New Study About Ferritin Levels, Fatigue and Iron Supplementation.

[Gamboa]

This study, published on-line in CMAJ.ca, July 9, 2012, looked at the effects of iron supplementation in women with low ferritin levels but normal hemoglobin and hematocrit levels. In the past, if you had low ferritin but normal hemoglobin you were not considered anemic and the low ferritin was not considered a cause of fatigue. This study found that this is not the case and that supplementation with iron reduced fatigue in low ferritin/ normal hemoglobin women.

http://www.cmaj.ca/content/early/2012/07/09/cmaj.110950.full.pdf

They conclude: " Iron supplementation should be considered for women with unexplained fatigue who have ferritin levels below 50 micrograms per milliliter".

This is very interesting to me since I have had very low ferritin ( ranging from 11 to 25 : normal ferritin is 80-300 ) for the last ten years but always have had normal hemoglobin, hematocrit and RBC's. All the doctors I have seen, including an ME/CFS specialist, weren't concerned about the low iron since they were taught to look at hemoglobin results. It is only a few naturopaths who believed low ferritin was causing a problem.

I don't think it is the cause of my illness but if getting my ferritin levels up will reduce some of my fatigue then that is a good thing. Every little bit of improvement helps.

 

[Gamboa]

Here is the abstract:
Effect of iron supplementation on fatigue in nonanemic menstruating women with low ferritin: a randomized controlled trial

1. Paul Vaucher,
2. Pierre-Louis Druais,
3. Sophie Waldvogel,
4. Bernard Favrat

+ Author Affiliations

1. From the Department of Community Medicine and Primary Care (Vaucher), University of Geneva, Switzerland; the National College of General Practitioners (Druais), Le Port Marly, France; the Blood Transfusion Service of the Swiss Red Cross (Waldvogel), Lausanne, Switzerland; and the Department of Ambulatory Care and Community Medicine (Favrat), University of Lausanne, Switzerland.

1. Dr. Bernard Favrat, E-mail Bernard.Favrat@hospvd.ch

Abstract

Background: The true benefit of iron supplementation for nonanemic menstruating women with fatigue is unknown. We studied the effect of oral iron therapy on fatigue and quality of life, as well as on hemoglobin, ferritin and soluble transferrin receptor levels, in nonanemic iron-deficient women with unexplained fatigue.
Methods: We performed a multicentre, parallel, randomized controlled, closed-label, observer-blinded trial. We recruited from the practices of 44 primary care physicians in France from March to July 2006. We randomly assigned 198 women aged 18–53 years who complained of fatigue and who had a ferritin level of less than 50 ug/L and hemoglobin greater than 12.0 g/dL to receive either oral ferrous sulfate (80 mg of elemental iron daily; n = 102) or placebo (n = 96) for 12 weeks. The primary outcome was fatigue as measured on the Current and Past Psychological Scale. Biological markers were measured at 6 and 12 weeks.
Results: The mean score on the Current and Past Psychological scale for fatigue decreased by 47.7% in the iron group and by 28.8% in the placebo group (–18.9%, 95%CI –34.5 to –3.2; p = 0.02), but there were no significant effects on quality of life (p = 0.2), depression (p = 0.97) or anxiety (p = 0.5). Compared with placebo, iron supplementation increased hemoglobin (0.32 g/dL; p = 0.002) and ferritin (11.4 µg/L; p < 0.001) and decreased soluble transferrin receptor (–0.54 mg/L; p < 0.001) at 12 weeks.
Interpretation: Iron supplementation should be considered for women with unexplained fatigue who have ferritin levels below 50 µg/L. We suggest assessing the efficiency using blood markers after six weeks of treatment. Trial registration no. EudraCT 2006–000478–56.

 

[justy]

Thanks for this Gamboa - interesting indeed.

My Ferritin has been at 5 for many years and only increased to 11 after a YEARS suplementation with iron. Like you my other bloods are normal. What i dont iundersatnd is why i cant get my ferritin up, even with supplementation. I have switched a few months ago to a transdermal iron spray, but havent had a test yet to see if this has helped. My fatigue has lessened in this time, but i had atributed that to the B12 injections.

All the best, Justy x

 

[rlc]

Hi Justy, have you ever been tested for H Pylori ? Studies have shown that it causes iron deficiency and stops iron replacement treantment from working see http://www.indianjgastro.com/IJG_pdf/july2005/icat05i4p147.pdf

All the best

 

[Timaca]

Justy~ I had to take over 200 mg of elemental iron a day (that was 3 iron supplements + my multi-vit) and still my iron indices did not improve. I ended up with a uterine ablation. Then, I took that much iron to get my ferritin level close to 100 ng/mL which is where my iron disorders doctor wanted it. (My ferritin had been at 5). That took some time. I still, years later, take iron and test myself once a year to see where I'm at. I recently discontinued the iron supplements (I was taking one 4 times a week) to see if I can keep my ferritin level over 50 w/o taking supplements. Time will tell.

You may not be taking enough iron, or you may be losing too much to effectively replace orally.

Best, Timaca

 

[barbc56]

Thanks for this Gamboa - interesting indeed.

My Ferritin has been at 5 for many years and only increased to 11 after a YEARS suplementation with iron. Like you my other bloods are normal. What i dont iundersatnd is why i cant get my ferritin up, even with supplementation. I have switched a few months ago to a transdermal iron spray, but havent had a test yet to see if this has helped. My fatigue has lessened in this time, but i had atributed that to the B12 injections.

All the best, Justy x

Sounds like you need to see a hematologist. Five is way to low of a ferriting count. Norma can change due to different conditions. My ferretin was very low with okay hemaglobin. Because I have restless legs syndrome, my neurologist wanted my ferretin to be at least 120. I have IBS so my he believes this is causing an absorption problem. I tested negative for h pyloria. I was also low in vitamin D and B12 which are now normal. I had a nine hour iron infusion. While I didn't notice that much of a difference as far as fatigue (which shows that the fatigue is primarily from this DD)., but it dramatically helped my RLS and at least my ferretin level is now normal.

 

[justy]

H

Hi Justy, have you ever been tested for H Pylori ? Studies have shown that it causes iron deficiency and stops iron replacement treantment from working see http://www.indianjgastro.com/IJG_pdf/july2005/icat05i4p147.pdf

All the best

Hi rlc - always nice to see you pop in with your inormation!
Just had the blood test for H Pylori last friday - waiting for the results. I now have severe gastritis.
Justy

 

[justy]

Sounds like you need to see a hematologist. Five is way to low of a ferriting count. Norma can change due to different conditions. My ferretin was very low with okay hemaglobin. Because I have restless legs syndrome, my neurologist wanted my ferretin to be at least 120. I have IBS so my he believes this is causing an absorption problem. I tested negative for h pyloria. I was also low in vitamin D and B12 which are now normal. I had a nine hour iron infusion. While I didn't notice that much of a difference as far as fatigue (which shows that the fatigue is primarily from this DD)., but it dramatically helped my RLS and at least my ferretin level is now normal.

Interesting about the restless leg - i also have this, although relatively well controlled with magnesium.
My Manganese is also low and i know this has a relationship of some sort with iron and absorption. Ive been supplementing magnesium for nearly two years now as well.

About 2 years ago my GP looked very concerned and considered sending me to the hospital immediately - but then lost all interest - he hasnt even mentioned it in over a year. Must make them retest me when i go back in September to see him.
Take care, Justy

 

[Ema]

I'd like to echo Timaca's point that sometimes it can take a great deal of oral iron to get levels up. It took me upwards of 100 mg of iron bis-glycinate a day to get iron levels where I wanted them and I have continued to supplement to keep them there.

It's also important to get regular iron labs to make sure that the TIBC (or binding capacity) remains high so as to limit free iron in the body which can oxidize and cause harm.

Being hypothyroid also makes it harder to hold onto iron. It can be a vicious cycle.

 

[biophile]

Interesting. I know someone who has been taking about 90mg (elemental) iron per day for nearly 20 years and AFAIK her "iron levels" (based on ferritin I guess, I do not have details about recent blood tests) are still borderline low/normal. She reports that cutting back on the iron leads to increased lethargy.

 

[rlc]

Hi Justy, it will be interesting to see what the results of your H pylori test are. I remember you had strong reactions to taking mebendozole some good and some bad, it is occasionaly used as a alternative treatment for H pylori if people are alergic to the antibiotics normaly used to treat H pylori, but not in the same kind of doses that are used for worming. So maybe your reactions were because it was having an effect on the H Pylori. Hope you get your results soon, if its postive it is reasonably easy to treat and your iron levels should go up after the H Pylori infection is cleared.

All the best

 

[sedonagal]

Justy,
I mostly lurk but read your post and I remembered I had a study about copper deficiency and anemia. I could not find the study I had, but I did find this. I don't know if it is even relevant in your case, but basically it says that when taking ample iron is not increasing your iron stores, it could be due to copper deficiency, and that continuing to take iron while deficient in copper can have adverse effects.

http://www.clinchem.org/content/43/8/1457.full

Ferritin should not be used to assess functional liver iron stores in copper deficiency and as such may not provide a clue to potentially serious underlying disorders. Unlike most iron-deficiency anemias, the anemia of copper deficiency reported herein was not due to depleted iron stores but to hepatic iron overload and an impaired release of iron from body iron stores. Unlike the anemia of iron deficiency that responds to iron supplementation (14), the anemia of copper deficiency should not be treated by iron supplementation but should be treated by either lowering the intake of dietary iron or by chelation therapy (15)(16)(17).

This is the first report, however, that demonstrates that serum ferritin, a key conventional laboratory test, is inadequate in identifying anemia and assessing functional iron stores in copper deficiency. This finding may have practical significance to clinicians dealing with cases presenting as anemias of iron deficiency.


Also, taking zinc without adequate copper in the diet can cause copper deficiency.

 

[natasa778]

Thanks for this Gamboa - interesting indeed.

My Ferritin has been at 5 for many years and only increased to 11 after a YEARS suplementation with iron. Like you my other bloods are normal. What i dont iundersatnd is why i cant get my ferritin up, even with supplementation. I have switched a few months ago to a transdermal iron spray, but havent had a test yet to see if this has helped. My fatigue has lessened in this time, but i had atributed that to the B12 injections.

All the best, Justy x

If iron is not getting absorbed it is worth trying to cut off dairy from diet (if not dairy-free already?) to see if it helps as milk can hinder absorption. It worked for a friend of mine (not ME/CFS) who had 20+ years of low iron regardless of supplementation. Now not supplementing and iron normal for the first time.

 

[barbc56]

If iron is not getting absorbed, (my absorption probems are caused by my IBS), you really need to have the infusion or some way to bypass the stomach..Sometimes a doctor can give shots but you really need a hematologist to figure this out. You can supplement, change your diet, whatever but you are not getting to the root problem if it's absorption. You also need a series of tests to rule out other health problems.

My hematologist, PCP, sleep neurologist as well as my gastrointerologist confered to get a better idea of what was going on.

Hope things are improving

Barb C.:>)

 

[apepper]

I have been through the mill. I have done all the tests and then some. I am no genius but adrenal fatigue test come back positive with cfs/FM. Also ANSAR test for autonomic nervous system dysfunction (the ANS controls every aspect of your homeostasis.... half of you here fall in this category realistically. You also probably have high rheumatoid factors or sed rates which shows imflamation of the body. The ANSAR test will put your mind at ease. Knowing what's causing the problem is better than playing with websites for answers. Check thyroid, pituitary, adrenals and autonomic nervous system. You will find out what you have and what to take for your best results. Also an endocrinologist might check for other hormones while you visit which might play a role. God bless all of us.

 

[apepper]

Cardiologists also for the irregular blood pressure and the orthostatic issues.

 

[roxie60]

Just got test back and Ferritin at 41, two years ago it was at 70 but HBG and Iron are within range. Dont what it means if anything.

 

[GiulioM]

I also suffer from an abnormally low level of Ferritin. My Ferritin count is usually 6 and the iron count is usually near the lowest end of the gap. I'm also on supplements but every time i'm put on them after 4 months Ferritin barely reaches levels such as 21; Iron goes normal instead. My diet is, in one word, varied. I'm also physically active.

Although i'm male, i can tell you that i have a deviated nasal septum and therefore lots of mucus being ingested each day since i was a child. I also regularly drink milk and i've got no problem with dairies. No trouble with gluten either. I think that i've been affected by restless legs type scenarios in the past. By the way i'm 20 years old.

As for my own situation, medics won't go further from giving me supplements and i am trying to investigate my disease by myself.

 

[Johnmac]

How did that end up @justy ? Did the transdermal iron help?

Thanks for this Gamboa - interesting indeed.

My Ferritin has been at 5 for many years and only increased to 11 after a YEARS suplementation with iron. Like you my other bloods are normal. What i dont iundersatnd is why i cant get my ferritin up, even with supplementation. I have switched a few months ago to a transdermal iron spray, but havent had a test yet to see if this has helped. My fatigue has lessened in this time, but i had atributed that to the B12 injections.

All the best, Justy x

 

[justy]

How did that end up @justy ? Did the transdermal iron help?

No, the transdermal Iron did not work. In the end Ferricure has helped my levels AND doesn't cause any GI issues - ive been taking it for around 6 months.