Help with supplements please!

[luckyed]

Hello all,

I was hoping for some advice about supplements. Last week I had some great advice from SlowDragon , SeasideSusie and humanbean after my last blood tests. In summary: Low Ferritin at 24 (range 10-291), but blood iron and rest of FBC fine (apart from high % hypochromic cells), B12 good at 874 (range 211-911), but Folate low at 6.07 (3.38-23.9).

I have now spoken to my GP – I sent her a 3 page document in advance of our call summarising all that I’ve learned on this forum about vitamin levels and how it affects someone with thyroid issues. Thankfully she was amazing, and actually thanked me, saying she was learning through me! How refreshing to have someone who listens (unlike the endo)! (I had to wait for an appointment with the one GP at the surgery who I though would listen, and I’m so pleased I did!)

Anyway, she has now prescribed me 2x 210mg Ferrous Fumarate daily for a month, then to recheck Ferritin levels to see if it has made a difference, but also to check blood iron to make sure that is not being pushed up too high (currently at 20.2, range 12.5-25). (I read your post about the dangers of supplementing @humanbean, so I am pleased that my GP suggested the rechecking after 1 month). She has left it to me to sort B vits and Folate, as she would only have been able to prescribe Folic Acid.

I have been looking for a B-Complex with lower levels of B-12 (as suggested by @SeasideSusie, as my level is already at the top end, and have now come across one with no B12 or Folate (seekinghealth.com/products/..., and then I thought I would add in my own Folate (uk.thorne.com/products/dp/5.... Does this sound like a sensible idea?

Also, I am aware that the iron tablets prescribed may not be the best option – when I was pregnant I took liquid Spatone as a more easily absorbable option, and I have also seen spray versions available. I am conscious of how to fit this all in to the daily schedule, around the Levothyroxine (which GP has also agreed should be upped to 50mcg daily. FT3: 4.2 (range 3.5-6.5), FT4: 15 (range 11.5-22.7) ).

Am I right in thinking that Iron should be kept 4 hours away from Levothyroxine and other supplements? Should iron also be on an empty stomach?

If I take my Levothryroxine (and hydrocortisone) at 6am, then have breakfast with B Vits and Folate at 8am, then I could have the iron (with some vit C) at midday, an hour before food? (GP said to take 2 iron tablets per day to begin, so the next one at 4pm?? And I have Vit D as a spray, so I can have that at any time as it’s a spray? Does that mean that if I got a spray iron, that this could be any time too? Sorry for all the questions!

Last question. I have been using Better You DLux oral spray (3000 IU), but I read on here about having K2 with vitamin D and have seen Better You do a Vit D spray with K2. Would this be a good idea?

Thanks so much for your help.

[humanbean]

Also, I am aware that the iron tablets prescribed may not be the best option – when I was pregnant I took liquid Spatone as a more easily absorbable option, and I have also seen spray versions available.

Always bear in mind that an important thing to know about iron supplements is how much pure iron they contain. Spatone contains 5mg iron per sachet. Each individual pill of ferrous fumarate 210mg (FF210) contains 69mg of pure iron per pill.

I took FF210 tablets, one tablet three times a day for about 21 months to get my ferritin up to mid-range. My serum iron improved but was still quite low in range. I really, really don't absorb iron well at all. I tried Spatone but actually ended up with my iron and ferritin levels dropping.

With any iron supplement the dosage is very important but it is also important to be able to absorb it.

I still take FF210 now, but I only take one tablet about four days a week. It keeps my ferritin reasonably close to optimal.

Something to bear in mind - there has been recent research that suggests that taking iron supplements on alternate days is helpful. I've never tried this myself, but it is worth knowing. I don't know if this research has been replicated. I don't think it has made it into any treatment guidelines for iron deficiency that I'm aware of.

Iron absorption from oral iron supplements given on consecutive versus alternate days and as single morning doses versus twice-daily split dosing in iron-depleted women: two open-label, randomised controlled trials

sci-hub.tw/https://doi.org/...

If you struggle with absorbing iron or tolerating iron supplements it is worth trying some alternatives.

Ferrous sulfate has roughly the same quantity of iron as ferrous fumarate, but based on comments on this forum fewer people seem to tolerate ferrous sulfate than tolerate ferrous fumarate.

Ferrous gluconate contains roughly half the pure iron of ferrous sulfate and ferrous fumarate.

See the table on this link :

bnf.nice.org.uk/treatment-s...

The higher the dose of pure iron in an iron supplement the fewer people tolerate it.

There are also over-the-counter iron supplements such as ferrous or iron bisglycinate which contains between 15mg and 25mg of iron per pill (but check the packaging to be sure). Sometimes this is referred to as "Gentle Iron". A translation of that is "doesn't contain much iron".

Then there is Floradix which some people like (I've never tried it), and Spatone (which never did anything for me but helps some people).

It is also possible to supplement actual ferritin rather than iron, but it is hard to get hold of in the UK, is expensive, and is usually imported from the USA. I've never tried it myself.

If you want to improve your iron levels with food take a look at this link :

dailyiron.net/

And a final link :

dropbox.com/s/g8y4e7alm5ow0...

[humanbean]

Am I right in thinking that Iron should be kept 4 hours away from Levothyroxine and other supplements? Should iron also be on an empty stomach?

Yes, take iron four hours away from everything else, and this is particularly important with thyroid hormones. Iron supplements can block absorption of so many things, including thyroid hormones.

As for taking it on an empty stomach...

When I was first prescribed FF210 several years ago the Patient Information Leaflet (PIL) said to take it on an empty stomach. I simply couldn't tolerate iron that way so I started taking it with food. It must have reduced my absorption, but I had no choice but to accept that because it was the only way I could get iron into me and I was desperately short of it. I didn't know very much about iron at the time, nor did I know about all the other options there were.

I don't think that the PIL for iron supplements mentions taking it on an empty stomach any more. But I could be wrong. Just take it whichever way you can tolerate it.

[luckyed in reply to humanbean]

Thank you once again humanbean

that's really helpful. The PIL doesn't say anything about taking on an empty stomach, in fact it says "taking with meals may help to relieve any stomach related side effects". I think I'd just read it somewhere. I'll see how it settles!

[jsy_girl]

I’ve definitely read elsewhere on here about the benefits of taking vitamin D with k2 and now take that same better you mouth spray. It helps how your body absorbs and uses calcium I think.

Also sounds every sensible on the b vitamins front. I am going to take a glucose optimiser b complex which doesn’t have folate in so was going to also get the Thorne one as it’s a very good brand.

[luckyed in reply to jsy_girl]

Thank you jsy_girl . I'll go for that D with K2 spray. Yes, I've read quite a few people on this forum mentioning Thorne. I haven't heard about Glucose Optimiser...I feel about green, there are just so many options/combinations, the mind boggles a bit!!

[jsy_girl in reply to luckyed]

Oh I’m taking that because I have PCOS with insulin resistance as the cause so I’m taking several supplements to improve my insulin sensitivity and balance my blood sugar. So don’t worry! Haha.

Yes Thorne looks good. Going to get my ferritin and folate levels checked end of month with my next thyroid function test and will go from there

[luckyed in reply to jsy_girl]

Ah, I see, that makes sense. Thank you, it feels like there's so much to learn to manage your own condition. Thank goodness for this forum! 🙏🏻😊

[jsy_girl in reply to luckyed]

Yes I feel exactly the same. Has helped me so much and great not to feel alone with the struggle