Very low iron stores and very confused

[grace11]

I'm 28 weeks pregnant and have been told my iron stores are 14 (outside of the range which is 20-200). I've been put on Ferrous Fumarate syrup and I'm taking half the dose (I have chronic constipation issues) plus 2 x Spatone which should hopefully help. I also need to address my diet, but the more I look, the more I get confused. There are tons of things that stop iron absorption, including most things supposedly associated with boosting iron (broccoli, spinach, kale, lentils). Does anyone know of a really good evidence-based book or website on this - or can speak from personal experience of having anaemia and correcting it in pregnancy? I'm getting sick of all the contradictory information out there and just want to plan what to eat! I was planning a homebirth but with iron this low I think this is probably out of the question now...

Thank you! x

By iron stores, do you mean ferritin? In my first pregnancy, at 24 weeks my ferritin was down at 17, and I felt rubbish - I had to take extra iron. I just took Spatone for 6 weeks to see if that would help without having to take the tablets, and my ferritin went up to 18.2. I carried on taking lots of Spatone, and my ferritin was not checked again before I had the baby.

I was also worried that if my levels didn't go up enough, that I wouldn't be 'allowed' to have a homebirth, but even that small rise was enough for the midwives to be happy with my planned homebirth. I guess it will depend if you have any other risk factors, as to whether you will be able to aim for a homebirth, but if you can get your ferritin levels to start going up then I don't see why you shouldn't aim for a homebirth.

I didn't find any good websites about iron-rich diets - I think you should just eat a good varied diet, including red meat if you eat that. Whatever supplements you take, make sure you space them out across the day, and try to take the Spatone with some orange juice. I assume you are already managing any constipation as best you can, but look into something like Fibogel if you havn't tried it already?

My ferritin was checked again 6 weeks after having the baby, and it was 15. But I just carried on taking Spatone every day and having a good diet, and now 1 year on my levels are up above 40.

I am currently 35 weeks and I have been on 3 iron tablets (ferrous fumerate) a day for the last couple of months... My ferratin levels were in my boots at 5!!! I make sure that when I take my tablet I eat a Clementine as it has the vit c (and helps with the taste). I agree with sai just try to eat right. Make sure you eat fortified cereals and As many veggies as you can too. Good luck

Ferrous fumarate shouldn't cause you the same sort of constipation issues as ferrous sulphate would, the cheaper and much less effective supplement that is usually given.

Iron absorption is helped by taking with vitamin C sources, and you will absorb haem iron (from meat and animal products) far easier than non-haem iron (from vegetable sources). Excessive phytate in certain vegetables (including cruciferous veg) can inhibit absorption of divalent metal ions, such as ferrous iron, magnesium, manganese, zinc etc. - but phytates can be reduced by cooking. So avoid raw green veg.
Iron is competitively absorbed - that is, an excess of other divalent metal ions will compete to be absorbed with iron, especially manganese www.ncbi.nlm.nih.gov/pubmed/2058577, calcium www.ncbi.nlm.nih.gov/pubmed/21462112 although this is time limited.

So avoid taking dairy products with your iron-based meals, and also limit these foods www.healthaliciousness.com/articles/foods-high-in-manganese.php, but don't cut them out entirely because you still need some manganese in your diet!

Although spinach is high in iron, its not easily absorbed plus you would have to eat vast quantities of spinach to get anywhere with it. Spinach being good ofr iron is a longlasting myth - Popeye has a lot of answer for!

Are you vegetarian? There are iron rich vegetarian sources but if you aren't, the easiest source of iron is meat.

It's calcium which interferes with iron absorption. Vitamin c helps. So have your spatone with juice and on an empty stomach. Then get your calcium later in the day.

Thanks so much for all your replies, feeling quite low about it all - heart palpitations and hair loss isn't helping (both signs of low iron apparently)...

Yes, it's the ferritin - I haven't seen the full blood count yet but just had a letter through to call the dr next week about some more test results so I imagine I'm scoring very low on hb too.

I'm not taking fybrogel as it doesn't work on me but soaked linseeds morning and night have been a saviour for years - not sure whether they'll be enough with ferrous fumerate (I chose it for its milder side effects but things have definitely slowed down over the past few days) ...we'll see.

I always have a glass of grapefruit juice when I take iron and I eat grapefruit after a meal, so hopefully that's the vitamin c covered. I've stopped all heavy calcium foods such as cheese (I don't drink milk) when eating iron-rich food BUT I have been eating a lot of kale thinking it was helpful. If kale and spinach aren't so great, then what about watercress and rocket? Broccoli is full of calcium so I suppose that's out too?

The thing I don't understand about iron fortified cereal is that you would have it with milk - and milk stops absorption. So what do you do? Both almond milk and soy milk are also supposed to be bad for absorption too. Beans on toast for breakfast every day?? At the moment I'm having porridge with soya milk, seeds and dried apricots.

I'm not vegetarian but never ate red meat or much white meat - until now! But is there any point in having lamb stew if you serve it with kale, for example?

I guess I can only do so much. Thanks for all your help - I'll check out the websites. I found a book called 'Anemia: Iron Deficiency Diet' which looks quite informative.

I'd give the soya a complete miss because of the phytate content as well. If you do eat soya regularly, then go for the fermented stuff, because the fermentation reduces the phytate content.

www.precisionnutrition.com/all-about-phytates-phytic-acid this might help.

Moderation is the key in terms of the vegetables, I think. Cooked veg will be less inhibitory than raw veg; but not cooked for too long or you lose the vit C content as well (kale is a great source of vit C, for e.g. but as a water-soluble vitamin that is heat-labile, cooking for too long will destroy most of it)

I'll use almond milk instead then - I don't think there is an iron-friendly equivalent of milk is there really? I don't eat huge amounts of soy - I swapped from almond milk as nut milk made me feel sick in early pregnancy.What I need is a high iron recipe book that takes all these issues into consideration! You've been so helpful, thank you - I'll combine my iron-rich foods with vegetables high in vitamin C and hope for the best.