low iron questions

I am 5 yrs post op......just had physical and my iron level was LOW...  27 ...when the low norm on lab indicated 40...My general pract. has suggested 325 mg of iron sulfate (?) three times daily and wants to re-check me in 30 days...if oral iron does not come up (I am not sure up how much) she wants to do IV iron.  The nurse that called me with the results indicated that she too has low iron issues and receives IV iron about every 18 mo. and doubted that the oral iron would catch me up in 30 days....Does anyone have any experience or advice....All other levels were great and B-12 a little on the high side (using sublingual). 

I hate ferrous sulfate.

This is something I wrote yesterday for someone about iron:

325mg of ferrous sulfate is equivalent to 65mg of elemental iron.  Not 200mg.  No way, no how.  He's up and down wrong.  Go look it up.

With that said, he's giving you the absolute worst iron out there.  And there's no reason for it.


The difference is this -- there are different types of iron supplements.  I think you've gathered that by all of this.  The ones you've mentioned are both ferric salts.  And quite honestly, I wouldn't take either of them.  Ferric salts are horrible on the GI tract -- constipation, bloating, discomfort on the stomach, problems with absorption, but whatever.  Personal preference.

The ferric salts are ferrous sulfate, ferrous gluconate, and ferrous fumarate.  There's tons of speculation as to which is the best absorbed -- and my answer is NONE OF THEM.  The most commonly found, however, is ferrous sulfate.  It is litterally metal filings.  No, I am not joking.

The 325mg is the entire ferric salt amount.  When you look at it, though, only 65mg of it is iron.  The rest is the "salt" part.  It's the "sulfate" portion of the name of it.


Now, there are other formulations -- poly-sacharide iron, carbonyl iron, and heme iron to name just three.  Carbonyl iron is a straight up elemental iron.  When you see it mentioned as 25mg carbonyl iron, it really IS 25mg elemental iron.  This is the ionic iron that I'd recommend as it has no GI upset and is absorbed in a neutral pH environment (ie with no gastric acid like RNY has).  Heme iron is a completely different ballgame -- and is most like eating a steak.  It's completely different, absorbs completely differently, and cannot be equated to like elemental iron.  People who try shouldn't because it just isn't the same.  And yes, you'd know it if you are on it because you pay much more for it.  It has no GI upset and absorbs WONDERFULLY -- but you pay through the nose for it.


When you take ionic iron, do not take it within 2 hours of calcium over 300mgs, dairy over 300mgs, whole grains, legumes,copper, zinc, or large amounts of tanins (tea and coffee).  Also, you need to take it with 200mgs of C for every 30mgs of elemental iron (so that 65mg?  Take with 500mg of C).


Additionally, here's some more info about iron on my blog:

General Iron Info

On 12.07.09, In Minerals, By Andrea

Some of the things discussed in our post-op health can be a bit confusing.  Iron is one of those things, IMHO.  So how about a session just on iron?

What is iron?
Iron is a mineral that can be found in plants, animals, soil, air, water, meteorites, and rocks, including on the surface of the moon.  Here on earth, plants absorb iron through their root systems; animals eat these plants.  Humans consume these plants and animals.  Many think iron is a heavy metal, which it is not.  Iron is an essential micronutrient.  Essential used in this way means that the body does not produce the nutrient; micronutrient means that the body only requires tiny amounts to function.

Types of iron?
There are two forms of iron – heme and nonheme.  Nonheme iron primarily comes from plants and heme iron comes primarily from meat.
Nonheme iron represents the majority of iron humans consume in their diets and is the type of iron in most supplements.  Nonheme iron is inorganic and is found in grains such as rice, wheat and oats.  It’s also found in nuts, fruits, vegetables, most iron pills, fortificants, or contaminant iron such as from water, soil or cooking utensils.
Meat, especially red meat is the best source of heme iron.  Heme iron is easily absorbed by the body and the best source of iron for people who are iron deficient.

Iron terminology

• Transferrin – a protein that is the major transporter of iron and ideally is saturated with 25-35% iron; when working properly, transferrin binds to iron and transports it to all tissues, vital organs, and bone marrow so that normal metabolism, DNA synthesis, and red blood cell production can take place
• Ferritin - a protein that acts like a large holding vessel; contains iron that we don’t presently need
• Hemaglobin (hgb) – a protein that transports oxygen to the body
• Hematocrit (hct) – proportion of blood volume that is occupied by red blood cells

So someone who is anemic can still have normal hemaglobin and hematicrit numbers because their ferritin is being depleted in order to maintain those counts.  But if the ferritin is in the toilet and no relief comes, the hgb and hct will eventually fall as well.

Types of non-heme supplemental iron:

• Ferric salts: These include ferrous sulfate, gluconate, and fumarate.  Typically, the way these compounds are made is that pure iron is dissolved in sulfuric or hydrochloric acid.  Once dissolved, a counter ion  is added and the pH is adjusted to make neutral once again.  When this happens, the iron binds to the counter-ion and drops out of the liquid solution.  The slurry is then dehydrated and the dry stuff that is left is the iron salt.  Ferric salts, especially ferrous sulfate, are not known to be easy on the digestive tract.  Once ingested, it is imperative that the stomach contains acid to dissolve the iron salt.  If a person is taking antacids or H2 blockers, their stomach will be “achlorhydric" – their stomach won’t contain acid and the iron salt will not dissolve.
• Carbonyl iron is often used by physicians because it is less toxic to accidental overdose.
• Polysaccharide iron is a newer form that is coming up in popularity, absorbs better than the ferric salts, but is more expensive than the standard supplementation routes.

I discuss my current experiment with the heme iron, Proferrin, here.  Information about it from the Iron Disorders Institute:

About Proferrin(tm):  Performance studies indicate that iron absorption rates are between 15% and 20% withoute erythropoietin (EPO) therapy and as high as 30% with EPO therapy even in patients with high serum ferritin values (>600 ng/ml).  In one study, the change in serum iron from Proferrin(tm) was nearly 23 times greater than from an identical dose of ferrous fumarate.  Also, study participants were able to tolerate up to 60 mgs per dose on an empty stomach with fewer gastrointestinal side effects; a common complaint from patients taking traditional oral iron preparations.  An additional benefit of heme iron supplementation is that patients can take it with their meals, unlike ionic iron preparations, which must be taken on an empty stomach between meals.

Info courtesy of the Iron Disorders Institute

 

Hi Andrea

Doc put me on Se-Vate Iron pills....know anything about them? Of course they tell me I'm low, um yeah I knew that already. Said my Folic Acid and B-12 were a bit high. hmmm

I know your good at this....

Irony:  Telling your patient that they are high in B12 and folate, yet putting them on an iron that contains folate and B12.


It's a scripted iron that has C, folate, and B12 with it.  It's the same as Repliva.

So is it the right iron for absorbtion?

It is a very good iron, yes.

Give it a try, see how it works for *you*  -- your labs should always be your guide.

It did not work for me, but that is not to say it won't for you.  (Cause like I said, I think I was broken for ionic irons.)

It can constipate because it's an iron salt -- so be aware of that and add some extra water and fiber.

Repliva went off the market and is now only available as a generic as Pruvate and the name she said.  I took both repliva and Pruvate and they worked great for me.  I actually ended up with a ferritin too high and don't take iron anymore

Yeah, I know -- but I think everyone on the preggo board has been on Repliva at least twice, and she's one of the preggo board ladies ;-)

Thank You!  and like others I was hoping you would reply...I read the info you posted yesterday and others and obtained many helpful iron hints....I hope they work.  My main concern that if I am at 27 mcg/dL and the normal is 40-175  can I catch up with oral meds?  other numbers you will understand ...
     
     iron binding capicity 585 mcg/dL with normals listed 250-450
     %saturation               5%                          "                           15-20
      hemoglobin              9.5 g/dL                                              11.7-15.5
      hematocrit                29.3%                                                   35.0-45.0
       mcv                           67.8 fL                                                   80.0-100.0
       mchc                         32.5 g/dL                                              32.0-36.0
                  


and obviously I have not been  absorbing it because it is the only low number I had...how can I possible catch up enough to avoid the IV treatment?  And as far as the other numbers out of whack is there any other concerns I should be aware of? 

You can try ferrous sulfate, but it is not easily absorbed.

If you want your numbers to go up, I'd try carbonyl or heme.  Honest.


Vitalady sells both.

CVS and Walgreens now sell a heme combo with poly called Bifera.

CVS and Walgreens also sell carbonyl by Feosol --- but they also sell a non carbonyl by the same name, so you have to really watch to be certain you get carbonyl.


But I wouldn't take ferrous sulfate.  Cause it doesn't absorb AND you'll need a bottle of Miralax as well.