I love a good iron question. It makes me emit a sound like Jack Sparrow might, when faced with something pleasingly piratey 🏴☠️ Lucky because I am asked SO MANY GOOD ONES, SO OFTEN!! Being one of the earliest minerals discovered to be essential…we know so much more about it than the other latecomers but that ABSOLUTELY DOES NOT MEAN WE KNOW IT ALL! Sorry…I also tend to shout with excitement when faced with a good iron question. Yes, run for cover, I do have an even higher volume setting 🙉🙉
Just this month, I received this little ripper:
I was wondering about the expected timeframe for iron supplementation to improve ferritin levels?
Yes of all the nutritional answers we can quickly ‘google scholar‘ our way towards, actual realistic expectations for response to treatment, is rarely an easy find! And yet, this critical clinical detail seems to be the thing that can leave so many of us stranded at sea with our patient prescriptions. Did I give up too soon? Or should it have worked already by now? Some of the best naturopathic approaches are easy to execute…but when those patients come back after maybe a few repeats & perhaps minimal change you realise, you have a major piece of information MIA: what to expect. Rapid relief or a cure by Christmas?! Aka, it won’t happen overnight but it will happen. So, great, let’s talk ironing out our expectations around responses to iron repletion!!!
First – We need know where iron goes First!
So if your iron deficient individual is actually suffering from iron deficiency anaemia, no guesses who the VIP (very important priority) is during repletion! Consequently, you can throw lots of iron at somebody (oral or even IV) and find there’s limited increase in their ferritin initially, a rather ‘disappointing’ show actually but if you keep your other eye (Jack Sparrow style) on their FBE, you’ll see the iron is being funnelled into producing haemoglobin and red blood cells. Sneaky! And if sensible can ever be associated with sexy…this is it! Ferritin is for iron surpluses only and right now, we ain’t got none! Medical texts advise that in these scenarios, confirmation of efficacy equals an increase in Hb levels of approx 10g/L a week. In reality, no one wants to turn patients into pin cushions (esp when we’re trying to build iron back up not keep springing leaks!) so we might retest in a month or more. But an increase in Haemoglobin of 40g/L per month sounds rather aspirational with oral iron, doesn’t it!!
If we bring in the personalised perspective here, we recognise that most of our anaemic patients may only be just on the wrong side of the line, with values at 110g/L and tbh we would be shocked and a little worried if this grew in a month to 150 in a woman! Erythropoiesis is not the result of iron alone! But the point is, if the iron replacement is working well enough, you should be moving out of anaemia within a month not a millennium!
And only once this job is done will the ferritin start to build.
So what if your patient isn’t anaemic – just low in ferritin? Well then, if you’ve a) fixed the leaks (unintended or excessive blood loss anywhere Rectal, Renal, Repro) and b) buoyed bioavailability (HCl & prebiotics while minimising iron-blocking issues like excess Ca, tannins etc) and c) corrected for low intake via a sound supplemental approach (daily dosing for those not consuming much dietary iron and alternate days for the rest) you should be seeing ferritin increase within the month of at least 10mcg/L, but hopefully more. And if it’s not? Go back to the beginning of this little to-do list…because it means we’ve missed something. Doh!
Yes it’s true the learning doesn’t ever end and as I’ve continued to learn about new iron research I’ve added to our one-stop-iron-resource-shop..the Iron Package. Earlier this year we added a new clinical cheat sheet with some other important numbers on there you want to have at your fingertips whenever you read iron studies. So if you’ve already purchased and have access to the Iron Package…SURPRISE! 🤩 Go back and look again and if the iron package is not already on your ‘bookshelf’ there’s no time to waste!
You’ll never look at iron studies or your iron-challenged patients the same way.