Hi, this is my first post although I’ve been following the book and fasting since late September. I decided to try the overnight fasting as this fit into my day really well, and I’ve found it easy. Extra push on eating whole foods and generally been eating very well (am vegetarian for 40 yrs but rather keen on pasta, pizza and crisps!).

I have lost nearly 12lbs, feel great, and so went along to my Dr to get checked out, see where I was starting from cholesterol and glucose-wise etc. while I work on the next 6 stone! Yes, obese vegetarian 😉

Everything is fine, except my iron is low (9) and red blood cells on the “lower end of normal”. So I’m iron deficient without anaemia.

Thing is, every time I’ve ever had my iron tested I’ve been low, for years. Sometimes with anaemia. Lowest iron has been 3 and highest has been 36 (that I know of)

So yet again I have a prescription for iron tablets – but I’m scared to take them: I can never take as prescribed because I feel terrible…stiff, painful joints, legs feel like lead, weak, tired, dizzy. I stop taking them and go back to normal. I have told my doctor(s) this at least 3 times but they just say my symptoms are more likely to be the effects of the iron deficiency and so to persevere (how can they be the low iron, the symptoms stop when I stop the pills…still got low iron but no symptoms).

So today, they’ve given me Ferrous Fumarate instead of Ferrous Sulphate, and to my dismay, these are higher iron, 3 times a day. I’ve to try these for 6 months. I understand they are different, but I am *so* reluctant to take these. I daren’t! I asked to see a Dietician but Dr said I don’t need to …until I’ve tried more types of supplement 🙁

I have read online that the upper tolerable limit is 45g a day – taking these 3 times a day means I’m taking 207mg (69g each) on top of all my iron rich foods. How is that good?

I know these cause nausea and gut issues, but that’s not the worst of it for me and what happens in my body seems more akin to iron overdose … maybe my body is used to low iron and this is overkill *for me*. Last time I was on pills my iron went up to 17, not exactly a big jump.

I’m pleased with my fasting, my new whole food diet and feel great – I didn’t go to the Dr feeling lousy, so was saddened to see my iron at 9. Part of me wants to just keep on with the diet and see what happens, but I also don’t want to become anaemic. I won’t have bloods tested again for 3 months.

So, apologies for the long post but I feel I can’t go ask/question the Doctor’s opinion *yet again* but after all these years, can’t we just skip the horrible pills and go to the Dietician, or look at absorption issues?! I also don’t know when to take the pills – I only eat twice a day and they say to take them with food to avoid the gut issues. Doing well with the fasting, do not want to change it. For all I know, my iron might have been even lower before I started fasting, and the whole foods have bumped it up…so if I keep going I might boost it naturally. But then again I might not.

Thanks if you read this far!

OliveOil: Are you completing a detailed food and symptom diary, weighed and measured? Is your current diet properly balanced and varied in ALL the food groups/ types you can eat?

Are you taking any vegetarian specific micronutrient supplements (vitamins, minerals, essential fats)? Are you following healthy eating guidelines on vegetarian charity websites/ healthcare provider articles for veggies?

My concern is that a vegetarian diet is naturally restrictive in that meat, fish and seafood are eliminated. Eating twice daily is another restrictive practice. It would be very challenging to construct a nutrient complete, balanced vegetarian diet in only two meals. I would struggle, and I have a background in lifestyle healthcare!

Ideally you would consult a registered dietician. But they may well not support DIY combo diets, instead advising weight management via evidence-based methods.

Consult your pharmacist on the iron tablets. The mg weight is the combined iron and sulphate/ fumerate portioms.

Hi Firefox,

I use an app to record everything I eat (which I weigh/measure/scan) and I started using this for the very reason of keeping an eye on my iron and potassium. The app also shows if you are keeping within the nutrient balance each day, including macros, and I usually do ok, sometimes go overboard with carbs but these are now whole grains and not white pasta like it would’ve been before. I also record symptoms on another app and I have a fitness tracker. Oh and I have a plate and bowl with portion sizes marked on it, recommended by our weight management clinic, who I’m also going to be monitored by 🙂 I’m hoping to pick the Nurse’s brain on the iron too.

I ‘top up’ with a multi-vitamin (3 tablets – general, including iron; calcium + VitD; omegas etc) My B12, folate and calcium were all very good in the blood tests.

I follow Michael Mosely’s books, another nutrition website and NHS healthy eating stuff on occasion.

I’m concerned over the restrictions too, this is why I wanted to see a Dietician. but not the vegetarian aspect – I’ve become allergic and/or have reactions to things since my last child 9 years ago, that I used to eat normally before e.g. apples, kiwis, cherries, quorn, pine nuts, almonds and hazelnuts *with* skin, but OK without, salt, coffee…even alcohol. Now the iron pills shouldn’t be taken with dairy, spinach, almonds or walnuts. Have been vegetarian most of my life so very used to no meat. My diet in the last few months has been the best it’s ever been, our house looks like a health food store. But foods are getting eliminated that I relied on.

I haven’t met with much enthusiasm even when mentioning Dr Mosely and other research I’ve seen. Gets scoffed at as ‘internet stuff’. Was really surprised my Doc didn’t bat an eyelid when I mentioned I’d been trying fasting.

I am going to ask our Pharmacy re the Ferrous Fumerate at 210mg = 69mg elemental iron. It’s what everyone else takes isn’t it, but just doesn’t agree with me.

Thanks for your reply, answering you made me realise how much I’m paying attention to myself at last.

Just reviewed your post and noted your reference to nutrient absorption issues and aversion to prescribed tablets.

The best absorbed form of iron in the human diet is haem iron, found particularly in organ meats and animal blood (eg. black pudding). Many Western omnivores won’t eat these, and it would be insensitive for a medical professional to recommend such ‘delicacies’ to a committed vegetarian!

Dietary iron is best absorbed in a meal containing vitamin C: found in various fruits and vegetables.

Iron tablets are backed by a solid body of published research but, like all prescription drugs, there are side effects which are worse for some than others. Unfortunately supplement tablets/ capsules are a necessary evil for anyone whose diet is sufficiently restrictive to fall short on essential micronutrients.

OliveOil: sometimes the journey is frustrating, but the goal of lifelong good health is tempting! You sound very positive which is a great attribute.

Potential imbalances in vegetarian diets include magnesium to calcium ratio, anti inflammatory long chain omega-3 (in oily fish!) to inflammatory omega-6 (in many nuts + seeds) ratio.

Long chain omega-3s are toughest to adequately supplement, since marine algae extracts are expensive in worthwhile quantities. Good to read you are taking vitamin D.

Few multis are decent sources of absorbable magnesium (eg. citrate) but some calcium supps do include it.

Hi there Oliveoil. We have recently become vegan and we don’t always feel hungry through the day. We eat oatmeal and a slice of toast for breakfast, a few nuts or stir fry for lunch if we are hungry, then a salad wrap for an evening snack if we are hungry. I have found that some foods tend to hold onto weight and muck up the iron, potassium balance. My partner just donated blood today and his iron levels were higher now than when he was eating meats and leafy green veges. So perhaps something in your diet is depleting the iron. We don’t eat those foods now and feel better for it. I do eat 2-4 bananas throughout the day though.

Hi OliveOil

Firefox’s advice above about diet is spot on and I’d go with that. The cleverguts diet is one I highly recommend. But WHY are you anaemic in the first place? What tests has your GP done to establish the reasons and what other tests have you had? Anaemia can be caused by many things but you want to know IF there is an obvious cause. There may well not be

You GP’s prescription is totally appropriate. I think you are confusing the elemental iron with the total size of the tablet. Iron is presented as a salt of one sort or another (hence ferrous sulphate or ferrous fumeratate) but its the no of mg of elemental iron that counts. I’d really not worry about taking an iron supplement.. the risk of toxicity is incredibly low, whereas the side-effects of iron deficiency are really not pleasant.

People (wrongly) assume that a veggie diet is automatically healthy. It is’n’t! But a healthy veggie diet IS the healthiest. That said maybe your iron deficiency is dietary related. Simply put, find an iron supplement that you get on with, one that contains sufficient elemental iron to be effective, and stick with it at least until your levels normalise