Discontinuing iron during virus

[Maldeerum]

I’ve had Covid for the last two weeks and stopped my iron supplements during the infection. Can anyone shed any light on when it is safe to restart supplementing? Many thanks.

[Maldeerum]

Thanks, I’m just tired now post virus. I’m concerned about taking iron too soon if my hepcidin levels are still high after the infection. I can’t find information about when these drop back down. I don’t want my iron levels to drop too low through lack of supplementing but also don’t want unsafe iron storage if hepcidin might still be high. I’ve been unable to find anything out about when it is safe to restart.

[Maldeerum]

That wouldn’t address the hepcidin issue, though.

[FallingInReverse]

hi there Maldeerum - what iron supplements were you on before?

When was your last iron panel and the results, including CRP-hs ?

When is your next blood test coming planned?

[Maldeerum in reply to FallingInReverse]

Many thanks. I had iron testing on 5 Nov and some elements (plus electrolytes etc) tested a week before covid (19 Dec). I’ve got a reading from 19 Dec of serum C reactive protein as 1.2 mg/L (ref 0-4). I’m assuming that’s CRP-hs? Is that right?

The rest of the iron levels:

Serum iron 10 umol/L (14-29)

Tsat 21% in Nov 50% in Dec (due to inc iron)

Serum transferrin 1.95 g/l

Ferritin 64 ug/L (this level is ever changing, dropped from 90 within a month due to slight decrease in iron supp. Usually hovers around 27 if I’m not utterly rigorous about my iron intake. Achieving 90 drove my TSAT to 80% hence the dose juggling)

Haemoglobin 134g/l

My current iron regimen is Three Arrows Simply Heme. Long standing iron deficiency anaemia in the past, iron deficiency thereafter. In the last year I’ve been really trying to get a healthier iron level. Ongoing issues are Hashimoto’s, B12 deficiency (gastroscopy pending so cause as yet unknown but autoimmune issues strongly indicated).

Many thanks!

[FallingInReverse in reply to Maldeerum]

Hi there, sorry I missed your reply!

Well here you are… 2 weeks post Covid.

Did you decide to start your three arrows again?

When I’m sick I stop iron mainly because viruses and bacteria feed on iron to replicate.

I then wait because the inflammatory response throws off all sorts of things… yes, hepcedin, but also thyroid blood tests, etc.

So it’s really waiting until that inflammatory response dissipates, balancing that with the knowledge that going without iron that long would kick up my anemia symptoms.

My rule for starting iron iron again is 1-2 weeks depending on how bad my sickness was.

I usually wait 2-4 weeks until testing anything again ( including thyroid panel).

If you're still feeling post-viral fatigue, that’s probably the best bet that your inflammation lingers and your hepcidin might be raised.

Tsat 21% in Nov 50% in Dec (due to inc iron)

Your Dec tsat% also stands out. I can see you are well versed in the delicate balance that is iron homeostasis… so I’m curious if you are up and down on your Three Arrows every time you test?

I’d be inclined to get a new iron panel before starting, if you can, to confirm CRP is down, and also calibrate your supplements lower to bring that tsat down a nudge.

When you start supplementing again, you can ramp up in the first week vs taking your full daily regimen.