Low iron - possible causes and timeframe to increase it?

[MarklahMarklah]

Was feeling a bit unwell a few weeks back so GP sent me for blood tests for a variety of things. All the scary-looking things came back ok but I was told that my iron levels were "borderline" and a retest was requested.
I got a phone call yesterday to tell me that they had a prescription for me to pick up for iron tablets as my levels were still 'borderline'.

FWIW, my blood iron has been around this way for years - when I was in my late teens, in my thirties and now in my 40's. I have never had anaemia.

I have started taking an iron supplement (not long before the retest) as I am obviously aware that my health is something I need to be careful with.

However, I cannot take iron tablets. They give me, what I'll call politely, 'a loose stomach'. If I take iron syrup or liquid supplements I seem to fare better. I did this after DD was born (I had an emergency CS, lost blood, had a transfusion and had to take a supplement for a while). I had a big row at the time about tablets as they wanted to put me on tablets that were something like 65mg iron per day (I understand daily recommendation for iron intake is approx 10-15g).

I spoke with the surgery and explained I'd just bought a supplement, and that I also had some Spatone (which gives approx 5mg per sachet). I said I would like to use what I had first, and explained about the issue with tablets.

I have no health conditions that showed up on the bloods. I have been vegetarian all my life, but will concede that I don't always eat as healthily as I ought to. I'm working to rectify this. Kale is often on my plate!

Does anyone know how long it might take to 'correct' my iron levels? And what reasons there could be for my iron to be low? I'm not suffering from any physical problems that would suggest anaemia, nor have I ever.

I managed to get my borderline levels up a little when pregnant eating two bowls of fortified breakfast cereal, dried apricots, spinach and spartone I tried to make sure every meal & snack was with iron rich food. But no idea how long it takes to rise.

Many people can't tolerate the cheapest 'first line' iron supplements, so you are far from unusual. When I was at medical school, one of my supervisors was a haematology professor whose opinion was that many many women of childbearing age are in fact iron deficient due to regular blood losses, but the ranges are set too low which means their tests come back as 'normal'. Hope that makes sense! He thought a lot more should be on iron supplements.

A vegetarian diet can make it more likely for you to be iron deficient, and it's good you are aware of this. You probably should supplement. Your GP can try different tablets that have iron in a more easily tolerated form if you speak to her about it?

If you have reasonably heavy periods, that's enough to make you deficient. You should also look out for any change in bowel habit, as polyps, tumours or diverticulitis in the bowel have a habit of silently and gradually bleeding, leading to iron deficiency. That's more common in older people, and those with a family history of bowel cancers, but not unheard of in younger people.

If there are no red flag symptoms that your doctor feel need investigating, you will probably be asked to stay on iron supplements until your levels have returned to normal for at least six months. So I would imagine you should be taking supplements for about a year, give or take.

It's definitely worth asking for another appointment to discuss changing your prescription to a better-tolerated tablet if you have had problems in the past. Taking spatone for a year will set you well on the way to bankruptcy!

Also, if you take your iron tablets with or soon before a cup of tea, or glass of milk (or milk with helping of cereal), it reduces the absorption a lot. Vitamin C helps you absorb iron well, so eating an orange or washing tablets down with orange juice is a good way of maximising absorption. Just a tip!

(Medically trained, although not currently working so my sure what current favourite iron tablets are by GPs these days).

I take ferrous fumarate which increased my hb from 8 to 14 over six months. My ferritin has risen from 4 to 26, so still a bit low so need to take them for at least another three months if that helps.

Thanks all, I have been advised to have a follow-up test in three months.
I think my main concern was given that I have low iron and a reasonably drastic reaction to tablets, I was a bit worried about suddenly taking 3x daily RDA in one hit.

I've got 2 boxes of spatone so I'll work through those and I have a bottle of iron syrup (Feroglobin) which I'll take as per the details on the bottle. I am trying to cut my caffiene intake too, and I don't drink dairy, so I've been having bran cereal with dried fruit in the mornings + soya milk, and a cup of tea. Follow that with just a glass of water and then take my first lot of iron supp with water or juice at lunchtime. I then have tea mid-afternoon and have water/juice with my evening meal which I'm bulking out with kale/spinach/chickpeas/kidney beans and take my second lot of supp.

Today I had a mid-morning juice with spatone. I've just taken my iron syrup.

Only change to bowel habits is definitely iron-related. I'm dairy-intolerant which produces similar, but I can tell by the timings it's the iron.

I'd be happy to talk to the GP next time around about how to naturally get more iron in my diet and I'm happy to take iron supplements in liquid form. Lets hope the next few months will show an improvement. Good to know it can be done, and good to know that it's something fixable.

Periods are erratic in heaviness. I'm at peri-menopause stage so that's not unexpected, but it's hard to determine how much of an effect it has.

I've found some useful online guidelines for upping dietary iron from a veggie/vegan forum so I'll check out some of their suggestions too. I realise that at the moment, not all my meals are iron rich. I'd rather change my eating habits if I can, as I know that cookies (brought over by a visiting friend yesterday) are not that good, but they are so much nicer than broccoli! :)

I'm not sure how long it takes but I had a major surgery last month and had blood transfusion due to low iron and I'm still suffering and very pale / weak but some of that's due to major surgery. I'm hoping iron levels will increase soon

The RDA is for people with normal haemoglobin and iron levels, so if somebody has got to the stage where they have exhausted their back-up iron stores and are anaemic, they need to be replaced, so your requirements are higher than in people with normal levels. Hope that makes sense. Tablets will replace your stores quicker than dietary changes and other supplements, but as your levels are borderline and not critically low, it seems reasonable to take supplements that you tolerate. Nobody will be happy to stick with tablets that make them feel terrible!

Yep agree dietary changes alone are not enough, not unless you are prepared to start consuming tons of haem iron.

You need vit c to absorb iron so it's a really good idea to have it with juice.

Milk intolerance (to the protein, not the lactose) can worsen anaemia so good to avoid that for time being and replace with other non-dairy sources of calcium and fat soluble vitamins.

I'm aiming for a gradual increase in iron intake to get where I ought to be. Fingers crossed!

I'm anemic too and they gave me the same mahoosive dose of iron tablets.

The side effect of going to the toilet 5 times a day every day and the resulting sore arse was worse than being knackered, so I've stopped taking them.

I was told by my dr that 'most' women who are vegetarian and menstruate will have low/borderline iron levels... mine were diagnosed a couple of years ago. I tried the tablets...awful. Had good success with Spatone and Floradix. I now take Floradix regularly, but if I run out or forget for a while I feel the symptoms coming back. My last test was 6 months ago and iron levels back to normal. Hope you feel better soon x

I am exactly the same. I always struggle to keep my iron levels high enough (V. heavy periods). Gp always insists I take prescribed iron but that makes my Ibs so bad. I am getting better with spatone and lots of spinach/watercress and blackstap molasses (I eat very little meat.) It will be a longer process with spatone but just stick with that and an iron rich diet and you should get there. I'm waiting to have endometrial-ablation and am hoping that will sort the anemia out.

I have ridiculously low iron and have had all sorts of supplements and at one point transfusion. It's frustrating as not budging very fast at all. I think spatone usually really quite a low dose compared to iron supplement dose. Take it with orange juice, try to increase other dietary sources of iron, inform GP if you have what you think are heavy periods, cut down on things like caffeine.

I've been given 3 months of iron due to low ferritin (not anaemia) & ive only ever been anaemia post c section due to blood loss (&dilution?). Took 3 doses of the ferrous fumarate & been constipated for a week despite loads of fibre & orange juice & feel awful!
I can run 5k without breathlessness or tiredness so I'm thinking of stopping it & just regularly taking a multivit + iron. I'm veggie too & never needed to supplement previously. I wonder if adding a laxative would affect the absorption of the iron. It's so doing my head in!!

My low iron turned out to be coeliac disease.

Its very unlikely any shop bought ferrous supplements will increase your iron levels (or stores) adequately as the amount in them isn't high enough to provide your body with what it needs normally day to day plus replace that lost. Replacement therapy is normally 200-600mg ferrous sulphate daily and this takes around 2-3 months to get your levels back up to satisfactory levels, over the counter supplements only generally offer 5mg ish so youcan see this is a huge difference and is likely to either not increase your levels or be very very slow at doing so. Depends how symptomatic you are.

There are alternatives to ferrous sulphate tablets if they don't suit you, discuss with your GP (they might not be too fussed re treatment if your borderline) - also check the ingredients as many tablets have lactose in them, as your dairy free this might also be part of the problem.

Hopefully youll feel better soon! X

My iron tablet's are 210mg and I'm supposed to take 3 a day! I am managing 1 a day, and taking floradix as well as increasing iron rich foods.

Out of interest what level are people? My Dr seems to think I have a problem with absorbing iron.

I was found to be dangerously anaemic about 6 years ago to the point they wanted me to have a blood transfusion. Mine was due to erratic periods, some of which were horrendously heavy. I had to have a womb ablation.

I saw this thing the other day called ferinject being used in older people.
www.ferinject.co.uk/prescribing-information/
I'd ask my gp but I'm not actually anaemic (Hb 12.6), just have low iron stores (ferritin 8) so don't think I'd be worth it. More severe anaemia & side effects might be worth discussing with your gp x

I have ME/ CFS & was told by my consultant that my ferritin levels should be 70+ to give me the best chance of reducing fatigue (& getting a life back)
Having a retest next week so hopefully the results will show the effect of ferrous f, spatone, multivitamin, green leafy veg, red meat, eggs etc etc.
Good luck, OP

Minor things:
As vitamin C is good for the absorption of iron, and red pigmentation in fruit and vegetables is an indication of iron content, then drinking red grape juice ( or red wine), and eating beetroot etc with a meal is good.

Also, avoid drinking tea within 90 minutes of eating as this inhibits iron absorption.

I once heard on the radio that in certain Italian prison that had lots of Mafia , the crooked prison doctor gave them iron tablets and bananas, so that their poos looked like they had ulcers, so they would be sent to the hospital from where they could escape more easily!

Have you tried sublingual drops? They can be gentler on your tummy.

Food wise, agree with upping vitamin c, especially alongside iron containing veggie foods.

And curry. Lots of spices, especially cumin and fenugreek, are quite high in iron. So e.g. chickpea and kale curry with freshly squeezed lemon and lots of chopped flat leaf parsley.

Forgot to say that I was prescribed 3 tablets daily which I couldn't tolerate, so reduced to two and then one. My body did seem to adapt to taking them too, so worth persevering I think.

Kale and spinach don't actually contain as much iron as you might think. Better sources for vegetarians include lentils, eggs, dried apricots and black treacle (molasses). Eating with a vitamin C source (e.g. glass of orange juice) increases iron absorption.

To go back to the original & very interesting post -
As well as menstruation, surgical bleeds etc what else can cause low iron levels?
It'd be nice to be able to fix any underlying causes wherever possible.
Thanks.

Causes: many!! But mainly gastrointestinal problems; ulcers, reflux disease, IBD, coeliac, lactose intolerance, absorption issues (including induced by diet/caffiene or medications), chronic inflammatory diseases, some malignancies (normally other symptoms too)