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June 30, 2009 at 7:29 pm #1110gu3varaMember
Hi,
First let me say this board looks very promising and I’m speechless in regard of Dr. M knowledge really. I wish I had a doctor like him near me (though I found a really good doctor in the last months, finally :))
To introduce myself, I’m a man of 29 y.o and I’m struggling with CFS for a couple years now. I’m diagnosed with primary hypogonadism, hashimoto, adrenal fatigue, vitamin D deficiency and I had diagnoses of psychosomatic disorder with anxiety and low grade depression too (doctors seems to think that the psychosomatic tag was erroneous now that my hypogonadism was found).
I’m seeking for help to find out the best schedule to take armour with iron and multivitamin.
I currently take Armour (brand name ERFA Thyroid in Canada) at 7 AM, 11 AM and 3 AM. I was taking my multivitamin (with 250 mg of Calcium and a little Iron) at 9 AM and 6 PM. I was finally taking Slow release Iron 100 mg at 9 PM.
However, I think my Armour absorption isn’t good right now so I’m looking to find a better schedule. The slow release Iron is supposed to take 8 hours to fully release but I’m not thinking that it might still be in my gut by the morning. Also, 2 hours after Armour for Calcium supp might be too short.
I heard I shouldn’t take Calcium at the same time as Iron so now I’m pretty much clueless on what to do.
I didn’t switch to sublingual because it does not dissolve easily.
Could I take my multivitamin as 6 PM and 8PM and a regular Iron supp instead of slow release at 10 PM?
I’m not even sure if I should take Iron or not, my Ferritin is : 38.3 (23.3 – 366)
Thx!
July 1, 2009 at 9:06 pm #2363pmgamer18MemberI have low Ferritin levels and Dr.’s missed this for yrs. I am on Armour and wake at 5 am every morning at this time I take my Cortef HC and 2 grains of Armour and do my hormone shots HCG or Testosterone at this time. I then go back to bed and when I wake I feel better I then eat at 9am and take my Iron pill this is what I take because it good on my stomch.
Feosol Carbonyl Iron Supplement
http://www.amazon.com/Feosol-Carbonyl-Supplement-Therapy-Caplets/dp/B001G7QLSG/ref=sr_1_1?ie=UTF8&s=hpc&qid=1246482101&sr=1-1I have been on this for some time doing one table 2x’s a day now my Ferritin levels are still on the low side so I am taking this 3x’s a day each time with food. And I take Vit. C with it.
http://www.myvitanet.com/supbiocbuf36.html
But only 2x’s a day.My first set of labs were below normal for ferritin then my Dr. tested my Iron this showed low also. My last set of labs showed my Ferritin at 77 I feel better when it’s higher near 150.
PhilJuly 1, 2009 at 11:48 pm #2354DrMariano2Participant@gu3vara 393 wrote:
To introduce myself, I’m a man of 29 y.o and I’m struggling with CFS for a couple years now. I’m diagnosed with primary hypogonadism, hashimoto, adrenal fatigue, vitamin D deficiency and I had diagnoses of psychosomatic disorder with anxiety and low grade depression too (doctors seems to think that the psychosomatic tag was erroneous now that my hypogonadism was found).
I’m seeking for help to find out the best schedule to take armour with iron and multivitamin.
I currently take Armour (brand name ERFA Thyroid in Canada) at 7 AM, 11 AM and 3 AM. I was taking my multivitamin (with 250 mg of Calcium and a little Iron) at 9 AM and 6 PM. I was finally taking Slow release Iron 100 mg at 9 PM.
However, I think my Armour absorption isn’t good right now so I’m looking to find a better schedule. The slow release Iron is supposed to take 8 hours to fully release but I’m not thinking that it might still be in my gut by the morning. Also, 2 hours after Armour for Calcium supp might be too short.
I heard I shouldn’t take Calcium at the same time as Iron so now I’m pretty much clueless on what to do.
I didn’t switch to sublingual because it does not dissolve easily.
Could I take my multivitamin as 6 PM and 8PM and a regular Iron supp instead of slow release at 10 PM?
I’m not even sure if I should take Iron or not, my Ferritin is : 38.3 (23.3 – 366)@pmgamer18 415 wrote:
I have low Ferritin levels and Dr.’s missed this for yrs. I am on Armour and wake at 5 am every morning at this time I take my Cortef HC and 2 grains of Armour and do my hormone shots HCG or Testosterone at this time. I then go back to bed and when I wake I feel better I then eat at 9am and take my Iron pill this is what I take because it good on my stomch.
Feosol Carbonyl Iron Supplement
http://www.amazon.com/Feosol-Carbonyl-Supplement-Therapy-Caplets/dp/B001G7QLSG/ref=sr_1_1?ie=UTF8&s=hpc&qid=1246482101&sr=1-1I have been on this for some time doing one table 2x’s a day now my Ferritin levels are still on the low side so I am taking this 3x’s a day each time with food. And I take Vit. C with it.
http://www.myvitanet.com/supbiocbuf36.html
But only 2x’s a day.My first set of labs were below normal for ferritin then my Dr. tested my Iron this showed low also. My last set of labs showed my Ferritin at 77 I feel better when it’s higher near 150.
PhilMy current ideals for iron level – as measured by ferritin is: Males 150 ng/ml, Females 100-120 ng/ml. These are mid-range values, with values over the top of the range (300 ng/ml) considered consistent with hemochromatosis – or excessive iron storage. Lab values will vary depending on what is seen in the population of people who come to a particular lab. In places where there are sicker people, more malnutrition, the upper end will be lower. But this upper end doesn’t necessarily mean hemochromatosis if one is over that lab’s range.
In regard to timing of thyroid hormone and iron, I try to keep it simple. The simplest schedule is best. Most people can’t do more than one or two doses a day. If more doses are scheduled, patients will often not adhere to treatment. Some treatment is better than non-treatment by nonadherence.
If some person cannot take their medications more than once a day, I would reasonably combine them even if they may inactivate each other to a certain extent. In this case, I would monitor lab levels to see how much of a dose change (e.g. increase) I may need to do to get the target level I want.
For example, with Armour Thyroid, the T3 component is generally absorbed well. T3 can be taken with or without food. The T4 component can be lost to a certain extent if one takes it with food, particularly if the food has heavy proteins – such as caseinated proteins in milk. One colleague measured this and found a 15% loss of T4. In the case when patients cannot separate thyroid hormone from breakfast, I make a dose adjustment after I find out how much is being absorbed in the steady state.
Iron can inactivate thyroid hormone to a certain extent by binding to it and preventing its absorption. But this doesn’t mean they have to be totally separated. Separating them is the ideal if one is to get maximum absorption. But there is one study where both were combined into one pill, and the patients were both hypothyroid and iron deficient. The combination pill worked to help both conditions. Thus if forced to by a patient who can’t adhere to more than one dose of medications a day (e.g. some kids, forgetful adults, some college-aged adults, etc.), I’d have the patient take them at the same time rather than not taking the treatment at all.
To keep it simple, I generally would separate Thyroid and Iron by having two doses in treatment. In the morning, the patient takes thyroid. In the evening, the patient takes Iron. I then make dose adjustment in the steady state, as needed. With multivitamins, I may have the patient take the multivitamin in the morning with thyroid so long as iron isn’t more than about 15-18 mg. This keeps dosing simpler.
If it can be done, if iron content is greater, I’ll put the multivitamin at a later time – such as the afternoon or evening. However, realizes that many patients cannot take the afternoon dose. They either forget it or can’t take it due to their schedule at work or school, etc. A mid-day dose is inconvenient. Thus the evening dose, for the multivitamin, so long as it isn’t too activating and contributing to insomnia, would be a good choice.
To summarize, if I had to, to allow the patient to comply or adhere with treatment, I’ll do both thyroid and iron at the same time, making adjustments in dosing as necessary. But usually, I’ll separate them with thyroid in the morning and iron in the evening. If a multivitamin with iron is taken, so long as the dose is about 18 mg or less, I would have the patient take it with thyroid, otherwise I would have the multivitamin taken in the evening, again, making dose adjustments in thyroid as needed.
July 2, 2009 at 12:23 am #2359hardasnails1973MemberWhat is the maximum amount of iron that can be consumed at once to get the most absorption. If one is doing 100 mgs a day can this be taken all at once or will 50 mgs a time is more exceptable. From your clinical experience if a person is under 40 ng/dl for ferritin what is the usually starting dosage for iron supplementation which is recommened? I have read that people may need as high as 200 mgs a day for 2-3 months before getting to optimal levels. When rechecking the ferrtin levels in the blood stream how long before the blood test should iron be discontinued in order to get an accurate reading. I have heard 3 days and up to a week. Do you recommend taking iron with 500 mgs of vitamin C to help absorption?
July 2, 2009 at 1:07 am #2355DrMariano2Participant@hardasnails1973 433 wrote:
What is the maximum amount of iron that can be consumed at once to get the most absorption. If one is doing 100 mgs a day can this be taken all at once or will 50 mgs a time is more exceptable. From your clinical experience if a person is under 40 ng/dl for ferritin what is the usually starting dosage for iron supplementation which is recommened? I have read that people may need as high as 200 mgs a day for 2-3 months before getting to optimal levels. When rechecking the ferrtin levels in the blood stream how long before the blood test should iron be discontinued in order to get an accurate reading. I have heard 3 days and up to a week. Do you recommend taking iron with 500 mgs of vitamin C to help absorption?
Increasing Ferritin is generally not a medical emergency. Thus, it can be done gradually over time rather than subject a person to the side effects of high doses, which would then complicate treatment since more substances need to be added (e.g. when iron causes severe constipation and other gastrointestinal problems).
With kids, especially, a slower ramp up is important, since iron toxicity can be reached quickly.
Since separating iron from thyroid is an issue, this limits iron dosing to the afternoon and evening. Then, generally, the maximum dose I would give is about 100 mg or elemental iron (equivalent to about two tablets of 325 mg of Iron Sulfate) in the afternoon and another such dose in the evening.
Frequently, I start with 325 mg Ferrous Sulfate or equivalent at Noon and the Evening. But I frequently also start with just one or two 325 mg dose of Ferrous Sulfate in the Evening since a simpler dosing schedule is more likely to be followed. Then, only if ferritin does not increase sufficiently or quickly enough do I add doses in the afternoon. Most of the time a single dose of one or two Ferrous Sulfate tablets is sufficient.
No need to hurry. The larger the dose, the more frequently must one do lab testing to make sure iron doesn’t overshoot the mark and cause tissue destruction. Hurrying just causes inconvenience to both the patient and the practitioner and increases the risk to the patient. Thus, why hurry?
To improve iron absorption, I generally add 250 to 500 mg of Vitamin C to the dose of iron. With Vitamin C and Iron, I expect gradual improvement in ferritin level over a few months. Usually, by a month, a person can experience significant improvement in their symptoms associated with low iron. Then the rest of the time is spent with optimizing dose.
July 2, 2009 at 1:14 am #2360hardasnails1973Member@DrMariano 446 wrote:
Increasing Ferritin is generally not a medical emergency. Thus, it can be done gradually over time rather than subject a person to the side effects of high doses, which would then complicate treatment since more substances need to be added (e.g. when iron causes severe constipation and other gastrointestinal problems).
With kids, especially, a slower ramp up is important, since iron toxicity can be reached quickly.
Since separating iron from thyroid is an issue, this limits iron dosing to the afternoon and evening. Then, generally, the maximum dose I would give is about 100 mg or elemental iron (equivalent to about two tablets of 325 mg of Iron Sulfate) in the afternoon and another such dose in the evening.
Frequently, I start with 325 mg Ferrous Sulfate or equivalent at Noon and the Evening. But I start often also with just one 325 mg dose of Ferrous Sulfate.
No need to hurry. The larger the dose, the more frequently must one do lab testing to make sure iron doesn’t overshoot the mark and cause tissue destruction. Thus, why hurry? Hurrying just causes inconvenience to both the patient and the practitioner.
To improve iron absorption, I generally add 250 to 500 mg of Vitamin C to the dose of iron. With Vitamin C and Iron, I expect gradual improvement in ferritin level over a few months. Usually, by a month, a person can experience significant improvement in their symptoms associated with low iron. Then the rest of the time is spent with optimizing dose.
Dr.M
Thank you for that response. Yes I agree totally slow and steady is always better then the shot gun approach. I have read on alot of forums that Dr start people off at 200 mgs a day and then 4-5 days later these people are complaining of the symptoms you mentioned. Dr M. when rechecking your patient ferritin levels how far out from their blood work do they stop the supplements to get an accurate reading on serum? This has been such a huge debate.July 2, 2009 at 1:21 am #2364wonderingMemberseems simple to me, but not all peoples schedules are the same.
I leave my Armour on my nightstand with water and take first dose the instant I wake up. By the time I iron a shirt, take a shower and shave a half hour has passed and I can have breakfast and take the vitamin as needed.
By 11:30 AM my stomach hasn’t consumed any food for about 3 – 3.5 hours so I take my split Armour dose. Lunch can sometimes be late do to busy morning schedule, but never too early.
I would NEVER bother with a 3rd dose. If your Iodine, Selenium consumption is ok, I don’t understand why a 3rd dose would ever be needed.
July 2, 2009 at 1:43 am #2361hardasnails1973Member@wondering 450 wrote:
seems simple to me, but not all peoples schedules are the same.
I leave my Armour on my nightstand with water and take first dose the instant I wake up. By the time I iron a shirt, take a shower and shave a half hour has passed and I can have breakfast and take the vitamin as needed.
By 11:30 AM my stomach hasn’t consumed any food for about 3 – 3.5 hours so I take my split Armour dose. Lunch can sometimes be late do to busy morning schedule, but never too early.
I would NEVER bother with a 3rd dose. If your Iodine, Selenium consumption is ok, I don’t understand why a 3rd dose would ever be needed.
According to Dr Crisler dosing armour and t-3 does not need to be more then 2 times a day.
“There is absolutely no need to take Armour that many times each day. The pharmacokinetics don’t support such a notion, as half-life of T3 is 7 hours. And once enzyme D1 gets tuned up, more is flowing from T4, which has a half-life of 7 days. This stabilizes T3 further, without the resultant spike which can easily disrupt sleep. Many have had to add sleep aids, when all they really needed was proper dosing.”
July 2, 2009 at 12:50 pm #2365gu3varaMemberAmazing replies guys, thx for that 😎
I’m considering switching to two doses of Armour instead of three, it would be a lot more convenient and will allow me to take my multivitamin in the morning.
One last question, I think that Calcium and Iron are competing for absorption right? Is it wise to space them by a couple hours then?
July 2, 2009 at 1:21 pm #2362hardasnails1973MemberDr Crisler and I debalted about zinc lowering ferritin levels. I have found studies that do actually confirm this. I have also seen in clinical setting that patients that are iron supplement replacement need between 30-50 mgs of zinc a day to help off set this imbalance. I have also seen people that have >50 mgs of zinc a day will lower ferritin levels. Excessive zinc can also damage ones DNA as well if one is not careful. In order to achieve this one would have to be consuming large amounts of it for a prolong period of time.
July 2, 2009 at 2:05 pm #2356DrMariano2Participant@hardasnails1973 447 wrote:
Dr.M
Thank you for that response. Yes I agree totally slow and steady is always better then the shot gun approach. I have read on alot of forums that Dr start people off at 200 mgs a day and then 4-5 days later these people are complaining of the symptoms you mentioned. Dr M. when rechecking your patient ferritin levels how far out from their blood work do they stop the supplements to get an accurate reading on serum? This has been such a huge debate.Storing iron in ferritin is a metabolic process. I haven’t seen it being bumped up significantly by iron intake the day before.
So I simply have patients obtain a ferritin level in the morning before taking any medications or supplements.
July 2, 2009 at 2:15 pm #2357DrMariano2Participant@hardasnails1973 452 wrote:
According to Dr Crisler dosing armour and t-3 does not need to be more then 2 times a day.
“There is absolutely no need to take Armour that many times each day. The pharmacokinetics don’t support such a notion, as half-life of T3 is 7 hours. And once enzyme D1 gets tuned up, more is flowing from T4, which has a half-life of 7 days. This stabilizes T3 further, without the resultant spike which can easily disrupt sleep. Many have had to add sleep aids, when all they really needed was proper dosing.”
Since Armour Thyroid is 20% T3, which is significantly higher than what the human body produces from the thyroid gland, some people will be sensitive to changes in T3 levels. T4 is essentially flat after 6 weeks. It won’t compensate for T3 changes which are large to an individual.
The T3 half-life varies depending on the reference. Some say 8 hours, some 16, some 24 hours. Perhaps the true half-life varies from person to person and thus should be stated as 8-24 hours.
The half-life determines dosing. Dosing is approximately at half-life intervals except when sleeping to help flatten out the blood levels of the medication. Divide a 24 day by the half-life to have an approximation of the daily dosing schedule.
For example, erythromycin has a half-life of about 4 hours. Thus, during the waking hours, it is taken 4 times a day. With testosterone cypionate, if the half-life is 7 days, then dosing is once a week. If the half-life is 3 days, then dosing twice a week would give more stable levels.
If the half-life of T3 is about 7 hours, then it should be taken about 2 to 3 times a day (if sleep can be an 8 hour interval separating doses of T3).
If the half-life of T3 is 16 hours, then a twice a day dose can be considered in some people, though many would be able to get away with a once a day dose.
If the half-life of T3 is 24 hours, then a once a day dose should provide sufficient stable blood levels.
July 2, 2009 at 2:30 pm #2358DrMariano2Participant@hardasnails1973 477 wrote:
Dr Crisler and I debalted about zinc lowering ferritin levels. I have found studies that do actually confirm this. I have also seen in clinical setting that patients that are iron supplement replacement need between 30-50 mgs of zinc a day to help off set this imbalance. I have also seen people that have >50 mgs of zinc a day will lower ferritin levels. Excessive zinc can also damage ones DNA as well if one is not careful. In order to achieve this one would have to be consuming large amounts of it for a prolong period of time.
Iron, Zinc, and Manganese (and microscopic amounts of inorganic Cobalt) compete for the same transporting protein for absorption from the intestine.
Thus, when supplementing with Iron, once may have to consider Zinc and Manganese measurements in addition to Ferritin to confirm if one needs to supplement Zinc and Manganese also.
However, if one has a nutritionally dense diet already, this many not necessarily need to be done since Zinc and Manganese would be absorbed in the food one eats.
High iron supplementation does not need to be done forever. Once the target Ferritin level is reached after a few months, then maintenance treatment is done.
Maintenance treatment is done either through improving one’s diet to a more nutritionally dense diet that has sufficient iron (e.g. from meats) or supplementation with a good multivitamin and mineral supplement. Even regular Centrum (or its generics) is good enough as a multivitamin and minerals supplement to supply more than enough iron in most people (it has 18 mg of iron).
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