Raising ferritin FAST (a how-to, not a question)

[FDV70]

Forum won't let me make edits. This process evolves; see my site for the latest changes.

 

[mcs]

Saw this thread and here goes:

• Normal serum iron, low ferritin (idiopathic hypoferritinemia)
• moderate anemia (low or low normal HCT/HGB/RBCs)
• no evidence of bleeding on colonoscopy, EGD, capsule endo, negative FOBT.

Latest iron labs:






Tried every oral iron form (always with vitamin C) and the result is optimal serum iron levels, but not ferritin. Have always had low normal ferritin - just keeps getting lower over time as you can see in the labs.

Iron infusions to bypass the gut the only way?

What does it mean when serum iron is high but ferritin is low? - Dr Wholeness

FacebookTweetPinEmail This question comes up all the time. Patients are baffled when their serum iron levels come back elevated and their ferritin levels come back low even though they have all of the symptoms of iron depletion. What’s going on? Often doctors or even patients who see this think...

drwholeness.com

Thoughts?

 

[FDV70]

Saw this thread and here goes:

• Normal serum iron, low ferritin (idiopathic hypoferritinemia)
• moderate anemia (low or low normal HCT/HGB/RBCs)
• no evidence of bleeding on colonoscopy, EGD, capsule endo, negative FOBT.

Thoughts?

If you're on Test, you can't make ferritin because TRT = increased EPO = increased erythroferrone = lowered hepcidin = ferroportin lets iron release from hepatocytes = ferritin doesn't rise. However there's a lot more going on here... In your case, if you are anemic on Test (like for real, an HGB below 13) [edit I do see you said low normal like 14], and low RBCs, you have a disorder like inadequate erythropoiesis or thalassemia. The low ferritin might be an HFE mutation and the high sat% makes me think hemochromatosis (when you are young, hemochromatosis means LOW ferritin levels. They go high after age ~50 or so because of decades of high serum iron).

You won't be able to use my protocol with a low hemoglobin. Also, my protocol's results come from a high RBC load (i.e. RBC of 4 = poor results, RBC of 6 = good results). But you won't keep the ferritin with a low hemoglobin. My protocol only works with an HGB of 16 or higher. (15 can work but the protocol will make the 15 go up).

I would get genetic testing for hemochromatosis with that sat%, and also an electrophoresis test to check for thalassemia.

edit again. Get tested for gene mutations first since you're on Test and an iron infusion might not actually be stored in ferritin if you have a disorder involving hepcidin, which many HFE mutations cause. You don't need a hemoglobin of 20, after all. Go very light. Your doc should have ordered an electrophoresis test knowing you have a low HGB on TRT.

 

[mcs]

If you're on Test, you can't make ferritin because TRT = increased EPO = increased erythroferrone = lowered hepcidin = ferroportin lets iron release from hepatocytes = ferritin doesn't rise. However there's a lot more going on here... In your case, if you are anemic on Test (like for real, an HGB below 13) [edit I do see you said low normal like 14], and low RBCs, you have a disorder like inadequate erythropoiesis or thalassemia. The low ferritin might be an HFE mutation and the high sat% makes me think hemochromatosis (when you are young, hemochromatosis means LOW ferritin levels. They go high after age ~50 or so because of decades of high serum iron).

You won't be able to use my protocol with a low hemoglobin. Also, my protocol's results come from a high RBC load (i.e. RBC of 4 = poor results, RBC of 6 = good results). But you won't keep the ferritin with a low hemoglobin. My protocol only works with an HGB of 16 or higher. (15 can work but the protocol will make the 15 go up).

I would get genetic testing for hemochromatosis with that sat%, and also an electrophoresis test to check for thalassemia.

edit again. Get tested for gene mutations first since you're on Test and an iron infusion might not actually be stored in ferritin if you have a disorder involving hepcidin, which many HFE mutations cause. You don't need a hemoglobin of 20, after all. Go very light. Your doc should have ordered an electrophoresis test knowing you have a low HGB on TRT.

I'm not on TRT and now wonder how bad ferritin would plummet if I were to be!

I do not have HH (I have 1 copy of H63D, carrier of hemochromatosis, unaffected since I'm not also a C282Y hemochromatosis carrier). My electrophoresis test results are all within range.

Here's something I have to rethink and warn anyone with low iron/ferritin: BEWARE OF TURMERIC/CURCUMIN. It is a master chelator of iron.

The Dark Side of Curcumin

Should you use the whole herb or extract of turmeric, also known as curcumin?

lifespa.com

"Phenols in curcumin bind ferric iron (Fe3+) to form ferric-curcumin complex. In mice, liver hepcidin and ferritin expression were strongly suppressed and iron concentrations in the liver and spleen were reduced by over 50% by curcumin. Curcumin represses synthesis of hepcidin, one of the peptides involved in iron balance, and has potential to induce iron deficiency."

It is also linked to anemia.

Iron Deficiency Anemia Due to High-dose Turmeric - PMC

Turmeric is increasingly studied as an anti-inflammatory and anti-neoplastic agent. It binds to ferric iron in the gut and causes iron deficiency in mice. We report here a possible case of iron deficiency anemia in a human taking turmeric. ...

www.ncbi.nlm.nih.gov

I've expressed concern over the suppressive effects of curcumin on iron and ferritin as well. I have been taking ~ 1600mg/day of curcumin for joint issues. I am going to disconitnue all supplements containing turmeric/curcumin for at least 2 weeks, then retest and hope my ferritin/HGB/HCT levels will be repleted.

Iron chelation by curcumin suppresses both curcumin-induced autophagy and cell death together with iron overload neoplastic transformation - Cell Death Discovery

Iron overload, notably caused by hereditary hemochromatosis, is an excess storage of iron in various organs that causes tissue damage and may promote tumorigenesis. To manage that disorder, free iron depletion can be induced by iron chelators like deferoxamine that are of increasing interest...

www.nature.com

 

[andrewBwinter]

Hi all, I started TRT in 2001 and have been giving blood over the years and have always had issues with recovering my ferritin. Long story short, I got tired of waiting for others to do the research, so I did it myself, created a protocol, hired a hematologist in May 2021 who thought it could work, ran it by him, and tried it on myself. It worked (I was able on my first try to raise ferritin 10 points in 3 days, but I've learned more since then). I have shared it with other guys on TRT who have seen the same success. Now I'd like to share it with you.

How to raise ferritin, the short version
Three 60mg doses a day of Ferrous bisglycinate chelate spaced apart at 9am, 3pm, and 8pm all on the same day, at least 3 days in a row. You MUST NOT be taking vitamins C and D. Your Estradiol should ideally be 20-60pg/mL range. (I'm not saying never take vitamins C and D. Just not during these days.) The times of day absolutely do matter. Your initial dose of iron MUST be 60mg or higher. Subsequent doses may be 60 or higher. Right now I'm telling people do not exceed 300mg in a day.

The key to raising ferritin is understanding how hepcidin works. Saying that it "blocks absorption" as you see in a lot of blogs is incredibly misleading. It binds to and degrades ferroportin, trapping iron in cells and blocking export of iron into serum. A large portion of that trapped iron will become ferritin. Vitamins C and D both crush hepcidin (which obviously increases the amount of iron in your blood, but guys with high hemoglobin want to avoid that).

My ferritin drops 5 points with a donation of whole and 10 points with a double red donation. Most recently, my ferritin was at 26. I donated 455ml of RBCs, followed my post-donation protocol for 4 days, and my ferritin was at 28. My intention is to develop my protocol further with more days and use of Adenine. The point for now is that you can put ferritin back to where it was pre-donation.

I have this written up in lengthier form because it's a LOT, and I wanted to explain everything about it to doubters and put sources to it. I have the long explanation here on my own, non-commercial site:

Fixing High Hemoglobin or Hematocrit and Low Ferritin While on TRT

I'm a regular blood donor (for the community aspect) and this is my second run using what I will call the "Black Tar Protocol". A little uncomfortable but it restores some of the vitality lost to the donation. I'm less sluggish after three days.

 

[Runnerman]

@FDV70 - when taking the iron as part of this protocol, should it be taken on an empty stomach or is is ok to take with food? Thanks!

edit: After looking around I may have answered my own question. it looks like it is best absorbed on an empty stomach.

 

[FDV70]

@FDV70 - when taking the iron as part of this protocol, should it be taken on an empty stomach or is is ok to take with food? Thanks!

edit: After looking around I may have answered my own question. it looks like it is best absorbed on an empty stomach.

Thanks for this -- I just added it to the protocol. Days 1 and 2 are especially critical to have an empty stomach. The rest of the time we're just keeping hepcidin up so it's less criticial I would guess.
Random thought: so many of us take Semaglutide and that keeps food in the stomach longer so I wonder if that has an impact. Probably, I have no idea.

 

[ziemny]

If you're on Test, you can't make ferritin because TRT = increased EPO = increased erythroferrone = lowered hepcidin = ferroportin lets iron release from hepatocytes = ferritin doesn't rise. However there's a lot more going on here... In your case, if you are anemic on Test (like for real, an HGB below 13) [edit I do see you said low normal like 14], and low RBCs, you have a disorder like inadequate erythropoiesis or thalassemia. The low ferritin might be an HFE mutation and the high sat% makes me think hemochromatosis (when you are young, hemochromatosis means LOW ferritin levels. They go high after age ~50 or so because of decades of high serum iron).

You won't be able to use my protocol with a low hemoglobin. Also, my protocol's results come from a high RBC load (i.e. RBC of 4 = poor results, RBC of 6 = good results). But you won't keep the ferritin with a low hemoglobin. My protocol only works with an HGB of 16 or higher. (15 can work but the protocol will make the 15 go up).

I would get genetic testing for hemochromatosis with that sat%, and also an electrophoresis test to check for thalassemia.

edit again. Get tested for gene mutations first since you're on Test and an iron infusion might not actually be stored in ferritin if you have a disorder involving hepcidin, which many HFE mutations cause. You don't need a hemoglobin of 20, after all. Go very light. Your doc should have ordered an electrophoresis test knowing you have a low HGB on TRT.

Hello FDV70 I am a bit confused if the protocol will work in my case and looking now for Your advice, I want to donate as I am a donor, and with prior donation, my RBC is 5.77 Hgb is 16.9 and Hct is over 51 Ferritin is right now 42. After donation, my number will hypothetically go down by 10% Rbc to 5.193 Hgb 15.21 and ferritin will drop by 50%.
So before the donation, I qualified for Your protocol, and it should work but after the donation numbers will not look so good. I just wonder if I should not first rise ferritin and then give blood with my numbers, please correct me if I am totally wrong best regards.

 

[Lockout888]

TLDR: Tried this solution and it didn't work at all.

Background: I have struggled with Iron / Ferritin levels since I donated too much blood back in 2015 & 2016.

I saw this thread and was excited to try it.

My most recent Iron labs were from 6/9/23:
FERRITIN 20 LOW 38-380 ng/mL
IRON, TOTAL 57 NORMAL 50-180 mcg/dL
IRON BINDING CAPACITY 360 NORMAL 250-425 mcg/dL
% SATURATION 16 LOW 20-48 %
RETICULOCYTE, ABSOLUTE 107280 HIGH 25000-90000 cells/uL

But I have had low Ferritin for a long time:
1/30/23 FERRITIN 11 LOW 38-380 ng/mL
6/6/22 FERRITIN 8 LOW 38-380 ng/mL
3/9/22 FERRITIN 16 LOW 38-380 ng/mL
11/13/20 FERRITIN 16 LOW 38-380 ng/mL

You get the idea.

My most recent Labs on 8/4/23 showed it was time to donate blood:
Hematocrit 01 54.1 High % 37.5-51.0
Hemoglobin 01 17.5 g/dL 13.0-17.7

I donated blood on 9/3/23 - a Double Red.

I started @FDV70's Raising ferritin FAST protocol while I was sitting in the donation center's lounge room immediately after donating.

I stuck to the protocol of: Nutricost Ferrochel Ferrous Bisglycinate Chelate 72mg 3x per day, 6 hours apart, empty stomach - for 5 days.

Yesterday, 9/11/23 I had my blood tested again:

IRON, TOTAL 41 L 50-180 mcg/dL
IRON BINDING CAPACITY 386 250-425 mcg/dL
% SATURATION 11 L 20-48 %
FERRITIN 10 L 38-380 ng/mL
RETICULOCYTE, ABSOLUTE 143910 H 25000-90000 cells/uL
HEMOGLOBIN 15.1 13.2-17.1 g/dL
HEMATOCRIT 43.8 38.5-50.0 %

 

[mcs]

TLDR: Tried this solution and it didn't work at all.

Background: I have struggled with Iron / Ferritin levels since I donated too much blood back in 2015 & 2016.

I saw this thread and was excited to try it.

My most recent Iron labs were from 6/9/23:
FERRITIN 20 LOW 38-380 ng/mL
IRON, TOTAL 57 NORMAL 50-180 mcg/dL
IRON BINDING CAPACITY 360 NORMAL 250-425 mcg/dL
% SATURATION 16 LOW 20-48 %
RETICULOCYTE, ABSOLUTE 107280 HIGH 25000-90000 cells/uL

But I have had low Ferritin for a long time:
1/30/23 FERRITIN 11 LOW 38-380 ng/mL
6/6/22 FERRITIN 8 LOW 38-380 ng/mL
3/9/22 FERRITIN 16 LOW 38-380 ng/mL
11/13/20 FERRITIN 16 LOW 38-380 ng/mL

You get the idea.

My most recent Labs on 8/4/23 showed it was time to donate blood:
Hematocrit 01 54.1 High % 37.5-51.0
Hemoglobin 01 17.5 g/dL 13.0-17.7

I donated blood on 9/3/23 - a Double Red.

I started @FDV70's Raising ferritin FAST protocol while I was sitting in the donation center's lounge room immediately after donating.

I stuck to the protocol of: Nutricost Ferrochel Ferrous Bisglycinate Chelate 72mg 3x per day, 6 hours apart, empty stomach - for 5 days.

Yesterday, 9/11/23 I had my blood tested again:

IRON, TOTAL 41 L 50-180 mcg/dL
IRON BINDING CAPACITY 386 250-425 mcg/dL
% SATURATION 11 L 20-48 %
FERRITIN 10 L 38-380 ng/mL
RETICULOCYTE, ABSOLUTE 143910 H 25000-90000 cells/uL
HEMOGLOBIN 15.1 13.2-17.1 g/dL
HEMATOCRIT 43.8 38.5-50.0 %

It is possible that something your ingesting is blocking absorption of iron. Phytates in foods, turmeric, milk thistle, certain meds are all chelators/inhibitors. Or - you have gut issues which are contributing to malabsorption. I have similar issue (see my post above) and don't have any other explanation. Have you had a colonoscopy to check for bleeding?

 

[Lockout888]

It is possible that something your ingesting is blocking absorption of iron. Phytates in foods, turmeric, milk thistle, certain meds are all chelators/inhibitors. Or - you have gut issues which are contributing to malabsorption. I have similar issue (see my post above) and don't have any other explanation. Have you had a colonoscopy to check for bleeding?

I have no isuses absorbing Iron when I use a product called Blood Builder. This is how I normally raise my iron levels after a donation.

 

[FDV70]

TLDR: Tried this solution and it didn't work at all.

But I have had low Ferritin for a long time:
1/30/23 FERRITIN 11 LOW 38-380 ng/mL
6/6/22 FERRITIN 8 LOW 38-380 ng/mL
3/9/22 FERRITIN 16 LOW 38-380 ng/mL
11/13/20 FERRITIN 16 LOW 38-380 ng/mL

You get the idea.
Yesterday, 9/11/23 I had my blood tested again:

FERRITIN 10 L 38-380 ng/mL

There is a high probability that your body does not make hepcidin and you are a carrier, or have, C282Y hemochromatosis.
For a basic explanation as to how you would have low ferritin but have or carry hereditary hemochromatosis, see this post on FB:

https://www.********.com/groups/591473358577668/posts/792355721822763/

If on the other hand you are 55 or older, it's not likely but you may have a different HFE genetic mutation. I've run into a few guys who ran the protocol, it didn't work, and came up positive for hereditary hemochromatosis.

 

[Clear]

There is a high probability that your body does not make hepcidin and you are a carrier, or have, C282Y hemochromatosis.
For a basic explanation as to how you would have low ferritin but have or carry hereditary hemochromatosis, see this post on FB:

https://www.********.com/groups/591473358577668/posts/792355721822763/

If on the other hand you are 55 or older, it's not likely but you may have a different HFE genetic mutation. I've run into a few guys who ran the protocol, it didn't work, and came up positive for hereditary hemochromatosis.

Hey man, quick question. I get heart palpitations when taking iron supplements, I've read others with acid reflux also get them with iron supplements but a PPI stops them. I was recently tested for any gene mutations and am fine, my low ferritin is just due to my TRT.

Would taking a PPI interfere with your method? I've used it before to great success, but the palpitations were bad. Hoping I can add a PPI and all will be good (besides the bathroom trips lol)

Thanks

 

[Systemlord]

I get heart palpitations when taking iron supplements, I've read others with acid reflux also get them with iron supplements but a PPI stops them.

I always thought the iron supplements was causing GI dysfunction, irritation, and not actual palpitations. I get them at specific times, later in the day before my evening Jatenzo, in the morning as a slowly start waking.

If I change my iron or vitamin D dosage, take my Jatenzo early, a few days passes with no GI/palpitations at all. They eventually return. If I over supplement on iron, I don’t get them or they are suppressed.

TRT suppresses my ferritin as well.

I believe TRT changes my iron metabolism and that’s what’s causing these symptoms.

 

[Systemlord]

Would taking a PPI interfere with your method?

Bad idea! PPI’s increase your risk of dementia later in life. Also there are several mechanisms for an increased risk of cardiovascular disease from long-term use of PPIs!

Cardiovascular Risk of Proton Pump Inhibitors - PMC

Proton pump inhibitors (PPIs) are effective agents for the treatment of gastroesophageal reflux (GERD). However, these drugs have not been approved for long-term use. Now sold over the counter, these agents are being used chronically for GERD ...

www.ncbi.nlm.nih.gov

 

[Clear]

Bad idea! PPI’s increase your risk of dementia later in life. Also there are several mechanisms for an increased risk of cardiovascular disease from long-term use of PPIs!

Cardiovascular Risk of Proton Pump Inhibitors - PMC

Proton pump inhibitors (PPIs) are effective agents for the treatment of gastroesophageal reflux (GERD). However, these drugs have not been approved for long-term use. Now sold over the counter, these agents are being used chronically for GERD ...

www.ncbi.nlm.nih.gov

I was just going to take them during the 5 day protocol, I never take them otherwise haha

 

[Clear]

I always thought the iron supplements was causing GI dysfunction, irritation, and not actual palpitations. I get them at specific times, later in the day before my evening Jatenzo, in the morning as a slowly start waking.

If I change my iron or vitamin D dosage, take my Jatenzo early, a few days passes with no GI/palpitations at all. They eventually return. If I over supplement on iron, I don’t get them or they are suppressed.

TRT suppresses my ferritin as well.

I believe TRT changes my iron metabolism and that’s what’s causing these symptoms.

Mine aren't exactly "palpitations" - what tends to happen is my heart will "slow down" for a few seconds then beat extremely fast to "catch" up. It took me a long time to find others with the same issue. It's very strange and neither my PCP or the hemotologist knew what I was talking about. But it definitely happens, I've had them record it on one of those chest heart rate monitors and they were confused. However the hemotologist doesn't want to do infusions and is sending me to a place to check my gut out instead. But I've just been so extremely lethargic. Ferritin low teens as of now

 

[Systemlord]

Mine aren't exactly "palpitations"

Neither are mine. I’ve always felt a cramping or twitching in my lower abdomen. To this day I don’t know what it is, but it doesn’t happen off TRT.

 

[Clear]

Neither are mine. I’ve always felt a cramping or twitching in my lower abdomen. To this day I don’t know what it is, but it doesn’t happen off TRT.

Ah weird. I've always gotten heart rhythm issues when taking iron supplements. From what I read, it could stimulate the vagus nerve and cause them in certain ppl, especially with those who have GERD, which I do. And my brother has vasovagul response, where sometimes he will pass out when he gets bad stomach cramps. So I'm assuming maybe it's connected. I've read people have good luck with PPI during iron supplementation, but if it increases absorption or messes with hepcidin or something else, I'll just have to deal with it. They are quite uncomfortable feeling tho

 

[Systemlord]

The twitching in the lower abdomen is always accompanied by twitching in the legs as well, mainly the thighs and glutes.