Iron deficiency is one of the most commonly diagnosed diet-related ailments. Few people know, however, that in order to properly determine it, it is necessary to test not iron levels per se, but ferritin levels.
In a nutshell, ferritin is an indicator of how much iron is stored in the liver. The level of the element itself in the blood is completely unreliable, for example, it drops during infections, when the body “hides” iron to avoid feeding it to bacteria. The administration of supplements at that time can even kill the patient, a very serious medical mistake that some doctors are repeatedly making.
Deficiency can be divided into three stages, in the first the level of ferritin itself drops, in the second it is very low, but there are further reserves in the bone marrow, in the third only, the last, there are changes in the blood, i.e. anemia. Already this first stage gives serious symptoms, among others it is associated with thyroid disorders, depression or hair loss. A poor doctor, seeing bad thyroid results, prescribes hormones right away, instead of considering whether by chance the body has slowed down to save itself from the consequences of iron deficiency. How many cases of such patients have already been drugged with psychotropics….
For full health, the level of ferritin should be above 70 ng/ml, with the understanding that if there has been any inflammation in the past month (even a more severe cold), the result may be falsified, such inflammation raises the ferritin in the blood above its natural limit. Only after the limit of 70 ng/ml do hair follicles function properly, only then do conditions such as restless legs syndrome disappear, then the mood of people with depression improves. In some countries, the lower limit of normal is set at 10-15, and people with such results are told they are healthy. After it the doctor prescribes a dozen prescriptions for ailments resulting from low levels.
I have repeatedly encountered situations where, despite months or even years of supplementation, ferritin has remained at a constant level, below the optimum. This is dangerous in two ways, firstly, the health and well-being of the patient (or most often the patient) will not improve, and secondly, excess iron from supplements is not inert to health, it is a concentrate of free radicals, wreaking havoc on tissues.
In other words, the most important thing is not to provide iron, because this does not bring much benefit, and can even cause damage. You need to make the body use and store this iron efficiently.
To begin with, you need to rule out absorption problems at the intestinal level. Task the doctor, you can make a diagnosis of celiac disease, you can do a test to see if the level in the blood rises after the supplement, you can simply test the level of, for example, vitamin B12, in people with improper absorption the level will usually be very low.
Then rule out dietary errors. Drinking coffee or tea within 2 hours before and after a supplement / an iron rich meal can completely block its absorption. Likewise, eating something very rich in calcium, as well as phytic acid, will be primarily bran.
Then it’s worth looking at other potential sources of iron escape from the body. Are there gastrointestinal bleeds? You may not see them, but it’s worth doing a fecal occult blood test. By any chance, is there a cancerous process that uses iron to grow rapidly?
Only when all these questions are answered can one look for the reason why the body does not store the supplied iron and raise ferritin levels. This is not as simple as it might seem, since the process depends on literally hundreds of intermediate processes and additional conditions, but a general framework can be attempted to spell out.
To begin with, it is worth looking at the thyroid gland. Here is one important thing – low iron levels disrupt the function of this organ! The proper therapy then is to supplement iron, not to load it with synthetic hormone, as some “specialists” do. The characteristic picture of such a deficiency is low levels of FT3 and FT4, but at the same time a reasonably good level of TSH. It is also common to see severely reduced FT4 levels, but at the same time normal or even elevated FT3 levels.
An example can be seen in this study:
https://www.jceionline.org/article/the-effects-of-iron-deficiency-anemia-on-the-thyroid-functions-3153
After supplementing with iron alone, without taking thyroid hormones, the results changed as follows:
- TSH level dropped from 3.3 to 1
- FT4 level increased from 0.9 to 2.4
- FT3 level dropped (!) from 3.5 to 3.15
- Cortisol level dropped from 17 to 12
However, will low levels of thyroid hormones, resulting not from iron deficiency, but from disease of this organ, prevent the deficiency from being corrected? A study comes to the rescue, where a 3-month treatment of iron alone and iron together with a synthetic hormone was compared in women who were hypothyroid:
https://academic.oup.com/jcem/article/94/1/151/2597906
As it turns out, iron alone did not raise ferritin levels very significantly, but nevertheless some increase was there, from 12 to 15. Iron combined with the synthetic hormone raised ferritin from 11 has 24. Other indicators, such as hemoglobin and blood cell counts, also rose more markedly.
One can cautiously conclude from this that severe hypothyroidism can almost completely block ferritin synthesis, since in 3 months the level rose by only 3, and was 60 short of the ideal level.
Antioxidants and oxidative stress in general seem to have little effect on the ability to absorb iron per se, but may protect against the side effects of excess iron in the blood. Of particular note is vitamin A, which is quite closely related to iron. In case of its deficiency or even suboptimal levels, supplementation of this element can be highly problematic. However, it is not completely indifferent to health, and the decision should be made by everyone on their own, in case of suspected deficiency, supplementation requires very high doses, up to 25,000 units per day for a month. We are talking about real vitamin A, not beta carotene. Vitamins C and E can be taken shieldingly in small amounts without fear of side effects. Contrary to popular belief, high doses of vitamin C do not affect iron levels in the body:
https://pubmed.ncbi.nlm.nih.gov/6466873/
Especially in women, protein deficiencies are common, specifically branched-chain amino acids, which are closely related to iron metabolism. You can buy BCAAs for pennies, preferably in a 2:1:2 ratio, just eat a serving of 5 grams twice a day.
An unusual nutritional deficiency is nucleic acids. These are – literally – fragments of DNA and RNA, present in every cell. The modern diet can be surprisingly devoid of them, for example, white flour has almost none, similarly, milk and its products or eggs. Products such as spirulina, yeast or fish are very good sources.
Vitamin D3 did not affect iron levels in the body in any way:
https://nutritionj.biomedcentral.com/articles/10.1186/s12937-016-0192-7
For that, zinc supplementation yes, had an effect, but quite a negative one:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4179171/
With zinc deficiency, supplementation would be advisable, but if the deficiency is not present, supplements can even cause anemia.
Copper is a bit problematic here. Excess iron can cause severe deficiency of this element, and copper supplements, in turn, can save you from iron poisoning. But it’s not a completely safe element either, and there are diseases in which it’s excess copper that can be a problem. There are no studies that suggest what to do. I think small doses of copper would be advisable when trying to supplement iron.
Studies suggest that very high doses of thiamine (vitamin B1) may protect the brain from excess iron:
https://alz-journals.onlinelibrary.wiley.com/doi/full/10.1002/alz.12146
In addition, if you are taking high doses of iron, you need to take equally high doses of other B vitamins at the same time, but here a simple B complex vitamin will suffice. only thiamine, vitamin B1, I would suggest more, because of its potential protective effect.
A positive effect was shown with taurine, but this applied to women in a country where nutritional deficiencies are a daily occurrence, and it is unclear how this will translate to conditions in western countries, but at least for vegetarians and vegans this will be important information, as they almost certainly have taurine deficiencies:
https://pubmed.ncbi.nlm.nih.gov/12431243/
There is no research on this, but I have encountered patient feedback that high doses of vitamin B12 can very much raise ferritin levels and improve overall well-being. It is advisable to dose at least 5000 mcg (5 mg) per day if you take tablets.
And that’s about it. As usual, the key is not to buy different forms of iron, test hundreds of different supplements, search for new therapies, but to do detailed research to determine where the problem lies.
To summarize:
- we test ferritin, we test parameters such as transferrin saturation or iron binding capacity
- we do tests for occult blood, possibly testing B12 levels
- we do tests for all three basic thyroid parameters, i.e. TSH, FT3, FT4
- only after adjusting all this, we take iron
- we take B vitamins, especially B1, as well as vitamin E, and possibly do vitamin A therapy, as a protective measure
- to support synthesis we take BCAAs, 1 gram of taurine and some meal rich in nucleic acids, possibly high doses of B12
- shielding we can take small doses of copper from time to time
And that’s it. If there is no serious illness (it is impossible to discuss all possible illnesses in such a post), if there are no problems like anorexia, ferritin should go up. If there is no improvement, the cause in the case of women usually lies either in too drastic weight loss, which blocks metabolic pathways, or in an untreated / poorly treated thyroid gland.