Tips for getting my ferritin up?
February 25, 2016 1:39 PM Subscribe
I’m a 31-year-old iron-deficient menstruating lady. My doctor would like my ferritin level to increase before my husband and I try to conceive. However, iron supplements make me feel awful (not just for digestive reasons). Details inside.
I started feeling fatigued and easily out of breath, probably in early 2014. It got worse until June 2015, when my GP did a ferritin test and my level was 4.6 (oops). A few months of heavy-duty iron supplements did bring up my ferritin somewhat (it was 11 in October 2015), but also completely wiped me out.
I essentially spent the whole time I was taking iron on the couch, feeling what I thought at first were just anemia symptoms catching up to me, but (an embarrassingly long time) later realized were correlated with taking the iron.
My side effects were:
* The fairly standard gastrointestinal stuff – started with diarrhea for a few days, then constipation and nausea
* Extreme fatigue – I described it to my husband as a feeling like a baby elephant was sitting on my chest
* General malaise/sick feeling – sort of like having a mild version of the flu the whole time
* Headache and trouble concentrating
I’m a writer and I wfh, so technically I can stay on the couch all day, but obviously that’s not optimal.
When I stopped taking the iron, I felt better, and have continued to feel mostly okay. However, I sometimes go back to the fatigue/out of breath thing, especially around my period. And, of course, I’m thinking ahead to a possible pregnancy.
I have several questions.
1. Does anybody else have this weird reaction to iron? My doc said the GI stuff is normal but the other isn’t something she’s heard before. Help me feel like a (still special but less lonely) snowflake!
2. What iron supplement has given you the fewest side effects (even if it’s just fewer GI side effects)? So far I’ve tried two different brands of ferrous sulfate at different dosages, with and without orange juice or vitamin C, with or without food, as well as Floradix and something called Easy Iron (ferric pyrophosphate). Same side effects with all of them, including the liquid Floradix, which I know is a silver bullet for many.
3. What’s the best way to get more iron in my diet? I eat meat, including a fair amount of red meat, and I try to be careful about interactions with calcium, tannins, etc., as well as including Vitamin C for absorption. But I find many of the conflicting recommendations (do eat spinach for iron/don’t eat spinach because the oxalates cancel out the iron) frustrating.
4. How much do I need to worry about my ferritin levels during pregnancy? I’ve never been anemic when tested through a blood draw, though I have been turned away from donating blood several times. I know anemia is common in pregnancy, and I suspect I don’t really want it, but is building up my iron stores something super important, or just sort of a “it would be great if you can” sort of thing? In other words, would you consider it a blocker for TTC? (I know YANMD – just curious how you’d interpret it.)
Other potentially relevant info:
* Heavy periods like clockwork every month. Never been on hormonal BC (it gave me migraines when I tried it), and don’t want to start now since we want to try to conceive relatively soon.
* Used to give blood fairly regularly with no ill effects, but haven’t in the past two years or so.
* Iron, TIBC, and iron saturation normal. Other blood-related labs normal too, with the occasional exception of an elevated RDW.
* Low-ish Vitamin D (28). Normal folate and B12.
* I am heterozygous for the MTHFR mutation, which I know impacts folate metabolism. I don’t have a lot of good information, though, because most of what I see online looks fairly woo and my GP hadn’t heard of it.
* Always low BP (in the 104/64 range).
* Super low cholesterol (total cholesterol was 96 in March 2015).
Thanks in advance!
I started feeling fatigued and easily out of breath, probably in early 2014. It got worse until June 2015, when my GP did a ferritin test and my level was 4.6 (oops). A few months of heavy-duty iron supplements did bring up my ferritin somewhat (it was 11 in October 2015), but also completely wiped me out.
I essentially spent the whole time I was taking iron on the couch, feeling what I thought at first were just anemia symptoms catching up to me, but (an embarrassingly long time) later realized were correlated with taking the iron.
My side effects were:
* The fairly standard gastrointestinal stuff – started with diarrhea for a few days, then constipation and nausea
* Extreme fatigue – I described it to my husband as a feeling like a baby elephant was sitting on my chest
* General malaise/sick feeling – sort of like having a mild version of the flu the whole time
* Headache and trouble concentrating
I’m a writer and I wfh, so technically I can stay on the couch all day, but obviously that’s not optimal.
When I stopped taking the iron, I felt better, and have continued to feel mostly okay. However, I sometimes go back to the fatigue/out of breath thing, especially around my period. And, of course, I’m thinking ahead to a possible pregnancy.
I have several questions.
1. Does anybody else have this weird reaction to iron? My doc said the GI stuff is normal but the other isn’t something she’s heard before. Help me feel like a (still special but less lonely) snowflake!
2. What iron supplement has given you the fewest side effects (even if it’s just fewer GI side effects)? So far I’ve tried two different brands of ferrous sulfate at different dosages, with and without orange juice or vitamin C, with or without food, as well as Floradix and something called Easy Iron (ferric pyrophosphate). Same side effects with all of them, including the liquid Floradix, which I know is a silver bullet for many.
3. What’s the best way to get more iron in my diet? I eat meat, including a fair amount of red meat, and I try to be careful about interactions with calcium, tannins, etc., as well as including Vitamin C for absorption. But I find many of the conflicting recommendations (do eat spinach for iron/don’t eat spinach because the oxalates cancel out the iron) frustrating.
4. How much do I need to worry about my ferritin levels during pregnancy? I’ve never been anemic when tested through a blood draw, though I have been turned away from donating blood several times. I know anemia is common in pregnancy, and I suspect I don’t really want it, but is building up my iron stores something super important, or just sort of a “it would be great if you can” sort of thing? In other words, would you consider it a blocker for TTC? (I know YANMD – just curious how you’d interpret it.)
Other potentially relevant info:
* Heavy periods like clockwork every month. Never been on hormonal BC (it gave me migraines when I tried it), and don’t want to start now since we want to try to conceive relatively soon.
* Used to give blood fairly regularly with no ill effects, but haven’t in the past two years or so.
* Iron, TIBC, and iron saturation normal. Other blood-related labs normal too, with the occasional exception of an elevated RDW.
* Low-ish Vitamin D (28). Normal folate and B12.
* I am heterozygous for the MTHFR mutation, which I know impacts folate metabolism. I don’t have a lot of good information, though, because most of what I see online looks fairly woo and my GP hadn’t heard of it.
* Always low BP (in the 104/64 range).
* Super low cholesterol (total cholesterol was 96 in March 2015).
Thanks in advance!
Lucky iron fish in cooking pots have reduced iron deficiency in Cambodia, but I don't know if that kind of iron is what you need.
posted by nicebookrack at 1:50 PM on February 25, 2016 [2 favorites]
posted by nicebookrack at 1:50 PM on February 25, 2016 [2 favorites]
Oh, also! My GP was very very keen to get my iron levels back up, because some studies have linked post-partum anemia with post-partum depression (which makes a lot of sense... newborns are hard enough if you aren't anemically wiped out on top of it). So "how much do I need to worry about my ferritin levels during pregnancy"... I'd try really, really hard to keep them reasonable, particularly during the third trimester in preparation for the inevitable blood loss during delivery, to set yourself up for the post-partum period. (My GP was happy enough with my third trimester readings, but prescribed another round of IV iron about four weeks after my daughter was born, just to keep me topped up through the rest of the newborn period)
posted by olinerd at 1:50 PM on February 25, 2016 [1 favorite]
posted by olinerd at 1:50 PM on February 25, 2016 [1 favorite]
When they were trying to get my kids' iron levels up, one thing the pediatrician recommended was cooking with a cast-iron pan. It appears there is some decent research backing up that idea.
posted by Area Man at 1:55 PM on February 25, 2016 [2 favorites]
posted by Area Man at 1:55 PM on February 25, 2016 [2 favorites]
I was told that ferrous gluconate is easier on the stomach than ferrous sulfate.
I'm currently taking a supplement recommended by my doctor that is available without a prescription but I had to ask the pharmacist for it. It's ferrous fumarate (Palafer). No GI effects so far, after about a week.
posted by fansler at 2:04 PM on February 25, 2016 [1 favorite]
I'm currently taking a supplement recommended by my doctor that is available without a prescription but I had to ask the pharmacist for it. It's ferrous fumarate (Palafer). No GI effects so far, after about a week.
posted by fansler at 2:04 PM on February 25, 2016 [1 favorite]
I had really terrible GI problems from the iron when I was anaemic a few years ago. I tried a bunch of different brands, some were better or worse. I hated to waste the money trying a bunch of different types, but sometimes it's worth it. I can't remember what the brands were that I tested, sorry about that.
Molasses has high iron content, and I know some people who have about a Tablespoon per day instead of taking a supplement. There are other foods than spinach which are good, like broccoli, etc.
I'm sure you know anaemia can cause heavy menstruation, which is completely ironic. Sorry about the pun, ha! There are other health conditions that can cause heavy menses, like hypothyroidism and PCOS. You can ask your doctor about any possibilities, just in case. Of course, it could just be a normal thing for you to have heavy menses.
Good luck!
posted by annsunny at 2:23 PM on February 25, 2016 [1 favorite]
Molasses has high iron content, and I know some people who have about a Tablespoon per day instead of taking a supplement. There are other foods than spinach which are good, like broccoli, etc.
I'm sure you know anaemia can cause heavy menstruation, which is completely ironic. Sorry about the pun, ha! There are other health conditions that can cause heavy menses, like hypothyroidism and PCOS. You can ask your doctor about any possibilities, just in case. Of course, it could just be a normal thing for you to have heavy menses.
Good luck!
posted by annsunny at 2:23 PM on February 25, 2016 [1 favorite]
Anemic before pregnancy and did my best to get the levels even, mildly anemic and pregnant now. Anemia + first trimester exhaustion are no joke. I have America's least physically fatiguing job and I would get home from work and need a nap before I could muster up the energy to put on my pajamas and go to bed. I was sleeping 12+ hours a night and still exhausted.
I tolerated Vitron C pretty well, which is ferrous fumarate + Vitamin C. I took it at night, which seemed to help with the GI stuff quite a bit.
I am not a doctor or your doctor, but be sure you understand what MTHFR can do when pregnant or TTC.
posted by notjustthefish at 2:25 PM on February 25, 2016 [2 favorites]
I tolerated Vitron C pretty well, which is ferrous fumarate + Vitamin C. I took it at night, which seemed to help with the GI stuff quite a bit.
I am not a doctor or your doctor, but be sure you understand what MTHFR can do when pregnant or TTC.
posted by notjustthefish at 2:25 PM on February 25, 2016 [2 favorites]
Okay, maybe this is a dumb suggestion, but are your other issues while taking the iron supplements (super fatigue, headache, trouble concentrating) maybe just still side effects of having low ferritin levels? Like maybe at 4.6 your body has a couple major problems (fatigue, out of breath, possibly something going on inside that you're not aware of) and between 4.6 and 11 the problems are different (trade in the out of breath for more obvious fatigue and headache)? I clocked in at a ferritin level of 4 about 3 months ago and managed to bring it up to a 17 with these Nature Made 65mg iron tablets and these Nature Made 500mg Vitamin C tablets (one each per day, right when I got home from work, on an empty stomach) and didn't have any GI issues, which shocked the hell out of me because I tend to have a lot of issues with constipation and really have hardly had any since I started on the iron.
I agree with the poster above that you should ask your doctor about an iron infusion. It sounds like your levels can go up drastically if you go that route with maybe fewer (or at least new!) side effects.
posted by jabes at 2:37 PM on February 25, 2016 [1 favorite]
I agree with the poster above that you should ask your doctor about an iron infusion. It sounds like your levels can go up drastically if you go that route with maybe fewer (or at least new!) side effects.
posted by jabes at 2:37 PM on February 25, 2016 [1 favorite]
I had an iron infusion. It was fantastic. Iron supplements make me feel terrible and never really worked that well. About 10 days, maybe 2 weeks after the infusion I suddenly felt human again.
IANAD and maybe there are reasons they don't give these as standard but I would ask your doc. If I get that anaemic again and they won't do an infusion, they are going to have to give me damn good reasons because being given GI torture medicine when you already feel 90% dead is just cruel.
posted by kitten magic at 2:53 PM on February 25, 2016 [5 favorites]
IANAD and maybe there are reasons they don't give these as standard but I would ask your doc. If I get that anaemic again and they won't do an infusion, they are going to have to give me damn good reasons because being given GI torture medicine when you already feel 90% dead is just cruel.
posted by kitten magic at 2:53 PM on February 25, 2016 [5 favorites]
I always thought I couldn't take iron but then someone suggested taking Flintstones chewables. Revolutionary! They don't make me sick! If even that doesn't work for you, try fortified cereal: both Cream of Wheat and Life, for example, are fortified with iron.
posted by Violet Hour at 3:29 PM on February 25, 2016 [3 favorites]
posted by Violet Hour at 3:29 PM on February 25, 2016 [3 favorites]
Consumer Lab has a super-helpful guide on iron supplements. Mefi mail me your email address if you'd like a copy.
posted by invisible ink at 3:44 PM on February 25, 2016
posted by invisible ink at 3:44 PM on February 25, 2016
My grandmother said it really helped to cook everything in cast iron skillets, which I do now as well.
The highest iron content in cereal I can find is Wild Berry Special K, which I eat with almond/oat/soy milk because dairy inhibits iron absorption. It helps. (I'm not big on meat, even when not pregnant!)
Floradix worked for me, so I can say that when the iron kicked in after a few days I felt like I was on freaking speed (or so I imagine)! It was nuts.
I have almost the exact same health profile as you do at the same age, and I did turn out to have atypical PCOS and likely endometriosis. I am still breastfeeding and my period is still irregular, but if it goes back to what it was before I may very well ask to try BC to mostly eliminate my period. (Total anecdata, but I got pregnant on the first try.) Using a Diva cup or similar is interesting because then you know how much blood you're actually losing (think you can't overflow them? I can!) - which is good data to take back to your GP later.
posted by jrobin276 at 3:56 PM on February 25, 2016 [2 favorites]
The highest iron content in cereal I can find is Wild Berry Special K, which I eat with almond/oat/soy milk because dairy inhibits iron absorption. It helps. (I'm not big on meat, even when not pregnant!)
Floradix worked for me, so I can say that when the iron kicked in after a few days I felt like I was on freaking speed (or so I imagine)! It was nuts.
I have almost the exact same health profile as you do at the same age, and I did turn out to have atypical PCOS and likely endometriosis. I am still breastfeeding and my period is still irregular, but if it goes back to what it was before I may very well ask to try BC to mostly eliminate my period. (Total anecdata, but I got pregnant on the first try.) Using a Diva cup or similar is interesting because then you know how much blood you're actually losing (think you can't overflow them? I can!) - which is good data to take back to your GP later.
posted by jrobin276 at 3:56 PM on February 25, 2016 [2 favorites]
1. Does anybody else have this weird reaction to iron? My doc said the GI stuff is normal but the other isn’t something she’s heard before.
I'm wondering what type of doctor she is - general practitioner, internist, gynecologist? I don't think your symptoms would sound abnormal to a GI doctor. I've had IBS issues ever since about of food poisoning back in the early 90's; most of the time I'm fine and can eat whatever I feel like, but when I'm suffering gastrointestinally, I'm almost always also deeply tired & miserable. I don't get an 'elephant on my chest' shortness of breath, it's like a full-body heaviness, like the blood in my veins has partially solidified and is weighing me down. It becomes kind of a 'chicken or the egg?' situation -- am I tired/sick because my intestines are on the fritz, or are my intestines on the fritz because I'm sick? The question is mostly academic though, I just know that the symptoms are linked, that the IBS flare-up and the exhaustion and pervading sense of despair all start & end around the same time.
(I don't have any good advice on getting your ferritin level up, but everyone else seems to have that covered, just wanted to say that your symptoms didn't sound that weird to me.)
posted by oh yeah! at 6:52 PM on February 25, 2016 [2 favorites]
I'm wondering what type of doctor she is - general practitioner, internist, gynecologist? I don't think your symptoms would sound abnormal to a GI doctor. I've had IBS issues ever since about of food poisoning back in the early 90's; most of the time I'm fine and can eat whatever I feel like, but when I'm suffering gastrointestinally, I'm almost always also deeply tired & miserable. I don't get an 'elephant on my chest' shortness of breath, it's like a full-body heaviness, like the blood in my veins has partially solidified and is weighing me down. It becomes kind of a 'chicken or the egg?' situation -- am I tired/sick because my intestines are on the fritz, or are my intestines on the fritz because I'm sick? The question is mostly academic though, I just know that the symptoms are linked, that the IBS flare-up and the exhaustion and pervading sense of despair all start & end around the same time.
(I don't have any good advice on getting your ferritin level up, but everyone else seems to have that covered, just wanted to say that your symptoms didn't sound that weird to me.)
posted by oh yeah! at 6:52 PM on February 25, 2016 [2 favorites]
My iron levels hovered around 6 for years and I started cooking everything in a little cast iron skillet when we decided to start making tiny humans and my iron level increased to 13 after three months. I was slightly anemic during pregnancy (9-11 range) but two flintstone vitamins a day (kids chewable) brought it back up.
I've sense increased my cast iron collection and gotten much better at caring for it and plan on using it forever.
posted by julie_of_the_jungle at 6:54 PM on February 25, 2016
I've sense increased my cast iron collection and gotten much better at caring for it and plan on using it forever.
posted by julie_of_the_jungle at 6:54 PM on February 25, 2016
This comes from a sleep medicine perspective but a ferritin that low + pregnancy is a recipe for god awful restless legs.
I have occasional restless legs caused by low ferritin (mine is no where as near as low as yours by the way). I very rarely eat meat so I have resorted to eating a huge kale and/spinach salad every day with pumpkin seeds (or other but but pumpkin are highest in iron), a bean of some sort (usually white, garbanzo, or lentils) and some sort of fruit. It works for me but my ferritin isn't as low as yours.
I have a patient with low ferritin and she eats chicken liver once a week.
posted by teamnap at 7:31 PM on February 25, 2016 [1 favorite]
I have occasional restless legs caused by low ferritin (mine is no where as near as low as yours by the way). I very rarely eat meat so I have resorted to eating a huge kale and/spinach salad every day with pumpkin seeds (or other but but pumpkin are highest in iron), a bean of some sort (usually white, garbanzo, or lentils) and some sort of fruit. It works for me but my ferritin isn't as low as yours.
I have a patient with low ferritin and she eats chicken liver once a week.
posted by teamnap at 7:31 PM on February 25, 2016 [1 favorite]
After diagnosed with anemia, iron supplements disrupted my GI tract. The body stores Iron so one doesn't need to eat it daily. Between splitting Iron pills and increasing frequency of liver, sardines and beef (my favourite high Iron foods) anemia cured. Half an iron Pill did cause GI tract distress, but it was minor. I took a half tablet every four days, my current preventive dose.
posted by Homer42 at 7:56 PM on February 25, 2016
posted by Homer42 at 7:56 PM on February 25, 2016
I get sick if I take iron on an empty stomach - try the liquid iron after a big meal?
Prenatal vitamins made me soooo barfy. I'm not even I had 1st trimester nausea so much as the prenatals were making me so sick. Then I realized I ought to take them after a big lunch and the nausea totally went away.
posted by St. Peepsburg at 10:06 PM on February 25, 2016
Prenatal vitamins made me soooo barfy. I'm not even I had 1st trimester nausea so much as the prenatals were making me so sick. Then I realized I ought to take them after a big lunch and the nausea totally went away.
posted by St. Peepsburg at 10:06 PM on February 25, 2016
Ugh, I really feel for you. My periods are not super heavy and I'm not trying to get pregnant, but my iron is still lowish even after several months of taking 100 mgs about every other day (with vitamin C, not with calcium etc.) because more often makes me constipated, iron juice etc. Just like you, my vitamin D is also low, and I have a lot of similar symptoms. I'm also a vegetarian...
I have tried to take magnesium on the nights I don't take iron because it seems to make me anti-constipated (if you get what I mean.)
I don't know if you can get them where you live, but in Germany, they sell iron powder/sugar things that you can take without any water. They're usually low Dosis, about 10 mg, but you can take several during the day, which should be easier on the stomach. Maybe you can also buy those tablets you put in water? I personally hate those because they make me queasy, but maybe they work for you?
Are you sure you don't have any absorption problems? I'm starting to worry I am because 100 freaking milligrams every second day! My vitamin D doesn't really go up either... Can you have that checked out?
Also, not sure if it's just dairy you should not take with iron, it may be all calcium-rich foods. (I wonder what happens when you eat foods that contain iron AND calcium...)
posted by LoonyLovegood at 3:29 AM on February 26, 2016 [1 favorite]
I have tried to take magnesium on the nights I don't take iron because it seems to make me anti-constipated (if you get what I mean.)
I don't know if you can get them where you live, but in Germany, they sell iron powder/sugar things that you can take without any water. They're usually low Dosis, about 10 mg, but you can take several during the day, which should be easier on the stomach. Maybe you can also buy those tablets you put in water? I personally hate those because they make me queasy, but maybe they work for you?
Are you sure you don't have any absorption problems? I'm starting to worry I am because 100 freaking milligrams every second day! My vitamin D doesn't really go up either... Can you have that checked out?
Also, not sure if it's just dairy you should not take with iron, it may be all calcium-rich foods. (I wonder what happens when you eat foods that contain iron AND calcium...)
posted by LoonyLovegood at 3:29 AM on February 26, 2016 [1 favorite]
Gentle Iron by Solgar
http://www.amazon.com/gp/product/B00013Z0QA?keywords=gentle%20iron&qid=1456494285&ref_=sr_1_2_a_it&sr=8-2
posted by claptrap at 5:45 AM on February 26, 2016 [1 favorite]
http://www.amazon.com/gp/product/B00013Z0QA?keywords=gentle%20iron&qid=1456494285&ref_=sr_1_2_a_it&sr=8-2
posted by claptrap at 5:45 AM on February 26, 2016 [1 favorite]
Response by poster: Thank you for all these suggestions and ideas! You guys are seriously the best. I'm not going to mark any best answers because these are all helpful - it's seriously a huge relief to have a list of things to try after feeling sort of like I was beating my head against the wall on this issue. And those of you dealing with similar issues - hope you find solutions and feel better soon!
posted by bananacabana at 11:20 AM on February 26, 2016
posted by bananacabana at 11:20 AM on February 26, 2016
This thread is closed to new comments.
(1) Anemia during pregnancy sucks. You think anemia makes you tired? Anemia + pregnancy basically means you never ever want to get up from that comfy bed or couch. Unfortunately, you have to. Not being anemic helps a lot with this. Also, I only very occasionally get restless leg syndrome issues at night, but while pregnant it was a surefire way to know that my iron was dipping again - I'd have entire nights of constantly having to move and it sucked.
(2) My body just doesn't like to absorb iron, so my GP went for the nuclear option and had me do an IV iron infusion. That shit is GREAT. My body absorbed it better (my ferritin was up to 25 two weeks later) and I didn't experience any side effects. That said, oral supplements usually aren't too bad for me side-effect wise, so YMMV. But within 24 hours I felt a huge difference in my energy levels that I'd never really experienced with oral supplements. Can you see if this is an option for you?
posted by olinerd at 1:48 PM on February 25, 2016 [3 favorites]