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

[redsun]

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...

You need larger than normal doses of iron for a longer period of time to actually fix iron deficiency. It is pointless to be so resistant to taking iron you simply waste time when you likely would have improved your health complaints if your took iron from the start. Iron deficiency will compromise ATP production which will contribute to fatigue and cognitive dysfunction and lower hemoglobin levels which will affect oxygenation of your tissues.

Yes, you may deal with acute gut symptoms, but iron bisglycinate makes that minimal. Heme iron is way too slow as absorption is saturable. You can only absorb approximately 3mg or so from a 11mg heme polypeptide supplement at a time. This is why nonheme iron is preferred. Your doctor is probably right you may not absorb iron as well. Either too many absorption inhibitors in your diet, or old age which leads to generally reduced absorption of minerals like iron.

By the way at your age its really not healthy to give blood unless you have confirmed iron overload. Theres already a general slowing of the system at that age. When you reduce your oxygen carrying capacity through donation consistently at this age its overall going to hit you harder then someone younger. Hemoglobin levels that are barely sufficient are not optimal for anyone, especially elderly. They should be at least middle range or a little higher.

 

[Parrot]

@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.

Thanks BaM

I decided that I certainly won't be donating again until I have my next labs which are dialled in for three months time.

 

[Parrot]

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

Thanks for your comprehensive reply and links to those studies cs3000. That is the gear and dosage I have. I took my first sachet today, not on an empty stomach though, and it caused me no discomfort.

Interesting about the coconut oil as that is all I cook in, although I don't supplement it. I will now add a tbsp per day.

I reviewed my results and, although the raw numbers look very poor, the fact is in the fourteen week gap between the tests I have:-
- increased my ferritin by 40% (10 to 14) [This is still half of the low end of the scale, however the trend is good!]
- increased my saturation by 10% (19% to 22%) [It seems accepted that 35% to 38% is ideal, so heading in the right direction.]

I don't plan to go mad on supplementing iron (say 3 sachets/week) but since the next labs are booked I will continue with my oysters/molasses/liver regime (I like that these all have copper too) and add in my coconut oil. It will then be interesting to see the results...

 

[Parrot]

You need larger than normal doses of iron for a longer period of time to actually fix iron deficiency. It is pointless to be so resistant to taking iron you simply waste time when you likely would have improved your health complaints if your took iron from the start. Iron deficiency will compromise ATP production which will contribute to fatigue and cognitive dysfunction and lower hemoglobin levels which will affect oxygenation of your tissues.

Yes, you may deal with acute gut symptoms, but iron bisglycinate makes that minimal. Heme iron is way too slow as absorption is saturable. You can only absorb approximately 3mg or so from a 11mg heme polypeptide supplement at a time. This is why nonheme iron is preferred. Your doctor is probably right you may not absorb iron as well. Either too many absorption inhibitors in your diet, or old age which leads to generally reduced absorption of minerals like iron.

By the way at your age its really not healthy to give blood unless you have confirmed iron overload. Theres already a general slowing of the system at that age. When you reduce your oxygen carrying capacity through donation consistently at this age its overall going to hit you harder then someone younger. Hemoglobin levels that are barely sufficient are not optimal for anyone, especially elderly. They should be at least middle range or a little higher.

Thanks redsun - I hear what you are saying in your first paragraph. Without those second lot of results I just found it hard to accept that this was possible. I ride (cycle) about 4,000 kilometres a year and have felt strong on the bike lately, I go to the gym a couple of times a week as well as do Pilates or yoga once a week and am generally reasonably active.

As mentioned above, I now don't plan on donating again until at least after I have my next round of lab results which will be in late April - and I will post them up.

I will also check out the iron bisglycinate - thanks