I’m desperate to pep up my energy levels
QI’M 51 years old, I have not had a period in almost three years and I have been exceptionally tired and dizzy of late. A blood test showed my ferritin levels are low, with a reading of 45, and I was prescribed iron tablets. Do you think vitamin injections would give me more energy while I wait for the tablets to start working?
Anne Marie Imundi, Liverpool.
ASevere fatigue can be debilitating, so I sympathise with you. Ferritin is a combination of iron and protein and is used as a measure of your blood’s iron stores. We measure ferritin levels rather than iron because it is more stable; the iron levels in the blood can vary from hour to hour according to, for example, what someone has eaten.
The normal ferritin range is between 15 and 180 ng/ ml ( nanograms per millilitre). Your reading of 45 is certainly at the bottom end of normal, but nowhere near the level of depletion in someone considered iron deficient.
Iron deficiency can lead to a condition called iron deficiency anaemia, the most common form of anaemia. Here, the blood lacks the iron it needs to make haemoglobin, a protein required for creating red blood cells which ferries oxygen around the body.
Most people with iron deficiency anaemia actually have few symptoms — typically weakness, fatigue, headaches, breathlessness and a sore tongue.
Anaemia is linked to a number of causes, most commonly blood loss, but, since menstruation is no longer a feature of your life, this is improbable in your case.
It is also often caused by reduced iron absorption, which can occur with coeliac disease, when the lining of the small intestine is damaged by an immune system reaction to the protein gluten, found in bread.
Another possibility is that your diet might be lacking in foods containing iron — these include dark green leafy vegetables such as curly kale and broccoli, pulses such as lentils and peas and red meat or fish.
The iron supplement you have been prescribed (called ferrous fumarate) contains a form of iron that the body can use to make more haemoglobin.
It is best absorbed when taken on
alternate days, so the intestine is not overloaded with iron.
Take with a glass of water or fruit juice (vitamin C aids the body’s absorption of iron).
Avoid drinking tea, coffee or milk or taking calcium supplements with the iron tablets and for two hours afterwards, as these reduce absorption of iron.
The same applies when eating iron-rich food.
As for your question about vitamin supplements, I definitely do not believe you should take them — orally or by injection — to help ease your fatigue. There is no evidence that they are of value in this situation.
If iron supplements do not ease your symptoms in a month or so, then return to your GP, who may decide further tests are necessary — if the problem is iron deficiency, you should have seen an improvement by then.
If not, you might, for instance, need your thyroid function checked, as an overactive or underactive thyroid — a common problem in women — can lead to fatigue (although it’s possible this has been considered and ruled out already).