When Low Iron May Be Part of the Body’s Defence
- Gary Moller
- 5 minutes ago
- 10 min read
Lessons I first learnt from animals
Over the years I have carried out Hair Tissue Mineral Analysis, or HTMA, on many people, but I have also tested sheep, horses and other animals. Animals are fascinating to work with because they remove quite a lot of the psychological and lifestyle clutter that accompanies human health problems. They cannot tell you what is wrong, of course, so we must observe carefully and look for patterns involving their environment, diet, mineral status and health.
One observation that has interested me for many years is the association I sometimes see between abnormal iron patterns on HTMA and animals suffering from chronic health problems, including bacterial and parasitic infections. I have seen enough of these cases to take notice when a similar mineral pattern appears in a person, particularly when their history contains other clues suggesting persistent inflammation or infection.
I need to emphasise from the outset that HTMA does not diagnose an infection, rheumatoid arthritis or iron-deficiency anaemia. However, there are consistent patterns on HTMA where there is medically diagnosed conditions, including for infections and inflammatory autoimmune conditions. Nevertheless, there is some fascinating physiology sitting behind these observations. Reacting by prescribing iron as a supplement, or iron injections, may not be a good idea because it may be inadvertently feeding the infection. It is a bit like doing food drops to the enemy that you are attempting to expel.
“An unusual iron pattern should make us ask questions.”
Brown Trotter taught me to look at the soil first
One of the most pivotal books I read many years ago concerned a remarkable New Zealand farmer named Brown Trotter. He farmed Romney sheep near Fairlie in South Canterbury and became convinced that many of the problems affecting livestock began much further down the food chain than most people realised. They began with the mineral status of the soil.
Farmers, more than anyone else, recognise and value the link between soil minerals and the health of their animals, crops, and themselves, as well as other people who consume these products.
Trotter had followed the conventional fertilising practices of his era, but his stock were performing poorly. Through years of observation, experimentation and good old-fashioned farming common sense, he began paying close attention to trace minerals deficient in his soils, pasture and livestock. These included minerals such as copper, zinc, iodine and selenium.
The health and performance of his animals improved dramatically. His sheep became sufficiently impressive that he was consistently winning ribbons at agricultural shows and sheep-breeding competitions. The lesson was simple but profound: before blaming the animal, look at what is feeding the animal. Then look at what is feeding the pasture.
Trotter's story was later recorded in Soil Minerals: The Key to Farming Wealth and Your Own Health and Stay Healthy by Supplying What's Lacking in Your Diet. His work made a lasting impression on me because he was essentially practising an early form of nutritional detective work.
Rather than simply treating the sick animal, Trotter looked at the pasture. Then he looked beneath the pasture to the soil. He asked what was missing, what was excessive and what was out of balance.
That way of thinking has influenced my clinical work ever since.
“Brown Trotter taught an important lesson: when an animal is unhealthy, do not look only at the animal. Look at the pasture, and then look beneath the pasture.”
Humans can show similar patterns
We are obviously not sheep, but we share much of the same fundamental mineral physiology. Over many years of using HTMA in clinical practice, I have encountered unusual iron patterns in people who subsequently turn out to have inflammatory or infectious problems.
These may include persistent bacterial infections of the urinary tract or bladder, gastrointestinal or parasitic infections, and inflammatory conditions including reactive and rheumatoid arthritis. Sometimes an infection is quite obvious. At other times the person may have little idea that something infectious or inflammatory has been simmering away in the background.
This is particularly interesting in inflammatory arthritis. Reactive arthritis provides an established medical example of the relationship between infection and subsequent joint inflammation. It can occur following an infection elsewhere in the body, including the gastrointestinal or genitourinary tract, or even an infected tooth. Sometimes, the original infection was relatively mild or has already passed by the time the joints become troublesome. I had one case where a woman was bitten on the finger by a mouse and developed a mild bacterial infection of minor signficance, that then appears to have triggered a full-blown onset of rheumatoid arthritis.I would also note that carefully constructing timelines by questioning the patient can be very insightful.
I have written previously about the patterns I have observed in people with reactive and rheumatoid arthritis:
The mineral patterns with HTMA not only provide clues that encourage further investigation, but also point the way to lasting non-drugs management of the condition.
“Sometimes the infection is obvious. At other times the person may have little idea that something infectious or inflammatory has been simmering away in the background.”
The body and the invading organism are fighting over iron
This is where modern immunology provides a fascinating explanation for something that farmers and health practitioners may have been observing long before we understood the mechanism. Iron is essential to human life. We require it for haemoglobin and oxygen transport, mitochondrial energy production, enzyme function, DNA synthesis and numerous other biological processes. But we are not the only creatures that need iron.
Many bacteria and other microorganisms also depend upon iron for their metabolism, respiration, growth and proliferation. Once an infection develops, therefore, a competition begins between the host and the invading organism.
Our immune system has evolved an ingenious response: hide the iron. Researchers refer to this process more broadly as nutritional immunity. During infection and inflammation, the body alters the availability of nutrients required by invading organisms. Iron is one of the most important. I call it "Mangy Horse Syndrome" because the animal with these kinds of chronic infections is typically mangy in appearance. The same could be said for their human equivalents.
“Iron is precious to us, but it is precious to many invading organisms as well. During infection, a biological tug-of-war begins over who gets it.”
Hepcidin is the traffic controller
One of the key players is a small peptide hormone called hepcidin, produced mainly by the liver. When inflammation increases, particularly through signalling involving the inflammatory cytokine interleukin-6, hepcidin production can rise. Hepcidin then acts upon ferroportin, a protein responsible for transporting iron out of intestinal cells, macrophages and storage sites and into the bloodstream. As hepcidin increases, ferroportin is suppressed. Less iron reaches the circulation from the intestine and more becomes retained within macrophages and other cells. Serum iron falls.
At first glance, this looks like a nutritional problem. From the perspective of the immune system, however, it may be entirely deliberate. The body is effectively saying: there is an invader here that needs iron, so I am going to make iron harder for it to obtain. This is important to understand because our first instinct when confronted with low iron is often to put more iron in. Sometimes that is exactly what is needed. Sometimes, however, we need to ask a few more questions first.
“Sometimes low circulating iron is not simply a deficiency. It may be the body deliberately moving iron out of reach of an invader.”
The price of starving the invader
This strategy makes biological sense during an acute infection, but there is a price to pay if inflammation continues. Our bone marrow also requires iron to produce haemoglobin and new red blood cells. If iron remains sequestered for long enough, iron availability for red-cell production declines even though the body may still contain iron. This is one of the mechanisms underlying anaemia of inflammation, historically called anaemia of chronic disease.
Someone with genuine iron deficiency may have depleted iron reserves because of heavy menstrual bleeding, gastrointestinal blood loss, poor dietary intake, impaired absorption or increased physiological requirements. Such a person may genuinely need additional iron, while the cause of the deficiency is investigated. Another person may have low circulating iron because chronic inflammation has increased hepcidin and altered iron distribution. The iron is there, but the body is making it difficult to access. A third person can have both genuine iron deficiency and inflammation-related iron restriction at the same time. These are not interchangeable problems and they should not automatically receive identical treatment.
Moreover, it's quite common for an abnormality, such as low iron levels, to have multiple causes. Even if someone appears to have low iron due to heavy menstrual bleeding, it doesn't rule out other potential causes like a parasitic infection or an infection in a tooth's root canal. Treat one only and not the other, and the outcomes may be disappointing.
Ferritin does not always settle the argument
Ferritin is one of our most useful measurements for assessing iron status, but it needs to be interpreted in context. A clearly low ferritin is strong evidence supporting iron deficiency. The difficulty is that ferritin is also an acute-phase reactant. Infection and inflammation can push ferritin upwards independently of the body's iron reserves.
Consequently, someone with chronic inflammation can have low circulating iron and reduced transferrin saturation while their ferritin appears normal or is even elevated. This is why I am uncomfortable making decisions about iron from one laboratory number when the clinical situation is complicated.
Depending upon the circumstances, I would want to consider the person's history and symptoms alongside a full blood count, ferritin, serum iron, transferrin or total iron-binding capacity, transferrin saturation and an inflammatory marker such as CRP. Where the picture remains unclear, additional medical investigations may be appropriate. The question should not merely be:
“Is the iron low?”
It should be:
“Why is the iron low?”
“A low iron result is a clue. It is not, by itself, an explanation.”
Inflammation may have a cause that has been missed
Another lesson from clinical practice is that persistent inflammation deserves investigation rather than simply being regarded as an unfortunate condition that needs suppressing. Sometimes there is an identifiable infectious trigger. Sometimes there are environmental contributors. Sometimes there are several things going on simultaneously.
I published the account of a woman whose years of complex illness were ultimately associated with significant household mould exposure. Her story is a useful reminder that an inflammatory burden may have a driver that remains hidden until somebody goes looking for it.
I have also written about the concept of the biological terrain. I think we need to approach this sensibly rather than turning germ theory and terrain theory into competing religions. Pathogens clearly matter. So does the condition of the host. Nutrition, immune competence, metabolic health, environmental exposures, chronic stress and mineral balance may all influence how well a person copes with microorganisms encountered throughout life.
Brown Trotter understood an agricultural version of this principle remarkably well. He did not merely ask what disease his sheep had. He asked what sort of biological environment he had created for them, beginning with the soil beneath their feet.
Are we feeding the enemy?
This brings me back to iron supplementation. If someone has low iron, the temptation is to give iron. If they have proven iron deficiency, that may be entirely appropriate and important. But suppose the low circulating iron is partly the result of an inflammatory response to persistent infection. The immune system may be deliberately restricting microbial access to iron. Does pouring substantial amounts of supplemental iron into that environment always make sense?
I sometimes put the question this way:
“Are we inadvertently feeding the very organisms the immune system is trying to starve?”
There is genuine biology behind the question. However, microorganisms differ enormously in how they obtain and use iron. Some live outside our cells, while others occupy cells such as macrophages. Manipulating iron availability can therefore have different effects depending upon the organism and circumstances. Significant untreated iron deficiency also has consequences of its own. I am certainly not saying that somebody with an infection should never receive iron, nor should anyone stop medically prescribed iron on the strength of this article. The principle is much more measured:
Do not supplement iron blindly merely because an iron measurement is low. Investigate why it is low.
HTMA is a clue, not the diagnosis
This also illustrates how I use HTMA. I do not look at a high or low hair iron value and declare that somebody has an infection. Instead, I look for patterns, mineral relationships and changes between successive tests, then place those observations alongside the person's symptoms, medical history, diet, lifestyle, environmental exposures and conventional investigations.
Sometimes a pattern raises a question that nobody has previously asked. That question might be whether there is chronic inflammation. It might be whether there is a hidden bacterial or parasitic infection. It might concern copper metabolism, toxic-element exposure, digestion, blood loss or something entirely different.
The HTMA does not provide the final answer. It tells us where it may be worth looking. This is very similar to the lesson I learnt from working with animals. The sick sheep cannot explain what is wrong. The farmer must observe carefully, look at the whole environment and work backwards from the clues.
“Treating the number is easy. Working out why the number is abnormal is where the real detective work begins.”
Food first, then investigate
If chronic infection or inflammation is suspected and iron markers are abnormal, I prefer not to treat the laboratory result in isolation. We need to establish whether genuine iron depletion exists. We should consider blood loss, menstrual history where relevant, gastrointestinal problems, absorption, inflammation and possible infection. Significant anaemia deserves proper medical investigation because gastrointestinal bleeding and other serious conditions must not be overlooked.
Meanwhile, nutritious whole food remains the foundation. Meat, seafood, eggs and organ meats provide iron together with protein, zinc, copper, B vitamins and many other nutrients required for blood formation, immunity, tissue repair and energy metabolism. This is very different from assuming that an isolated nutrient must be supplied in concentrated form simply because one laboratory measurement looks low.
The lesson Brown Trotter taught me all those years ago still applies. Look at the whole system. For his sheep, that meant beginning with the soil, then the pasture, then the animal. With people, it means looking beyond a laboratory number to nutrition, digestion, inflammation, infection, environment, lifestyle and the person sitting in front of us.
Final Comments
Iron is essential to life. That is precisely why the relationship between iron and infection is so interesting. We need it, and many microorganisms need it too.
The body has evolved sophisticated mechanisms for deciding where iron should go and, importantly, where it should not go. During infection and inflammation, lowering circulating iron may sometimes be part of that defence.
That does not mean low iron should be ignored, nor does it mean iron supplementation is wrong. Genuine iron deficiency and iron-deficiency anaemia need to be identified, their causes investigated and treatment provided where appropriate.
But before automatically reaching for an iron supplement, particularly when chronic infection or inflammation may be present, ask one more question:
Why is the iron low?
At times, that question brings us significantly closer to the core issue and, eventually, to solutions.
Further reading
Medical Disclaimer
This information is provided for educational purposes only and is not intended as personal medical advice, diagnosis or treatment. Low iron and anaemia have numerous possible causes, some of which require prompt medical investigation. People taking prescribed iron should not discontinue it on the basis of this article. Always consult an appropriately qualified healthcare professional regarding your individual circumstances, medications and health conditions.
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