From the Guidelines
Your iron level of 34 and ferritin level of 20 indicate iron deficiency, and I strongly recommend taking an oral iron supplement to address this condition and improve your overall health and quality of life. According to the most recent and highest quality study available, iron deficiency can have negative implications for aerobic performance and can be identified through blood screening 1.
Diagnosis and Treatment
The diagnosis of iron deficiency is typically made by determining serum ferritin, which is the most established marker for the amount of stored iron 1. In this case, a ferritin level of 20 is considered low, indicating iron deficiency.
Recommended Treatment
I recommend taking an oral iron supplement such as ferrous sulfate 325 mg once or twice daily, preferably on an empty stomach with vitamin C (like orange juice) to enhance absorption 1. It is essential to take the supplement at least 2 hours apart from calcium supplements, dairy products, coffee, tea, or antacids, which can reduce iron absorption.
Duration of Treatment
You should continue supplementation for 3-6 months, even after symptoms improve, to fully replenish your iron stores 1. Common side effects include constipation, nausea, and dark stools; taking the supplement with food can reduce these effects but may decrease absorption.
Importance of Treatment
Iron deficiency occurs when your body's iron demands exceed intake or when you experience blood loss. Low iron affects hemoglobin production, reducing oxygen delivery to tissues and causing fatigue, weakness, and decreased exercise tolerance 1. If symptoms are severe or don't improve with supplements, consult your healthcare provider for further evaluation and possibly intravenous iron therapy.
Additional Considerations
It is also important to note that iron deficiency can be caused by inadequate dietary intake, and increasing consumption of iron-rich foods such as red meat and seafood can help alleviate this condition 1. Additionally, vitamin C can enhance iron absorption, while foods or fluids that impair iron absorption, such as tea and coffee, should be avoided around meal times 1.
From the Research
Iron Deficiency Diagnosis and Treatment
- Iron deficiency is diagnosed by low serum ferritin (typically <30 ng/mL) in individuals without inflammatory conditions or by transferrin saturation (iron/total iron binding capacity × 100) less than 20% 2
- Given the ferritin level of 20, it is likely that the individual has iron deficiency, as the normal range is typically above 30 ng/mL 2
- The causes of iron deficiency should be identified and treated, and oral iron (ferrous sulfate 325 mg/d or on alternate days) is typically first-line therapy 2
Treatment Options
- Intravenous iron is indicated for patients with oral iron intolerance, poor absorption (celiac disease, post-bariatric surgical procedure), chronic inflammatory conditions (CKD, HF, IBD, cancer), ongoing blood loss, and during the second and third trimesters of pregnancy 2
- Sucrosomial® iron is an oral formulation that has higher iron intestinal absorption and excellent gastrointestinal tolerance compared to oral iron salts, and can be used as a valid first option for the treatment of ID and IDA 3
- Lactoferrin supplementation has been shown to have better effects on serum iron, ferritin, and hemoglobin concentration compared to ferrous sulfate, and may be a superior supplement for improving iron status and erythropoiesis 4
Considerations
- It is essential to identify and treat the underlying causes of iron deficiency, as well as to monitor the individual's response to treatment 2
- Intravenous iron therapy is reserved for iron deficiency anemia patients with intolerance or unresponsiveness of oral iron, and individual selection of the appropriate iron therapy is mandatory to safely deliver improved outcomes 5