Low Ferritin?

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  • #53039

    This may be better suited in one of the medical forums, but I’ve been struggling with exhaustion and feeling like I can’t breathe going uphill (legs feel fine, lungs struggling) for about a month and I finally was able to get an appointment with my GP for this Thursday. She had me do labs in advance and I have low-end-of-normal ferritin with normal hemoglobin. Turns out those symptoms + low tolerance for exercise are the characteristic symptoms of low ferritin normal hemoglobin.

    Pubmed leads me to believe iron supplementation is the treatment (and obviously I’ll talk to my doctor on Thursday about next steps), but I’d love to hear any person anecdotes about others with low ferritin and how you manage it long term?

  • Moderator
    Thomas Summer, MD on #53052

    Hi Lindsay!

    How low is your ferritin? Any other abnormalities in the lab? The first step is to find out why your ferritin is low (if it is really too low) and then see what is the best therapy option. But there could also be other reasons for your symptoms. I’m sure your doc will find out what’s wrong and provide the best therapy.

    hope that helps!? If you have any other questions just ask (in whatever part of the forum you like;-))

    gute Besserung!

    LindsayTroy on #53062

    Thanks Thomas!

    My Ferritin was 24 ng/mL and my hemoglobin is 15.0 g/dL. Everything else is within the normal range (we did a basic metabolic panel, B12, thyroid hormone test, and kidney function test).

    I got it looked at because early March I suddenly was EXHAUSTED, clearly clinically something was wrong, at the same time, easy exercise Z1 HR was feeling like Z4 (nothing was a “conversation pace”). I though maybe it was COVID (it wasn’t) because it came on so fast. Like one day I was PRing everything and then BAM. I stopped training almost immediately thinking perhaps it was overtraining but after a week with no improvement, I scheduled this appointment but its taken a month to get seen.

    Thomas Summer, MD on #53079

    Hi Lindsay!

    24ng/ml is a bit low. I would like to see it over 50. But the hemoglobin is very good. I doubt that your symptoms are from an iron deficiency. Did anything happen in early March. Why did you think about overtraining? Let’s see what your doc says about it. But iron substitution is probably something to consider anyway.


    russes011 on #53084


    Sorry to hear you’re going through this. I concur with Thomas. Since there isn’t much of a downside to a trial of iron supplementation, I would recommend that for a few weeks. Dose and duration can be guided by your doctor, of course. I believe most folks without anemia, even with borderline low ferritin have less fatigue after a brief course of iron–this may be in part placebo. Dosing every other day can help prevent GI upset. Also, make sure you don’t take it chronically, iron overload is a real problem.

    It may be overtraining, considering you were PR-ing right before. I read somewhere, maybe on UA, that once you start PR-ing in training then you have already entered the early phase of overtraining. Not sure if this is true, so don’t quote me on this. I personally would switch to work-out I am excited to do and don’t do the ones that feel like drudgery or work at this point. And for LSD I would consider switching up the sport for variety, like biking or hiking or something. You can consider additional calories, but I don’t think that necessarily works for RED-S or overtraining, unless you were severely limiting calories beforehand.

    Was you thyroid levels definitely normal, or low normal? If low normal, it may be worth repeating. Chronic high volume exercise often causes an induced hypothyroidism that resolves with less exercise. This is why many elite athletes are on synthroid.

    Finally, you didn’t mention Vit D. I believe this is an underappreciated cause of fatigue in the winter due to low light exposure. You can get this tested or just take Vit D in the winter. There is not much downside to doing this. The average dose is 1000U per day, with 5x or 10x that for a few days to start–review the dosing with your doctor first to confirm, of course.

    Best of luck, let us know what happens if you don’t mind.

    — Steve

    Thomas Summer, MD on #53086


    Steve, don’t let us talk her into overtraining or even RED-S with this little information;-)
    of course overtraining is something to consider, but it’s a diagnosis of exclusion. Fortunatelly PR-ing is no sign of overtraining. Who would want PRs then?!;-) It’s true that peak performance is a fine line, but only if you stay there for too long, with too much sharpening.
    Vit D is something to consider. But check your levels first, before you dose too high.
    What was checked for thyroid function? also fT4 and fT3 or only TSH. Thyroid is an area of discussion not only in sports med…

    your doc knows more about you! Let’s see what she thinks…

    all the best!

    LindsayTroy on #53099

    Thanks Steve and Thomas!

    I have been working with Scott, and we were in the muscular endurance phase, which PRs are supposed to be happening. So all seemed on track. Plus my gym workouts always felt fine, even after this started. So I actually thought work burnout (I’m an epidemiologist studying COVID at an R1 institution) more than overtraining but stress is stress.

    Vit D is normal, thyroid is solidly normal FT4 and THS. B12 was lower-middle of normal.

    The only thing that happened around the same time as this was 1. spring sprung, so I thought maybe it was allergies??? Would that be totally crazy? and 2. I hit the 1 year mark of working on COVID. So burnout? So I told my bosses I needed to scale back and its now been a month of probably 50% work load.

    Things are now spotty. Some days I wake up and feel totally normal and some days I wake up and feel like trash. When I feel like normal, I’m not as speedy as I was in Feb, but I’m not slow either and have managed to tick off a few big goals of mine locally. When I feel like trash, I sleep 10+ hours and require a 2-3 hour nap. For about 3 weeks, I’ve been eating more dark leafy greens and using an iron fish as well as taking a B vitamin. About 2 weeks ago I started taking claritin daily. The same day I started taking claritin (actually about an hour before I took it) was the first day I felt like “WOW! I want to go for a run!”.

    Thomas Summer, MD on #53100

    Hi Lindsay!

    lab sounds good.

    working with Scott sounds even better.

    Allergy? Do you have any known allergies? Any other (respiratory…) symptoms? Symptom improvement before taking claritin sounds cool. I’ll try that with one of my next patients;-) but seriously: claritin is an antihistaminic, so a side effect is actually tiredness. Are your symptoms still better since taking it? Mention the allergies at your doc. It’s possible to test for that. But don’t stress too much about it, if you don’t have any other symptoms.

    Stress because of COVID is really something to consider. Especially if you even work with it. Do you have psychological support at work? This pandemic is creating so much stress for most of us. And on so many different levels. It’s also big stress for me. Especially working at the clinic. I found a very good psychologist. She helps me to deal with all the stress.
    As you sad “stress is stress”. Some stress is good. Too much stress is… too much stress!

    so: hakuna matata!

    LindsayTroy on #53313

    I thought I’d give an update!

    I saw my doctor last week and her thoughts were iron deficiency without anemia and (likely) burnout from work. She put me on ferrous gluconate and told me to try to take care of the work stress/mental health. While I haven’t found a psychologist that I like, I’ve been doing yoga/meditation more. She’s also ordered an exercise stress test for me, just in case theres something (unlikely) going on with my heart.

    I’m a week into taking the iron pills and I’m already feeling a lot better. Some days I still need a nap, but it feels less and less like I’m moving through quicksand. I’ve even started waking up feeling like I want to go for a run! The other day, after skiing 4 days in a row, I went for a run and my leg muscles were the tired ones, not my brain/body, thats the first time in two months that’s happened!

    So in case any other women are having this problem, I’m not 100% back to normal yet, but I’m already improving, 1 week in.

    russes011 on #53318

    Great to hear! Thanks for the update.

    Thomas Summer, MD on #53328

    Hi Lindsay!

    Good approach and great to hear that you are already feeling better.

    take your time and enjoy the mediation:-)

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