Iron is a mineral part of hemoglobin, the protein in red blood cells that transports oxygen from the lungs and throughout the body.
Dr. J and Evan also discuss identifying underlying issues to deal with them effectively. You could be having digestive problems, menstruating for women, or you're not eating the right foods to source iron or adequately absorb it. So if your body doesn't have enough iron, it won't get enough oxygen, and your cells (powered by oxygen) won't function efficiently. Suppose you're experiencing symptoms of iron deficiency.
In that case, Dr. J and Evan suggest consuming vitamin C to help increase iron absorption, eat iron-rich plant foods, and have yourself tested to have comprehensive test results and fix your health issues.
Dr. Justin Marchegiani
In this episode, we cover:
1:19: What is iron deficiency and how to test it?
5:36: Iron-rich food template
10:04: Other issues to consider when dealing with iron deficiency
17:09: Iron deficiency in men
Dr. Justin Marchegiani: And we are are live! It’s Dr. J here in the house with Evan Brand. Today we’re going to talk about about iron levels and how can they negatively impact your health. Of course, we have two sides of the same coin here. We have high iron and low iron. And then, high irons going to be a bigger issue, right? Men don’t menstruate and women potentially, low iron is going to be a bigger issue because women menstruate every month at cycling; it’s a cycling age. Menopausal women, when their cycle tends to cease, then there could be more issues there. But out of the gates, women iron is going to be an issue. Most of the time if it’s hormonal issues and men’s going to be the opposite. We’re going to dive in and give you guys a crush course on both sides of the fence. Evan, how are you doing today, man?
Evan Brand: Doing well! Let’s jump right in. So looking at blood work. If you’re looking at a female, you and I test ferritin which we find conventional medical doctors rarely test ferritin. Ferritin being the iron storage protein and I did a whole video on Youtube. Those are my most popular videos ever on low ferritin and hair loss. We’ve seen how if your ferritin is let's say 20, that’s far too low. You’re going to experience maybe some shortness of breath, major hair loss. If we can get the ferritine to 70, 80, or 90, women feel much better. Their hair stops falling out and they can catch their breath. So do you mind like, teasing a part when you’re looking at these labs, like total iron versus a ferritin. If you see a female with low total iron, are you really prioritizing that or are you after ferritin or are you going after both? How do you approach it?
Dr. Justin Marchegiani: Well the first thing that we look at with iron, we have to see how low it is.Okay? There’s func- I consider functionally low levels of iron. And um, and there could be um, you know more, I just say more acute levels of iron that are are more low. Right? We could have functional imbalances versus the more anemic that conventional medical doctors would say you’re low in iron. We have both side of the fence, right? We have the functional issues, and we have the pathological issues. So the first thing we look at is going to be a CBC, right? On the CBC we’re going to look at red blood cells, hemoglobin, and hematocrit. If we see those start to get low, especially red blood cells you’re going below 4, hemoglobin into the 11, hematocrit below 30s, we have problems. Danger will rob– the red blood cell size is dropping which is the hallmark of low iron. Because we need iron that attaches to hemoglobin that help us carry oxygen. So we have hypochromic microcytic anemia. These are going to be smaller red blood cells, right? Smaller blood cells are going to be on the iron side. On the B12 side, it’s actually the opposite; they're actually bigger. It’s called megaloblastic anemia. They’re actually too big. The red blood cells are opposite. We think of humans, we start off as babies and as we get bigger right? Red blood cells, they start off bigger and they actually get smaller as they get older. And so, B12 is needed to mature. Red blood cells, and so if we don’t have enough B12, you’re stock in this more immature state which is bigger, and you don’t have enough B12 than you can’t get smaller. Now with the iron, it’s actually the opposite. You actually get too small when the iron is too low. And of course, you can’t carry oxygen which is really important because aerobic metabolism which is how we mostly generate energy requires oxygen. And so that’s like, you know partly the kreb cycle, the electron transport chain, and all that stuff um, requires oxygen. So on that front, just kind of out of the gates there, we’re looking at um, iron from that perspective. Red blood cells, CBC, hemoglobin, and then we can dive deeper into an actual iron panel. And that’s we’re going to look at serum iron, that’s going to look at iron in the blood. Then we can look at ferritin. It’d going to look at our storage form of iron. So iron serum and ferritin are two different things. So think of, You're driving a car, right? You have your check engine,Or should say you have your gas gate, right, for your fuel, right. Your fuel gauge that's kind of your ferritin. Are you on full are you an empty? The iron serum, that's the fuel that’s in the– ready to be, ready to be um, combusted to generate energy. Think of iron serum, that's what's in the engine, that's what's in the blood right away. Ferritin is going to be what’s in the gas tank. So you know of course If you see iron low on the serum side, you wanna look deeper but it's not beol or endol. You have to look deeper on what's in the gas tank. That's where iron serum um, sorry, that’s where ferritin will be more helpful and other markers like Iron saturation can be helpful too. Because that tells you how saturated the cells are, and also things like binding proteins. Um those tend to do the opposite, those tend to go up When iron goes um, goes down. So think about it, thinking about iron binding proteins is like fingers right. The more or hands right, the more hungry you are the more hands reaching out to grab stuff right. And so your body creates this protein and will try to reach out and grab these extra irons to create more binding proteins when iron is lower. It's trying to get that much iron into the cells as possible. Does that make sense out of the gates?
Evan Brand: Yeah it's a great breakdown. The analogy is super helpful. Because you know some of the blood chemistry training that you and I have looked at, some of the doctors, they will talk about the importance of ferritin. But that visualization of the gas tank Makes a whole lot of sense because you have doctors, if they do recognize low iron, they'll treat that. But then if you see low ferritin, The woman still doesn't have the results she's looking for with regards to hair loss and catching her breath and all that. So once you get the ferritin levels up, Which typically I go for lactoferrin. What are you doing in terms of trying to get the ferritin back up? I know optimizing the gut is some of it, we can talk about that. But what about just straight supplements?
Dr. Justin Marchegiani: So first thing is you may see higher levels of iron in women that may have low iron. So you have to look at all the markers that I've mentioned because if they are inflamed, iron is also a reactive oxygen species right? Think of it as like It's kind of inflammable if you will and so, and so when you are in inflamed because of poor food, poor diet issues, or toxicity issues, you may have higher levels of iron ferritin because of inflammation. If you're really inflamed i always I like to make sure that it calm the inflammation down a little bit first before throw iron in there, it’s like gasoline in the fire. So you really want to make sure you know if iron’s really high or looks really high and then we see some inflammation markers like CRP also high, we see a lot of symptoms, right? Brain fog, joint pain, energy issues; Maybe we wait a little bit before we jump on that iron train right away. Maybe we just chew some iron rich foods, you know on the animal side and work on getting the inflammation down. So it depends upon where they’re at.
Evan Brand: That's smart, let me comment on that real quick. That's really smart and really wise to say, because people would just jump on that iron train right? Those doctors who prescribe iron probably low-quality form which is going create constipation and other problems. And if they are already having high iron Information due to some toxicity, that makes them worse. I had one high iron when I was first exposed to mold. I actually look back on some of my olde levels. My ferritin was high, my iron was high. And i did some pretty high potent seed turmeric extract, and i was able to get the iron back down. And i'm sure the blood donations may have helped too. But it was interesting to see that on paper, how my exposure to toxicity cranked that up a little bit.
Dr. Justin Marchegiani: Exactly and then There is a marker called Seruplasman Which is a marker for copper So sometimes copper and also affect iron as well. Again i'm not too worried of copper If you're like Paleo and you're eating high quality organic meat and high quality animal products. close your typically going to see the zinc and iron products cause you also have copper in there. So i don't typically get worried about copper unless we’re really I don't know, eating a lot of plant-based products. And we're kind of deficient and some of those minerals, and so eating good quality animal products may not be that big of a deal. And also it's good to look at if we're doing iron, If someone is vegan or vegetarian, you know there’s different kinds of iron that we use right? So in my line, i have a product called vegan supreme which is an iron disglycente which is found in the glycine, which is good. It it’s better like conventional medicine which is ferrous sulfate which will be more constipating, leaving the stool black-er and darker. Glycinate tend to be pretty well absorbed so i like that in the glycine Which is same kind of amino acid and collagen and bone broth so i like that. Also, i would say depending on vegan vegetarian you may want to add some grass fed liver. Something like that that's going to have some other nutrients like B12, vitamin A in there as well. Just depends upon how good or bad someone's diet is too, if they can eat animal products. And so…
Evan Brand: How about lactoferrin? Do you use lactoferrin?
Dr. Justin Marchegiani: I mean lactoferrin it's like it's like a protein right? It’s gonna also… Yeah, it’s like a milk protein like it increases iron levels, kind of vitamin C in a senseWhere it increases that binding in absorption of iron, is that correct?
Evan Brand: Yeah, yeah. I’ve seen like a couple of iron lactoferrin combos that we’ve used. Man, it’s like rocketfield to get women back up really quickly.
Dr. Justin Marchegiani: Yeah for me i don't typically use lactoferrin in general. I’ll do my iron supreme which is the bisglycinate, And then i'll throw in some potential iron granular Is there a not eating enough animal products (Evan: like a liver) Yeah, like a liver glandular and a little bit vitamin C on top of that. But um, don’t you know, I see a lot of guys out there. I see people say “Don't eat vitamin c, it’s going to increase your iron.” No, if you're a guy, eat vitamin C it's not a problem. It's in every leafy green vegetable, every high quality fruit that’s out there, it’s too Important. Guys the solution to iron is just give blood. Get a comprehensive blood test once or twice a year. Maybe give blood once a year um, twice a year depending on how many blood tests you get, just give blood is the solution. Don’t avoid nutrient dense food that have vitamin c that would increase your iron. Just give blood and do some testing. Keep it simple.
Evan Brand: Yeah. That’s the fun part. When you do comprehensive panels like we’re doing. I just donated a blood, got blood work this morning. I gave a lot of tubes. It was probably not much as a donation, it wasn't a pint but for me, it was a good slow drip out of my system If i'm running some blood panels throughout the year. And you get data. You get data out of it too.
Dr. Justin Marchegiani: I think it's fun for sure So we talk about you know how to assess these are patterns right? We have our general cbc, we have Iron panel that will include Iron serum, ferritin, Iron saturation um, TIBC, UIBC, which are your similar binding proteins. You can also look up reticulocytes for baby red blood cells you're losing blood. You're gonna see a lot more red blood cells because the babies are being formed to kind of filling the gap of the older adult cells that were losing it; it there's an ulcer or some kind of tummy bleed, IB you know, Irritable bowel disease kind of bleed in the intestines or colon or wherever. So that's helpful to look at. And in general, you know, if you’re vegan, vegetarian, and you have a history of not getting iron in your body, you gotta fix that. That’s whole different podcast conversation about animal products. We’ll, you guys can go back to our channel, search for that, we had conversations, just on those topics. The second issue for women Is just to get rid of the hormonal Imbalances that are causing you to bleed too much. So if you are bleeding four more tampons, 4-2 days or more, probably just menstruating too much, you know classic cases of hemorrhagic if you will. And there’s probably a lot of estrogen dominance, way higher estrogen, lower levels of progesterone. Maybe progesterone is falling out soon in the cycle and some of the things are diving just excess bleeding and that’s possible too, and you gotta get to the root cause of why that is. Estrogen dominance usually some adrenal stress that affects some underlying issue that is causing that. And of course if you have a lot of digestive inflammation, whether in the stomach area or intestines, or lack of stomach acid, or enzyme you may not be able to break down the high-quality animal products that you're consuming that could also create a bottleneck of absorption.
Evan Brand: Yeah when somebody here's that, they might not realize how big of an impact that could be, right? When somebody here's what you're saying. It’s like “oh this gut Ingestion, digestion blah blah blah” But we've seen it on paper and clinically Where you have women that are eating paleo, doing breastfed meet, doing a great job with diet, and they're still very low. Some of it like you said high you know, the excess menstruation but, i’ll tell you personally i've seen big changes with my wife’s energy levels after clearing her gut infections out. And we knew that she was having malabsorption. So, and so I mean when your 40 50 or 60 and beyond, you are making Left stomach acid due to age even if you're eating that grass fed steak, and that liver capsule, who knows how much you’re getting from that. So to me, i think enzymes will be part of a good Iron supporting protocol because you know, people will say you are what you eat. But really, you are what you digest from what you eat. So i think This is a good point to bring up enzymes and acids to make sure that if you have H.Pylori Infection that could be something to address, that will be driving the low iron. Is that a safe statement to say? Is h pylori that big of a smoking gun, that it could drive blow iron due to the malabsorption?
Dr. Justin Marchegiani: Yeah, i mean there’s always you know. There’s always going to be different degrees of how that infection is causing a stress in your body. If it's there, it's chronic, it's creating a lot of inflammation, digestive wise enzymes have dropped significantly. That may impair your ability to absorb usually there is going to be symptoms that will tell you the severity you know, just things like not having a good bowel movement, having a lot of bloating, or gassing, or flatulence, and gut inflammation, those are pretty good signs there’s stress going on there. Um, looking at your stools, how formed do they look, are you regular, are there undigested stool pieces in your stool? Those are all pretty good ideas that you’re on a bad track. So it’s good to look at that. Of course if you have chronic iron, and you're fixing menstruation issues, you're eating meat, you’re adding in Digestive support that's all great. You probably want to look deeper and get your got tested and see if there are other bugs in your gut like SIBO, or just general dysbiosis, or parasites or h.pylori, or other issues that could be in place. You gotta look at all of it.
Evan Brand: Yeah. And you mention the inflammation I mean. That could be exposure, that could be the diet, it’s simple. It sound simple but It's still worth mentioning. We still have so many women that are going to the starbucks drive-thru and getting a pastry, a bagel or a muffin, or whenever, and they have their coffee and that's it. That’s it for their breakfast and they wonder why they are exhausted. I mean nutrient density is just foundational.
Dr. Justin Marchegiani: Yeah, nutrient density is really important and um, to really have good nutrient density You have to be eating some level of animal products. You're just not going to get same level of nutrient density from an amino acids standpoint. You're not going to get the iron, the b12. It's harder to get the fat soluble vitamin A, I mean you can get some from b12, I mean some from beta-carotene but, you won't get enough. And if you have insulin resistance, you won't convert b12, you won't convert beta-carotene well. You also won't convert a lot of your ALA-based omega 3. It’s like flax and Chia. You won’t convert that to your longer chain EPA and Your DHEA fats which are good for inflammation in your brain. There's a lot of precursor things that We just assume like “Oh, we’re getting iron from spinach. I’m going to convert that non-heme iron to non-heme based iron right.” No, I'm getting enough bioflavonoids In my vegetables that are vitamin A right? Well, no. That’s beta-carotene you may not convert that. Or same thing with um, i'm trying to think here what other analogies that you can do. So You have the plant-based iron, you have beta-carotene stuff, you have the vitamin, I'm trying to thank you for what else um, zinc and a lot of your minerals may be tied up in antinutrient plants. You might think you're getting a lot of this vitamins and minerals but you may be having them tied up with a lot of antinutrients – the lectins, fitates, the mineral blockers, the trypsin inhibitors, and so you might think you’re getting some of these things on the nutrient label but, there might be some absorptions because of this nutrient blockers. Proteolytic enzyme blockers.
Evan Brand: That's a good point. So far vegetarians-vegans listening, if you could get them on liver capsules, you'd say get them on some pastured liver would be a great option. If their opposed to that even, I mean what do you do? I've seen women from paper suffered for years, and I honestly just used the labs as justification to push them harder into something like liver capsules if they just absolutely don’t wanna do the meat.
Dr. Justin Marchegiani: Yeah liver capsules or going to be ideal That's where i put my iron supreme which is a ferrous-glycinate, and add in some amino acids like collagen and some kind of free form amino acid to get the protein of without antinutrients and carbs in there as well ‘cause a lot of vegan vegetarian proteins, they're just very carb heavy right? Rice and beans, quinoa, they’re just you know, they’re just 60, 80% carbohydrate for the protein to get in. So it’s hard if you need to keep your carbs down for insulin, For inflammation or fat burning means it's hard to do that If you try to stick to a vegan vegetarian diet I need you can do that if you're adding some protein or rice protein but then, you’re heavily reliant on processed food for most of your protein. And that's not great so we don't want to have things to be so processed, like we have to be overly reliant. It probably tells us that your diet needs to be tweaked and adjusted if you're heavily reliant on processed food to get your nutrients up.
Evan Brand: Yep. Well said. So men definitely get your iron tested too I mean females are probably gonna be more symptomatic than men, meaning, the fatigue, the hair loss-that kind of thing with the low iron. But man, you can have symptoms from that. I will tell you i've had, when i went to donate blood, I found my hemoglobin was very high. They’ll cut you off by 20 It's above 20. You have to get a prescription to donate blood, and then back at the therapeutic blood donation but I would like a 19.6. I felt like I was going to be mentally foggy, mentally cloudy and certainly more brain fog, and I would say my energy levels were a little bit less. And I ask some of the donation people like, “What would you think i will experience based on this level of hemoglobin?” They were like “Oh, man you're high.” And I go like, “Ok, what should I feel like?” And they actually said exactly what I felt. They thought you would feel cloudy and then I would remember this feeling when donating a pint, boom! It was like this release. Like literally almost like an energy drink after I got that excess iron out. So i tell you, it's very very therapeutic.
Dr. Justin Marchegiani: Yeah, and again iron is going to cause oxidative stress. So if you're a male, and you are over accumulating iron you know, give blood. Get some therapeutic functional tests doneSo you're actually losing blood via the testing means. And make sure that you know, taking in a really good high antioxidants you know, through organic vegetables, maybe low sugar fruit. Because at least the antioxidants that you’re getting in will help at least buffer the oxidative stress from the iron right? So at least you want to make sure Antioxidant levels from fruits and vegetables Are dialed in and we're getting healthy. You know antioxidants and maybe through curcumin or other high quality nutrients that help buffer some of that, help offset some of it.
Even Brand: Yeah yeah cool well If you want to get tested uh, Dr Justin able to run blood work, I'm able to run blood work, we do it around the world which is pretty cool; I guess, technically blood work that we do In the United States. Little tricky internationally for blood work (Dr. J: It’s still better but it’s harder), yeah it is harder but for the other, for the functional testing which you can do functional blood testing and that's what we do. Our panels are much more comprehensive than what you're going to get down the street from your doctor. So if you need help you can you can reach out And just please let us know If you have trouble a lot of time people are begging their physicians to run a comprehensive fire oide panel, run the antibody, to run the ferritin, you shouldn't have to beg someone to get these markers done. This is very simple we can literally get your requisition form the same day. You go straight to the lab, you don't have to beg somebody to run it. So if you need help, please reach out to Dr. J justinhealth.com or me Evan Brand evanbrand.com. We would love to help you with this and other related things too. Whether it’s gut Infections we need to look for Four sources of inflammation driving this. There's probably some root cause It's not just magically going to happen like this. There’s probably a couple others– you know, It's an entangled spider web If you will. So we're going to kind of tease that. We love doing that; it's very rewarding when you see a woman who is buying all these hair loss control shampoos and these special products and their get sucked in into by their hair salon, and they just simply needed to optimize their ferritin levels.
Dr. Justin Marchegiani: Yeah if your iron levels are low, It can impact your thyroid. If your iron levels are low, it can impact your adrenals because you need high quality you need to carry oxygen to be able to um, you have aerobic metabolism, you need to carry oxygen to have good thyroid function. If you don't have good thyroid hormones Important for stimulating hair to grow, and of course if you're not breaking down your protein, and or iron you're not going to be absorbing all the proteins and facts to build up your hair to make our hair healthy. So all those things can play a major role. So guys get blood, get some testing done. Women, make sure people in general, women especially make sure you're eating high quality animal products or at least something right. Maybe eat some egg yolk. Maybe eat some liver capsules. Just try to do something that ‘s going to meet the middle of it. And then outside of that, get tested as well, and if you're female and you're bleeding, you gotta look at the estrogen dominance, and you gotta look at the progesterone. Conventional medicine is just going to throw birth control pills at you and that's not going to fix the issue. It's actually going to compound and make the problem worse because estrogen pills can lower B vitamins-B-12, and Folate, and calcium. It can lower other nutrients and it actually makes your estrogen dominance worse right. It's giving you more estrogen; giving you a consistent level which is better you know, having the up and down but, it's not fixing all of the hormonal imbalances; Just covering things up. So If you want to get to the root cause, reach out to Evan Brand evanbrand.com or myself Dr. J at justinhealth.com, we’re here to help.
Evan Brand: Amen! You did a great job. I think we killed it.
Dr. Justin Marchegiani: Alright. Excellent. By the way, what are my ranges, uh, ferritin 30-40 enough for women, uhm, men you know 60-80sh i think pretty good for that, iron saturation 25 and up. And i think it’s a pretty good kind of starting point there. Maybe binding proteins below 300 that’s a pretty good thing out of the gates.
Evan Brand: Yeah, i had a woman with a ferritin level of 6 She can hardly get up a flight of stairs because she was so short out of breath, her hair was falling out In clumps, her husband is mad at her because she was clogging the shower all the time. Once we got her ferritin back up to the 50s, her hair stopped falling out. She felt so much better. She can run of the stair without passing out. I mean, it was just incredible so don't underestimate this. I know you guys listen to us on a regular basis. Even some clients they tell us they listen to us while going to sleep. Don't sleep on this issue. This is something you really got to address.
Dr. Justin Marchegiani: Yeah, it's an important issue for sure. And for guys, with low iron yeah, vegetarian-vegan, make sure you're not doing that. Vegetarian vegan, look at the gut. You are probably not absorbing or digesting or breaking It down. Get the gut, look deeper. All right Evan, have a phenomenal day, man! Great chatting with you!
Evan Brand: Take care now you too.