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“You can get past the dead end. You can break through the ceiling. I did and so have countless others.”

Clinical Pearl Wednesday #149

Various symptoms can be attributed to anemia, low iron, or low ferritin.  Oftentimes, we overlook these lab tests and think of them as unnecessary.  However, more and more functional and holistic providers are ordering the iron/ferritin panel and guiding patients to correct the lower levels.  According to functional providers, ideal ferritin level is 70-80 ng/mL, optimal iron level is 70-80 ug/dL, and iron saturation is preferred at top end of range.

Most of us were taught as RNs to recommend the use of Vitamin C with iron or red meat intake, but many patients typically don’t use enough Vitamin C to be of real value or to improve iron, ferritin, or saturation.  As a result, iron levels rarely or slowly increase, making patients believe they cannot absorb iron.  Another problem that impairs iron/ferritin absorption/utilization is using non-heme iron supplementation. Multiple studies have indicated very poor absorption & utilization of non-heme iron.  What is non-heme iron? Plant-based iron.  Ferrous polysaccharide will be absorbed at a rate approximately 60% less than ferrous bisglycinate, or heme-iron.  Most other forms of iron, like gluconate or sulfate, cause terrible constipation, impacting compliance.

Takeaways: 

  1. Check iron and ferritin panels with patients who report of fatigue, brain fog, or lack of stamina to get through the day.
  2. Recommend heme iron for best absorption.
  3. Recommend Vit C 2000 – 4000 mg with every iron dose, every red meat meal, and most any meal to optimize iron absorption from food.
  4. Recheck iron & ferritin panel every 4-5 months and remind patients to never take iron supplements “unchecked” because too much can be risky to the liver. 
  5. Ideal absorption & use of iron/ferritin results in iron and ferritin numbers that should be near each other (note that they are different measures though) and a iron saturation around 40%.

6 Responses

  1. Any concern for development of kidney stones with vitamin C intake of 2000-4000 mg per dose of iron? I learned that consistent intake of vitamin C over 2500 mg per day may be associated with development of kidney stones and iron replacement therapy usually lasts 6-9 months to replete iron stores fully.
    Any comment on every other day dosing of iron supplements for better absorption and tolerability?
    Thank for your pearls!

  2. Personal problem I deal with 😔. Requires iron infusion yearly. It’s time now for another iron infusion, asks my ice machine.

    1. So sorry to hear that, but I am sure you always feel better. Plus, it could always be worse. That is how I try to rationalize health problems I have experienced….

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