitchell Medical Group, NYC & Long Island

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