Iron Tests Vary- Normal?

[Harvey]

Hi,
I am wondering if someone may be able to help me/direct me to where I can learn more about iron. (I am willing to slog through medical texts)

In the last 10 months, I have had my iron levels checked four times. My ferritin is stable in the range of 21-55. My iron saturation levels fluctuate from between 22%- 75%! I've had two on the lower side and two on the higher side of this range, so I am ruling out lab error. While, I am female (mid-20s), I cannot see a link between levels and menstruation. I purposefully had tests down at different points in my cycle to try to see a pattern. Liver, other iron tests (TIBC, transferrin), thyroid etc. are all normal. I can give more specific numbers if needed. I am on no medications, no allergies, healthy diet etc. I take vitamin D, multi-vitamin (no iron).

I am searching for the answer to these questions as my doctor cannot answer these for me. (Currently, looking for a specialist)
1) Is it normal for saturation levels to fluctuate this much?
2) What causes the saturation levels to fluctuate so much?
3) Even though ferritin is normal, could the high saturation levels cause damage to the body?

Thank you in advance!

 

[Blossom]

I found this post from forum member @Mittir that might partially answer your questions. If you do a forum search of the word 'Iron' in posts by 'Mittir' I'm sure you will find even more helpful information.

[Update] Reactive Arthritis / 20 day fast
Mittir wrote,
"I used to measure my whole iron panel regularly, have not done lately.
My saturation index varies between 24 to 32 percent and there is rise and
fall in ferritin number corresponding to saturation level
My understanding is that body store more iron in ferritin form when there is
inflammation or other problems. When ferritin is low, saturation index is higher
and vice versa, total iron remaining same. Ferritin is the most stable form of stored iron."

 

[tankasnowgod]

Hi,
I am wondering if someone may be able to help me/direct me to where I can learn more about iron. (I am willing to slog through medical texts)

In the last 10 months, I have had my iron levels checked four times. My ferritin is stable in the range of 21-55. My iron saturation levels fluctuate from between 22%- 75%! I've had two on the lower side and two on the higher side of this range, so I am ruling out lab error. While, I am female (mid-20s), I cannot see a link between levels and menstruation. I purposefully had tests down at different points in my cycle to try to see a pattern. Liver, other iron tests (TIBC, transferrin), thyroid etc. are all normal. I can give more specific numbers if needed. I am on no medications, no allergies, healthy diet etc. I take vitamin D, multi-vitamin (no iron).

I am searching for the answer to these questions as my doctor cannot answer these for me. (Currently, looking for a specialist)
1) Is it normal for saturation levels to fluctuate this much?
2) What causes the saturation levels to fluctuate so much?
3) Even though ferritin is normal, could the high saturation levels cause damage to the body?

Thank you in advance!

Hi Harvey,

Welcome to the forum! I'm really interested in the iron issue, since I used to have high iron levels that I lowered through phlebotomy.

The brief and not-so-helpful answers to your three questions, in order, are 1. Maybe 2. Lots of things and 3. Maybe.

Getting more into it, TSAT is a calculation, dividing serum iron by TIBC. Serum Iron fluctuates a lot, even during the day, so TSAT will as well. The simple act of eating can cause serum iron to spike, so if you didn't do all your tests while fasting, that could be your answer right there. However, the big thing I would look at is TIBC. If it's low (or on the lower end of the lab range), I would wonder if your protein intake is adequate. Low protein diets are known to compromise TIBC, since transferrin is a protein. If you have any history of going low protein (like going vegetarian or vegan), I would make a conscious effort to eat more animal protein, and maybe supplement with taurine, which can help protein utilization. If TIBC is low, that could make normal serum iron changes seem like drastic TSAT changes.

I could also see how the fluctuation could be linked to menstruation. Since you are losing red blood cells every month, there may be certain times of the month where TSAT spikes, as your body's demand for red blood cells increase. Since high iron is a bigger problem for men and post-menopausal women, the TSAT spikes could be a fairly normal thing for menstruating women, and the research might not reflect it.

Also, ferritin is an acute phase reactant, which goes up when your body is fighting off a pathogen (such as a cold, or infection, even a minor one). If the higher TSAT numbers correlated with your higher ferritin numbers, if could be that your body was fighting off a pathogen and sequestering iron any way it could.

To answer your third question, I think you are right to be slightly concerned, but it's probably not a huge issue. Learning more and monitoring labs is a good course of action. If you didn't get hemoglobin tested, you should probably find that out too.

Lastly, I think the best resource on this matter is "Exposing the Hidden Dangers of Iron" by Weinberg and Garrison. I would start there, you can find it on Amazon. Dr. Fachinni has also done some great work on the dangers of high iron, and his book "The Iron Factor of Aging" is also a worthy read.

 

[Harvey]

All my labs have been done in the AM after fasting. I have never been vegeterian, and definitely eat plenty of protein. My hemoglobin and hemocrit over the last two years have been on the edge of normal to slightly high: HGB: 14.3-16 on a reference of 12-16 g/dl.
HCT: 43-46 on a reference of 36-44.

TIBC has been anywhere from 281-340 on a reference of 250-400.
Serum iron has been from 72-176 on a reference 35-175.
It's only the saturation that seems to go way over the normal reference range. I wonder why I have so much iron floating around and where is it going? Am I absorbing more than I should?

Anyways, for all I know these fluctuations are normal. Getting information for high iron is tricky enough, and throw in that I'm a young female, well there seems to be hardly anything (or anyone) who has definitive answers. I have only one mutated HFE gene, so I'm not panicking. I do have joint pain and somewhat high blood sugar numbers (despite being fit/ruling out Type 1 diabetes), so I get curious if iron is causing this or if it is totally unrelated. My doctor's response is: "If you're concerned, go give blood." My ferritin has been as low as 20. Do I really want to give blood though? Isn't the result of that to lower ferritin, which doesn't seem like the goal.

Thank you both for your time and answers. It is an interesting topic! I will look into reading through those sources.

 

[tankasnowgod]

I think the lab may have mis-calculated some of your high TSAT numbers. When I divided your highest serum iron by your lowest TIBC, I got 63%. Still high, but not quite as concerning.

With your hemoglobin numbers, it should be safe to donate blood. In my experience, that's the only numbers blood donation centers check anyway. When I started donating, my ferritin was 444. When I checked last year, it was 28. I still donated pretty much every two months (which was about 5 donations) until this April of this year I checked ferritin in May, and it was 18. I personally never experienced any anemia symptoms, and my hemoglobin was always above 13.5, but I decided I would wait 4-6 months before donating again. By the way, I'm compound heterozygous for H63D/S65C.

In the Weinberg-Garrison book, they mention a target ferritin number of 25. However, they state that if a patient's TSAT number remains high, they can continue to donate so long as hemoglobin remains above 12.5.

I get your frustration on the lack of info on the iron issue. On the positive side, you probably already grasp it better than about 90% of doctors out there, and will reap the health benefits for decades to come.

Personally, I think you'd probably benefit if you donated blood once or twice a year. If you donate for the first time ever, be sure to eat lots of extra carbs that day. If you find you have lowish energy days after donating, then a steak could be a delicious fix!

 

[Harvey]

Thank you, I appreciate your help!

 

[tankasnowgod]

Thank you, I appreciate your help!

Also, if you decide to donate, I would recommend a local hospital over the Red Cross, especially a Children's Hospital or one associated with a university. I've heard about bad experiences and weird denials from the Red Cross. Meanwhile, I've donated at Children's Hospital Los Angeles and had good experiences, and also the donor center at UCLA , which is flat out excellent.

 

[Peater Piper]

IWhen I started donating, my ferritin was 444. When I checked last year, it was 28. I still donated pretty much every two months (which was about 5 donations) until this April of this year I checked ferritin in May, and it was 18.

Wow, that's a substantial drop! Did you notice health improvements as it came down?

 

[tankasnowgod]

Wow, that's a substantial drop! Did you notice health improvements as it came down?

I did. It's important to note that it took about 10 months or so to get it into the desirable range (from 444 to about 50 or so). So it's not like it was a drastic overnight improvement. Still, I seemed to notice better energy over time (I was pretty lethargic at the beginning), and I also noticed an improvement in mood. Hypothyroid symptoms also improved, although that could have been due to a number of other factors (I was supplementing thyroid and getting more into Peat at that time). Something that was interesting that could be related, I was starting to get a few gray hairs when I started donating, and now, they seem to be completely gone. My hair in general has a deeper, richer color. I've heard that copper gives hair it's color, and that iron and copper antagonize each other. So, a combination of iron reduction along with more copper rich foods (oysters and beef liver) might be responsible for that.

I also noticed an improved ability to handle carbs. I would sometimes get a bit of carb crash after eating something like rice or potatoes. That doesn't really happen anymore. Magnesium and chromium supplementation seemed to help as well, but I think the iron lowering was huge. I think it may have also improved liver function. I think both of these helped me to lose a lot of weight. I currently follow Colpo's Fat Loss Bible plan along with Peat's ideas and a Fitbit, usually eating around 300g of carbs a day, and I am in the best shape I've been in over a decade, both in how I look and how I feel.

Lastly, it became easier to give blood over time. The first time I donated, I was wiped out for the rest of the day (I think partially due to minor hypoglycemia). Now, I can donate in the morning, go to work and still be lightly active the rest of the day.

 

[ddjd]

@tankasnowgod @Peater Piper @Harvey
so which tests do we need to assess iron. is this correct-

iron serum
ferritin
transferrin