Fatigue

Episode 3- Iron- THE MOST COMMON Nutrient deficiency people don't talk enough about

Functions of Iron in the body? 

  • Oxygen transport, and use,

  • Amino acid metabolism,

  • CARNITINE synthesis

  • COLLAGEN synthesis,

  • THYROID hormone Synthesis

  • Some Enzymes that iron is involved in

    • Catalase (anti-oxidant defense)

    • Cytochromes (mitochondria for ENERGY)

    • myeloperoxidase,

    • thryopeproxidase,

    • lysine/proline dioxygenases,

    • PEPCk

Symptoms

●Fatigue

●Restless legs syndrome

●Headache

●Exercise intolerance

●Exertional dyspnea

●Weakness

●Dry or rough skin

IRON FACTS

Absorbed in Small intestine- Duodenum

Things that cause us to be deficient

  • #1 heavy menstrual bleeding

  • Pregnancy

  • Gut issues- Celiac, PPIs, Gastritis, H. pylori, SIBO

  • Exercise induced loss - (probably causing a GI issue)

Q: Sources of Iron nutritionally- 

  • Top 3-5 Animal (Clams, Oysters, Liver, Red Meat, Dark Chicken)

  • Top Plant Sources- (Spirulina, Molasses, Chickpeas, lentils, Spinach,)

Q: Who's at risk for Iron Deficiency? 

Q: How do we define Iron Deficiency?

  • Lavs vs. optimal Reference range

    • Iron expert Dr. Michael Auerbach MD uses a cutoff of 30 ng/mL. 

    • Normal ferritin concentration ranges from 30 to 200 mcg/L

Iron Deficiency on Labs

  • Serum ferritin <30 ng/mL

  • Transferrin saturation <19 percent

  • Different Reference ranges in different countries, 

  • Also different clinics have different ranges, ie GI clinic.

Problems w/ Insurance

  • Iron Infusions

Supplements we love and WHY? 

IV Infusions

Enhancers of absorption:

  • Acids (ascorbic acid/vitamin C) - brush-border enzyme DCYTB (duodenal cytochrome B) reduces ferric to ferrous iron

  • Meat, fish, poultry (MFP) – cys residues bind and help solubilize ferric iron, amino acids and peptides improve iron bioavailability and absorption  Nutrients 2017 PMID: 28617327

  • Iron deficiency (low iron status)

Inhibitors:

Competitors for transport

  • Zinc, manganese, calcium

  • " zinc-DMT1/FPN1 axis is a critical determinant of zinc-deficiency-induced changes in iron homeostasis and helps understand the mechanism of iron and zinc interactions.” 2019 Nutrients, PMID: 31412634

  • Mechanism of calcium inhibition is more short-term and no long term effects, don’t eat in same meal

Formers of insoluble complexes

  • oxalic acid (dark leafy greens like spinach and chard, nuts, grains, legumes)

  • phytic acid (unsprouted/unfermented grains, legumes and nuts) Phytic acid, an abundant secondary metabolite of plant foods, chelates dietary iron, and limits its intestinal absorption. Since phytic acid also inhibits the zinc absorption, higher risk of zinc deficiency is expected in populations with high prevalence of anemia

  • tannins (teas, wines, beer, chocolate, berries, legumes, nuts, grains)

Physiological states

  • Reduced stomach acidity

To support healthy iron levels:

Animal sources of (heme) iron are bio-available whereas plant sources (non-heme) are extremely hard to convert and absorb.

  • Include red meats (beef, bison, lamb, game meat) at least 3x/wk. Preferably from grass-fed sources.

  • If possible include liver 1-2x/wk: either in capsule form (Vital Proteins Liver Capsules or Paleovalley Organ Complex) or hidden into ground meats. Use a 4:1 ratio (1lb ground meat to 1/4 lb ground liver) when making meatloafs, meatballs, patties, or meat sauce.

Plant sources include 1 tbsp molasses, spinach, spirulina, dried apricots or lentils. Though portions necessary to reverse deficiency or maintain levels are difficult to obtain solely from plants so supplementation may be necessary.

Other tips:

  • Cook your food in a cast iron skillet or use the "lucky iron fish" in your cooking

  • Always pair your plant-based-iron foods with vitamin C foods to help enhance absorption, such as bell pepper, citrus, kale, strawberries, or rosehip tea.

  • Avoid having plant-based iron with other calcium or zinc-rich foods/supplements (like dairy or grains) or absorption inhibitors like tea or coffee.

Prevalence

For females, iron deficiency anemia was present in nearly one in five!

Women are at a greater risk, so get tested

 Vegan’s/Vegetarians are at a greater risk

Where does Iron go in the body?

●RBCs – Approximately 2 g goes to the RBCs

●Iron proteins (eg, myoglobin, cytochromes, catalase) - 0.4grams

●Plasma iron bound to transferrin – 3 to 7 mg

●Storage iron in the form of ferritin or hemosiderin – about 1 gram for men and 0.5 grams for women

Sources

  • 5mg /3oz Liver

  • 2 mg/3 oz Hamburger,

  • 1 mg/3 oz white turkey chicken, 2 mg for dark meat turkey

  • Clams- 12/3 oz, oysters 8mg/3oz

  • Spinach 3.7mg/cooked per half cup

Avg American gets 10-14mg/per day

RDA-

  • 8mg MEN

  • 18 mg Women

  • 28 mg if Pregnant

SOURCES-

Causes and diagnosis of iron deficiency and iron deficiency anemia in adults

Author:Michael Auerbach, MD, FACP

Literature review current through: Apr 2020. | This topic last updated: Apr 15, 2020.