Can someone please talk to me about ferritin levels...

[Springgrowth]

I have Googled this a bit, plus read some previous threads on here and I'm none the wiser, so if someone knows about this I'd appreciate an easy explanation. There are also two of us who have issues

DD17, always tired, always looks quite unhealthy but has some underlying health issues plus ASD, ADD so some of the tiredness could be put down to her neurodiversity. She sleeps deeply as far as I can tell and never avoids sleep - always happy to toddle off to bed by 10pm. She is on the pill for heavy periods so only has a bleed every 3 months or so. Her diet is pretty poor (ASD) though she does eat red meat. Her recent ferritin level was 5 so she has just finished 3 months of ferrous fumarate to bring her ferritin back up to 15.

My question is, now that she's finished the course, won't her ferritin just drop down again? And isn't it a concern that a 17 year old meat-eater who doesn't have periods has such a low ferritin level? I queried this with the GP and she just said to come back to the doctor's if she has any symptoms of low iron. However, last time, although DD had had a few dizzy/fainting episodes, (the fainting episode which ended in an ambulance to hospital due to potential head injury didn't even prompt any form of investigation) and the blood test was actually just a routine LDs check-in with the nurse.

Issue number 2 is me. Perimenopausal, 48yr, vegetarian for 35 years but healthy diet although obviously only plant sources of iron, still regular and heavy periods. I've been to the GP four times now querying peri symptoms (poor sleep, fatigue, hair loss, disappearing eyebrows, itchy scalp, restless legs, anger, PMT). I've had bloods done for potential thyroid, all okay and my ferritin was 13. I was told this was fine. Most recent appointment was a menopause clinic when the Dr said ferritin needs to be 70 for hair growth. I've been prescribed contraceptive pill as a half-way house to HRT but nothing for iron levels. Both me & DD take OTC multivits. Is there something we can both take which will help as it seems like a minefield and I don't really know what I'm looking for? Or should I just buy ferrous fumarate online for DD? I do feel like we're just supposed to crack on feeling like shit until there is some crisis...

sorry that was so long!!

Your ferritin needs to be in the region of 75-100. Oddly labs seem to set normal ferritin at 30 and I wonder whether this is based on old evidence. The amount of iron in a multivitamin & mineral tablet is unlikely to significantly improve your ferritin level. I would ask the pharmacist what they’d recommend, I think you can buy ferrous sulfate over the counter, and definitely spatone.

Also worth knowing that dairy and caffeine can inhibit absorption of iron, and so should avoid for an hour before and two hours after an iron containing meal or supplement.

Thank you, I had read about the dairy but I didn't realise about the caffeine until recently. I'm mainly decaf but I am a big coffee and tea drinker!

as ever, bloods need interpreting in the context of the whole picture (and for your DD the important things are probably the 'underlying health issues' and when she started taking the OCP and if she's still just catching up from iron deficiency due to the heavy periods. If that's all that was causing it then it's not beyond the realms of possibility that her iron stores will recover now she's not haemorrhaging monthly, but the advice needs to be from someone with access to the whole set of results and medical history).

The whole 'ferritin must be 70' thing is probably true for some people, but really isn't for others and the wide normal range just reflects that some of us really are fine with low iron stores (for comparison, am a 40 something yr old, perimenopausal (currently gifted erratic but mainly heavy periods) veggie and my ferritin's been under 10 for the last couple of years... I only had symptoms when it was down to 5 and associated with a mild anaemia). If you feel better when it's higher, then keep it higher (you can buy FeSO4 tablets or lower dose iron supplements easily). Would have thought that if the doctor who told you it should be higher didn't prescribe any iron supplements then they can't think it's a massive problem?

I could have written most of your post, except dd is 19, suspected ADD but not ASD and I'm not a vegetarian!

I was prescribed iron years ago, but didn't take it because it played havoc with my already dodgy digestion (undiagnosed gluten and dairy intolerance). I now take a Wellwoman 50+ supplement (which has iron but I can tolerate it), ashwagandha and a probiotic, all of which have made me feel much better from various perimenopausal symptoms too.

Interestingly though, after little action by dd's home gp, she's switched to a gp at uni, who is investigating her for underactive thyroid, which apparently not only has similar symptoms to anaemia but can actually cause it.

Ah I’ve also just remembered that the tannins in tea can also reduce absorption so sometimes even decaf isn’t going to help!

Ferrous fumerate 630mg a day is what I've been on for a year (buy on line ) as ferritin was 5. I felt atrocious, couldn't function at all, had every test under the sun to find out the problem. I get so angry on people's behalf when GP's just fob off patients with such low ferritin.

Also check folate.

I take ferrous fumerate every other day with 1000mg vitamin c fizzy tablet. Both cheap to buy, and taking it every other day decreases any side effects
my ferritin is 66 but my saturation is 14% so the GP advised me to take it

Just keep taking the iron every other day. You can buy it very cheaply.

My ferritin and folate were low for many years. Hb was good. Later on, l became anaemic and was diagnosed with Coeliac disease. I had not had any of the classic symptoms of Coeliac. Possibly worth checking this?

Sound advice

OP- Sorry, this is long. You've mentioned the ferritin levels, but what was the Hb? Ferritin is your store of iron, where as Hb measures your current level. Normally, a full blood panel is taken because 1 reading on its own doesn't provide a full picture. Also B12 levels and iron saturation are normally checked. I eat meat, but in my early 20's had a ferritin of 2 and an Hb of 8. I was going out too much and just not eating well. I did a great deal of reading up on anaemia afterwards.

Meds and iron rich foods are absorbed easier with a Vit C rich food as orange juice, peppers, kiwis etc. Tannin rich food/drinks will decrease the absorption, so avoid tea/coffee/wine/grapes/berries when taking meds or eating meat. Another supplement called spirulina, is a blue-green algae high in iron and comes in tablet form. Its not a substitute for iron supplements, but could be used in addition to get levels up.

When did she start on the pill? Red blood cells take 3mths to replicate, so changing diet and starting iron pills isn't a quick fix to a deficiency. You said DD does eat meat- but how much and what type? I started eating liver/bacon/onion, more lamb and steak and anything rich in iron.

There is a big difference between iron supplements to correct a deficiency, those that help maintain a normal level and then there are things like spatone. People on these threads always say spatone is a gentler iron supplement, but that is because it only contains 5mg of iron and is the same as filling a swimming pool with a teaspoon! Its only of any use for someone with a perfectly normal iron level, who also already eats well! For comparison:
Spatone- 5mg iron
A multivitamin with iron- 14mg iron
Ferrous Fumurate- Depending on the dose/strength, could be 70- 210mg iron

Unlike other vitamins like Vit C which you excrete (wee) out if you have too much, iron builds up. I'd only be taking a corrective, high dose if prescribed.

I too was going to ask about any intolerances, coeliacs etc. Did DD's Hb also improve after the 3mths of supplements?

Interesting about the tea. Dd and I both drink a lot of it!

Take a high dose of vitamin C (1000mg) with every dose of iron - is essential for iron absorption and also helps alleviate any gastric side effects from the iron.

Also, Vitamin B12/folate and Vitamin D are key. They along with iron are used together in many body processes, so if you take more iron those processes start up again and then deplete your B12 and D levels with similar symptoms to low ferritin. If you have a deficiency in one you should really supplement all three to get the best results.

And finally, it’s a long term thing. Three months is not enough, think years. But you can buy ferrous sulphate from any pharmacy, and there are also different forms of iron (heme) that you can take that some people claim are better, but hard to get in the UK and not suitable for vegetarians.

My daughter had ferritin levels of 11 and lower and was white and unable to function. She can’t take oral iron and received an iron infusion which made a massive difference

It has to be supplementation, you won’t increase or maintain levels with a diet of any sort. Lots of good advice above about how to go about it. I find the spray supplements don’t cause constipation

You both still have very low ferritin levels. Keep taking the supplements. I took supplements and went for a blood test every 3 months. It took 15 months before my ferritin was back above 50 micro g/L (from < 5). My GP told me that the life of a red blood cell is about 3 months, so you have to take supplements for at least that long. I am a post menopausal veggie, but I still take supplements. I no longer go for blood tests every 3 months, but I donate blood 3 times a year, and always pass the blood iron test then!

The the meat-eating non-periods teenager though, I'd query why she's not absorbing iron.

Thanks all, sorry I've been out all afternoon! Interesting re. the tannins and disappointing as I love my tea!

I'll look into the coeliac thing. Don't know much about that so I'll have a Google. DD has been running her pill together for about 9 months so I would've thought that would be long enough to recover from heavy periods? She eats beef mince, steak, sausages but obviously as I'm vegetarian we eat a lot of non-meat meals, but plenty of pulses. To be honest, she is an incredibly picky eater so pushes decent food around her plate whilst eating junk and sweets at college.

Re. me, I'm knackered but not faint, dizzy, breathless etc. But I don't sleep well so maybe I'm just tired from constant lack of sleep? And the hair loss is every time I wash my hair but it's not like I have bald patches, just very thin hair compared to how it used to be. I've been refused blood donation a couple of times due to failing the iron test but both times were during my period.