Amanda: Hey, this is Amanda, women’s health dietitian.
Emily: And I’m Emily, nutritional therapy practitioner.
Amanda: And this is the Are You Menstrual? podcast where we help you navigate the confusing world of women’s hormones and teach you how to have healthy periods.
Emily: Each week we will be diving into a different topic on women’s health and sharing our perspective using nutrition, female physiology, and metabolic health.
Amanda: Our goal is to help you wade through conflicting health information and empower you on your healing journey.
Emily: We hope you enjoy it.
Emily: In our last episode, we talked all about how to replenish nutrients and specific minerals in the body using our favorite foods to do so. And our main focus is always going to be food, because that is the best place to get your minerals and nutrients from—it’s Mother Nature…the way it intended it. But we know that there will be inevitably questions about supplements. So we do want to go through that in this episode. We plan to share which supplements we do love and use. But this episode is all about the supplements that we actually don’t recommend, because they can cause more harm in the body than good for a number of reasons. And a couple of them actually may surprise you.
So this might go against the grain of what you’ve heard before, but we hope you’ll keep an open mind. And as always, we definitely encourage you to do your own research. Talk to your doctor or your dietitian before you stop or start any supplement. We are nutrition professionals, but we are not yours. So this podcast is only for informational purposes only. So we do hope this episode empowers you to learn more about your body and to think harder about what you’re actually putting inside of it so that you can make the best decisions for your body. So that said, we are actually going to start with one of our favorite supplements to talk about and Amanda is going to get us going because we’re both pretty passionate about this one—and it’s iron.
Amanda: Yeah, and I think just kind of emphasizing that when we, when we go through these supplements…it’s not saying that these nutrients aren’t important…because they are. They’re so important that we want you to really understand how to replenish them in your body versus using more of a bandaid approach by just taking that supplement. So we’re going to start with iron. We have an episode…episode six talks all about copper and iron. We talked more about in relation to like the hair test, how they work together. But I think this is an important one to discuss, because a lot of the women we work with will come to us taking iron, or if they’ve taken it in the past, or it’s been in a multivitamin or prenatal that they’ve taken. And the reason why we don’t recommend supplementing with iron and why it’s kind of just like putting fuel on the fire as far as inflammation goes in the body…is because if we have low iron on bloodwork—and we’ll talk a little bit more about that in a bit—then it doesn’t mean we need more iron, right? That’s just one measurement.
We need to look at the full picture when it comes to iron status in the body. And that includes a lot of other markers like serum iron. We also want to look at iron saturation, your copper levels, your retinol—there’s so many other areas that impact how we use iron in the body. And if you remember in episode six, we talked about the iron recycling system. So since we all have this sophisticated iron recycling system in the body where we take iron, we put it into the iron recycling system using copper and vitamin A…magnesium is also very important for this…and then that’s how we use iron and move it around the body. If this system isn’t working properly, of course, your iron is gonna show up low on your blood work.
And I love the way that Morley Robbins, he’s the founder of the Root Cause Protocol…we talk about him all the time. We did his training, and it was amazing. And he talks about serum iron is like your miles per gallon in a car. It’s like your iron efficiency. And how efficiently are you getting that iron recycling system going to improve serum iron levels in the body. So if you see…if you saw low gas mileage in your car, you wouldn’t add more gas to fix that problem. So we wouldn’t add more iron in the body to fix a low iron because we already have the iron recycling system. So we want to think about instead of just taking this iron that could potentially be leading to insulin problems…It’s a, there’s a huge link with excess iron and gestational diabetes. We’ve seen so many clients with PCOS and high iron issues. Endometriosis is very linked with iron. So we want to think about are we causing more harm than good by adding in this iron? Is it really getting to the root of low iron on our bloodwork?
Emily: I love that analogy. I mean, about putting gas in a car with bad gas mileage. I think that’s so clever, and it, it really does make a lot sense when you think of it like that. And just as an example, if we’re talking about a client…We have clients that come to us with low iron, but when we actually do their hair mineral test, and we do a little bit more digging, we see that they are eating plenty of iron-rich animal foods, but they’re lacking copper and vitamin A-rich foods. So maybe they’re not eating a lot of dairy, which is a major source of vitamin A for a lot of people. So if that’s the case, then when we increase those foods that have copper and vitamin A and we also support minerals just in general, that’s gonna help rebalance and improve serum iron, hemoglobin, copper, vitamin A—all of those things that need to help that recycling system in the body.
So it’s super important to keep this in mind. And another thing, too, I want to mention not only about rebalancing the minerals with food, but if you’re someone who is constantly in a stressed out state and you do not address your stress alongside replenishing those minerals with food, you’re never going to get that iron recycling system working optimally in the body. Because as we’ve talked about before in previous episodes, stress is what sends everything out of balance even further and keeps that depletion going. So I feel like this is what we want to drive home. And we did talk about it a lot in our episode six when we talked about copper and iron. So if you need a refresher, definitely go back and listen that episode. But the iron recycling system is so important to understand before you ever supplement with iron.
Amanda: I think the whole stress piece also comes back to magnesium, right? So many people are deficient in magnesium. And while we definitely need copper and vitamin A in order to make proteins that move iron, we actually we need enough magnesium for that process too. So I think that’s probably where the stress hinders that whole process the most, of course, because we’re gonna deplete so much magnesium during that stress response. And most people already have depleted levels of magnesium. So that’s, that’s kind of like the whole copper-iron piece.
I think another way that we often see this show up in clients is with hemoglobin, especially with our pregnant clients. What typically happens is their hemoglobin, maybe it was strong going into pregnancy, but it’s lower. Now maybe it wasn’t great going into pregnancy…kind of depends on the person. But what often happens is that they’re recommended to take iron. And I understand the thought because our hemoglobin contains 70% of our iron. So it is a good marker for, hey, how is your iron status. But in pregnancy it is going to decrease, especially during that third trimester. That’s why the pregnancy hemoglobin optimal ranges are different from non-pregnant women. So we know that it’s supposed to decrease. If it gets too low, that’s definitely a concern, but it’s not an iron issue—it’s typically a vitamin A issue.
And there’s actually, there’s a really cool study that I’ll put in the show notes. And it’s got a nice visual of a graph. And it shows people that had low hemoglobin and they took iron to increase their hemoglobin and it goes up quickly and then it goes back down. And then people that took cod liver oil, which is very high in vitamin A, to increase their hemoglobin and it takes a little bit longer to go up but then it stays high. Right? It stays in that optimal range. So it just shows you like, yes, it makes sense. And iron could be an issue, but is it that you need more iron or is it that you need more of these other nutrients? So we always recommend, especially if clients come to us, maybe they’re in their third trimester, and they’re like, my doctor wants me to take iron…we recommend that they get the retinol tested, which is that vitamin A. Make sure they test your retinol not beta carotene. And then we can see from there, do you need more retinol? Right? Is it appropriate for you, because there’s so many concerns around vitamin A and pregnancy, and we get it. But we also need vitamin A for pregnancy. And I do think it’s very different when it’s coming from whole foods. And like, yes, I get that there’s concerns of birth defects, but like what is your vitamin A status? What if you need more? So if you’re not taking it because someone is telling you that it could cause birth defects, like, you could still have just as many issues with the vitamin A deficiency. And then you end up supplementing with something like iron that is not what you really need and it’s not helping you, and you don’t see that increase that you want in your hemoglobin levels. So third trimester of pregnancy…if you’re concerned with hemoglobin, we see this all the time in clients—get your retinol tested, consider cod liver oil, obviously talk to your doctor and see their thoughts. But there’s plenty of research to support this.
Emily: And I think too, it’s worth mentioning even if you’re not pregnant if you’re someone, for example, who has been like a lot of our clients, maybe with PCOS or irregular cycles. Think about this—you are maybe not menstruating every month, and therefore you’re losing less iron. So obviously women, most women bleed every month, right? That’s kind of the natural cycle of things and through their menstruation, they’re losing iron. But when you think about how much we end up absorbing…it’s, it’s definitely good that we’re losing some, but we’re absorbing more. So the people that are losing even less by having, you know, irregular cycles, pregnancy, menopause…I mean, that’s going to, that’s gonna encourage that buildup of iron in the body, even if it’s not showing up on blood test. And Amanda, can you talk more about menopause?
Amanda: Yeah, I think that’s a really important one to cover. And something that’s come up for me recently with a few clients is this concern around, like, do I need to use hormones, which we’re not going to address that in this podcast. But a lot of the reasons why women in menopause want to use hormones, especially estrogen, is because they’re concerned about their bone health, right? They’ve seen a decrease in it, a lot of times, maybe they’ve done like a DEXA scan, where you can see that bone density and it’s decreasing. Maybe they’ve been diagnosed with osteopenia. And so they, they’re like, should I do estrogen to, like, improve my bone health? Yes, estrogen is important for bone health, but iron accumulation is huge for menopause, because you are no longer getting rid of iron. Women absorb much more iron than men, and so your needs actually, like your, your dietary needs of iron do decrease with menopause. But if you’re eating animal foods, it’s like you’re gonna, you’re gonna get a decent amount of iron in your diet, even from some plant foods as well. And so if we are in menopause, we’re not getting rid of iron anymore, we’re accumulating more.
One thing that that excess iron can do is it can prevent bone reformation. And so then it’s, like, is it an estrogen issue? Or is it an iron issue? And I do find…it’s so interesting in a lot of my menopausal clients, their serum iron is like 200, which is pretty high. So optimal is closer to 100. And their other markers are typically low. Vitamin A is low, copper, zinc low, magnesium is low. So the main focus is, like, replenishing all of their minerals, but especially all the ones really important for the iron recycling system, like copper and vitamin A and magnesium. But it’s also just getting them to understand, like, let’s work on this excess iron piece first and get you to a place where you have more optimal iron levels. And then, you know, repeat that DEXA scan, see how is that bone density, is osteopenia is still a concern…there’s a lot more to that piece of the puzzle than just estrogen.
Emily: Okay, so we hope that makes sense. We’re gonna move on to another kind of controversial one, because this one is very…it has grown very popular and mainstream and even [in] functional medicine circles. So this is excess vitamin D. So similar to iron, vitamin D status is way more complex than just one measurement. So if you are told by your doctor that you have low vitamin D, the answer is not just to throw more vitamin D supplementation on top of that and just watch your vitamin D go up. It’s so much more complicated. And according to Morley Robbins, who we mentioned previously…he’s the founder of the Root Cause Protocol, vitamin D is the most misunderstood and over-recommended supplement. So, Amanda, can you tell us a little bit about what needs to happen to even convert vitamin D?
Amanda: Yeah, I think…and people, some people are going to be like, this is insane. There’s so many studies on vitamin D and inflammation and disease. And I want, so I want to start by saying that low vitamin D does not cause inflammation—I understand the concern. I totally understand that it’s like a tangible thing that people can do is supplement with vitamin D, and they think they’re doing something good for their health. But it’s the low vitamin D that’s a symptom of inflammation, right? It’s not the cause of it—it’s a side effect. And so vitamin D is so important that we feel you have to work on the other building blocks and little pieces that help you convert it in the body in order to truly have optimal levels and use it. Because the question is, are you using that vitamin D, right?
So when we look at vitamin D, it acts a lot more like a hormone than a vitamin. And a lot of this is how the body converts it, right. So it’s, it’s made from cholesterol just like all of our other hormones. And once that gets activated by the sun, we start to convert it into vitamin D in the body. But all these steps to convert vitamin D…pretty much all of them require magnesium. And so there’s another piece of the puzzle. If it’s low vitamin D that’s a concern for you, what is your magnesium status? Right? Do you have optimal levels? That’s one piece of the puzzle. And then we also want to think about vitamin A. We need vitamin A in order to utilize that vitamin D properly. And I think this is…you, you’ve probably seen this in supplements where they have like vitamins A and D together or vitamins A, D, and K together in order to try to utilize all the different things vitamin D impacts in the body properly. But at the end of the day, it’s so much more than just your vitamin D levels. It’s just like iron, right? Why are we taking one measurement and supplementing adding more vitamin D based off that one thing when we know that vitamin D is converted in the body [and] requires other nutrients—we have to think deeper.
Emily: And like you always say…it’s biochemistry. And something that kind of happened to me, which I learned later from you, is that when we supplement with vitamin D, the intestines absorb more calcium and release that into the bloodstream—which further sends our magnesium levels down. So this is especially harmful for slow metabolizers like I am who already have high calcium levels and are losing magnesium through stress. So for example, just to give you guys an example, when I was working with a functional medicine doctor about a year before I started seeing Amanda, I was told that my vitamin D levels were low, so she put me on a pretty high vitamin D supplement. And I was probably on that for a year or so. And then my vitamin D levels did go up. But when I started working with Amanda, my calcium levels were through the roof and my potassium levels were low, which is most likely because of that excess vitamin D supplementation. So again, this is just another example of how utilizing certain supplements in isolation can really throw other things out of whack in the body. And it’s so important to be careful when you’re going to supplement with anything, especially something like vitamin D.
Amanda: Yeah, and I think too, it’s like, you know, how does vitamin D impact some other nutrients in the body? You mentioned magnesium, right? So, like, if you guys remember listening to our Minerals 101 episode, I’m pretty sure that’s the one that we talk the most about, like, calcium, magnesium, and how they work together. Just like, if you supplement with calcium you’re gonna deplete magnesium. And if you supplement with magnesium, if you don’t get enough calcium in your diet, the same thing can happen. So it’s super important for keeping the minerals balanced to not do excess amounts of certain nutrients. But then also potassium is a really big one. Potassium stores get depleted, and then of course that’s going to impact so many areas of health: blood sugar, thyroid, so many different…like, even, like, blood pressure and stuff, you know. Muscle cramping…I tend to see a lot of the women that have supplemented a lot of vitamin D in the past, and they start working on rebalancing their minerals, they deal with a lot of muscle cramping—the magnesium doesn’t help, sodium doesn’t help. It’s like controlling the calcium and the potassium are what makes the most difference.
And then I would say the last big thing about excess vitamin D supplementation is that it can deplete vitamin A—that’s why a lot of vitamin D supplements have vitamin A in it. And so if you deplete vitamin A, say it with me everyone, what happens? You’re gonna have low iron, right? You remember from the first one and from the episode six, like, we need enough vitamin A. If all of a sudden we’re getting depleted levels, we can look anemic. So then it’s like, you know, you’re taking all these supplements, but somehow…and you’re eating well, so how…but somehow you’re still anemic. It’s like how does this happen? You know, so we just want to have you guys think more. Do your own research. There’s so much information about vitamin D out there now. And I know so much of it is like positive…take 20,000 IUs of vitamin D a day, like crazy dosages. But there’s also a lot more people starting to come out and talk about the negative effects, like, hey, should we rethink this? Should we do lower doses? You know, the, the RDA is like 600 to 800 IUs—it’s not a lot. And so taking five to ten thousand…it’s like, is that really appropriate? Or should we focus on getting more magnesium? Getting outside more? That’s, that’s what we really do like to focus on with people is like, what is your magnesium RBC? That’s a great blood test you can get to see your magnesium status. How does your hair test look? How much are you using? That’s really what your hair test tells you. And then are you getting it in your diet? You know, we can get some vitamin D in small amounts through food. So like getting, obviously different types of liver, eggs are a great one, wild-caught fish, mushrooms, things like that can have small amounts. But also, are you getting the magnesium? Are you getting outside? Like, sunshine is so, so important. Even if it’s not sunny out, you still want to get that light exposure for a lot of different reasons. But for that vitamin D production as well.
Emily: Right, and I think it’s, what you just mentioned, it’s such a shame, because I feel like it’s always about, okay, this is low, let’s throw a pill at it. And that’s the easy fix. But it’s like, when we go back to the basic foundations of health, what is important? Like you just said, Amanda, getting outside, prioritizing these mineral [and] nutrient-dense foods. We just…I feel like that’s completely been lost in medicine nowadays. And so just going back to those foundations is going to work way better in the long run.
Amanda: And I just think about all the links between, like, vitamin D and like, depression and things like that. And it’s like, but are you going outside? Are you the, you know, like, are you constantly working? Are you constantly inside? Do you take care of yourself? I feel like they’re…we’re losing these basic things. And we’re relying so heavily on supplements in order to, like, manipulate different levels of certain nutrients in the body. When in reality, it’s, like, if you were eating nutrient-dense foods, taking care of yourself, prioritizing rest, getting outside…I think a lot of those things take care of a lot of the issues that people deal with.
Emily: Amen. And y’all are gonna hear us wax poetic about this pretty much the entire podcast, but yes, agreed for sure. So we’ll move on to the next one. We are going to talk about ascorbic acid now. And that is going to be what you are familiar with if you take a vitamin C supplement. If you look on your vitamin C supplement bottle, nine times out of ten you will see this ingredient on there, and it’s usually all it is, is the ascorbic acid not the whole food vitamin C. So why do we recommend staying away from ascorbic acid? So the reason we don’t recommend ascorbic acid is because it actually depletes copper. What happens is there’s a protein that carries copper around the body so it can do its job, and this is called ceruloplasmin. What ascorbic acid does is cause the ceruloplasmin to dump copper. So that is what leads to copper being unable to be used. And that’s when it can accumulate in other places. Well, if you can’t use…if you don’t have copper, like bioavailable copper in the body, you can’t transport the iron that we were talking about. So your iron recycling system is going to be all messed up. So research has also shown that ascorbic acid depletes the liver of copper as well. So you’re just compounding the problem when you take something like ascorbic acid in a supplement.
Amanda: And I think it’s confusing, because we’re often told that vitamin C is, like, one of the most powerful antioxidants. It’s so, so important for our health or our immune system. And it absolutely is—it’s just…it, the type is relevant, right? We always want to keep it in context. And I really, we say this all the time, but nature really does know best. So if we are comparing like a whole food vitamin C to an ascorbic acid. Yes, ascorbic acid is in…it is a, it is one compound that’s in whole food vitamin C, but it’s only one part of it, right? It’s not everything. So instead of…like, you can get some benefits from ascorbic acid, but then you get all the downsides, right, of depleting the copper stores, creating more imbalances in the body. So there’s definitely some pros, but we always want to think about how is that going to impact us like five to ten years from now. And I think that’s something we don’t think about a lot with supplements.
So when we go for the whole food vitamin C, not only is that going to help support our immune system, but whole food vitamin C helps with gland signaling. So it can help our brain signal to our thyroid to make thyroid hormone. It helps support our immune system. It’s even important for our adrenals. And I think that’s why a lot of people will start to take it, you know. They’re, like, my adrenals need support, I’m going to get some more vitamin C in…but then sometimes we take way too much ascorbic acid form of vitamin C. Like, I just think of the supplements. They’re always like 1000-2000 milligrams, you know, it’s, like, such a big amount. And then you have to think about, okay, well that vitamin C, that’s going to, that can actually increase your adrenal function. If you don’t have the minerals to back that up, it’s not going to help you, right. It’s going to use up more magnesium, more sodium, more potassium. And again, even though you had the best intentions of supporting your body when taking that supplement, it’s just creating more chaos.
So we always like to go for the whole food forms of vitamin C, because there’s likely compounds that we haven’t even discovered in whole food vitamin C. And even those foods in general, right? That’s what I always think about…like, we’re still discovering some vitamins and we’re always discovering new phytochemicals and antioxidants. So if we, if we always isolate everything, we’re gonna miss out on all these things from the whole food that we didn’t even know were there. And our favorite ways to get vitamin C are things like citrus fruit…any fruit is going to have vitamin C. I think citrus, berries, guava, those are definitely like the highest in vitamin C, but any fruit is going to be beneficial. We of course love fruit, because it’s got lots of potassium, very nourishing And then you know, our adrenal cocktail that we always recommend, that’s going to have about 60 milligrams of vitamin C. And you don’t need these mega doses. Just like vitamin D, like, we need vitamin D, we do not need 10,000 IUs of vitamin D from a supplement like we could get that from the sun. But it’s very different. And same thing with vitamin C.
Emily: Right, and I think ascorbic acid is such a good example of when you try to cheat Mother Nature bad things happen. So when you focus so heavily on the isolated nutrients in a whole food, and you try to extract that and use that for your own benefit…that is not going to work as you intend it to work. And this, you see this with everything, but I feel like ascorbic acid is probably the best example of this. Of taking something out of vitamin C, of the foods that have so much else going on for them, and are wrapped up in this pretty little package that nature intended. And just utilizing this one part of it is not going to have the intended consequences.
Amanda: And I think we forget that supplements are really powerful. Like, just because it doesn’t have to be prescribed by a doctor doesn’t mean that it’s not going to work and make great changes and, you know, mess with different systems in the body. I think of how NAC, you know, like N-acetyl cysteine, they took that. You can’t even order that online anymore. You can only basically now you’re only going to be able to get a prescription I think in order to get it like I used to have it inside my practitioner account in Fullscript. It’s all sold out. You can’t buy it on Amazon. They stopped selling it all because it is powerful. Right? And it makes me…it made me really nervous when they did that. So I’m like, oh my gosh, are they gonna start taking away other supplements? Are you now gonna have to be prescribed supplements? And like, I think there’ll be some pros with that. But I also think there’d be a whole lot of cons because most doctors are not looking at it from a whole food lens.
Emily: Agreed. Okay, should we move on to the next one?
Amanda: Yeah, let’s do zinc.
Emily: Okay, zinc is a fun one, too. So what we want to say about zinc actually kind of goes back to the ascorbic acid, just the first point of talking about copper. Because zinc actually increases a protein that binds to copper and makes it unavailable for use in the body. So sort of, like, we were saying with the ascorbic acid, if you don’t have enough available copper everything gets imbalanced, particularly iron. And it’s also an antagonist to copper. So this is why in nature, you’ll always find zinc and copper together in those mineral-rich foods. Where you have zinc you’re gonna find that there’s also copper and the correct ratios that your body needs. So most often people are supplementing with zinc because they assume they’re low. And it’s been said to be good for everything, right? You have skin problems, take zinc. You need immunity boost or you have low immunity, take zinc. Like, there’s so many things that people recommend zinc for. But it’s important to test your zinc levels.
Amanda: And I think that’s where, you know, looking at zinc on bloodwork, looking at zinc on your hair test…what are those levels look like? And if it is low, it’s just like everything else, right? You guys are probably so annoyed with us. But if it is low, again…like, zinc is a mineral. Minerals we can use, we can interchange them, some of them are synergistic, some of them work against each other. And what most often happens is that when we get very depleted in magnesium, your liver is going to start to use up zinc. So you would want to always try to see, like, if you’re looking at zinc levels on bloodwork or on your hair tests, you always want to look at your magnesium too and see, how is my magnesium. Magnesium RBC…we mentioned that for vitamin D status. Same thing, you can use that here, and then if it’s below that 6.5, that is likely a huge piece of the puzzle for you as to why zinc is low.
So yes, we want to increase the food forms of zinc in your diet. If you don’t already have those in there. Like, red meat—that’s going to give you four ounces, over five milligrams of zinc. You can eat one medium oyster, that’s going to be 5.5 milligrams of zinc. Beef liver…one ounce of beef liver has about two to three milligrams of zinc. Eggs have zinc. So there are ways that you can definitely get adequate zinc from your diet, but maybe you’re not digesting that as well. So maybe you need some digestive support like apple cider vinegar or digestive bitters. Or maybe it’s a deeper issue. Maybe your other minerals are depleted as well. And magnesium is going to be a big piece of that puzzle. So we always recommend trying to focus on that food first approach, making sure you understand is this a zinc or a magnesium issue.
And then if you do really want to supplement with zinc, go for a whole food based one. Like they make oyster supplements. Like OysterZinc from Smidge is a great one. MITOLIFE has an oyster supplement…I forget what it’s called. I think there’s one other one that I like, I can’t think of the name. But they do have a lot of iodine. So, you do want to pay attention. If you have a thyroid health history, if you do not have water filters or shower filters. When we add in a lot of iodine, you can get, like, a flushing ef