Restless Legs Syndrome (RLS) Discussion Board

I have searched through the boards and was not able to find any clear explanation of the role ferritin plays in RLS. I am continuing to work with my PCP in the transition from ropinirole to gabapentin. My iron level has been very low and I am taking an oral supplement twice a day. I mentioned to her about there being a relationship between ferritin and RLS but am not clear about what that is.

Could someone direct me to a good resource I can share with her? She is very willing to learn and I would like to provide a good starting point for her.

As sufferers of RLS we are likely to have lower than normal iron stores in some areas of our brain. A check on our Ferritin Serum level while not perfect is a way to try and assess the brain's iron stores.

Take a look at the link in my signature which is The Management of Restless Legs Syndrome: An Updated Algorithm and scroll down just a little to Box 1 and Box 2.

That’s a bit helpful but what is the difference in the roles played by iron and ferritin in RLS? Does a low iron level necessarily mean the ferritin level will be low? Does the iron supplementation for low iron levels also raise low ferritin levels? Can ferritin levels be low and iron levels normal?

It would be hoped that iron supplementation for low iron would also raise Ferritin levels. It can take time.
Iron supplementation can work better for some more than others.

Interpreting Ferritin levels can be difficult as they can be raised by infection/inflammation.
Serum Ferritin level is the test that most reliably indicates body iron stores.
A normal SF level can be from 20. But a SF level of greater than 100 may not rule out iron deficiency anaemia.

shinderlider wrote: ↑

Tue Sep 26, 2023 10:37 pm

That’s a bit helpful but what is the difference in the roles played by iron and ferritin in RLS? Does a low iron level necessarily mean the ferritin level will be low? Does the iron supplementation for low iron levels also raise low ferritin levels? Can ferritin levels be low and iron levels normal?

Oral iron supplementation can take a very long time to give results, or it may not work at all. IVs are the better choice, if possible.

I'm not an iron specialist so someone correct me please if I'm wrong. But a the back of my brain I have stored the following info:
* Low ferritin is a good indicator of a lack of iron. On the other side, high ferritin is NOT sufficient for good iron state.
* For oral iron I believe it helps to take it on an empty stomach with some acid like vitamin C. Stomach acid in general is crucial, you may run into trouble when taking anti-acid drugs like proton pump inhibitors (omeprazol or other -prazols).
* Iron bound to meat (liver and red meat) are much better in bioavailability than supplemented iron. Eating liver from organic meat (to avoid drug and toxin residues) would be my recommendation #1. (I'm not one of the "always has to be organic" people, but in the case of liver I believe this is important, as the liver collects all the toxins we're exposed to, animal or human.)
* Oxalates may interfere with iron transport. Looking into a low oxalate diet may help.

* Low ferritin is a good indicator of a lack of iron. On the other side, high ferritin is NOT sufficient for good iron state. Therefore, low ferritin means that the body's total store of iron is "depleted". High ferritin can mean a number of things. It can be an indicator of infection (the body moves iron to help with fighting the infection), it can mean that you have a high source of iron (recent iron infusion or long term use of oral iron supplements) or it can mean that you use iron inefficiently, possibly due to issues with iron transport across the cell walls (such as the blood brain barrier) or you could have a genetic condition called hemachromatosis, which needs to be treated by a physician (usually be frequently giving blood donations).
* For oral iron I believe it helps to take it on an empty stomach with some acid like vitamin C. Stomach acid in general is crucial, you may run into trouble when taking anti-acid drugs like proton pump inhibitors (omeprazol or other -prazols).
* Iron bound to meat (liver and red meat) are much better in bioavailability than supplemented iron. Eating liver from organic meat (to avoid drug and toxin residues) would be my recommendation #1. (I'm not one of the "always has to be organic" people, but in the case of liver I believe this is important, as the liver collects all the toxins we're exposed to, animal or human.)

These are essentially correct.
1. Ferritin is a measure of the body's storage of iron. Free ferric iron can be toxic to the cells, so the body binds it in the ferritin protein and stores it for those applications where iron is needed. A single ferritin unit contains 4500 iron atoms.
2. The role of vitamin C is to keep the ingested iron in a form so that it can be adsorbed by the bloodstream. The bacteria in the intestines produce compounds that can react almost immediately with iron to precipitate it (the cause of the black/green color of stool). Vitamin C (and the citric acid in orange juice) both react with the iron to form a iron complex that remains in solution and therefore bio-available.
3. The only useable source of iron in the diet is red meat. Iron from green leafy vegatables is not in a form that the body can pick up.

Now, for too much chemistry, but I will add it anyway. Dissolved iron exists in two states, ferrous and ferric. I am not going to claim to understand the biologic differences (my professional expertise is inorganic iron chemistry), but I can say that free ferric ions are HIGHLY oxidizing (worse than hydrogen peroxide). The high acidity in the stomach allows both to stay in solution, but as soon as the stomach acid is used up and the acidity level drops, both forms of iron will come out of solution unless complexed with species like citrates (orange or lemon juice) or ascorbates (vitamin C). Doctors will tell you that the role of Vitamin C is acidify the iron, that isn't completely correct. My experience is that doctors are either don't have a full understanding of the chemistry (frequent) or are dumbing down the explanation to what they perceive as their patient's ability to understand.