The Truth About Iron Deficiency: What Your Doctor Isn't Telling You

Welcome to the Dr. Gundry podcast. Let's talk about iron deficiency. Now, don't click away because what I'm about to tell you about iron may explain why you're tired, aging faster, or struggling with your health, even if your doctor says everything looks normal. Now, I'm old enough to remember that back in the 50s and 60s, there was an iron supplement called Geratl. >> Doctors have a special name for it. They call it iron deficiency anemia, but we call it tired blood. And to feel stronger fast, I wish you'd give Geratl a try. >> And Geratl sponsored the Ted Mack Hour. Geratl was everywhere. and you needed geratl because you had iron poor blood. And most of America was convinced that all of our problems were because we had iron poor blood. And of course, geratl was the fix. Well, sadly, it's a whole lot more complicated than that. Here's the deal with iron. We need iron to make the hemoglobin molecule. And hemoglobin, as most of us know, is the molecule in red blood cells that carries oxygen around our body. And without hemoglobin, we don't carry oxygen around our body very well. And so if we have a low hemoglobin, we're likely to not have a lot of oxygen delivered to our cells. And so a low hemoglobin or a low hematocrit is one of the signs that you may be deficient in iron. But it's only one of the signs that we should be looking for. There are multiple reasons as we age why we might have perfectly normal amounts of iron and yet we have a low hemoglobin or hematocrit and I'm not going to deal with that. Most of it is because of a precancerous condition in our bone marrow called milo dysplasia. We're [clears throat] not going to talk about that today. I want to talk about the usual causes of low iron. Now, if iron's so important, then should we all be taking iron? And the answer is an absolute no. Iron, unfortunately, ages us. Iron makes us rust. Now, here's something that should be obvious. Most women live about seven years longer than men. And one of the main reasons is that women do a blood donation once a month for half of their lives during menration. So women are always getting rid of iron. Men, on the other hand, uh, don't wrestle saber-tooth tigers anymore, which is how we used to get rid of iron, it's assumed. So, women have a built-in advantage of getting rid of iron. The other thing that I've written about in several of my books, blood donors live longer than age match controls who don't give blood. And one of the most interesting studies was done in Denmark where they took blood donors and looked at longevity and matched the people who gave the most blood the most often to the people who were blood donors who gave the least amount of blood less often. So among blood donors who live longer than non-b blood donors, the people who gave more frequently lived longer than the people who gave less frequently. Why? Because they were getting rid of iron. Now there's a fine line and I take care of a number of people who are blood donors by choice and who are blood donors because they carry a genetic mutation hemocerosis where they actively absorb iron and they have to give blood uh to keep their iron levels down. So just because iron is important doesn't mean that we should all be on iron. The main reasons I see low iron in people, let's start with women first. First of all, the number one reason I see low iron in women is heavy menstrual cycles. And that's by far the number one reason. Number two, there are women who are past menration who still have low irons. In general, and this applies to men as well, so we'll talk about this together. There's usually a source of slow bleeding that's so slight that you don't detect it. These are usually from polyps in the colon. Occasionally we see it from gastritis. Occasionally we see it in people who have a long history or a recent history of taking a lot of incaids, uh, ibuprofen or leave, uh, Advil for a sports injury or pain. And all of these conditions are well known for causing slow leakage of blood. the one with ibuprofen or any of the NSAIDs, whether it's aspirin or the other ones. We've only recently realized how common that is with the advent of pill cameras where you swallow a little camera that takes pictures of your small intestines as it passes through and we can see the irritation and damage to small intestines. Now, I've written about this. Drug companies when these NSAIDs were being developed knew that this happened. But when they were first introduced, we knew that they were so dangerous that Advil, for instance, could not be given without a prescription. And you could only write that prescription for two weeks because the known side effects like this were known. Now, of course, ibuprofen, Advil, Alie, these are over-the-counter drugs and the most widely used over-the-counter drugs there are. And so, many people can have a subtle blood loss from using these medications, and it's one of the things we stop in someone who has low iron. Now, let me back up for a minute. So just because you have a low blood count or a low hemoglobin or a low hematocrit does not mean you have a low iron. So you have to get a low serum iron level drawn. Now many people like to follow feritin. Now I've been measuring feritin levels in everyone for over 25 years. One of the things I've found is that feritin is actually a very useful marker in women of inflammation and it's a less useful marker for looking at iron amounts. So if your feritin is normal, quote unquote, or even elevated, if you're a female, that does not mean that you have a normal iron level. Conversely, I have a number of patients with lowish normal feritin levels who have absolutely low iron levels. Don't trust a feritin level too much, particularly if you're a female. Again, just because you're tired, just because your blood count is low, doesn't mean you have a low arm. And make sure you ask your doctor for a complete blood count with indices. Now, those indices, we look at the size of red blood cells. We look at the amount of hemoglobin in the red blood cells and those will all be displayed in a complete blood count with indices. So you need a serum iron, you need a complete blood count with indices and then and only then do you go to the next step. Okay. So you have a low iron, you have a low hematocrit or hemoglobin and you have indices compatible with low iron. You need to find out why that is. If you're a menrating female and you have heavy menes and you're young, that's usually the cause. So you're the person who most likely will need to supplement with iron. One of the things we know about iron, number one, you need vitamin C to absorb iron. So when you're taking your iron supplement, and there are multiple ones, make sure you take an additional 500 mg of vitamin C every time you take your iron. And that's really critically important and it's not widely known. Number two, many people get constipated with iron. Usually most people if you supplement with magnesium, and I'm not particularly worried about which magnesium you choose, some magnesiums work better for other people than others. Magnesium glycinate is popular. That's fine. But if you notice that you're getting constipated with iron, make sure you add magnesium. Number three, if you're a menrating woman with low iron, this is the only time I recommend getting a cast iron skillet and using a cast iron skillet to cook your meals. You get a lot of iron from a cast iron skillet. And if you don't have an issue with low iron, as you've heard me say, please, please, please do not use a cast iron skillet. If you got to have a cast iron skillet, then make sure it's a ceramic coated cast iron skillet. And there are plenty commercially available. But if you're a woman heavily menrating with low iron, a cast iron skillet is your friend. may not be the rest of your family's friends, including your husband, but for you it's good. Yes, there are ironrich foods. Obviously, animal protein, beef, lamb, pork is rich in iron. And so these are useful sources for iron. vegetables like Swiss chard, like kale, like spinach, any of the dark green leafy vegetables are rich in iron. If you're a vegan or vegetarian, you're more than likely not getting enough iron from animal sources. So, this is even more important for you. All right, so those are some of the things you can do. Now, let's address the elephant in the room. You've been told you have a low iron and you need to get your blood count up. Do you automatically start taking iron? The answer is no. You need to find out, are you losing blood somewhere? And sadly, I see so many times when a well-meaning physician puts you on iron for your low iron without looking at, well, where are we losing iron? Just this week, I have a patient with a history of colon polyps, and he routinely has colon polyps. every time he has a colonoscopy. But his last colonoscopy was about two years ago and he's been doing fine. And a few weeks ago, his blood test showed that his iron, which had been perfectly normal, was low. And sometimes labs can be wrong. So I did with a new lab, a different lab, an iron level, a serum iron level and a complete blood count with indices. And sure enough, it was low again. And he did [clears throat] have a low hemoglobin and he had indices indicating low iron. So our next step is he needs a colonoscopy now because almost certainly he's leaking from a new polip. So just giving him iron is not the solution to his problem. You've got to find out where it's coming from. Same way I have NSAID users who are heavy NSAID users. We stop that first and then look and see where we are with iron. But don't just take iron cuz you have iron poor blood. You've got to find the reason. Now, sometimes you're lucky. Sometimes you have a bleeding hemorrhoid. That's the cause. The good news about that almost always you know it because you either see bright red blood when you wipe or you see bright red blood in the toilet. That's an easy one. But the point is don't just take iron for the purpose of taking iron. Are there symptoms [clears throat] of low iron? Well, there are numerous symptoms for low iron. you know, constant fatigue that sleep doesn't fix, brain fog and trouble concentrating, uh, feeling cold all the time, uh, shortness of breath, or you notice your exercise tolerance has changed dramatically. Sometimes low iron can show up with brittle nails, hair thinning, pale skin. Somebody goes, "Oh, you look pretty pale." That's some of the most common signs of low iron. So, it's a real thing. But just because you're fatigued or just because you're tired all the time doesn't mean you need an iron pill. You need a further investigation.