Last week, the 🧃 Does apple cider vinegar actually help your iron? issue took a look at whether simply increasing stomach acid helps you absorb iron.

This is the other half of what can be going on in your stomach: infection.

It’s called Helicobacter pylori, and I was surprised at how common it is. About half of adults have the infection right now, though many without any symptoms.

It can pass from person to person. It’s not caused by stress, spicy food, or anything that you’ve really done.

It doesn’t go away on its own. But, unless you have particularly bothersome symptoms, there’s no real need to treat it.

So, since it’s a reasonable factor to consider if your iron levels aren’t moving, let’s take a closer look at how it works and what you can do about it.

Here’s what caught my eye this week:

📄 Among people with iron-deficiency anemia, depression was on record far more often for women: In 8,593 adults with IDA in a US health system, 23.2% carried a single-episode major-depression diagnosis and 7.2% a recurrent one, with women at 1.52× the odds of men for single-episode and 1.84× for recurrent.

📄 For the women oral iron fails, one or two infusions moved the numbers within weeks: In 30 adults who couldn't tolerate or didn't respond to oral iron, IV ferric derisomaltose lifted hemoglobin by at least 2 g/dL in 81% by week 8, alongside ferritin and transferrin saturation, with four mild adverse events and transient, symptom-free low phosphate in 10%. Note that this is a start: a small, single-centre and open-label, not completely conclusive proof.

🧴 All G launched precision-fermented lactoferrin in the US: This is primarily a story about innovation in supply. It’s hard and expensive to extract lactoferrin from cow’s milk. The Australian company's LFX is a cow-free apo-lactoferrin powder (under 5% iron saturation) aimed at supplements and functional foods, and it has an FDA "no questions" letter behind its GRAS status. (Lactoferrin's iron-regulation and gut/immune claims have solid mechanistic evidence and some clinical work in pregnancy anemia.)

Just sharing here what's new this week. No affiliates, no sponsorships, no freebies. A mention here isn't a recommendation.

Iron from food and supplements is absorbed high in your gut, and your stomach acid is what makes it absorbable in the first place.

Lower the acid, an less iron gets in.

H. pylori blocks iron in three ways at once:

Let’s keep it in proportion.

Most iron deficiency responds to iron supplements — about 6 in 7 cases. It’s the remaining 1 in 7 that has something else going on, keeping iron levels down despite supplementation. And in this case, it’s worth looking at what’s going on in your gut.

And H. pylori is surprisingly common: about half of adults have it, usually without symptoms.

If you do carry it, iron deficiency anemia is meaningfully more likely. The odds run roughly 70% higher. And it’s one of the few causes you can actually fix. After treatment, hemoglobin and ferritin rise.

So it’s not a reason to worry, but a reason to test. A breath or stool test is all it takes.

H. pylori isn’t a women’s infection. It’s about as common in men and its link to iron deficiency doesn’t differ by sex.

What differs is how much wiggle room we have for iron loss. If you’re losing iron ever month with your period, you’re already closer to the edge of deficiency.

That means that the same infection a man might have with no consequence is more likely to leave you fatigued.

So if your iron level isn’t increasing after months of supplements, it’s worth a simple test for H. pylori alongside your next iron workup.

🦠 If your iron hasn't moved after ~3 months of taking it consistently, ask for an H. pylori test during your next appointment. It's a routine, usually-covered test, but a lot of doctors won't ask for it without gut symptoms.

⏱️ Booking the breath or stool test? Come off acid-blocking reflux meds (PPIs) for about two weeks first. They suppress the bug enough to trigger a false negative. If you take one daily, remind your doctor so they can time the testing right.

🔁 Recheck your ferritin about 2 to 3 months after finishing treatment, not before. It's how you find out whether the infection was the thing keeping your iron down.