IRON AENEMIA (3.0)
What's really going on when we show up in our doctor's office and leave with the simple recommendation to add in an iron supplement?
As always, I will add in this little disclaimer: I am not your health care provider or your medical professional. If you want to utilize any of these tips, that is completely up to you!
As we learned last week, there's always more to the story. The typical labs run for checking iron are primarily Ferritin, hemoglobin, and sometimes serum iron and a few others. Let's unpack this a little bit: Ferritin is a storage protein that is meant to be Intra-cellular (meaning housed within our cells). Ferritin stores iron, because if iron was not locked up, it would be causing all kinds of oxidative stress. However, when we see ferritin rising in the blood, we actually know that there is something wonky going on. You see, once ferritin has left the cell (of whatever tissue it was residing in), it's leaving empty… that's right. Iron has been released from the protein and is left in the tissue, while the ferritin floats around the blood, like an empty shell. So ferritin is not a great measure of iron status. There is a famous iron researcher, Sir Douglas Kell, who states that ‘rising ferritin is a sign of tissue pathophysiology’. The second thing to note about ferritin is that when it's really low, it's not necessarily because iron is low, but very often because it's feeding into pathogenesis. Parasites are known for using up ferritin due to the fact that they have high needs for iron in order to survive.
So I'm always looking at the question: are these iron markers reflecting a true iron deficiency, or do we need to dig a little deeper to find out what's going on. Here's the thing. Iron doesn't manage itself. I've spent the week brainstorming an analogy.. and this is what I've got:
We could think of iron like kindergarten students. Imagine the chaos in the classroom if the teacher just didn't show up for work… would the students remain at their desks? Would they even remain in the classroom? No! They are probably on the playground. Now let's imagine for a second, that the principal walks into the room and sees all the empty chairs in the class and simply decides to bring more kids into the classroom. This happens for days and days on end, while the principal is baffled by the fact that there are never kids in chairs. We are left with a chaotic classroom and no ‘kids in chairs’ (think: iron in bloodstream). This is an obvious analogy, but in our current system we have sliced and diced nutrients up so much, that we tend to look at them completely in isolation. So we can tell a patient with ‘low iron’ to go take iron supplements, but we aren't really getting to the root of the issue at all. Once the ‘classroom manager’, or teacher is back on the job, the students will be back in their chairs.
Copper and retinol manage iron, and more specifically, Ceruloplasmin. Retinol has a role in the liver, where it is involved in loading copper into the Ceruloplasmin protein. And then Ceruloplasmin is the classroom manager. The one who will direct and guide all of that energy to the right place. Unless our levels of ceruloplamsin are looked at, we will never truly know the root cause of the iron ‘deficiency’ in the first place. Ceruloplasim has a function called FOX (or, ferroxidase) and this enables it to alter the state of iron from ‘reactive’ to ‘agreeable’. In the reactive state, iron causes oxidative stress and inflammation so we really need that bio-available copper to change the state of iron to the useable and agreeable state – and then it can be carried through the bloodstream and recycled in the bone marrow where it's made into hemoglobin. PS. You make 2 million red blood cells per second!
SO WHAT'S A BETTER, MORE HOLISTIC WAY?
HERE'S THE BLOODWORK I LIKE TO RUN ON ALL MY CLIENTS:
Full Monty Panel
Morley Robbins Magnesium Advocacy Group's Full Monty Panel contains the following tests:
Ceruloplasmin
Copper
Ferritin
Hemoglobin (Hgb)
Iron and Total Iron Binding Capacity (TIBC)
Magnesium, RBC
QuestAssureD™ 25-Hydroxyvitamin D (D2, D3), LC/MS/MS
Transferrin
Vitamin A (Retinol)
Zinc
These tests, when looked at as a whole group in comparison to one another provide us the full picture of iron metabolism in the body. We can see the balance of minerals between iron, copper and zinc. We can see if there's adequate retinol or if we've been overwhelmed by vitamin D and blowing through those stores. We can see the two primary iron transport proteins bringing iron to and from the bone marrow. It's in this huge picture that we can get a clearer sense of what's going on and make very clear recommendations using the results.
The last thing I want to say, and I know this is lengthy, is that if you're a menstruating woman, an iron panel should never be run during a bleed or even in the days following. Ideally we want to run these labs right in the middle of your cycle for the most accurate data reflecting true iron metabolism.
