Thread by @DrBPHealth

My low iron anemia patients often suffer with:

•Extreme Fatigue
•Brittle Nails
•Brain Fog
•Thinning Hair
•Constipation
•Cold Hands & Feet
•Soreness on Tongue
•Inflammation
•Headaches

There’s an often-overlooked root cause.

Let’s discuss.

THREAD

Today I’m going to cover 4 parts:

1) What often happens to patients with the above symptoms

2) Common issues with the standard approach

3) A needed test that is practically never ran

4) What to do to address the root cause

I’m going in depth today, so let’s dive in…

Often patients will go to their doctor with some (or all) of the above symptoms and know something is not right in their body.

Their doc will then run standard blood work and get results back.

Very often the results will come back that these individuals have low iron levels.

Which is no surprise. They are then diagnosed as anemic.

Their provider will then tell them that they need to increase their intake of iron rich foods like:

•Spinach
•Kale
•Broccoli
•Beans
•Red Meat
•Organ Meats

The doc will also typically recommend an iron supplement.

So, people follow what their doctor suggests & prescribes.

Here’s The Problem Many Experience:

Several of the above food items have very poor absorption rates.

And 99%+ of the iron supplements have poor absorption rates.

Additionally, the iron supplements regularly have side effects like:

•Constipation
•Nausea
•Dark Stools
•Stomach Cramps
•A Metallic Taste

The patient pushes through the side effects because they don’t like feeling the way they do & having all the other health symptoms.

After about 90 days they go back, get their blood work re-tested & it is marginally improved along with their symptoms.

They're left frustrated.

They eventually find their way to my clinic and get the help they need.

Why?

Because we work at addressing the root cause(s).

And get them the correct supplementation without the side effects.

First, you need to understand iron’s role in the body.

Iron is involved in many physiological processes, but one of the biggest is the formation of hemoglobin and red blood cells, which carry oxygen to the cells in your body.

If you don’t have sufficient amounts of iron (an essential mineral), you literally will have issues getting enough oxygen to your tissues.

Your body obviously needs oxygen to function.

It’s why patients with low iron will have such extreme fatigue, brain fog, etc.

6 Root Causes Of Iron Deficiency That Are Often Overlooked

1. Low Dietary Intake

I will cover this in more detail below, but the following have a high propensity for low iron levels:

•Vegan Diet
•Vegetarian Diet
•Eating The Wrong Types of Food

2. Blood Loss

This can be from monthly menstrual cycles.

The average menstruating female loses 20-60 mg of iron each cycle.

This is why females tend to be iron-deficient at higher percentages.

Stomach ulcers and other digestive issues can also lead to bleeding.

Frequent blood donation can too.

Both in turn lower iron levels.

3. Poor Absorption

This can be due to:

•Gut Dysfunction
•IBS
•Chron’s
•Celiac
•Bariatric Surgeries
•MTHFR Gene Mutation
•Frequent Antacid Use

4. Rapid Growth

•Pregnancy
•Breastfeeding
•Rapid Adolescent Growth

5. Frequent Exercise

Specifically exercise that is “excessive”.

Think more along the lines of endurance athletes that put a long amount of continuous stress on their body.

6. Chronic Disease & Chronic Inflammatory Response

Bacteria, viruses, and cancer cells all need iron to function.

If they are proliferating, your body will take a protective measure and store more iron via ferritin to keep the iron from pathogenic cells… and subsequently, from your body being able to use iron too.

More about this later.

Iron Is Toxic To Our Body, But An Essential Mineral We Need

Iron is an essential mineral. Meaning our bodies can’t make it.

So, we must get it from food or with help via supplementation. More about proper supplementation later.

Iron is not just involved in transporting oxygen to the body, but it is involved in 100’s of other metabolic and cellular functions in the body.

The human body cannot work correctly without sufficient levels of iron.

While iron is an essential mineral, it is also toxic to our body if left “free floating”.

However, our bodies have “chaperones” that protect us from iron’s toxicity whenever we are currently using it or for storing it for future use.

Examples of “Chaperones”:

•Ferritin
•Hemoglobin
•Transferrin
•Ferroportin
•Myoglobin

Ferritin is a protein “chaperone“ that safely stores iron for future use.

Hemoglobin is the iron “chaperone” that transports oxygen via our red blood cells, throughout the body.

Ferritin plays a critical role in the majority of the cellular processes that involve iron.

Your metabolic function is ultimately at a cellular level and is dependent upon how much energy a cell can produce via the mitochondria.

So, if you have deficient levels of iron or ferritin, you will have metabolic dysfunction.

Which will affect so many aspects of your health.

This is precisely the reason I write so much about metabolism.

Get your metabolism functioning correctly, and so many health symptoms and disease processes take care of themselves.

The Importance Of Hemoglobin & Ferritin

I’m going to focus primarily on hemoglobin & ferritin to help you understand why you may be experiencing the above-mentioned symptoms.

To keep it very simple:

•Ferritin is safe iron storage
•Hemoglobin is safe iron circulation

As stated, iron needs a “chaperone” (ferritin & hemoglobin) to be safely used in the body.

To help explain, I’m going to use an analogy of an electric vehicle (EV)

Iron = Electricity or Charge
Hemoglobin = Car Battery
Ferritin = Charging Station

Just like electricity can shock you, free iron is harmful to you.

But if electricity (iron) is contained within a battery (hemoglobin), the battery can then release the electricity as it is needed.

If you have a full charge on your battery, your EV (body) works it’s best.

And if there are charging stations (ferritin) that are close by and up and running, you frankly have no issues and can keep your battery near full all the time.

This would represent health & no symptoms.

But what if you had no charging station available or they were broken down?

Yes, you could still run your EV for a while without much decrease in performance.

But not having a charging station available would get you worried.

As your battery went down to 50%, you’d see a decrease in performance (beginning symptoms).

This is actually the first stage of iron deficiency that is missed by most doctors.

𝗜𝗠𝗣𝗢𝗥𝗧𝗔𝗡𝗧:

This is why in addition to the CBC that most doctors run (which includes hemoglobin), you need to also have your serum ferritin ran too.

Patients can have low iron symptoms for years, their doctor test their hemoglobin levels, and tell them they are normal.

But in truth, there is a functional problem that is being overlooked with low ferritin levels. This is first stage iron deficiency.

1st Stage Iron Deficiency Bloodwork

•Low Ferritin
•Normal Hemoglobin

But if your doctor does not test serum ferritin, your bloodwork will appear normal, even though you have symptoms.

With our EV analogy, what if you continued to have no charging stations?

And if your battery dipped down to 20% charge, the performance of your EV (body) would reduce even more (i.e. more symptoms).

If your battery (hemoglobin) got down to 10%, your EV (body) would still perform but it would have a lot slower performance & have even more issues (even more symptoms).

This is the stage when most doctors test and find abnormal bloodwork.

This is second stage iron deficiency.

2nd Stage Iron Deficiency Bloodwork

•Low Ferritin
•Low Hemoglobin

As mentioned earlier, there is a third type of iron deficiency and that is anemia of chronic disease.

Bacteria, viruses and cancer cells all need iron to function and proliferate.

Your body will try and protect itself and reduce the amount of circulating iron (hemoglobin).

And instead, will store iron away with ferritin to “hide” the iron from those cells causing the chronic disease.

3rd Type- Anemia of Chronic Disease Bloodwork

•Elevated Ferritin
•Low Hemoglobin (sometimes normal)
•Increase White Blood Cell Count
•Increase CRP (Inflammatory Marker)

Going back to the EV analogy, think of your ferritin & hemoglobin levels in the following 4 ways:

80% battery charge or more = optimal levels for both (see below optimal levels)

50% to 79% battery charge = normal levels for both

20% to 49% battery charge = low ferritin & normal hemoglobin

20% and under battery charge = low ferritin & low hemoglobin

What Lab Tests You Should Request From Your Doctor

In addition to the typical CBC that most doctors run, you want to also request having the following ran:

•Serum Ferritin
•Iron Panel

Which the Iron Panel includes:
•Serum Iron
•Transferrin %
•TIBC (total iron-binding capacity)

“Normal” vs. Optimal Ranges

The “normal” range for ferritin is 13-200. This is based on outdated research.

So, if your bloodwork comes back and you are a 20, you are “normal”.

However, we now know through research that 20 is severely iron deficient and would cause your symptoms.

In fact, hair re-growth requires ferritin levels of at least 70 mcg/L.

This is also needed to repair brittle nails.

Your ferritin levels need to be at least 70, ideally 100, to eliminate symptoms.

**𝘈𝘴 𝘢 𝘴𝘪𝘥𝘦 𝘯𝘰𝘵𝘦, 𝘪𝘧 𝘺𝘰𝘶 𝘩𝘢𝘷𝘦 𝘵𝘩𝘺𝘳𝘰𝘪𝘥 𝘪𝘴𝘴𝘶𝘦𝘴, 𝘺𝘰𝘶’𝘭𝘭 𝘸𝘢𝘯𝘵 𝘧𝘦𝘳𝘳𝘪𝘵𝘪𝘯 𝘵𝘰 𝘣𝘦 𝘢𝘣𝘰𝘷𝘦 100 𝘮𝘤𝘨/𝘓.

Below are the tests with their normal values and what would be optimal.

Hemoglobin

Normal:
Adult Males: 13.1-17.5 g/dL
Adult Females: 10.6-15.6 g/dL

Optimal:
Adult Males: 14-15 g/dL
Adult Females: 13-14 g/dL

Ferritin

Normal: 13-200 mcg/L

Optimal:
For ferritin to be at optimal levels, you will want it definitely above 70 mcg/L, and ideally > 100 mcg/L if having thyroid issues.

Optimal for males is 70-200 mcg/L and for females is 70-150 mcg/L

Serum Iron

Normal: 60-170 mcg/dL
Optimal: 110-140 mcg/dL

Transferrin %

Normal: 15-50%
Optimal: 35% Females, 40-45% Males

TIBC

Normal: 240-450 mcg/dL
Optimal: 300-350 mcg/dL

The Issues With 99% Of Iron Supplements

Patients often go on an iron supplement to bring up their levels.

I would estimate that 99% of iron supplements on the market are elemental non-heme iron supplements.

I can’t think of a time when a patient has brought in an iron supplement they’ve been taking, and it was not this type of iron!

Why is that important?

1st: horrible absorption rates- typically less than 5%

2nd: stimulates a hormone (hepcidin) in your body that actually BLOCKS iron absorption!

This also causes inflammation in the gut.

And because of the poor absorption and increase in inflammation, it is why so many start to have issues with constipation and nausea when going on these type of iron supplements.

Also, certain foods block the absorption of this type of iron supplements because they create a more basic environment in the stomach/gut.

Which is why these supplements often have Vitamin C added to them (to make the stomach more acidic).

The best sources of iron are from food.

There are 2 types of iron from food.

•Plant-based Iron
•Animal-based Iron

Plant-based sources are referred to as non-heme iron. Plant-based sources have approximately a 2-15% absorption rate.

Animal-based sources are referred to as heme iron. Animal-based foods have ~15-30% absorption rates.

Non-Heme Iron Sources:

•Fortified cereals, rice, breads & pasta
•Spinach
•Kale
•Raisins
•Apricots
•Kidney, navy & lima beans
•Nuts & Seeds
•Tofu
•Lentils
•Peanut Butter

Heme Iron Sources:

•Organ Meats
•Beef
•Lamb
•Venison
•Goat
•Chicken
•Fish
•Shellfish

However, if someone has any of the following, this presents a problem with absorbing the iron from food:

•Gut Dysfunction
•Gut Diseases
•Bariatric Surgery
•Stomach Ulcers
•MTHFR Gene Mutations (~40-60% of population)
•Frequent Antacid Use

With the above-mentioned issues with 99% of iron supplements (elemental non-heme iron), you want an iron supplement that is 𝙝𝙚𝙢𝙚 𝙞𝙧𝙤𝙣.

Heme Iron Supplements Have These Advantages:

•Have Up to 10X Absorption
•Doesn’t Cause Constipation
•No Heartburn
•No Nausea
•No Stomach Cramps
•Doesn’t Need Vitamin C for Absorption
•Can Be Taken Without Food

A heme iron supplement is what I use with patients.

The one I use also comes from grass-fed cows and has 60.6 mg of heme iron per capsule.

This allows for some of the most rapid increase in iron levels, typically with no side effects for patients.

This heme iron supplement is the foundation of the Iron Booster protocol I use with patients.

You can learn more about it below.

Additionally, I use some other key nutrients to help with absorption rates in the above Iron Booster protocol.

Iron is better absorbed with methylated folate (Vitamin B9) and methylated B12.

Folic acid is the synthetic version of Vitamin B9.

This is what is added, or fortified, in foods. You will see it on the labels.

Again, poor absorption rates and conversion to a usable form.

Folate is the natural and methylated form. This is what your body can use.

Those with MTHFR gene mutations are at a definite disadvantage to methylating B9 and B12 properly.

Methylation is needed for these vitamins to be absorbed (and subsequently used by your body).

It’s why I insist on using methylated forms of both vitamins.

In the Iron Booster protocol (below) I use with patients, I use a proper dosage of these methylated nutrients in conjunction with the heme iron.

Finally, hemoglobin needs sufficient levels of Vitamin D to form.

I have found most patients are not in optimal Vitamin D ranges.

A number are not even within “normal” levels of Vitamin D!

So, of course, they are going to have trouble making enough hemoglobin!

Plus, there are SO MANY other metabolic and immune dysfunctions that can occur when individuals have deficient levels of Vitamin D.

Which is why I also use Vitamin D3 in the Iron Booster Support protocol with patients.

These 3 products combined can really get my patients feeling better quickly.

If you are in the United States, Fullscript can ship the supplements directly to your house.
us.fullscript.com/plans/drbpheal…

“Normal” vs. Optimal Bloodwork for Nutrients

If you’ve had bloodwork on these 3 nutrients, the following is what you want to look for to have optimal levels.

Vitamin B12
Normal: 180-900 pg/mL
Optimal: 800-900 pg/mL

Vitamin B9 (it will say “folic acid”)
Normal: 2-20 mcg/L
Optimal: 14-17 mcg/L

Vitamin D
Normal: 30-100 ng/mL
Optimal: 70-90 ng/mL

How Long Should I Follow This Protocol

It takes ~90 days for red blood cells to replace themselves, so you will want to follow the protocol for 90 days, and then re-test your lab work.

I have my patients take certain amounts of each until they are at optimal levels.

Then they take a different amount to maintain their optimal levels.

These are given in the description of the Iron Booster protocol on Fullscript.

With my patients, I also simultaneously address the underlying gut dysfunction that so many of them have issues with.

I know I covered a lot of info today (and I could have given more details).

However, if you are struggling with low iron symptoms, I wanted to provide you with sufficient info to get you started in your recovery.

So many suffer too many years when they don’t need to.

Often, I will see patients start to notice a vast difference within a few short weeks after they begin implementing what I’ve discussed above.

If you are suffering with low iron, or symptoms of low iron, I’d highly suggest you begin making the changes I’ve outlined above.

It will make a VAST difference in your quality of life.

Your 4 Actionable Steps:

1) Focus on eating iron-rich foods, with an emphasis on heme-iron foods.

2) Begin taking a heme-iron supplement.

3) Consider taking methylated B9 & B12, along with D3 for better absorption and hemoglobin production. All are included in the Iron Booster protocol.

4) Clean up your gut dysfunction for better absorption.

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