Lifestyle Expert Explains Why You May Feel Tired Despite Normal Haemoglobin

It is a common story: you feel constantly tired, foggy, your hair is falling out, and your skin looks dull. You run to the doctor, get your bloodwork done, and your haemoglobin levels come back normal. You are told everything looks fine. But your body says otherwise. Lifestyle coach and wellness expert Luke Coutinho is urging people not to dismiss these symptoms.

In his latest Instagram post, Mr Coutinho highlights a condition called Iron Deficiency Without Anemia (IDWA), where ferritin levels – the body's iron storage – are low, even though haemoglobin is still in the normal range.

“You're not imagining it,” Mr Coutinho says. “There's something deeper going on.”

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What Is ferritin and why it matters

Luke Coutinho explains that ferritin acts as the body's “iron bank.” It is a protein that stores iron inside your cells and releases it when needed. Iron is crucial for making haemoglobin, the component in red blood cells that carries oxygen. 

If your ferritin levels are low, it means your iron reserves are running low, even if your current red blood cell count is fine.

This silent depletion can often go unnoticed in standard tests, which focus mostly on haemoglobin. That is why checking ferritin is vital, especially when unexplained fatigue or hair loss sets in.

Symptoms of low ferritin

According to Luke Coutinho, these are some of the red flags:

• Fatigue or low energy.
• Brain fog or poor concentration.
• Hair thinning or brittle nails.
• Restless legs or unusual cravings (like ice or dirt).
• Pale skin or dizziness.

These signs often precede full-blown anemia and are early indicators that your iron levels need attention.

What causes low ferritin?

According to Luke Coutinho, several underlying factors could be behind a drop in ferritin levels:

• Heavy menstrual bleeding or pregnancy.
• Poor iron intake (especially in vegan or restrictive diets).
• Gut issues such as ulcers, celiac disease, or poor absorption.
• Chronic blood loss, including internal bleeding.
• Intense exercise or overtraining.

What you can do

Coutinho lays out a step-by-step approach to tackle this issue holistically:

1. Talk to your doctor
   Get comprehensive blood tests for – ferritin, serum iron, and transferrin saturation.

2. Improve your diet
   Focus on iron-rich foods:

• Haeme iron from meat, poultry, and fish (better absorbed).
• Non-heeme iron from spinach, lentils, beans, and fortified cereals.

Pair these with vitamin C (like citrus fruits or bell peppers) to boost absorption. Avoid tea and coffee during meals as they inhibit iron uptake.

3. Use supplements if needed
   If diet alone isn't enough, your doctor might prescribe oral iron (like ferrous sulfate). Take it with vitamin C, and avoid taking it with antacids. In severe cases or when absorption is poor, IV iron therapy may be necessary.
4. Support your system

• Manage menstrual issues with the help of a gynecologist.
• Check for underlying gut problems.
• Prioritise rest and recovery.
• Try gentle exercises like walking.
• Recheck ferritin levels every 3-6 months.

So if you are feeling low on energy, foggy in the head, or your body's just not behaving as usual, and your tests come back "normal", consider checking your ferritin. 

Disclaimer: This content including advice provides generic information only. It is in no way a substitute for a qualified medical opinion. Always consult a specialist or your own doctor for more information. NDTV does not claim responsibility for this information.