Iron deficiency in women, especially during the perimenopausal age, can lead to symptoms such as fatigue, difficulty breathing, and heavy menstrual bleeding. The root causes can include hormonal imbalances, vegan/vegetarian diets, and poor digestion. Functional medicine approaches include optimizing iron intake from heme sources, improving absorption, and addressing underlying issues such as estrogen dominance and inflammation.
💡 Iron deficiency in women can be caused by hormonal imbalances, vegan/vegetarian diets, and poor digestion. Addressing these root causes is crucial for resolving the issue.
💡 Assessing iron levels through ferritin and iron saturation provides a more comprehensive understanding of overall iron stores and helps guide treatment approaches.
💡 Optimizing iron intake from heme sources, such as grass-fed organic red meat, and improving absorption through co-factors like vitamin C can support iron levels in women.
💡 Progesterone supplementation can help balance hormones and address estrogen dominance, a common issue in women with iron deficiency.
💡 Addressing gut health, managing stress, and reducing exposure to phytoestrogens and xenoestrogens are important factors in preventing and treating iron deficiency in women.
💡 Functional medicine approaches focus on identifying and addressing the underlying causes of iron deficiency, providing personalized treatment plans for each patient.
💡 Regular monitoring and adjustment of treatment protocols are necessary to ensure optimal iron levels and overall health in women with iron deficiency.
Dr. Justin Marchegiani: Hey guys, it's Dr. Justin Marchegiani. Welcome to the Beyond Wellness Radio podcast. Feel free and head over to justinhealth. com. We have all of our podcast transcriptions there, as well as video series on different health topics ranging from thyroid to hormones, ketogenic diets, and gluten. While you're there, you can also schedule a consult with myself, Dr.
Dr. Justin Marchegiani: J, and or our colleagues and staff to help dive into any pressing health issues you really want to get to the root cause on. Again, if you enjoy the podcast, feel free and share the information with friends or family. Hey guys, Dr. Justin Marchegiani here, welcome back to the podcast. We're gonna be talking about all things iron today, especially low iron in females.
Dr. Justin Marchegiani: I got Rob Edwards here from heritagehealth. life, so excited to have Rob back on the podcast. What's going on, man?
Rob Edwards: Hey, good. Hey, everybody. Um, yeah. Thanks for having me back. Appreciate it. I'm excited to jump in to the topic. Um, have a client, of course, my wife that's been dealing with some of this stuff lately.
Rob Edwards: Hey. Hey. And I don't know if she's okay with me saying that, but
Dr. Justin Marchegiani: it's a common issue.
Rob Edwards: We'll dig into it because it's a common issue. It's something that people struggle with, especially getting around the paramenopausal age, which is where she's approaching. Um, and so,
Dr. Justin Marchegiani: but even that you can have this issue and be.
Dr. Justin Marchegiani: A teenager, right? Because, you know, we'll go over the big commonalities of what can drive it, but hormonal imbalances at any age can cause excessive menstruation issues. And again, part of what drives a lot of the topics that I talk about are patient experiences, and this is a common one. So, I'd like to to bring it to a head to you guys so you can see what it looks like kind of as you make the sausage, so to speak.
Rob Edwards: Dr. Justin Marchegiani Absolutely, man. Yeah. Dr. Justin Marchegiani
Dr. Justin Marchegiani: So first thing out of the gate, let me just kind of give a little physiology with iron. So iron is really important for the body. It helps make this protein that binds to red blood cells called hemoglobin that helps carry oxygen. And oxygen is really important for aerobic metabolism.
Dr. Justin Marchegiani: So I'll pull up here on screen just so you guys can see. We have the Krebs cycle. Most of our energy production comes from aerobic metabolism. Pull this up on screen. So, first big thing out of the gate, um, you'll have carbohydrates and you'll have this pyruvic acid. This is like glycolysis right here.
Dr. Justin Marchegiani: Like right this pyruvic to lactic. Uh, this can be anaerobic and aerobic, and there's one pathway you don't even see here. It's called the phosphocreatine pathway. That's like the first 10 or 20 seconds of an extreme movement. Think of a sprint. Think of like a really explosive movement. So these are the only pathways in the body, energetically, that, that, Dr.
Dr. Justin Marchegiani: Justin Marchegiani. Well, the first pathway is the anaerobic. So, anaerobic means that you can generate energy without oxygen. So, anaerobic means without. Now, most of these other pathways, whether it's beta oxidation with fatty acids, whether it's acetyl CoA going into the citric acid cycle, or the electron transport chain where you generate more ATP.
Dr. Justin Marchegiani: This is going to be how you generate energy in the body. And then you can see here, see these little Fe's right here, Fe, Fe, that stands for iron. And so iron comes in specifically into the Krebs cycle and it helps, um, generate, helps run that Krebs cycle as well. But we need to carry oxygen because oxygen is part of the body.
Dr. Justin Marchegiani: that metabolic substrate to run these metabolic pathways. I mean, go back to your high school science class, you have the candle, take a glass jar, you put the glass jar over it, the candle goes out because oxygen is not there, right? You need, you know, oxygen and heat and to maintain that flame, right? And so, in general, we need that same thing for our metabolic pathways.
Dr. Justin Marchegiani: And so, if we kind of just review what metabolism looks like just briefly, you have fatty acids on one side, all funneling down to Acetyl CoA, carbs, Acetyl CoA, proteins, amino acids, acetyl CoA. And then you have this little side pathway here where you can generate a lot of ketones and have ketogenic, uh, ketogenesis with beta hydroxybutyrate.
Dr. Justin Marchegiani: These are ketones. And you can also generate ATP from beta oxidation, which is actually involving a lot of, um, carnitine. So, this is where, this is where we generate a lot of energy. And then most of our energy, then we go into the Krebs cycle or citric acid cycle. This pumps around twice per unit of energy.
Dr. Justin Marchegiani: And each time it goes around, we get three. NADHs and one FADH2. And so, once it pumps around twice, we get six NADHs and then two FADH2s. And all this is doing, it's just grabbing hydrogens. It's called a reduction, right? But reduction is a gain in hydrogens. Oxidation is a loss. So, even though reduction sounds like we're losing something, we're actually gaining hydrogens.
Dr. Justin Marchegiani: So, that's just good. It's science and conventional medicine trying to confuse people. And so, we get all these hydrogens that go through here. These hydrogens then go into the electron transport chain. This is where most of our ATP is. So, we have like two to three units of ATP up here in glycolysis, then we have maybe Another four to six down here in the Krebs cycle, then like 32 or so down here.
Dr. Justin Marchegiani: So about 38 in total. Most of it comes from the electron transport chain. And you can see CoQ10 is involved down here, glutathione. We have a lot of oxidative stress, so vitamin C, very important. So that's generally what's happening in our body metabolically under the hood and how we generate energy. iron plugs in because it's actually a cofactor, but we also need the oxygen because this is aerobic metabolism.
Dr. Justin Marchegiani: Just like we put the glass over the, um, the flame, the fire goes out. Same thing metabolically. Go ahead, Rob. Dr. Justin Marchegiani
Rob Edwards: Yeah. And I think, you know, just hit on that is, you know, this is the organic gases profile. Both Justin and I run these for clients. Dr. Justin Marchegiani You know, they get a lot of insight into what's going on inside of their body whenever they look at this because this is all nutrient deficiencies.
Rob Edwards: And, you know, not understanding, for example, that iron is a part of Um, you know, it, it, it makes them aware. You know, I can't create great energy if I don't have iron, if I don't have magnesium, I don't have B vitamins. So if I'm lacking in these areas, you know, I'm just not going to be able to produce and I'm going to show signs of fatigue, I'm going to be tired.
Rob Edwards: My cells aren't going to be able to function optimally. And you know, the next comes is dysfunction. And of course the final thing is disease sets in. So this is like the beginning of, you know, this is one of the first things that we look at. I think it's one of the first things that you look at it as well.
Rob Edwards: When you have clients coming in is. We wanna know what's going on nutritionally with you. And iron plays a big role with, uh, in, within this cycle.
Dr. Justin Marchegiani: Yes. And just to kind of give a little bit more insight, we run some of these tests on patients, you know, quite frequently, but like with fatty acid metabolism, we could see nutrients like carnitine be very low.
Dr. Justin Marchegiani: So we start to go on the high side here, which means we're depleting carnitine. Mm-Hmm. carnitine is needed to run the carnitine shuttle. So if we were to look at, you know. above here. Just a second. We would have this beta, beta acid or beta oxidation, this fatty acid oxidation, but we're breaking down fat and generating ATP.
Dr. Justin Marchegiani: That happens right here. So we have two ways we utilize fat for fuel. We have this beta oxidation where we are breaking down free fatty acids. And then we also can take these fatty acids and Go through ketogenesis where we just take that glycerol backbone, rip it off the fatty acid, and we have this ketone.
Dr. Justin Marchegiani: And ketones can be used by the body directly. So we have some fatty acids here that are just being burnt up and then generating ATP. And then some over here, we have ketones that can actually be used as fuel directly by the brain, the heart, the brain. deliver even the muscle. So, we have a couple ways that fat could be used, either through fatty acids and the carnitine shuttle and ATP, or through ketogenesis and just making ketones.
Dr. Justin Marchegiani: And ketones are an alternative uh, fuel source. Most people when they hear about ketosis, they think about ketoacidosis. That's totally different. Ketoacidosis is a, at a level typically where you're at 20 to 30 millimoles of ketones. Normally, nutritional ketosis is like 1 to 2. And to really be in ketoacidosis, you have to have Um, Type 1 diabetic, very low insulin levels.
Dr. Justin Marchegiani: Fuel cannot get into the cell. The body freaks out and says, we need to generate an alternative fuel source and makes a whole bunch of ketones. Ketones are so high because they're acidic, right? Keto acid and it lowers the pH of the blood and it puts you in a coma. So that's how that happens. But usually, uh, That's how like a diabetic whose type one passes away because they forget their insulin or their pump falls out in the middle of the night.
Dr. Justin Marchegiani: People that have really severe alcoholism, right? That can be a factor too. And so, we see here, down here, we see the fatty acid metabolism with ketones. These being high means carnitine could be an issue. And with some of the carb metabolism too. So, at the top of that Krebs cycle list, carbs play a big role because pyruvic acid, lactate, um, alpha ketoglutarate, succinate, malate.
Dr. Justin Marchegiani: These all correlate with like CoQ10, B vitamins, alpha lipoic acid, magnesium. And so, when these are high, our metabolism is burning through these at a very, very high level. And so, we gotta make sure we're getting it in our diet. But metabolically, there may be a stress. We may need to supplement additional nutrients in it.
Dr. Justin Marchegiani: So, these are the things we may look at if we have low energy, and we have low iron, and we have an anemia. We may look at some of these nutrients, because they also play a big role. When looking at that Krebs cycle.
Rob Edwards: Yeah, absolutely. So, you know, talking about iron, um, so there's two different, there's two different types of iron.
Rob Edwards: So we got heme and then we got, which is primarily fat, right. Or from animals. And then we have non heme, which is fruits, vegetables, nuts, grains, those kinds of things. And, uh, so I'm curious as to your take, what is your preference? Uh, when people are trying to get up their levels of iron, what's your take on that?
Rob Edwards: Dr.
Dr. Justin Marchegiani: Justin Marchegiani Yeah. So, most of the iron in the body is gonna be from heme based iron. So, your animal based iron. People may say, like vegetarians may say, Oh, look at the back of the bag of the spinach. It's got this much iron in there. Or look at the, you know, the nuts. It's a lot of iron, right? And say, Well, that's gonna help my iron levels come up.
Dr. Justin Marchegiani: Well, most of the iron in your body that makes up ferritin is gonna be your heme based iron. These are going to be your animal based iron. There's a lot of studies on this topic as well. We looked at it. It's like 95 percent of the iron in your body is made up of heme based iron. This is why vegetarians, no matter how good they do, they, a lot of times, can still be anemic.
Dr. Justin Marchegiani: I mean, you can go look at, everyone probably heard, here's the biohacker guy, Brian Johnson. Brian Johnson does a lot of good health things online. Problem is he's also a vegan vegetarian. I think he's making a mistake at that. But if you look at Brian Johnson, his first morning routine is what? He wakes up, he does the red light thing, and then he tests his iron.
Dr. Justin Marchegiani: He's chronically anemic with low iron. He takes iron pills every day. Even his diet that is perfectly crafted, like Brian Johnson's line is, Every food has to fight to get into my diet. That's his big thing. Well, your food's so great, you're chronically anemic. You have to take iron pills. Like, if you're taking iron pills, outside of you losing it because you're menstruating heavy, or outside of you not absorbing it, it means your diet's deficient in something.
Dr. Justin Marchegiani: Because if it was truly good, you would have enough nutrients coming in. And so, iron's in a really important way. I think if Brian Johnson tweaked that and got some grass fed meat in, a couple times a week, he would do so much better. I digress. And so, looking at the iron, yeah. So, you're gonna have your animal sources will be the best.
Dr. Justin Marchegiani: Obviously, things like vitamin C and other cofactors can help improve the absorption of iron. So, having some meat with some salad, having some vegetables with your animal protein, I think, is always good. I think it's a great way to do it. Um, supplementally, you know, we may add in like an iron bisglycinate, which is a great way to improve iron stores.
Dr. Justin Marchegiani: We may even add a heme based iron in, in the form of a liver glandular can be great, too, because you get other co factors like vitamin A and B12, too. Dr. Justin
Rob Edwards: Marchegiani Yeah, and I was reading some research on that as well, some others that kind of help with iron absorption. So, you got yellow duck root, you got nettle leaf, you got nandelion greens, and you got alfalfa.
Rob Edwards: So, there's other supplemental ways you can deal with that, either that or bringing them into your diet. I mean, it's hard to find those things, of course, into your diet. Most of those are going to come in supplementally. Uh, but those are also from an absorption factor. And then I think coming back to your heme, um, it's just keeping it simple is it's compatibility.
Rob Edwards: What are we compatible with? And if it's heme that's within us, it's heme within the animals. That's our compatibility, right? It's sort of like the whole like Apple versus Microsoft, right? I know there's some interplay between that, but it's like one program doesn't run well within another program.
Rob Edwards: Doesn't mean you can't tweak things together and kind of make it work. Right. But it just doesn't work efficiently. So heme iron, I think is a way to go. I think plenty of the data shows that not only that, but clinically, um, you keep, you hear that from people that are dealing with patients from a functional medicine perspective over and over and over again.
Dr. Justin Marchegiani: Dr. Justin Marchegiani 100%. And so getting your high quality animal sources are going to be great. You know, you read me, it's going to be a great way to do it. I recommend four to five servings a week. Just choose some kind of a grass fed organic red meats and it'd be a way to go. Like at least step four at Whole Foods is good.
Dr. Justin Marchegiani: You know, pasture fed, grass fed's good. There's some great sites online, US Wellness Meats or Butcher Box or there's a bunch of, you know, you know, online farms that, that sell um, good high quality animal meat. eatwild. com is a great resource to find some local farms near you. So great options. We'll put some links in the description as well.
Dr. Justin Marchegiani: Also, if you want to get an iron test, you want to get an iron panel, we'll put a link, um, in the description as well. If you want to grab that too, there'll be a link there for y'all.
Rob Edwards: Dr. Justin Marchegiani Yeah. Well, as you can say, let's kind of make a distinction between like ferritin and iron because of course that's, you know, a lot of the traditional conventional medicine still only gets, you know, regular serum, serum iron.
Rob Edwards: Whereas ferritin makes a big difference. So wanted to kind of play with that a little bit.
Dr. Justin Marchegiani: Yeah. So pretty simple, right? Here's my analogy. So you have ferritin is going to be how much money is in the bank. Iron serum is how much money's in your wallet, right? So the best way to assess kind of your overall iron stores is what's in the bank account.
Dr. Justin Marchegiani: We start to see iron, uh, ferritin go low. That's the iron that's in the bank, the money in the bank that tells me that your overall stores of iron are starting to become depleted. Now, over time you will see iron also drop as well. Because that's the money in your wallet. So it makes sense if your money in the bank drops, eventually your money in your wallet will drop.
Dr. Justin Marchegiani: Um, but also you have different binding proteins we look at. Whether it's UIBC, which is an unsaturated iron binding protein, or TIBC, which is a total binding protein, total binding protein incorporates UIBC plus iron serum, and these are inverse markers, so UIBC and TIBC go up when iron levels go low, it's like, uh, It's like, you know, the more hungry you are, the more you're reaching out with more fingers to grab that food, right?
Dr. Justin Marchegiani: It's like, these binding proteins are like, Oh, I really want that iron, and it's really reaching out with all of its fingers and tentacles to grab that iron. So binding proteins are inverse. Um, high binding proteins typically mean low iron. You know, normal binding proteins tend to mean, you know, normal levels of iron, and if it goes really low, it could mean your iron's high, but, you know, typically you're gonna see like ferritin be high or iron serum go high as well.
Dr. Justin Marchegiani: So just usually we're seeing. High binding proteins, um, lower iron levels.
Rob Edwards: Dr. Justin Marchegiani Yeah, and then every once in a while, I know we'll see inside of a, a lab, you'll see high level ferritin, but then iron serum will be low. And uh, you know, can you play on that just a little bit?
Dr. Justin Marchegiani: Dr. Justin Marchegiani Yeah.
Dr. Justin Marchegiani: So first thing is, in practicality, the first thing you're going to see is usually ferritin. The second thing you're usually going to see is iron saturation. Once you have those two markers looked at, like everything else is just like another check mark in the column of like, yeah, you have an iron issue.
Dr. Justin Marchegiani: But let's say UIBC or TIBC looks okay. You're still going to go forward and work on fixing the microcytic hyperchromic anemia, right? That's what we call low iron is a microcytic. You have two major anemias. You have hypo, you have hypochromic microcytic. That just means the iron, the red blood cells are really, really small.
Dr. Justin Marchegiani: Then you have anemias that usually are B vitamin derived, usually B12 derived. Um, how red blood cells mature is they actually like are big and as they mature, they get smaller. Right? And then essentially with low B vitamins, they stay big. They stay big and goofy. They don't mature. And then with red blood cell, with the red blood cells being really, really small when there's no iron, they shrivel up.
Dr. Justin Marchegiani: They become anemic and small because they're missing that good level of hemoglobin protein on that iron, on that um, red blood cell that gives it that strong backbone. So getting back to your question, what was your question again?
Rob Edwards: Well, so it's more, no, the differences between, you know, you could have a high ferritin level.
Rob Edwards: Oh, yes. Yes. So,
Dr. Justin Marchegiani: so Ryan's, uh, uh, iron is also a reactive oxygen species. So it's a powerful oxidizing agent, right? Think, think of like the iron, you know, pipe you'll leave outside or something and it gets rusty, right? Iron oxidizes really well. And so it's a powerful, think of it as like gasoline. And a spark coming near it, right?
Dr. Justin Marchegiani: It can oxidize and it can combust. And so, if you have a lot of inflammation in the body, then iron could potentially go up as an acute intermediary kind of compound due to the oxidation, due to the inflammation. And so, if you're seeing someone who's like really inflamed, lots of pain, lots of symptoms of inflammation, pain, etc.,
Dr. Justin Marchegiani: you may want to run like a CRP. highly sensitive to reactive protein next to it. See how the inflammation is. Look at their clinical signs or symptoms. Um, look at iron serum as well. Because a lot of times, you may see ferritin up and iron's normal. Or the binding proteins may actually be on the higher side too.
Dr. Justin Marchegiani: Or you may even see low red blood cells, low hematocrit, low hemoglobin. Because when you're looking at iron deficiency, the first thing you tend to see is the ferritin and the iron saturation maybe go off. As that gets deeper and deeper and deeper. You'll see the red blood cells start to drop because they're getting smaller, right?
Dr. Justin Marchegiani: Anemic means smaller, so red blood cells start to go below 4 2, 4 1, below 4s, now you're in the 3s. You start to see hemoglobin itself, that's the binding protein that iron binds to, to help carry oxygen. That starts to go below 13. And you may even see hematocrit start to drop somewhere in the mid 30s, right?
Dr. Justin Marchegiani: Hematocrit is another component of that red blood cell. And so, those are the big three things you'll start to see drop. But you could see ferritin potentially high acutely because of that reactive oxygen intermediary compound due to the inflammation. And so, if you see that, you probably don't want to give anyone any additional iron until you get the inflammation down.
Dr. Justin Marchegiani: Again, you gotta, that's kind of more of a clinical pearl for us practitioners. But if you're seeing that you're inflamed, you have a lot of inflammation symptoms. brain fog, a lot of weird inflammation in the body, then you may want to hold off doing supplemental iron. You will get it from your food, your grass and meat, but you will not like take supplemental iron.
Dr. Justin Marchegiani: Dr. Justin Marchegiani
Rob Edwards: Yeah. And in some ways, sometimes what we end up doing too is like, I know with Emily, what we just decided to do is to go every other day. Um, because the other side of iron, I think iron overload as well can cause constipation. Um, In some people, depending on how often they're taking it.
Rob Edwards: So yeah, it can definitely work against you, which comes to the idea of homeostasis, which our body tends to like to work within a homeostasis. Like anything can become toxic for you if it's too much, you know? And so that's the other side of the coin that you're talking about is, you know, if we see high levels, that's, that's an issue on the other side versus the low levels.
Rob Edwards: But for women, which we're talking about today, for women, What are some of the, uh, the symptoms? What are some of the things that they go through? What are we looking? I know with Emily, she had high levels of fatigue, difficult breathing, um, restless leg syndrome, all of sort of the classic signs that you see with low iron.
Rob Edwards: Um, and then of course she had heavy menstrual bleeding. longer than normal. Um, you know, that's sort of her onset of, of what we thought, not just the iron, of course, but the root cause being the fact that she's losing blood. But, um, yeah, just talking about the symptoms and then starting to talk a little bit about the root causes that we oftentimes see women.
Dr. Justin Marchegiani: Yeah. And so obviously anything fatigue wise, brain fog wise, energy wise. uh, out of breath, uh, lower oxygen capacity. If you put a pulse ox on your finger, probably in the low 90s, maybe. Um, you know, you could be moody as well because if your systems aren't carrying oxygen, you know, for your systems to function, you need healthy aerobic metabolism.
Dr. Justin Marchegiani: So, if your mitochondria is not generating energy, it'd probably be easier to be moody, to be anxious, to be depressed. So, all of those symptoms are on the table. Uh, of course, you know, when you look at how a woman develops low iron, like there's three major areas. It could be vegan vegetarian diet, so they're not eating, you know, animal protein.
Dr. Justin Marchegiani: Or if they are, it's like lean, lean, lean white proteins. It's not the darker meats that have more of the rich hemoglobin in there, right? Rich iron, myoglobin, the red meat, right? Or it's gonna be really crummy digestion, not enough enzymes or acids. You need good hydrochloric acid levels to be able to ionize the iron so you can make it soluble and absorb it.
Dr. Justin Marchegiani: And then also, um, estrogen dominance, if you have a lot of hormonal balances. typically estrogen dominance that estrogen ratio to progesterone is off or progesterone is lower relatively speaking that can cause progesterone to drop out a little bit sooner in the cycle and cause prolonged bleeding, heavier bleeding, spotting.
Dr. Justin Marchegiani: Um, you know, typically if a woman's bleeding more than, you know, four, you know, four or more tampons a day, it's probably too much blood. And, you know, usually it's around four to seven days. So if you're bleeding, You know, more than 4 days and you're at more than 3 or 4 tampons, you're gonna be losing a lot of blood, you know, just via your menses.
Dr. Justin Marchegiani: And that's gonna be causing a significant depletion that may take you the whole month to try to get back from it. You know, we saw Emily's ferritin lab, she was around 2, which is just like, once you get single digits, you're like the walking dead. You know, and there's acute ways to do that, you know, we know she's not super inflamed or anything and her CRP's fine, so.
Dr. Justin Marchegiani: An iron transfusion may even be a good acute option because it will literally make her feel like a brand new person. It will make her feel like she slept for a week. And she feels like totally recharged. So, that's good acutely, but that will not fix the underlying issue. So, kind of just kind of highlighting that hormonal imbalances, vegan, vegetarian diet, and um, and absorption.
Dr. Justin Marchegiani: Those are the big three.
Rob Edwards: No, I think in the, those pieces I think are key and essential for, you know, Um, you know, being able to absorb iron, but there's other, there's other things in consideration here. Like, so the, the malabsorption, whether or not your gut can digest in the first place, um, obviously, if you're getting older, you're in your forties, your HCL is oftentimes will reduce your enzymatic activity is reduct is reduced.
Rob Edwards: And so those are the two, two of the things that we put HCL enzymes. Just to start to break down things, make things a little bit easier in terms of the gut. And, you know, most of the people, we haven't got a GI map on her yet, but I'm, I presume just from the amount of people that I've seen. Yep. That you're going to see other things going on that are causing, um, not only, you know, a microbiome issue, but also a digestive issue.
Rob Edwards: So I'm sure she's not probably digesting as much of this stuff as she ought to be. Um, so I think that's another piece of the puzzle. But right off the bat, what we did with her was, uh, Vitek's Chaseberry. Um, and that sort of seemed to slow down things, which is great. Dr. Justin
Dr. Justin Marchegiani: Marchegiani So, but let's break down the mechanism, right?
Dr. Justin Marchegiani: What's, what's Chase Tree or Vitek's doing, right? Vitek's Agnes. It's like three different names for it. It's working on signaling LH in the brain better. So, it's helping that pituitary signal the LH. LH is then helping better ovarian output of progesterone. So, we're trying to prevent that falling out of progesterone in that last half of the cycle too early.
Dr. Justin Marchegiani: So, that's gonna naturally start to get her progesterone levels up a bit. It's gonna work on the pituitary signaling. And of course, anytime we work on that, we gotta make sure like inflammation and stress and, you know, make sure the diet's good. There's good protein in each meal. There's a stable bit of nutrition in each meal.
Dr. Justin Marchegiani: When women have hormonal issues, I don't like fasting because fasting is. It's like saying you get paid every week, but now I'm going to pay you every two weeks or every three. It's like, wait, I was really counting on that coming in this week. What happened? It's like, well, your body needs to count on nutrition coming in throughout the day.
Dr. Justin Marchegiani: And so having that stable cadence of nutrition coming in, your body's less likely to be in fight or flight. And then if you're having good fats and good proteins and you're, and you're dialing in the carbs and everything's nutrient dense, your body's going to be a lot happier because it'll have that constant supply of nutrition.
Dr. Justin Marchegiani: And aerobic metabolism is already impaired because there's less oxygen. So we want to make sure that those B vitamins and those nutrients are really dialed in consistently.
Rob Edwards: And just to bounce off of that, that's why we also chose to get a um, progesterone test on her as well at day number 20 to see, you know, is she kind of stressed out?
Rob Edwards: Because I know that progesterone can pinch hit for cortisol, right? Yep.
Dr. Justin Marchegiani: Dr. Justin
Rob Edwards: Marchegiani Um, so just making sure that everything is working properly within that, it's just a simple trick or some simple way that you can kind of test it. What was her progesterone levels? She was 7 0 7. Um, say it again.
Rob Edwards: 7 0 7. The range being 10 to 1563. So she was somewhere right there in the middle. So, so she was 7.07? 7 0 7. So, oh, se
Dr. Justin Marchegiani: yeah, I wanna, I wanna make sure say so. 7.0.
Rob Edwards: No, no, 707.
Dr. Justin Marchegiani: What's the reference range? That's not a blood test reference range.
Rob Edwards: So reference range, well, I did lab course, so it might be different, but the blood range is Okay,
Dr. Justin Marchegiani: so that has to be picograms per ml.
Dr. Justin Marchegiani: So you move the decimal place to the left three times. So she's at, is she 7? Is she 0. 707? I don't know. Well, I don't know. Yeah. Let's pull up. Let's pull up her lab and look at it. Because typically, um, in the luteal phase, right around day 20 or so, I think the range is PG per ML. Um, that is going to be like around 15 is going to be a good, uh, range.
Dr. Justin Marchegiani: Like progesterone 15 to 20 is really good. And so when you say seven Oh seven, I'm like, that's way out. That's like even a pregnant woman. That's not even close. So we're probably just dealing with a different reference range. We can convert that though. Um, but in general, we'll, we'll figure this out in a second.
Dr. Justin Marchegiani: I'll pull up a lab test converter in a second where we can figure that out. Are you able to see it yet? Um, why don't you just tell me,
Rob Edwards: okay, what's that? What's
Dr. Justin Marchegiani: that conversion on
Rob Edwards: there? So the, the conversion is, uh, nanograms per deciliter.
Dr. Justin Marchegiani: Yeah, that's the issue, right? Your nano versus. Yeah. Okay. I'll convert it here in just a second.
Dr. Justin Marchegiani: I'm pretty sure that's your NG per deciliter. Oh, it's the deciliter throwing it off.
Rob Edwards: Yeah, and she is in it from their reference rate. She sits right in the middle, right in the middle.
Dr. Justin Marchegiani: Yeah, but their reference range is, is, is, uh, not funky. Yeah, it's funky. And then, um, that's a luteal reference range, right?
Dr. Justin Marchegiani: Uh, yep. All right. And then what was she again? She was nanograms per deciliter. Yeah. So typically what is used is per milliliter. All right. Go ahead. 707. 707. Yep. Okay. Yep. All right. So nanograms per deciliter. Um, it's normally nanograms per milliliter. So that means you move it to the left twice. Um, so it's 7.
Dr. Justin Marchegiani: 07. So as I was saying earlier to the everyone, 15 to 20 is optimal. So she, you can see she's. You know, 50 percent below the reference range, maybe even 60 or 70, so 7 is definitely on the lower side. So, someone like that, we're gonna be adding in even a little bit of progesterone. Dr. Justin Marchegiani
Rob Edwards: You know,
Dr. Justin Marchegiani: anywhere between 25 to 100 milligrams in divided doses, the last half of the cycle.
Dr. Justin Marchegiani: Again, you wanna work with a functional medicine provider, you don't wanna just throw progesterone at things. You wanna actually fix it. You wanna make sure you're getting to the underlying cause of the inflammation first. If not, you're just adding a bunch of gasoline on the fire, too.
Rob Edwards: Well, and especially because it's a cycle, right?
Rob Edwards: So it's not like for women in particular, like there's a first half, there's a second half. It's not like you're just taking one thing all the time. Sometimes you're cycling these things. Um, especially parent going through perimenopause and that kind of a thing, because you've got a lot of different things going on and trying to figure it out on your own is very difficult to do because you'll think I'm supposed to be on this, you know, like you're saying, progesterone, like all 30 days of the month.
Rob Edwards: And it's like, no, no, you don't want to do that 30 days of the month. You have to dial again. Okay. Dr.
Dr. Justin Marchegiani: Justin Marchegiani Yep. And I've been using this site for like a decade. It's awesome. But it's unitslab. com and I can just take any, any unit here, any hormone test and I can just go in and I can plug it in and it tells me the units for all of it.
Dr. Justin Marchegiani: So that's a good little handy dandy thing. Cause I got patients from Europe and Australia and Canada and they all have different reference ranges. And I only have the American ones memorized. So, but it's good to know, right? You have the progesterone low. So we would definitely want to work on that. See, I'm a big fan.
Dr. Justin Marchegiani: This is where like a lot of conventional medical people. Or like, let's say you're a functional medicine MD, they'll slap progesterone on like crazy. But then, they may do too much, and then they may do a cream, well, why does that matter? Because she's still cycling, so we need that progesterone out of her system as soon as she starts to bleed.
Dr. Justin Marchegiani: Well, if it's a cream and it's super saturated or subcutaneous fat, well, that could throw off her cycle. So that's why, in sublingual progesterone. And do it sublingually twice a day in a coconut oil carrier. I like that cause it's, it's in and out and it's not super separate, not super saturated in the subcutaneous fluids or tissue.
Dr. Justin Marchegiani: We may even do like a little bit of a vaginal cream if we need, but usually that's more for menopausal women. But we'll do the progesterone, but we're also dealing with the upstream signaling, which is going to be. Um, the LH, right? We're gonna work on the LH. And we may even give additional herbs to work on the estrogen receptor sites, too.
Dr. Justin Marchegiani: Kind of tone down a lot of that estrogen dominance. And then on top of that, there could be a lot of phytoestrogens or xenoestrogens in our system. I'm not saying, you know, this is her, but in general, you gotta be on the lookout for soy. You gotta be on the lookout for plastics. Are you eating, you know, some of the, the fake frankenfood, like the Beyond Burger, the Impossible Burger?
Dr. Justin Marchegiani: These are loaded with soy and phytoestrogens. Are you cooking your food in plastics? Are you drinking your water in plastics? Use glass if you're going to do, you know, water or stainless steel water bottle because these are all could have a massive impact on your overall estrogen load.
Rob Edwards: Dr. Justin Marchegiani But I think that brings up a really good point that, you know, when we look at stressors of the body, I mean, it's like, you know, You know, conventional medicine will look at one thing and generally one thing only.
Rob Edwards: And then if they can't figure it out, they send you to somebody else and then they got one thing and one thing only. And then they send you to somebody else and functional medicine is going to do the research, right? It's sort of like, usually it's not just one thing because your body can handle typically one thing, right?
Rob Edwards: It's multiple things. And so we look at multiple angles in terms of what's going on, not just externally outside the body. Environmentally, EMS, all these other things, it's not, and the thing is, I used to think that like, you know, functional medicine, uh, practitioners were like hypochondriac, they're too worried about so many different things, but the reality is, it's not that it's that we've now live in a world that has so many different things that create stressors and we just have to know how to manage those, right?
Rob Edwards: We're on the internet right now. You and I both are getting EMF exposure right now. We know that, right? But. But it's to manage those things and to drill those things down because it's a reality in our life. So, uh, I think that's a, that's a good point. So another thing that we did with her was liver. Um, because we don't, we don't eat, we don't eat head to tail anymore.
Rob Edwards: So I know she's not getting liver, right? Not just from a nutrient perspective of the nutrients we know, but the more and more you study nutrients, the more you realize we don't know. Um, plus you're getting
Dr. Justin Marchegiani: a lot of important cofactors like vitamin a very important antioxidant. So we know iron could be a powerful.
Dr. Justin Marchegiani: oxidizer. It could be a kind of reactive oxygen agent. And so, adding in some antioxidants, like vitamin A, could also help prevent any additional oxidative stress that iron's causing, too.
Rob Edwards: Dr. Justin Marchegiani Yeah. Yeah. Yeah. So, we did a little bit of liver. We did heme. But we're doing heme, I think, every other day now.
Rob Edwards: We want to bring that up slowly because of the oxidative aspect. I mean, she's kind of The, the liver has helped her out quite a bit. Her symptoms have diminished in terms of her energy. And she does respond pretty quickly. I mean, when she was pregnant, she had a baby. She lost a lot of blood then. I mean, I think we brought her iron back up to the normal levels within 60 days.
Rob Edwards: So
Dr. Justin Marchegiani: it's normal to go anemic, you know, low iron with a, um, with a pregnancy anyway, that's common. That's why you're testing it. You know, at least once a, you know, a trimester, but yeah, that's, that's pretty common.
Rob Edwards: Yeah. And then we got to earn some probiotics. So, and she's been doing great. Cause this is her, this is our next cycle after the fact, and everything's kind of normalized.
Rob Edwards: So for her, she actually hit back. I mean, we'll see, right. Cause we're not all the way through yet, but right now, uh, everything seems to be going pretty well with just those four things. And in there, we have other things just in case. Right. Um, but that's sort of what we hit. Just kind of right up front. Dr.
Rob Edwards: Justin Marchegiani
Dr. Justin Marchegiani: Yeah. And so like, if Emily's my patient, right, we're going to be adding in some additional mitochondrial nutrients because we know how iron plugs into the mitochondria and how important that oxygen is for aerobic metabolism. So we may plug in additional carnitine and B vitamins and CoQ10.
Dr. Justin Marchegiani: I think that's good, especially to give her that energy. We're going to be working on the adrenals because if our hormones are off, we're going to be working on the adrenals. We're going to be testing those out too, right? We're obviously going to be fixing the gut. There could be some H. pylori and some gut dysfunction going on that's impacting the hydrochloric acid.
Dr. Justin Marchegiani: Also, is she taking any progesterone at all?
Rob Edwards: Uh, she is not taking progesterone yet. So we did actually add in B vitamins and carnitine too. Good. I forgot about that. So I would
Dr. Justin Marchegiani: definitely be adding a little bit of progesterone and even at a conservative dose, like 25 milligrams, that's really low. Like your typical, like, repro MD will be throwing 200, 300 milligrams, right?
Dr. Justin Marchegiani: I don't like to use hormones like drugs. I like to use hormones, you know, just to replace what's physiologically missing, not to, you know, give someone a wheelchair and cart them around. I want to just give them that little bit of a spot and not, you know, make them on a wheelchair, so to speak, hormonally, if you will.
Rob Edwards: Yeah, because you don't want to be on the other side of the coin that can happen, you know, it's sort of like you messed up everything. You messed up everything, but on the other side now, and um, yeah, so and then for adrenals, what we did is we did an aspergillus rhodiola tea and I had her double, double bag that three times a day and we removed her coffee.
Rob Edwards: There's some literature out there that's showing that coffee is actually an inhibitor for iron as well. So we removed her coffee, replaced that with adaptogenic teas. Um, and she's doing like, she's doing great. I mean,
Dr. Justin Marchegiani: yeah, I would say, you know, as long as you're not taking your iron or your liver heme with it, I think it's okay.
Dr. Justin Marchegiani: As long as you're not getting anxious or jittery afterwards, you know, um, you can make coffee and nutrient if you put some MCT oil in it and a little bit of collagen, then it time releases any caffeine. It's really about, do you feel jittery? Do you feel anxious? Do you feel worse afterwards? If not, then, Then it's about, you know, just time releasing it so it hits you more in a gentle way versus, you know, like, um, makes you anxious or like, you know, taking a shot, right?
Dr. Justin Marchegiani: Um, but in general, you know, you just adjust that to what's best for her. So, adaptogenic tea is awesome. Any of the adaptogenic mushroom tea with cordyceps or lion's mane or reishi. Dr. Justin Marchegiani
Rob Edwards: Yeah, Lion's Mane is great and I thought about adding that because for LH, right? Dr. Justin Marchegiani Because he was responding so well to the Vitex or to the Chaseberry.
Rob Edwards: I thought, well, maybe we can give a little bit more of a push there with uh, with the Lion's Mane. And that's the great thing with some of the stuff. We've got so many options, right? And it's uh, it's figuring out what is going to work. I mean, of course, we got clinical things that, that we know work over time clinically um, and through data, but just in terms of like working with patients in and out on a daily basis, um, It's huge, correct?
Rob Edwards: Yeah. And then another way that you could get iron. I mean, you know, of course it was cooking on cast iron. So that's a simple way. I don't know how absorbable that is. It's not going to be,
Dr. Justin Marchegiani: it's not going to be a heme based iron though.
Rob Edwards: Yeah. And the other piece piece, I guess I was thinking is it could be oxidative already.
Dr. Justin Marchegiani: That's the thing. Cause that iron is heated, heated, heated, heated, you know, and then you're just getting what's peeled off. You know, I hear that, but in the end, like, I think you're doing the right thing. I think that may be a side benefit. You know, if you're, consuming it with some good healthy vegetables, you know, any of the oxidative stress, you'll, you'll combat it with good antioxidants.
Dr. Justin Marchegiani: But in general, the progesterone is really important because if you look at what's happening in a woman's cycle, here's the first half, here's the last half. So the first half of the cycle, like a typical cycle works is you have menstruation happens at the previous month, That menstruation is triggered by a drop in progesterone and estrogen.
Dr. Justin Marchegiani: So estrogen, progesterone drop at the end of the cycle, drop, that causes the uterine lining to shed. And then day one, day two of the cycle, this is how many days after the first day of bleeding, you start to have this FSH signaling. The pituitary says, Oh, let's make some FSH. That's follicle stimulating hormone that causes the follicle and the ovary to grow.
Dr. Justin Marchegiani: A woman is born with all the follicles you're ever gonna have. That's it. So, that follicle starts to grow. As that follicle grows, it produces Estrogen. So, you have FSH go first. Estrogen trails by. As Estrogen goes up, LH now starts to go up. The LH is luteinizing hormone that now triggers progesterone. So, Estrogen is now tapped out at day 10.
Dr. Justin Marchegiani: Progesterone comes up and is tapped out around day 15. So, this like, 15 is where you can get pregnant only like two days out of the month. It's not a lot.
Rob Edwards: This
Dr. Justin Marchegiani: is where you ovulate. And then from there, progesterone continues to go up and taps out around day 2021. And how the body works is if you are not pregnant, it's like, You're pregnant, progesterone keeps on going, and it's basically supported by the corpus luteum and the human chorionic, uh, growth hormone or gonadotropin, it keeps on going.
Dr. Justin Marchegiani: If it's not, if you don't get pregnant one week after ovulation, it goes up, false alarm, let's shed that uterine lining and try again next month, progesterone drops, boom, and then we menstruate, and then we're good. But what happens is, due to stress, due to inflammation, nutritional deficiencies, that progesterone is at day 20.
Dr. Justin Marchegiani: Instead of gradually coming down like this, it goes right down or it never even gets high and then peters out. And then that triggers this incomplete lack of punctuation on that hormonal drop that causes this sloughing off of the endometrial lining that's not consistent and punctuated. Dr. Justin Marchegiani And if Emily would have gone to a conventional MD, I mean, they may recommend like an ablation, right?
Dr. Justin Marchegiani: Or even a hysterectomy at some level to have it stopped. Like, none of that fixes the underlying issue. And it's really good for cancer risk. To be shedding that uterine lining every month, scraping it off is not a good thing or pulling out uterus is not a good thing. So it's good to understand kind of the root cause of what's happening in the background.
Dr. Justin Marchegiani: Dr. Justin Marchegiani
Rob Edwards: Well, again, just kind of a fun little fact and I know a lot of people that work with from a functional side, people that are trying to get pregnant. It's like, you know, stress is a big thing because again, progesterone, pinch hits for cortisol. So again, it's got to pull it from somewhere in your body is going to always perceive the threat as the first thing that it needs to deal with, right?
Rob Edwards: Dr. So it's like being able to take adaptions during that time, allowing progesterone to grow and to continue to, to, to do it, do what it does is important. So, yeah, this is, um, Yeah. There's a lot to talk about with iron. And of course, there's a million rabbit holes that we go into with it. A hundred percent.
Rob Edwards: Uh, but you know, women's health, especially like getting around, like you said, it can happen anywhere from earlier times. And then we have a lot of people on birth control and that creates all kinds of issues. And then trying to get off birth control that creates all kinds of issues. Then women oftentimes get into their forties and that creates other issues and menopausal.
Rob Edwards: So in terms of conventional medicine, it really does a number on women, in my opinion. It does. You know, it does.
Dr. Justin Marchegiani: And like, I mean, like I just. I like to take people through like a compare and contrast. Okay, you have this issue, you go to your conventional OB, here's what happens. Hey man, would you like to have a uterine ablation?
Dr. Justin Marchegiani: Uh, would you, do you want to go on a birth control pill? Oh, by the way, here's this ferrous sulfate, like the worst kind of iron that's going to constipate you and make your stool black. Uh, do you want this? It may not even work that great. You know, functional medicine, we may play around with the heme based iron or like a bisglycinate, a better quality one, not as cheap as a sulfate.
Dr. Justin Marchegiani: Uh, and then also, how do we fix the estrogen dominance? Because most birth control pills are like a, a low, low estrogen or a Yasmin. They're going to be mostly a, um, synthetic estrogen, which then further exacerbates the estrogen dominance, right? Or God forbid, you know, you, they put you on like a Marina or a synthetic, uh, Levonorgestrel, which is a synthetic progesterone.
Dr. Justin Marchegiani: Well, now you don't cycle, right? You just have this like low grade of progesterone that's secreted at like, you know, 15, 12 micrograms a day. So you never really have a cycle. You just constantly menstruate. So you're not really ever sloughing off your uterine lining every month like you should. That could be a problem too.
Dr. Justin Marchegiani: And so, you know, conventional medicine wise, um, they're just kind of covering up symptoms, not fixing the underlying issue. Also, how are we doing metabolizing our Estrogen? There's so many Estrogens, you know, we're gonna be running different hormone tests that look at 2 Estrogen. Are we metabolizing our 4, 16, and 2 hydroxy Estrogen metabolites?
Dr. Justin Marchegiani: How are we doing with that? Do we have enough glutathione and enough sulfur compounds to run the pathways to detoxify Estrogen? That matters a lot. We can give different herbs to modulate the receptor sites. we're obviously gonna make sure that we're avoiding the plastics. We're gonna get maybe a good RO water filter to get the microplastics out.
Dr. Justin Marchegiani: You know, a lot of our pesticides, guess what? They're estrogenic. A lot of our plastics, estrogenic. And if we don't have good sulfur uh, levels, glutathione levels, you know, thiandol, methane, indol 3 carbinol, our healthy gut bacteria makes indol 3 carbinol, which helps metabolize estrogens. All these things play a super important role.
Rob Edwards: Yeah, and then get him out of the body, right? And get stuck in the liver and the liver transported through the body again. So it's, uh, you know, being able to go through the phase one, phase two of the liver and getting it flushed out of the body, you know, after they've been used and they've got the metabolites and everything else.
Rob Edwards: So, uh, there's so much to the conversation. And it's interesting because, you know, a lot of people, And, and, you know, I've talked about this before, we'll say, Hey, where do I start? How do I get help? And, and we think it's one thing or it's, or it's this thing over here, or it's that thing over there that's causing the iron thing.
Rob Edwards: Really? It starts, uh, it starts from the very beginning, which is, you know, getting a good workup, getting a good history on somebody, understanding what your symptoms are, what symptoms are going on, what body systems are those affecting. And then we put together the whole story from there, uh, because it can be coming at various different angles.
Rob Edwards: Um, like we discussed today, right? Gut, hormones, immune system, detox, digestive issues. There's a lot of different places that can be contributing to iron deficiency, uh, in women. Dr.
Dr. Justin Marchegiani: Justin Marchegiani Yeah. And women are just sick of going to their conventional OB and it's like birth control pill, SSRI medication.
Dr. Justin Marchegiani: Hey, this is just you getting older. Hey, do you want a hysterectomy? And it's like, that's it. And it's just ridiculous. Most guys are a little bit more stubborn. They either get brought in by their wives or they're like us. They're biohackers, right? They're like, you know, I see a lot of biohacking men and women where they're always just trying to optimize.
Dr. Justin Marchegiani: That's kind of like me and you. And then there are women that have these hormonal issues and they're just sick of the answers. Like, no, that doesn't make sense. No birth control really in my 40s or like a hysterectomy or an ablation. What? And you know, Because of YouTube and Instagram and other stuff, there's a lot of good information but there's a lot of conflicting information.
Dr. Justin Marchegiani: And so when we do these podcasts, I want to actually educate people so they can understand what's happening under the hood physiologically and kind of, Help it make sense to them. I think if it makes sense, then you can be like, okay, yeah, I get it now. I get it.
Rob Edwards: Yeah. And really what we're doing is we're lifting up the hood a little bit.
Rob Edwards: It's not, there's a lot more to this than just that. And, and, but the thing is, I think, uh, clinically speaking at some point when you go to conventional medicine, and I've been through this, you've been through this, eventually you start using your logic and you start thinking, what that doctor just told me made no sense.
Rob Edwards: It made no sense, uh, and that's when you start saying, you know, I think I want to look for a different route. That's what functional medicine is all about. It's a different route. Uh, we have a lot of success in these areas. It's a lot of people that still need help. Uh, women, children, families, um, And, uh, and that's what we're here for.
Rob Edwards: So, Dr. Justin Marchegiani
Dr. Justin Marchegiani: 100%. Now, let me just kind of, um, you know, put some bookends on a couple things. Someone wrote in the chat, like, how is low iron connected to thyroiditis, Hashimoto's? Well, first off, the iron is a really important cofactor to make the TPO enzyme that helps make and bind thyroid hormone.
Dr. Justin Marchegiani: So, the thyroid peroxidase enzyme takes the, the T, right, for T4, T3, that essentially stands for tyrosine, that's protein, and then the I is, is, uh, How many iodines there are and it takes it and it binds it together enzymatically and iron is important cofactor. So if you have low levels of iron, that could impact you being able to bind and make thyroid hormone.
Dr. Justin Marchegiani: That's number one. All right. And then obviously too, if you're have a lot of inflammation and you're eating gluten that could It could be attacking your thyroid level, it could be attacking your autoimmunity, increasing the antibodies and attacking your thyroid tissue, and that can create a whole host of other symptoms because your hormone levels are up and down because your tissues are just spilling out hormone uncontrollably.
Rob Edwards: Dr. Justin
Dr. Justin Marchegiani: Marchegiani Now, how do you know iron is an issue, especially if during your menses and right after your menses you're fatigued? That's a common way to know if iron's a problem. A lot of times, the underlying driving factor of women is this estrogen dominance mechanism of of of essentially lower progesterone relative to estrogen.
Dr. Justin Marchegiani: But you could also have high you could also have lower estrogen in general, but you could have lower estrogen, but the ratio of progesterone Marchegiani
Rob Edwards: And so,
Dr. Justin Marchegiani: it doesn't always mean high estrogen. You could, but it could just mean progesterone's a little bit lower. that on average kind of ratio is like 23 to 1 progesterone to estrogen.
Dr. Justin Marchegiani: And I think when you in the luteal phase, it can go high as 200 to 300 to 1 because progesterone goes so high on that one. And so keep that in the back of your head. Um, and then in general, a lot of women have this low progesterone thing before men's season. So, That can also, chloride channel opener, so that can also open you up for like irritability, inability to relax, anxiety, mood issues, cause progesterone does open that GABA chloride channel which helps relax the brain, it's that inhibitory neurotransmitter that says relax, chill out.
Dr. Justin Marchegiani: So, a lot of times you can have that open. leading into menstruation, and then menstruation, the heavy period starts. We want to be ideally around four days under four tampons. If you're four or more for three or more days, then you're definitely excessively bleeding. So keep that in the back of your head.
Rob Edwards: Dr. Justin Marchegiani Yeah, absolutely. Yeah. Um, yeah, it's been a great discussion. It's funny, like this one could probably keep on going for another hour or so, you know, but uh, um, yeah, low iron is an issue for a lot of people. Obviously, it's a discussion that's been around for a long time, especially for women.
Rob Edwards: And You know, yeah, I mean, both you and I deal with this, um, with our clients, with our patients. And, uh, you know, it's not, it's not foreign to us. Uh, we kind of know sort of where to begin and what kind of a journey that looks like for somebody. So I think, you know, reaching out number one to Justin or reaching out to me, both of us can help you guys in whatever it is that you're struggling with.
Rob Edwards: Um, especially if you're kind of in this, this cycle of going between doctor to doctor, to doctor, to doctor, and can't figure things out. whether or not it's this or it's something else related to any other condition that you can't figure out. Um, that's what functional medicine is all about. That's what Justin does.
Rob Edwards: That's what I do. And, um, yeah, it's been great, man. Dr. Justin
Dr. Justin Marchegiani: Marchegiani Yeah. And reach out to robheritagehealth. life. We'll put Rob's link down in the description and myself. justinhealth. com. I want to just review the labs real quick. I know there's a lot of information and repetitions, the kind of the mother skill, but your top indications, if you're gonna run one marker, run ferritin.
Dr. Justin Marchegiani: That's your stored iron. That's how much money's in the bank. That's how much iron's in the bank. You can also run an iron panel. I'll put the link to the one I run in the description. You want to run it, click it, you pay it, and go to the lab and get it run. Just make sure you do a fasting, okay? Because if you eat, let's say, some bacon for breakfast, that could increase the iron artificially.
Dr. Justin Marchegiani: So, keep that in mind. So, ferritin's most important. Next, you can run iron saturation next to it. That gives you an idea of how saturated that red blood cell is with iron. You can look at iron serum as well. Again, iron serum, you know, you want to be somewhat in the mid-range. Um, ferritin I think is the most sensitive.
Dr. Justin Marchegiani: And then you can look at the binding proteins. Those are inverse, so as they go high, U-I-B-C-T-I-B goes high. That's a sign that iron's low. Now when it's more chronic, you start to see the red blood cells, the hemoglobin, hemoglobin and hematocrit get impacted. You'll see it be low red blood cell below 4.2, hemoglobin below 13 hematocrit In the mid thirties.
Dr. Justin Marchegiani: You may not have all three. You could have one out of three. You could have two out of three. If you see anything, that's a sign. That's a problem. All right. Next, we have the indices. These are how big the hemoglobin is. MCV, MCH, MCHC. All right. Typically, how you differentiate like a megaloblastic anemia, with a microcytic anemia, microcytic being iron, megaloblastic being B12, megaloblastic, big, right?
Dr. Justin Marchegiani: Mega, right? MCV, MCH, MCHC are higher, you know, MCV, upper third, or MCV would be in the upper 90s, MCH, MCHC like the mid 30s. They're at the higher side, bigger hemoglobin, bigger red blood cell. Okay. Now, those same markers with a micro acidic anemia, I know I'm getting technical, all right? All right. You guys can rewind it.
Dr. Justin Marchegiani: Just keep it as simple. Those would be lower. Why? Because it's smaller, right? We have two anemias. One's for small red blood cells, one's for big B vitamins, B big megaloblastic. Iron, microcytic, small, right, anemic, small, that's gonna be low MC, low MCHC, low MCV, and then you're gonna have your red blood cells, hemoglobin, hematocrit are also low.
Dr. Justin Marchegiani: Now here's the thing, you don't have to have tick all those boxes, if you just tick one box out of those seven or eight, you got a problem. So don't think like, oh my god, I don't have all of them, it's okay. You know, but you, if you had 'em all, if you have all of 'em or have most of them, then you know it's more severe.
Dr. Justin Marchegiani: And so it's good to know how many boxes you check out. If there's a lot, then you know it's more severe and it has to be worked on. Uh, we always call in the functional medicine world, anemias deal breakers. If you do not fix an anemia, a patient will not feel better. They will not stick around long enough because they will not believe in you.
Dr. Justin Marchegiani: They will not have enough energy to think that they're doing the right thing. And so you have to fix anemias. And again, like with your wife's anemia, Rob. Like, part of that will be supplement, yeah, but you have to fix the hormones. And, and in her situation, there also may be a gut thing. So, it may not be one thing, it could be like, well, it's 20 percent there, 50 percent there, 10 percent there.
Dr. Justin Marchegiani: And so, be open to multiple kind of inputs as driving the problem, if you will.
Rob Edwards: Yeah. And so that's why we were looking at already dealing with our gut. We're waiting on the GI to come back the Dutch as well. So, you know, we're kind of getting to the next steps with her, but, um, yeah, it's, um, and I think to your point is like, we can, you can do a ton of testing on this, but really, you know, if we get a two or three, a good two, three, four good markers, um, likely the way that we're going to recommend.
Rob Edwards: Uh, what we're going to do is that's going to be enough to give us enough information to go off of that and your symptoms, you know, what you're dealing with, what you're struggling with. And
Dr. Justin Marchegiani: also too, like if I have patients who are on thyroid hormone and their irons low, well, and their ferritin is low.
Dr. Justin Marchegiani: Well, what does that mean? Well, it means that. As their ferritin gets up, they may need less thyroid hormone. Right. They may actually start to get a little bit anxious because now they're making thyroid hormone organically in their body. Yeah. Organic better. So they may need less exogenous hormone. So this is why it's good to know and be testing it, because then you can adjust that patient's needs accordingly, right?
Dr. Justin Marchegiani: Yeah. And so you gotta look at everything.
Rob Edwards: Yeah. A lot of times that because that's moving the medication now and that's a good thing, right? You're moving, you're, you're, you're moving in the right direction with medication. So that, that's, that's kind of the, uh, the alternative way of doing it. But, um, yeah.
Dr. Justin Marchegiani: Dr. Justin Marchegiani And if you are taking thyroid hormone, be careful, do not take it with iron because that can impact the absorption or calcium or whatever. Really, any minerals. So, just be mindful of iron with your thyroid, you know, empty stomach, 30 minutes before food. You know, more with food when it comes to iron and definitely heme iron is preferable.
Dr. Justin Marchegiani: But if it's serious like your wife's, you know, you're gonna do a combination of the both just to get it up faster. Yeah. Dr. Justin Marchegiani Awesome. All right, guys. Justin Health out. Dr. J here, Rob, heritagehealth. life. We're here to help you put links for lab tests and different supplement recommendations in the description.
Dr. Justin Marchegiani: And feel free, share with family or friends. Again, we get the word out there, kind of our mission is we're, we're teachers. We're about helping. You got to have a heart of a teacher. And I want to empower you guys who are listening, guys and gals, probably mostly gals this podcast, but guys, for sure, if your wife or a significant other has this issue, they're going to live a much better life.
Dr. Justin Marchegiani: Well, if their iron levels get up, I'm telling you, Rob can speak, uh, can speak from actual experience. And so, it's good to be on top of that and understand kind of what's going on from the root cause perspective, right? Low iron from gut absorption issues and hydrochloric acid, um, gut, uh, iron issues from being vegan, vegetarian, and iron issues from estrogen dominance and hormonal imbalances cause the excessive menses.
Dr. Justin Marchegiani: Those are the big three out of the gates.
Rob Edwards: All
Dr. Justin Marchegiani: right, guys.
Rob Edwards: All
Dr. Justin Marchegiani: right. Take care. Bye, y'all.
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