Are You Truly Iron Deficient?

Is it possible that your diagnosis of anemia isn't actually an iron deficiency but something else?
Approximately  million people worldwide will be diagnosed with anemia every single year, children under 5 years old and pregnant women being the most at risk. It begs the question just why is it so prevelant, especially when we live in a world where iron fortification is so popularized in many of our foods. 
Let's look into it.

First, let's understand what is iron deficiency anemia.
Iron deficiency anemia is when there is an insufficient amount of iron to form hemoglobin, a part of red blood cells that help carry oxygen and remove carbon dioxide from the body. Iron is mostly stored in the hemoglobin and a third of it is stored as ferritin and hemosiderin in the bone marrow, spleen, and liver.

Symptoms of iron deficiency anemia are as follows:

• Pale skin
• Fatigue
• Brain fog
• Fast heart rate
• Swollen tongue
• A desire to eat non-food related products, like ice
• Dry skin
• Brittle nails
• Hair loss
• Dizziness
• Cold hands and feet

Now some of you may be wondering, just how is it that someone becomes iron deficient? Well, for the most part, people who are truly iron deficient have a few factors that make them susceptible:

• They are bleeding internally or have a disorder that causes them to lose blood
• They have genetic mutation that causes them to not be able to absorb iron appropriately
• They aren't ingesting adequate iron

However, in today's day and age, where most of our grains are fortified with iron, from granola bars, cereals, toast, pasta, even baby formulas, you'd think our iron ingestion would be adequate. Majority of people don't have internal bleeding or a genetic mutation, so it leaves us to wonder how are all of these cases of deficiencies forming? Is it possible it's not a deficiency but something else?
Let me explain.

Every single person has something we would call an Iron Recycling System also known as the Reticuloendothelial System (RES). The RES consist of our red blood cells, small intestine, liver, spleen and bone marrow. The liver is the main organ of red blood cell removal as well as iron recycling. The liver depends on the bone marrow to derive monocytes that consume damaged blood cells, eventually turning into macrophages that are capable in recycling the iron. The reason the body recycles iron is because there is no physiological regulatory mechanism for our bodies to remove iron. We lose a bit through our gastrointestinal system, sweating, and even shedding cells, but the over all amount we tend to lose is an average of 1-2 mg a day.

Our RES can recycle 24mg of iron a day, leaving us with that only 1mg of iron that we lose, which we can simply ingest from food. It’s important to note that we need about 25mg of iron to support red blood cell production, so the 24+1=25mg makes perfect sense.

Still, we're left with the problem: people are still going to their doctors and being diagnosed with low iron. What gives? 
A few things:

1. Many people are consuming a diet rich in these iron fortified foods. Too much iron fortified foods can stress the RES.
   
2. Doctors are not ruining the correct blood work. In order to make a diagnosis of iron deficiency, doctors must check hemoglobin’s and ferritin together, yet many are only running ferritin panels. This is wrong because 70% of our iron stores reside in our hemoglobin, 10% in our myoglobin, and the rest in our RES. Ferritin is considered an intracellular protein, and checking it on its own doesn't provide the full picture.
3. Many people are deficient in iron's co-factors, such as retinol, magnesium and particularly copper. This is the key component.

Just like with any other mineral, no nutrient in the body works independently, iron included. Iron needs a lot of help, it can't just be floating around in the body alone and expect for everything to be alright. In fact, iron needs to be ushered in and out of tissues so the body can utilize it appropriately. If it isn't carried, the body becomes concerned, thinks there is a stress, and starts accumulating iron in the tissues as a means to protect itself. This is because if iron is alone, it can cause a lot of inflammation and feed unwanted critters in the event we ever contract a pathogen. As inflammation increases, so does iron storage, our bodies start producing hepcidin which is a protein that prevents iron to enter into our hepatic system which furthers the cycle of having the body keep iron stored in the tissues rather than use it within our RES. Our RES now is slowed down and we're just in one big mess. 

But wait, hold up, how was iron even left alone in the first place? Where was its usher? Who was its usher? Copper was missing.

Copper is the one mineral that can move iron in and out of tissues through an enzyme called ferroxidase. Without it, iron is holds onto oxygen, but is immobilized, which can be dangerous and cause oxidative stress. If iron cannot leave tissues it looks like there is a lack of it in serum levels. 

Ironically, iron is important to transport oxygen through our system and copper helps active oxygen, having it turn into water in our system. This is a critical piece on as to why these two minerals must work in unison, because if copper isn't present with iron, iron will quite literally turn into rust in our bodies.

Now some of you may be thinking, "Okay, let's just take in more copper" but this won't solve the problem. Copper can only be utilized by the body and be recognized as "bioavailable" if it's bound to a specific protein called ceruloplasmin. If you haven't read our estrogen and copper blog check it out here, we mention ceruloplasmin a lot.

Ceruloplasmin is a protein made by the adrenal glands and the liver. It needs three co factors to bind to copper which are retinol (Vitamin A), ascorbic acid (Vitamin C) and magnesium. Essentially, we need to not be overly stressed and not pounding our liver with things to filter through, as well as these co nutrients, to produce adequate ceruloplasmin to help bind to copper, to then attach itself to iron.

Things are a lot more complicated than they may seem, as you can see.

So now you may be asking "Okay, so let's say I am considered iron deficient, but I consume adequate iron in my food, what can I do to help myself if this is my issue?"

Here are a few tips:

1. Remove iron fortified foods and focus on eating meat. Excess fortification can hinder the RES.
2. Enjoy copper rich foods such as liver, bee pollen, oysters or chlorophyll.
3. Consider a magnesium supplement. Unfortunately most of our food sources are deficient of adequate magnesium.
4. Reach for retinol rich foods such as eggs, organ meats, and fatty fish.
5. Make sure to enjoy an array of vitamin C foods like fruit.
6. Support liver detoxification with the help of castor oil packs, eating bitter foods, getting in enough protein for those amino acids and b vitamins as well as eating adequate saturated fats to help with bile.
7. Focus on nervous system health to not stimulate the adrenals too much.

Barbara Madimenos
Hair Tissue Mineral Analysis Practitioner
Functional Diagnostic Nutrition Practitioner
Integrative Health Coach