How much iron

[rideaway]

How do I know how much iron to take? What about iron toxicity that I read so much about?

[SueJohnson]

You first need to have your ferritin checked to see if you need iron. When you see your doctor ask for a full iron panel. Stop taking any iron supplements 48 hours before the test, fast after midnight and have your test in the morning when your ferritin is lowest. When you get the results, ask for your ferritin and transferrin saturation numbers. You want your ferritin to be over 100 and your transferritin saturation to be over 20% but less than 45%. Improving it to that helps 60% of RLS patients. If your ferritin is less than 75 then take 325 mg of ferrous sulfate with 100 mg of vitamin C or some orange juice since that helps its absorption. Take it every other day at least 1 hour before a meal or coffee and at least 2 hours after a meal or coffee since iron is absorbed better on an empty stomach and preferably at night. If you have problems with constipation switch to iron bisglycinate. If your ferritin is between 75 and 100 or if your transferrin saturation is below 20, you may need an iron infusion since iron isn't absorbed as well above 75. If you take magnesium take it at least 2 hours apart since it interferes with its absorption. Don't take tumeric as it can interfere with the absorption of iron. It takes several months for the iron tablets or iron infusion to slowly raise your ferritin. Ask for a new blood test after 3 months.

[PoorRichard in reply to SueJohnson]

To complement Sue's protocol, in my case, my ferritin was just over 100 when I started the oral iron (iron bisglycinate 25mg, brand "Gentle Iron" - Amazon, et al.) and it helped me a great deal. In combination with dietary changes I was able to manage RLS without drugs - no gabapentin, no nothing - except iron and diet (see Eryl re: low inflammation diet). After 3 months, I had another blood test. My ferritin was over 275 at that point, and my sleep doctor recommended reducing iron supplement from every other day to 1 per week. It's two months later, and I'm on a reduced frequency, but still more than 1 per week because RLS returned. My primary care doctor scheduled another blood test at 3 months (a few weeks away) so I'll get an update on my ferritin level soon. All this to say, you should be able to easily determine any toxicity trend long before it's an issue. Clearly 100 ferritin is too low for me. Follow Sue's advice.

[SueJohnson in reply to PoorRichard]

I suspect you meant this as a reply to rideaway. You might want to copy it over as a reply to her so she will get a notification. That is great by the way that you are able to do without drugs.

[rideaway in reply to SueJohnson]

Iron is 345 so I guess I can't solve my RLS that way.

[WideBody]

There have been some excellent comments so far.

First, please do a morning fasted full iron panel first. Supplementing with iron will skew the numbers heavily. Let your doctor know you have been supplementing with iron (if you have). According to Johns Hopkins Restless leg foundation.

"Since the 1950s, it has been known that iron therapy, even without the presence of anemia has benefits for RLS symptoms. Studies have shown a strong relation between body iron stores as determined by serum ferritin and the severity of the RLS symptoms. A study has shown that in patients whose serum ferritin was < 75 µg/l, oral iron therapy (325 mg ferrous sulfate twice a day on an empty stomach) on average improved RLS symptom after 3 months. "

I would not worry about iron overload unless you have hemochromatosis. If you do have hemochromatosis, I would think it would be known by now.