Dr. Justin Marchegiani and Baris Harvey tackle the different types of anemia and how it causes fatigue, thyroid and/or adrenal problems. More specifically, they discuss in detail about the differences of microcytic anemia, macrocytic anemia, iron-based anemia, and pernicious anemia. We also explore the different iron supplements as well as the available functional medicine treatments used to combat anemia.
Find out about the kinds of lab tests to detect anemia and the various markers you need to take notes of, as well as know more about the different types of B vitamins necessary and their functions revolving around the issue of anemia. Dr. Justin also shares with us the foods you can take where you can get iron the most.
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Baris Harvey: Thank you guys for tuning to another episode of Beyond Wellness Radio. In today’s show we are talking about anemia and I know this is an issue for a lot of people, so first off, I wanna say thank you guys for tuning in and how’s it going today, Dr. Justin?
Dr. Justin Marchegiani: Baris, it’s going great, and actually just for everyone at home, we’re on location today. Baris is in Austin, Texas and we couldn't quite figure out how to record it on the same computer in the same room, so Baris is actually in my family room while I'm across my house in my office, so it kinda feels weird but it's quite–I just thought everyone would like to appreciate that little bit of side info.
Baris Harvey: Yeah, definitely. If I were to get up–I’m too comfortable now. But if I were to get up, I can peek over and send after this thingie.
Dr. Justin Marchegiani: I know. I got you set up on the recliner with some mixed nuts and the fan going in, so you’re–I think you’re dialed in.
Baris Harvey: Oh, yeah. I'm ready to roll. This is probably gonna be the one of the best, at least in my perspective, one of the best podcast.
Dr. Justin Marchegiani: Yes, I think so, too. And I also wanted to let everyone know that we’re gonna have all of the podcasts moving forward dictated with show notes, with kind of a summary, full translation, YouTube and podcast mp3. So moving forward, just adding that full service because you’ve demanded, we've listened, and we're trying to provide the best service possible. So you can go to beyondwellnessradio.com, and that will forward over to justinhealth.com/podcast where all the podcasts will be housed. So feel free. You can go to the old URL which forwards over or the new one which is justinhealth.com/podcast.
Baris Harvey: Yeah, definitely. So and we made it more simplistic for you guys and over there at Dr. Justin’s justinhealth.com, there’s a lot of blog content that you can read up on as well, so this makes it easier for you guys to get access to the information that you need. So, of course, the first question has to be–
Dr. Justin Marchegiani: Oh and I also wanna say one thing, we also–we’re gonna have some links there, too, to your site as well.
Baris Harvey: Oh, yeah.
Dr. Justin Marchegiani: Would you mind sharing your site, Baris?
Baris Harvey: Yeah, so I have the healthatarians.com which is going through some changes right now and same thing with the reallyhealthynow.com. But there's a lot of cool changes going on, and so I'm excited and I'm excited to share those. With that being said, what did you have for breakfast today? And we can even maybe talk about lunch because we’re actually doing an afternoon pod–is this–this is like one of the first afternoon podcast–
Dr. Justin Marchegiani: Yeah. It’s actually 5 o’clock now, so it’s almost night.
Baris Harvey: Yeah.
Dr. Justin Marchegiani: Well, today was a just a–today was a bulletproof fasting day, MCT, butter, coffee but you were here for lunch and lunch was–I just had my rotisserie chicken I just picked off all the extra meat around the chicken and had an avocado, and then we’re like, “Oh, shoot, I–we gotta get this podcast going, so I did 4 grass-fed or pasture-fed, I should say, organic eggs, rocky style, down them.
Baris Harvey: Uh-hmm.
Dr. Justin Marchegiani: And then I had a tablespoon of butter and a carrot and that was it, and then I–my cat ate lunch with me as well and I gave him some of the carcass and paleo kitty also got a little scoop of grass-fed butter that he downed in a second.
Baris Harvey: Oh, yeah. I looked over and he was–he was all over it.
Dr. Justin Marchegiani: Oh, absolutely.
Baris Harvey: Carnivores gotta get there–gotta get there meat in, right?
Dr. Justin Marchegiani: Absolutely.
Baris Harvey: Definitely.
Dr. Justin Marchegiani: And my cat’s get the best, right? They’re spoiled, they’re picky as heck, but they eat grain-free, they–I try to go as organic and clean, but you know, they get picky, so I gotta find something they actually eat but also, you know, meets good standards.
Baris Harvey: Sounds–sounds like my puppy. My puppy is very, very picky. He actually eats what we eat. Oftentimes, he doesn’t even eat the food if it’s cold.
Dr. Justin Marchegiani: Yup.
Baris Harvey: It needs to be like–he looks at me like, “Well, why is your–why is your steak warm? I want my steak just as warm.” And I’m like, “Oh, you picky dog.” But he’s a happy dog though so that's–that’s what matters.
Dr. Justin Marchegiani: That's good and that's pretty rare. Typically dogs will eat almost anything.
Baris Harvey: Yeah.
Dr. Justin Marchegiani: You got–you got a high maintenance pup.
Baris Harvey: Oh, yeah. We–we like to say that is a very bougie dog. Yeah, definitely. So, alright I had one of those simple days as well where I just had–when I came over, I literally had a can of some salmon, looked like tuna but it was–
Dr. Justin Marchegiani: Yup.
Baris Harvey: Some salmon in there.
Dr. Justin Marchegiani: Oh, that’s what that was, okay.
Baris Harvey: Okay. And just–and you had that Latino hot sauce that I love.
Dr. Justin Marchegiani: Yes.
Baris Harvey: So I was like–I saw that in your fridge, “Ooh!” I had to put the–yeah, the hot sauce and it just makes it all– makes it all beautiful. So I had some of that and had a–had a protein shake that you had here. But because–because we always get on these Fridays, our–our meals are kinda boring. I wanna tell you what I ate last Friday coming out here to Austin. I actually got taken out by Garrett who was–if you guys listened to one of our older podcast, we had him on the show, and there's a pork chop place out here which is amazing and it’s called Perry’s. So if you guys ever get the chance to come down here, it’s beyond belief.
Dr. Justin Marchegiani: Nice.
Baris Harvey: So all this red meat talk really has me excited–excited to talk about anemia.
Dr. Justin Marchegiani: Love it.
Baris Harvey: So–so we have a lot of people–and this is–this is something that's close to home for me. I hadn’t had anemia but personally in the past, even some recently as well, had times where I've been lightheaded and maybe because I’m very active and–
Dr. Justin Marchegiani: Yeah.
Baris Harvey: And maybe not had the nutrient base that I needed but I've had times where I've been lightheaded. I have fainted before in the past. My sister has fainted and she is anemic and she takes certain iron supplements and the same thing with my mom. But there's other things that I've been working with them to start–help them. They started change and they're seeing improvements and that’s also about the type of supplementation.
Dr. Justin Marchegiani: Uh-hmm.
Baris Harvey: But with that being said, there's so many people that are dealing with anemia. Before we just kinda go–go into it and devour it. Let’s get a little bit of the overview. I think the general idea is people just know that, “Hey, my blood doesn’t–isn’t working right.” And that’s kinda all people know is like iron and for some reason my blood and iron, but there's so much to it. So we'll go ahead and break down what’s–what’s kind of happening with anemia.
Dr. Justin Marchegiani: So anemia is basically just like result–it's basically blood that's just not healthy.
Baris Harvey: Uh-hmm.
Dr. Justin Marchegiani: It’s either too big or too small to keep it simple and we have genetic forms of anemia like thalassemia or sickle cell anemia. Things like that which are maybe more genetic-based. But for this show, we're gonna just keep it simple, alright? We have our–our microcytic anemia, right? Microcytic hypochromic, that’s the technical term. We keep it real simple here. It’s your iron-based anemia where the red blood cells get small, okay? And then we have our big cell anemia or a macrocytic anemia. Macrocytic normochromic anemia or a megaloblastic anemia and this tends to be where there's B-vitamin deficiency, in particular B12, folate, and sometimes B6. So B12, folate, B6. So those are the two different kinds of anemia just generally speaking then we can go into what they–what that actually means from a medical perspective.
Baris Harvey: Okay, definitely. So nutria–you mentioned that either our red blood cells are too big or too small. What is the importance in that? Because this is something that I know people dive into anatomy and really get deep into nutrition–and how the body works, don’t know well that blood’s supposed to be carrying in oxygen and the hemoglobin carries oxygen and that's what matters. So it's almost like a boat going down the river trying to carry–carry the fuel to–to the rest of our body. So not having right iron, not having the right B vitamins. What are some of the big symptoms of not having the proper type of blood flowing through you? Almost like your–your stream in your body. What would be some of issues in there?
Dr. Justin Marchegiani: Great question. So one of the first things that we're gonna see with anemia that most people are fully aware of is just fatigue.
Baris Harvey: Uh-hmm.
Dr. Justin Marchegiani: Because think about it, right? Especially when we're dealing with an iron-based anemia where the cells are too small, the red blood cells are too small. So if we’re–we run a blood test, one of the first then we're gonna see on our typical CBC, is we're gonna see three values called red blood cells, RBC's, hematocrit and hemoglobin, okay?
Baris Harvey: Uh-hmm.
Dr. Justin Marchegiani: And these markers tend to be a little bit on the lower side when we have iron-based anemia. Those are the first things we'll see. We'll see red blood cells almost below 4. We’ll see hemoglobin, you know, below 12. We'll see hematocrit in the lower range, the lower 10% in the range, 20% of the range as well. So that gives us a good starting point that we're starting to be low in iron. And again there are other markers that can give us earlier detection as well such as our iron markers like TIBC, UIBC, iron saturation, iron serum and ferritin. We're gonna go into those later but I’m just setting the tone there. So regarding the symptoms, getting back to the symptoms now, Baris.
Baris Harvey: Uh-hmm.
Dr. Justin Marchegiani: Fatigue is a big one because with iron-based anemia, the iron is essential to being attached to the hemoglobin to carry oxygen. So many of us go back to high school science class where we have the candle and then we light a candle. We put the mason jar on top of the candle.
Baris Harvey: Uh-hmm.
Dr. Justin Marchegiani: One of the biggest things that we see is the candle goes out in just a matter of time.
Baris Harvey: Uh-hmm.
Dr. Justin Marchegiani: So that's one of the big things we see. So that's important because if we're not carrying oxygen, we're not going to be able to have cellular metabolism because we need oxygen for that to happen.
Baris Harvey: Uh-hmm.
Dr. Justin Marchegiani: Does that make sense?
Baris Harvey: Yeah, so I guess in the inverse way I was actually just telling someone the other day, don’t fight fire with fire. Deprive it of its oxygen and then it–and then it has no fuel. That’s what you wouldn't want to happen in your body though. You wouldn’t wanna deprive your body of this essential–I think a good way to–to structure, to really have a paradigm shift for people is to start thinking of oxygen almost as a nutrient.
Dr. Justin Marchegiani: Yeah.
Baris Harvey: If people of it that way all of a sudden it starts becoming, “Oh, I mean it's just air.” It’s like, “No.” If someone, you know, put you in a choke hold and put pressure right on that, you know, right on your neck, all of a sudden you're blocking those veins from getting the oxygen to your brain, I mean you can go–you can go, maybe if you're, you know, really die-hard and have a good metabolism about a month without food, maybe a week without water, but 10 minutes without oxygen, I don't know if you're coming back, buddy. Right?
Dr. Justin Marchegiani: Yeah, I would say 3 minutes maybe. The most without oxygen, forget it. You got some brain damage–
Baris Harvey: Oh, yeah.
Dr. Justin Marchegiani: Going on.
Baris Harvey: Oh, yeah, definitely. So we know that, if we kinda restructure the idea of–of oxygen being one of the–one of that base metabolic like nutrient, we kinda start to pay a bit more attention to this, because I know some people are just, “Ahh, iron.” But it’s usually the people that have, you know, fainted and just like, “Wait, I just momentarily lost consciousness and found myself on the floor.” That’s dangerous. Those are the people that, okay, “I hit rock bottom.” That’s not a good feeling.
Dr. Justin Marchegiani: Uh-hmm.
Baris Harvey: What’s next? And we know and we know it's not just iron, right? It could be other, other things. So you mentioned the fatigue.
Dr. Justin Marchegiani: Yeah, we’re also gonna see things like waking, because–
Baris Harvey: Yeah.
Dr. Justin Marchegiani: You know, metabolism is so tied in to being able to carry oxygen for aerobic respiration, also depression, leaky gut, low thyroid because we need iron to make thyroid hormones.
Baris Harvey: Uh-hmm.
Dr. Justin Marchegiani: And again, a lot of times celiac or gluten sensitivity because a lot of times people that are low in iron, a lot of times they’re gut is inflamed and they’re just not able to absorb the minerals because of inflammation in the gut and/or low stomach acid. So there’s a lot of different things that can drive this whole entire symptomatology around anemia.
Baris Harvey: Yeah, definitely. From an athlete's perspective, I mean, knowing how a lot of this iron is gonna be coming from like the really dark, dark leafy greens or like the darker meats and we know what are our muscles, what are some of the issues that you might see with–I know that you might have worked with a significant amount of athletes and also a lot of female athletes who might even be more prone to having anemia, what are some of the first key things that they start noticing?
Dr. Justin Marchegiani: Well, again, we're gonna see the recovery issues, the waking, the depression, energy is gonna be a big one, circulation, feeling cold, right? Again, as an athlete–
Baris Harvey: Yes.
Dr. Justin Marchegiani: They gotta create energy and if we're not creating energy, there's going to be a ton of problem, so I wanna differentiate a thing–couple of things because we’re talking about iron-based anemia now–
Baris Harvey: Uh-hmm.
Dr. Justin Marchegiani: And we’ll shift gears to B12 or B-vitamin anemia shortly, but regarding iron anemia, you're gonna see it more frequently in females.
Baris Harvey: Uh-hmm.
Dr. Justin Marchegiani: Just to be straight up and the reason why is because women menstruate every month.
Baris Harvey: Uh-hmm.
Dr. Justin Marchegiani: Guys don't. So a lot of the problems I have with my guys is they’re gonna have excessive iron. That’s a big one.
Baris Harvey: Yup.
Dr. Justin Marchegiani: Because we don’t menstruate. So when guys have iron anemias, it’s a problem. Most of the time it's gonna be because they’re vegetarian. They’re not eating red meat. They’re not eating in general. They're more plant-based. That's gonna be number one. Number two is you’re gonna see guys that are celiac or really gut inflamed, massive, massive leaky guts. And these are gonna be people that you’re gonna–they’re just not absorbing it and/or have low stomach acid. So number one is kinda leaky gut, gut inflammation. Number two is gonna be more diet-based.
Baris Harvey: Uh-hmm.
Dr. Justin Marchegiani: Okay. That’s–
Baris Harvey: And–
Dr. Justin Marchegiani: Yeah.
Baris Harvey: Yeah and I wanna say something really quick because I know that there was a point someone made to me the other day about like the acid-alkaline thing and yes, we do wanna be more overall alkaline in our body, so greens are great for you, but different parts of our body are different pH and I don’t know if you, you know, have seen different metals in–in its entirety like maybe not in food, but just–but if you look at that, you’ll know that you can’t just throw that in a balanced solution like water and expect that to dissolve and break down. Not saying that we’re–I’m eating, you know, like quarters and coins, and other metals, but like we have to remember that these minerals, I mean they're not the same. They’re in a smaller area but for us to actually have that reaction happen, our stomach has to be–has to have the right environment to break that down and actually draw from the nutrients. A lot of people just think that they can just take a supplement in and bam, “Okay, my iron’s up.” But if you–what if you, you went to the bathroom and you saw that–it’s just the same way when if you eat corn and you see corn came out like–
Dr. Justin Marchegiani: Yeah.
Baris Harvey: It didn’t become a part of you. It’s the same thing as throwing up, right?
Dr. Justin Marchegiani: There’s actually–
Baris Harvey: From the back, yeah.
Dr. Justin Marchegiani: Yeah, there’s actually a condition called pica, where people are nutritionally deficient and they’re eating like crazy stuff because they’re body is just freaking out in trying to get these minerals especially iron anemia. Iron and zinc is a big one.
Baris Harvey: Uh-hmm.
Dr. Justin Marchegiani: But like these people will literally eat animal feces. They’ll eat like paper clips or paint, or they–a common one, you see it a lot, a clinical diagnostic indicator and it’s a little bit more normal, is people chewing on ice. That’s a good one.
Baris Harvey: Uh-hmm.
Dr. Justin Marchegiani: Sand, dirt, animal feces, those probably are, you know, you’re probably–you’re probably not hanging out with people that are eating animal feces especially if it’s, you know, someone close to you. You’re probably, that’s probably on your radar screen, so you–
Baris Harvey: I–it’s funny that you mentioned that not that I know anybody personally that’s done that just–but I did notice that the other day on TV, not the other day, it was probably a couple of months, I always use that term. But it’s funny because one side of me was like, “Oh, that person must be insane.” But the other side of me was like, “What innately in their body?” The same way a dog that’s being fed garbage just says like, “Hey, I’m just gonna start eating this grass because I have to look somewhere.” Like what innately is telling their body and saying, “Hey, dude, I don’t know what you’re eating, but go eat that poop, because at least it’s–it’s, you gotta be eating,” like something has to be breaking down in your body so bad for your body to say, “Hey, maybe, you know, whatever the–,” maybe there’s a little bit of good stuff left that the dog didn’t absorb–
Dr. Justin Marchegiani: Right.
Baris Harvey: And hopefully it isn’t that poop.
Dr. Justin Marchegiani: Yeah, exactly. So look at that right there, so we wanna be eating things that are observable. So when it comes to iron, animal products are gonna be the best. I mean, you gonna have some non-heme iron sources in vegetables especially spinach and your greens, but it's not gonna have the effect of really–of increasing your overall iron levels like animal products will.
Baris Harvey: Uh-hmm.
Dr. Justin Marchegiani: Definitely not and the same thing when it comes to B12. But again you can have some effect with vegetarian sources, but your best bang for your buck is going to be animal sources especially darker cuts of meat. So that's a real important thing and when it comes to looking at the iron–I already gave you a couple of markers, let’s continue to piggyback on that.
Baris Harvey: Uh-hmm.
Dr. Justin Marchegiani: So in case anyone look at their lab test out there and they're dealing with some of these symptoms, we also want to look at MCV, right? MCV is a–it's your mean corpuscular volume. So it's looking at how big the hemoglobin is or how big your red blood cells are. So if that’s small it starts to be a sign of iron deficiency. Also mean corpuscular hemoglobin, MCH, and then even our MCHC. When these get lower, right? This starts to be a sign of iron deficiency. And I'll give you a couple of markers here. When we go below 82 on MCV, that’s a big one, 82. So check the show notes for these on the flip side if you wanna refer back, to below 27 on the MCH and below 32 you on the MCHC. So you'll have the translation to review this, but this is–when we combine the red blood cells, the hemoglobin, hematocrit, the MCV, MCHC, MCH, we have a pretty good window at what markers we’re looking at to get a window how our iron levels are. So that’s–that’s number one right there and then number two, we can dig a little bit deeper at some of these other markers here called ferritin, okay?
Baris Harvey: Uh-hmm.
Dr. Justin Marchegiani: Ferritin is a storage form of iron. It’s kinda like 25-hydroxy D. 25-hydroxy D is the marker we'll use to look at our vitamin D which is really important–we got a whole bunch of podcast and videos on that already, so refer back to those, we’ll have that in the show notes. Vitamin D is really important. So ferritin is analogous to our 25-hydroxy vitamin D test. So it’ll get us a good window of storage form of iron. And we’ll even look at this iron-binding proteins such as UIBC and TIBC, and these markers are interesting because they are binding proteins. So imagine when the body wants more iron, these markers actually go up. So you think they may go down, but they actually go up because the body is trying to get more efficient at grabbing for iron. So low iron, we see higher amounts of these you UIBC and TIBC protein markers, okay? And then we’ll also start to see serum iron drop and we'll start to see iron saturation drop, but a lot of times your conventional doctors won’t run this type of comprehensive panel and I see it many times every week, there's always a least one or two anemics that come into my office. When we run this full comprehensive panel and only one or two markers show up, or we start to see them drop at the lower end of the range. So with functional medicine evaluation, we can pull, you know, these people and–into the diagnostic criteria–
Baris Harvey: Uh-hmm.
Dr. Justin Marchegiani: Because we’re using the more sensitive testing. So it’s really helpful because we can pick them up before it’s a big problem.
Baris Harvey: Yeah, and then with that testing, to, where you’re able to do is, is kinda track because if people really take a close look at the way that physiology and homeostasis and even things that really small levels are even at really big levels just like how the sun rises and sets, things usually go–goes in curves, and that’s one on the big issues that I see when people go into their–their doctors and their–their normal–their lab tests look normal, the only thing is you can’t tell if it’s going–like they’re usually getting caught on the way down, so it gets back into, “Oh, it’s in that normal range but what direction?” People usually don't notice that so like you mentioned, it could be because it–you know, your body starts to elevate those numbers because it's–it has to overcompensate at a certain point and eventually it can only hold up so much and those systems start to break down and when those numbers starts to fall back down, your doctor says, “Oh, look, you're in the normal range.”
Dr. Justin Marchegiani: Right.
Baris Harvey: Maybe not, right?
Dr. Justin Marchegiani: Exactly. And then let me just piggyback on that and just give some of the other markers here. So when we're talking about ferritin, that’s the storage form of iron, any time we go below 30 on ferritin test, that's a sign up of lower iron. That’s a sign of lower iron right there. Also when your iron serum is below 85 and when our iron saturation is below 20. Those are some good markers. So review the show notes to get those dialed in but if you look at your blood work and you see any those, then we got some problems. And if you're eating meat already especially red meat and you're already eating leafy greens, then we get some serious because we got some gut infections going on here. We got some low stomach acid and more than likely some serious gut inflammation on top of that.
Baris Harvey: Yeah, definitely. Now I have a personal question. Will measuring your oxygen saturation, like if you have one of those little, here I don't know why I can’t–
Dr. Justin Marchegiani: Yes.
Baris Harvey: I think–
Dr. Justin Marchegiani: A pulse oximeter.
Baris Harvey: Pulse oximeter, there you go. Will having that around, because they’re not that expensive–
Dr. Justin Marchegiani: Uh-hmm.
Baris Harvey: You can go into like Walgreen’s or CVS and find one. If you know that there's an athlete or maybe–or just someone with these symptoms. Will having something like that be a good tracking tool for them?
Dr. Justin Marchegiani: Well, it could be. I mean, when I am adjusting and working with patients on a function neurological level, we’ll even put a pulse ox on them to see where their–where their O2 saturation is. And just for everyone, a pulse oximeter, if you go on Amazon, it's a little device that clips on to your finger and it tells you your oxygen saturation, and ideally you want to be upwards of, you know, 97-98 ideally and when they see people drop below 95, 94, 93, it starts getting into the danger zone and we’ll even cut the treatment off depending on where they’re at if they’re that low, because they’re just not gonna have enough oxygen and be able to generate enough ATP to withstand the stimulus of the treatment. So it can be a good indicator but the blood tests are gonna be the most important to get a complete clinical picture of what's going on.
Baris Harvey: Uh-hmm. Definitely. Okay, now let’s switch gears a little bit, and it’s funny, too, because a lot of this stuff is gonna come from the same food base. But B vitamin deficiency.
Dr. Justin Marchegiani: Yeah, well, let me just–let me–I think that’s a great idea. I forgot to talk about iron supplementation though.
Baris Harvey: Oh, yeah, yeah, yeah.
Dr. Justin Marchegiani: Yeah.
Baris Harvey: Let’s go there, so–
Dr. Justin Marchegiani: So–
Baris Harvey: First of all, we always wanna mention because sometimes we assume that the nutrition is right, we want to make that assumption because we believe that you guys are gonna make sure you're eating the right foods first. So we just–we start to go at the supplementation, it's not because we're saying, “Hey, do the supplementation, that’s it. You're good. We’re seeing if you’re doing the diet parts first–
Dr. Justin Marchegiani: Yes.
Baris Harvey: And the lifestyle parts first, and you're still having these issues, then maybe you just need kind of that that kickstarter.
Dr. Justin Marchegiani: Yes.
Baris Harvey: And that supplementation to get you back on the right track. It's not always for everything, sometimes you do need to take some certain supplements forever, but some things are just take get you back into momentum–
Dr. Justin Marchegiani: Yeah.
Baris Harvey: So, that just is a premise but definitely, let's dive into the supplementation because I know there are the general ones that you can just walk into this–the doctor’s office and pick up for like–because iron isn't that expensive but the ones that are like $2, like those are even–can be very constipating–
Dr. Justin Marchegiani: Uh-hmm.
Baris Harvey: Don’t–don’t break down very well, could even have negative effects. So what are–is someone to do when looking out for an iron supplement? What should they be looking for?
Dr. Justin Marchegiani: So when it comes to iron supplementation. Well, number one, you wanna make sure that whenever you take an iron supplementation, you wanna make sure you have a finger or pulse on what the underlying cause is, okay?
Baris Harvey: Uh-hmm.
Dr. Justin Marchegiani: So if you're a vegetarian or vegan and you've made a decision that you're just not gonna incorporate meat, well, I think you're missing out because there’s a lot of meat–there’s a lot of good nutrients that are in meat that you're not gonna be able to get in certain vegetarian products. So–but if you've come to that decision and that's where you're at and you’re at peace with that, well, you might want to add in some high-quality iron support to keep your iron levels within the normal ranges that I mentioned. So first thing we can do something like liver, predigested liver–
Baris Harvey: Uh-hmm.
Dr. Justin Marchegiani: Or whole liver capsules, again depending on if you’re vegetarian vegan that may probably won't work, but some people can wrap your head around it, well, if it’s in a pill, it’s okay, it's more medicine. So if that works for you, good quality liver capsules. That's a great start in the right direction. If not, we can do a chelated version of iron called ferrous glycinate. Ferrous glycinate is a really highly absorbable amino acid call glycine bound to an iron molecule. So when we do these chelation blend, they tend to work much better because the body soaks up the amino acid and absorbs it much better without causing constipation.
Baris Harvey: Uh-hmm.
Dr. Justin Marchegiani: Because your conventional iron supplementation is ferrous sulfate that you get at the doctor’s office will get your stools nice and black and you just constipate yeah a lot of times, so not the best to start off the bat. So we have our ferrous glycinate. There’s also some ferrous succinate, and then for a good vegetarian source as well there's a product called
Floradix.
Baris Harvey: Yes.
Dr. Justin Marchegiani: F-L-O-R-A-D-I-X. That’s been around for about a hundred years and they have a vegetarian form of one and it’s liquid, too. So that can be a really good helpful kind of option. I go with the amino acid chelates because they absorb really well. And we’ll talk about the females. The females, I have a little bit different of approach to than my typical male counterparts just because of their cycle and what's driving iron can be a little bit different and more punctuated in females. So those are the blends right there. We have the iron chelates, succinic; we have glycinate, we have liver, we have Floradix.
Baris Harvey: Yeah. And one thing I might wanna add in is EPIC bar is coming out with a–with a liver bar that actually–if you’ve tasted EPIC bar stuff, they’re actually really good and their liver one was actually good. And you don't really, you know, usually you think of liver and it's like, “Oh, it has that funny texture.” So I guess today's unofficial sponsor of the day would be EPIC bar.
Dr. Justin Marchegiani: We’re definitely gonna have to call them and hit them up for some free product after the show, I think.
Baris Harvey: Oh, yeah. We might as well.
Dr. Justin Marchegiani: Absolutely. So we kinda talked about, you know, the scenarios there, right? Vegetarian, vegan, that type of, you know, more of a nutritional dietary intervention issue, so something that works fine. Now what if we have a whole bunch of inflammation. Well, if we got a whole bunch inflammation going on with some low iron and we run a comprehensive test that looks at some inflammatory markers like fibrinogen or let’s say C-reactive protein or elevated homocysteine, we may wanna be careful of adding iron back into the protocol because that can actually create more inflammation by throwing iron in there. Think about iron as like gasoline on the fire. Now with our female patients, it’s a little bit different because there’s a couple extra variables regarding females. So the advice I just gave already applies but there’s another element and that is hormones. So a lot of times most female patients are having iron anemia because they’re menstruating too much. They’re having too much bleeding right at the end of their cycle which starts their new cycle essentially. So the biggest driving factor of that is estrogen dominance. When we have higher amount of estrogen, typically our ratio is about 25 to 24 times more progesterone to estrogen. And when we start going below that ratio, right? As we start having 20, 15, 16, 13 times progesterone to estrogen, when that that ratio starts dropping beneath 20 or so, we start to go on this estrogen dominance-like state and that throws off our hormones because now that ratios aren’t correct. And when we start menstruating, right? The drop in hormones at the end of the cycle is now delayed. We don’t have that punctuated drop and that can drive prolonged bleeding. And what’s prolonged bleeding? When we’re bleeding more, three days or more a lot of times, when we're going through 4 for more tampons a day. If you’re going–using pads for the most part, it's not an issue, just one or two maybe three tampons, not a huge deal. Once we go beyond three days and we're doing at least for tampons a day, that’s an excessive menstruation and that could be driving a lot of the anemia. So when that situation comes, one of the things we do with most of our female patients is we eat–we consume liver while we’re menstruating. Consuming liver while we’re menstruating, we up the iron supplementation while menstruating, we continue taking iron throughout the cycle but we have to put our focus on the female hormones and getting them balance so we don't have this estrogen dominance driving this excessive menstruation.
Baris Harvey: Yeah, basically, women take–take care yourself, love yourself, it’s okay to–just like you said you have to eat those. You know, some people, “Oh, the liver.” Traditionally in other cultures, if you’re about to get pregnant, well, it’s time to–we’re gonna make sure that we save this liver just for you. I mean I was gonna eat it, but we wanna make sure that the baby comes out healthy, you know, or we’re gonna make sure that we protect the mother and that's super important and if it was any other person that was–like if you slit your arm and your–you bled a normal amount, you just patch it up, you say, “Oh, I’ll be okay.” But if it just excessively start to bleed, you–you would tell yourself, “Hey, this is getting dangerous,” but we sometimes just say like, “Oh, it’s just a heavy flow. It’s uh–.” But like you said we have to be mindful that, “Hey, like our–the blood in our body is literally the river in which nutrients are transported throughout her body and oxygen is transported,” so you mentioned excessive–it’s just normal to bleed but excessive amount, it should be an indication for you to–to look deeper into–to what's actually going on.
Dr. Justin Marchegiani: Absolutely and I wanna just reiterate one more thing because it may have been cut off there in the past, was the fact that we gotta be careful of inflammation, too. For significantly inflamed, I mentioned some of the markers of inflammation. C-reactive protein, elevated fibrinogen, elevated homocysteine. These could be potential signs of inflammation and if we’re significantly inflamed, you gotta be careful in giving any iron supplementation when we’re inflamed because it can drive more inflammation. So we gotta make sure we have our finger on what the underlying cause is and we also have to make sure we have our finger on inflammation, what's happening in our body via inflammation.
Baris Harvey: Yeah, definitely, sounds good. Anything else to add on to the iron side of things?
Dr. Justin Marchegiani: I think we're ready to transition to macrocytic anemia.
Baris Harvey: Let’s go for it. So that’s another one of the big, I want to say issues with a vegan or vegetarian diet. Not that it’s impo–there’s people that can totally do it but you have to be very smart about where you get your supplementation, and that’s one of the big things is B vitamins and–alright, we kind of I guess get this idea that because it's so readily–we make it appear to be so readily available, almost in these little 5-hour ENERGY, people start to forget about how important it really is, they’re “I just get my B vitamins for energy,” but when it comes in that whole complex in food when you're getting, you know, the B12 but also the folate, the B6, and all the other nutrients that you need in there as well makes so much of a difference. So what's happening when someone is B12 or just B vitamin overall deficient? What’s kind of the mechanism going on there?
Dr. Justin Marchegiani: So we're talking about a specific group of B vitamins. We’re talking about B9 and B12. So this is important. B9 is your typical folate. Now there’s a lot of buzz out there on methylation and this whole genetics snip test out there called 23-amino looking at a lot of genes, but a lot of my patients are bringing them in. And one of the key ones we look at is this MTHFR, which stands for methylenetetrahydrofolate reductase. And the -ace at the end of that is indicative of it being an enzyme. All enzymes end in -ace. So this is an important enzyme that’s there to help metabolize folate into activated MTHF folate. Now the issue is a lot of people today are taking folic acid. They’re taking cheap supplements with folic acid in there. They’re taking crappy fortified grains with extra folic acid and they’re gonna have problems metabolizing folic acid into activated folate and could potentially even convert this folic acid downstream to dangerous metabolites. So what’s the take home message? We wanna make sure we’re using methylated B12, if not adenosyl B12, and we wanna make sure that we’re using activated LMTHF folate; this is activated. So then we're getting good absorption. Now on top of that, another important vitamin for methylation is B6 or pyridoxal-5-phosphate, P5P. This is an important B vitamin and P5P or pyridoxal-5-phosphate is an active B6. So if we take good forms of these B vitamins, B6, the folate, the activated folate, the activated methylcobalamin and/or adenosylcobalamin, we're on the right track because then we have activated nutrients and typically with most of my patients that have B vitamin issues, right? B12 for instance, you're not gonna be able to get much B12 in a plant-based diet. It’s just not gonna happen. The B12 analog in plants is not gonna raise your B12 levels and there’s been many healthy vegetarians that are very aware that they have to supplement B12 if they’re gonna go vegetarian or vegan long-term.
Baris Harvey: Yeah, a lot of them that I knew took a weekly B12 shot.
Dr. Justin Marchegiani: Uh-hmm.
Baris Harvey: Which when you take a B12 shot, you feel great. But having a necessity for it, it–you know, it’s not where you necessarily want to be if you have the opportunity to kinda, you know, do a month of a week of booster shots for 4 weeks, then go for it and take that advantage. But to be very extremely dependent on it isn’t great either, so making sure that you are trying to get it through your food is super important and yeah, the only really, really, really rich B12 source I know of in a plant-based which is a little bit more expensive, it’s a healthy food, is spirulina. I know energy bits is a good form in the Hawaiian spirulina and I think there's a health warrior, it would be one more, but those would be some good plant sources, but like you said, besides that, eat some meat. It makes it–may be makes it a little bit easier. So what about the physiology in there? Like why is the lack of B vitamins have–causing this, this problem of anemia? Like what do the B vitamins do inside of the red blood cells in order to have it function properly?
Dr. Justin Marchegiani: Great question, Baris. So B vitamins especially be B9 or folate and B12 and B6, they’re really important for the maturation of the red blood cells. So red blood cells are interesting, right? If we, you know, have a kid, right? It’s–if anyone has a baby out there, right? The baby starts and then grows big. But in the red blood cell world, the red blood cell actually starts out pretty darn big and then it gets smaller as it loses its nucleus. So what happens is we get these big, goofy red blood cells that are not able to lose their nucleus so they stay really, really big. And we have these markers like I mentioned, MCV, MCH, MCHC, these are just markers looking at how big the red blood cell is and when we see MCV, MCH, and MCHC elevated or high, that's a sign that the red blood cells not maturing and there’s potential for B12, folate, and/or B6 issues.
Baris Harvey: Yeah, and just for those again who haven't taken an anatomy class, somebody might hear like, “Wait, red blood cell loses its nucleus, like I thought all cells had that,” just for people out there, the nucleus takes up energy in ATP and that’s probably not the best thing if you need that blood to just be a carrier of the oxygen. You don’t want it to kind of use all the fuel before it gets to its destination, so that’s–if anybody was wondering like, “What the heck Dr. Justin was talking about?” That’s kinda what's happening. It's going from this big like sphere-like thing. If you’ve ever looked in like a microscope, you’ll notice like the more purple looking things that’s when it’s still young and it starts to mature and then it starts to go down and kinda create this almost like this doughnut shape or to this this little like kinda of–reminds of a lifesaver actually.
Dr. Justin Marchegiani: Yeah, it does. It reminds me of a lifesaver, too. So when we see that, right? It’s important because we can use these tests. These blood tests to assess exactly how big your hemoglobin or blood cells are. I just wanna run through those ranges, people that are listening.
Baris Harvey: Yeah.
Dr. Justin Marchegiani: We have our MCV, anything 89.9 and above; MCH at anything at 31.9 and above; MCHC anything at 36 or above. So that’s a good kinda lab range off the bat so you know if you're getting your levels too high and there's a potential B vitamin issue.
Baris Harvey: Uh-hmm.
Dr. Justin Marchegiani: Okay?
Baris Harvey: And in the B vitamins, these are–the solubility of them–solubility of them, it’s water-soluble so it’s not that you're gonna take too big of a risk overdosing on B12 now, will you?
Dr. Justin Marchegiani: Well, B12, a lot of it does get stored in the liver.
Baris Harvey: Uh-hmm.
Dr. Justin Marchegiani: So the liver is a pretty big storage site of B12. That’s why vegetarians can go so long because it will store it. Now other B vitamins, B vitamins are typically water-soluble, so if you excess on them you will over–you will kinda have extra B vitamins in your urine. You’ll the urine get extra yellow. But with B12, it will get stored in the liver and you can store a couple of months’ worth in the liver. So gotta be careful of B12. I typically go with anywhere between 400 to 800 micrograms and we do it sublingually when we’re doing it because we wanna maximize absorption because a lot of B12 issues, they happen because of gut inflammation, too. There’s another element to B12 that’s very unique that we don’t see in iron and that is pernicious anemia. And pernicious anemia is an autoimmune condition regarding the parietal cells. The parietal cells are the cells in your stomach that produces compound called intrinsic factor. An intrinsic factor binds to B12 and then it goes down in your intestinal tract and gets absorbed in your ileum at the very end of your intestine. So duodenum, jejunum, ileum, the very end of your small intestine. Now if we have this autoimmune condition where it’s destroying intrinsic factor, well, you’re not gonna be able to tag that B12 and absorb it downstream in the small intestine. So pernicious anemia is vital because if we don't rule that out, we could be giving B12 ‘til the cows come home, but the intrinsic factor to absorb it isn't there.
Baris Harvey: And then so these are the people that–not only should they be taking a sublingual, it’s probably like a necessity, or these are the people that might even, where I was talking about to be an auction earlier, might even need the B12 injections, is that correct?
Dr. Justin Marchegiani: Yeah, these is where B12 injections could be really, really helpful with a condition like this, that’s shown that some of the sublingual may also bypass some of that because you can get into the bloodstream through the losenger or drop form.
Baris Harvey: Uh-hmm.
Dr. Justin Marchegiani: But again it's really important, if that's the case we wanna do the right test to know if that's the case. So we wanna run intrinsic factor antibodies and we wanna run the parietal cell antibodies. And it’s important because 25% of Hashimoto’s patients have this issue. So again, the sicker you get, the more we have these issues and the more we have the issues, the sicker you get. So it's kinda like, you know, that if you're not feeling too good, the chances are that you have other elements like the ones we were talking about with the pernicious anemia, the chances are very strong. So you wanna be working with a good functional medicine doctor that can run these tests and rule these other variables out.
Baris Harvey: Yeah, definitely because at that point if you're still dealing with these hidden levels of stressors, you can be–you can be like a dog chasing its tail. You’re just reaching for the symptoms. So you wanna make sure that you’re not just, you know, spending that much money on supplements or you can even be eating the right foods but if your body is not breaking them down correctly, if you don't have the right–if your gut is not breaking it down, you’re not actually absorbing those foods then you’re not actually healing. So you wanna make sure that you're removing the things that are–that are in your way and blocking you from healing, right?
Dr. Justin Marchegiani: Yeah, that may be cutting out gluten, right? It may be maximizing glutathione and vitamin D to help with the autoimmunity. I mean, these are vital things. Even though they don’t necessarily deal with taking the actual nutrient but they have amazing effect on cooling down the immune response that may be driving a pernicious anemia. So on that note, we have serum B12. And I’ll
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In this episode, we review:
07: 29 What is anemia
12: 55 What causes anemia
19:10 How to test for anemia
25:21 Whats the functional medicine treatment for anemia
47:38 What does anemia really mean.