Calling on anemia / iron utilization experts

[Elie]

Trying to help a 73 yo male with chronic low ferritin, hemoglobin, RBC and fatigue even with multiple iron infusions

While there is low grade Inflammatory bowel disease, no overt bleeding has been detected.

It seems like the iron is taken up by cells and doesn't bind ferritin nor to produce hemoglobin

Insulin and kidney markers are great despite obesity and ceruloplasmin and copper levels are within normal

ESR is normal by CRP is high

TSH is below 2 but not at 0.5 and the temperature is relatively high at close to 37

What might prevent iron to bind to ferritin and to be used to form hemoglobin?

 

[youngsinatra]

I’d check:
Ceruloplasmin
Copper
Ferritin
Hemoglobin
Iron & TIBC
Transferrin
B12 & Folate

Iron needs to be managed by co-factors. If those are missing then iron is stored in tissue to prevent major oxidative stress in the circulation, but it still causes systemic oxidative stress. (high CRP)

A female friend of mine had tons of iron infusions without success of fixing anemia, but she became chronically ill after those with a baseline body temperature of 38.0 C and high inflammatory markers. (chronic low grade fever basically)

 

[tankasnowgod]

Trying to help a 73 yo male with chronic low ferritin, hemoglobin, RBC and fatigue even with multiple iron infusions

While there is low grade Inflammatory bowel disease, no overt bleeding has been detected.

It seems like the iron is taken up by cells and doesn't bind ferritin nor to produce hemoglobin

Insulin and kidney markers are great despite obesity and ceruloplasmin and copper levels are within normal

ESR is normal by CRP is high

TSH is below 2 but not at 0.5 and the temperature is relatively high at close to 37

What might prevent iron to bind to ferritin and to be used to form hemoglobin?

Lack of B Vitamins would be my guess. There are several anemias that can happen even in the face of high ferritin, like pernicious anemia and pyridoxine deficiency anemia. These ones are pretty well established.

I know from personal experience when getting De-Ironed that B vitamins have a big influence over hemoglobin. Ferritin started off at 444, and my goal was near deficiency. Over the months, ferritin declined with regular blood donation, but hemoglobin did, too. As it was getting near the donation cutoff for hemoglobin, I started using a B Complex (or Life Extension's iron free "2 per day" multi), and Hemoglobin went up by 2 points by my next donation. It stayed in the 14s as I continued donating, even as Ferritin got towards near deficiency (I've even tested as low as 28 and 18 and still had good hemoglobin levels)

I have read other's reports of people with low ferritin having little success with iron supplements (often, making things worse), but B Vitamins/Complex working really well, even without any additional iron. Of course, eating liver would probably be a good thing for B vitamins, too.

Iron infusions can be very dangerous. Even though Iron is a needed metal, but it's not a safe one, and if it's not getting bound to things like ferritin or transferrin, it's likely making health worse. Meat and liver is probably the safest way to get iron, probably followed by something like a lactoferrin supplement with iron (they even sell ferritin supplements). I've heard Iron Bis Glycinate is a more gentle form.

 

[Peatness]

Riboflavin Deficiency - StatPearls - NCBI Bookshelf

From the article
Research has shown that riboflavin deficiency can alter iron absorption and cause anemia, which leads to fatigue. Riboflavin is involved in red blood cell production and transportation of oxygen to the cells. Improving the amount of riboflavin in the body can increase circulating hemoglobin levels and increase red cell production.

 

[Elie]

I’d check:
Ceruloplasmin
Copper
Ferritin
Hemoglobin
Iron & TIBC
Transferrin
B12 & Folate

Iron needs to be managed by co-factors. If those are missing then iron is stored in tissue to prevent major oxidative stress in the circulation, but it still causes systemic oxidative stress. (high CRP)

A female friend of mine had tons of iron infusions without success of fixing anemia, but she became chronically ill after those with a baseline body temperature of 38.0 C and high inflammatory markers. (chronic low grade fever basically)

out of all of these I think just folate is left to check.
Not sure what is causing the storage of iron.
All WBC are normal too, so likely no infection

 

[youngsinatra]

out of all of these I think just folate is left to check.
Not sure what is causing the storage of iron.
All WBC are normal too, so likely no infection

Even ceruloplasmin normal?

 

[Elie]

Riboflavin Deficiency - StatPearls - NCBI Bookshelf

From the article
Research has shown that riboflavin deficiency can alter iron absorption and cause anemia, which leads to fatigue. Riboflavin is involved in red blood cell production and transportation of oxygen to the cells. Improving the amount of riboflavin in the body can increase circulating hemoglobin levels and increase red cell production.

Thanks Pina.
He does take a supplement with B1, B2, Niacinamide and B6. Has been taking 1.5 mg B2 for a few months now.

 

[Elie]

Even ceruloplasmin normal?

Yes, 297 mg/l (ref 190-370)
... and I do appreciate the input.

 

[Peatness]

Thanks Pina.
He does take a supplement with B1, B2, Niacinamide and B6. Has been taking 1.5 mg B2 for a few months now.

Does he eat liver? He may benefit from natural sources of B2. Liver will have iron and other nutrients too

Also look into candida

Candida albicans specializations for iron homeostasis: from commensalism to virulence

Candida albicans is a fungal commensal-pathogen that persistently associates with its mammalian hosts. Between the commensal and pathogenic lifestyles, this microorganism inhabits host niches that differ markedly in the levels of bioavailable iron. A ...

www.ncbi.nlm.nih.gov

 

[Elie]

Lack of B Vitamins would be my guess. There are several anemias that can happen even in the face of high ferritin, like pernicious anemia and pyridoxine deficiency anemia. These ones are pretty well established.

I know from personal experience when getting De-Ironed that B vitamins have a big influence over hemoglobin. Ferritin started off at 444, and my goal was near deficiency. Over the months, ferritin declined with regular blood donation, but hemoglobin did, too. As it was getting near the donation cutoff for hemoglobin, I started using a B Complex (or Life Extension's iron free "2 per day" multi), and Hemoglobin went up by 2 points by my next donation. It stayed in the 14s as I continued donating, even as Ferritin got towards near deficiency (I've even tested as low as 28 and 18 and still had good hemoglobin levels)

I have read other's reports of people with low ferritin having little success with iron supplements (often, making things worse), but B Vitamins/Complex working really well, even without any additional iron. Of course, eating liver would probably be a good thing for B vitamins, too.

Iron infusions can be very dangerous. Even though Iron is a needed metal, but it's not a safe one, and if it's not getting bound to things like ferritin or transferrin, it's likely making health worse. Meat and liver is probably the safest way to get iron, probably followed by something like a lactoferrin supplement with iron (they even sell ferritin supplements). I've heard Iron Bis Glycinate is a more gentle form.

Thanks.
Ferritin is 4 (22-275). See my response to Pina re B vitamins

 

[Elie]

Does he eat liver? He may benefit from natural sources of B2. Liver will have iron and other nutrients too

He did for a while. let me check...
thank you

 

[tankasnowgod]

Thanks Pina.
He does take a supplement with B1, B2, Niacinamide and B6. Has been taking 1.5 mg B2 for a few months now.

What about B12? That's the one low in Pernicious Anemia. I think folate may be a factor, too,

Pernicious anemia - Wikipedia

en.wikipedia.org

 

[jackierae]

Perhaps the B complex helps iron absorption because it has biotin in it. This study suggests that biotin is needed for heme synthesis. I don’t know if it’s accurate or not.

Biotin Deficiency Inhibits Heme Synthesis and Impairs Mitochondria in Human Lung Fibroblasts

Abstract. Four of the 5 biotin-dependent carboxylases (BDC) are in the mitochondria. BDC replace intermediates in the Krebs [tricarboxylic acid (TCA)] cycle tha

academic.oup.com

 

[golder]

Is Morley Robbins accurate when he states low blood iron equates to high tissue iron, which means copper must be low? If copper does help mobilise the iron, would taking 2mg of copper biglycinste once or twice a day help with this low ferritin issue? Seems like a simple fix but I want to know if it is actually that simple in reality? Would love to hear people’s expertise on this!

 

[Don]

Is Morley Robbins accurate when he states low blood iron equates to high tissue iron, which means copper must be low? If copper does help mobilise the iron, would taking 2mg of copper biglycinste once or twice a day help with this low ferritin issue? Seems like a simple fix but I want to know if it is actually that simple in reality? Would love to hear people’s expertise on this!

I believe Morley recommends copper from foods like bee pollen, shellfish (especially oysters and shrimp) and beef liver over using supplements.

 

[golder]

I believe Morley recommends copper from foods like bee pollen, shellfish (especially oysters and shrimp) and beef liver over using supplements.

Yeah you're right actually, I'm just making my way through his "Do's and Don'ts" in his new Copper book. I don't understand why he's incredibly pro copper but strictly only from food. Obviously it's much better balanced in food form, but in the case of someone with phenomenally low ferritin, if copper is the solution I don't see what's wrong with few milligrams of copper glycinate for a few months at the same time as increasing oysters/liver etc? Does he mention anywhere why he dislikes copper supplements so much?

 

[Don]

Yeah you're right actually, I'm just making my way through his "Do's and Don'ts" in his new Copper book. I don't understand why he's incredibly pro copper but strictly only from food. Obviously it's much better balanced in food form, but in the case of someone with phenomenally low ferritin, if copper is the solution I don't see what's wrong with few milligrams of copper glycinate for a few months at the same time as increasing oysters/liver etc? Does he mention anywhere why he dislikes copper supplements so much?

I agree with your thinking but I dont have the knowledge to answer that. Worth experimenting with for sure. Personally for copper/iron ratio I will stick with copper rich foods and blood donation.

 

[Rinse & rePeat]

Lack of B Vitamins would be my guess. There are several anemias that can happen even in the face of high ferritin, like pernicious anemia and pyridoxine deficiency anemia. These ones are pretty well established.

I know from personal experience when getting De-Ironed that B vitamins have a big influence over hemoglobin. Ferritin started off at 444, and my goal was near deficiency. Over the months, ferritin declined with regular blood donation, but hemoglobin did, too. As it was getting near the donation cutoff for hemoglobin, I started using a B Complex (or Life Extension's iron free "2 per day" multi), and Hemoglobin went up by 2 points by my next donation. It stayed in the 14s as I continued donating, even as Ferritin got towards near deficiency (I've even tested as low as 28 and 18 and still had good hemoglobin levels)

I have read other's reports of people with low ferritin having little success with iron supplements (often, making things worse), but B Vitamins/Complex working really well, even without any additional iron. Of course, eating liver would probably be a good thing for B vitamins, too.

Iron infusions can be very dangerous. Even though Iron is a needed metal, but it's not a safe one, and if it's not getting bound to things like ferritin or transferrin, it's likely making health worse. Meat and liver is probably the safest way to get iron, probably followed by something like a lactoferrin supplement with iron (they even sell ferritin supplements). I've heard Iron Bis Glycinate is a more gentle form.

This is just the info I was looking for! Thanks Tank!

 

[Rinse & rePeat]

What about B12? That's the one low in Pernicious Anemia. I think folate may be a factor, too,

Pernicious anemia - Wikipedia

en.wikipedia.org

Do you recommend an oral B12 Tank?

 

[tankasnowgod]

Do you recommend an oral B12 Tank?

It could be helpful, if you are low in hemoglobin. I have used the methylcobalamin form tablents in the past. It's not something I take consistently.