apart from a multitude of symptoms which are ongoing something else that has been nagging me since my last blood results in Sept 20 was the fact that there was an asterisk mark against one of my iron results and i would welcome any input from anyone who understands iron results far better than i do. Some of the symptoms for iron deficiency are Breathlessness, hair loss, light headed, palpitations, fatigue, i am suffering with all of those and more but obviously appreciate they are also classic examples of Hypo but i was just wondering if i might actually be iron deficient as part of my problems, what is a bit confusing is when i have googled serum transferrin it indicates my iron stores might be on the High side which would imply i don't need iron supplementation ?
Serum Iron Level 18.1 (range 14.0 - 31.0)
Serum Transferrin 2.35 (range 2.52 - 4.29) the NHS put an asterisk against this.
Transferrin saturation index 31% (range 20 - 50)
Serum Ferritin 121 (range 22 - 322)
Any advice would be very much appreciated.
Thank you very much.
Steve.
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Iron --- Optimal for the range you've given is 55% - 70% of the way through the range i.e. 23.35 - 25.9, higher end of that for men.
Your iron level is clearly too low suggesting you need more iron.
Transferrin --- Optimal according to that link I gave above :
Low in range indicates lack of capacity for additional iron
High in range indicates body's need for supplemental iron
Your transferrin is way below range suggesting that you have too much iron.
Transferrin saturation --- Optimal is 35% - 45%, higher end of that for men. Yours is too low suggesting you need more iron.
Ferritin --- Optimal for most of us on this forum (and we are mostly female, so discussing low iron with a man is unusual) is around 50% of the way through the range or a bit more, and yours is substantially lower than that suggesting you need more iron. Men generally have higher ferritin than women, so I would suggest that a safe optimal for you might be around 60% - 70% of the way through the range, which would be approx 190 - 230.
Okay, so you have three results suggesting you need more iron, and one - transferrin - that suggests that you have more than enough. This is the same pattern of results that I had when my iron was very low, and I ended up ignoring the low result and supplementing anyway. (It was TIBC that was low in my case, I never had transferrin measured, but they serve a similar purpose in interpreting iron results.) Unlike most people I knew why my iron was low - I had a long-term, chronic GI bleed caused by a large polyp which took years to be fixed. I also have a very strong family history of iron deficiency and anaemia - and that includes a few males with anaemia too, so I suspect a genetic problem.
Ideally, everyone who takes iron supplements should have some idea why their iron is low because in some situations iron supplementing can be dangerous.
Is it dietary?
Are you vegetarian or vegan with low intake of iron in food?
Is it purely caused by low stomach acid (a common consequence of hypothyroidism) and poor absorption from the diet as a result?
Could you possibly have a GI bleed?
Or any of the following - anal fissures, haemorrhoids, ulcerative colitis, Crohn's disease, coeliac disease, non-coeliac gluten intolerance. (This list is not exhaustive, by the way.)
If there is a known reason for your iron deficiency then your doctor should do their best to fix it.
Some people find their iron absorption improves if they try a 100% gluten-free diet.
The most dangerous reason for low iron that I can think of is cancer. Anyone with cancer taking iron supplements would most likely be encouraging the growth of the cancer. The only reason I mention it in this reply is that it is fairly uncommon for men to be short of iron, so it would be helpful to know why yours is low.
I suggest that you do a web search for "causes of low iron in men over 50".
Assuming you decide that you can't live with low iron symptoms and consequences of a deficiency any longer and you must improve your level (which is how I felt)....
For advice on how to supplement and what options are available to supplement with I wrote this reply to another member - ignore the first bits about pregnancy!!!
Please note that the important thing with any iron supplement is not the brand but the iron content. I used maximum dose of ferrous fumarate 210mg for nearly two years because I absorbed it so poorly. But some people can raise their iron from very low to optimal in 4 - 6 months. Don't make assumptions until you have plenty of evidence of your absorption rate. And be aware that dietary changes can change absorption rates. Once I got my ferritin where I wanted it my serum iron was still low, but I just lived with that. I won't deliberately push any iron-related measure above optimal. I want optimal or lower rather than optimal or higher.
Hi, thank you so much for taking the time to reply with such detail and for the links.
I have had a niggling feeling that i might be low on iron for a while but given that my GP said my iron and ferritin were both very good i sort of put it on the back burner.
I am not vegan but cut red meat out years ago and didnt have any issues whatsoever prior to the 3 incidents i suffered 18 months ago that i have previously posted about. i eat a reasonable amount of iron rich foods but its perhaps not enough or i have developed an absorption issue.
I have had a anal fissure for about three years but i only occasionally notice any blood, not sure if that might be part of, or the actual issue..
I know that low iron can cause head hair loss but not sure if it causes eyebrows, arm pit, pubic hair, chest hair shedding and slows beard growth which i am suffering with. the conundrum being if it does cause body hair loss then i am puzzled as to why there is the total contradiction going on of rapid hair growth on arms and legs at the same time as all the other hair loss issues.
I do notice occasional light headedness. I also become a little breathless when i am exerting myself with exercise. My energy levels have dipped generally, and i now find myself with overwhelming tiredness around 9.30-10pm every night and have difficulty keeping my eyes open, i then shut my eyes for around 10 minutes and then i seem to recover and be reasonably ok for the remainder of the evening, its a bit bizarre. Along with all my other symptoms its difficult to know whether its iron or thyroid plus something else or any combination. Not in a good place at all with all that is going on. I will look to start iron supplementation.
I have had a anal fissure for about three years but i only occasionally notice any blood, not sure if that might be part of, or the actual issue..
Presumably the blood is bright red? If people bleed from high up in the digestive tract e.g. the stomach, the blood gets digested and gets darker. The further the blood has to go before it "exits" the darker/blacker it will be. In cases where blood is lost high up in the digestive tract the blood can look like coffee grounds. If blood is lost quite near to the outside world e.g. from piles, the blood will be bright red.
Any loss of blood from the digestive tract could cause problems of iron deficiency with or without anaemia. Anal fissures probably don't cause dramatic blood loss for most people, but it is really up to you to use your own judgement whether you need treatment for it. Obviously if you can keep your "output" soft enough it may give any anal fissures some chance to heal.
I know that low iron can cause head hair loss but not sure if it causes eyebrows, arm pit, pubic hair, chest hair shedding and slows beard growth which i am suffering with. the conundrum being if it does cause body hair loss then i am puzzled as to why there is the total contradiction going on of rapid hair growth on arms and legs at the same time as all the other hair loss issues.
Low iron and ferritin (iron stores) can cause hair loss. Untreated or under-treated hypothyroidism can also cause hair loss.
diogenes wrote a post about the thyroid and hair loss just a few days ago :
As to why your hair loss and regrowth is not consistent, I can't help you with that, sorry. But I do know that hair loss, even when caused by a problem which gets fixed, can take ages to recover from - several months at least.
...
I do notice occasional light headedness. I also become a little breathless when i am exerting myself with exercise. My energy levels have dipped generally, and i now find myself with overwhelming tiredness around 9.30-10pm every night and have difficulty keeping my eyes open, i then shut my eyes for around 10 minutes and then i seem to recover and be reasonably ok for the remainder of the evening, its a bit bizarre.
Quite a few of your symptoms sound like adrenal/cortisol issues. I noticed you talked about tremors in some of your older posts. One description of adrenal issues that I've seen is that people feel they get "internal vibration". This could be caused by low cortisol or high cortisol or a mixture of the two, with low levels at some times of the day and high levels at other times. Cortisol output has a circadian rhythm so it is at different levels at different times in the day.
Those accidents affecting your head that you had a few years ago could have damaged your pituitary, which is the organ that produces TSH. But the pituitary produces lots of hormones, with loads of very important functions, and you could now have several other problems caused by pituitary damage.
If your pituitary is no longer functioning properly it could cause some of your problems because your body is not producing sufficient ACTH and this leads to one type of Adrenal Insufficiency.
Please note that doctors dismiss "adrenal fatigue" as a made up condition but accept that "adrenal insufficiency" is real. Never use the term "adrenal fatigue" to a doctor. They will just dismiss you. With adrenal fatigue the adrenals may be perfectly healthy but they are just "under-performing". If this is your problem then I'm afraid self-help is the only solution. But at the moment you don't have any information on your cortisol output, so you would need to get some info with a saliva cortisol test. I notice you've had information about these a few times in previous posts.
That link above about adrenal insufficiency mentions three types. Doctors will usually test for only Primary Adrenal Insufficiency, when what you probably have (if you have a problem at all) is secondary or tertiary. This makes your situation very difficult, because if you pass the test for primary adrenal insufficiency doctors will just assume your cortisol levels are fine and won't test further.
You should find this document, known as the endocrine bible, helpful
It was written by an endocrinology department to cover all tests that they might perform in a hospital.
See pages 68 - 70 for the "Short Synacthen Test". Notice on page 69 it refers in the Method section to this (my bold) :
0900h: take 7ml blood for cortisol (red or yellow top Vacutainer) and ACTH (purple top, on ice to lab immediately).
Doctors do two stupid things with adrenal investigations.
Firstly they sometimes don't pay attention to the time a test is done - it should be as close to 9am as possible because of the circadian rhythm issue with testing cortisol. The idea for the test is for it to catch cortisol at its highest level.
And secondly, they often won't test ACTH which means they can't diagnose pituitary or hypothalamus problems. You will have to do whatever you can to persuade anyone testing you to do the ACTH test, because otherwise you are probably wasting your time. Unfortunately, doctors claim that secondary and tertiary adrenal insufficiency are very rare. So therefore they won't test, therefore they rarely diagnose it, so therefore it apparently gets even rarer still.
...
I would suggest holding off on cortisol testing until you've got your nutrients and thyroid as close to optimal as you can. Low iron stresses the body, so making cortisol rise. Fix low iron, and cortisol may go back to normal again. The same arguments apply to other low nutrients and/or low thyroid.
The kind of information you can get from cortisol testing is shown in this thread :
And this thread is about someone who turned out to have Addison's Disease (Primary Adrenal Insufficiency) which was suspected after she did a cortisol saliva test.
Thank you very much indeed for taking the time to send further detailed information and links, very informative reading.
I did have a full blood count at the same time as the iron tests, plus 9am cortisol fasting blood test which was 383nmo/L and deemed "Normal" i concur with your comments about adrenals, i need to check those further as well.
Had loads of other tests also which were all deemed "Normal" but i can say quite confidently i am anything but Normal given the numerous health issues!
I am a bit concerned about supplementing iron for obvious reasons, if i decide to have a go its difficult to know if and when i might notice benefits weighed up against am i doing myself any harm but i have definitely taken onboard your observations about 3 versus 1 in iron results.
I think i am definitely going to have to seek the services of an Endo to further investigate possible pituitary damage as the blood tests that were sent by my GP to a local hospital Endo were basic pituitary tests and although he didnt flag anything up i think far more in depth testing is required.
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