Iron Deficiency and Fatigue: The Endocrine Connection
Why is it important for Endocrine patients to take iron?
Many patients with fatigue as a main complaint are eventually diagnosed as having an endocrine problem. However, an often-overlooked reason for fatigue in women who are menstruating is iron-deficiency.
Iron is needed for thyroid hormone biosynthesis and action, including the conversion from the inactive thyroid hormone, T4, to the active hormone, T3. Women taking thyroid hormone are especially likely to benefit from treating iron deficiency. Men are unlikely to be iron deficient as the main reason for low iron in younger patients is loss through menses.
Understanding Ferritin vs. Anemia
That severe iron-deficiency leads to anemia as manifested by low hemoglobin and hematocrit on a CBC blood test is well known. However, mild iron-deficiency leads to low ferritin in blood tests BEFORE a drop in hemoglobin and hematocrit occurs.
An article published in the May 2003 British Medical Journal showed that patients with low ferritin, but normal hemoglobin and hematocrit, have fatigue that is reversed by iron treatment. Since Dr. Friedman’s goal is early diagnosis of treatable diseases, he recommends measuring a ferritin level in all women who have fatigue. Performing a CBC is not needed.
Note on Screening: Colon cancer can also give a low ferritin level, but it is unlikely in younger females whose main complaint is fatigue and who do not have weight loss. In men or older women, a low ferritin may warrant a colon cancer work-up, depending on evaluation by the patient’s primary doctor.
Measuring Ferritin Levels
The normal range for ferritin listed by the laboratory is usually between 30 and 300 ng/mL, but Dr. Friedman recommends iron treatment for everyone with a ferritin less than 60 ng/mL.
Raising ferritin levels to a value between 70 and 90 ng/mL is usually achieved with oral iron treatment. Raising ferritin to this range may be needed for patients with hypothyroidism to have an optimal response to thyroid hormone treatment. Dr. Friedman’s philosophy is proper ferritin levels are crucial for good hormone health and he advocates attempting to raise them fairly rapidly in those with low levels.
Iron Treatment Options
Oral Supplements
Ferrous sulfate (325 mg orally) has usually been the recommended treatment, however, this preparation is often poorly tolerated. Rather, Dr. Friedman’s first choice for iron supplementation is Life Extension Iron Protein Plus (300 mg/day).
It contains Iron Protein Succinylate (IPS), an iron complex specially prepared to reduce irritation of the stomach. IPS is gentle to the stomach because it dissolves in the intestine, and the added lactoferrin helps with iron absorption.
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Dosage Protocol: * Ferritin 50-60 ng/mL: One pill a day.
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Ferritin 30-50 ng/mL: Three pills a day.
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Ferritin < 30 ng/mL: Five to six pills a day.
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Other Options: Ferrets (Pharmics), Feosol, Vitron-C, Ferrasorb by Thorne, and Floradix Liquid.
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Natural Alternatives: Some patients use a natural, desiccated beef liver supplement (1-2 capsules in the morning before food).
Another choice is Fusion Plus, which combines a high dose of different iron sources with Vitamin C and Probiotic Cultures. It contains 130 mg of iron and requires a prescription.
Iron Patches
Ironplus topical patches are now available. One patch a day is reasonable for those with a ferritin above 30 ng/mL, while two patches (or one patch plus Iron Protein Plus) are recommended for levels less than 30 ng/mL. There are no reports of constipation with this patch, though it is often not as effective as iron pills.
Iron Infusions
Patients not responding to oral iron or patches may be prescribed IV iron treatment. Because of difficulties in getting referrals to hematology, Dr. Friedman is happy to provide a prescription for an iron infusion (such as Venofer) to established patients.
Best Practices & Side Effects
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When to take iron: All oral iron products should be taken at least an hour after thyroid medication. After taking iron for 3 months, a ferritin level should be rechecked and the dosage adjusted.
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Absorption Boosters: Vitamin C (250 mg) helps with absorption and should be taken at the same time as the iron. Note that bran, zinc, antacids, and vitamin E may interfere with absorption.
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Side Effects: Common side effects include constipation and black stools. Patients should increase fiber and fluids or use a stool softener such as Colace.
For more information about Dr. Friedman’s Endocrinology clinic or to schedule an appointment, please visit his website at www.goodhormonehealth.com.