Low Haemoglobin and Low Iron - Any advice and comments please...

[Parrot]

I am an unvaccinated 59 yo male, height approx. 1.815 cms (circa 6ft) weight approx. 87kgs living in Australia.

I went to give my regular blood recently and could not because my Haemoglobin (Hb) from a finger prick was considered too low at 126 g/L. They then took a sample from a vein and it was 129 - it must be a minimum 130 before they will accept a donation. They then sent my sample off for a ferritin test and it came back at 16.46 ug/L. In Australia the reference range for a male is between 30 and 300, therefore my reading is quite low.

The irony is I feel in good health - fit/vibrant/strong/looking forward to each day etc. I have some floppy fat around my hips and pecs but not much! I ride (bicycle) usually three times a week, have a simple weights routine x twice week (hand weights) and a simple aerobic routine x twice a week. (I am looking to lose the floppy fat!)

I usually eat quite well:-
Breakfast was usually coffee/meat (bacon and/or kangaroo steak)/egg/tomatoes/mushrooms/lettuce until quite recently (now usually coffee and rolled oats with milk/honey/cinnamon/maple syrup/sugar/molasses (very small amount)
Lunch is usually a smoothie - mango/banana/blueberries/milk/1 x egg yolk/cardamom/cacao/honey/cinnamon/maple syrup - about 900ml.
Dinner is usually similar to what I have for breakfast with some chorizo and carrot salad.
A late afternoon snack, when I have it, is usually either cheese and an apple or chocolate or potato chips

Two factors this year which may have had an impact??:-

1) On 28 Feb I had a bike vs. car accident where I came off second best, spending 5 days in the high dependency unit of one of our hospitals. I couldn't feel or move my legs for the first 10 minutes = very scary!! The upshot was that I had 4 x fractured neck vertebrae - C4 through C7, a fractured cheekbone and fractured eye socket. Plastic surgery to my face was required to repair the damage, however all fractures knitted by themselves. During my recovery I had to wear a neck collar for 8 weeks and over this time I lost about 7kgs my weight dropping to 82kgs - I looked gaunt and sickly. It was only about 3 weeks ago I was given the all clear to start riding again.
I have given blood once since my accident and my Hb level was fine.

2) On 23 July I contracted Covid. I didn't sleep for 24 hours due to coughing, however that was my only symptom and after the first 48 hours I was fine although the cough did stick around for a while.

I will be interested in people's thoughts - thanks.

 

[yerrag]

What were the markers like prior to the accident and in between the accident and your COVID incident?

 

[I'm.No.One]

Have you checked your copper levels?

 

[Parrot]

Hi Yerang

I do not have any other markers as it is effectively an exception report - ie: they take your Hb and blood pressure (mine is usually in the region of 120/75) and only go into further detail if you are outside their parameters. Going back over past blood test results from the last 10 years I don't seem to have had an iron test done.

 

[Parrot]

Have you checked your copper levels?

Hi INO

No I haven't. Part of the correspondence received from the Blood Bank advises that I should book an appointment with my General Practitioner (GP/Dr.) for further investigation. I will ask him to test for copper at the same time.

Any other thoughts on additional blood tests I should get anyone?

 

[Parrot]

Also, in addition to the above info, when I was an early teen an Aunt was diagnosed with Haemochromatosis and I seem to remember all male members of the family had to be tested. One of my cousins tested positive and had to have some type of key hole surgery. He is still kicking at 65 so can't have been too bad!

 

[I'm.No.One]

Hi INO

No I haven't. Part of the correspondence received from the Blood Bank advises that I should book an appointment with my General Practitioner (GP/Dr.) for further investigation. I will ask him to test for copper at the same time.

Any other thoughts on additional blood tests I should get anyone?

I would be sure to get a mineral panel done, not just nutrients & specifically ask that they check your copper levels.

Almost no one is iron deficient, it's typically a copper deficiency that's preventing your body from utilizing the iron.

 

[tankasnowgod]

I went to give my regular blood recently and could not because my Haemoglobin (Hb) from a finger prick was considered too low at 126 g/L. They then took a sample from a vein and it was 129 - it must be a minimum 130 before they will accept a donation. They then sent my sample off for a ferritin test and it came back at 16.46 ug/L. In Australia the reference range for a male is between 30 and 300, therefore my reading is quite low.

The irony is I feel in good health - fit/vibrant/strong/looking forward to each day etc. I have some floppy fat around my hips and pecs but not much! I ride (bicycle) usually three times a week, have a simple weights routine x twice week (hand weights) and a simple aerobic routine x twice a week. (I am looking to lose the floppy fat!)

I don't think it's that ironic, really. Peat has talked about how people with lower iron stores have better health. If you read "Exposing the Hidden Dangers of Iron" by E.D. Weinberg and the works of Dr. Fachinni, you will see a similar theme.

Of note, 126 g/L isn't really a "low" hemoglobin number, though it is lower than you'd expect in most adult males. The cutoff for blood donation used to be 125 g/L, they recently raised it to 130 (for males in the US, and probably Australia, too). So, it doesn't appear you are anemic.

Ferritin is lower than you'd expect, too. I can see why some would be concerned with this number. Personally, used to have high ferritin (444), and lowered it through blood donation and some complementary strategies. I got to "near defiency," and noticed improvements in energy and mood. I kept monitoring it, and keeping it under control, and ferritin tested as low as 28 and 18 on two different occasions. At neither time did I feel sick or down in any way, nor had any anemia symptoms. I don't think a low ferritin number under the range is necessarily concerning (based on personal experience), but I wouldn't donate blood in that range, either.

I noticed a B complex was excellent at raising hemoglobin, even with low iron. Did you lose any blood during that accident and subsequent hospital stay? And are you frequent blood donor? That would have had a very quick iron lowering effect, and if it was couple pints, that could easily explain the lower ferritin, especially if ferritin wasn't "high" previously. You may also want to look at your diet. If you aren't eating a lot of red meat, and are drinking a lot of milk and/or eating a lot of eggs, that could be a factor in the lower number. As could aspirin use. A few months eating some more steak/lamb could get your ferritin number back into "range."

 

[yerrag]

Could you post your complete CBC with differentials, and with platelets?

 

[Parrot]

I would be sure to get a mineral panel done, not just nutrients & specifically ask that they check your copper levels.

Almost no one is iron deficient, it's typically a copper deficiency that's preventing your body from utilizing the iron.

Will do...

 

[Parrot]

I don't think it's that ironic, really. Peat has talked about how people with lower iron stores have better health. If you read "Exposing the Hidden Dangers of Iron" by E.D. Weinberg and the works of Dr. Fachinni, you will see a similar theme.

Of note, 126 g/L isn't really a "low" hemoglobin number, though it is lower than you'd expect in most adult males. The cutoff for blood donation used to be 125 g/L, they recently raised it to 130 (for males in the US, and probably Australia, too). So, it doesn't appear you are anemic.

Ferritin is lower than you'd expect, too. I can see why some would be concerned with this number. Personally, used to have high ferritin (444), and lowered it through blood donation and some complementary strategies. I got to "near defiency," and noticed improvements in energy and mood. I kept monitoring it, and keeping it under control, and ferritin tested as low as 28 and 18 on two different occasions. At neither time did I feel sick or down in any way, nor had any anemia symptoms. I don't think a low ferritin number under the range is necessarily concerning (based on personal experience), but I wouldn't donate blood in that range, either.

I noticed a B complex was excellent at raising hemoglobin, even with low iron. Did you lose any blood during that accident and subsequent hospital stay? And are you frequent blood donor? That would have had a very quick iron lowering effect, and if it was couple pints, that could easily explain the lower ferritin, especially if ferritin wasn't "high" previously. You may also want to look at your diet. If you aren't eating a lot of red meat, and are drinking a lot of milk and/or eating a lot of eggs, that could be a factor in the lower number. As could aspirin use. A few months eating some more steak/lamb could get your ferritin number back into "range."

Very, very interesting - thanks for that.

I lost blood, but not buckets of it afaik. I donate every 10 weeks and have donated once since the accident with no issue. (28 Feb, 2022)

I actually avoid aspirin because I have tinnitus and it makes that more pronounced.

 

[Parrot]

Could you post your complete CBC with differentials, and with platelets?

Can do - will probably be nearer the end of this month.

 

[Parrot]

Okay, I got my results back today. Interestingly in the cbc column there are no Haemoglobin or WCC results, just ESR which is 2 (range 1-15) Will need to follow this up with the GP at my next visit?? The two previous results - March, 2020 and June, 2021 everything was within range.

Copper was 21.2 (range 10-22)
Zinc was 14.2 (range 9-18)
Cortisol 135 (range 110-550)
DHEA 3.9 (range 0.9-5.9)
Prolactin 190 (range 45-375)

Iron 13 (range 10-30)
Transferrin 2.87 (range 2.10-3.80)
Saturation 19 (range 15-50)
Ferritin 10 (range 30-500)

They also wanted me to do a stool test in case I was losing iron via the bowel however the reading was 0.

The Dr. wanted me to start a course of iron tablets however I declined as I feel really good atm. Also, at our last visit he gave me a sheet with 12 symptoms of iron deficiency and the only one that occasionally get is cold hands - usually at night and probably because I underdress. (it has been winter here.)

I told him I would increase my red meat consumption, which has declined to about once/day usually at night and not enormous amounts. I am certainly not eating as much as I used to before the bike accident but have gone back to around 89kg and not hunting food. I had already started to put a tsp of black strap molasses in my milk and honey before bed so will keep this up. (I feel I have slept better since doing this.)

We agreed to re-test in 3 months.

Be interested in people's opinions and comments - thanks...

 

[sunny]

Here is some info I have been accumulating that might give you some insight. I once had a saturation % that kept increasing, (I think it was estrogen); now I have very low sat %, and "low" ferritin, so there is reference to both in the following random quotes.

Random IRON info:

RP: High Iron, particularly if it’s the Iron Saturation %, just like Prolactin, is a sign of high estrogen. Are you dealing with your thyroid first?

DR: “Estrogen and the hypoxia , and the low thyroid increasing the estrogen promoting the hypoxia, that is what’s making the iron accumulate and displace the copper. It’s not just a random iron overload situation right”

DR: “So the iron overload is actually hyperesteogenemia
RP: “I think so, in most cases”
Danny Roddy Clips

High Iron, particularly if it’s the Iron Saturation %, just like Prolactin, is a sign of high estrogen. Are you dealing with your thyroid first?
-------‐------------
think improving nutrition in general might be a better idea than addressing iron directly since people can have a high level of stored iron combined with a low level of red blood cells. One should be eating gelatin, liver, oysters, shrimps, fruits, cooked green vegetables, etc. (e.g.: Vitamin A, Vitamin D, Vitamin E, copper, zinc, magnesium, selenium, etc. ). Here are a few articles/quotes which might help:

Ray Peat on copper deficiency and iron, their relationship
Ray Peat - Iron's dangers
Danny Roddy - Iron Overload, Perturbed Redox Balance, and Meddling Serotonin

On Anemia
Anemia in itself doesn't imply that there is a nutritional need for iron. - Ray Peat
It is possible to have too much iron in the blood while being anemic. - Ray Peat
Anemic means lacking blood, in the sense of not having enough red blood cells or hemoglobin. - Ray Peat
Most people define anemia as low iron, but should be classifying it as low bio-available copper causing increased saturation of iron in the tissues. - EastWest Healing

Thyroid
Abnormal thyroid status can affect ferritin level, without necessarily affecting your iron load. - Ray Peat

High estrogen
High estrogen causes hypoxia which in turn causes iron accumulation. - Danny Roddy (paraphrased from Ray Peat)

Copper and Vitamin A
Too much iron and too much stress makes us lose copper. -Ray Peat
The copper in oysters is protective against iron excess. - Ray Peat
Copper defends agains activated iron. Copper can turn ferrous iron back into the safer ferric iron. - Ray Peat
Vitamin A and bioavailable copper [from liver and shelfish] play a huge role in regulating iron ferrous to ferric iron. - EastWest Healing
Low iron and Low iron saturation –a sign your iron recycling programing is slowing down in response to a deficiency in bio-available copper [from liver and shelfish]. - East West Healing
Iron is regulated by bio-available copper and vitamin A. - EastWest Healing

Sunlight or Redlight
Regular good light exposure is probably important for preventing the displacement of copper by iron. - Ray Peat

Things that lower iron
We are always shedding iron from intestines and skin cells. - Ray Peat (Patrick Timpone interview 2020-08)
Vitamin E and aspirin are two extremely effective ways of lowering iron levels in both tissues and brain. - Georgi Dinkov
‐-‐--------------------,------
"Low ferritin means low iron stores. Whether that means lower inflammation is not always clear but testing CRP and ESR would tell you that. In general, the lower the ferritin the lower inflammation since iron plays such a prominent role in inflammatory reactions." - Haidut

 

[Sefton10]

I donate every 10 weeks

This seems overkill/pretty regular, could that be a factor?

 

[Parrot]

Here is some info I have been accumulating that might give you some insight. I once had a saturation % that kept increasing, (I think it was estrogen); now I have very low sat %, and "low" ferritin, so there is reference to both in the following random quotes.

Random IRON info:

RP: High Iron, particularly if it’s the Iron Saturation %, just like Prolactin, is a sign of high estrogen. Are you dealing with your thyroid first?

DR: “Estrogen and the hypoxia , and the low thyroid increasing the estrogen promoting the hypoxia, that is what’s making the iron accumulate and displace the copper. It’s not just a random iron overload situation right”

DR: “So the iron overload is actually hyperesteogenemia
RP: “I think so, in most cases”
Danny Roddy Clips

High Iron, particularly if it’s the Iron Saturation %, just like Prolactin, is a sign of high estrogen. Are you dealing with your thyroid first?
-------‐------------
think improving nutrition in general might be a better idea than addressing iron directly since people can have a high level of stored iron combined with a low level of red blood cells. One should be eating gelatin, liver, oysters, shrimps, fruits, cooked green vegetables, etc. (e.g.: Vitamin A, Vitamin D, Vitamin E, copper, zinc, magnesium, selenium, etc. ). Here are a few articles/quotes which might help:

Ray Peat on copper deficiency and iron, their relationship
Ray Peat - Iron's dangers
Danny Roddy - Iron Overload, Perturbed Redox Balance, and Meddling Serotonin

On Anemia
Anemia in itself doesn't imply that there is a nutritional need for iron. - Ray Peat
It is possible to have too much iron in the blood while being anemic. - Ray Peat
Anemic means lacking blood, in the sense of not having enough red blood cells or hemoglobin. - Ray Peat
Most people define anemia as low iron, but should be classifying it as low bio-available copper causing increased saturation of iron in the tissues. - EastWest Healing

Thyroid
Abnormal thyroid status can affect ferritin level, without necessarily affecting your iron load. - Ray Peat

High estrogen
High estrogen causes hypoxia which in turn causes iron accumulation. - Danny Roddy (paraphrased from Ray Peat)

Copper and Vitamin A
Too much iron and too much stress makes us lose copper. -Ray Peat
The copper in oysters is protective against iron excess. - Ray Peat
Copper defends agains activated iron. Copper can turn ferrous iron back into the safer ferric iron. - Ray Peat
Vitamin A and bioavailable copper [from liver and shelfish] play a huge role in regulating iron ferrous to ferric iron. - EastWest Healing
Low iron and Low iron saturation –a sign your iron recycling programing is slowing down in response to a deficiency in bio-available copper [from liver and shelfish]. - East West Healing
Iron is regulated by bio-available copper and vitamin A. - EastWest Healing

Sunlight or Redlight
Regular good light exposure is probably important for preventing the displacement of copper by iron. - Ray Peat

Things that lower iron
We are always shedding iron from intestines and skin cells. - Ray Peat (Patrick Timpone interview 2020-08)
Vitamin E and aspirin are two extremely effective ways of lowering iron levels in both tissues and brain. - Georgi Dinkov
‐-‐--------------------,------
"Low ferritin means low iron stores. Whether that means lower inflammation is not always clear but testing CRP and ESR would tell you that. In general, the lower the ferritin the lower inflammation since iron plays such a prominent role in inflammatory reactions." - Haidut

Thank you Sunny, that is very helpful.

I have liver once or twice/week, I enjoy oysters so will dial them in for a dozen/week. Diet is 85% "good." (I don't have a lot in the way of cooked green vegetables - I do have carrot salad, lettuce, fermented cabbage, cooked mushrooms and a few cooked tomatoes regularly.

I have always had very good Vitamin D levels and as my ESR reading was 2 that seems quite good.

 

[Parrot]

This seems overkill/pretty regular, could that be a factor?

I just checked and it is actually about every 12 weeks. (that is the minimum time you must leave between donations.) Also, I had only given one donation since my bike accident which was in late February so I don't think that would have been a factor.

Interestingly, the minimum time between plasma donations is only two weeks!

 

[Parrot]

Following on from this I just met with the Doc to review my three month follow up blood results.
10 Jan, 2023 results are in the first row under each heading and 29 Sep, 2022 results are in the second row under each heading.

Iron - Ideal Range = 10 to 30 umol/L
15
13

Transferrin - Ideal Range = 2.10 to 3.80 g/L
2.74
2.87

Saturation - Ideal Range = 15 to 50%
22%
19%

Ferritin - Ideal Range = 30 to 500
14
10

Lab comment - 'Iron studies are consistent with iron deficiency.'

In September the Doc wanted me to take iron supplements, however I declined and said I would increase my intake of molasses and beetroot
There has been a very minor uptick in my ferritin, and iron level. After reading through a lot of iron threads it does seem my saturation is low.

I do have days where I feel quite flat, unmotivated and don't seem to achieve a great deal and on these days I am aware I yawn and sigh a lot too. Sleep has not been great either.

I am thinking of taking a liquid iron supplement called spatone along with vitamin C. (I don't supplement vitamin C, however I do eat freshly squeezed orange juice quite regularly.)

FWIW, the Doc is keen for me to supplement iron and re-test in 3 months. He is of the view I am not absorbing iron.

All comments welcome - thank you...

 

[bornamachine]

@Parrot I have quite a history with iron researching and donations.

Sometimes things are that simple, try an iron supplement and see how it makes you feel. Don't over think this. Try to donate again, if ranges ok, then you found the culprit. If it's the case, consider donating once every year instead of 2.5 month. Donating too much can be a bad thing as well.

 

[cs3000]

In September the Doc wanted me to take iron supplements, however I declined and said I would increase my intake of molasses and beetroot
There has been a very minor uptick in my ferritin, and iron level. After reading through a lot of iron threads it does seem my saturation is low.

I do have days where I feel quite flat, unmotivated and don't seem to achieve a great deal and on these days I am aware I yawn and sigh a lot too. Sleep has not been great either.

I am thinking of taking a liquid iron supplement called spatone along with vitamin C. (I don't supplement vitamin C, however I do eat freshly squeezed orange juice quite regularly.)

FWIW, the Doc is keen for me to supplement iron and re-test in 3 months. He is of the view I am not absorbing iron.

All comments welcome - thank you...

the common recommendations can harm gut health so it was worth holding off on that
spatone has 5mg iron per sachet , which is ferrous sulfate. Iron absorption from a natural mineral water (Spatone Iron-Plus) - PubMed
should give +5mg elemental iron

ferrous sulfate causes gut damage at least in the doses its normally prescribed at 65 mg of elemental iron multiple times a day , which is likely way too much overkill as 20mg elemental daily has shown some effectiveness with few side effects. so it may be good on low doses with a healthy gut, but still i'd rather not take that if there's existing gut health problems

but you posted your levels are going up slowly atm so maybe you don't need much extra.

as a broad estimate assuming you absorb 25% of heme iron & naturally lose 1.5mg daily (without the extra blood donations, and without taking it with food that impairs absorption like wheat), you'd need 6mg heme or well absorbed iron daily to keep blood levels the same.

whether that works in practice idk ive read people often needing like 4x-6x that to raise levels through supplements that are supposed to have similar absorption rates,
going by posts / reviews i've seen 22mg of heme iron polypeptide or 30mg-45mg of iron protein succinylate sounds effective

-
Body iron excretion in man: A collaborative study <- daily natural iron loss ranges from 0.9mg - 2.42mg. probably higher end for people who do frequent prolonged endurance exercise.
Estimation of Dietary Iron Bioavailability from Food Iron Intake and Iron Status <- estimated typical iron absorption is ~13% 14% average with mid-low ferritin (but this ranges a lot)

depends but we can probably assume absorption of heme/meat iron intake is at least ~15%, up to ~35%. absorption increases to the higher end for when ferritin is in the low 2 digits.
-

heme iron polypeptide looks good to supplement if you can find it. it doesn't spike serum iron at 12mg unless serum iron is already low end <80mcg/dl (<14umol/L) , as its regulated by the heme receptor. small study but probably a safer form as other forms spike serum levels without limiting mechanisms.

Taken together with our findings, we suggest that the regulation of iron absorption from HIPk does occur and thus, continual supplementation of HIPk does not lead to iron overload.

11mg x2 daily shown to be as effective as IV iron within a couple months (tho idk why the P levels for the results are off)
another one https://juniperpublishers.com/jgwh/pdf/JGWH.MS.ID.555810.pdf
GI upset was reported in 1.6% of patients receiving oral HIP. This suggested oral HIP as an effective and tolerable treatment which can be considered as an alternative to intravenous iron saccharate complex for iron deficiency anemia of pregnancy

some formulations arent water soluable as they should be. so good to take this with a protein source or amino acids to ensure absorption.


also coconut oil can help increase levels Effects of type of fat in the diet on iron bioavailability assessed in suckling and weanling rats - PubMed and a couple mgs riboflavin daily too if typically low

iron protein succinylate was the next alternative a lot less damaging than other forms with same or better effectiveness. serum iron goes up slower than other forms but still elevates

personally i'm going for a combination of 1 iron protein succinylate + later on 2 heme iron polypeptide taken with meat & coconut oil, to hit both angles for a couple months. or could just eat red meat x2 daily for a while to see if its enough