s4 e8: iron deep dive part 2

Iron Deep Dive Part 2

Strap in, we have a controversial one. It’s time for our mineral deep dive on iron! The mineral that gets many people up in arms, probably even more so than copper. Like most minerals, I think once you understand how our bodies regulate iron, you can see past the confusing information that tends to go to extremes. Most often, things fall somewhere in between. In this episode, I will go through the iron recycling system, what we use iron for in the body, and different iron imbalances.

The bonus episode will breakdown iron case studies where I show an iron deficiency case and an iron overload case that go through labs. I also have an iron rich foods list with the amount of iron per serving and a sample day showing how you can get 20-25mg of heme iron and 34-38mg of total iron. I also cover how iron impacts estrogen. You can get access to the bonus episode by joining patreon.com/hormonehealingrd

Quick reminder, this podcast is for informational purposes only. Please talk with your healthcare provider before making any nutrition or lifestyle changes. 

This episode covers:

  • What is macrocytic anemia? {1:21}
  • Three examples of microcytic anemia {4:20}
  • Highlights of anemia of chronic disease {15:09}
  • Risk factors for iron overload {28:40}
  • The connection between PCOS and iron overload {33:58}
  • How to test for iron {39:39}

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Episodes mentioned:
Calcium deep dive
Magnesium deep dive
Sodium deep dive
Potassium deep dive
Zinc deep dive
Iron deep dive part 1


Iron Deficiency:

Iron Biochemistry: https://themedicalbiochemistrypage.org/iron-and-copper-homeostasis/ 

Iron & Copper:

Iron, Gut Health, Pathogens


Iron Supplements:


Iron Overload:

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I had to split the iron episode into two episodes, because we hit like over 45 minutes. And I’m like, I still have a lot to cover. So the first episode ended up being all about the basics and the foundations of iron, how we store it in the body, what it does, how we recycle it, coppers roll in iron. And then in this episode, we’re gonna dig more into anemias, and then iron overload. And then I have a ton of q&a questions that I’m going to answer for you guys. So let’s get right into it. If you didn’t listen to part one, this probably won’t make sense. So make sure you listen to part one first. Now that you know we’ve covered copper and its role in how the body regulates iron, and how much we need in a day, talked about the RDA in the episode, let’s get into the different types of anemias. And then I’ll go to overload but I’m breaking down into three categories. There’s even some I’m not covering in here, believe it or not. So we’re not going to go into like an insane amount of detail. But I like to break it down into macrocytic, microcytic normocytic anemia, cuz I think when people hear anemia, they think it’s only iron deficiency anemia, but it’s not. But it doesn’t mean it doesn’t impact red blood cells, hemoglobin, and iron status. So this is why I think iron is very nuanced. And I think that we can’t live in the extremes. So macrocytic anemia, what the heck is that it’s basically causes really large red blood cells, and they can’t carry enough oxygen throughout the body. So the symptoms are similar to other kinds of anemia. And I think this is what makes anemia confusing, because a lot of symptoms are the same, but it’s based on a different root cause so we can identify a macrocytic anemia, the large red blood cell, if we have an MCV I think it’s like mean corpuscle volume of 100. So that if you get a CBC complete blood count panel, then you get an MCV measurement. If it’s over 100, that’s a sign of macrocytic anemia, there are a couple causes. One is a folate deficiency. So this often is like you may not have enough in your diet, or you could have an increased need in pregnancy and you are already deficient or close to being deficient. So folate deficiency can cause a high MCV can cause fatigue, like symptoms, like iron deficiency anemia, vitamin B 12 deficiency is another one, there’s often there can it can be really too a couple of things, it could be that you do not have adequate stomach acid or intrinsic factor, poor digestion and you can’t absorb vitamin B 12 definitely part of it. So like if you don’t you know, digestive juices or if you’re not eating those foods, obviously, it’s an animal foods, you can also have pancreatic insufficiency. So in pernicious it could be like an autoimmune thing. So like in Pernicious anemia, our parietal cells that release intrinsic factor are destroyed by the immune system, it’s like a whole autoimmune process, and that impairs the absorption of B 12. So sometimes this macrocytic anemia could be from a fully deficiency a B 12 deficiency, which may be from the diet digestion, or an autoimmune issue, and something that you tend to see with the macrocytic anemias, as you often see high homocysteine levels with the folate and B 12 deficiency. So that’s something that you can like look out for, you can also have this the symptoms in the high MCV. If we have alcoholism, hypothyroidism, or certain prescription medications, they can all contribute. So that’s macrocytic anemia. And that’s when we have other B vitamins involved, not necessarily iron. The tricky thing is you can have multiple types of anemia at once. But this is a really common one microcytic anemia is the opposite. It’s when we have MCV of less than 80. So this leads to a lack of hemoglobin, and it causes us to divide more red blood cells to try to maintain the hemoglobin concentration. And so instead of the mag macrocytic, where we have these big red blood cells that are not transporting oxygen properly, we have smaller paler red blood cells, and things are being broken down. So microcytic anemia can 100% Because by iron deficiency, typically you’ll see an MC v less than 80. You’ll see a serum iron that’s low and you’ll see a transparent saturation which is sometimes put on there as iron saturation that’s also low. So that in ferritin tends to be low too. And then what you’ll typically see is TIBC total iron binding capacity is high meaning there’s not Iron Bound, because it’s got plenty of slots open. So basically everything is low except for the TIBC. That can be a sign of iron deficiency anemia. This is one You can get the smaller, paler red blood cells, I think it’s really important to still look at Copper and vitamin A for this. Because you need to make sure that you can get that iron it stored in your tissues out. Right? And so we would be looking at things like, Do you have enough copper and vitamin A in your diet? Do you have adequate whole food? Vitamin C? Are you super duper stressed? Like, are you at the, you know, end stage of exhaustion, and how are your adrenals functioning, because that’s going to play a big role. If you can make that Surya plasmin, which helps get that iron out of our tissues, it transports that electron. So we still want to look at all these other factors before or during some sort of increase in iron intake. I would always address this with food first, I think it’s so important to do that. Especially as like your first line of defense. Are you eating these foods? How is that person’s digestion? And then look, you can definitely obviously those are kind of like the foundational things, you’d always want to address those. And then you also want to look at is there a recent blood loss, you can have iron deficiency related to like significant blood loss if they donate blood recently, you want to wait eight weeks to retest to test your iron panel after a blood donation to get like an accurate picture. But if they’ve had a blood loss, and they have GI bleeding, iron deficiency is very heavily associated with people with like inflammatory bowel disease. So you want to make sure that it’s like our true true iron deficiency i for blood loss, like it could be really heavy periods. It’s typically like a long, heavy period, like a heavy period is I think it’s like more than 80 mils. of blood in a day is like Orrin like the whole time. I don’t know, I gotta look that up one second.

There’s like a definition.

Okay, so I’ll go back and say that again. So you’d want to look at like a deeper root cause, like a heavy period could definitely be one of them blood loss in general. But a heavy period will be defined as losing more than a third cup or 80 milliliters of blood each cycle, I would say it like a longer heavy period is probably going to be much more likely to lead to that. And the clients that I’ve seen that have like, even some bleeding outside of their periods are clients with fibroids and polyps. And so those can definitely lead to more blood loss, of course, and then that could lead to like a true true iron deficiency. I still almost always see some sort of other imbalance with these clients. Like for example, fibroids, polyps, there’s almost always a thyroid connection, because thyroid is very tied to estrogen. And if we have estrogen excess, that can those estrogen, it increases a certain protein that can bind to the thyroid hormone, and then you have less bioavailable thyroid hormone. What helps make Cirilo plasmin T three. So everything is always connected. I think when we start to think like, oh, well, I only have an iron deficiency. I don’t have copper, and retinal deficiencies, but it’s like, well, how’s your thyroid function? We should always be trying to connect these dots and look at the body holistically, especially since it’s like, well, we probably have enough iron stored, why can’t we get out of tissues? That doesn’t necessarily mean that we should never like try to increase our iron intake, or maybe even use like a whole food supplement like the ones I mentioned in the previous episode. But you still want to take into consideration but how do I correct this long term because supplementing with iron can be inflammatory and cause more oxidative stress in the body. And, you know, depending on the person, I just think like, you know, if I have someone with polyps and they have excess estrogen, like I don’t want to add more fuel to that fire, especially with estrogen, it can lead to increasing iron even more. So that’s just something to consider when it comes to looking at iron deficiency anemia and the major root causes but like recent blood loss, blood donations, GI bleeding, really heavy periods, fibroids polyps, I have seen it with some clients with Endo, but I’m like very cautious with iron and Endo. Because iron is like it’s there’s some studies that show it there’s like a connection to endometriosis. And of course, you wouldn’t want to cause more inflammation for those clients because they’re already dealing with enough inflammation. So that’s like the big things that we’d want to consider with an iron deficiency anemia but basically everything looks low, but TIBC is high. So that’s one type of microcytic anemia sideroblastic anemia. This is characterized by defective protoporphyrin synthesis. It’s basically it’s preventing the formation of heme. So it leads to an issue with hemoglobin. And the iron portion of hemoglobin is like totally fine. It’s not necessarily like an iron issue. It’s a heme issue. And this leads to iron building up in the mitochondria and it creates sideral blasts. A lot of this is there’s typically like a genetic root cause where there’s an issue in the enzyme ala s. But it can actually we can acquire sideral, blastic aplastic anemia through alcoholism, lead poisoning or vitamin B six deficiency because just like, you know, if there’s a genetic defect in that als enzyme, we can also have a defect in that enzyme with out vitamin B six, because it’s a cofactor. So siter aplastic, anemia,

definitely can cause issues, it’s basically leading to a lack of hemoglobin iron status is fine. But you could look at B six deficiency, and you could look at possible genetic issues. And then thou Samia, I mean, I can’t tell you how many clients have had with thalassemia. There’s different types. It is an inherited genetic mutation that impacts the globin gene. And there’s different they’re classified into different types, like there’s an alpha or a beta, and that tells you what gene is affected. And there’s also like the severity, so there’s major minor or trait. So like, for example, you’ll get like thou Samia, beta minor, I get a lot of or beta thalassemia minor, I get a lot of like alpha Thalassemia traits, I’ve had a lot of alpha majors and minors and a lot of beta beta thalassemia. Minors in clients. As far as like, Who’s most likely to struggle with this specific genetic trait it’s most frequently is occurring in the Mediterranean, African, Western and Southeast Asia, India and Burma. And the reason that it’s primarily caring in those populations is because that will Samia can be protective against a specific type of malaria. So in those populations, it’s the same populations that you would see more malaria in. And so it’s like this genetic, like evolution that has occurred for these populations were their bodies. I mean, I think it’s kind of cool when you think about it, their bodies literally trying to protect them from malaria so they can survive, which is why it’s increased and more people have it, it’s because it helps increase survival. So it’s gonna get passed on more, what you’re gonna see with this for labs is typically in MCV, that’s 80, or lower, like less than at a normal ferritin, often, and then you’ll have abnormal hemoglobin molecules. So it could be like the shape, you could have low levels. And then positive genetic testing, because the genetic testing for this is like pretty easy to get, you can definitely ask your doctor, I would just say like, this is under the microcytic anemia section. But this is you have to be very careful with iron, and the Thalassemia population. And I don’t think that it matters, the alpha or beta or the major, minor, or trait, like the severity of it, you have to just look at the person and their labs. But a lot of them struggle with too much iron not too little, but hemoglobin is still impacted. So often they’re going to like their doctor might still say, take an iron supplement. Most of these people, if it is major or minor often will do blood transfusions. If it’s major, it’s usually from the time that they’re a small child. And so typically, they’ll also take iron key laters on a regular basis so that they don’t get iron overload. But thou Samia it’s a microcytic anemia, iron is not the issue. It’s the hemoglobin that’s the issue. And we need to be very careful with iron with this population, because it’s typically that they have too much not too little. Then finally normocytic anemia, so we went through macro, which is like nutrient deficiencies, folate, B 12, possibly B six, and then microcytic, which is we went through iron deficiency sideroblastic, which could be genetic code, BB six deficiency could be alcoholism, and then thalassemia, which is technically an anemia, but we got to be careful with iron for normocytic anemia as we’re gonna go through anemia of chronic disease, and then we’ll talk about sickle cell anemia. And then Hema lysis. And that’s it because we could, we could go through a lot of these. So with the normocytic anemia, MCV is normal, it’s 80 to 100 and the red blood cells are not altered. The decrease in hemoglobin is the main concern. And it’s either from destruction of red blood cells with Is Hema lysis or it’s from under production of normal red blood cells. So it’s either we’re breaking them down, or we’re not making enough. And when it comes to anemia of chronic disease, I think this is such an important one to highlight because a lot of I’ve a lot of clients with autoimmune conditions that have definitely struggled with this, even though I think of like when I was in school to be a dietician, they’re like, this is so rare, you’re never going to see it in practice. And I mean, I see on a regular basis, so I would have to disagree with that. But basically what happens this can occur if there’s an underlying chronic disease, it could be some sort of malignancy. So like related to cancer, it could be a chronic infection, I’ve seen it with Lyme before, it could be an autoimmune condition that makes the liver produce too much hep seitan. Or not enough. But this can lead to iron hiding in ferritin, and it reduces the bioavailability in our blood. Remember, ferritin is supposed to be inside the cell. So don’t when I say ferritin don’t always equate it to blood levels, think of like, oh, that’s how we actually have iron stored in our cells, it’s bound to ferritin. So what often happens for anemia of chronic disease, it starts out as a normocytic anemia. So it has a low MCV. But it can MCV. But then it can progress to a microcytic. So or a normal MCV. And then it progresses to a microcytic, which is a low MCV. So that’s the other thing is like a lot of these can start out one way. And eventually they can look like an iron deficiency anemia, because they’re not being treated properly. A lot of providers again, they say it’s rare, I don’t agree with this, I think it’s very common with autoimmune conditions. And like Lyme, especially like chronic Lyme, what you’re often gonna see is low serum iron, low iron saturation, or transparent saturation, sometimes it’s called high ferritin. And then a low TIBC. So low TIBC means that there actually is a lot of Iron Bound. There’s not a lot of spaces for iron left, so people see this. And sometimes if you don’t look at ferritin, and are only looking at iron, or iron saturation, it can be very confusing, you might think I need an iron supplement. But in reality, you look at that ferritin, it’s high. And that’s a sign that your body is there’s a lot of inflammation present. There, there could be some if you have if it’s chronic infection, it could be related to bacteria, pathogens as well. And it’s not necessarily that you need more iron, it’s that we need to understand like, why is iron being sequestered to the tissues? Why can’t we get it out, and I would still want to address all the other areas, but I would really take a close look at inflammation for these people. And like what, where that’s happening in the body and chronic stress. So I think all i times we want to like skip over the foundations. But for these kinds of populations, I think it’s even more important to get the foundations in place, especially if there’s an autoimmune component, because chronic stress is what eventually will lead to an autoimmune disease. So that’s something that like we always need to address.

And it just kind of depends on like, what their main concerns are. But if the you know, this kind of client were taking iron because they had low hemoglobin levels, I would say, you know, there are studies that show that copper oil can help with hemoglobin levels. So maybe we try that instead, or upping retinol rich foods. Or maybe we just focus on increasing iron through food. If there’s some sort of autoimmune component, there’s almost always a digestive and gut issue. And so that’s like another area that’s so important to address like, how is your digestion? Are you breaking down your food properly? How is your gut health, I almost always do a GI map with clients that have autoimmune conditions, especially if it’s like not under control. Because we want to get a better look at like what is going on with impacting your immune system, because that is going to impact inflammation in the body. And then of course, that’s going to impact like thyroid health, iron status, adrenal health, so many different things. So that’s anemia of chronic disease. Pretty much everything is low, but ferritin is high. You can also have a normal MCV sickle cell anemia. This can occur for those that have sickle cell disease, or trait and it’s associated with the deformation of red blood cells into a sickle shape. This typically occurs during due to a mutation in the beta globin chain of hemoglobin. And what happens is it causes baleen, which is an amino acid to replace glutamic acid. And sickle cells actually, it’s typically the most common with African and Caribbean ancestry. But I mean, it’s not. I’ve had Asian clients that have sickle cell My husband has sickle cell he’s Puerto Rican I like you can. It’s not like doesn’t really No matter like anyone can have it. But typically, you’re not always tested for it unless you have a family member with it. So like his mother has it. So that’s how we found out that he had it. My daughter also has it. So that’s fun. But with sickle cell disease, you have to have normal sickle cell genes with the trait you have one normal sickle cell gene and one normal hemoglobin gene. And they say that the sickle cell trait population doesn’t usually have symptoms. But I mean, it’s kind of depends on like, what you’re reading, but it’s typically under chronic stress is when the symptoms could occur. And I definitely have seen this in my husband, I remember, we used to think you have blood sugar issues, but it was actually like a tissue oxygenation issue, because his blood sugar was fine. So that was like a hole. And then that’s when we figured out he had sickle cell trait. I was like, Are you kidding me? You have sickle cell trait? How do we not know this? But I do. I did. When I was doing a bunch of research for the zinc deep dive episode. I’ve always focused on copper, retinol, and then like thyroid and stress for sickle cell trait for him, and I to optimize iron status, and like hemoglobin and everything. So that has always worked really well for him. When I was doing research for the zinc episode, I came across all this information on how zinc deficiency is like one of the major contributors still, to sickle cell anemia. And I was like what I mean, I had never even like heard of that. But it’s interesting, because when he doesn’t get enough iron rich foods, which are also very rich in zinc, he’ll have symptoms come up. And a lot of that, for him is like uric acid buildup. And that’s like one of the things that you can measure if you want to see like what’s going on with sickle cell anemia. So you can have higher serum uric acid levels. And that’s due to an increase of Leist red blood cells so broken down red blood cells. And there is there are some associations. I don’t know how there’s not more research on this. But there are some studies that I’m one of them I linked that show sickle cell anemia is related to gout. Because forever, we thought he had gout, but I think I don’t think he just has gout. I think the root cause of that is the sickle cell. I don’t I mean, sometimes if you do bloodwork, sometimes he looks anemic. When he’s home and eating well, he’s fine. But if he’s like deploys or something, or if he’s away at a training, and he can’t eat the way that is optimal for him, then typically, that’s when he’ll get symptoms, or if he’s under a ton of stress, like that sort of thing, like not getting enough sleep, all that kind of stuff. The uric acid will build up, he’ll get the Gout symptoms in his toe. And yeah, we always thought it we thought for so long, he had blood sugar, insulin stuff, but like all the testing that we did showed otherwise. And then finally, I came about the sickle cell anemia and how uric acid levels are increased. And then, of course, uric acid is one of the major contributors to gout, in the crystallization and stuff on the joints. So if you have gout, and you also have sickle cell, it could be related. The other thing that you can see with sickle cell anemia is a really high reticular site count, because basically, your bone marrow is trying to compensate, it’s trying to catch up. And so you’ll have a higher articulate sight cow, higher serum uric acid levels, and then sometimes low iron, because of breaking down red blood cells. Remember, red blood cells are supposed to live for 120 days, but if they’re being broken down, that’s more iron that’s going to be lost in the urine. And so you can definitely look for you can definitely see like iron deficiency stuff. And so yes, like for my husband’s specifically adding more iron rich foods in the diet, which now I’m wondering, does zinc impact that? After like doing all that research, but also focusing on copper and retinol, like beef liver is a staple for him? Cod Liver Oil is a staple for him. That’s just what has worked. Talk with your provider, please. I’m just sharing like what’s worked for my husband, a lot of people ask me about sickle cell. And because I’ve mentioned that my husband has it before. But a lot of it is managing chronic stress diet, trying to get those foods, we’re gonna work on a different plan for the next deployment because he ended up having some Gowdy stuff again. It’s just so hard because you don’t know what kind of food they’re going to have access to. And it’s, you know, it’s definitely like, it makes me think could it possibly be more of a zinc thing because we don’t store zinc? And that’s really like the only thing that is really hard for him to get when he’s deployed. So who knows, but we’ll experiment and I’ll share but yeah, that’s sickle cell anemia. Sometimes it there is a true iron issue but we have to look at other areas as well. And I feel like for this population, especially it’s so important to have adequate copper and retinol, because that’s what helps them get the iron out of storage because they I need that serial plasma. And if you can’t get that, that can definitely lead to iron deficiency, and not having enough iron available in the system. So those are the things you want to look at. And then finally, the last normocytic anemia is hemo lysis. And this is a type of anemia that’s caused by the destruction of red blood cells, it’s increases the breakdown of hemoglobin, it causes low hemoglobin levels is typically what you’re going to see. And that’s kind of like how this would be classified. And it’s similar to sickle cell anemia where it’s your bone marrow tries to compensate. And so you have a higher reticular site count. It can be caused by autoimmune conditions. So again, this is why you got to compare like anemia of chronic disease, you’d still want to look at could this possibly be more that you’re breaking down red blood cells, so you would want to compare it to that ridiculous light count on genetic disorders, chemical exposures, certain prescription meds, and then infections. So there’s definitely a lot of overlap with different types of anemia. But I hope that you understand that copper and vitamin A are still component of many of these, because we still need that surreal plasmin to get that iron, convert it, get it to transfer and get it into circulation. And then like chronic stress, digestion, your gut health, any like pathogens, those are all still going to be something that we want to consider, no matter what type of anemia because again, like we don’t, we don’t want to skip the foundations in the basics, because that’s what that’s going to impact all areas of health. And I think this goes back to like looking at the person as a whole, and not just getting so caught up in like one lab value or a few lab values. You have to like keep everything in mind. So I would still look no matter what type of anemia? Do they get enough of like iron, retinol and copper in their diet? Are they are they vegan or vegetarian? That’s going to be something you want to consider. If they if it’s B 12? Like do they have low stomach acid report digestion? Do they have copper imbalances? I always look at like the history of the birth control pill that increases bio unavailable copper levels in the body copper IUD, which I have a whole podcast episode on, that can increase inflammation in the body. Zinc supplementation, please look at zinc supplementation that can cause copper deficiency, less bioavailable copper, and then that can lower iron levels. So that can be like a very easy fix for someone. Lack of folate rich foods in the diet, if it’s one that’s related to folate deficiency, and then chronic inflammation, this is a huge one.

Again, I think it’s important when it comes to any like iron issue. But that can lead to the sequestering of iron and then excess ferritin. And then blood loss. Okay, we always want to address that heavy periods, fibroids, polyps, those are big bleeding in the GI depending on your health history. And then finally, genetics. So like, we have to always dress the basics always dress food and digestion and gut health. And then I think that’s when you can look further at like, is there another big root cause we need to consider genetics is important, but that’s one where I’m like this can be a slippery slope because I think some people think that the other things don’t matter if they know the genetic piece. Genetics doesn’t always confirm something but it can like help rule other things out. So those are the areas that we want to focus on when it comes to iron overload. iron overload is considered to be present if we have an iron saturation or transferrin saturation greater than 45%. And the main risk factors for iron overload are going to be genetic impairments that are going to impair how we balance iron in the body in the iron recycling system and have Sidon and then excessive iron intake. A lot of this is from supplements. chronic alcoholism is another very common one loss of a menstrual cycle. And I feel like people do not talk about this enough but that can lead to iron overload. PCOS which I have some notes on we’ll go through or frequent blood transfusions. Like I mentioned, the Thau seameo population very commonly gets a lot of blood transfusions. Hopefully they’re taking an iron key later. I mean, that would be like pretty crazy if they weren’t. But even then I have clients that maybe they did a ton of blood transfusions when they were younger. They did do iron key leaders but they still struggle with iron overload today. So if we go through first the hemochromatosis this is what I got the most questions about. This is the genetic component. So it’s a genetic disorder that causes the body to absorb way too much iron from diet and it impairs how we balance it in the body. So we store the excess iron in our tissues, skin, heart liver, primarily Pinker’s and joints. Eventually this is going to lead to damage and often it’s going to show up like liver disease, diabetes, excess iron is very rough on diabetes and our blood sugar balance because of the oxidative stress it creates in the body. And you know, we do store it in our pancreas and which releases insulin. So that genetic disorder is a big one. It’s the HFP gene is where the genetic issue lies. And what it’s doing is it provides instructions for hep siding, which is the protein that’s made in the liver. And it basically that proteins interacting with our transferrin receptor, it’s trying to detect the amount of iron in the body member. If when have Sidon increases, it shuts down iron absorption and movement, when it decreases, it increases our absorption and movement. When we have mutations in this HFP gene, it doesn’t allow hip Sidon to increase. So if we’re not increasing hip sight, and we’re not shutting down our in absorption and movement, and we can, we eventually will get iron overload. There are two variants, I’m not going to go into like a ton of detail. Because I feel like this is probably hard to visualize. And I don’t have like a visual for it. But the two major ones are C 282, y, and h six, three D. There’s like a whole thing on like, Oh, if you’re homozygous for both, and you’re more at risk, I think it’s anyone that has these genotypes is at risk, even if you only have one. So if you’re homozygous you have both if you’re heterozygous, you have to. The main reason for this is because they can start with moderate iron overload. But that then leads to more oxidative stress and inflammation in the body, which can exacerbate iron overload in the future. Remember that oxidative stress that chronic stress eventually it’s going to impact your gut health, your immune system digestion, your adrenals, your thyroid, your hormones, and all of those things can trickle down and impact your iron further in the future. So I don’t think we need to be homozygous with one of these variants in order to be like, Oh my gosh, this is a concern. For me. I think just having the knowledge. And if you’re someone I’ve had clients that test for it. These are the two big ones you can test for you can do like I think it’s 23andme and ancestry. And then you just have to search for the variants once you get your test results. But basically, I do have them test if we are concerned with iron overload, not because it’s necessarily going to change what we do. But it’s important for them to know that this is probably going to be something that we have to work on long term and that you have to have awareness round. But you know, I don’t it’s not essential to fix it. But I think it’s helpful to know when it comes to testing for iron overload and iron status in general, we really want to make sure that we’re looking at bloodwork, I know that there’s iron on the hair test, but that is not enough. You need to compare it to bloodwork in my opinion. When I like to look at transparent saturation or iron saturation, that percentage specifically. That is very important when it’s above 45%. That’s like iron overload. Honestly, if it’s creeping above 40%. For me, I’m like we need we’re still going to address it. I don’t think we need to wait until someone has like extreme iron overload to address their iron status. Ideally, you’re working with a practitioner with this. But you all I also like to look at like their full iron Paranal serum iron, iron saturation, transparent, hemoglobin. And then if you can look at Copper and surreal plasma, and that’s ideal, but you need someone to help you figure out what those mean. And then I do like to look at CRP. So C reactive protein, that’s systemic inflammation. And then liver enzymes. Those are big ones, because you want to have things to monitor like iron is important and helpful. But you also want to look at like their inflammatory markers and their liver function for sure. So that’s, that’s like hemochromatosis was the genes. It’s basically impacting hip sight, and it’s preventing it from working properly. And so we have iron overload, PCOS and iron overload. There’s a huge connection with this. There’s, I have a study linked, and it’s called PCOS, polycystic ovarian syndrome and iron overload biochemical link underlying mechanisms with potential novel therapeutic avenues. It is from 2023. I’ll link in the show notes. But they talked about how there’s a link with PCOS and hemochromatosis and how the disorders both have a lot of similarities like they both have insulin resistance. They both have increased body fat diabetes, fatty liver infertility, and high androgens. And something else that I thought was interesting. And this is like right from the article was they talked about how nonetheless noticeable accumulation of excess iron in the body is a common finding in both disorders even in adolescence. So people that have hemochromatosis and PCOS both experienced them at a young age. Have side in the iron regulatory hormone secreted by the liver is reduced boost in both disorders and consequently increases intestinal iron absorption. So in PCOS, I mean, I see it all the time in clients. I would say most of my clients with PCOS also struggle with iron overload. And it’s because hep seitan is reduced, and so they have an increase absorption of iron. And a lot of these women don’t have regular cycles for a large portion of their lives. And of course, that is also going to increase iron overload. And it’s also mentioned that recent studies have shown that gut bacteria play a critical role in the control of iron absorption in the intestine. As dysbiosis is a common finding between PCOS and hemochromatosis. Changes in bacterial composition in the gut may represent another cause for iron overload in both diseases via increased iron absorption. So basically, they talk about how like using iron key laters or or probiotics could have like potential therapeutic benefits. I go through a case study that walks through this in the bonus episode for iron. So make sure you can grab that on Patreon. But yeah, I just was like PCOS. That’s the mechanism have sided and is impacted. We get iron overload. So yes, some of in some of my clients PCOS also have hemochromatosis. hemochromatosis gene. And PCOS is very genetic, but not all of them. And I think that’s just such an important thing to know. Because I’ve had plenty of them that are like, you know, I was put on iron for a while or they took birth control that had iron in it. It’s just like, it’s very scary. And then really quick thalassemia. Remember, iron, if they’re getting a lot of blood transfusions, they can have iron overload, hopefully, they are using iron key laters they should be if they are getting a lot of blood donations. And I just want it like one I often hear that like this is rare. hemochromatosis and our iron overload are rare, but Salah Samia and primary hemochromatosis are two of the most common genetic diseases in humans. And they both often lead to iron overload and one in 10 Women have PCOS. So I’m like, How rare is this? Like, I definitely think iron deficiency can exist. I still think though, looking at the root, it’s not just iron. I think there are other nutrients and foundations that we have to address like diet and stress and Digestion and Gut health and inflammation. But I do think that mild iron overload is an issue for a lot of women. And they’re being shrugged off because there’s just not enough of an understanding around iron and around all these intricacies and iron homeostasis and recycling in the body.

Other contributors to iron overload liver disease, I mean a lot of iron stored in the liver, and if someone’s on hemodialysis. Those are other two big ones. So areas that I would investigate for iron overload, definitely the blood levels, for sure CRP, liver enzymes. Genetic testing, I do think is important. If they’re not present doesn’t mean that you don’t have iron overload. So just remember that but I think just knowing that you have this genetic predisposition can help you understand the root cause more. And then things that can help blood donation a lot of people ask about blood donation, I’m going to say if appropriate, because it’s not appropriate for a lot of people. It’s very stressful in the body and not everyone is in a good place mineral wise to do it. So if appropriate, and I think people probably donate blood way too soon. You should be focusing on the foundations for a while before you donate blood. Milk Thistle and sulforaphane are also very helpful and they can help get iron into ferritin which is protective because it’s not going to be as inflammatory. Quercetin is a natural iron key later. It inhibits iron absorption and it inhibits fair important so that prevents you know, iron leaving the tissues and overloading more castor oil packs they have ricinoleic acid which has the ability to Kili iron. Turmeric is a natural iron key later, and then green and black tea so you can consume that with your meals to reduce iron absorption. If you do again, this is like iron overload. So this is not like if you are not concerned with excess iron, and please bloodwork bloodwork. We don’t want to guess on this stuff we want to do testing. And then again, like the bonus episode goes through the different impacts of hormones on iron. I talked about how to get enough iron from food. And then I do go through case studies. So lots of fun stuff in the bonus episodes for this. Alright, let’s do q&a. How can you test for iron? I didn’t bleed for a year and now I’m scared. So I went through those labs. You can get a full iron panel ask your doctor and then I would also look at similar plasmin because remember that gives an electron to iron to make it get out of the stored storage in the liver. I would also if If you’re worried about excess iron, and you’re not totally sure, from there, you could consider doing like C reactive protein tests liver enzymes, but you’d want to ask for a full iron panel and look at your hemoglobin to, there were a lot of lab questions, I’m going to say. Like, if you won, a lot of it was low ferritin. I have super low ferritin. But I eat a lot of air animal foods. The only iron marker that’s low is my ferritin. What is high serum iron and low ferritin. Mean? We, we have to be so careful with obsessing over like certain lab markers in ferritin. Remember, I’ve talked about this so much in these episodes. ferritin is supposed to be inside ourselves, when we have an excessive amount outside ourselves, that’s not a good thing that is a sign of inflammation. So if you were concerned, I would be like very careful and make sure that you’re talking with your doctor about all this and getting the full testing done. And then just looking at your copper, surreal plasma and vitamin A status as well. Those are all also really important. But if someone has like all normal, I don’t even know what low ferritin means. It could be like what I consider normal ferritin. But it’s like you got to keep it in context to yourself. I could never answer any of these questions, because I don’t know anything else about these people’s health history. So it’s something that I just say like, you have to take into account all the foundations have already gone over. Someone did ask about third trimester and low ferritin. And like is iron bisglycinate and beef liver enough to raise iron levels. So if you’re pregnant, they should be going by your hemoglobin. I mean, you can do a full iron panel for sure. But you should not be making adjustments based on a low ferritin. You should look at hemoglobin, iron saturation. You can look at your red blood. A lot of times you’re looking at your CBC like red blood cell count and everything. I would not make changes off of one marker, I would ask for more lab testing. How do I know if excess iron is leaving my body I’m a fast one and my iron and my htma was 2.4. So they had high iron on their hair test. A few things I would consider one you have to do bloodwork if you want us as iron status, so do bloodwork. I would also look into your water source like a well water tends to be higher and iron depends on like the piping that you have at home. But I would check those two but I would do bloodwork compared to your hair test. There’s other markers in the hair test that can make give you some insights in the iron as well. Like if you have really high zinc high or low boron, you definitely want to consider those. They can be signs of inflammation really high chromium, but you’d want to look at those other markers as well. And then bloodwork i You don’t know if it’s like that’s the only way you’re really truly going to know, signs and symptoms that aren’t being moved from the body when it’s high. I would say like the probably most common ones are histamine symptoms. That comes up for a lot of people I really like using like quercetin and milk thistle. nettle tea is really helpful to what is the best time to take iron with or without food Morning or night. I recommend whole food supplements because it’s not going to lead to any issues you can take Him at any time and it’s not going to lead to any nutrient deficiencies, like zinc or anything like that. So I would just stick with whole food supplements and they don’t have to worry. What’s a good ratio to start balancing copper and vitamin A? I’d say it depends on your status. I don’t know what this person’s copper and vitamin A levels are. Or their health history. Like did you take birth control? Do you have excess copper x and you might want to use taurine like there’s so many things to consider. And there’s not really like a good ratio to start because it just depends on your health history. But I would listen to the copper episode if you’re maybe thinking that you could have some copper imbalances. Does high iron affect the menstrual cycle? Yes, it’s very common with PCOS it’s going to impact blood sugar, insulin, androgens, 100% and it can affect your menstrual cycle. If a blood test comes back saying iron levels are good, but you feel like they aren’t because it mean there’s a better way to test or something else may be wrong. I mean, a lot of symptoms of low iron are common with low thyroid as well. So I would look further maybe do a full iron eye, full thyroid panel or consider like a hair mineral test. What’s the best way to raise iron levels without synthetic supplements I would say like eating iron, retinol and copper rich foods iron rich foods you’re asking me rich in zinc which can help with an absorption of iron in the gut. And I have a list of all these foods in Patreon. How to get rid of excess iron If you can’t donate blood, I’m recovering from H A N and I am a high in iron. So I would say Claire’s attend milk thistle casserole packs, things to talk to your doctor about are your dietitian or practitioner. But those can all help their natural ironkey leaders. Does iron really play a role in melasma I’m going to talk about how estrogen impacts hip seitan in the bonus episode, but it does it’s it’s it’s just it’s not just I think people are like it’s just iron overload, but it’s how iron impacts estrogen. And how Astrid excess estrogen can impact iron. So it definitely plays a role. But it’s not just iron. It’s also hormonal. They just like interact together. Is there a correlation between iron supplementation, high cholesterol, there’s a causation. iron overload causes inflammation and increases cholesterol. We also see this with zinc supplementation, though, because it lowers copper, and then that can cause a cause excess iron, and then that can cause high cholesterol. So yes, there’s definitely a correlation. How to manage low iron and pregnancy. This is one where I really like to focus on like, we want to assess zinc status, copper and retinol. Those are the big ones I would focus on. And like, if you need to take a whole food supplement and take a whole food supplement, somehow I’ve had clients that have actually gotten iron infusions. And because that’s like what they felt like was best for them. And it really did help them feel better. And then like they worked on managing their iron status and everything postpartum but in a lot of that had to do with gut health. So sometimes we can’t do everything we need to in pregnancy. We need to work on things postpartum as well. But working on zinc, copper, retinol, work with your doctor, share your concerns, and like get all your options, the pros and cons. And then I think it’s you got to make the best decision for you. Do you think it’s always a copper or Cirilo plasma issue? Whenever we’re dealing with an iron rush issue? It’s like, I don’t know is like the short answer. When I think of it’s, it’s like, yes, copper is real plasma are so important. But then, you know, that brings up Do we have? Is it like a bioavailable copper issue? Is that a retinal issue? Is it maybe we’re supplementing with zinc? Maybe we don’t have enough zinc to absorb iron in the gut? Is there a chronic stress? Is a person eating enough? Do they have a lot of inflammation? How’s their gut health? How are their hormones? So I don’t think it’s, it’s like how all those things affect copper Ansarullah plasmin, but how they also affect thyroid health, our adrenal health all those things impacted. So I don’t like I know a lot of people simplify it to those but I think it’s just because the at the at the core, like that’s the issue, but there’s so many other things that impact it. And just someone’s health history. I feel like people forget about that. We have to look at your health history.

How did you eat your whole life? How did your mother eat? What supplements have you taken? What have you not taken? What other deficiencies Do you have? What kind of stress Have you been through? Where are you at right now with your stress and your thyroid function and your resiliency, like, all these things matter? And it’s really easy to want to reduce it to something so that you feel like you have an easy answer, but oftentimes, it requires like more digging and reflection. But those are those are all the questions. That is our iron deep dive part one and part two. I hope that you guys enjoy these episodes. We’re adding in an extra episode this season, I was only going to do eight but iron turned out so long that it’s two. And then next week, we’re gonna do a deep dive on selenium. Again, if you want the bonus resources, go to patreon.com/hormonehealingrd, and I’ll see you in the next episode.

Amanda Montalvo

Amanda Montalvo is a women's health dietitian who helps women find the root cause of hormone imbalances and regain healthy menstrual cycles.

Master Your Minerals

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