Recovery from iron deficiency

[Popcorn76]

I am wondering what the best way to recover from iron deficiency is.

I have always had quite low ferritin but with no symptoms. I had a mirena fitted 9 weeks ago and for the 1st 8 weeks had a mix of heavy bleeding and spotting which I think depleted my iron.

The first sign I noticed 2 weeks ago was heart palpitations and not sleeping past 3 am, feeling very wired like I was running on adrenaline. My RHR went up 10 points and my HRV dropped to 17.

I had an iron test last week which showed my ferritin was 32 but my TSAT was just 13%. Serum iron was 8 and serum transferrin level 2.31. My haemoglobin was on the low side at 125 but not anaemic.

I started taking solgar gentle iron 2 capsules 40mg 5 days ago and in the last 2 days have slept much better and my RHR has stabilised and HRV increased a little to 25 but my body feels so achy and tired. ChatGPT seems to think this is the normal recovery process as oxygen gets into tissues and adrenaline and cortisol drops and I will feel worse before things improve, but I was wondering if this is others experience?

I was also wondering if this dose is ok, should I be taking the 20mg stated on the bottle or take it every other day?

I already get iron 20mg in my multivitamin but I have been on this for a year and it does not seem to do much, possibly because the other minerals in it block absorption?

Any ideas on the best strategy to boost iron? I am waiting on GP advice but it takes a while. Alongside the solgar I an upping vit c, taking away from calcium and having more red meat in my diet. I seem to be getting slightly looser stools today so wondering about dropping to 1 solgar.

40mg isn't very much, ferrous fumerate or sulphate are over 200mg. Take with vit c every other day and avoid tea/coffee/dairy either side.

Have you read the NICE guideline?

• In all people, a serum ferritin level of less than 30 micrograms/L confirms a diagnosis of iron deficiency. Low levels of ferritin can result in symptomatic and functional impairment even in those individuals with a normal haemoglobin, especially in women who are menstruating.

A serum ferritin concentration of greater than 100 micrograms/L may not rule out iron deficiency anaemia, but a result greater than this level should be interpreted in addition to other iron studies.

it will take a lot longer than 5 days to get your ferritin up to 100 where it should ideally be especially as the iron you are taking is not super strong. Have you previously tried ferrous fumerate 210mg? That’s what I take and I take two daily. It increased my ferritin by 50 in three months.

although I saw a big improvement in my ferritin, my haemaglobin only went up by 9 from 123 to 132 in the same three months and I was also taking high strength B12 and a multivitamin with folate in it. To make haemaglobin your body needs iron, B12 and folate. Did your GP test those? Do you take multivitamins as well? Do you eat meat?

https://cks.nice.org.uk/topics/anaemia-iron-deficiency/diagnosis/investigations/

Thanks both. @Choux I realise my ferritin is normal under the NICE guidelines but the TSAT is below the reference range.

The Solgar Bisglycinate 40mg is meant to be equivalant to 200mg ferrous sulphate or 120mg ferrous fumarate but without so many gut side effects and impact on hepcidin.

I eat read meat 3x a week and lots of fish/chicken other days. My B12 is 530, folate 8.9.

I am pretty sure the low iron was caused by blood loss which has stopped now.

My ferritin has never been above 50 and it is only recently I have had symptoms. I think because my TSAT is so low now. It used to sit at 30%.

What makes you think you are taking the same amount of elemental iron as in other types? The novice guideline I posted has a page showing 2 x 210mg ferrous fumerate (the dose I take daily) is 130mg elemental iron. You are taking 40mg and already considering halving the dose.

You ask for the best strategy to boost your iron. The best strategy is to take as high a dose as you can comfortably manage with vitamin c to aid absorption. @EuroTour is correct that some research has shown every other day is as effective as every day and you need to avoid tea, coffee, dairy for 2 hours before or one hour after.

The faster you can get more iron in your body, the faster you should start to feel better.

Your TSAT is low because you don’t have enough iron.

Transferrin is the major protein in the blood which binds to iron and transports it round the body. This TSAT test measures how much this protein is 'saturated' by iron.

Low transferrin saturation levels can indicate iron deficiency as it means that very little of the transferrin is saturated with iron. Iron deficiency can be caused by blood loss (gastrointestinal bleeding or menstruation), lack of dietary iron, or pregnancy. Inflammatory bowel conditions can also cause low iron through malabsorption.

Sounds like your blood loss is under control now so now you need to improve your dietary iron with supplements and as much iron rich food as you can.

Don't waste time on red meat. eat liver, pate, faggots, kidneys . You need offal.

My pharmacist recommended Spatone sachets which taste like a shot of apple juice. My daughter took them too and said she was feeling significantly better after just a few days. You can buy them in Boots, Holland & Barrett etc. Might be worth a try.

Spatone is nowhere near high enough to make any difference to OP

I had iron deficiency anaemia for 15 years. I finally gave in and had a Mirena and have never been anaemia since.
However, you need to give the Morena a chance to settle and sort out your periods.
In the meantime, get yourself on Ferrous Sulphate for 3 months then retest.

Iron IV infusion if funds allow?

This. On an empty stomach and only every other day. My ferritin went from 13 to 118 in 6 months.

Did people build up to the higher doses slowly? I am getting diarreah on just 40mg. I switched to every other day (didn't take any yesterday due to the diarreah) and slept much better and did not get the body aches today so am wondering if I should just build the iron gradually.

Yes I am hoping I am over the worst of it now, 10 weeks into the Mirena and the bleeding has stopped now so just need to rebuild the iron.

What is the advantage of Ferrous Sulphate over bisglycinate? Everything I have read says bisglycinate is absorbed better with less side effects.

@Popcorn76 I never had any side effects from iron, though I believe it can cause constipation. I eat tons of fibre so not an issue.

I don’t know if one is better than the other. Ferrous sulphate worked for me and as long as you eat well to help side effects then the pros more than outweigh the cons.

My ferritin was 12 6 months ago, I took ferrous gluconate for 6 months, it is now 14. It must be the way my body is as I feel fine. Everyone is different.

I’m so glad I read your comment. I didn’t know it’s ok to take 2 of 210mg tablets. I’ve been taking 1 a day for a month and not really feeling any better.

Hi @Honeysucklelane are you taking your iron with Vitamin C? That helps you absorb it. I take 1,000mg vitamin C with my iron tablets and take it on an empty stomach.
Here’s what the NHS says about doses to treat anemia
https://www.nhs.uk/medicines/ferrous-fumarate/how-and-when-to-take-ferrous-fumarate/