Returned to the Dr Today as my Ferritin from last weeks blood test results were 16 ( 10-290 )
When I challenged her she said quote “ well it’s a little low but it’s in range and we there fore cannot prescribe an iron supplement ! Really , I said , I had read it should be around 80 ! She reluctantly agreed but kept saying the guide lines say your in range ! Eat more leafy green , nuts , liver etc, etc ! I do that already !
I went because I am so tired even after I wake up it takes at least a couple of hours for me to feel awake enough to start my day ! I use to go to the gym 3 x week and walk at least 2-3 miles 2 x week ! I’m to exhausted most of the time ! Is it my ferritin levels ? Any suggestions of what the most are the best supplement are are tolerable ?
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Oliva1955
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Short answer - yes, your ferritin is causing symptoms.
If you aren’t vegetarian, myself and many others on the board recommend Three Arrows heme supplements.
If you supplement iron, you must commit to regular testing for a full iron panel. Iron is toxic at high levels and if not managed will cause irreversible organ damage.
Hi. My ferritin is 9.5 and I have all the symptoms but attributed it to long covid. My white and red blood cells counts were normal six months ago, but have been too ill to get a full iron panel. I wonder if it’s safe to do take iron in a multi without doing a full blood test.
Serum ferritin level is the biochemical test, which most reliably correlates with relative total body iron stores. In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency.
Never supplement iron without doing full iron panel test for anaemia first and retest 3-4 times a year if self supplementing.
It’s possible to have low ferritin but high iron
Test early morning, only water to drink between waking and test. Avoid high iron rich dinner night before test
Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption
The Clinical Knowledge Summary from NICE was recently updated to say:
Serum ferritin level is the biochemical test that most reliably correlates with relative total body iron stores. In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency.
Since then we have seen the reference intervals for ferritin at a number of labs have had the bottom raised to 30. Which seems entirely sensible. I really don't know how anyone, anywhere, lab worker, biochemist, doctor, or literally anyone else could think 10 or 16 (values we've seen several times) are acceptable.
Even 30 is low, very low.
Allowing lab to lab variation does not, in my opinion, mean 10 or 16 are acceptable.
I personally take the Bisglycinate form, it's non-haem so comes from a plant source. I take it with a vitamin c supplement (to help absorption) on an empty stomach twice per day. I have had to take very high doses to get my ferritin up from 8 ug/L, I was also anaemic. It's taken 6 months to get to around 60 so still have a way to go to get to 80-100 but I am no longer anaemic. It's slow going and takes time especially if you've been deficient for a long time. This type of iron doesn't hurt my stomach whereas ferrous fumarate (prescribed) eventually lead to pain after a couple of months of use. You can have iron deficiency with or without anaemia and even without anaemia, iron deficiency alone can still make you feel terrible.
As others have said, you will need to regularly test your full iron panel to make sure you're not overdoing supplements. This is super important. The ideal is one eats iron rich foods but often this is not enough when one is very low (at 16 you are very low) and supplements are needed to get levels up, then you can maintain with diet. You also need to try to find out the cause of why your ferritin is low - iron deficient diet, eating meals high in the iron alongside vitamins that block absorption like calcium, bowel complaints that prevent absorption such as coeliac, heavy periods. That's just a few, there is quite a list. You are welcome to PM me if you'd like to talk through what I have found helpful and not helpful, I have had to do a lot of learning to be able to help myself.
A serum ferritin concentration of <30 µg/L is the most sensitive and specific test for the identification of iron deficiency in patients with or without anemia.
And yet we see lab references intervals starting at 10, 16 or other values below 30. I find it incredibly hard to understand why such low values are ever regarded as acceptable. No-one can ever be good with a ferritin between 10 and 29, surely?
Exactly, it's beyond belief! I know the 'normal' ref range from my GP changed from 15-250 to 30-250 some point between 2021 and 2022. Maybe it's because iron deficiency is ubiquitous, they like to keep the level very low so as to avoid the need to deal with it, run further tests, prescribe iron tablets or god forbid, refer on to haematology to enable iron infusions. I did not qualify for an iron infusion or referral with ferritin of 8 and anaemia. Not sure what it takes...actual collapse and hospital admission.
What makes that self-defeating is that if they acted at 30, or even just low within the reference interval - say, 40 - then all that would be required for most is a combination of possibly prescribing and advice. Not the cost of infusions!
We get lots who do not realise they can buy many iron products without prescription. Which some are happy to do because of the freedom to choose the product, switch as wished, and adjust when needed.
(We get many who cannot tolerate one product but are fine with another. Handling that is obviously a burden for GPs. But even then proper discussion might avoid some of the issues.)
The only support they need is a blood test from time to time and a touch of friendly support/advice.
Well said! How is it we all know this but the medical profession doesn't. 5 years ago, after a blood test showing iron deficiency, my GP told me 'I can prescribe iron tablets for you but they will destroy your stomach, do you really want to risk that? Your levels aren't that low (12) I wouldn't worry about it too much'. I declined and carried on in my chronically iron deficient state none the wiser of alternatives. If only I had been given options then. What I have learnt is that I have to be my own health detective. I think all of us here know this. Thank goodness for the forums on HU!
Hello Bertiepuss, your post is very interesting, please could you tell me which iron tablets you take? I am vegan and have tried both ferrous fumarate (prescribed for 2+ years) and other supplements but with little improvement so would like to try what you are taking.
Hi thyr01d I take a mixture of Terranova Easy Iron Complex and Avvalabs Iron Bisglycinate. I won't tell you how much I take because it's based on body weight so very individual. You do need a lot to start moving the needle but without knowing what you are doing iron can become toxic and damaging. It really is important to learn how to supplement properly as it's very nuanced.
It has a very comprehensive set of guides (about 3 hours of reading) and this has taught me how to evaluate my own needs and how to take tests to ensure you don't overdo it. I would highly recommended it if you're on FB.
You're welcome Do spend the time reading all the guides, it takes a while to get to grips with it but is well worth going over them a couple of times before implementing the suggestions.
I was the same they won’t prescribe even though I have suffered with low ferritin for years so I asked him to write down a good supplement I could buy which I now do from the chemist speak to the pharmacy hope everything gets sorted it’s the worst feeling fatigue all the time
This is a summary of what I have read up and found out about iron supplements over the past few years. I am not in any way medically trained. You are strongly encouraged to check every detail before making any decisions for yourself.
If you have the gumption refute her each time with "but I have symptoms". After that "what else could be causing my symptoms?" Wait for an answer. If no answer ask if you should seek another opinion. Disclaimer; I'm in the U.S. and permitted to get another opinion. Yours is a disgusting situation that needs pushback. I have no qualms in thinking of the medical paradigm as my enemy but be respectable, even kind since they are also under pressure, as you attempt to save your own life. After decades of errors and dismissals which almost cost my life twice........ the internet came along.
Helvella's suggestion to try over the counter iron is an option. Your genetics may prefer a certain type but hopefully one will offer some relief.
When you don't absorb iron well it may also be the same with a supplement as Dr. Datis Khazzarian suggests.
You could also try Betaine HCL with meals which will add acid for digestion which minerals must have in order to metabolize in your body.
Olivia, I have no credentials and these are opinions chosen from functional doctors I've watched over the years. Feel free to ignore any and all.
30 plus years ago my Dr said "women can operate on low iron levels" my ferritin was 11.
25 years ago, in my 40's my ferritin was 5.5. My Dr called me to the surgery, asked if I had someone to drive me to the hospital and was in for three days with overnight blood transfusions.
15 years ago I told my doctor that I quite simply could not operate on ferritin at less than 30, ( range started at 11) I was falling asleep at my desk in the afternoon, I needed matchsticks to keep my eyes propped open. I was a vegetarian and took the generally suggested vegetarian iron options. I never managed to particularly raise my ferritin levels. I took ferrous fumarate for some years and then relented and started to make my own chicken liver pate, retested ferritin was at 176. Stopping the pate and ferrous fumarate, within a a year I was back where I started. I now, despite my disgust at the thought as I have not eaten red meat in 45 years, take freeze dried beef liver. My ferritin doubled very rapidly, so much so I have had to cut back to keep my levels in the 70 -100 range. This is a summary of 30 years dealing with low ferritin (and hypothyroidism).
My brain tells me I want to be a vegetarian, but my body tells me otherwise.
My daughter had been a vegetarian for 30 years, her test results for ferritin have come in today at 6. She is hypothyroid: history repeats itself!
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
Do spend the time reading all the guides, it takes a while to get to grips with it but is well worth going over them a couple of times before implementing the suggestions.
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