The Iron Lady: Sandy’s Close Call

As you may have read in earlier newsletters, Sandy had to undergo three operations for a life-threatening bowel obstruction about two years ago and lost about 2/3rd of her colon and 5 feet of her small intestine. Since the lower intestinal tract is importantly involved in absorbing water and minerals, among other things, a problem for people with “short bowel syndrome” is getting adequate quantities of certain nutrients that would normally be absorbed in the lower tract. (If too little water is reabsorbed from the intestinal fluids, for example, then you can have chronic diarrhea, which also causes losses of electrolytes. Indeed, Sandy’s sodium levels were low so she is now taking sodium chloride tablets to normalize that.)

So it was that we recently found out from routine lab tests that Sandy was remarkably deficient in iron (with reduced levels of red blood cells and hemoglobin, as well as a shockingly low transferrin saturation level of 4%). Transferrin is a protein that transports and stores iron and is supposed to be saturated in the range of 15 to 50%. Sandy’s local physician (head of our regional hospital) said that he didn’t know anybody could be walking around with such a low level of available iron! Sandy’s main problem that could definitely be attributed to low iron was a dramatic worsening of her restless legs syndrome symptoms.1 This disorder is known to be associated with inadequate iron supplies and it is hypothesized that deficiency of iron in dopamine-containing neurons in the brain may be a cause.2

Iron supplementation to the rescue! We have described an iron formulation we put together for our own personal use that has the tremendous advantage over other forms of iron in that it is very unlikely to cause stomach upset. She started with two capsules a day of the iron supplement (one capsule contains the RDA of iron) on Jan. 31, 2014. At that time, she had a measured iron level of 20 mcg/dL, whereas the normal range is 40–160 mcg/dL. As mentioned above, her transferrin saturation was 4%, only about 25% of the value at the low end of the normal range.

Today, March 28, 2014, her latest iron and transferrin measurements have come back, the blood having been drawn on March 14th. We (Durk and me as well as our doctor) were all amazed at the new numbers: her iron had increased to 229 and was now HIGH, so she has reduced her supplement to a single RDA level capsule of iron a day. Her transferrin saturation level had increased to 54%, which is slightly higher than the 50% upper end of the normal range. She will return for further testing in a few weeks. Her hemoglobin, which was 10.9 g/dL (with the normal range being 12.2–16.2 g/dL) as of Jan. 31st, had also increased to 12.5 and is now in the normal range.

Moreover, the improvement in her restless legs syndrome symptoms has been dramatic, with her need for dopaminergic agonist medications to control it reduced by about 80%.


  1. Restless legs syndrome is now being called Willis-Ekbom Disease by a foundation devoted to its treatment and cure. Apparently, the fear was that “restless legs” sounded too trivial and because the disease can have a highly negative effect on the quality of life, depending upon its severity, the disease was renamed apparently to convey a more serious image. The Willis-Ekbom Disease Foundation, formerly the Restless Legs Syndrome Foundation, has a variety of literature available, including “Nightwalkers” (a newsletter for sufferers — the nightwalking refers to the difficulty sleeping that is often a problem with the disease), plus surveys of available treatments for clinicians. If you have this condition and are not able to find satisfactory treatment, it would likely be worth your while to contact them. They can be reached at 1530 Greenview Dr. SW, Suite 210, Rochester, MN 55902 ( ; PH 507–287–6465).
  2. Allen and Earley. The role of iron in restless legs syndrome. Mov Disord.22(Suppl 18):S440-8 (2007).