The Iron Protocol
Guide 1. The Iron Protocol The Iron Protocol is shared research, supported by scientific articles, studies, and analytics of hundreds of testimonies with very specific circumstances, and the American Society of Hematology’s guidelines (amongst other doctors familiar with iron deficiency) targeting the effective treating Iron Deficiency with or without Anemia. The Iron Protocol Facebook Group is a Protocol Facebook Group, with a focus of answers and research. -----The Iron Protocol - Preface -----Step 1: Identify who The Iron Protocol could work for -----Step 2: Calculate Daily Range needed by most people, per The American Society of Hematology and others. -----Step 3: Cofactors, Contraindications, and Drug Interactions (How Iron should and shouldn’t be taken) -----Step 4: Set Schedule -----Step 5: Identify Cause (and fix if treatable)
The Iron Protocol - Guide #1 Preface & Outline
The Iron Protocol - Guide #1 Preface & Outline
Read this Preface & Cheat Sheet Outline below. If you still feel overwhelmed or confused, I offer one on one consultations to answer questions, help you understand, or creating your protocol. It is not medical advice and I am not medically trained. To schedule, simply PM Caitlyn R Hartigan.
The cheat sheet Outline is below.
Preface: Open your mind to learning! Most of us have to completely throw everything we've ever heard about Iron Deficiency from our doctors or anyone else, before we're able to mentally let ourselves understand the steps in The Iron Protocol. You have to compartmentalize and put what your doctor has said to the side for the moment in order to let your mind focus on learning what the protocol is. Much will be explained and make sense. You have to trust the process and read each Step in Guide 1, then read the supplementing and treatment options in Guide 2. Then later, when you've got your schedule and protocol down, read the Featured Posts. Don't try to memorize any of this. Get used to the layout and refer back to it when you need it. If you are struggling because you're trying to make sense and a connection of what your doctor has said, simply tell yourself that you are focusing on a new perspective for the moment. You can compare after you first understand this new perspective.
Trust the process, and the methodically structured steps, and you will fly through it! Just go with it! DO NOT SPEED THROUGH OR SKIP AROUND. YOU WILL CONFUSE YOURSELF AND ASK QUESTIONS ABOUT THINGS ALREADY THOROUGHLY EXPLAINED IN GUIDE 1. TRUST THE PROCESS. COMPLETE THE GUIDES IN ORDER STEP BY STEP. IT CANNOT BE LAID OUT ANY EASIER. IT'S LIKE I AM HOLDING YOUR HAND THROUGH THE WHOLE PROCESS!
Guide #1 The Iron Protocol Outline
Here is an outline to help you keep track, should any of you need it. Keep this outline open in a separate window as you work through each step. Or you can grab a piece of paper and write these in bold down. You can also copy and paste this into a Word document so you can print it. It will help you keep track of your thoughts and understand what and where you are in Guide 1.
1. Guide 1, Step 1: Identifying Iron Deficiency & Goal of The Iron Protocol
- What's the point? Find out if you're Iron Deficient or not if you don't know yet, using the Ferritin number. Why we use it is section A.
- How do we find that out? See section B. Write down your ferritin number and if you're Iron Deficient or not.
- What's the GOAL of The Iron Protocol? The goal is to maintain optimal Ferritin of OVER 125ng/mL (typically), for OVER 6 months. For some who have been deficient over a decade, Ferritin levels maintained higher than 200ng/mL may feel better. In general, those with Iron Deficiency need to be on The Iron Protocol.
- Why is this the GOAL? Healing from Iron Deficiency depends on TIME and CONSISTENCY. See Step 1. A.3 for why.
2. Guide 1 Step 2: Calculate Daily Range (Non-Heme)
- What's the point? Find out how much iron to supplement with, if one wants to take what the American Society of Hematology says MOST people need to take daily in milligrams of iron to treat their Iron Deficiency. This Guide goes over the differences between non-heme elemental iron and heme iron. This protocol was built for non-heme elemental iron, although there is information here and in Guide 2A over heme iron.
- How do we do it? It's simply a minimum of 2X your weight in kg, with a maximum of 5X your weight in kg. That's 2 different numbers. (400 is the max if your number came out to over 400). Write down your range.
3. From Guide 1 Step 3: Cofactors, Contraindications, and Drug Interactions
- What's the point? Certain things block non-heme iron absorption and certain things help enhance iron absorption. Don't take iron with things that block it. Take iron with it's c"o-factors" for best absorption.
- How? Look at the list. Write down any medications that you're on that block Iron Absorption. You'll use it in the next step. You don't have to memorize everything here, but you need to understand the notes here.
4. From Guide 1 Step 4: Set Schedule
- What's the point? It's extremely hard to raise Ferritin or any other vitamin/mineral without being on a protocol. You need to set a routine and schedule
- How? Use what you learned in Step 3, your current routine, and the information here in Step 4 to set your new protocol schedule.
5. From Guide 1 Step 5: Identify Cause and Treat It
- What's the point? You can't effectively treat Iron Deficiency without fixing the cause(s) of the ID (iron deficiency). It's like trying to fill up a bucket with holes in it and expecting the water to stay inside, if you don't fix the causes and treat.
- How? Look at the list of Causes, and vet them out with your doctor.
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SUPPORT FOR THOSE ANXIOUS OR OVERWHELMED BY READING:
*Feel free to help yourself by using a paper and pencil, to write out each step as you go, and fill in your answers, to help you keep track. It makes everything super simple.
*Pay attention to your resources. You do not have to memorize everything. Get comfortable with where your resources are. The Units are organized and structured, with beginning, middles, and ends, as detailed out above. The announcements also have most talked about and asked topics. The files are being updated and organized. Everything has been methodically figured out to be of easiest use for you. Much time has been invested so you can benefit from this for free. You are totally in a space that much care has been given to you.
*If you feel overwhelmed or confused, simply stop, and rewind. Go to the previous Step and re-read the Summary to make sure you feel confident within it. If you don't feel confident within the summary, simply start from the beginning of that step and redo it. Then take your time and focus, and re-read the step you are on, starting with the top. Ask yourself why you are confused. Is it because you're trying to make sense of something your doctor told you, and it's different than in the protocol? You have to compartmentalize and put what your doctor has said to the side for the moment in order to let your mind focus on learning what the protocol is. Much will be explained and make sense. You have to trust the process and do the Units and then the announcements.
*If you skim the Guides, you will be lost, confused, and post questions that are already answered in the required reading. If you feel overwhelmed, simply take a breath, and remind yourself that I have spent tens and tens of hours spelling this out in a very specific way to hold your hand through the process. You absolutely can do this. I am already holding your hand. Promise. Simply start with Step 1, start from the beginning and read through the end. Focus on feeling very confident within each step before moving on. Do not pressure yourself to understand everything right off of the bat, and do not pressure yourself to memorize anything. You have everything you need at your fingertips in the Guides & Featured Posts. They are organized in a very specific way for you to easily go back to and reference. This is the easiest way this can be communicated. You can do this! It ends up much easier than we anticipate, if you simply trust the process and do it in order. Be excited!
*As I stated before, this is actually much easier than many of us anticipate. I understand many of us have brain fog, and feel overwhelmed simply from the idea of reading, let alone understanding the units. Believe me, you could have already finished the Guides by the time you finished reading the Welcome post and this post.
*Be kind to yourself, love yourself, have faith in yourself, and help yourself. I have now done everything I can, and it is up to you to do what is working for everyone, and simply do the Units (and then announcements). It is up to you if you want to feel better, and try. You do not need to post immediately when you are confused with questions. You need to stop, take a breath, and re-read the Step, and perhaps the prior step, to find out where you got confused. It is okay, and you can do this. Please be respectful and try to help yourself first. If you do want to schedule a one on one consultation, please feel free to PM me.
*Please feel free to post questions after you have tried helping yourself, and followed these instructions. Some times we just get stuck on one thing, or need a little help, especially with this brain fog. No big deal! Please help yourself by re-reading the parts you need to, first, before asking for someone's time for free. If you notice, I put the most important points that will most likely need to be re-read out loud, in bold (for a reason!).
Be patient, you do not have to understand everything all at once. Take it one small step at a time. Be excited!
Step 1. Identifying Iron Deficiency & Goal of The Iron Protocol
Step 1. Identifying Iron Deficiency & Goal of The Iron Protocol
Could The Iron Protocol work for me?
This Step 1 is the fundamental basics of The Iron Protocol. Complete A, B, C, & D below to find out. I've spent tens of hours organizing this so that it's extremely easy for you, and actually quite fast, no matter how much brain fog you have. Remember, I've been there. You are in good hands. Do not move onto the next section until you understand what you just read. I've written an outline at the bottom of this section, if you would like to take a look or copy and fill in. Re-read the Summary at the bottom below, out loud when you are finished, and write it down in your notes. Do not move onto Guide 1 Step 2 until you understand everything here in Guide 1, and can answer each section of your outline.
If you still feel overwhelmed or confused, I offer one on one consultations to answer questions, help you understand, or creating your protocol. It is not medical advice and I am not medically trained. To schedule, simply PM Caitlyn R Hartigan.
A. Focus on Ferritin.
- A.1 What’s the Ferritin number? Don’t have it? It’s needed. Go get it tested and then come back. You can easily Google about ordering blood work online, instead of having to wait weeks to meet with your doctor and pay for a doctor’s visit. In the UK and other countries, at home tests are even available. Google it. Unless you and your doctor have already confirmed you have an iron deficiency, then you may not need your ferritin number (although it will be useful to gage progress).
- A.2 What is Ferritin? Ferritin is the safe storage of excess iron in the body. WRITE THIS DOWN AND KNOW IT BY HEART. Don't worry about understanding the rest of the iron process and details right now. Focus on understanding the point and process of The Iron Protocol, by completing Guide 1. Then move onto Guide 2, and then Guide 3 where the iron process is explained. Focus on one step at a time. Trust me and this process. Write this down, wrap your head around the point, and don't get distracted wondering about details at the moment, "Ferritin is the safe storage of excess iron." Write it down.
- A.3 Why Ferritin? Because "Ferritin is the most specific indicator" of iron status, used to determine Iron Deficiency, when it is under 100ng/ml or 100ug/L, and when the body is without the presence of inflammation, fatty liver, obesity, hyperthyroidism, or any malignancies. This is how Iron Deficiency is clinically diagnosed. Focus on what was just told to you in bold. That's what you need to know and write down. You do not need to understand the rest I have spelled out in this section right now to move forward. If you are overwhelmed or easily overwhelmed, skip ahead below to A.5. ----------------------Additionally, just FYI, SERUM IRON IS USELESS TO DETERMINE IRON DEFICIENCY. Stop looking at it for the purposes of determining iron deficiency. Here are the details, that you don't have to read or understand right now, and may actually distract you from completing Guide 1 Step 1, but I know many of you will be curious, so here it is if you choose to read it now. You can always come back and read this later after you've completed Guide 1. You do not have to memorize this or fully understand it right now to complete Guide 1 Step 1, or complete Guide 1: Using Serum Iron is like looking at your cash in your wallet or amount in your checking account to gage your financial status. We don't do that. We have to make sure we have money readily available during our day-to-day lives so we can operate and buy what we need, like food, gas, pay bills, and such. So, typically make sure we have enough cash in our wallet/money in our checking account. That's what Iron Serum is- it's the cash in our wallet or money in our checking account. We don't use this to assess our full financial status. We look at what money we have stored in our savings and assets to assess our financial status. This is the same thing for Iron status. Our stored money in our savings account is our Ferritin, the safe storage of excess iron. We're typically always going to have enough Iron Serum in our blood, because the body is amazing and is going to make sure we have enough to run around and operate, even minimally, so we don't die. This does not necessarily mean the body is sending iron to all places it needs to. We use Ferritin, the safe storage of excess iron, to determine Iron status. If we notice our savings account getting low, we typically ration and budget what we spend, can start selling some things, and also get new or more jobs. This is the same thing the body does, when it realizes we're depending on our savings (Ferritin). This is why we have symptoms. The body will prioritize where the iron is spent, rationing out where it goes, and prioritizing making sure it always has enough iron to fuel the bone marrow so we can make new red blood cells and hemoglobin (because that's the most critical & important use of iron for the body). This is why Anemia (low or insufficient red blood cells or hemoglobin) is the last stage of Iron Deficiency. We've been suffering from hundreds of other biomechanical processes not functioning properly, well before we reach anemia, if we ever do. Anemia caused by Iron Deficiency is called "Iron Deficiency Anemia." More on this in Guide 3, but don't get distracted- we need to finished Guide 1 because it spells out the fundamental basics of The Iron Protocol step by step. This was just an explanation WHY Ferritin is the most specific indicator of Iron Deficiency. Let's go back and focus on completing Step 1 of The Iron Protocol. If you're confused about the above, stop and re-read at your own pace out loud. If you have questions on details about the Iron process, everything is spelled out in Guide 3, but honestly, put that aside and just focus on the point that Ferritin is the most specific indicator of Iron Deficiency when someone does not have inflammation, fatty liver, obesity, alcoholism, hyperthyroidism, or any malignancies, and that anyone with a Ferritin below 100 has a possible Iron Deficiency. Confused? read everything above at your own pace. The main points are in bold. You do not have to understand the reasoning on why Ferritin is used and not Iron Serum to be able to complete Step 1 or even do The Iron Protocol.
- A.4 "Optimal" Ferritin vs Normal Lab Reference Range. There's a huge difference. Is your Ferritin just in normal lab reference range? Or is it optimal? You want it to be optimal. The body tends to optimally use iron when Ferritin is in "optimal" range. When the body optimally uses minerals and vitamins, we don't have symptoms from lacking enough of the mineral or vitamin. We have an optimal amount. An "optimal" range or amount is different than the normal reference range a lab uses. The lab simply samples a couple of thousand people they deem "healthy," and average out the results, and take one standard deviation from the mean, to result in their lab reference range. What does this mean? It means scientists and doctors have not researched and dug into the body to find out what exact Ferritin level our body's should have. They simply sampled people they presumed were healthy and took an average of that, to use as the range. The lab reference range does NOT mean it is our "healthy" range for Ferritin. How could it be when it is so wide, anyhow? It's usually 10-300! Hair loss, insomnia, air hunger, head aches, and brain fog usually start with a Ferritin around 75-100. Would you call that "healthy?" Or "optimal?" The fact that labs take a simple average of people they subjectively deem healthy, is another reason why different Labs have difference ranges. Some ranges are 15-250, while others are 8-200. Does that mean if someone in Topeka, Kansas has a lab reference range of 15-250, and their Ferritin comes back at an 11, that they have Iron Deficiency, but if they get tested in Destin, Florida, with a Lab that uses a range from 8-200, that they're no longer Iron Deficient? NO! How does that make sense? It doesn't! So understand what and why lab reference ranges are. They are not what experts have deemed "healthy" range. Lab reference ranges are simply what one company has sampled after selecting who they deem is "healthy," not because the range actually represents what exactly our Ferritin should be to function best. Optimal range has been deemed by doctors who focus in Iron Deficiency (there are very few, and they are not necessarily Hematologists. More on that later), and will be explained below in the GOAL of The Iron Protocol. For this point, focus on understanding that there is a difference between "optimal" and "normal."
- A.5 What to do about Ferritin number:
- If you have your Ferritin number, or have been diagnosed with Iron Deficiency, move onto section B below. The units of measurement for Ferritin are the same in every country, so you don't need to worry about converting.
- If you do not have your Ferritin number, have not been diagnosed with Iron Deficiency before, and do not have any of the conditions above or possibility of the conditions above, go get it and then come back.
B. Ferritin Number Ranges. Now that you have your Ferritin number, or have been diagnosed with Iron Deficiency, here's the breakdown. Simply go to the ONE section below that applies to you. Ferritin by the numbers:
- B.1. If the Ferritin is 30 and below (remember, the units of measurement are the same world wide so there is no conversion), it is an ABSOLUTE IRON DEFICIENCY per clinical papers and findings. There is no need to look at any other blood work or condition if Ferritin is under 30 in order to identify an ABSOLUTE Iron Deficiency. This means it does not matter whether you are anemic or not, or any other blood work. Skip down to Section C. Do not read the rest of this section (B). Skip straight down to section C. There is no confusion on this. If someone has a Ferritin of 30 or below, they absolutely have an Iron Deficiency. If your Ferritin is 30 or under that, you just identified that you have a clinical absolute Iron Deficiency. It does not matter what any other blood work says. It's that easy. Do NOT make a post asking "Well by Ferritin is an 8 and my TIBC is _____. What does that mean?" It means you have an ABSOLUTE IRON DEFICIENCY. No matter what anything on the Iron Panel or any other blood work of any kind says. The TIBC and %TSaturation does not matter, unless your %TSaturation is in the 50-100% range while fasting, then go to Guide 3 for more understanding. It still means you have an Absolute Iron Deficiency, there are just some specific notes about it you'll want to see. You may want to focus on completing Guide 1 first though so you don't confuse yourself about the current task at hand, which is understanding The Iron Protocol. If your %TSaturation is below 50%, then don't worry about it, this noting did not apply to you. Don't get confused. Many are in this position, and treating themselves or their doctors are treating them on The Iron Protocol. You may have been like the majority of us, and told you were "normal" and not diagnosed with and Iron Deficiency. If so, your doctors is wrong. Why? Because a Ferritin of 30 and below is a clinical ABSOLUTE Iron Deficiency. If your Ferritin is 30 or below, you have a clinical absolute iron deficiency. Do not read the rest of this section (B). Skip down to Section C.
- B.2 If the Ferritin is 45 AND you are anemic, it is a clinical Absolute Iron Deficiency according to the American Gastroenterological Association (AGA) Clinical Practice Guidelines on the Gastrointestinal Evaluation of Iron Deficiency Anemia. Anemia can be if your Hemoglobin is below 12, or if any of the other CBC red blood cell markers indicate that your red blood cells are insufficient. If one has a Ferritin of 45 or below, while also anemic, there is no confusion, it is an ABSOLUTE IRON DEFICIENCY. There is no need to look at any other blood work or condition if Ferritin is 45 or below while anemic in order to identify an ABSOLUTE Iron Deficiency, per the AGA. Skip down to Section C. A Ferritin of 45 and below is an ABSOLUTE IRON DEFICIENCY, and needs to be treated. Many are in this position, and treating themselves or their doctors are treating them on The Iron Protocol. You may have been like the majority of us, and told you were "normal" and not diagnosed with and Iron Deficiency. If so, your doctors is wrong. Why? Because a Ferritin of 45 and below is a clinical ABSOLUTE Iron Deficiency. Skip the rest of the B section and go straight to section C below. Link to AGA clinical diagnostic criteria for iron deficiency with or without anemia: https://www.gastrojournal.org/.../S0016-5085(20.../fulltext
- B.3 If Ferritin is 30-100, with or without anemia, remember, anything below 100 can be symptomatic and can mean one has an Iron Deficiency. Many people and educated doctors in Iron Deficiency will look at a Ferritin number that is 30-100, and see if there are any symptoms and potential causes, and diagnose with Iron Deficiency. They will treat on the protocol. Either way, if I personally had a Ferritin of 70, and symptoms, it's a possible Iron Deficiency because its below 100, AND it's below optimal in treating an Iron Deficiency anyhow. Since the lab range for Ferritin is usually around 10-300, moving my Ferritin up to optimal is within the normal range any how. Plus, a Ferritin of 70 is below optimal any how. Many doctors and people will treat this on The Iron Protocol, because there is likely room to feel better. More on Optimal below in the GOAL section. If you've read this and your Ferritin is 30-100, go straight to section C below.
- B.4 If Ferritin is above 100, verify it isn't a false high first. This is in Guide 3E. Higher Ferritin “False” Readings! JUST BECAUSE SOMEONE'S FERRITIN MAY BE ABOVE 100 DOES NOT NECESSARILY MEAN THEY DO NOT HAVE AN IRON DEFICIENCY, it can be a false high from the multiple conditions I've already mentioned. Secondly, typically most doctors don't diagnose someone with an Iron Deficiency if their Ferritin is above 100 and fasting %Tsaturation is above 20. Does that mean it's optimal for you? It may or may not. I would suggest understanding how the iron process works more, to assess for yourself, in Guide 3. If your Ferritin is below 100, then this section of B3 doesn't apply to you. I repeat, if your Ferritin is below 100, then this section of B3 doesn't apply to you, and you weren't supposed to read this section any how. Don't let yourself get overwhelmed in trying to understand things that don't even apply to you. You should only be looking at once section here in section B. Focus on it. If you're confused, re-read the section that applies to you. After reading Guide 3E, decide if your Ferritin over 100 is a false high, and if you want to treat or not. If you want to learn more about tending to iron deficiency on the iron protocol, continue to section C below.
- B.5 Diagnosed with Iron Deficiency but don't have your Ferritin number? If you've been diagnosed with Iron Deficiency but don't have your Ferritin number, you will probably want to get it done right away to assess your progress in the treating of your Iron Deficiency. Many doctors will diagnose Iron Deficiency on high TIBC and low %Tsaturation alone. If you have your Ferritin number, do not worry about the TIBC or %TSaturation just yet and this section did not apply to you. Many will not need it.
C. GOAL: The goal to treat Iron Deficiency, on The Iron Protocol, is to reach & maintain optimal recovery levels of Ferritin. This is OVER 125ng/mL, for 6 months to years, before letting it drop down to optimal maintenance levels which can often be anywhere from 90-125ng/mL. The longer one has been deficient, and is suffering from other nutritional deficiencies, the higher the likelihood is that one will need to reach and maintain even higher Ferritin levels, for a longer period of time. Why? Treating Iron Deficiency is unique in that it takes longer to convince the body that it is no longer deficient. So, just because your number is optimal, doesn't mean you'll feel optimal right away. Why? Re-read above. More on this in another unit. Reaching and maintaining optimal recovery levels will treat the deficiency, get rid of symptoms, and have one feeling & operating most optimally. “Optimal range” can be unique to the individual, where some may physically feel better at lower or higher numbers. For example, I was deficient for over 15 years because my Iron Panel was always normal, so doctors never checked my Ferritin number. Anyone deficient especially for over a decade is likely going to need more time and a higher maintained Ferritin number to heal and convince the body it no longer is deficient and needs to be in a rationing and starvation mode of iron. It can take up to 2 years for one to feel most optimal. I have just finished my first year of recovery, and many symptoms come back with a vengeance if my Ferritin drops below 200. So, while in physical recovery, I am reaching and maintaining The Iron Protocol goal of at least 125 for longer than 6 months. Don't worry about maintenance right now, or how high you'll need to go. This is not a fast process, and your mental fog and anxiety will lift with every month on the protocol. The only focus needed to be worried about right now is REACHING the minimum goal of at least 125 for at least 6 months. It can take usually 4-6 months to get there, so don't worry about maintenance right now. Right now, the focus needs to be on understanding the fundamental basics, because you can't even worry about maintenance until this is understood.
D. Therefore, one needs to treat if one is experiencing Iron Deficiency symptoms and is below the optimal level (90-125ng/mL usually), especially if one is below 30ng/mL or 30ug/L. If these requirements are met, we do not need to look at the Iron Panel to know if one is Iron Deficient or can likely feel better if one reaches and maintains optimal. To supplement or treat per The Iron Protocol, follow these next easy step by step instructions in Step 2. Those with unhealthy guts, especially with current stomach acid imbalance, pathogens, etc, should not necessarily treat Iron Deficiency with oral iron, and should treat their gut first. Read the Summary below, and write it down. Reference the outline below if you're lost or need to write it down to keep track of the fundamental basics of The Iron Protocol. How you treat is up to you. Decide whether or not you want to be on The Iron Protocol. If you decide you want to be on the protocol, continue to Step 2.
Step 1 SUMMARY: Ferritin of 30 and below is an absolute Iron Deficiency .Anything below 100ng/mL can be symptomatic and mean one has an Iron Deficiency. The goal is to maintain a Ferritin over 125ng/mL (typically), for 6 months or longer. For some who have been deficient over a decade, Ferritin levels maintained as high as or higher than 200ng/mL may feel better. In general, those with Iron Deficiency need to be on The Iron Protocol. The Iron Protocol consists of the GOAL and optimal methods of treating and identifying Iron Deficiency. Decide whether or not you want to be on The Iron Protocol. If you decide you want to be on the protocol, continue to Step 2.
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Here's an outline of Step 1 if you need it. Write this down, and make sure you can answer each section before moving on to Step 2.
The Iron Protocol, Step 1. Identifying Iron Deficiency & Goal of The Iron Protocol. Step 1 consists of sections A,B,C, and D.
A. Focus on Ferritin.
- A.1 What's the Ferritin Number?
- A.2 What is Ferritin?* The answer is in bold. Know this.
- A.3 Why Ferritin?* The answer is in bold. Know this.
- A.4 "Optimal" Ferritin vs Normal Lab Reference Range
- A.5 What to do about Ferritin number
B. Ferritin number ranges. Go to the section that applies to you.
- B.1 Ferritin is below 30 with or without anemia
- B.2 Ferritin is below 45 WITH anemia
- B.2 Ferritin is 30-100
- B.3 Ferritin is 100+
- B.4 Diagnosed with Iron Deficiency but don't have your Ferritin number?
C. GOAL
- C.1 Write down the minimal Ferritin number
- C.2 Write down the minimal amount of time to maintain this number
D. Therefore, what does it mean?
Summary: Are you confident in understanding the Summary? Write it down!
Check yourself:
Do you understand everything that applies to you in the outline? If not, re-read and focus. Do not move on to Guide 1 Step 2 unless you can fill out the outline in the sections that apply to you, and fully understand it. Do not focus on memorizing something that doesn't apply to you. If your Ferritin is an 8, why are you reading and trying to wrap your head around the section labeled for Ferritin of 45-100? Right? Keep it simple. It is extremely easy. Focus on your Ferritin number, and go to the section that applies to you to decide if you want to continue and read the protocol. Can you believe how easy it can be to identify an absolute iron deficiency?! Can you believe how easy it is to identify if it's likely you'll feel better after the protocol or not? All you have to do is compare your Ferritin number to the optimal number! (If you don't have inflammation, hyperthyroidism, fatty liver, obesity, alcoholism, or any malignancies of course. Then see Guide 3E.) For so many of us, it's extremely easy to identify our Iron Deficiencies!
Now if you feel confident within Step 1, now you can move onto Step 2. Do not move on until you understand Guide 1 Step 1 sections A,B,C, and D.
Comment below with what applies to you!
CLINICAL SUPPORT:
https://www.facebook.com/notes/the-iron-protocol/guide-1-steps-1-3-clinical-support/751747045462973/
Step 2. Non-Heme vs Heme, & Calculate Daily Range Likely Needed
There are 2 different types of iron, non-heme and heme.
- non-heme elemental iron: iron that doesn't come from meat. traditional iron supplements or plants. Needs to be taken with "cofactors" at the exact same time to be best absorbed. Otherwise the absorption rate is really low at 1-15%, and is often a waste of time and money, and furthers our suffering. Has a many things that will block it's absorption. We cover the details on this in Step 3 and Guide 2A. Let's focus first on calculating our daily range here in this step. ALL IRON SUPPLEMENTS ARE NON-HEME IRON SUPPLEMENTS UNLESS THE SUPPLEMENT SPECIFICALLY SAYS IT IS HEME IRON. THE AMOUNT OF NON-HEME ELEMENTAL IRON IS ON THE NUTRITION LABEL ON THE BACK, NOT THE CHEMICAL COMPOUND AMOUNT ON THE FRONT.
- heme iron: iron from animals. Dramatically higher absorption rate starting around 35%. Doesn't need to be taken with cofactors, and doesn't get blocked by many things, making it much easier to take for most people because it can be taken with most meals. We cover the details on heme iron in Guide 2A in the Heme section, here https://www.facebook.com/.../posts/3769296229768492/...
To calculate the amount of non-heme elemental iron most people end up needing to take to treat their Iron Deficiency, according to The American Society of Hematology, GRAB A PIECE OF PAPER, READ THE STEPS OUT LOUD, WRITE DOWN THE ANSWERS, and follow these steps in order. It's easy!
1. How much do you weigh (in kilograms)? Don't know? Just Google it.
2. Multiply your weight in kg by 2. Write down your answer. Easy.
3. Now multiply your weight in kg by 5. Write down your answer. Easy.
4. These two numbers represent the minimum and maximum range of how many milligrams of non-heme elemental iron one likely ends up needing to take daily to fix the deficiency, according to The American Society of Hematology as what works for most people. So the first number you wrote down is your minimum, and the second number you wrote down is your maximum.
****(If you calculated over 400mg for your maximum, replace your maximum with 400mg. In the clinical support linked below, you will see that typically, the most a body can safely take in a day, is 400mg tops.)
****It is best to split iron intake into multiple doses, especially around the 150mg range. Meaning, each dose should really be a maximum of 150mg.
For example, if I answered step 2 that my weight in kg multiplied by 2 is 100, and then I answered step 3 with 250, then my calculated range for how much non-heme elemental iron I want to take is 100-250mg daily. THERE IS NO SUBTRACTION. IT'S A LITERAL RANGE.
Most supplements have any where from 18-150mg in each pill. So, there can be multiple iron pills/tablets needed to be taken to meet the range. Hold tight, keep your calculated range written down, and focus on the next steps. We will get to Supplement favorites and important notes on them in Guide 2. There are three more important Steps to finish here in Guide 1 before getting there. Trust me.
Make sure you calculated your range correctly, and understand the point and the Summary before moving onto the next step. Read it out loud and write it down.
That's it!
STEP 2 SUMMARY: Taking 2-5mg/kg you weigh of non-heme elemental iron a day, on an empty stomach with cofactors (1,000mg+ of Vit C) taken with each iron dose, in the morning and early afternoon, is the most effective form of oral treatment using non-heme elemental iron for an iron deficiency, for most people, according to The American Society of Hematology. We see that most people suffering from Iron Deficiency, especially for extended periods of time, don't ever supplement with enough iron, don't take it with cofactors, take it at night, and typically take their iron near other supplements, medications, or foods, that block iron absorption. More on that next Step 3.
CHECK YOURSELF:
-Double check you calculated your range correctly. WRITE IT DOWN.
- WRITE DOWN THE SUMMARY. Understand what exactly is being calculated here. It's very easy and already very specifically spelled out for you, and I see lots of posts asking about many things already explained here. Re-read this several times, and multiple times going forward.
-Heme Iron notes are in Guide 2A for now. Focus on completing Guide 1 first before concerning yourself with Guide 2.
Clinical Support:
Curious about the clinical documentation? Click here.
https://www.facebook.com/.../guide-1.../751747045462973/
Step 3. Cofactors, Contraindications, and Drug Interactions
If you still feel overwhelmed or confused, I offer one on one consultations to answer questions, help you understand, or creating your protocol. It is not medical advice and I am not medically trained. To schedule, simply PM Caitlyn R Hartigan.
You do not need to memorize this. You need to remember this Step as a reference, and most likely refer back to it several times when you are creating your schedule in Step 4. Read this, learn from it, write down certain ones you take that conflict with non-heme elemental iron, and use that information to help you make your Schedule in Step 4. If you have many contraindications that you need to take daily, then heme-iron may be a great option for you, because it doesn't have nearly the amount of contraindications like non-heme does. There is more heme-iron information to follow in Guide 2. Trust the process and read this, learn where this resource is so you can refer back to it when you have a question. Complete this step and then continue to Step 4 and 5.
1. A cofactor is a non-protein chemical that assists with a biological chemical reaction. https://biologydictionary.net/cofactor/
- Vitamin C (HUGE. Makes all of the difference. Taking iron with Vit C is part of The Iron Protocol. You basically cannot take non-heme elemental iron without it. This is what makes The Iron Protocol so successful. This is also why it works better than the alternate day, or every-other-day method that some have heard about.)
One "must" take preferably several cups of water and 1,000mgs of Vitamin C with each iron dose. One can scrape by with 500mgs and even 200mgs, but will absorb more and have fewer negative side effects if one supplements with 1,000 mgs+. ORANGE JUICE IS NOT ENOUGH UNITS. Want to know if you can take something instead of a Vitamin C supplement? Go to Google and find out how many mgs of Vitamin C it has. One ideally needs 1,000mgs or more. If one cannot tolerate 1,000mgs of Vit C, one can work their way up or take as much as they can tolerate. If you cannot tolerate this much Vitamin C, simply don't take as much. You may also need a different Vitamin C, which is discussed in Unit #2. Some sources claim at least 14mgs of Vit C per 1 mg of elemental iron are needed, although we typically see fantastic results with just 1,000mgs of Vit C taken with each iron dose. Our favorite Vit C supplements are in the Supplements Post (Guide 2) in the Vit C section.
- Beta-Carotene, Lysine (not as much research done as with Vit C)
2. Definition of contraindication: something (such as a symptom or condition) that makes a particular treatment or procedure inadvisable https://www.merriam-webster.com/dictionary/contraindication
The following are not recommended to be taken within 1-4 hours of iron, because of blocking absorption of iron or reducing effectiveness of medication.
Magnesium, Calcium, Zinc, Manganese, phosphorous
Tannins and polyphenols (Coffee & Black Tea are common ones)
Tumeric, Curcumin, Quercetin
Phytates of Phytic Acid (for example whole grains, cereals, soy, nuts and legumes)
Fibers, and oxalates
Polyphenols (for example some cereals and legumes, tea, coffee and wine)
Phosphoproteins (Eggs are an example)
Low stomach acid
Cholestyramine and Colestipol
Proton pump inhibitors (or example fomeprazole (Prilosec))
Medications used to treat ulcers or other stomach problems (for example cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid), and nizatidine (Axid))
Levodopa (Sinemet® and Stalevo®), Levothyroxine (Levothroid®, Levoxyl®, Synthroid®, Tirosint®, and Unithroid®)
ACE inhibitors These are a class of medications used to treat high blood pressure. Examples include captopril (Capoten), enalapril (Vasotec), and lisinopril (Zestril or Prinivil).
Quinolones -- These are a class of antibiotics that include ciprofloxacin (Cipro), norfloxacin (Noroxin), and levofloxacin (Levaquin).
Tetracyclines -- These are a class of antibiotics that include doxycycline (Vibramycin), minocycline (Minocin), and tetracycline (Sumycin).
The following can make raising Ferritin difficult or a lengthier process:
High dose supplementing of other nutrients like B12 and Vitamin D.
Remember, it is important to know that when supplementing one deficiency, it fuels the biomechanical processes that were previously slowed down by that deficiency. So when these processes are fueled, it uses the other vitamins/minerals for that process. This means if you are supplementing with B12 for example, the iron you have or some of what you are supplementing with will be used in the biomechanical processes they are needed for (which are many). So, your Ferritin may not rise as quickly as it could without the B12 supplementing/injections, but this is not necessarily bad- you may just need to compensate for the use, like with more iron. This can be said of any vitamin/mineral that you are supplementing with. For another example, Vitamin D and Iron are critical for many biomechanical processes, like hair for example. When one supplements with Iron, it can put more Vitamin D to use, therefore, lowering the amount of Vit D you have on blood work, which means you may need to support it with supplementing. It may be complex, but the point is, is that just because you may have one deficiency, it may mean that you also need to support the body with other supplements. This can be something you monitor with blood work. Do not get overwhelmed by this, it is just to explain a whole body working, and that the whole body may need to be supported.
Some high dose supplementing of another nutrient will put iron to work, instead of putting the iron into storage, like in the case of B12 supplementing or injections. You may find your Ferritin raise at a slower rate while taking B12 injections.
Always check your Drug Interactions before supplementing or taking medications. If you don't know if one of your supplements, foods, or medications interacts with your iron supplement, simply check the Drug Interactions at the link below:
Creating your schedule using this information is the next step!
CLINICAL SUPPORT:
https://www.facebook.com/notes/the-iron-protocol/guide-1-steps-1-3-clinical-support/751747045462973/
Step 4. Set Schedule
It is important to look at your current medications, supplements, and eating schedule in order to create the most effective schedule. Creating a schedule to ensure your sticking to The Iron Protocol helps ensure the best possibility of following through with correct supplementation. After reading this, should you wish to know if you can take any of your other supplements near iron, simply start by looking at Step 3 again.
*Putting your supplements physically where you will be during your routine, helps many of us stick to our schedule. For example, if you take your Iron & Vitamin C first thing in the morning, an hour before eating, it can be most helpful to keep a bottle of your Iron & Vitamin C on your nightstand, so you take it immediately upon waking up every day. If you typically run around during the day, or do not have a set schedule for work hours, it can be most beneficial to create another container of Iron & Vitamin C that you keep in your purse.
*Putting labeled daily alarms on your phone can make all of the difference in following through with sticking to a schedule.
Because it is common for those low in Ferritin to also be sub optimal in Vitamin D and B12, many have asked us to create example schedules that adhere to both The Iron Protocol and the Vitamin D Protocol. Optimal Vitamin D can be anywhere from 60-100 ng/mL or 200-250 ng/moL.
Vitamin D make sure to read our Vit D Protocol Post in Guide 5 for tips and favorite supplements.
https://www.facebook.com/.../theiron.../learning_content/...
Vit D must be taken with at least 14 mg of fat, because it is fat soluble and needs the fat to absorb. For Vit D to work in the body, it needs to be supported by it's cofactors- magnesium being the most critical one. Magnesium is not needed by Vit D to be absorbed, it is critically vital for Vit D to work in the body, so it is not necessary to take at the exact same time. However, it needs to be taken multiple times a day for it's most optimal intake. Magnesium blocks iron absorption, so it should be taken away from iron. Some sources say it should be taken 1-2 hours away from iron, while other sources claim it should be taken 3-4 hours away from iron. There are sources that claim if the magnesium is less than 200mg, it does not block iron absorption. Educated sources say the most amount of magnesium that should be taken at one time, should be 200mg anyway. I personally have not seen a sample pool of thousands of people treating their deficiencies while taking their Magnesium with or very close to iron. I have however analyzed thousands who separate them by 4 hours and have consistently seen success stories. Here is a great resource for a Vitamin D Protocol. Optimal Vit D is argued to be 80-100ng/ml by most, which is 200-250nMol/L.
B12 Make sure to see our B12 post in Guide 5 for tips, tricks, and favorites. B12 can be taken at any time (although you may not want to take it towards the end of the day because it may keep you up at night).
Folate can be taken at any time as well. It is most absorbed on an empty stomach as well.
The Iron Protocol and Vitamin D Protocol Schedule example:
This is an EXAMPLE schedule for those with a Vitamin D deficiency and wanting to integrate their Vitamin D Protocol and The Iron Protocol. This schedule is not telling you to supplement with anything, it is simply an EXAMPLE schedule since so many people asked for it.
7:00am Magnesium Malate & Vit D3, with 14mgs+ of fat
11:00am Iron & Vit C (1 hour before eating or 2 hours after eating, preferably)
3:00pm Magnesium Malate or 2nd dose of Iron & Vit C (1 hour before eating or 2 hours after eating, preferably)
7:00pm Magnesium Malate/Glycinate & K2m4
Bedtime Magnesium Glycinate
The Iron Protocol and Vitamin D Protocol Schedule example while on Thyroid medication:
6:00am Thyroid Meds
10:00am Magnesium Malate & Vit D3, with 14mgs+ of fat
2:00pm Iron & Vit C
4:00pm Magnesium Malate
8:00pm Magnesium Malate/Glycinate & K2m4
Bedtime Magnesium Glycinate
If you are overwhelmed or confused as to how to create your schedule, simply re-read Step 3, and always check your Drug Interactions before supplementing or taking medications. If you don't know if one of your supplements, foods, or medications interacts with your iron supplement, simply check the Drug Interactions at the link below:
Step 5. Identify Cause and Treat It
CAUSES OF LOW FERRITIN:
They all end up making sense! Notice the grouping of the causes.
1. Being a woman (You lose more blood cells and iron than your body can replace through periods and procreation):
-Periods
—menorrhagia (heavy periods): regular variation among individuals, hormonal imbalance, estrogen dominance, peri-menopause, IUD use, or medication side effects. Adenomyosis, endometriosis, PCOS, etc. (Heavy periods are usually viewed by doctors as a cause of low ferritin (iron deficiency), but heavy periods without a particular cause, actually are a symptom of low ferritin. Low ferritin causes heavy periods. As one increases their ferritin, their periods lighten in a normal situation where a woman doesn’t have anything mentioned above or a reason for the heavy periods.)
-OBGYN
— Pregnancy, increases iron demands because the baby requires the iron to develop
— Miscarriage (blood loss)
— birthing a child (extreme loss of blood during process)
— breastfeeding
-Endometrial Polyps
-Fibroids
2. Absorption Issues (low gastrointestinal absorption or things that compete with iron absorption):
-low stomach acid
—SIBO
—H. pylori
—Hypothyroidism
-postbariatric surgery (( gastric bypass (gastric bypass - the specific part of the gut removed is the one in charge of iron absorption, it’s called the duodendum) gastric sleeve, or laparoscopic band surgery))
-gallbladder removal (most likely unable to digest fats)
-Celiac disease
-Crohns disease
-high intake of calcium (drinking a lot of milk, eating cheese- because it interferes with iron absorption)
-commonly used medications such as antacids and proton-pump inhibitors for gastroesophageal reflux disease, tetracycline
-inflammatory bowel disease
-Vitamin A Deficiency (Get Vit A tested that includes Vit A Palmitate)
-Vitamin B12 deficiency (try to get Active B12 tested as well, also MMA)
-Manganese deficiency
-heavy metal toxicity (including copper toxicity)
-low copper (get Copper RBC tested)
-low ceruloplasmin (get Ceruloplasmin tested)
3. Low iron diet: (Your body is able to absorb iron, but you are not eating enough foods that contain iron)
-vegan/vegetarian diets
-appetite suppressants
-taking supplements that block iron absorption at the same time as iron supplements
-only eating iron in the evenings
4. Increased bleeding/losing more iron than you take in:
-donating blood
-bleeding disorders
-ulcers, gastritis, or parasites
-gastrointestinal bleeding from the long term use of aspirin, NSAIDs such as ibuprofen, and arthritis medications
-angiodysplasia, a bleed in the small bowel.
-peptic ulcer disease
-Cancer in the esophagus, stomach, small bowel, or colon
-Esophageal varices, often from cirrhosis
-hookworm infection
-fibroids
-urinary tract bleeding
-ulcerative colitis
-hemorrhoids, colon cancer, peptic ulcer, hematuria
-anticoagulants (preventing blood from clotting)
-going through puberty (the body requires a ton of iron to develop)
-excessive sweating (athletes or those with hormonal issues are prone to iron deficiency because of this. Saunas and more can cause excessive sweating of course)
5. Things that steal, deplete, or chelate our iron:
-parasites
-Hookworm infections
-bacteria
-supplementing with b12 and other vitamins in high doses (frequent B12 shots for example, or high doses of Vit D for example)
-gluten robs us of iron
-Turmeric, Curcumin, Quercetin
-Hyperoxaluria, high oxalates
-Mold exposure
6. Here are some wildcards:
-“Rarely, hypoferritinemia may be due to disorders of iron metabolism”
-it’s possible for genetic mutations to cause not only the loss or lack of absorption of iron, but also the managing of where the iron or ferritin goes!
-Puberty
-being born Premature
-Nutritional deficiencies from the mother having nutritional deficiencies during pregnancy
-Perhaps low copper, ceruloplasmin, and Vit D
-Undiagnosed Iron Deficiency due to falsely raised Ferritin; including but not limited to Anemia of Chronic Disease, Chronic Kidney Disease, fatty liver, systemic lupus erythematosus, rheumatoid arthritis, Long-term infections, such as bacterial endocarditis, osteomyelitis (bone infection), HIV/AIDS, lung abscess, hepatitis B or hepatitis C
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CLINICAL SUPPORT:
Studies included (and some not included) below along with collected testimonies (posts) from members of Low Ferritin support and awareness group and Low Iron & Ferritin
https://thyroidpharmacist.com/.../most-common-nutrient.../
https://www.google.com/.../heavy-metal-iron-and-the-brain...
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5629903/
GUIDE 2
Treatments & Countries
Guide 2A. Supplements, Oral Iron Guide 2B. What to Expect While Supplementing / Treating Guide 2C. Iron Infusions Guide 2D. Patches and Miscellaneous Guide 2. UK Guide 2. Canada Guide 2. Australia Guide 2. South Africa
Guide 2A. Supplements
(To use only after completing Guide 1)
This post has different links and codes to make sure The Iron Protocol gets compensated for it's work and exposure! Make sure to use these links and codes when purchasing, so we can continue our work here!
As a reminder, The Iron Protocol is an educational resource and is in no way telling you what you should be doing with your body, and is not medical advice. Always talk to your doctor before doing anything to your body.
Many with GI issues, especially current pathogen, bacteria, and low stomach acid issues may need to fix their gut issues first before supplementing with oral iron.
Here are the sections of this post in order:
-Heme Iron Notes
-Favorite Heme Iron Supplements
-Favorite Animal Organ Supplements
-Non-Heme Iron Notes
-Favorite Non-Heme Supplements
-Favorite Liquid Non-Heme Supplements
-Favorite Vitamin C Supplements
-Clinical Support
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Heme Iron Supplements:
(iron supplements from animals, as opposed to plant based iron or synthetic iron)
Neither heme nor non-heme are "better" than the other. It all depends on the specific person. The notes below are important to read to figure out which one will be best for you.
Heme and non-heme can be taken together at the same time. It will increase the non-heme iron's absorption. Many people incorporate both into their protocol, and take at different times of the day as well.
Heme Iron Supplements weren't really available until relatively recently. Non-heme Iron Supplements like Ferrous Sulphate were traditionally used as protocol because it is extremely cheap to manufacture, and really the only one doctor's knew about. Heme Iron Supplements do not have nearly the amount of complications that traditional supplements have (non-heme iron). They are highly absorbable, so we do not need to take as high of a dose. They also do not require Vit C, or need to be taken away from thyroid meds, zinc, or magnesium. The exact absorption of Heme Iron Supplements is not as well studied or documented as non-heme iron supplements, so we will be adding more content on this as we analyze more people's experiences taking these supplements.
Heme Iron is a great option for most people. Remember, if you have gut issues, it's highly likely you need to fix them before taking iron, especially if it is parasite, microbe or bacteria related, like SIBO for example (just don't take any iron yet until you fix it and do more research on it). We have analyzed the group's progress and testimonies on heme iron and find that most people are fairing well & increasing their ferritin taking a total of 1.5-2mg/kg total of heme iron spaced out, during the first half of the day. It does not need to be taken with Vit C, can be taken with food, and can usually be taken near or around thyroid, zinc, magnesium, vit d, or any other supplements other than Calcium. Calcium is the only other food/supplement that it competes with for absorption. People love heme-iron supplements because there are typically little to no side effects, unlike non-heme iron. Some people have side effects if they take it on an empty stomach, so this is great that it can be taken with food. I'm still researching and trying to figure it out, but there is a chance if we have high histamine or histamine intolerance, that we may have side effects such as a racing heart and dizziness from heme. Most people can tolerate taking 60mg in one dose.
Calculation: 1.5-2mg/kg per day total. This is what we've realized after analyzing the group's progress and testimonies on heme iron. We find that most people are fairing well & increasing their ferritin in this calculated range. Remember, it's a maximum of 60mg total in one dose. If you want to take more than 60mg of heme iron a day, you will need to take them spaced out by at least 4 hours and take another dose. Always start low and work your way up at your own pace. It's always best to test the safety of your dose (see Guide 3C).
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Here are our current favorite heme supplements:
Iron Repair Plus or Iron Repair Simply Heme by Three Arrows Nutra: Most heme-iron supplements are extremely limited in the amount of milligrams they provide. We have discovered a great heme-iron supplement, that seems to be an absolute favorite for many in the group, called Iron Repair Heme Plus or Iron Repair Simply Heme by Three Arrows Nutra. It has 20mgs of heme iron, compared to what only used to be available of 2mgs or 9mgs.
Iron Repair Heme Plus has methylcobalamin (active B12) and methylfolate (active folate) in it. It's not a lot, and we are seeing some people sensitive to methyls get headaches from taking this. As it says in this guide, we do not recommend purchasing a combo supplement without vetting out whether or not one can tolerate it or not. Do not chose this one if you do not know if you can tolerate the form of B12 or Folate in it.
Iron Repair Simply Heme is simply just 20mg of heme iron, and nothing else! This is great! This is a fantastic product for most people because it's simply one nutrient in the supplement, limiting the chance of having a reaction to it!
Use the code 10PROTOCOL for 10% Off both website and Amazon orders! Double check and make sure it applied in your cart!
Company website: www.threearrowsnutra.com/discount/10protocol
Iron Repair Simply Heme from Amazon: https://amzn.to/3QfhiY6
Discount Code 10Protocol
Iron Repair Heme Plus from Amazon : https://amzn.to/3Qc1PYS
Discount Code 10Protocol (always double check if your discount code worked!)
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Animal Organ Supplements:
Dessicated Liver pills are popular because the combination of natural vitamins and minerals in them often makes many people feel better in general, although the iron amount is relatively low.
THE HEALTH BENEFITS OF PERFECT DESICCATED LIVER
- Nutrient Dense Source of Naturally Occurring High Quality Protein
- Highest Concentrated Source of Vitamin A Found in Nature
- High Content of All B Vitamins, including B12
- Potent Source of Folate (B9)
- Highly Bioavailable Form of Iron
- Good Source of Naturally Occurring Copper, Zinc, and Chromium
- High Content of Cardio-Vascular Function Boosting CoQ10
- Helps Repair DNA and RNA
- Boosts Energy
Perfect Supplements is a favorite brand. Use this link to make sure The Iron Protocol gets compensated!
http://www.perfectsupplements.com/?Click=62cb9324b7659
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Non-heme Iron Supplements:
You now have choices! There are several types of “elemental iron.” This phrase refers to non-heme iron only. You may even see these two phrases uses interchangeably in clinical resources. The elemental iron is the specific type of iron in the supplement. It is located on the back nutrition label, with the number of units included, NOT the front label. That's the chemical compound amount. Ferrous Sulphate is one of them. Most all work the same, except ferrous sulphate. Ferrous glycinate, ferrous bisglycinate, ferrous gluconate, iron chelate, and polysaccharide iron complexes can all be great options (there are many elemental irons, just because one you have isn't listed here doesn't mean it's good or bad. There are plenty that exist). The amount of mg on the front label is NOT typically the amount of elemental iron, included on the nutrition label. No, you are not taking 325mg of elemental iron when you are taking ferrous sulphate, for example. The 325mg is the chemical compound make-up, where as the amount of elemental iron in the chemical compound is on the back label. It is also depicted in the picture here in this post. You need to use the amount of elemental iron (on the back nutrition label) for the calculation of daily milligrams of iron needed by most people to fix a deficiency, according the The American Society of Hematology. As a reminder, The Iron Protocol is an educational resource and is in no way telling you what you should be doing with your body, and is not medical advice. Always talk to your doctor before doing anything to your body.
ALL IRON SUPPLEMENTS ARE NON-HEME IRON SUPPLEMENTS UNLESS THE SUPPLEMENT SPECIFICALLY SAYS IT IS HEME IRON. THE AMOUNT OF NON-HEME ELEMENTAL IRON IS ON THE NUTRITION LABEL ON THE BACK, NOT THE CHEMICAL COMPOUND AMOUNT ON THE FRONT.
-Ferrous Sulphate, Ferrous Fumerate, Ferrous Gluconate (Ferrous Salts): We at The Iron Protocol have found that ferrous salts, especially Ferrous Sulphate, overwhelmingly give the worst of side effects, consistently. It is the standard iron prescribed by doctors, and is highly absorbable, but because of the severity of side effects, most women cease use, prolonging their Iron Deficiency. We also see this mistakenly give women the impression that they simply can’t tolerate iron, which prevents them from treating their Iron Deficiency. We have also seen that it is the most consistent iron to create weight gain. Therefore, if you have not tried Ferrous Sulphate yet, we recommend skipping this iron instead of taking the risk. If one already takes it, and tolerates it just fine, we are not suggesting that one switch it.
-Heme iron polypeptides, carbonyl iron, iron amino-acid chelates, and polysaccharide-iron complexes: We at The Iron Protocol have found that heme iron polypeptides, carbonyl iron, iron amino-acid chelates, and polysaccharide-iron complexes, have consistently provided little to no side effects, especially compared to ferrous/ferrous salts (sulphate, fumarate, gluconate, etc). See notes above for Heme iron/heme iron polypeptides (HIP).
-Iron Bisglycinate or Iron Chelate or Ferrochel: We at The Iron Protocol have found that those currently suffering from gastrointestinal issues have severely harsh side effects from any of the “glycinate” irons. We have also seen that for many without gastrointestinal issues, it can make one dizzy and have heart palpitations, especially at the higher doses, even just above 30mgs for many. However, we have seen several people raise their ferritin with a lower dose than their calculated range from Step 2, on this form. It is not the typical expectation but it can happen.
We at The Iron Protocol have found that the majority of people cannot tolerate supplements with multiple vitamins/minerals in them. We have found that people who have harsh reactions to these, typically presume they can’t take “iron” and therefore don’t continue to treat their Iron Deficiency. We have found that it is harder to identify what exactly one is reacting to when the supplements have more than one vitamin/mineral in them. These combo supplements also typically do not have enough of the vitamins/minerals needed in them. For these reasons, we do not encourage initial purchases of combo supplements, unless one has already vetted out all forms of vitamins/minerals in them.
It is not recommended to start multiple medications/supplements all at the same time. Just like with any medication, one can have side effects. If one introduces more than one supplement and has side effects, it can be hard to pinpoint what exactly is causing the side effect. It may be more wise to start taking the Vitamin C cofactor for a day to see if one has side effects, before introducing the iron.
We at The Iron Protocol have found it is most safe to take iron in multiple doses. It is best to split iron intake into multiple doses, especially around the 150mg range. Make sure to test the safety of your dose. Details how are here in Guide 3C https://www.facebook.com/groups/theironprotocol/...
Do buy reputable brands and supplements. Always check 3rd party independent reviews, as opposed to relying on reviews a company has on their own product. iHerb is a very well known reputable popular international retailer. There is a discount code CPW2772.
DO CHECK YOUR DRUG INTERACTIONS and speak to your doctor before supplementing. Always make sure it is safe for you to supplement before supplementing.
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Here are some of our current favorite non-heme supplements:
Many of us in the group are having great experiences with them (these are NOT "recommendations." These are simply the supplements we are seeing the most people take, and notes on them):
IRON (non-heme elemental iron):
iHerb Discount Code CPW2772
1. Ferrex, 150mgs polysaccharide-iron complex
-US
- Maximum amount of elemental iron in a supplement
Amazon: https://amzn.to/3aS4kQ5
2. NovaFerrum, 50mg polysaccharide-iron complex
Amazon: https://amzn.to/3zuH1Gm
3. Vitron-C, 65mg Carbonyl Iron, dye free
Amazon: https://amzn.to/3NFWU0D
4. Healthy Origins, Iron Ease, 45 mg (Featuring Albion Ferrochel, Non-GMO, High Potency, Ferrous Bisglycinate Chelate), 180 Veggie Caps (IF YOU HAVE CURRENT GI ISSUES, DO NOT BUY IRON BISGLYCINATE. We are seeing that most people with current GI issues cannot tolerate this iron or the elemental iron, Iron Bisglycinate. If you do not have current GI issues, this can be a fantastic option. We are seeing that many people without GI issues end up becoming dizzy and have a racing heart once they raise their intake to the higher levels, usually over 80mg.)
Amazon: https://amzn.to/3NI6YGK
5. Maltofer, polymaltose complex
-AU
Liquid Irons (non-heme elemental iron):
iHerb Discount Code CPW2772
I have seen a small handful of surprisingly amazing results on some liquid irons, despite most being a much lower dose than the protocol calculations being taken. How? I do not know why yet. Remember, it's a combo supplement, increasing the likelihood of one having reactions, and the amazing results on such a low dose are not typical. However, these are popular and many people enjoy them. Many people also prefer liquid due to their GI issues, and being under the impression that it absorbs better. I have seen, that sometimes it can, although it's not a consistent result. If you choose a liquid iron, please keep me updated as to your progress so that I can assess and perhaps drill down as to why it works astoundingly well for a small few, and as expected for others (not enough in a dose to increase ferritin).
- NovaFerrum 125 High Potency Liquid Iron, polysaccharide-iron complex (best option for those with current GI issues. We have seen fantastic experiences with this supplement, especially for those with current GI issues. We have also seen half of people have reactions to all of the added ingredients and preservatives, preventing them from taking the supplement further. Those side effects include dizziness, rashes, headaches, lethargy, insomnia, and extremely vivid dreams.) Available in the US. Amazon: https://amzn.to/3aKmh2J
- Hematex Liquid Iron, 100mg Polysaccharide Iron Complex (Chocolate Caramel Flavor) Amazon: https://amzn.to/39eMMgH
- Gaia Herbs, Plant Force Liquid Iron, 16 fl oz (473 ml) Amazon: https://amzn.to/3xg4CYB
- Floradix, Liquid, 17 fl oz (500ml) Amazon: https://amzn.to/3MEBMqv
- MaryRuth Organics Vegan Liquid Iron Supplement for Adults Discount Code MROCAITLYN15 on https://www.maryruthorganics.com/
Vitamin C:
iHerb Discount Code CPW2772
1. Garden of Life Raw Wholefood Vit C, 500 mgs
-US
- Real wholefood Vitamin C, as opposed to synthetic. Reputable brand
-Can be hard for those with some current GI conditions to use
Amazon: https://amzn.to/3xEa3C8
2. Real-C - Organice Acerola Cerry
-Global (Ebay)
- Real wholefood Vitamin C, as opposed to synthetic. Reputable brand
-Can be hard for those with some current GI conditions to use
https://www.ebay.com/itm/181152506075...
3. Many of our members with current GI issues prefer “buffered” Vitamin C. Here's an example: NutriBiotic, Immunity, Sodium Ascorbate, Crystalline Powder, 16 oz (454 g)
iherb: https://www.iherb.com/.../nutribiotic-immunity.../10178...
Amazon: https://amzn.to/3tOTGAn
4. NutriBiotic, Immunity, Ascorbic Acid, 100% Pure Vitamin C, 16 oz (454 g)
-often used for constipation, can cause serious GI distress and diahreah at too large doses
iherb: https://www.iherb.com/.../nutribiotic-immunity.../24191...
Amazon: https://amzn.to/3aGmS5I
What are your favorite Ascorbic Acid, Liposomal, Buffered, or Raw Wholefood Vitamin C supplements? Provide them below, and why they are your favorite!
Ordering Supplements and more:
For a 5% discount every time you order anything on iHerb.com, used the code CPW2772
iHerb has so many products online, like a drug store pharmacy with cosmetics and more. Check the clearance, I got some of my favorite makeup more than half off!
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CLINICAL SUPPORT:
American Society of Hematology
Supplementing, Oral Iron
“There is no evidence that any one type of iron salt, liquid, or pill is better than the others, and the amount of elemental iron varies with different preparations. To be sure of the amount of iron in a product, check the packaging. In addition to elemental iron, the iron salt content (ferrous sulfate, fumarate, or gluconate) may also be listed on the package, which can make it confusing for consumers to know how many tablets or how much liquid to take to get the proper dosage of iron.”
https://www.hematology.org/.../pat.../anemia/iron-deficiency
*the term “better” is in the context of being more effective at raising Ferritin numbers
National Institutes of Health
Office of Dietary Supplements
“Frequently used forms of iron in supplements include ferrous and ferric iron salts, such as ferrous sulfate, ferrous gluconate, ferric citrate, and ferric sulfate [3,28]. Because of its higher solubility, ferrous iron in dietary supplements is more bioavailable than ferric iron [3]. High doses of supplemental iron (45 mg/day or more) may cause gastrointestinal side effects, such as nausea and [5]. Other forms of supplemental iron, such as heme iron polypeptides, carbonyl iron, iron amino-acid chelates, and polysaccharide-iron complexes, might have fewer gastrointestinal side effects than ferrous or ferric salts [28].
https://ods.od.nih.gov/factsheets/Iron-HealthProfessional/
https://www.tandfonline.com/doi/full/10.1081/CLT-200068842
Guide 2B. What to Expect While Supplementing / Treating:
- A long & often difficult process usually filled with side effects to physical recovery and symptom relief. This is especially depending on how long you’ve been deficient and what other concurrent conditions/deficiencies you have. Some people feel relief from their air hungry, heart palpitations, restless leg syndrome/throbbing legs at night, and shedding of hair relatively quickly, sometimes within days to several weeks. This is great but should not be expected. It all depends on if you’re doing the protocol correctly, how long you’ve been deficient, and what other concurrent deficiencies/conditions you have. If you’ve been deficient, it can take up to 2 years for you to return to most “normal,” but it’s most likely you have some other issues as well when the deficiency has been that long. If you don’t do the protocol or an iron infusion, it will take much longer for physical recovery. See our announcement on Iron Infusions for more info. Almost no one has a perfectly smooth oral iron supplementation process. Expect a bumpy road.
- Fatigue, just like any other symptom can reoccur. If it's debilitating, it's likely one needs to switch their iron supplement.
- Constipation is common and expected, read our Constipation post in Guide 4 for remedies. Believe me, it can be handled. This is the most common side effect of iron supplements and should not prevent you from treating iron deficiency.
- Appetite changes.
- Cramping and nausea can happen, so you may want to eat a little food to help alleviate this. You may have also started on to high of a dub for your body. It’s always best to start low and work your way up to mitigate these side effects.
- Possible weight gain, especially if on ferrous _____. Many of the ferrous salts can cause weight gain.
- Hair texture changes. We have even seen peoples straight hair go wavy, and then curly.
- Hair shedding after an infusion. It's temporary and we don't know why it happens.
- Drink LOTS of water with your supplements. This has been extremely helpful to many women who are experiencing headaches, cramping, and nausea from their supplements. It’s been great to learn that trick from so many women’s
- Not tending to low/sub optimal Vit D will keep your symptoms dragged down. You can do both protocols at the same time. See our example schedule in the announcements and recommended group for more info on Vit D.
- B12 injections will put more of your iron to use. Some people phrase this as “depleting” iron. It’s not necessarily depleting the iron, because it’s putting it to use just like we went over above, but it is putting so much to use that it can take longer to raise Ferritin. It’s about math. Some B12 supplementing is helpful for raising Ferritin if you’re lower on B12. Daily self injections can be “too much” to raise Ferritin in a quick manner, but it may or may not necessarily be a “bad” thing. Just don’t expect to raise Ferritin as quickly if you are taking daily or frequent B12 injections.
- Black stools. Normal, no big deal. Doesn’t mean you’re not absorbing iron.
- Runny stools. You may want to look into less Vit C (or a different Vit C), or a different iron supplement.
- Some symptoms to be alleviated for a while, slowly, and then come back, even harshly, only to go away again. Very normal and should be expected. You do not need to freak out if your symptoms come back. It’s only temporary. Sometimes new Iron Deficiency symptoms occur, that we've never even had. This is normal and expected, and totally temporary. Remember you are now fueling biomechanical processes and channels with more fuel than they’ve been operating on for however long you’ve had your deficiency. They’ve been running at 10% capacity so to speak, and are now fully operating. But all of these biomechanical processes and channels require more than just one vitamin or mineral, like iron. Many of them require iron, B12, and vitamin D altogether. This is another reason why many of the symptoms are similar. So your body is going to be using more of the B12 or vitamin D for example then you usually are using. If they are extreme, many people like to take a day or two break for relief, and of course it's possible that the type of iron your taking isn't the best for you. Luckily there are options! DO NOT HURT YOURSELF. PAY ATTENTION TO YOUR BODY.
- So, it’s important to support the treating of the iron deficiency with whatever else it needs, now that it will be putting more vitamins and minerals to work. So many of us will need to eat more or supplement of another nutrient, especially if we were lower or sub optimal in it before. We have seen some folks in here treat their Vitamin D deficiencies, and then focus on their Iron heavily, only to see their Vitamin D drop. It’s important to recognize that the body is complex, requiring all sorts of different components and types of “fuel,” to operate optimally. This is why it’s important to monitor other blood work when monitoring your Iron during treatment.
- Expect to need to check ferritin starting anywhere from 4-6 weeks from first starting the protocol. Do the Complete Blood Count (CBC), if you’d like, but make sure to test Ferritin and the Iron Panel.
- It’s probably best to retest Ferritin & the Iron Panel over a month from there, especially if you will be doing the same dosing. Usually people check 3-4 months after their first test, and another 3/4 months after that. Usually fasting is required for Iron Panels, but if you eat and take your iron supplement 2-5 hours before your blood work, it can give you a better picture as to what your real %TSat is while supplementing. This can be a great way to monitor how well your body is handling the dosing, by keeping an eye on how much Transferrin is actually in use when you’re supplementing.
-A higher HMG or RBC, but this is typically temporary and will go back down to normal.
-Higher Liver enzymes, but this is typically temporary and will go back down to normal.
- Spotting / Heavier periods and even skipping/late/early periods temporarily as you increase your dose. This is temporary because the body still isn’t convinced it needs to stop rationing out the iron to the biomechanical processes. It’s like the tunnel of iron flow has purposely been made smaller to only leak out so much iron to each process, as a way of rationing out the iron to best handle the deficiency. So the body can think at first “OMG WHAT IS THIS?! TOO MUCH! GET OUT!!” Lol. But you’ll notice as you maintain consistent on the protocol and increase doses, the next period or one after tends to be much lighter. If you don’t have endometriosis/adenomyosis/PCOS, most of us end up with much lighter periods, even well before reaching optimal. If it’s heavy at first, don’t worry, it’s normal and temporary.
- Possibly needing to adjust other medications and supplements. Lots of parts of the body can’t operate optimally with lower or sub optimal ferritin. We often are on lots of over the counter medications, supplements, or treatments, that are actually stemming from or contributed by lower ferritin. For example, the thyroid can’t function optimally without optimal ferritin, so many people have to adjust their thyroid medication mid protocol, because of noticing the thyroid medication now being too strong. It’s all about paying attention to your body, and adjusting what you need to.
Look out for:
- immediate harsh reactions. The elemental form of iron may not be best for you and your conditions, and simply switching elemental iron can help. More details on this in the supplement sction, Guide #2A. You may also be having side effects from the other nutrients or ingredients in your supplement. We see lots of people have reactions to methyls in the combo supplements. This is another reason why it says in Guide 2A not to purchase combo supplements unless you've vetted out that you can tolerate all of the nutrients and ingredients in the supplement. More info on methyls in the announcements in The B12 Protocol.
Guide 2C. Iron Infusions
Iron Infusions are typically DANGEROUS when one has lower or sub optimal Vitamin D and phosphate. It can be almost like a guarantee to get hypophosphatemia. You literally feel like you’re dying. Hypophosphatemia is terrifying. However, it has been really exciting to see handfuls of women come into the group and share that they had recently received an Iron Infusion with low Vitamin D and did not get hypophosphatemia, and all of them had currently been on a Vitamin D Protocol, like in Improving Health with Magnesium, Vitamin D & Nutrients that work in Teams, This has been great to see this trend. I don't have details on how long they had been on the Vitamin D protocol, but several were on it from 1-3 months.
I also see doctors over prescribing infusions, and it’s not really ever necessary.
Iron infusions can range from 20-1,250 mls of iron. Doctors/GPs/PCPs have the authority to write up an order for an infusion, just like a hematologist does. (Your state/country may differ on this)
Many still don’t know how to order, hence why they over and under prescribe, but it’s why I’ve consistently seen that the ordering is so inconsistent. Many doctors will order patients to have five 50ml infusions over a two week span. While many order 5 250ml infusions over a 2 week span. Many order 2 infusions of 750mls I’ve the course of 2 days. It’s very sporadic with no rhyme or reason, not even condition or cause of ID of the patient giving reason to the inconsistent ordering. It typically takes 1,000-1,500ml of iron in iron infusions to become iron replete.
It's been argued that Iron Infusions can cause oxidative stress. This is why many doctors will prescribe 2-10 low dose infusions, to best mitigate and prevent this. For this reason, this approach can be preferred over single large doses. For example 750ml and over in one dose is not as preferred as multiple 100-200ml infusions.
They're often administered in 30 minute doses, but one can request that the drip is administered in a slower fashion to best equip your body to handle the incoming iron. I have seen some people get infusions over 7 and 9 hours, which is completely unnecessary. Unless the dose is only 20ml, which would arguably be useless, it is never recommended to get them as fast as 15 minutes, or any time less than 20 minutes.
Under the right circumstances, which can be relatively easy to figure out, iron infusions are quite low risk. They are one of the safest procedures/treatments out on the market. They don't hurt, and the set up is usually quite comfortable. It is often at a Cancer/Oncology center, so for those of us who aren't prepared, it can feel a little scary going in. This is just typically where this type of treatment is done. Sometimes folks have allergic reactions and rarely some folks go into anaphylactic shock from their allergy to something in particular in their infusion. This is why the nursing team is there at all times monitoring you. They often give Benadryl before the infusion as well. One can also take one on their own before, or ask their staff if they can.
It’s also possible that iron infusions “make” some other nutrients deplete (like vitamin D & phosphate, ha!), just like we see it will oral supplementation, because the body is now opening up biomechanical processes it had limited before. We see often that b12 numbers drop after iron supplementation, or vice versa for example. This is along with Vitamin D and phosphate.
I am homozygous for the Hereditary Hemochromatosis gene mutations and had to do a lot of research into whether or not I would overload if I got an infusion. After being yelled at by what felt to be hundreds of people in the many HH groups I joined, I had found only 3 women in my search who had an iron deficiency, had the HH gene mutations like me, who had overloaded. Thankfully they caught it right away and had a phlebotomy. I had Injectafer 750, and did not overload, even though I have both gene mutations for making me “highly likely” to overload.
If you are interested in an Infusion it would be most wise to:
-call your insurance and ask how they cover infusions. This is one of the most important and critical steps and should really be done right away.
-check your Vitamin D (25hydroxyD), optimal is said to be 80-100ng/ml or 200-250nMol/L
-check your Phosphate and make sure it's not low or close to low
-ALWAYS KNOW THE DOSE THE DOCTOR IS PRESCRIBING OR CONSIDERING. Write it down or keep it in your phone. Whatever you need to do to know your dose(s).
If you yourself have had experience with infusions, please feel free to comment below, but please make sure the comments are quality by including:
-your dosage & name of infusion
-your ferritin numbers before and after infusion
-what your cause for iron deficiency is
-what your Vit D & Phosphate was at the time of infusion if it was ran
Guide 2D. Patches and Miscellaneous Treatments
It's seen very frequently throughout FB groups and comments that "patches can't work." However, I have seen from plenty of people who have actually tried them, that they do. Because of a bought of gastritis, I decided to try the PatchAid patches, because they had the most iron content at 50mg a patch versus other brands at 15mg a patch.
PatchAid patches have the most iron content in a patch that I can find, at 50mg each. It seems that the absorption rate is much lower than heme or non-heme combined with high dose Vitamin C, so we have to wear more patches to get the same effect. Each Iron patch is 50mg, and I required wearing 6 patches a day at the same time to be able to maintain my Ferritin number (I weigh 150 pounds/ 68kg). So if we want to raise our Ferritin, we would likely need to wear more than 6 at a time. These are great for anyone with a sensitive stomach, children or teens or adults who can't swallow pills or have a hard time sticking to their schedule and taking their doses when they need to, bariatric patients or anyone with absorption issues, or just anyone who needs a boost and doesn't want to or can't take supplements or IVs. So these can also be great for anyone on the go who wants to maintain or prevent another deficiency. I am also very sensitive to adhesives on my skin, and noticed that I was fine wearing these for the 8 hour duration they're meant to be worn, and would often have a red mark if I left them on for longer. So this is great news for anyone with sensitive skin. I did not experiment on myself if the patches could be reused, but if anyone tries that, please keep me up to date on how that goes. I reached out to PatchAid because I liked them so much, and they agreed to give us a discount code!
Our link is: patchaid.com/TIP15
Our discount code is: TIP15
The coupon code provided above will provide you all with 30% off of your FIRST order! *Please note this discount does not apply to recurring orders if you set that up, and cannot be combined with other offers. Once you all have used your code for your first order, you all will then need to use my link above to access the site in combination with any available discount code (like the monthly specials) so that I can continue to earn a commission on your purchases. This post will always be here for you to refer back to to use If you find my content helpful and valuable, please help me by using my links and codes in The Treatments Guide (2) so I can do this full time! Thank you!
These can potentially be a great option for those with GI issues, since they bypass the gut.
If you are using Patches, please comment here and keep us up to date with your progress so we can best help others.
Guide 3. Understanding Ferritin, The Iron Panel, & Iron Deficiency
Guide 3A. What is Ferritin?
(Interpreting the Iron Panel & Ferritin tests)
Iron is iron. On the blood test, it’s iron, or serum iron, and it’s the active iron running around your system. It’s in charge of tens of enzymes that are in charge of 180+ different biomechanical processes! "In the human body, iron exists mainly in erythrocytes as the heme compound hemoglobin (approximately 2 g of iron in men and 1.5 g in women), to a lesser extent in storage compounds (ferritin and hemosiderin) and in muscle cells as myoglobin."* Meaning, most of our iron is bound to oxygen inside hemoglobin, and about a third of our iron is safely stored away in a protein called Ferritin. If we eat food before our blood tests, our iron will be normal or high. If we fast and stop supplementing, it will be low to normal. The iron on the iron panel, is a snapshot picture of the active iron in your body that’s been absorbed and running around in use. So it makes sense, if you eat iron and absorb it, what’s going to happen to your iron number? It’s going to increase. If you iron and supplement before your blood test, and you have absorption issues, what should happen? Your number should be lower.
When we consume and absorb too much, it’s not like a water soluble vitamin like b12 that we just pee out. “The mechanism of iron excretion is an unregulated process arrived at through loss in sweat, menstruation, shedding of hair and skin cells, and through rapid turnover and excretion of enterocytes (red blood cells)."* It’s not good to have too much of anything in our bodies because it doesn’t have the right places to go, so we call it a “free radical,” and those cause us problems.
So the body does this cool safety guard thing with iron to protect us from that. When we have too much unbound iron running around or deposited in our organs, the Transferrin grabs it and puts it in a red blood cell protein in this safe casing now called Ferritin.
Ferritin is the safe storage of excess iron. If you don’t have an excess of iron, there’s nothing to store.
So, when we eat too little of iron, the body senses it doesn’t have that iron it needs for all of those 180+ biomechanical processes, so the ferritin naturally releases the iron from the safe storage, for us to use.
Really cool!
The big problem is, when the body senses that it doesn’t have enough iron for the 180+ biomechanical processes, it starts shutting off those channels of iron to the processes that are least critical. That’s when we experience problems. Like hair falling out for example. That’s waaaaay less critical than the iron going to the bone marrow to create red blood cells. So, we start experiencing symptoms. Even if we take in enough iron daily, our body still senses that our reserves are low, and that’s not safe, so it shuts down certain channels, and more and more and more as time goes on, and we become more and more and more symptomatic.
This is why all of us with iron deficiency have the same symptoms as Anemia.
It’s because sending iron to the bone marrow is the most important critical process for iron, so Anemia is the last stage of iron depletion and deficiency.
Anemia is actually a symptom of Iron Deficiency. So of course we have all of the same symptoms as someone who is anemic, because if they’re Iron Deficient Anemic, we’ve got all of the same symptoms! They’ve just depleted more iron and are in the last stages of the iron deficiency, but they’ve got all of the symptoms they were suffering with before the full depletion. Over 180 symptoms basically lol.
So, Ferritin is very cool because it’s our body’s natural defense and protection from too much or too little iron. Unfortunately, doctors aren’t experts in nutrition and only take 3 hours of it in Med school, and haven’t learned the most important part, that when the body senses it doesn’t have enough iron or reserves, it starts rationing the iron and stops sending it to all of its processes and starts prioritizing which processes it sends the iron to. Because they think that ferritin is “just storage” and doesn’t have any biomechanical processes of its own. It doesn’t necessarily, but it influences the biomechanical processes, so it basically does.
Key takeaway: Remember, Ferritin is our safe storage of excess iron. And the “excess iron” amount basically indicates and signals to the body when to shut off places to send the iron, starting with the least critical first (like hair, and saving ceasing sending iron to the bone marrow to create more red cells, resulting in Anemia, last). You can only increase ferritin by taking an excess of iron.
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Transferrin, TIBC, & %TSaturation
The reason most of our Transferrin numbers and TIBC numbers is usually high, is because the body senses a deficiency, so it’s producing as much Transferrin as it can, in efforts to do whatever I can to help in the iron deficiency. That way if a morsel of iron comes it, there’s essentially no excuse for it to not be absorbed and used (in the body’s mind).
Transferrin is the transporter of the iron, taking it from the absorption stage to where it needs to go. Like all of the enzymes and biomechanical processes it’s in charge of, or when those are shut off or fully fueled, into the ferritin.
TIBC stands for Transferrin iron binding capacity. Really, showing how “capable” and ready the body is prepared to take in iron. It will be high when the body senses it is depleted in iron, because it’s going out of its way to try to do what it can to help in the iron deficiency.
Transferrin has a high “affinity” to iron, meaning it’s a strong attraction like a magnet, and it’s job is to look for the unbound iron, and “bind” to it, to safely transport it to where it needs to go.
%TSaturation or the “percentage saturation of transferrin with iron” is calculated by dividing the serum iron concentration by the total iron binding capacity (TIBC) and multiplying by 100. What is means by the word “saturated” is really to communicate the Transferrin “in use,” meaning that it is a calculation representing the percentage of the available Transferrin (our “capability” meaning, our TIBC, because it’s Transferrin Iron Binding “Capacity”), that is currently occupied in use bound to iron, transporting it to where it needs to go. Basically, it’s your “absorbed” iron being safely transported to where it needs to go, but presented in a way that also communicates the amount of Transferrin abilities left to transport it. It’s the percentage of Transferrin in use doing its job. If it gets too high, like especially in the 80-90s, we get worried because our ability to handle the incoming iron is almost at max capacity. For example, if your TIBC (Transferrin Iron Binding Capacity) is 1,000, and 40% of your Transferrin is Saturated (meaning, in use), that means you have 60% or 600 Transferrin left available to grab the next incoming iron and do its job. When treating an iron deficiency, we are purposefully taking an excess of iron to raise our ferritin, so it is normal to have normal-high iron and %TSat. It’s the only way to create and raise ferritin. Where you want to monitor and be worried about, is when the %TSat gets so high that there’s not any Transferrin left available to bind to any incoming iron. Normal %TSat can top out around the 50% mark, but it’s ok if while supplementing it reaches higher, just not so high that the body doesn’t have time to create more and handle the next incoming iron, like in the 80-90s. It makes sense that your %TSat will be higher while treating iron deficiency, it just needs to be done safely, like on the protocol. You do not want to maximize your %TSat because then the iron being absorbed will have no Transferrin to bind to it and drive it to where it needs to go. When it happens it is unbound iron, running around our body as a free radical wreaking havoc, and settling or “depositing” in our organs. This is called iron overload or hemochromatosis. This is when iron is dangerous because it becomes a host for bacteria and pathogen to eat off of and multiplying the body, and causes diseases and cancers. This is exactly why the protocol is calculated based on weight, because it is a tailored customized amount of iron that is specific to you, that you can typically safely handle. The way to know that? And handle that? Is by getting blood test done every so often and keeping an eye on your %TSat. Remember, when the body senses a deficiency, it shuts off biomechanical channels of iron, resulting in symptoms, and creates more Transferrin, in efforts to best prepare the body with what it needs to beat the deficiency. Also remember, it is well documented in medical publications, and noted in The Iron Protocol, that the body tends to stop absorbing iron after 400mgs a day. The amount of Transferrin usually cannot handle more than 400mgs of iron. So if you are taking 300mgs of iron to treat your deficiency, you can feel very comfortable knowing that your body is typically prepared to handle that, and will typically result in a %Sat of less than 70%. Remember, we definitely get worried when %TSat reaches 80-90%+.
Remember, Transferrin binds to unbound iron. This includes iron just absorbed, and unbound iron deposited in organs (iron overload/hemochromatosis). More specifics on Hemochromatosis in another section.
The body naturally is in a rationing state and starvation mode while in a deficiency, so a low to lower end of normal %TSat is typical for someone Iron Deficient.
This means that plenty of us have normal iron panels, while being completely depleted of ferritin, and the body is in the middle of rationing it out. This is why so many of us go undiagnosed for so long. It is very typical for doctors to think that the iron, %TSat, and Ferritin, all run in tandem together. So they have been educated to look at an iron panel, and presume the ferritin reflects the same. Normal iron panel = normal ferritin for them. This is why they don’t typically test ferritin. But as you can see, even with depleted ferritin, an iron panel can be normal. This is why it’s critical for all women to know their ferritin number. It is the most specific indicator of iron deficiency.
The body naturally stops producing as much Transferrin when it’s sensed that it has absorbed enough, resulting in a low to normal range Transferrin instead of high. So this it can be an indicator of iron status, but not the most specific indicator, like ferritin is.
https://www.ncbi.nlm.nih.gov/books/NBK448204/...
Guide 3B. What is Anemia? What is Iron Deficiency?
Anemia = lack of hemoglobin, so it will have to be below normal range to be diagnosed by a doctor. Can also have insufficient/misshaped RBCs to diagnose anemia.
Iron deficiency = the body relying on iron stores (ferritin) to operate. Aka not getting enough iron in the body to compensate for losses /operate.
Anemia and Iron Deficiency are two different conditions. One can be anemic due to any reason, one of the top reasons is Iron Deficiency. If the reason for someone's Anemia is Iron deficiency, their condition is called "Iron Deficiency Anemia." One can be Iron Deficient that has not completely depleted yet and has not become anemic. There is no confusion on this. Anemia and Iron Deficiency are two different things. You can be one without the other. (Doctors and references often use the terms "Anemia" and "Iron Deficiency" interchangeably, which is why it has confused us, and this indicates that they are not familiar with basic nutrition. Remember, always consider the source of your information. These terms are not interchangeable.)
This can usually be a Ferritin under 100 with side effects and causes. If no side effects/symptoms, and no cause for concern, then there’s typically no iron deficiency. So someone at 80 may feel optimal, and that’s fine. Except for when treating an iron deficiency, one needs to maintain much higher, at least 125+, for several months to years, to convince the body it doesn’t need to be in rationing or starvation mode and ration its iron as to where it sends it to. I had an iron deficiency for over 15 years and am in my second year of physical recovery. My symptoms appear again if I dip below 200 right now. My body still needs convincing that it doesn’t have to store all of its iron like when I was depleted, and can now send it to all of the biomechanical processes and channels that require iron.
Absolute Iron Deficiency = ferritin 30 and below. This is an ABSOLUTE. No questions asked. Nothing else interferes with this. Does not matter what any other lab results from any tests are, this is an ABSOLUTE. If your ferritin is under 30, this should not be confusing that you ABSOLUTELY have an iron deficiency. An Absolute Iron Deficiency is so easy to diagnose! Doctors don’t know this because they don’t take but 1-3 hours of nutrition in Med school. You can print out the American Society of Hematology link and the Iron Deficiency without Anemia link by Dr. Soppi at the bottom of the protocol, it should be Unit 1 Step 1. Educate your doctors. Respectfully.
When the body starts rationing off where’s it’s sending iron and sending less of it thru these biomechanical channels, it begins to prioritize where it’s sending it. Starting by rationing the least critical processes first. Like hair. That’s why hair loss is one of the first signs of iron deficiency.
The most critical biomechanical channel for iron is sending it through the bone marrow, to create new red blood cells. Which then have a protein in them with oxygen bound to up to 4 irons, and this is called hemoglobin.
That’s why Anemia is the last stage of an iron deficiency. The body prioritizes sending iron to the bone marrow to create red blood cells and hemoglobin.
Anemia has tons of different causes. B12’s most important biomechanical process is going into the bone marrow as well, to create new red blood cells (and then hemoglobin). So this is the second most largest cause of anemia, second only to iron deficiency. But there are lots of causes, these are just a couple.
If you are anemic and have low ferritin (iron deficiency), your doctor will likely diagnose you with Iron Deficiency Anemia, and prescribe you iron pills or tell you to buy some over the counter. Over a matter of weeks to months, the doctor will ask you to come in for blood work, where your hemoglobin and iron panel (and ferritin) will be/ should be run. If the hemoglobin rises, that means your doctor was correct, and you had Iron Deficiency Anemia. If it doesn't rise, your doctor may look into other causes of anemia, and treat those potential causes. Most all anemias have the cause of the anemia in the name, just like Iron Deficiency Anemia.
Guide 3C. Labwork Prep, Safety of Dose, & Interpretting Iron Panel
SHOULD I STOP SUPPLEMENTING BEFORE MY BLOOD WORK? / WHAT IS SAFE? NOT SAFE? / INTERPRETING THE IRON PANEL
Taking or not taking your iron leading up to your blood draw all depends on the task you're trying to accomplish.
If you want to test the safety of your dose, you would take your dose 1-2 hours before your blood draw. This is also a great way to see if you're absorbing the iron.
Because the iron panel (Iron Serum, Saturation, and TIBC) reflect what's actively happening in the moment of the blood draw, it makes sense to expect a higher Iron Serum and Saturation if you were to take the dose 1-2 hours before the blood draw. The key is understanding how much is "too much" and what a safe dose would be. To do this, you need to understand how to interpret the iron panel. (Globally, the iron panel usually does not include Ferritin. It does in some countries but not most. Ferritin takes a day and a half to move, and is not affected by taking the dose before the blood draw or not or fasting or not.)
Interpreting the Iron Panel:
-To know what is dangerous, you want to avoid overload by making sure the body has the capacity to handle the dose you're taking. Iron Overload/Hemochromatosis, is when "unbound iron" deposits itself into our organs, which creates diseases and cancers.
-You can prevent overload by making sure the body has the capacity to handle and transport the dose of iron you are putting into your body. Transferrin's job is to "bind" to iron and take it where it needs to go. It's the car and the driver, that has a high "affinity" to iron. It looks for unbound iron like a magnet, to bind to it, so it is safely transporting it where it needs to go. When we consume and absorb iron, it's Transferrin's job to bind to it, to take it where it needs to go.
-%TSaturation reflects the body's current Transferrin in use doing it's job. So since the iron panel reflects what's actively going on with iron in that moment of the blood draw, if you take the dose 1-2 hours before the blood draw, and are absorbing it, we would expect the Saturation results to come in above the range. Which is fine, because the lab work was created to be done fasting. The key is to identify what is "too high" of a Saturation. You don't want all of your cars occupied transporting iron because that would not be safe. More details below.
-Ferritin is the safe storage of excess iron. Why is it safe? Iron is bound to the protein encasing, Ferrtin. Just like how hemoglobin safely holds iron, where the iron is bound in a protein (hemoglobin).
When we are supplementing, we are going to have more Transferrin driving the iron around, than when we are not, and it's important that we only do this at the capacity the body can handle. This means, when we are supplementing, the number of Transferrin "bound" to iron (driving it around) will increase. This is reflected as the %TSaturation.
If we currently have a %TSaturation of 75%, that means we are getting a bit close to max capacity of 100%, of 75% of our Transferrin driving around our iron, bound to it. This also means 25% of our Transferrin is sitting around waiting for more iron. When 100% of the Transferrin is in use and driving (bound to) the iron and taking it safely where is needs to go, if we put more Iron in our body, there will be no Transferrin left over to drive it around and bind to it, so we will have unbound iron running around our body, and it will deposit itself into our organs, until more Transferrin becomes available and picks it up to where it needs to go. This is why it's important to split large doses up into 2-3 doses, so we can make sure there is enough Transferrin to drive it around, and this is why it is actually important to take blood tests after a couple of hours of supplementing, so you can gage how safe your dose is.
The only way to Iron Overload/get Hemochromatosis is to have unbound Iron in your body. Transferrin is the key to this, because it prevents us from having unbound Iron in the body. When we supplement, it's likely we will have a higher %TSat, because we can only raise Ferritin if there is an excess of Iron. So just because your %TSat may be higher, does not mean its bad or dangerous. If it's in the 80-90s, yes, that can be dangerous, so you will want to lower the dose a bit and space out your doses more. This is another reason why it is noted in the protocol that only 400mgs of iron daily can be "absorbed." It's meaning that the Transferrin can typically only handle transporting (binding) to about 400mgs of Iron daily. So if you are no where near that, you most likely are totally in the clear. This is something not to freak out about, but understand and monitor. When our Iron and %TSat come back high on the Iron panel, that is normal because we're supplementing, to have an excess of Iron- why? Because Ferritin is the safe storage of excess Iron. We can only increase Ferritin with an excess of Iron. How much is too much? We know for a fact 400mgs of Iron daily is just at the verge of too much, but to understand really how much is too much Iron we need to look at and monitor %TSat and make sure it does not reach near 100%. It is common for us, when supplementing, to have a higher Iron and %TSat, like in the 60s, and that's ok. Even low 70s can be okay. We just want to make sure our body can safely take in and transport (bind to) the iron so we don't have unbound iron in our body.
Remember to split doses into 2-3 a day if you start taking more than maybe around 150mgs, and to watch your %TSat every time you get blood work to make sure you're no higher than 70s, 80s, 90s. It's great to get blood work done while on your supplements so you can get a true reflection as to how much Transferrin is in use (saturated) when you are supplementing.
Ask yourself:
- What is Ferritin?
- What is "bound" iron? What does it mean? Why is it important?
- What is Iron Overload/Hemochromatosis?
- What makes iron unsafe?
- What is Transferrin's role?
- Is we don't have any Transferrin left, what does that mean for incoming iron?
- How do you know how much Transferrin is currently in use?
- How can you tell if your body can safely handle binding to the dose you have?
- See how easy it is to mitigate free unbound iron?
Guide 3D. Iron Overload (Hemochromatosis)
“I’m scared of overloading!” "I don't want to take too much!" "Isn't this a lot?!"
What is Iron Overload (Hemochromatosis)?
- unbound Iron depositing in our organs, creating hosts for diseases, pathogens, and bacteria. Ends up giving us diseases and cancers.
- Remember, “ferritin” is our safe storage of excess iron. It is bound to transferrin and then placed & bound in a safe protein, now called Ferritin.
- Iron Overload (Hemochromatosis) is the direct opposite of an iron deficiency. Iron overload is too much iron- how much is too much? Too much for the transferrin to handle.
- How much is too much for trans ferritin to handle? Look at your lab work. %Sat in the 80-90s is definitely TOO MUCH.
Hereditary Hemochromatosis: Irish and Northern Europeans commonly have gene mutations that make them over absorb iron.
I have both mutations and unfortunately it didn’t help me beat my undiagnosed iron deficiency I had for 15+ years. When I was supplementing, it super helped.
It will make you absorb more iron. So your %Sat will likely be higher than others.
If you absorb too much for your body to handle, that means that all of your Transferrin are occupied and there aren’t enough left to transport the iron. Transferrin is what grabs the iron in the absorption process, and “binds” to it, to take the iron where it needs to go in the body. This is healthy and how the body works. The transferrin is the transporter. Like the car that will be occupied by the iron and takes it where it needs to go.
%TSat is the percentage of Transferrin currently driving iron around. It’s the % of Transferrin in use.
When it’s high, it gets scary that there won’t be enough Transferrin left available to bind to more incoming iron.
When there isn’t enough Transferrin to drive the iron around, and iron comes in, that iron is called “unbound iron.” That’s not good. It’s like a free radical running around and then settling itself wherever it likes, favoring organs. When the iron “deposits” itself in an organ, this is bad. This is what pathogens and bacteria feed on, and this is also what causes diseases and cancers.
That’s what iron overload (Hemochromatosis) is. It’s the depositing of unbound iron in organs, which is highly risky and likely to create diseases and cancers.
So, the genetic mutations are often referred to as the Hemochromatosis Genes, or Hereditary Hemochromatosis gene mutations, often abbreviated as HH, and such.
Having the gene mutations makes one highly likely to overload (develop hemochromatosis).
It does not mean one has a disease, let alone hemochromatosis.
Overload (hemochromatosis/depositing of iron in organs), happens when iron is unbound because there isn’t any Transferrin to pick it up (“bind” to it).
As I mentioned before, unfortunately, my 2 HH gene mutations did not help me in my 15+ years of iron deficiency.
It is not something to be alarmed by or freak out over. It is something easily monitored, and can be quite hard to get for someone with an iron deficiency, even with the gene mutations unless you’re deliberately trying to overload. I even had an infusion and did not overload. You just simply need to watch your %Sat. If it starts getting too high, cut back on vitamin c for a bit. Luckily, the treatment for overloading/Hemochromatosis, is donating blood/phlebotomies and in some cases chelation therapy.
Iron deficiency and Iron Overload (Hemochromatosis) are direct opposites of each other.
Guide 3E. Higher Ferritin “False” Readings!
Although Ferritin is the most specific indicator of iron deficiency, it should not be used to determine iron status in a few conditions & situations. Why? It's an acute phase reactant. In extreme layman’s terms that should be better written, serum Ferritin is “falsely” elevated in these following conditions:
-Acute or chronic inflammation. Simultaneously checking another inflammatory marker such as ESR or CRP may help to establish if inflammation could be a confounding factor in interpreting ferritin. If you were sick at the time of the blood draw, your ferritin can read higher than what it should.
-CKD (chronic kidney disease)
-Heart failure
-Liver disease
-Excessive alcohol intake
-Malignancy
-Hyperthyroidism
If you have any of these conditions, and have a ferritin of above 100 with symptoms, you’ll need to use symptoms, causes, and the iron panel to help interpret iron status. There are multiple announcements and posts here in Guide 3 explaining how to interpret this.
If you have any of these or may possibly have any of these, also make sure to get a SED rate and CRP blood test done, along with your Iron Panel (which typically shows Iron Serum, TIBC, and %TSaturation. It is rare that it will not have these, but just double check and make sure the TIBC and %TSaturation are taken). If you don't have any of the conditions above, don't worry about what was just mentioned. It does not apply to you. The point is, Ferritin cannot be used as an iron status marker in the presence of these conditions, and one has to look at the Iron Panel, these other tests, match up symptoms and causes, to identify a possible Iron Deficiency.
Always remember to read Guide 1, 2, and 3 multiple times once Iron Deficiency is determined. Please see the Files with the long article "Iron Deficiency without Anemia" by Dr. Soppi, who goes over how doctors typically will treat a presumed Iron Deficiency with the protocol, and retest a month or so later and assess their patient's symptoms. Typically, should they notice improvement, and Saturation is not too high, they continue with the protocol.
Guide 3F. The DOs & DON'Ts of The Iron Protocol
The “DOs & DON’Ts” List
Here's a quick Do's & Don'ts to help you remember the main points. But, make sure you read the details within the Guides so you do not unintendedly harm yourself or do something incorrectly. Using this will enable best absorption, raise your ferritin the quickest & safest, prevent you from wasting time and money, all while limiting or eliminating side effects:
Supplements:
DON’T start with Ferrous Sulphate if you have access to other options in your country, unless it's worth the cheap gamble for you.
- Doctor’s traditionally have only prescribed this. It is notorious for consistently providing disastrous GI side effects. There’s a small chance you will be fine on it, but there’s an overwhelming likelihood that you won’t. We have plenty of options now! If you are already on this, and do not experience extreme side effects, feel free to continue. You may be one of the rare, like myself, that do not experience harsh side effects. More on this in the Supplementing Post Guide 2A.
DON’T start by taking supplements with more than one vitamin/mineral in it without knowing the risks:
- Look on the nutrition label on the back to see what is in the supplement. You may think it’s a good idea, but most of the combo supplements don’t provide enough of what you need, and contain vitamins/minerals that many react negatively to. Unfortunately, this often makes the person think that the “iron” is bad or causing the side effects, when in reality, it is another vitamin/mineral in the supplement. It’s critical to buy supplements that only have one vitamin/mineral in it, especially to pin-point what you are reacting to. Many people still tolerate combo supplements just fine. Should you have a reaction though, it's going to be extremely hard to figure out what exactly it's from. Many people do just fine on combo supplements, so if you are on them and tolerating them well, feel free to continue! It's totally fine! Just be forewarned. This forewarning will save many people many headaches, money, and suffering. More on this in Guide 2A.
DON’T initially take or recommend without the disclaimer above:
- Blood Builder
- Hemaplex
- Floradix
- SlowFe
- Any other combo supplements, especially that have synthetic B vitamins in them, like the above mentioned. 30-50% of people have the MTHFR gene mutations, and cannot process these, and often give negative side effects, even if the supplement worked for you in your experience. It is important to also make sure to provide a disclaimer when suggesting or simply commenting your supplement that is anything ferrous, because those are the ones most consistently likely to give negative side effects that many cannot tolerate. It is not recommended to start out with first, please do not recommend them to others without the disclaimer above, and it is likely that you and others have suffered from even mild-moderate negative side effects from these, without even realizing it. If you comment that you take a combo supplement or anything ferrous without the disclaimer, it is likely someone will buy them, and the majority will have side effects and have wasted their money. Please be mindful and most helpful when referring to any combo or "ferrous______" supplement by providing the disclaimers above. More on this in Guide 2A.
DON’T take or limit intake of supplements including red dye if you are sensitive to supplements, or want to limit bad ingredients.
For Proper Supplementing to enable best absorption and not block absorption:
DON’T take iron (and cofactor) within 2 hours of magnesium, calcium, manganese, or zinc.
DON’T take iron (and cofactor) within 4 hours of thyroid medication.
DON’T take iron (and cofactor) on a full stomach for best absorption.
- Too many other vitamins/minerals block absorption. You can still increase your ferritin if you absolutely must take your iron on a full stomach or at night, it will just not be at the same rate as if you didn’t. An empty stomach is 1 hour before eating and 2 hours after eating. It would probably be best to increase Vitamin C intake with meals to help compensate for sub-optimal intake of iron if you have to take on a full stomach. It's also probably best to limit the amount of calcium, zinc, and magnesium, for most optimal absorption in this situation, if you need to take food with your iron stomach. More on the above in Guide 1 Step 3.
DON’T take iron (and cofactor) at night without taking a high dose cofactor. (Unless you absolutely have to. If it's because of your iron supplement side effects, simply get another iron supplement.)
- We have the most hepcidin at night. Hepcidin is created in our body to help prevent us from over loading iron, so our bodies create more throughout the day, with the most being in us at night. Hepcidin blocks absorption. You can still increase your ferritin if you supplement at night, but you will increase your ferritin and get better at a much quicker rate if you supplement in the morning. If you absolutely have to take your iron supplement at night, try to increase your Vitamin C throughout the day, especially with meals, to help absorb as much iron as possible, as much as you can safely tolerate.
DON’T skip your iron every other day. If it worked better, than that method would be The Iron Protocol. It doesn't work as well. Search the group for "alternate" "eod" or "every other day" for anecdotes and proof. Or your could risk it yourself and try it, and prolong your iron deficiency. The studies look good on paper, but they don't take the high Vitamin C into account, which is where they fall short. If you have to take your iron supplement every other day because you're having debilitating side effects and that's the most you can tolerate, you either need to switch your supplement (Guide 2A) or fix your terrain because something in your body is not tolerating the supplement (see Guide 1 Step 5 for causes to vet out with your doctor). You do not want to hurt yourself and if you have to take your supplement every other day because of nasty side effects, it's a likely indicator that you have something else going on that you need fixed. Many people taking ferrous sulphate end up doing this because it's so harmful, so you can always simply try another supplement and see if it's still happening to then discuss Guide 5 with your doctor.
DON'T forget that when you are supplementing, you are putting other vitamins and minerals to work in the body as well, because you are now fueling biomechanical processes that had previously been "shut off" for lack of a better term, or were rationed off when the body realized it was deficient in iron, and went into starvation mode, prioritizing where it sent the iron. Most all biomechanical processes require multiple vitamins/minerals to fuel it, so when you start supplementing with one vitamin/mineral, the body will naturally try to complete the task and use what it needs to complete the task. This is why when we supplement with B12, our iron/ferritin often "depletes." The B12 is now going to try to go to the biomechanical processes that require it, and many of those also require iron. So, it's important to not forget to support our supplementing with all cofactors. Your body will now be requiring more of other vitamins/minerals than it had previously been using, so these fueled biomechanical processes can be supported. Vitamin D and B12 often need to be supported and monitored while taking iron in any form. More info on these in Guide 5.
For fully treating your Iron Deficiency, and getting to your optimal health:
DON’T ignore your other vitamin/mineral levels.
- Vit D and B12 are often lower in those with low ferritin. These are a critical component to full treatment of iron status.
- Vit D optimal is usually 80-100ng/ml or 200-250nMol/L for most people. Get on The Vitamin D Protocol if your Vitamin D number is below this. Nutrient Teams: Improving Health with Magnesium, Vitamin D & Their Mates is amazing for this. If your Vit D is below optimal, read this announcements in this tagged group right away.
- B12 needs to be 600+. The B12 Protocol
- Folate typically needs to be around 20+ for most women to feel best, from what we've seen as a collective group.
- Get a genetic panel done, you can use AncestryDNA or 23andMe.com, and then get the DNA analyzed to confirm whether you are one of the 30-50% of people who have the MTHFR gene mutations where you cannot process synthetic B vitamins, like folic acid/folate and cyanocobalamin. A genetic panel is important to do anyway, for all gene mutations. It gives us so many answers! The B12 Protocol has more info in the announcements.
DON’T not attend to or find your cause of Iron Deficiency.
- There is a Causes post in the in Step 5. This is critical to prevent from becoming Iron Deficient again or possibly other health hazards from occurring. Go out of your way with your doctor to test for as many GI issues as possible, because you do not want to find out the hard way by taking an iron supplement and having a violent reaction that you have h. pylori or Sibo. We have seen this happen.
DON’T give up on fixing your deficiency or give up on The Iron Protocol.
- When you do The Iron Protocol, it is common for those below a Ferritin of 15 to more than double their numbers in the first month.
- It is likely for everyone who is on The Iron Protocol to reach optimal levels of 125 within 6 months. If one is on multiple protocols at a time, it can take longer to raise ferritin, and that's okay.
DON’T give up when you think you’re experiencing side effects.
- It is common to have ups and downs with symptoms even getting worse for a short while when the body is readjusting to now not being deficient and finally sending iron through all of the channels that it had previously shut off. See more in the Expectations post in Guide 2B.
DON’T be disorganized or not prioritize this.
- Make sure you stick to a regimen, routine, and schedule and prioritize treating your Iron Deficiency with The Iron Protocol. Your quality of life will improve drastically when you fix your Iron Deficiency.
- Set labeled phone alarms for everyday if you need to.
- Make sure to put your supplements physically where you will typically be everyday when you need to take them. Able to take them first thing in the morning? Put them out on your nightstand so you see them next to your phone every morning you wake up, with water already there so you take them the moment you wake up. Typically won’t be in the same place every day when you need to take your supplements? Put them in your purse and keep it with you all times. Come up with ways to make sure that whenever you need to take your supplements, you have them near you.
DON’T be helpless and not even try.
- You have answers in front of you that took people decades to create and find. Everything is spelled out for you, easily.
- The group page has a search bar. Search for topics you have questions about before posting in the group.
- READ The Iron Protocol more than once. You will be so thankful!
DON’T keep this to yourself!
- Make sure to help all of your family and friends by sharing the FB Group with them.
- Women are susceptible to being low in ferritin. The majority of women will come back with a ferritin below 100 and need to be on The Iron Protocol.
-Think of how desperate you may have been for answers. You could be blessing many people by sharing this group with them.
DO get your bloodwork done after 4-6 weeks of being on the protocol. Most people only need to recheck their blood work about every 8 weeks after that.
DO re-read Guide 3C over supplementing or not before getting blood work done.
DO believe in yourself! Get a notebook, sit down, and write down The Iron Protocol Steps, and what's written in bold. Say it out loud. Do know this is much easier to understand that what most doctors lead us to believe. It's simply, take enough iron and safely.
DON’T DOUBT YOURSELF!!
DON’T WORRY!!
- YOU CAN DO THIS!!! YOU HAVE EVERYTHING YOU NEED AT YOUR FINGERTIPS, WRITTEN OUT STEP BY STEP! START WITH STEP 1!
- YOU’RE ABOUT TO FEEL SO MUCH BETTER! YOU GOT THIS!
BE EXCITED!
Guide 3G. When to NOT take Iron
Work in progress
-Chronic Kidney Disease
GUIDE 4
Common Diagnoses, Topics, & Symptoms of Iron Deficiency
These are all hyper relevant conditions and symptoms to Iron Deficiency. There are many more than what is included here, but these are the top core common topics. This Guide is a work in progress.
Guide 4A. Symptoms of Iron Deficiency with or without Anemia
“Iron deficiency may cause a myriad of symptoms [3]. Judging only by the symptoms, the differential diagnosis ranges from hypothyroidism and depression to MS and hypochondria. Some symptoms are quite common: fatigue, headache, difficulty to concentrate, memory lapses, reduced mental awareness, absent-mindedness, dyspnea, muscle and joint pain, hair loss and weight gain. Other symptoms may be rare or very rare. For example, nail clubbing is mentioned as a symptom of iron deficiency, but in my practice, I have encountered this sign only once in a patient with iron deficiency during the last 10 years. Pica is also a rare symptom with an assumed prevalence of 1–3 per 1000 iron deficiency patients. One patient had an appetite for ice cubes and soiled potato peels, another patient disclosed having ordered clay which was then consumed. A third patient described an irresistible desire to throw herself on the floor of parking garages and lick the floor made of concrete; to her, the scent of concrete generated this exceptional urge. Various nutritional preferences do surface in conjunction with iron deficiency. A couple of patients reported a development of strong desire to rice cakes; the crunching sound when eating gave satisfaction. I still learn of new iron deficiency symptoms, which fade off as the iron deficiency is corrected by iron substitution therapy. It is a pity to hear patients recall how they have been informed that their symptoms cannot be to iron deficiency, but whose symptoms have disappeared iron therapy.
The non-anemia patients have often been extensive examined as in- and out-patients during many years and may be unable to work because of extreme fatigue and they spend most of the day in bed, and are unable to work out or have a normal life because they have no energy i.e. their quality of life is close to zero. The associated costs are also huge.”
https://www.oatext.com/iron-deficiency-without-anemia...
Symptoms described by anemic and non-anemic patients with iron deficiency (Additional symptoms included by The Iron Protocol (TIP)):
COMMON:
1. Exceptional fatigue*
2. Reduced mental awareness*
3. Absent-mindedness and poor concentration*
4. Headache*
5. Hair loss*
6. Muscle and joint pain*
7. Edema*
8. Shortness of breath and dyspnea*
9. High resting heart rate and rapid acceleration of heart rate during exertion; palpitations*
10. Weight gain*
11. Loss of initiative
12. Memory lapses
13. Difficulties finding words
14. Vertigo
15. Depression
16. Anxiety
17. Globus, pharyngeal irritation and phlegm, dysphagia, cough#
18. Heartburn
19. Cold hands and feet
20. Diaphoresis or no sweating
21. Restless Leg Syndrome#
22. Throbbing leg muscles nightly with mild to extreme discomfort
23. Foot sensitivity, inability to walk barefoot without pain, burning feet (TIP)
24. Reduce aerobic performance, myalgia associated with even slight muscle strain
25. Sleeping disturbances
26. Abnormal menstruation
27. Mild pyrexia (<38oC)
28. Dry skin and pruritus
29. Easy bruising
30. Heavy periods (TIP)
31. Fibromyalgia (TIP)
32. Hypothyroidism (TIP)
33. Migraines (TIP)
34. Esophageal reflux/heartburn (TIP)
35. Burnout (TIP)
36. ADD/ADHD (TIP)
37. Incipient dementia (TIP)
38. Chronic Fatigue Syndrome (TIP)
39. Narcolepsy (TIP)
40. POTs (TIP)
41. Tachycardia (TIP)
42. Brain Fog (TIP)
43. Heart Palpitations (TIP)
LESS COMMON:
(Can depend on how long you have been Iron Deficient, or the combination of other conditions.)
1. Rash
2. Stinging tongue discomfort and pain
3. Abdominal symptoms (which often respond to exclusion of milk and grain products from the diet)
4. Loss of appetite
5. Nausea
6. Dysesthesia (pins and needles) of the extremities
7. Weight loss
8. Visual disturbances and blurred vision
9. Inexplicable fluctuations in blood glucose values of diabetics (especially if treated with insulin)
10. Irritability and anger tantrums
11. Feeling sick
12. Hypermobility
13. Tinnitus and buzzing of the ears
14. Muscle cramps
15. Hot skin
16. Poor heat tolerance
17. Syncope / Episodes of memory loss
18. Pale skin
19. Low and variable blood pressure
20. Rapid (within a few months) impairment of academic skills, e.g., in school or student life
21. Falling asleep involuntarily
22. Pica disorder (eating substances not suitable for human consumption)#
23. Nail clubbing#
24. Plummer-Vinson syndrome#
What Iron Deficiency symptoms do you have?
Guide 4B. Constipation
Constipation often comes with supplementing with iron. There are a few types of iron mentioned in Guide 2A that provide the least amount of side effects, and can be your best bets against constipation (especially heme iron, more in Guide 2A). In the case that one still has constipation, there are lots of helpful remedies that one can easily incorporate into their protocol to prevent suffering from constipation.
The top two easiest and most consistent constipation remedies are:
- Vitamin C - this is a water soluble vitamin, meaning we pee out any excess, making it extremely difficult to over-do it. Some people have conditions where they can't tolerate as much Vitamin C. For those who can tolerate it, most people need anywhere from 1,000-4,000mg to make them have a bowel movement. A phrasing you will often see in health groups is taking Vitamin C therapeutically "up to BT (bowel tolerance)." Too much Vitamin C can make one have diarrhea, so it's best to figure out your BT by starting with 1,000mg, and increasing it by 1,000mg every 15 minutes or so. You will find your BT with trial and error.
- Magnesium - we are all often far too low, especially because much magnesium is required to process sugar and alcohol, and many more reasons. Many people often take 800mg of magnesium bisglycinate at night to help them go to sleep. Even this amount can be too much and make one have diarrhea. It's very hard to over-do it on magnesium, although some people have conditions where they want to watch their magnesium intake. Often, I only need 200mg to have a bowel movement. Start low and work your way up to find your BT. To learn about all of the different magnesiums, their benefits, and when to optimally take them, please read the Magnesium Announcement in Improving Health with Magnesium, Vitamin D & Nutrients that work in Teams. Remember, NEVER take magnesium oxide.
Often doctors prescribe and we take over the counter stool softeners or laxatives. Be very mindful of these and do your own research if you are taking one or interested in one because they often cause short and long term malabsorption issues. The overwhelming majority of us need an almost extremely increased intake of Vitamin C and Magnesium anyhow, so for most of us, these are perfect approaches to try first.
If you suffer from gastroparesis, constipation, or IBS, before or after taking iron supplements, please read the announcements in Improving Health with Magnesium, Vitamin D & Nutrients that work in Teams or see the Vitamin D post in Guide 5 immediately. You could easily have sub-optimal Vitamin D and/or magnesium without even realizing it.
We have had another #constipation thread in the announcements before moving it here: https://www.facebook.com/.../permalink/3647500251948091/
There are plenty of other constipation remedies. What's your favorite?
Remember, you can use the code CPW2772 at international reputable supplement retailers www.iherb.com for a discount.
Guide 4C. Insomnia
Insomnia is often found in Iron and Vitamin D deficiencies. A hallmark indicator of these is especially when one is exhausted beyond belief but still can't fall asleep.
For those dealing with insomnia: there are some things that are a quick fix that no amount of melatonin, lavender, or white noise machines can fix. Here are a couple of things that no one ever told me to try, but work and make sense.
1. Have you put on socks? And perhaps pants? Some of our bodies tend to draw cold because of our condition and not thaw out even while under the blankets, for what feels is hours. Try soccer or compression socks as well, it may help with the restless leg syndrome. I will lie there for hours trying to warm up and nothing will work unless I put on socks. And someone’s pajama pants. Even in the summer, apparently, I need socks on. Put your pants and socks in the dryer for a couple of minutes if you need to heat them up.
2. Adjust your pillow. Have you paid attention to the position your body is in when you finally do fall asleep? Some of my pillows are simply too high. Even when I feel comfortable lying on them.
As a kid I had insomnia for hours and hours each night. It wasn’t until I slept face down (not good) that my body could actually fall asleep
-change out which pillows you’re using under your head and perhaps in between your knees, trial & error. Over the last two years, I’ve had to put my squishy King size pillows tucked under each side of my body. It’s like I’m the dang Princess & the Pea.
-change body positions, trial & error.
3. For that matter, when’s the last time you got an adjustment from the chiropractor or a deep tissue massage? Our muscles are not receiving the oxygen they need. This causes our body to be more likely to be misaligned even from simple things like lying too much on one side in a weird position. I used to have to see the chiropractor so frequently, I joined The Joint a couple of years ago for a monthly bill to visit 4 times a month. I had to go weekly. I thought I needed it because of my tiny bit of scoliosis. I used to have frequent headaches and migraines, and my muscles have gone weak so I don’t have the muscles to keep my adjustments in place. I raised my ferritin from 9 to 53 this past summer on The Iron Protocol, and my chiro and I realized that I haven’t seen him in those 2-3 months of me raising the ferritin!!! According to him, my neck adjusts completely differently, and doesn’t fluidly fall out of alignment. I also never get those seemingly life-ending migraines anymore! Remember, when your neck is off kilter, it’s literally kinking your blood vessels like a hose, preventing more oxygenated red blood cells from reaching your brain! After I get an adjustment, I usually have to wait a moment from rising, or I have to hold the wall for a moment, because I get dizzy from a surge of blood flow going to my head!
-get a deep tissue every 2 months for a while
-visiting the chiropractor at least once a month is probably more beneficial for you than you realize. The Joint doesn’t take insurance and is walk-ins only and nation wide in the US. Tell them I sent you in case I get some sort of credit in the future lol.
4. Ear plugs. Many of are hypersensitive, especially from forming ADD from the lack of oxygenated blood flow to our PFCs, (low ferritin causes poorer mental health because of this). I can hear the slightest of things, keeping me awake. I started using ear plugs years ago, and I started falling asleep within several minutes of my Restless Leg Syndrome kicking in (it’s like my own internal clock telling me I can fall asleep soon). Now that I've fixed my Ferritin, I do not have Restless Legs anymore.
5. Try a more weighted blanket. It’s got to do with the hypersensitivity as well (and perhaps more). A weighted blanket doesn’t mean it can’t be breathable. It’s not about making you hot and uncomfortable. Try several blankets out first if you want. It works. Beware, I bought the heaviest one available because I felt I needed it, and I am too weak to pull it up, so I am having to give it away.
6. Cover the back of your neck. This works for infants as well. We need the coverage and weight. I don’t know why. For the past year, I’ve been sleeping with one of my super plush throw blankets on the top half of my body. It makes me feel like a kid in pre-K at nap time. I’ve been using this blanket to make sure my chest is covered, and then I wrap it around at least one side of my neck, and then half of the time I use it as a “pillow.” It’s just kinked up once or twice, so not the whole blanket at all, just enough to meet and support the curve of my neck when I’m trying to sleep on my back.
7. It’s possible that you have to go number 2, but because of your metabolism being messed up or dealing with the constipation from the iron pills, you can’t necessarily go but your body knows it needs to and wants to. Figure that out. If you have insomnia, often making sure you have a bowel movement can help.
-Often, taking 1-4G of Vitamin C will help you go to the bathroom. Some of us only need 1G, while many of us need 4G. Some people need plenty more than that, and it's fine.
-most of the time brussel sprouts clean people out
-more #constipation remedies in another post here in Guide 4.
8. You may need a little bit of candy. Possibly. Something about sugar and blood sugar and what’s necessary for the body for falling asleep. Idk, you may need some sugar.
9. You may be dealing with unused stimulation. You need to get it out. It wasn’t until I was on stimulants that I was able to regulate my sleep. I think it was because I was actually able to apply myself during the day, and use up this mental energy that I had just lingering around. So when my stimulant wore off, yes there was a crash, but I was actually worn out and tired. Because I applied myself all day. It’s possible that you have pent up stimulation that you need to get out. Typically for men, they get this out physically. Think, sports, sex, fighting/hunting(providing). Makes sense. Whereas we women tend to use up this energy mentally through verbal communication. Try having some conversations before bed, or maybe singing! See what happens.
10. Message me to find out what I am studying next for us, and help me find the answers. This can be extremely mentally fatiguing
Seriously, try these immediately. Watch!
Comment here if any of them work for you!
Do you have some insomnia remedies that you love or have worked great for you?
Guide 4D. Hair Loss
Low Iron is a common cause of hair loss! The great news is, we typically see shedding cease within the first month for many people suffering from hair loss. We have also seen men and women have regrowth after fixing their iron deficiency. Lashes, eye brows, and leg hair too!
I often see the question, "What level does my Ferritin need to be to fix my hair loss?" Well, remember the goal of The Iron Protocol? That's the "number." You have to treat your iron deficiency fully, which is why the goal of The Iron Protocol is to maintain a Ferritin number of AT LEAST 125 for at least 6 months. Many, like myself, will need to maintain much higher Ferritin for much longer (my "optimal" during physical recovery is over 200).
"The decreased serum ferritin level is a very specific finding of iron deficiency. Serum ferritin is regarded as the most valuable laboratory test for iron deficiency [8]. Within this study, the mean serum ferritin level was significantly lower in patients than in healthy individuals. Furthermore, a low serum ferritin level was observed more frequently in patients than in the control group. Our results indicate that serum ferritin concentrations may play a role in the etiopathogenesis of diffuse hair fall."
"Since we have demonstrated significantly low serum levels of ferritin and 25(OH)D in the patient group, we suggest that serum iron and vitamin D status should be evaluated in all patients with diffuse hair loss prior to further treatment. Vitamin B12 and zinc deficiencies were determined in a few patients. Therefore, it does not need to be mandatory to check vitamin B12 and zinc levels routinely in every patient complaining of diffuse hair loss."
*I personally am not knocking B12 or Zinc as causes or potential causes of hair loss.*
"The results obtained from this study reveal that serum ferritin and 25-hydroxyvitamin D levels are generally low in patients complaining of hair loss. Therefore, serum ferritin and vitamin D levels should be evaluated and supplemented prior to treatment in all patients complaining of diffuse hair loss."
I am pointing out that ferritin and Vitamin D are very relevant to hair loss. Remember, when the body starts to sense a deficiency, it starts to ration out where and how much iron it sends out, limiting the amount of iron to the least critical biomechanical processes, like hair and nails. This is why anemia (iron being sent to the bone marrow to create new red blood cells), is the last stage of iron deficiency- because it is the most critical and vital biomechanical process of iron.
So, your hair loss may be from an Iron Deficiency. Your hair loss may be from several deficiencies, or a stressful event. Your hair loss can be genetically caused. "Anything" can cause hair loss, especially an Iron or Vitamin D Deficiency. Iron Deficiency (low or sub optimal ferritin) can absolutely 100% cause hair loss, just like Vitamin D deficiency.
*Just like with any other symptom, not all symptoms are experienced by every person with an Iron Deficiency. One may not experience hair loss with an Iron Deficiency- perhaps their Vit D and genes are optimally functioning, or any other reason. It does not mean that Ferritin is not extremely relevant to the hair loss discussion.
*This also means, if your hair loss was caused by or contributed to by low ferritin (Iron Deficiency), that once it is treated, hair loss should cease. (Iron Deficiency recovery is totally dependent upon how long you were deficient and what other deficiencies you may be experiencing.)
For Hair Loss, make sure you test and have optimal levels in:
- ferritin & iron panel
- diabetes
- Active B12 (needs to be over 175)
- Serum B12 needs to be over 600, but can be falsely elevated for several reason, hence why Active B12 is a better marker than serum
- folate (usually needs to be higher at least around 20-50)
- Vit D (optimal is argued to be 80-100ng/ml or 200-250nmol/L)
- thyroid - TSH, Ft3, Ft4
- zinc (argued to need to be on the higher end to be optimal)
- make sure you’re eating enough protein a day and can digest/absorb it
Guide 4E. Periods
Iron deficiency is a cause for heavy and often painful periods.
The thyroid and pituitary glands require optimal iron to operate optimally, among other parts of the body that are in charge of periods. When these dysfunction because of iron deficiency, most of the time it ends up with a much heavier, painful, and irregular period. Not everyone with iron deficiency has this experience, but the overwhelming majority do. When the ferritin is being raised, the period can spot, skip, or become heavier temporarily (maybe for the first one or two periods). After one has gotten "over the hump" of "re-programming" the body to convince it that it no longer has to hoard the iron in rationing and starvation mode because it's so used to being deficient, it then will start sending iron where it needs to go, and we consistently see that the overwhelming amount of women with heavy periods due to no known cause end up with much lighter and regular periods. This lasts as long as one maintains their optimal ferritin number.
I personally went to physically debilitating periods ever since puberty, that were irregular and heavy, making me unable to walk or stand. It was so extreme that the doctors speculated I had endometriosis and would need a hysterectomy at 15. I was put on Seasonique to control the irregularity and with the hopes that they would become more manageable over time on this treatment, and they did. Any time I would stop taking my birth control regularly or forget as well, my period would come back. I even had to repeat my capstone class in college because the professor dropped me a letter grade from not attending class, because I was bedridden from my period. I used to say that my period would make my back go out, and it felt exactly like I had just been beater with an aluminum bat. Doctor's never cared to monitor my ferritin knowing I had heavy periods off birth control, and never prescribed me more than prescription motrin or ibuprofin for the extreme pain. Now that I have maintained my treatment optimal of over 200, my periods are regular, and often only 2-5 days long. I use light and regular tampons instead of Super. I now know what those girls in the Midol commercials depict when they refer to "cramping." The first time I felt it, I laughed. If my pain I had previously felt was a level 10 or 20 out of 10, the new cramping I feel is easily and consistently either a .5 or 1.
We see this same experience regularly here in The Iron Protocol.
Do you have heavy periods from an unknown cause (meaning you don't have endometriosis, or any other diagnosed reason for heavy periods)? What's your ferritin number? At what age did you start getting heavy periods? Comment below!
Guide 4F. Thyroid
#thyroid
Iron status effects the functioning of the pituitary and thyroid glands. There is no way for the thyroid to perform most optimally without optimal ferritin.
Often, we see people's thyroid labs change while treating their iron deficiency. Many people have to adjust their thyroid medication while treating iron deficiency, and some people don't need thyroid medication anymore after treating their iron deficiency.
Guide 4G. Dysautonomia
I often see many conditions that claim to have "no cure" end up being tied to, correlated, or caused by nutritional deficiencies.
Remember, if you or a friend have dysautonomia, tachycardia, or POTs, and have low or sub optimal ferritin or Vitamin D, it is imperative to be on the protocols! These are some of the first symptoms that are typically relieved! Not everyone who has a form of Dysautonomia will find relief from fixing their nutritional deficiencies, and not everyone's Dysautonomia is caused by a nutritional deficiency. However, we frequently see these conditions evolve from nutritional deficiencies, especially iron, vitamin D, and b12, so tending to them is absolutely imperative.
I see many people in other groups comment that they have these conditions, don't know why, and that there isn't a cure- these are top core common symptoms of Iron Deficiency and Vitamin D Deficiency. Please bless others by enlightening them about the groups!
What is dysautonomia?
Dysautonomia is an umbrella term used to describe several different medical conditions that cause a malfunction of the Autonomic Nervous System. The Autonomic Nervous System controls the "automatic" functions of the body that we do not consciously think about, such as heart rate, blood pressure, digestion, dilation and constriction of the pupils of the eye, kidney function, and temperature control. People living with various forms of dysautonomia have trouble regulating these systems, which can result in lightheadedness, fainting, unstable blood pressure, abnormal heart rates, malnutrition, and in severe cases, death.
Dysautonomia is not rare. Over 70 million people worldwide live with various forms of dysautonomia. People of any age, gender or race can be impacted. There is no cure for any form of dysautonomia at this time, but Dysautonomia International is funding research to develop better treatments, and hopefully someday a cure for each form of dysautonomia. Despite the high prevalence of dysautonomia, most patients take years to get diagnosed due to a lack of awareness amongst the public and within the medical profession.
Some of the different forms of dysautonomia include:
Postural Orthostatic Tachycardia Syndrome (POTS) - estimated to impact 1 out of 100 teenagers and, including adult patients, a total of 1,000,000 to 3,000,000 Americans. POTS can cause lightheadness, fainting, tachycardia, chest pains, shortness of breath, GI upset, shaking, exercise intolerance, temperature sensitivity and more. While POTS predominantly impacts young women who look healthy on the outside, researchers compare the disability seen in POTS to the disability seen in conditions like COPD and congestive heart failure.
Neurocardiogenic Syncope (NCS) - NCS is the most common form of dysautonomia, NCS impacts tens of millions of individuals worldwide. Many individuals with NCS have a mild case, with fainting spells once or twice in their lifetime. However, some individuals have severe NCS which results in fainting several times per day, which can lead to falls, broken bones and sometimes traumatic brain injury. Individuals with moderate to severe NCS have difficulty engaging in work, school and social activities due to the frequent fainting attacks.
Multiple System Atrophy (MSA) - MSA is a fatal form of dysautonomia that occurs in adult ages 40 and up. It is a neurodegenertive disorder with some similarities to Parkinson's disease, but unlike Parkinson's patients, MSA patients usually become fully bedridden within a 2 years of diagnosis and die within 5-10 years. MSA is considered a rare disease, with an estimated 350,000 patients worldwide.
Dysautonomia can also occur secondary to other medical conditions, such as diabetes, multiple sclerosis, rheumatoid arthritis, celiac, Sjogren's syndrome, lupus, and Parkinson's.1,3
There is currently no cure for dysautonomia, but secondary forms may improve with treatment of the underlying disease.4 There are some treatments available to improve quality of life, both with medications and lifestyle changes/adaptations, but even using all treatments available, many dysautonomia patients experience disabling symptoms that significantly reduce their quality of life.
http://www.dysautonomiainternational.org/page.php?ID=34
Guide 4H. Biotin
Some of us have a genetic predisposition to low biotin, because of a biotinidase deficiency. The only thing to do about it is supplement with biotin.
If you break out from taking Biotin or any other B vitamin, taking around 450mg of B5 with the Biotin dose can prevent one from breaking out. I have been doing it for about a month and it's working very well! Sometimes I break out, and I can tell it's because I should have taken another dose of the B5 because I had increased the Biotin dose. Typically, I break out from taking nearly any B vitamin the exact same day, only hours after taking.
Have you ever tested your Biotin? What's your number?
Taking Biotin can alter blood test results. See the picture below for reference.
Guide 4I. Thalassemia
Work in Progress
GUIDE 5
Whole Health Approach (Work in Progress)
Guide 5A. The MTHFR Protocol
(Work in Progress)
30-50% of people have some form of the MTHFR gene mutations, where they can't fully process some inactive B vitamins, especially B12 Cyanocobalamin and Folic Acid.
Folic acid is argued by many to not even reach the blood barrier.
It's typically cheap. One has several more options, which are found here and in The B12 Protocol.
Guide 5B. The Vitamin D Protocol
What's your 25hydroxyD (Vitamin D) number?
Read the Announcements in Nutrient Teams: Improving Health with Magnesium, Vitamin D & Their Mates ASAP if your Vit D is below optimal. If you have not had your Vitamin D tested yet, please do so asap. It is very common for those with low ferritin to also be sub-optimal in Vitamin D, and there are many overlying symptoms. This is the absolute most impactful nutritional deficiency compared to Ferritin, because if it is still lower, you will barely feel any better just from fixing your Ferritin. It's as though the lower Vit D keeps us held down. If you're sub-optimal in Vit D and symptomatic, you will want to read the announcements here asap. Request to join, and just like any other group, answer the membership questions/agree to the group rules. If not, you don't get accepted. It didn't pop up when you requested to join? Cancel and try again. Give it a moment to load. If it's not working, you may need to update your FB app or access from your browser.
Optimal Vit D is argued by many to be around 80-100ng/ml or 200-250nmol/L.
Some argue that optimal Vit D is no higher than 60.
Vitamin D, B12, and Iron are some of the biggest fuelers of many of the same biomechanical processes. So, they will put each other to work, and often have common symptoms of their deficiencies. Think about it. If both Iron and Vit D are some of the 2 largest fuelers for hair growth, it makes sense that Iron and Vit D deficiencies share a common symptom of hair loss.
- They're also fat soluble vitamins/minerals, so when we have an adequate supply or excess, the body is going to try to push it where it needs to go and get used, because unlike a water soluble vitamin, we can't pee out the excess. If some of these biomechanical processes require other nutrients to complete, and we have too much of one of them, what's going to happen? If we are solely supplementing with as much iron as what we can safely tolerate, think about all of the Vitamin D in the body. It's going to be put to work a lot more than before heavy dosing with the iron. So if we don't start taking more Vit D to support it, we're going to deplete our Vit D.
- B12, Iron, and Vit D are some of the most common and largest fuelers for hundreds of biomechanical processes. That's why the three of them have so many similar symptoms. B12, Iron, and Vit D help each other work, and can heavily put each other to work when heavily dosing only with one of those. I often see these three deficiencies ruin lives, both individually and on their own.
- These three are either the Holy Trinity or the Devil's Pitchfork, depending on the status.
If your Vit D is much lower, you will experience often a very harsh, cruel, and just flat out unfair mental situation. Often people are paranoid, or have phobias. The crippling anxiety is typically out of one's control. I have personally come across a small handful of people claim their bi-polar is far less manageable when they're Vit D is lower, and say that that's when they realize they need to go get checked because they're likely low. Same for schizophrenia. Lower Vit D often causes a darker and more cruel state for the individual, especially below the 20ng/ml mark. Not all folks have this, but it seems most do. Lower Vit D also often causes an abundance of GI issues such as constipation, gastroparesis, IBS, and more, Especially if there are other deficiencies, it will end up making one extremely lethargic.
Always get copies of your labs.
Always confirm what the doctor ordered before you leave, and compare it to your list you came in with.
Always get copies of your labs.
Always consider the source. Follow the incentive and motivation.
The admin in Nutrient Teams: Improving Health with Magnesium, Vitamin D & Their Mates is absolutely incredible, and he spends a lot of his time vetting out what good supplements will be and why. It's also his professional background. Now that I've raised my Vit D, people want to know what I have been using. These are Improving Health approved supplements, that I purchased through iHerb.com.
For a 5% discount every time you order anything on iHerb.com, used the code CPW2772
Here is a link to my favorite from Amazon.
Bio-Tech Water Soluble Vitamin D3 (D3 5k IU, 250 Count)
I personally use this. I had a really hard time taking Vit D and digesting fats. This would be great for anyone without a gallbladder or who has issues digesting fats as well. It's known for having zero side effects.
Amazon: https://amzn.to/3tr9CbF
Guide 5C. The B12 Protocol
List for favorite B Vitamin Supplements with NO Cyanocobalamin or NO Folic acid in most in screen shots in announcement in The B12 Protocol
GUIDE 6
Why is this such a global problem? Conflicting info&lack of education
Guide 6. Every Other Day / EDO / Alternate Day Method
Just because something makes sense in a textbook does not mean that’s exactly how it works in real life, or that it’s the only way it could work in real life.
For example, the “every other day” (eod or alternate day) method studies go over how taking iron every other day increases absorption because of hepcidin coming into play. Hepcidin is another cool thing in the body that helps us protect ourselves from ingesting too much iron daily. So throughout the day we create more hepcidin, so at the end of the day we have the most hepcidin in our systems. Hepcidin blocks iron absorption. The studies test out dosing methods and found that iron taken every other day ends up with a higher %Saturation. Some of the studies indicate a faster rise in ferritin but only by a minimal amount honestly. However, the big takeaway for most people when reading this research, is that they should take their iron every other day, because it’s more effective at absorption.
What the studies don’t take into account is high dose vitamin C being taken with iron. Vitamin C inhibits hepcidin expression. This is why people diagnosed with hemochromatosis have to avoid Vitamin C as their standard protocol.
This is why the protocol works. The secret is not only to take enough iron, but taking iron with enough Vitamin C. And as always, orange juice is not enough!
This is a great example of how we need to be careful and simply mindful about what we read and research. Just because something makes sense on paper, or is presented to us as fact through studies or textbook, does not mean we’re not missing something or that real life plays out differently. That’s what makes these groups aiding us in communication and brainstorming so great!
Here is the specific science as to how Vitamin C inhibits hepcidin expression.
#guide6 #eod #everyotherdaymethod
https://pubmed.ncbi.nlm.nih.gov/22227182/
Guide 6. Stop the Thyroid Madness (STTM) on Ferritin and why they're wrong about Iron Deficiency/Ferritin/MTHFR.
STTM is a fantastic resource for thyroid info. However, they miss the mark when they speak outside of their scope.
Please be mindful that STTM has a focus on Thyroid, and is not experienced or equipped to allow themselves any opinion on Ferritin OR MTHFR. (Just like how I am not experienced enough to allow myself an opinion on Thyroid optimal levels and causes, etc.)
They claim “high iron” with low ferritin is indicative of several issues, but in the groups, they immediately focus on "having a methylation issue" as the cause- without indicating what “high” is, vetting out of the person even has MTHFR gene mutations, or even vetting out if the person fasted or not before the blood draw. You can see this on much all of the posts in the groups.
They also don’t say WHAT is wrong with the methylation or what needs to be done about it.
MTHFR gene mutations are in 30-60% of people.
The majority of people who are iron deficient have a much higher iron serum than ferritin (meaning a normal or high iron and lower ferritin number). This is because the body is always going to make sure it has enough iron to operate. You're not going to have iron in storage and empty iron serum. The whole point of ferritin is so that if there is an excess of iron, it's a safe storage, and if one does not have enough iron that day, it releases the iron so we can have enough to operate (active iron is iron serum). The above range iron is typically caused by not fasting/stopping supplementing. It is then usually caused by those who have the Hemachromatosis gene mutations making them likely to hold onto more iron. It can also easily be because they’re also dosing with vit d and b12 and putting the iron to work (that’s what iron serum is).
A person having both the MTHFR gene mutation (30-60% of people) and normal-high iron serum with low ferritin (majority of people with iron deficiency) is very likely. It doesn't mean they are correlated. In other words 30-60% of people who have an iron deficiency will have the MTHFR gene mutation. That has nothing to do with iron serum levels in comparison to ferritin.
I’ve never once found ONE single article or study that tied the MTHFR gene causing normal or high iron serum and low ferritin. Or anything that ever goes over any link as to how this is indicative of a methylation issue.
It’s total crap from STTM. Consider the source. They shouldn’t be allowing themselves to have an opinion on iron deficiency or MTHFR. They also don’t know how to explain it when the questions are asked of them. Because they’re simply applying two likely things together, when that’s not how things work. Most everyone has a normal iron panel and very reasonable reasons for a higher iron, and a huge amount of people have the MTHFR gene mutations. In my opinion so far, it’s a complete and total coincidence, and actually really stupid of STTM. And the reason I say stupid is because I have reached out to multiple admins of multiple groups stemming from STTM and not one of them is interested in actually learning, and providing a better service and more accurate service. Especially from someone who knows what they’re talking about. They purposely are unwilling to learn more about it. In fact, they have banned me for sharing my iron deficiency knowledge.
Always consider the source. STTM is not experienced in iron deficiency to be able to allow themselves to speak on it. Just like I will not be speaking on thyroid.
STTM doesn’t even realize that the thyroid can’t function optimally without optimal ferritin. How do I know that? Well, biology. Anyone can simply type in “iron thyroid” into google and find out how the thyroid needs iron moieties to function. Plus, we find it often that folks on thyroid meds have to end up adjusting their thyroid meds in the course of their protocol, and end up with much more optimal numbers after fixing their iron deficiencies. Some even get off of their thyroid medication because their thyroid issues were caused by the iron deficiency, some simply feel even better on their thyroid meds now, and some just need a smaller dose. Iron deficiency is a cause for hypothyroidism and sub clinical hypothyroidism. (Conversely, hypothyroidism typically causes low stomach acid, which causes absorption issues, which ends up in nutritional deficiencies, like iron deficiency.)
You will never find us at The Iron Protocol telling anyone their cause for thyroid issues (except for stating that iron deficiency can cause or contribute to them, but would never presume “Your hypothyroidism is caused by your iron deficiency”), or try to prevent them from tending to their thyroid issues or intervene in their thyroid treatment because it’s none of our business, we would never intervene with someone’s medical care, and beyond our scope of experience and knowledge. We stick to iron deficiency here.
Guide 6. Doctor's dismissing/ignoring Anemia & Iron Deficiency
Work in Progress
Please share with us your experience with doctors dismissing your anemia and/or iron deficiency.
We often see:
-Ferritin test never run because iron panel/hemoglobin are in normal reference range
-Fights from doctors when the patient asks for a Ferritin test to be run
-Doctors dismissing Ferritin results, especially when they are of a clinical Absolute Iron Deficiency and even below the normal reference range
-Patients told they just need to be on anti-anxiety meds and anti-depressants
-Patients finding unprofessional commentary in their charts especially to referrals, or to the patients' own face
-Doctor's not preparing patients for potential iron & other nutritional deficiencies from common causes while under their care/ Not preventing Iron Deficiency by dismissing obvious, common, and throughoughly well documented causes of iron deficiency/ Doctors causing Iron Deficiency from their care i.e:
--Doctor's prescribing PPIs long term without making patients aware of likely forming of malabsorption
--Doctor's not preparing Gastric Bypass patients before and after surgery for likely nutritional deficiencies to follow
--Primary Care & Gyno's knowing the patient has heavy to severely heavy (and often irregular, and longer) periods but does not monitor Ferritin levels/Patients being under doctor's care long term while suffering from long term heavy bleeds with Ferritin numbers not monitored
--Doctors/Psychiatrists prescribing anti-anxiety/anti-depressants before checking Ferritin/Vit D/B12 numbers for deficiencies/Doctors referring to Psychiatrists and other specialists (often Sleep studies, cardiology, admitting to psych ward as well, and more, but most frequently and consistently is referring to Psychiatry) before checking for deficiencies
Do you have any experience with this? How long did your doctor push off your iron deficiency and/or anemia?
Guide 7. Iron Resources for Parents & Pregnant Women
Work in Progress
Guide 7. Acute Iron Ingestions in Pregnant Women
Acute Iron Ingestions in Pregnant Women
Make sure to join The Iron Protocol for Pregnancy and read the Featured Posts there!
Adult Formulations of Ferrous Salts
No level 1–3 studies were found that specifically investigated a threshold dose for the development of toxicity in pregnant women with acute ingestions of adult formulations of ferrous sulfate, gluconate, or fumarate. There were, however, nine case reports (level 4) that contained information on the relationship of dose and clinical effects for adult formulations of ferrous sulfate 85576116-121 and one case report with an adult formulation of ferrous gluconate 122. The lowest ingested dose of ferrous sulfate to cause maternal effects was 30–50 mg/kg of elemental iron resulting in moderate abdominal distress 116. Six of the eight cases resulted in normal deliveries, one outcome was unreported, and one pregnancy terminated with a spontaneous abortion that occurred following a maternal ingestion of 29,000 mg ferrous sulfate at 16-weeks gestation, after which the mother died 120.
Tran et al. 122 described a patient who was in her 27th week of pregnancy when she ingested 16,200 mg ferrous gluconate (1850 mg or 24 mg/kg elemental iron). She developed vomiting and abdominal pain, a peak serum iron of 603 µg/dL (108 mmol/L), and later delivered a normal, healthy infant (level 4).
There was one level 4 article describing 68 cases of acute overdose of unspecified iron preparations in pregnant women. Follow-up information was available for 51 of the patients and the ingested doses could be estimated in 48 with a range of 470 mg to 10,000 mg elemental iron. The lowest dose associated with symptoms in a mother was 470 mg of elemental iron, which caused nausea. Only two patients developed systemic symptoms. There were 43 live births, three of which were premature, and another three had various abnormalities that the authors did not attribute to iron or deferoxamine therapy. There were two spontaneous abortions and four elective abortions 123.
Guide 7. Acute Iron Ingestions in Patients 6 Years of Age or Older
Acute Iron Ingestions in Patients 6 Years of Age or Older
Adult Formulations of Ferrous Salts
No level 1–3 studies were found that specifically investigated the threshold dose for the development of toxicity in patients 6 years of age or older with acute ingestions of adult formulations of ferrous sulfate, gluconate, or fumarate. There were, however, articles that contained some information on the relationship of dose to clinical effects, but establishing a toxic threshold was usually not the primary goal of the studies.
The efficacy of sodium polystyrene sulfate for reducing iron absorption was evaluated in a prospective crossover study in which volunteers were given 10 mg/kg elemental iron as 325 mg ferrous sulfate tablets 92. The volunteers tolerated this dose with only nausea and vomiting as side effects. Another level 1b study gave healthy volunteers 10 mg/kg of elemental iron as ferrous sulfate to test magnesium hydroxide's effect on absorption and found that the subjects developed nausea, vomiting, abdominal pain, and diarrhea that could be related to either the iron ingested or the magnesium hydroxide that was administered 93. Wallace et al. 94 administered 5 mg/kg of elemental iron to volunteers as ferrous sulfate 325 mg tablets and nausea developed in a small number of the subjects (level 1b). Another study (level 2b) compared the effects of ferrous sulfate tablets to carbonyl iron in healthy volunteers. Ingestion of 100 mg of elemental iron as ferrous sulfate resulted in mild effects, primarily gastrointestinal, but also headache and weakness were reported 10. Burkhart et al. 95 administered 20 mg/kg of elemental iron as 200 mg ferrous fumarate tablets to six healthy volunteers to study the effect of an iron overload on total iron binding capacity. All six volunteers developed nausea, abdominal cramps, and diarrhea. One developed vomiting and four were given intravenous fluid replacement. All symptoms resolved within 6 to 12 hours.
There was one level 3b study, a 12-year retrospective review of 113 acute intentional iron ingestions at one institution, that pooled data from ferrous sulfate, fumarate, and gluconate ingestions and stratified the outcomes according to ingested dose in mg/kg of elemental iron. The patients were reported to have ingested a mean of 70 mg/kg of elemental iron with a range of 7 to 350 mg/kg. Twenty patients developed severe toxicity and seven died. The patients who died were said to have ingested between 35 and 110 mg/kg of elemental iron. However, no details of individual cases were provided. Ferrous sulfate was involved in 45 cases (90%), ferrous gluconate in three, and ferrous fumarate in two cases 96.
Fourteen cases of iron poisoning in 13 level 4 articles were identified 86797-107. The lowest dose that resulted in adverse consequences was one tablet, which caused gastrointestinal perforation in three patients, two of whom died 97-99. The lowest dose resulting in systemic toxicity was a case in which the patient reportedly ingested 10 tablets of ferrous sulfate 325 mg and died 104. However, the patient's family noted that as many as 50 tablets were missing from the container and a serum iron measurement drawn 48 hours after the ingestion was 307 µg/dL (55 mmol/L). In another case in an adult, a dose of 3000–4500 mg ferrous sulfate (600–900 mg of elemental iron) ingested along with alcohol resulted in severe toxicity 106.
In a level 2b study assessing the effect of antacids on iron absorption, adult volunteers received 18 mg of elemental iron as ferrous fumarate and experienced no adverse effects 108. In another study, 6 mg/kg of elemental iron given as crushed ferrous fumarate tablets to six adult volunteers resulted in nausea, diarrhea, and dark stools in two subjects 109.
There were three case reports of ingestion of ferrous fumarate 104110. The lowest ingested dose to cause mild systemic toxic effects from ferrous fumarate tablets was 1650 mg of elemental iron (37.5 mg/kg) that reportedly caused drowsiness and confusion 110.
The lowest ingested dose of ferrous succinate to cause toxicity was 60 tablets (42 mg/kg of elemental iron) that caused mild symptoms of toxicity such as drowsiness and epigastric pain 111.
There were five cases (level 4) reported in two articles in which the ferrous salt was unspecified. Tenenbein 86 reported four adult exposures with ingestions of 35 to 150 mg/kg of elemental iron who were treated with whole bowel irrigation and did well. The second article was a description of a patient who ingested 166 mg/kg of elemental iron and died as a result 112.
There were no studies found specifically examining the time to onset of symptoms in patients of this age group who had ingested ferrous salt formulations. As in the case of ferrous salt poisonings in children, case reports in this older age group also demonstrated that the typical time to onset of symptoms, such as abdominal pain, nausea, and vomiting, was 1 to 4 hours 8,98101,102110116-122. There was one case report found where the time of onset to symptoms might have been delayed, possibly as a result of the treatment the patient received. In this case, a 19-year-old male presented within 1 hour of ingestion of a large number of ferrous sulfate tablets. He was given ipecac syrup, and gastric lavage with sodium bicarbonate solutions was performed. Surgical removal of 60 tablets was performed at 16 hours after ingestion. The only sign or symptom mentioned is a mild metabolic acidosis that was reported at 8 hours following ingestion 125.
Liquid Ferrous Salt Products
Gomez et al. 113 gave 5 mg/kg of ferrous sulfate to healthy adult volunteers for the purpose of testing the efficacy of various decontamination measures (level 1b). The only adverse effect noted with this dose was mild nausea. Jackson et al. 114 gave 5 mg/kg of elemental iron as ferrous sulfate elixir to volunteers to test the efficacy of decontamination regimens. Some of the subjects developed nausea and lightheadedness. One death in an adult was identified (level 4). A young man “accidentally” ingested 1/4 pound of a ferrous sulfate suspension. He presented with hematemesis, shock, and cyanosis and died within 3 hours of ingestion 67. No reports were found that described serious or fatal poisonings in adults from the ingestion of pharmaceutical liquid iron preparations.
Chewable Multivitamins with Iron
No level 1–3 studies were found that specifically investigated the threshold dose for the development of toxicity in adults with acute multiple vitamin with iron exposures. There were, however, two level 2b articles that contained some information on dose and clinical effects but establishing a toxic threshold was not the primary goal of the studies. In the first, 6 mg/kg elemental iron was given as chewable multivitamins plus iron (in the form of ferrous fumarate) to adult volunteers resulting in nausea, diarrhea, and dark stools in two of six subjects 109. In the second study, doses of 5 and 10 mg/kg elemental iron (salt unspecified) were given as chewable multiple vitamins plus iron to adult volunteers, resulting in all five subjects experiencing some degree of nausea, diarrhea, and headaches at both dosages 115.
Polysaccharide Iron Complex
In an analysis of TESS data for 1990–1998, Klein-Schwartz 91 reported 183 adults who ingested polysaccharide-iron complex products (level 4). There were no major effects or fatalities reported. The report concluded that the majority of exposures to these products result in minimal or no toxicity.
Carbonyl Iron
No level 1–3 studies were found that specifically investigated the threshold dose for the development of toxicity in adults with acute carbonyl iron exposures. There was however, one level 2b article that contained some information on the relationship between dose and clinical effects, but establishing a toxic threshold was not the primary goal of the study. In this study, healthy adult volunteers were given oral carbonyl iron in doses ranging from 100 to 10,000 mg. Side effects increased in frequency with increasing dose but were mild and consisted primarily of diarrhea and unpleasant taste, although some experienced headaches and/or weakness 10.
There was also a 2-year retrospective review of all carbonyl iron exposures reported to five poison centers (level 4). Thirty-three cases (age not specified) were identified but follow-up was available for only 17. Three adults were referred to emergency departments. One ingested an unknown amount, one ingested 72 mg/kg, and one ingested 450 mg, but this patient's weight was not reported. All three remained asymptomatic and had serum iron concentrations that were within the reference range 90.
Guide 7. Acute Iron Ingestions in Children Less than 6 Years of Age
Guide 7. Acute Iron Ingestions in Children Less than 6 Years of Age
#parents #children #kids #toddlers
(Use this to identify toxic or harmful amounts of iron for children less than 6 years of age)
Adult Formulations of Ferrous Salts
No level 1–3 studies were found that specifically investigated the threshold dose for the development of toxicity in children less than 6 years of age with acute ingestions of adult formulations of ferrous sulfate, ferrous gluconate, or ferrous fumarate. Multiple level 4 articles contained some information on the relationship of dose and clinical effects but establishing a toxic threshold was usually not the primary goal of the articles. Specifically, there were 62 level 4 articles consisting of case reports and case series and two level 6 abstracts with dose and clinical effect information on ferrous sulfate ingestions in children 720-82, seven for ferrous gluconate 21-2327294358, and three for ferrous fumarate 202583. Unfortunately, one of the case series included children more than 6 years of age in the case pool, raising the possibility that intentional ingestions were included, making interpretation problematic 20. In another article, the age range included children up to 8 years of age 23. In three of the large case series either the precise products or the exact clinical effects were not specified 21-23.
Among the reported cases, the lowest ingested dose of ferrous sulfate associated with the development of significant nausea, vomiting, diarrhea, and stupor was four tablets in a 22-month-old child 24. Similarly, a 20-month-old was reported to be “drowsy and ill-appearing” after having ingested fewer than five tablets of ferrous sulfate 56. Both patients were hospitalized, treated with intravenous fluids and supportive care, and did well. In neither case was the amount of elemental iron in the tablets reported by the authors. Two pediatric iron ingestion case series reported that ingestions of fewer than 10 325-mg ferrous sulfate tablets resulted in severe toxicity 20,22. Reynolds and Klein 22 reported the death of a 16-month-old child with the history of ingestion of “six ferrous sulfate tablets,” although the authors questioned the accuracy of the history based on a serum iron concentration of greater than 4500 µg/dL (greater than 800 mmol/L). The lowest dose of ferrous sulfate associated with a fatal outcome was a case of a 21-month-old child who, by history, had ingested five to 10 325-mg tablets along with 150–300 mg of phenobarbital and 75–150 mg of methamphetamine 25. The peak serum iron concentration was 2160 µg/dL (387 mmol/L). On autopsy, the child had a subdural hemorrhage, bilateral bronchopneumonia consistent with aspiration, renal tubular necrosis, and gastric erosions, indicating that the death might have been the result of a combination of effects of the ingested drugs.
The lowest ingested dose of ferrous gluconate associated with toxicity was 900 mg elemental iron (the exact dose of ferrous gluconate was not specified) that resulted in vomiting and drowsiness in a 15-month-old child 30. In another report, ingestion of 12–20 tablets of ferrous gluconate (exact dose and elemental iron content not specified) caused the death of an 18-month-old child. A serum iron concentration drawn at least 20 hours after the ingestion was 780 µg/dL (140 mmol/L) 27.
Greenblatt et al. 25 described a 35-month-old child who ingested 6000 mg of ferrous fumarate but they only reported that the child did not become “seriously ill.” In another case, a 17-month-old child ingested 43 ferrous fumarate tablets (294 mg/kg of elemental iron), underwent surgical removal of the tablets by gastrotomy, and developed no significant adverse effects 83.
There was one level 2b article and six level 4 articles in which the authors provided information on the dose of elemental iron ingested, but the exact iron preparations were not given or were not known. One article described a large, retrospective review of cases of acute iron ingestion reported to one poison center during a 2-year period 84. Three hundred thirty-nine cases were reported with an age range of 9 months to 33 years. The ingested doses were reported in 199 cases. In the group ingesting 20–40 mg/kg elemental iron, 22% developed abdominal pain, diarrhea, and vomiting while 42% and 33% for the 40–60 mg/kg and greater than 60 mg/kg groups, respectively, developed these symptoms. The higher dose groups had few patients and there was no statistically significant difference in the development of symptoms between the three groups. No deaths, shock, acidosis, or hepatotoxicity occurred.
Among the level 4 articles was a series of 29 patients in whom elevated serum iron concentrations were measured after ingestion of ferrous sulfate, ferrous gluconate, or unknown iron products, but clinical effects were not reported 21. Another level 4 paper was a retrospective review of 80 children less than 4 years of age with iron ingestions 22. The doses were known in only 23 patients and the authors stated that in four cases of severe toxicity the patients had ingested fewer than 10 tablets but the exact products were not specified. Among the four remaining case reports was a 7-week-old infant who was intentionally given “a few” tablets of an unknown iron product by the mother and developed lethargy, persistent acidosis, heme-positive stools, and dehydration. The serum iron concentration 36 hours after admission was 308 µg/dL (55 mmol/L) 85. There was a case of lethargy, vomiting, and watery black diarrhea after the ingestion of “fewer than 15 tablets” of an unknown iron product by a 21-month-old child. Although the time of ingestion was not provided, the serum iron concentration on admission was 463 µg/dL (83 mmol/L) 59. Death was reported following ingestion of 30 tablets of an unknown iron product by an 11-month-old infant 38.
There were no studies specifically looking at the time to onset of symptoms following the ingestion of ferrous salt formulations. In most case reports, the time of onset of symptoms is not reported. Instead, the authors report the time of presentation for medical care, which can be many hours after the initial onset of symptoms. In a few case reports and series there is evidence that the time to the onset of symptoms, such as drowsiness, abdominal pain, gastrointestinal upset, and vomiting, typically occurred within 1–4 hours of ingestion 72226-2931333643,44474955. In only one case report 37 did it appear that the time to onset of symptoms might have been delayed. This case involved a child who ingested 30 tablets of 325 mg ferrous sulfate and was then put down for a nap. The child awoke 10 hours later with vomiting and diarrhea and then soon developed lethargy.
Table 2 provides reported or estimated mg/kg doses for the fatal cases reported in the literature and in TESS for those cases where a dose of iron was reported. As most of the authors failed to report the weight of the children, estimated weights, as previously described, were used to calculate the mg/kg dose ingested.
TABLE 2 Reported or estimated mg/kg dose ingested for reported fatal iron ingestion cases in patients less than 6 years of age
Multivitamins with Iron
Only one case report (level 4) was found with information on the relationship of dose and clinical effects. In this report, a 2-year-old child ingested 780 mg of elemental iron as a multivitamin with iron product. The iron salt in the product and the weight of the child were not reported. No clinical effects were described and the patient was reported to have done well following treatment with whole bowel irrigation 86.
Chewable Multivitamins with Iron
One case report (level 4) was found with information of the relationship of dose and clinical effects for chewable vitamins with iron 87. In this report, a 2-year-old child ingested 25–50 tablets of a chewable multivitamin with iron product (exact dose and elemental iron content not stated), developed a serum iron concentration of 370 µg/dL (66 mmol/L), and experienced no clinical effects. No case reports were found describing serious or fatal poisonings with these products.
Anderson et al. 88 performed a retrospective review of all pediatric ingestions of iron products reported to the TESS over a 15-year period (level 4). No severe or fatal poisonings were reported in 195,780 reported ingestions of pediatric chewable multivitamin with iron products.
In a swine model in which each animal was given either 60 mg/kg elemental iron as children's chewable iron tablets or ferrous sulfate tablets, Nordt et al. 89 demonstrated that the time to peak serum concentration of iron was shorter and the peak serum iron concentrations were greater in the children's chewable group than in the ferrous sulfate group, although none of the animals achieved a serum iron concentration greater than 500 µg/dL (90 mmol/L). At necropsy 10 hours after iron administration, all animals in the ferrous sulfate group showed extensive esophageal and gastric inflammation and hemorrhage while two animals in the children's chewable vitamin with iron group showed only minimal esophageal inflammation. The other animals in the children's chewable vitamin with iron group showed no gastrointestinal injury.
Liquid Ferrous Salt Products
No case reports of serious or fatal poisoning following ingestion of liquid ferrous salt products were identified. Rodgers et al. 26 reported a 35-month-old child who ingested 76 mg/kg of elemental iron in the form of drops containing 75 mg of ferrous sulfate (15 mg elemental iron) per 0.6 mL (level 4). The child developed vomiting and abdominal pain. The serum iron concentration 3.5 hours following ingestion was 359 µg/dL (64 mmol/L). The child received deferoxamine intravenously for 12 hours and was discharged on the second day following the ingestion.
Carbonyl Iron
One case series (level 4) article described a 2-year retrospective review of carbonyl iron exposures reported to five poison centers 90. Thirty-three cases (ages not specified) were identified but follow-up information was available for only 17 cases. Of these, the ingested dose ranged from 2.2 to 72 mg/kg of elemental iron. One child developed diarrhea and lethargy but these symptoms were attributed to the child's pre-existing viral infection. There were no published reports of serious or fatal poisoning from the ingestion of carbonyl iron products.
Polysaccharide Iron Complex
Klein-Schwartz analyzed TESS data from 1990–1998 for children who had ingested polysaccharide iron complex products (level 4). Six hundred twenty children were identified with none reported as having developed major effects or fatal poisoning 91.
https://www.tandfonline.com/.../10.1081/CLT-200068842...
