My chronic ongoing struggle with low ferritin has finally reached the point of pushing me into the anemic range with the low energy and all. The PPI I take because of my EoE is probably interfering with my iron absorption because I consume plenty of iron. It’s gotten to the point where I’m concerned. My last ferritin reading was 7. Yes, 7. The range for women is 30–160 ng/mL and below 50 is considered iron deficiency. No one seems to know how to help me and I can tell it’s impacting me in ways that concern me.
If anyone has any ideas, I’m all ears. High dosage iron shots aren’t an option. Neither are supplements unless they are free of everything including fake sugars. I’m looking for baby and child level supplements here because that is all my system seems to handle.
Did anyone ever get iron shots when they were pregnant? I’m wondering if that might be the route to explore and if they are smaller doses than the megadoses they usually give people with iron absorption issues.
It’s so fantastic that every month we spend a small fortune to have health coverage that is useless because there are no doctors, nutritionists, or anyone else who seems capable of helping me. What makes me sad is that this is the norm for so many people in our country – spend a fortune and get no help. What a mess.
(Please note: There is some excellent information the comments!)
UPDATE: THIS was the solution I finally found. This is the first thing that has ever worked for me! It has changed my life! I used Spatone Iron Plus – Apple taste with Vitamin C.
Why I Closed My “A Woman’s Freedom In Christ” Website
I definitely feel isolated because of politics these days. I have been drawing on something George MacDonald wrote (paraphrasing): sometimes you just have to endure the discomfort of being misunderstood, for a while.
I’ve thought about the ferritin thing, to the extent that I can do so from my position of almost total ignorance. It seems to me like you have three potential avenues for raising ferritin: take in more iron, absorb more, or lose less.
Taking in more iron might include supplements, injections, IV drips [infusions], or even (I am guessing) actual blood transfusions.
Absorbing more iron sounds like it might require reducing or cycling off your PPI for a while. That doesn’t sound like a great option.
I saw an abstract for a study someone was doing on transdermal iron supplementation, but that is cutting-edge research right now.
Losing less iron…if you’re not in full menopause yet, you could perhaps try to get to 100% amenorrhea sooner. (Not the greatest option, either.) Also, doctors are advised to check for gastrointestinal bleeding in anemia cases. Hopefully your doctor has done that already.
(Later) I found this journal article, which is very technical but may be helpful:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4137115/
It mentioned (in the sixth paragraph) that PPIs interfere with nonheme iron absorption, so it seems that you will need heme iron (from meat) for your oral iron intake.
Also, there was something in there about copper helping with iron absorption. But…(following one of the authors off into his other publications)…way too much dietary iron (9x requirements) causes copper deficiency in rats:
https://www.ncbi.nlm.nih.gov/pubmed/29546308
It seems that iron, copper, and zinc are all metabolically related, and so an excess in one can mean a deficiency in one or more of the others. Elsewhere I read that too much calcium can interfere with iron absorption, and that vitamin B12 deficiency can happen in conjunction with low iron.
Here’s a book that does not appear particularly reputable:
https://www.amazon.com/Iron-Disorders-Institute-Guide-Anemia/dp/1581826923
But one of the things this author suggests is not just doing a ferritin test, but a full “iron panel”, claiming that some anemic people have good iron stores, but can’t access them. At this point an iron panel may not be necessary for you; it becomes important in more advanced anemia.
So to my initial list, you can add “iron pulled from storage”.
Another link that was not necessarily reputable suggested that the lower-acidity stomach environment created by the PPI tends to make usable iron oxidize (turning Fe2+ to Fe3+) and continue on past the iron absorption point in the upper small intestine; this is yet to be confirmed:
https://www.ebmconsult.com/articles/proton-pump-inhibitor-iron-ferrous-sulfate-replacement-anemia-evidence
I’ve read conflicting opinions on how much PPIs can affect iron absorption, anywhere from “a little” to “really a lot”. This article, about using PPIs to treat excessively high iron, says it’s “a lot”, and mentions the differential effect of PPIs on heme vs. non-heme iron:
https://gut.bmj.com/content/gutjnl/56/9/1291.full.pdf
This paper doesn’t look all that great, but it does make me think that perhaps tweaking the timing of oral iron intake vs. the PPI would be helpful (i.e., ingesting nonheme iron at times when your stomach acid is most acidic):
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3878540/
Somewhere I read an gastroenterologist saying that he was comfortable reducing PPI dosage in half in many cases, or even letting the patient only take it as needed.
There’s an overview of heme vs nonheme iron here, which also mentions some dietary factors such that can interfere with nonheme iron absorption, including tea and coffee (because of tannin):
https://www.gpnotebook.co.uk/simplepage.cfm?ID=x20110720105313880069
IV iron or iron shots would skip over the absorption problem, but they can be uncomfortable and they have some risks. I haven’t found much information on lower-than usual dosages for these, but I would think that with an IV infusion that they could stop it at any time, and not give you the whole bag. There is probably some flexibility with injection dosages as well.
It may be encouraging to note that the first article I listed said that iron metabolism tends to become more efficient during anemia. Stress reduction is probably also helpful.
Hopefully there is something in there that can be of some help to you! I did enjoy scanning through the research papers.
WOW, Peggy. This is amazing. Thank you so much for taking the time to do all this research. It will take me some time to go through it. That is really so kind of you to do this. Thank you.
Sallie
No problem–as I said, it was fun to dig around and learn something new.
I figured you probably knew most or all of it already, but sometimes it is just that one little thing more, that is what you need to get you over the worst of the difficulty.
I’ll keep praying for you as well.
And I really like that George MacDonald quote. That’s a new one for me. Thank you for sharing it!
Sallie