Iron supplementation

October 12, 2009 12:38 PM

I seem to be perpetually anemic, but my doc does not support my continuing to supplement with iron beyond bringing my lab numbers into the very low end of normal. Experiences, advice?

Every time I've ever had an iron test, I've been quite anemic (other than follow up tests after supplementation). This totals about 6 tests in 10 years.

Most recently, I finished 2 months of 2x per day ferrous gluconate at 325mg. I tried to do it "perfectly." Each dose was taken with vitamin C; I avoided coffee, tea, and dairy within 2 hours of each pill. My follow-up test showed that I'm now at the low end of normal - barely. My results came with a note from the doctor that said no further supplementation was necessary and to eat an iron rich diet.

I called and left a message about continuing the iron. Her MA called me back and said it was not necessary. I pressed, and she said she'd talk to the doc. The MA called me back again and restated that the doctor said it was not necessary. Some info:

+ This is a new doctor for me (as of this year) and I like her. I told her my history of anemia.
+ I always had very heavy periods. I've been recently tested (blood and ultrasounds) and cleared for hypothyroid, fibroids, endo, cysts, etc.
+ I do not eat red meat or egg yolks. I eat chicken and fish occasionally and pork rarely.
+ I tracked my diet for two months and usually get 90 - 150% of the RDA for iron from my diet.
+ I can take any form of iron. None has ever bothered me.
+ Maybe relevant: I'm a fairly serious amateur athlete and run about 45 miles a week.

This is not something I'm willing to fire my doctor over; I consider it a minor complaint and don't think it warrants a big fuss. Can I safely supplement on my own? Is there a form of iron or specific dosage that is safest? Can a person order their own lab tests or just walk into a lab and pay for an iron test? Any other advice welcome.

posted by anonymous to health & fitness (20 comments total)

I consider it a minor complaint and don't think it warrants a big fuss

Why do you think you know better than your doctor? You've presented zero evidence that his/her course of treatment is other than correct.
posted by Inspector.Gadget at 12:48 PM on October 12, 2009 [1 favorite]

Cook in cast iron; it's a small benefit, but still a benefit. There are non-meat sources of dietary iron; make them a central part of your diet. Take a vitamin with iron.
posted by theora55 at 12:48 PM on October 12, 2009 [2 favorites]

IANAD - personal experience only:

I've been slightly anemic my entire life and take over the counter iron supplements about half the days of the week (typically, if I'm eating red meat that day, I'll skip the iron, and some days I'm just lazy or forget). I get my levels checked once a year and they are always on the low end of normal, so I know I'm not getting a dangerous buildup or anything. I definitely notice that I have more energy and fewer headaches if I'm taking the iron regularly, so it seems to be having a positive benefit.
posted by something something at 12:50 PM on October 12, 2009

anemia can also be caused by GI issues. if it sounds like a possibility may be worth seeing a gastro.
posted by ejaned8 at 12:58 PM on October 12, 2009

You can get a second opinion without firing your doctor. There could be other issues at play. Especially if you feel weak or sick you should get it checked out instead of trying to band-aid it on your own.

If you get a prescription for them, they may be cheaper than over-the-counter, depending on your insurance. Also, if you're going through insurance, they usually don't pay for tests unless your doctor orders it and specifies why it's necessary.

If nobody here answers your question, this is also the kind of thing you can ask a pharmacist. If you have insurance, there is probably a 24-hour nurse consultation line you can call and ask as well.

It seems to me that with all the things taking iron out of your body and the fact that you're not putting any back in, over the counter iron pills should be good for you. But I do not know what I'm talking about.

(And I know you didn't ask this, but you should be able to get more out of your doctor than a second-hand "no really". Especially if you feel weak or sick.)
posted by amethysts at 1:39 PM on October 12, 2009

Nonheme iron, which comes from vegetables, is harder for the body to absorb than heme iron, which comes from meat, especially red meat. I don't eat red meat, and I actually became anemic because a medication I take (omeprazole) lowers stomach acid and makes nonheme iron even harder to absorb (I was also giving blood every two months). You might want to look into making sure that you eat your nonheme iron-rich vegetables (like spinach) with some kind of acid, maybe by drizzling some lemon juice on them or something, to help with absorption.

As far as supplementing on your own, it probably wouldn't hurt, especially if you follow a similar regimen to that described in something something's comment, but if you aren't actually having any symptoms, like tiredness, it's not really necessary, either.
posted by infinitywaltz at 1:42 PM on October 12, 2009

You might be interested in Why We Get Sick: The New Science of Darwinian Medicine (which I read as part of a college biology class on evolutionary medicine) — it talks about the role of iron in the body in dealing with infection, and (if I remember correctly) about how recommended levels for women are sort of up for debate. I'm a vegetarian woman who usually tests as borderline anemic (I take a standard multivitamin with iron every day), and I found the book helpful for understanding iron a little more.
posted by dreamyshade at 2:48 PM on October 12, 2009

Cream of wheat is a very good source of iron, even better than spinach, so I've been told.
posted by x46 at 2:58 PM on October 12, 2009

An IUD could help with the heavy periods, if that's a possible cause of your anemia. Definitely worth talking to a doctor (perhaps a new doctor) about.
posted by The corpse in the library at 3:06 PM on October 12, 2009

IANAD buuut I have been working on my own anemicness for the past 6 months.

1. Does being anemic bother you, physically? (Outside of your concern about your ferritin level : ) It appears that a whole lot of docs I've spoken to in the last year about being anemic seem to have differing opinions on what level "ferritin", specifically is "ok" to them. (i.e. some go 'well, your iron is a tad below the normal range, take some iron, no big deal, buh-bye, and others who go 'yeah, 12 is kinda low, keep hitting the iron for a while till it gets up near 70'). There are other blood measurements of iron besides the 'iron stores' (ferritin) that I understand are possibly? of equal/similar importance to ferritin.

2. If it doesn't, and you are otherwise healthy and can maintain the iron where it's at like you're doing - I know I have read in a few places that supposedly, woman or man, regularly training serious athletes are known to be measured as being more anemic, sometimes, than more sedentary folk. Can't remember where, though. Here's one on female athletes and anemia .

3. I have also read somewhere that to get the same amount of iron that you get from a 100% rda iron supplement in a single day, you'd have to eat 10-12lbs of steak - also all in the same day. This doesn't mean if you need iron you shouldn't give up on the iron-rich foods, but that if you need a whole lot more iron that the average joe, maybe the iron-y foods are not going to do you much good by comparison to increasing the supplement intake...

I've been looking for something online as well where I might find a citation of 'safe total amount of iron that's ok to take in a single day'....while I'm sure this varies from person to person, there must be some kind of known 'bad amount'.

4. I've been taking Floravital, the gluten-free form of Floradix , which has been mentioned in other MeFi threads about iron supplements previously. It's unfortunately crazy expensive, but I seem to absorb that a lot better than the other otc supplements I've tried, and it never messes with my digestive system that I can tell even taking double the dose in a day. It also needs refrigeration.
posted by bitterkitten at 3:15 PM on October 12, 2009

What is the cause of you being perpetually anemic? The possibility that you had another undiagnosed condition would worry me a little bit, something else to talk to you doc about?

Of course, iron supplements are over the counter so I guess if you don't mind the side effects (a lot of people do) then you might as well tell your doc that you are going to continue to take them.
posted by kathrineg at 3:15 PM on October 12, 2009

Are you actually experiencing symptoms from the low iron? If you're not, it may not be a problem -- maybe that's where the doctor is coming from.

Ideal blood ranges are not absolutes. Some people are natural statistical outliers on some of those scales.

Taking doctor-prescribed iron supplements is pretty heavy-duty, generally speaking. If you're looking to keep supplementing, I'd say that's totally your decision to make, but I'd also take your doctor's suggestion under advisement that perhaps you don't need to "big gun" supplements any longer, since they didn't make a whole hell of a lot of difference anyway, and since your diet appears adequate.

Another thing about iron absorption (which seems to be your issue) -- the more you eat, the less you'll absorb. And vice-versa. So if your body is set on using a certain amount of iron, despite your wanting to get your iron levels into a specific range, it's going to down-regulate to that level it wants despite your supplementing by diet or pill.

So -- to get to the point: if you really want to, you can take a multivitamin that includes iron and cook with iron cookware, etc.

But if you're not experiencing symptoms of iron deficiency anemia, I'd trust your doctor on this one.
posted by Ouisch at 3:21 PM on October 12, 2009

What iron test(s) exactly?

I, too, am perpetually anemic and it's a struggle to keep my numbers up. I couldn't tell from your original post whether you were suffering any symptoms from your anemia. For me, it's an incredible amount of fatigue and inability to stay warm. I can always tell when I trend low when I start to feel unusually tired, but it's something that sneaks up on you. It's easy to blame it on other things like not enough sleep, too much work, overdoing it, etc.

My humble opinion is to see how you feel after a couple of weeks off the iron. It's often hard to tell a difference as your iron levels get to normal, but (for me at least) it's more marked when your iron drops and you find yourself thinking "why am I so tired?"

If you do notice a difference, I say go back on it.

BTW, there are a lot of other (better) options besides the typical OTC supplements. MeMail if you want some other sources.
posted by SoulOnIce at 3:32 PM on October 12, 2009

Nothing in your post explains what the actual problem is. Forget completely any numbers you may be getting on tests. What exact symptoms do you experience? If you don't experience any negative consequences which can be traced to your iron status, then as long as your numbers are anywhere near the normal range, you do not have a problem, period. Measure your long term iron storage levels. Even if it's at the low end of the range, and you experience no problems, forget about it. Recent science seems to be moving more toward seeing benefits of lower iron levels vs higher ones. It's a feature, not a bug... unless you experience negative health consequences. IANAD, all IMHO, please consult a qualified physician and nutritionist.
posted by VikingSword at 3:46 PM on October 12, 2009 [2 favorites]

There is a theory that low levels of iron are an evolutionary adaptive mechanism to avoid infection, more on this.

There is also some evidence to suggest supplementation with iron raises succeptibility to infection
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=361162
posted by zentrification at 3:50 PM on October 12, 2009

This is not something I'm willing to fire my doctor over; I consider it a minor complaint and don't think it warrants a big fuss. Can I safely supplement on my own? Is there a form of iron or specific dosage that is safest? Can a person order their own lab tests or just walk into a lab and pay for an iron test? Any other advice welcome.

What kinds of problems are you getting from your current iron levels? IANAD, but have you considered not supplementing, as the real doctor has suggested to you?
posted by floam at 4:24 PM on October 12, 2009

I had severe anemia and very heavy periods. Along with iron supplements, I was prescribed Seasonale, and was directed by my doctor that I do not even have to take the placebo week once every three months, but could instead continue avoiding my period for as long as I wanted. I have been following that course of action for the past 5 years, and although I no longer take iron supplements, my anemia is gone. I do have periods sometimes (I will generally go ahead and do a placebo week if I notice myself spotting), but it's more like 1-2x a year.
posted by srrh at 7:41 PM on October 12, 2009

Cream of wheat is a very good source of iron, even better than spinach, so I've been told.

Spinach is not a particularly good source of iron, and, more on topic, low end of normal is still normal: if you are not having any other symptoms, I don't think this is something to worry about.
posted by Dr Dracator at 10:26 PM on October 12, 2009

follow-up from the OP

The symptoms I experience that usually lead me to make a doctor’s appointment are extreme fatigue/exhaustion, grayish skin and lips, and a severe decline in athletic performance. I also seem to get sick very easily and have a hard time recovering from even minor colds while anemic.

For those who are interested, my initial numbers were:

Ferritin 4 ng/mL
Iron 25 ug/dL
TIBC 315 ug/dL
Transferrin Sat 7%

Have I tried not supplementing? Yes, for 10+ years I’ve tried that. As I mentioned, I’ve been through this about 6 times. It does something like this: I experience the symptoms above, get tested for anemia, get a prescription and supplement for 2-3 months, test again with normal results. 12 – 18 months later, repeat.

"Why do you think you know better than your doctor? You've presented zero evidence that his/her course of treatment is other than correct."

I think I have. It seems clear from experience that me not being on iron = eventually anemic. I’m not looking to pump my levels up to some ridiculous level – I just want to maintain normal iron levels without going on and off prescription supplements.

Thanks everyone.

posted by jessamyn at 9:46 AM on October 13, 2009

Well, it seems like you should be finding the root cause of the problem and treating it. I know, I know, you've probably thought about it. With those symptoms over years, it's not a minor complaint. There is a problem that needs to be ruled out, if not medical then nutritional and maybe a nutritionist consult is in order.

I might be paranoid because a close relative was diagnosed with celiac disease after years of unexplained anemia.
posted by kathrineg at 11:11 AM on October 13, 2009