How to Increase Ferritin

[FoodIsMedicine]

Hello, newly researching RLS. Have seen low ferritin is a big contributor to symptoms in my readings. My symptoms are mild, but consistent over past 5ish years.

I’m 36, female. Ferritin is 62. Last Year it was 35, despite no changes to nutrition. I’m not on iron supplements. I also have low normal B12 (402) and low normal vit D (40).

What is an ideal ferritin level?

What form of supplementation is ideal?

Has anyone researched the connection between ferritin, vitamin D, and or B12?

Thanks all!

[stjohnh]

Hello, newly researching RLS. Have seen low ferritin is a big contributor to symptoms in my readings. My symptoms are mild, but consistent over past 5ish years.

I’m 36, female. Ferritin is 62. Last Year it was 35, despite no changes to nutrition. I’m not on iron supplements. I also have low normal B12 (402) and low normal vit D (40).

What is an ideal ferritin level?

What form of supplementation is ideal?

Has anyone researched the connection between ferritin, vitamin D, and or B12?

Thanks all!

Welcome FoodIsMedicine, Lots of helpful people here with lots of heart and knowledge. I hope you find the answers you are looking for.

The variation in your ferritin readings may be due to the timing of the blood draw. The ferritin level changes as the day progresses. For accurate readings, the test should be done in the morning, fasting, with no iron supplements for 48 hours before the test.

For RLS, there is no known ideal ferritin level. Basically, higher is better. RLS is more likely to occur if your ferritin is very low (less than 25 say). It is nearly impossible to get the ferritin above 100 with standard oral iron tablets. There is a slight possibility that heme-iron extracts (IE dessicated spleen, or eating real spleen) may bypass the normal regulation of iron. Likely the best you can do is Ferrous Sulfate+ vitamin C.

Most people receiving IV Iron that started with a ferritin less than 100 (me included) have found that RLS symptoms start returning as the IV iron wears off. It seems that 200-300 is the usual range. My RLS symptoms started recurring a month ago when my ferritin fell to 280. So I suppose you could say that an ideal ferritin for a person with RLS is 300 (assuming the ferritin is not artificially elevated due to inflammation).

RLS is caused by BID (Brain Iron Deficiency). Many people with RLS can have their symptoms markedly reduced or even eliminated with IV Iron treatments. This is the only treatment that gets at the basis for RLS (low brain iron). It has almost no side effects. The International Restless Legs Study Group has elevated IV Iron treatment to first line therapy. This means that IV Iron is one of the first treatments doctors should try, not one of the last (as has been done for many years). If you can get your doc to prescribe IV Iron treatment, that is the way you should go. Unfortunately this is fairly new information and most docs, even those that frequently treat RLS, are not aware of it. Note that the blood tests doctors usually do (ferritin test) to check for low iron only check for low BLOOD iron, there is no test available for checking for low BRAIN iron. Oral iron usually doesn't provide a high enough blood level increase to help, folks need IV Iron infusions. Here is a link to the recommendations:
https://www.sciencedirect.com/science/a ... via%3Dihub

[badnights]

Apparently the ideal concentration of ferritin varies from patient to patient (according to the researchers and clinicians who co-presented one of the Foundation's webinars a few years ago). So for some people - like Holland - it would be 300, whereas for another it might be 150. The guys who pioneered the iron infusion treatment would tell the patient who had just had an infusion to return when his/her symptoms returned. At that point, they measured the patient's ferritin, and gave another infusion. From that point on, they regarded that patient's ideal minimum ferritin level as the level measured when the symptoms returned. For some people it was higher, for some it was lower.

But there is just not enough data to say anything firmly.

Vitamin D is essential to manufacture myelin, the coating on nerve cells that helps them conduct faster. It also affects dopamine activity in the brain. So it's been theorized that deficiencies in D may affect WED/RLS. There was a study (in 2012) of 36 WED/RLS patients (comparing them to 38 controls) that showed that disease severity was inversely related to vitamin D levels (the lower the D, the worse the symptoms). There was also a case study (2010) of a woman whose WED/RLS was caused by vit D deficiency, and went away when the deficiency was cleared up. Another study (2016) of 57 patients and 57 controls found that low D correlated with worse symptoms in females, but not males, and especially in females with late-onset WED/RLS.

Another study (2014) approached the problem differently, taking 135 neurology patients and testing them for vitamin D levels, then for WED/RLS. Those with low D had significantly worse WED/RLS.

On the other hand, either D or placebo was given to 35 WED/RLS patients in another study, to see if D helped decrease symptom severity, but after 12 weeks there was no statistically significant difference in severity between the D and placebo groups - that is, the D did not have any apparent effect.

Nevertheless, it seems from the other studies that, at least in a sub-set of WED/RLS patients, low vitamin D does worsen symptoms.

I'm not aware of any links between B12 and WED/RLS - not saying there aren't any, though!

Your ferritin is kind of low, as Holland says most specialists like you to get it above 100 at least. Symptoms are known to be worse in patients with ferritin <75; not much is known above that, but anecdotes such as those from people getting and giving infusions suggests that this correlation extends to higher ferritin levels - meaning, you could benefit from taking iron. Don't discount the possibility of raising ferritin with oral iron - I managed to get from 23 to 204 with oral iron, though it took years. I also made dietary changes that may have helped whatever the primary problem is (maybe helped fix the damaged mechanism that controls entry of iron into the brain). Anyway don't give up on oral iron, in my experience it's possible to raise ferritin well over 100 with oral iron.