Before You Decide It Isn't Working

Most of us have a cabinet somewhere with a few bottles in it we stopped taking. One we finished, one we quit halfway through, one we can't remember buying in the first place. And not one of them ever really got a fair shot, because nobody said what it was supposed to do or when we'd know.

That's usually how it goes when you've been told your numbers are right where they're supposed to be and you're still tired, still losing more hair than you used to, still not feeling like yourself. A lot of the women I work with have been told exactly that. And when nothing turns up on a panel, there often isn't anything to come back for. There's no follow up visit put on the calendar, nothing scheduled to check it again later, and no next appointment where someone asks how it's been going.

So they went home and started working on it themselves. Maybe they cut something out of their diet just to see what would happen, or they started walking in the evenings, or they started taking whatever it was a friend or influencer online swore by. Some were already on something a provider had put them on a while back and told them to keep taking. I don't blame the instinct one bit, and a lot of the time it's the only move left. The walking and the food I've got no argument with at all. What I would say about the rest of it is that running low on something isn't an answer by itself. It's the start of a question, because something put you there, and taking more of it doesn't tell you what's using it up.

And there are many women who've taken to doing all of it on their own now, without anyone to tell them what to expect, so a few weeks in they can't really tell whether any of it is helping in the first place.

When I start someone on something, I don't bring her back the next week. I leave a couple of weeks, because she needs time to actually put it in place. Ask too soon and she won't have anything to tell me yet, and then she walks out thinking it didn't work. If you're doing this on your own, nobody is setting that timing for you, and the checking tends to happen whenever the question occurs to you. So what I'd want you to know first is that when you're rebuilding something you were actually short on, you're not waiting on your body to fix what it's already got. You're waiting on it to build something new, and that takes longer, for reasons that have nothing to do with whether you're doing it right.

The cells you already have

Red blood cells are where I'd start with this, because they show it better than anything else in your body does. A red blood cell has one job, which is carrying oxygen, and it's built to do that job as well as it possibly can. It starts out in your bone marrow, which is the soft tissue down inside your bones, and on its way to becoming a red blood cell, it throws out nearly everything else it was carrying, including the parts that every other cell in you uses to make repairs. Within a day or so of going out into your bloodstream it's finished, and what's inside it is hemoglobin.

Hemoglobin is one of those words most of us have heard for years without anyone ever explaining what it actually is. It's the protein that holds onto the oxygen, and the red blood cell is really just the container carrying it around. Iron sits right at the center of it, and the iron is what grabs the oxygen and then lets go of it again once it gets where it's going. So no iron, no hemoglobin. And hemoglobin is the number they're looking at when they tell you whether you're anemic.

However much got packed into that cell is the most it's ever going to have. So if you were running short on iron while it was being built, there was never enough to finish filling it, and it stays that way. And it's not that your body gave up on that cell, because it does still look after itself in small ways. What it can't do is build anything new, so the hemoglobin it came out with is the hemoglobin it's stuck with.

So the fix was never a repair. It's that cell finishing its run and a better one going in behind it. A red blood cell lasts somewhere around four months, and building a brand new one only takes about a week. Your body isn't slow at making them, and once it finally has what it needs it makes them faster than usual. The old ones just don't leave until their time is up, so the change comes in gradually as they work their way out. The underfilled ones don't tend to last as long as the healthy ones either, so you're not waiting on every last one of them.

And there's a stage in the middle of this where you could actually see it happening, if you put a drop of that blood under a microscope. In someone who's been treated for low iron, you'd find two different kinds of red cells sitting right next to each other. Some of them are small and pale, because those were built back when the material was short, and the rest of them are full, because they were made after. Same drop of blood, both kinds in there at the same time.

What the lab is actually looking at

Your body keeps a lot of what it runs on in two different places at the same time. Some of it is out circulating, doing today's work, and the rest of it is stored away where it can be pulled from later. Iron does this, and so do the vitamins that get stored in your liver and in your fat. When you start running short, your body looks after the circulating supply first and takes what it needs out of storage to get through the day, which is exactly what you'd want it to do. But it means the stored part is the first thing to run down and the last thing to build back up. So your number looking normal and you actually being stocked back up are two different things, and there can be months between them.

And this part matters even if nobody is running a single test on you, because the things you'd actually feel are the ones that get taken care of last. Go back to iron for a minute. Your blood was never the only thing using it. Your muscles need it too, your heart does, and so does your brain, which needs iron to make the chemicals it runs on. So when you're running short, your bone marrow ends up getting first pick of whatever is there, because keeping oxygen moving comes ahead of everything else. What that leaves you with is your muscles, your heart, and your brain standing at the back of the line, and those are the things you'd actually notice. So when you tell me nothing has changed, you might be completely right about what you can feel and still be reading it too early.

How long the rest of it takes to catch back up is a much murkier thing. We can watch the blood come back because we can measure it. With the muscles and the heart, mostly what we have is people telling us how they're feeling in the months after, and that isn't the same as knowing what's gone back into the tissue. It's slower than the blood. That's about as close to a number as anyone can get you.

What I can't tell you from a lab result

The question I get more than any other is how long this is going to take. It doesn't much matter what we're working on either. Whatever we're trying to fix, people want a time frame on it. And I understand that. If you've felt poorly for years, of course you want to hear that two weeks from now you'll be feeling better.

I don't have a crystal ball though. I can't look at someone's lab work and tell them the day they're going to feel normal again. Everyone is different, everyone responds differently, and what I ask people to do gets put into practice differently too. So I try not to pin anyone to a date. Because if that day comes around and things still aren't where we wanted them, that's usually when someone decides it isn't working and stops. Sometimes they're right about that, and it's the point where we change course. But sometimes it was working and we hadn't gotten far enough in yet to see it.

What I'll give instead is a range. When we're supporting your body consistently and taking away the things getting in its way, we usually start seeing meaningful change somewhere in the six to twelve week window. For women who have been struggling for years, it can be several months before they feel like themselves again. It doesn't happen all at once, and it rarely happens in a straight line.

The other thing I do is take the question off them entirely. When a woman comes back in to see me, I'll usually smile and ask her to tell me everything that's different since I saw her last, not just the one thing that brought her in today. I ask it that way on purpose. Left to ourselves, most of us answer that kind of question with a verdict, better or not better, and we tend to make that call on whichever one thing we've been keeping score on. The whole list tells me more, and it tells me more in both directions. Sometimes something has improved and she hadn't counted it. Sometimes something has gotten worse and she wasn't going to bring it up.

What I'd want you asking

None of this is a reason to sit on something that's getting worse. Knowing when something needs looking at right now matters just as much as knowing when you've got room to be patient with it. If you're getting worse instead of better, or something new turns up and won't ease off, that's your reason to go back in, whatever anyone told you last time. And if something comes on fast or comes on strong, none of this applies to it. That isn't a wait and see, that's a call your provider today.

And staying exactly the same counts too. Months of nothing moving isn't a reason to keep waiting it out. Usually it means whatever's behind it hasn't been found yet, and that's worth another conversation with your provider, even if the last one came back clear. It usually isn't a sign that anything failed. It's a reason to go looking again.

What I don't want is for this to turn into one more thing that didn't work for you. That's how some people end up stopping altogether, and usually without ever really deciding to. The prescription just runs out and it doesn't feel like it's worth ordering a refill.

I'm not asking you to come and see me. What I'd rather is that you knew the questions to ask whoever you do see. Ask what it's meant to be doing for you, and ask how long before you'd expect to notice anything at all. Those are two ordinary questions and you're allowed to ask them of anyone who hands you something to take. And if the answer is longer than you were hoping for, at least it's an answer, and you're not sitting there at six weeks wondering whether you're the reason it hasn't worked yet.

Disclaimer & A Note from a Caring Practitioner:

My goal is to translate complex wellness concepts into relatable ideas to support your journey. The explanations I provide are simplified models intended for general education and motivation, based on both clinical patterns and established wellness principles. They are not complete medical explanations, diagnoses, or personal advice.

Every person's body is unique. Your individual health needs, experiences, and underlying conditions must be evaluated by your own healthcare provider. This information is educational only and is never a substitute for professional medical consultation, diagnosis, or treatment. Always partner with your personal healthcare provider before making changes to your health regimen.