Question: After 8 days of intense physical activity and stress (remodeling of house to meet deadline to turn it into a vacation home), what would cause my serum iron to go from 104 (tested two weeks before this intense remodeling) to 56 (tested a week later). In just 8 days!! My ferritin was still close to 80, but % Sat now 21 (was 32). That is extreme metabolizing of iron in just eight days!! I had plenty of energy the first 7 days--yes was tired at night, but recovered by morning. Eighth day much tireder. Ninth day as we were leaving, achey--a typical symptom of anemia for me. Hemoglobin stayed around 15.3 (13 - 16.8). I live at 7000 ft, but did this work at 3000 ft.

And now, after eight weeks of taking 200 mg of elemental iron a day with Vit. C to bring my iron back up, it is STILL 56 and ferritin now 95! Anemia of Chronic Disease? But the biggest question: WHAT would cause me to metabolize iron that quickly? Did the stress lower a co-factor? And I'm now unable to raise my serum iron?? (P.S. TIBC has been at bottom of range all year, possible due to liver stress from mold inhalation the year before which had me in bed for three months in summer of 2013, very ill).

Hi Dr. XXXXXXX You are a wonderful person!

I am a person who has achiness with anemia, even if it's uncommon. And I was quite achey after that 8th day, and which lasted the first three weeks of iron supplementation--also common for me when I start supplementing to get it back up.

I think you are assuming that because my hemoglobin was still pretty good, I couldn't have been anemic. But there is plenty of evidence that one can have good hemoglobin, yet have vital tissues throughout one's body deficient in iron. That is mentioned many places, including here: http://www.askdrsears.com/topics/feeding-eating/family-nutrition/iron/my-doctor-measured-my-hemoglobin-and-its-normal-could-i-still-be-anemic

So i'm left to wonder if the extreme stress of those 8 days was able to quickly lower my iron serum and not the hemoglobin. Here are further questions I hope you can help me with:

1) You mentioned free radical formation as a potential reason for that massively quick lowering of my serum iron--are you saying that the free radicals (caused by the stress of the event) were causing a speedy liberation of my iron from the transferrin?? i.e. the iron was being quickly used up?

2) And since I've had low TIBC all year (which I think was the result of a massive inhalation of mold last summer of 2013, which put me in bed for three months), is it possible that both the low TIBC, plus the free radical damage, played a role in what happened to me in eight days?

(I did find a study which stated that "overproduced free radicals react with cell membrane fatty acids and proteins impairing their function permanently." http://www.ncbi.nlm.nih.gov/pubmed/0000 )

3) You mention myoglobin in #4 of your comment---how could that be involved in what happened to me in 8 days?

4) As far as the present and being totally unable to bring my serum up again....I truly doubt my age has as much to do with this. It seems related to whatever happened those 8 days! And I can't stay off the iron...I start feeling tired again. So my challenge is: how to I reverse whatever is causing the complete inability to raise my serum iron? It simply goes into storage! Because one can, in fact, have a raise Ferritin without having a raised CRP, so isn't it possible that the free radicals produced inflammation...and it's some kind of hidden inflammation that I need to lower in order to absorb iron better?

OK, your #1 underscores wonderfully how free radicals from stress can give iron. Makes complete sense and you get a gold star for that information.

But tell me this: with my low TIBC (probably due to the mold overload last year), I knew I needed to give myself protein with all my iron doses, and that was lactoferrin. I divided my 200 mg of elemental iron up into three doses a day to equal 200, and with EACH dosing, I took 500 mg of lactoferrin.

So I was taking 1500 mg of lactoferrin a day with 200 mg daily of elemental iron...and my serum iron STILL didn't budge, but my ferritin went up from 76 to 95. I need your ideas as to what is going on, because simply blaming my age doesn't add up. I am biologically and genetically a young 62 year old, for one. Second, with each dose of iron and lactoferrin, I was putting lemon juice in water since acid in the stomach increases absorption. And third, there is also research that shows it's "disease" which causes malabsorption in the elderly, not just because of their age. And 62 is NOT elderly. lol. http://jn.nutrition.org/content/131/4/1359S.long

As far as malabsorption of iron after this event, I have no injury to my bowels that I know of. I am not celiac nor gluten intolerant. I have no signs of disease. I would have to do an ESR and CRP to know for sure if I have inflammation of some kind. I am adequately treated for my hypothyroidism with desiccated thyroid.

So any other ideas as to why I'm not absorbing iron except in storage after this event? Maybe more lactoferrin since my TIBC is so low?

Having worked with thyroid patients all over the world for 12 years, and in looking at a large volume of each other's lab work, we have observed repeatedly that those "normal" ranges are ridiculous. In other words, we see over and over that those women who were optimal had a serum iron close to 110 (not my 56). And their % sat was close to 35 (not my 21), and TIBC was always in the lower 300's when optimal (not my bottom of the range close to 250), etc.

In other words, those ranges were developed using some individuals with sub-optimal iron and calling that "normal". 56 is horrible. Symptoms match that horrible.

As far as using Lactoferrin, that low TIBC implies my liver is not doing it's best job in making transferrin, which in turn implies that my liver is stressed, which could be because of my mold exposure last year. So I clearly needed some protein to carry the iron around--thus the lactoferrin. Also, a TIBC at the bottom of the range may fit the test subjects that were used to establish any lab facility's so-called "normal" range, but is definitely NOT normal, unless one defines "normal" as being "sub-optimal". Because a TIBC at the bottom of those erroneous ranges is sub-optimal and a hint that something is going on with the liver.

Also, we've noted repeatedly that serum iron DOES go up with supplementation for the majority, even if ferritin does not go up much at all. The latter can be due to an excess of heavy metals. i.e we see this problem with someone has an excess of copper or lead, for example, due to the MTHFR mutation.

But my serum did not budge after 8 weeks of high supplementation...and I do not have the MTHFR mutation...and that is the big mystery here that I am seeking an answer to. It simply has to be related to what happened to me when my iron took a serious dive due to what you have explained about free radicals. I just can't find a clue as to what explains this failure.

Bottom line, all I know to do is the following:

1) I've increased my liver support because of the continued clue of a stressed liver as revealed by the very low TIBC. I'm taking Liver Life twice a day (Agaricus Blazei mushroom, Red Root, Milk thistle seeds, Olive Leaf, Turkey Tail mushroom, Reishi mushroom, Maitake mushroom.) I'm taking EXTRA Milk Thistle, plus Dandelion Root, plus Liver Chi (Bupleurum chinesis, Schisandra chinesis, and Smilax Glabra)...all twice a day as well. Have also added in NAC which I see is an excellent support for the liver. I still suspect that my horrific mold inhalation last year is the cause for this liver issue.

And by the way, restarting all the above caused clear liver detox issues.

2) I'm back on iron, but at 150 mg a day and only sometimes 200 mg. I still take the lactoferrin, 1500 mg a day, because of my low TIBC. I add lemon juice to my water to improve absorption.

3) I'm taking anti-inflammatory supplements, just in case. Plus other vitamins and minerals.

So we'll see since I have no strong answer as to why my serum iron didn't budge. I would love to know the answer since it's simply too coincidental that it occurred after that swift fall of my iron after a particular stressful event.

Hi. It appears what I just sent didn't make it. Argh. I basically summarized what we had talked about (to help me remember it all) and my replies to you. Bottom line and to the contrary, one can have normal hemoglobin and still be anemic. I am proof. When my iron fell to 56 after those 8 days of high stress, I had my classic symptoms of anemia, which for me are extreme fatigue and achiness.

Also, no, a TIBC at the bottom of the range is NOT "normal", even if it falls in that erroneous "Normal" range. Working with patients all over the world as I have underscores that when patients have good iron levels, their TIBC will nearly always be in the low 300's (range 250 -450), NOT at the bottom of the range as mine is now. It's been low all year, in fact, after my mold incident last year.

Finally, here's something to consider:

From: http://web2.airmail.net/uthman/anemia/anemia.html

Anemia may be defined as any condition resulting from a significant decrease in the total body erythrocyte mass. Measurement of total body rbc mass requires special radiolabeling techniques that are not amenable to general medical diagnostic work. Measurements typically substituted for rbc mass determination take advantage of the body's tendency to maintain normal total blood volume by dilution of the depleted rbc component with plasma. This adjustment results in decrease of the total blood hemoglobin concentration, the rbc count, and the hematocrit. Therefore, a pragmatic definition of anemia is a state which exists when the hemoglobin is less than 12 g/dL or the hematocrit is less than 37 cL/L. Anemia may exist as a laboratory finding in a subjectively healthy individual, because the body can, within limits, compensate for the decreased red cell mass.

One must be careful in blindly applying this practical definition of anemia in every case. As the following diagram shows, it is possible to be severely anemic and have a normal hematocrit (and hemoglobin). This occurs when there is rapid hemorrhage, with red cells and plasma being rapidly lost simultaneously, before the body can respond by hiking up the plasma volume.

The final example in the above diagram illustrates that a person can have a low hematocrit and not be anemic. This occurs when a patient is overhydrated, typically as a result of overenthusiastic intravenous fluid therapy.

You are right. There was no overhydration. Something is just not right for my iron to dive as quickly and severely as it did in just 8 days of emotional/physical stress almost 3 months ago. My husband was with me doing the same thing, and his iron didn't dive, so perhaps that rules out an external factor like carbon monoxide.

Equally as puzzling is what is going on right now. Since I last did the labwork after 8 weeks of supplementation (and my serum iron didn't budge at 56, and ferritin went up from 76 to 95), I have simply stayed on 100 mg iron, continued to treat my liver, and felt okay...thinking perhaps time will help raise my serum iron as you and I discussed. If we went out hiking, I did 100 mg iron before the hike and 100 mg after the hike...and did fine. But....last weekend, we went out hiking again. On Saturday, it was quite a lot. Sunday, I was sleepier than normal. Sunday nite, it hit me!! I didn't take my iron Friday or Saturday and not sure I did Sunday!! Monday and yesterday---extreme fatigue. Yesterday afternoon, felt absolutely awful, as I have this morning. I did resume 200 mg elemental iron a day on Monday.

So the bottom line is that I'm still NOT out of the woods and can't even stop taking iron for two days if I'm active.

Looking back, it's like the stress of physical activity gobbles up my iron far more than emotional stress. I've had it happen before...just not this extreme. I've did genetic testing earlier this year, and am wondering if there is a mutation that has become active that explains this. I only studied my homozygous mutations, and wonder if I need to look my heterozygous mutations. I do have one homozygous mutation that means I tend to be a overmethyizer for that one. I need to relook. If you have any ideas on genes, let me know.

As far as my hemoglobin being good and serum iron at 56, I do want to underscore that I had the EXACT same symptoms as when I've been anemic before. Something has to explain that in spite of the normal hemoglobin, even if you disagree with the link I quoted from. And something has to explain that this easy fatigue is still continuing if I dare to forget my iron!!

By the way, something I found of interest to my inability to raise my iron:

Patients will often take an iron supplement for 3-4 months only to find their iron levels are unchanged or even lower. This is due to low bone marrow iron that has compensated by taking iron from the muscles (myoglobin). When iron is being replenished through supplementation, the bone marrow “debt” to the muscles and storage organs must first be repaid – hence iron storage (ferritin) levels remain static or even fall on the initial follow-up blood test. This is a temporary setback, and the person’s iron levels will eventually lift as they continue supplementing. At this time it’s important for the Practitioner to reassure the patient, allay anxieties and encourage continued compliance.

http://www.femail.com.au/iron-levels-tony-pearce.htm

So though I am never sure what did this to me so severely, at least that may explain why my serum iron stayed at 56. But I will still have to wrestle with why it dived so severely in the first place. I sometimes wonder if I just need to go to the beach and rest for two months. lol. I am so many responsibilities!! Argh.

You know, since my storage iron DID go up (from 76 to 95) after 8 weeks of supplementation, and since I did feel better in spite of a very low serum iron of 56 that didn't budge....I'm wondering if I just need a storage iron higher-than-normal to compensate for what could be that bone marrow “debt” to the muscles...or whatever debt I caused myself from those 8 days. And perhaps this is why I HAVE to take iron supplementation daily for awhile, and definitely need to INCREASE that supplementation when I am extremely active. I not only did NOT increase it last weekend when I was so active, I forgot to take it...and I'm paying a terribly price right now. :( So physically tired.

Do you think I'm on target there??