Ep. 279 Low Ferritin: More Than Just an Iron Deficiency

You are listening to Alpha Health and Wellness Radio. I am your host, Dr. Haley Schof, and my goal is to empower you to become the Alpha of your health. I don't know if it's just my algorithm or if it's everybody's, but Faritan very much so seems to be a huge topic of discussion on social media, but not even social media. I'm seeing so many cases of low-fairitan or when I'm reading labs, even if they haven't brought it up, I'm bringing it up because we're seeing a lot of low-fairitan. And what's cool is it is being so much more commonly discussed labs are changing their reference ranges, like it is becoming a topic of discussion, I think, for a very good reason. But why are we seeing such an issue? And we're going to be diving into what I'm seeing is a huge reason, a few different root cause reasons for why we're seeing Faritan below. We're going to, like, what is Faritan? What are some symptoms that I can have? What are things that it's tied to? So you'll know after listening to this podcast, you'll be able to walk away and have a little bit better, hopefully a much better idea of what this is. And if you're experiencing any of these symptoms, things that you can advocate for and ask for, and also really simple ways that you can support your Faritan without just an iron supplement. Because sometimes that can be very helpful, sometimes I will add an iron supplementation with key biofactors or key call factors into someone's protocol, but that's not that's not the sole reason, and I want to talk a little bit more about that. So Faritan is not the same thing as iron. Faritan is like your body's iron savings account. Faritan is your stored iron. So your body has normal circulating iron, what you can use on a daily basis, but Faritan is the stored version of that, right? So now when these iron stores become depleted, we can see symptoms start showing up a long time before someone might be diagnosed as being anemic, and being anemic also think of that as a few different things. So not only low iron, but we can see macrositic or micrositic anemia when we look at the size of the red blood cells on the CBC looking at the MCVMCH. I see that all the time that almost always goes undiagnosed when I'll see someone's MCVRMCH super low. I'll be like, has anyone told you that you need to be on a good quality methylbe vitamin that you do not absorb things while you have a micrositic anemia? This can totally be linked to a lot of the fatigue, fertility, ovulation issues that you've been experiencing, and a lot of times they say no. Same thing if that number is super high. You can either mac micrositic is on the low side. Macrositic is when those levels are on the high side, and that still is a form of anemia that I often unfortunately see go misdiagnosed very, very frequently. But again, when we say anemia, I think most of us just think of like an iron deficiency anemia, but it does go much further than that. So symptoms that you can see show up. Now these symptoms also might look very similar to symptoms of anemia, but these symptoms can these symptoms usually start showing up before you might see the drastic changes on the lab. And that is why in my practice, I really am huge at symptomology. Obviously, I like looking at labs, but sometimes your symptoms can help us catch something even before certain labs might show it. So in these cases, I see a lot of fatigue, a lot of hair shedding, brain fog, poor exercise, tolerance. You just feel more winded. You feel out of breath. You are very cold, feeling very cold easily. You've feeling maybe more restless legs. You might have very brittle nails. It's very hard for you to grow healthy nails. You might just even feel a lot of these people even just notice like low mood, low mood, low energy. They just don't quite feel themselves. They feel kind of dull. I do see a lot of these symptoms start to creep up also is fertility symptoms. A lot of ferritin, especially low ferritin, is linked to really poor ovulation. So that's very key when it comes to fertility. Fertility challenges, getting pregnant, remaining pregnant. And even if you're able to get pregnant, you just can have a lot more symptomology as it pertains to your pregnancy because these stores become very, very, very, very quickly depleted. Basically, within the first trimester, your body is basically utilizing and burning through your entire stored iron. So then as your blood volume begins to thicken in the second trimester, you know, we're really, really banking on a good quality ferritin level there. So I mean, I see this linked to fertility. I see this linked to even just like people coming to me being like my hair is falling out. My skin super dry. I'm super cold all the time. Like my, I don't have energy. Like none of these, none of the symptoms that I mentioned are fun. Nobody should have to deal with those symptoms. And I feel like a lot of what we're going to chat about is what we're looking for. So iron is, is incredibly, incredibly important. Like I just mentioned, it's essential for ovulation. We need it for certain hormone production. We need it for proper oxygen delivery. So that's like why we get so fatigued, so tired, we have that exercise intolerance. But even when we think about fertility hormones, we need that oxygen delivery to healthy follicles and to the uterine lining for pregnancy and then to baby through the placenta. So low iron stores are something that really irritates me that is not a routine check for preconception and fertility labs and someone who's struggling. I've seen, I've read so many, a lot of my patients and clients, they just, they invest in like the function type labs because it's so easy for them to get exactly what they want. And then they just send over the results when we're booking an appointment. So I read those very frequently. And I'm always impressed with the amount of data that those types of labs are testing. And in so many of the cases where they're like, I'm not getting strong ovulation. I'm tracking my basal body temperatures. They're super low. I'm not noticing that positive. I'll insert in almost all of the cases that I can think of that I'm actively working with right now. They're fertility, or they're ferritin is not optimal. I, the labs, now depending on which lab you use, whether lab core and quest both have different reference ranges for ferritin. I do not go off of anybody's range except for my own. It would, I use the functional range, which is 50 to 100 nanograms per milliliter. 50 is the bare minimum that I like to see on labs for ferritin. Women are coming to me with ferritin levels 14. The bare minimum I like to see is 50. I'm, I've seen six. I've seen 14. I've seen 20. I've seen 30. And again, I'm not, I'm not upset if there's level used to be 10 and then we brought it up to 30, but we need to bring it up higher. But again, we don't want to just kind of go blindly thinking like, okay, my stored iron is low. Now I just need to supplement iron. In, in some cases, like we do and we need to impact work on absorption. We need to work on gut health and we need to clear out pathogens. We're going to talk about all of those things. But like, why are we seeing so much more ferritin low in the first place? Why is this becoming so much more of an issue? First of all, and, and especially a lot of the fertility cases and hormonal cases, a lot of these low ferritin levels are in women who have pretty heavy menstrual cycles who are losing a lot of iron every single month through their menstrual cycle. I've also seen a lot of low ferritin in pregnancy and postpartum. Pregnancy again, there's a huge iron demand. That is why I can't emphasize it enough. Please do not wait until you're pregnant to start building up your nutrient stores. You should be building up your iron stores three to six months before you get pregnant because your body burns through it so quickly. Low dietary or iron intake. A lot of people just are like, I don't know, they just, they're not, especially not as much. I don't think that I'm personally seeing in my clinic like a lot of people that I see eat really good quality grass had me. A lot of people aren't afraid of chicken thighs and darker meats that have higher iron versus like 10, 15 years ago when everyone was just eating boneless, skinless chicken breasts, staying away from red meat. That obviously was a problem in terms of getting iron in because the wider meat, the lighter meats don't have iron versus, you know, chicken thigh, things like that. Those parts, chicken leg, all those much darker meats of those poultry items are much higher in iron and obviously ground beef, you know, a lot of people are getting a lot of the ancestral blends of ground meats, which is great because that includes liver, obviously beef liver is the most heium concentrated form of iron, but even chicken liver is really great, like it can really sneak easily into ground chicken and force of nature does a really good job of that. A lot of people have really not great stomach acid. A lot of people's, I've read thousands of of GI maps at this time in the amount of people whose elastase and digestive capability markers that are suboptimal is a majority. If we do not have good enough stomach acid, we have poor absorption. We're not going to, like, even if you're telling me, "Hey, I'm eating, I'm eating the red meat. I'm taking the defliver capsules. I'm doing these things, but I'm still not noticing a difference. You, we need to look at your digestion because if you are not making the enzymes and acids that you need to even digest that food, you could be eating the best things in the world. That's why, like, almost everything we, yes, nutrition is the best and it's so important. But if you're not breaking it down, it's not that it doesn't matter, but if you're not getting everything out of it that we should be. Obviously, more intense GI conditions like crones, celiac, things like that, where there's a pretty significant damage to those intestinal barriers that can impact absorption. Are other reasons why we can see low ferritin and just low nutrients across the board. That's why it's so pivotal that we want to protect and heal and seal those gut barriers, lots of anti-inflammatory things for the gut because when the gut is inflamed, it is not going to absorb and maintain our nutrients as we should. Chronic gut infections. This is a big one and this is why, again, I am not a fan of blindly supplementing iron because if you have, sometimes what our body will do, because it knows that pathogens in our gut, parasites, these, these overgrose, they feed off of iron. So what our body will do is literally protect ourselves so that it helps, it's like trying to starve the pathogens, which is great, but then we add an iron supplement on top of it and it feeds the iron or in it feeds the pathogens. So we have to look at what's going, like I always want to roll that out first. Always, always, always, always. Chronic inflammation is a big one. I see low ferritin in a lot of endurance athletes, cross-country runners, or just history of cross-counting, but then cross-country, but now they might just be doing a lot of endurance. We're burning through it. They're burning through a lot of nutrients stores and they need so much more iron to keep up with that anaerobic demand, but also poor estrogen detox and estrogen dominance is really heavily linked to low ferritin. Again, because that's also linked when you have poor estrogen metabolism, you're not detoxing it properly or as optimally as you should, and then therefore you are going to have heavier periods, so then therefore you're depleting your iron and your ferritin stores more. So, I mean, that's the kind of like a multipurpose roundabout, if you will. And a lot of times, okay, heavy menstrual cycles, low dietary intake, poor stomach acid, GI inflammation, chronic infection, how many endurance sport, how many people have a mix of all of these? Most, like it's very rare that it's like, I just actually saw one in the office a week. She has celiac, definitely some got inflammation because it was a misdiagnosis, like an undiagnosis celiac for years. Heavy menstrual cycles, endurance exercise, like all the different things, and we're like in, you know, like someone's like, what is my one root cause? I'm like, a lot of times there's not just one thing, you know? And it's okay, there doesn't need to just be one thing. In her case, it was totally a mix of everything. But that's great because it's like, well, that may, when we support one thing, it's supporting so many other things. Okay, so with that, like you want to make sure you're looking at the gut, you want to roll, you want to roll that out. Like if you get a ferritin low on your lab and you're like, okay, well, I definitely have gut symptoms. And even if you don't, it just depends, like some gut symptoms show up just on the skin, skin, some gut symptoms show up as hormone just array. So I really would urge people, like, and maybe your gut symptoms are just the fact that you're not digesting or you're, they're like, well, I'm just busy and I'm just, you know, like that's fine. But like if you're running around, never sitting down, not taking a few deep breaths before me, like not ever sitting and eating in peace, you, you could be eating the best food in the world, but you're just not going to digest and absorb it as well as you could be. You know, like it's, it's like a good, better best situation. Like a lot of moms, I see they're like, okay, I know I need to do better about meal timing. Like I have multiple kids, like we're running around all the time. And I know it's like, you know, it's, it's part of the season, right? So I'm like, okay, well, maybe, you know, for dinner for like a family meal when you guys are all sitting at a table, that's when you're having like, you know, your most nutrient dance, but like maybe during the day, if you're not being able to sit down, like at least have something that's really super easy to break down, not super hard on your system, or maybe we're just finding ways to work more of that nutrient density in and, uh, easy to digest ways, like, you know, throw some beef organ capsules, like in your smoothie, um, like, you know, open up the caps and put them in or something like that is, we have to sometimes get creative because we can't, we can't just live on depletion because that's also, we can't be there for other people if we're feeling down and out and chronically depleted. Um, so first things first, if you were to get a low ferritin below 50 nanograms per milliliter by the functional standards, you, first and foremost, are like, I want to optimize my digestion. Okay, so maybe we start taking more deep breaths before a meal, few deep breaths before a meal, maybe you start doing some digestive bitters or even my favorite, just a little bit of diluted apple cider vinegar, a little bit of lemon juice diluted with water, sip that as you're cooking your meal, that's going to strengthen your stomach acid, it's got naturally occurring enzymes, and it's going to actually help you break down the foothier eating, and the nice part about it too is the, the vitamin C from the fresh squeeze lemon actually helps you be able to absorb the iron better, because that's the other thing. If we're incorporating more heme iron rich foods, red meat, liver, bison, lamb, different types of shellfish, we want to pay, ideally, pair that iron rich food with some type of vitamin C. Um, so if you're doing something like with breakfast, you know, like, uh, I don't know, whatever, whatever, like a beef patty or something like that, cool, like, let's do a kiwi on the side, or if you're doing some ground beef with dinner, awesome, like, let's add some bell peppers with that for some good vitamin C absorption. Heme iron loves vitamin C, it just totally helps, but uh, at the same time iron is also picky, iron is really heavily impacted by calcium rich meals, like super, super high calcium rich meals, so that is why in a prenatal, you will see one or the other, needed prenatals have calcium, not iron, iron is to be supplemented separately and not at the same time, because, again, calcium and iron, they're going to have heads. Um, we natal, the other, like another top prenatal I use in our command, it has iron, it does iron by glycinate the best form of iron for absorption, it does not have calcium. So when I take the needed prenatal, I take it away from if I'm taking some beef organs or if I'm taking like a few times a week, I'll just do the wee needle iron by glycinate, because it has vitamin C in it, I've been taking that just a few times a week, usually at lunch or dinner, away from a high calcium meal, away from my coffee, um, and away from my calcium prenatal, it's a, it seems a little picky, but really if you just kind of like plan your meal a little bit or just think like, okay, if I just like this is kind of going to be the meal that I have coffee, this is the meal that I'm taking a supplement that has calcium, like, let me just take it a different one. It seems, it seems like a lot of admin and I know iron is a diva and it's really picky, but it's not that bad, like, just, there's other meals that you can just take it with, but it is best taken with food, do not, do not take an iron supplement on a, hard, I don't, um, de-sumic, and so many iron supplements are just going to cause constipation, gonna sit on your stomach heart, so please, please, please get a good form, um, whether you're doing that in like a beef organ kind of form, which is great, I will do that a few times a week as well, um, I do try to take, like I said, the weenatal iron by glycinate because it has liposomal vitamin C, I've just, I've just found that to be really, really effective and super helpful for me, um, for feeling good, for keeping my energy up for, um, at one point I was nervous because I was feeling a lot of shortness to breath, um, in the beginning ish, I'm not feeling that as much anymore, um, so again, we don't want large amounts of iron and calcium around the same meals because it can impact absorption, um, and then of course, like if you're still struggling like that's exactly, this is exactly what I am working with people with on and helping them through and figuring out what is their root cause, how much work and what type of work specifically do we want to be doing to the gut, is that just like some simple anti-inflammatory is that really boosting up digestion, is it, you know, really minimize, like supporting detoxification so that we can improve estrogen metabolism so that the periods are better while we're doing some of the support. I mean, everybody's is a little bit different and hopefully you heard something in this that resonates with you that then you also have tangible steps on things that you can do, you could do better food pairing, you know, I've done tons of episodes on heavy periods and estrogen dominance, you can go back and listen to those. So you have a lot of resources even just from this and with the podcast, um, And obviously, if there's any questions and if you want to work with somebody on this, it's obviously something that we could do together. I see it all the time. But I wanted to give you something and I wanted there to be something that lived permanently on the podcast about Faritan because I'm seeing it so frequently. And everyone's treatment protocol is slightly different. A lot of the times we're looking into the GI system, we're running GI maps and a lot of these cases, but in some cases I'm like, okay, I know that there's been some inflammation. We need to go in, we need to support that and we're able to really see some awesome results from that. And sometimes it doesn't mean simply just eating more iron. Sometimes there's not much that we have to change with what you're doing. We just change when you're doing things. Add some more of those co-factors like vitamin C along that really can help with that absorption. And minimum, try to take that away from calcium rich foods. But again, the strengthening of digestion goes so long, goes such a long way and it can really be something that is super mindful. I know it sounds silly. People look at me like, are you kidding me? Like you want me to just sit down and be calm and not be on my phone? Yeah, because it makes a big difference. Like your body does not think that you're digesting when you're behind your laptop, when you're on your phone, when you're watching TV. Like your body thinks you're digesting when you're sitting in front of your meal. You've been able to salivate as you're making your meal or heating it up, it's your body's natural way of making enzymes. And when you're able to chew properly, I feel like I'm eating it. My husband about this all the time. I'm like, we eat such freaking healthy food. Don't throw it away by finishing your meal in five seconds. Like this is not a competition. And we most certainly don't want that to be, we don't want our son to see this and then be like, okay, well, I have to eat fast 'cause that's how he got it. I was feeling like he had to compete to eat. And I was like, we're not doing that. Like we need to untrain this and it sounds so dumb and it sounds so silly. But I really encourage you to work on that if you know that that's a problem for you. And trust me, I'm working on it too. Like I just like, I love eating that I get so excited to eat that I have to remind myself to slow down and like chew my food because it's not a race. And if anything, I'm gonna get a million times more things out of it if I'm chewing adequately, if I'm eating slowly and if I'm like really just savoring the moment because my body will be in more of a parasympathetic state. I'm able to make more digestive enzymes and acids and actually get what I want out of the food 'cause that's why we're doing it in the first place. I mean, obviously, food is a whole experience and I love that too. But I end at the same time like, well if it's food's an experience and like we're making great food, I also don't want it to end. So I'm gonna eat slower. So there's a lot of benefits to eating slower. So I encourage you to do that. That's your homework. And then you can look into the other stuff as well. But thanks so much for listening. We'll see you next time. (upbeat music)