Over the past few years, I've developed an unexpected interest in iron metabolism, and there's a good reason for it. I've been caught between my own low iron levels and my husband's high iron levels. Unexplained health issues in my children prompted me to delve deeply into the complex natural iron recycling system.
We've misinterpreted numerous elements of health, with iron being a major one! Many individuals are unaware that what appears to be "iron deficiency" is often iron dysfunction, which can stem from nutritional and digestive problems.
Your body's ability to properly use oxygen and generate energy in your cells is the ultimate health indicator. Unregulated iron is at the core of chronic illness by way of it's ability to cause oxidation. This is why understanding how iron and oxygen interact in the body is crucial.
When discussing high iron, it may be related to a genetic condition known as hemochromatosis, or it might indicate dysregulated iron. In the case of anemia, it means the body has a decreased number of healthy red blood cells necessary for transporting oxygen throughout the body. There are many different types and names associated with low iron. This is indeed a serious issue. However, instead of investigating the causes of low red blood cell or serum iron levels, we frequently resort to adding iron supplements. There are numerous underlying factors that, when explored and addressed, can improve not only your iron levels but also your overall health.
Being genuinely "iron deficient" is quite difficult
Morley Robbins, researcher and founder of the RCP (root cause protocol) has brought confounding research on the iron recycling system to the forefront and its changing how we view how our body interacts with iron.
He explains, for over 70 years, iron has been extensively added to our food supply. It is found in tap water, pharmaceuticals, birth control, and even cosmetics. The question is, if this is true, how could we truly be deficient? Many individuals consume large amounts of iron daily, yet still experience low red blood cell counts and low serum iron levels. It doesn't make sense!
Iron does not readily leave our body, rather it stored in our tissues, the liver being its main storage site. This is unless, of course, you are literally losing blood.
There is a difference between iron deficiency and iron dysregulation, as well as between iron in the blood and iron in the tissues. Many of us are actually experiencing iron overload in the tissues. If we don't investigate further to uncover the underlying causes of iron dysregulation, we risk having high iron levels in the tissues, which has been associated with oxidative stress, essentially inflammation.
Exceptions to this rule always exist. There is true anemia and true hemochromatosis, but there is an in between that can be supported nutritionally. This blog is not meant to substitute medical advice. Instead, we believe it is important to provide insight into optimizing your natural iron recycling system through nutritional balancing.
What is iron overload?
Iron overload refers to the excessive accumulation of iron in tissues, the liver, endocrine glands, joints, and other organs. Typically, this is known as hemochromatosis. Many know this condition as genetic disorder that causes the body to absorb and store excess amounts of iron.
Iron overload is a major contributor to inflammation and chronic illness. This condition can lead to hormone imbalances, PCOS, arthritis, diabetes, hypothyroidism, infertility, chronic infections, bacterial/yeast overgrowth, depression, and various other chronic illnesses, such as fatty liver and gout in my husbands case.
We learned this the hard way through significant health challenges my husband faced as he aged. It wasn't until his late 40s that we found out he has hemochromatosis, although he had been experiencing health problems for the previous 10 years. No doctor considered investigating this as a potential root cause or even conducting basic blood tests that could have highlighted the issue.
Hemochromatosis is distinct from general high iron levels, and if you have elevated iron along with high ferritin, it might be advisable to ask your doctor to conduct genetic testing. Although blood donations are the treatment for hemochromatosis, enhancing your iron recycling system can also be advantageous.
Morley Robbins' work highlights that the main causes of iron overload (non genetic) are high iron levels in the tissue along with a lack of bioavailable copper and retinol. He thoroughly documents and references all his research, and I recommend reading his book for those interested in learning more.
How does iron get dysregulated?
Due to nutrient deficiencies and modern living, we are not able to metabolize or process iron the way we were designed. When iron can’t maintain homeostasis, it results in chronic unbound iron that reacts badly with oxygen (oxidation). So how does iron get unbound? There are many factors at play, but some of the biggest contributors are:
High Iron Consumption:
Fortified foods (grains, wheat, bread, cereals)
Birth control
Tap water
Pharmaceuticals
Prenatal and multivitamins
Baby formula
And not enough:
Bioavailable copper
Retinol (preformed vitamin A from animal foods)
Ceruloplasmin (copper-activated protein)
Balance in mineral system
The Iron Recycling System (RES)
Our body has a complex iron recycling system called the reticuloendothelial system (RES). Men typically have around 5,000 milligrams of iron, while women have about 4,000 milligrams. This iron sustains 25 trillion red blood cells. Each day, the body loses approximately 1% of its red blood cells, requiring the replacement of 250 billion cells daily. Only 25 milligrams of iron are needed for this process, with 24 milligrams sourced from the recycling system (the reticuloendothelial system). In total, we require approximately 1 milligram of iron each day for our food.
Excess iron in the tissues interacts with oxygen, leading to oxidation and inflammation. When the body experiences inflammation due to reduced energy production, it releases pro-inflammatory cytokines. This inflammation increases iron storage, which can result in lower iron levels on blood tests. This is a very different narrative from what many of us are told when our iron levels come back low.
Copper as an essential partner
Iron relies on an essential partner, copper, which must be optimized for the system to work optimally. Copper functions as the doorman, enabling iron to enter the system. Without copper, iron cannot be mobilized from the tissues into the blood. It facilitates iron's attachment to transferrin, a transport protein that delivers it to the bone marrow, where nurse cells produce the next day's red blood cells. This system is beautifully designed, and I am always in awe of the beauty and wonder of our body's design.
Taking supplemental copper isn't just a straightforward decision. The process is rather complex, and even though I'm simplifying it, I'm not fully capturing its intricacies. Like iron, copper can become imbalanced and cause major health issues. For copper to be optimized, it needs to be bioavailable, which requires pre-formed vitamin A (retinol), other essential minerals, and a protein called ceruloplasmin.
But hold on, there's additional information. The adrenal glands instruct the liver to produce ceruloplasmin, requiring optimal adrenal health, which can be affected by various stressors - blood sugar dysregulation being one. We also need a well-functioning liver, which can become sluggish due to everyday toxic exposures and surprise, high iron in the liver. Furthermore, to absorb the necessary nutrients from our diet to support this entire process, your digestive system and gut must be in excellent condition!
At this point, you are probably thinking that just taking an iron supplement would be way easier and to be fair, some need extra external iron while they are supporting their overall iron recycling system. But another layer to understand is sometimes iron can exacerbate infections because pathogens, like bacteria, need iron to grow and replicate and excess iron can cause them to thrive. Not a good situation!
The body has a natural ability to withhold iron from pathogens to prevent nourishing them. This raises the question: are your blood iron levels truly low due to an iron deficiency, or could they be low because you lack certain nutrients needed to support your iron recycling system, or perhaps they are low to shield your body from a pathogenic infection? These questions are important to explore before blindly supplementing with iron.
Iron low on a blood test?
Considering a nutrient in isolation without acknowledging its antagonists and agonists is reductionist thinking. Evaluating iron or ferritin by itself does not provide a comprehensive view of iron status. Iron stored in the tissues will not be detected in a blood test. The only true method to determine one's iron storage is through a liver biopsy and I do not know many doctors or people signing up to do that!
However, this is where Morley Robbins research really shines. He has developed a certain set of key blood markers that bring insight to how iron is stored and working in the body. No its not a direct measure of your iron stores, but it can bring great insight to your iron recycling system. The suggested blood labs are listed below.
Ceruloplasmin
Copper
Ferritin
Hemoglobin (Hgb)
Iron Serum
TIBC
Magnesium, (RBC)
25-Hydroxy Vitamin D
Transferrin
Vitamin A (Retinol)
Zinc, (Plasma)
B12 (I also like to include this marker)
Run your own panel here
In my practice, I also like to include an HTMA, which offers insights into other vital minerals and indicators of stress, thyroid, and adrenal function. Many heavy metals also compete with iron absorption, so this is a key piece of the exploratory data to review. Furthermore, when examining iron from all perspectives, I prefer to add a comprehensive stool analysis. This can provide insights into your body's ability to digest and absorb nutrients, and it serves as a good initial screening tool to explore pathogens in the gut.
Serum ferritin is a marker for inflammation
Ferritin is often seen as a great marker for iron status in the body. However, there are several reasons why that’s not an accurate way of thinking. Ferritin is a storage protein made inside the cell. It is responsible for storing iron. It is an intra-cellular storage protein, meaning it stores iron in the cell. According to Morley Robbins, elevated ferritin levels in the blood indicate that iron has been deposited in cell where it doesn't belong, potentially leading to oxidation and damage. More and more research is finally pointing to high ferritin as a marker of inflammation.
“A ferritin level is not a sign of iron vitality. It is a sign of tissue pathophysiology. The only time ferritin shows up in the serum is when organ cells are breaking down. By the time that ferritin protein shows up in the blood, the iron inside it is likely already released. Note: each molecule of ferritin can hold 4,500 atoms of iron. The ferritin showing up in the blood is most likely the protein, without the iron.” -Sir Douglas B. Kell, PhDde
There are three types of ferritin
What many people don’t realize is there are actually three different types of ferritin.
Heavy chain ferritin: Requires ferroxidase enzyme (dependent on bioavailable copper) in order for iron to load into it.
Light chain ferritin: Operates independently of ferroxidase. Increases in times of inflammation.
Serum ferritin: Empty of iron, as the iron has been discharged into the cell before it enters the blood.
When inflammation is present, light chain ferritin becomes more prominent and dumps iron inside the cell and then the empty ferritin protein is excreted into the blood. This process disrupts the RES (iron recycling system).
This is a very simplified overview of the system and you may have gathered this is a complex and fascinating topic. There is much more to high iron or low iron story for each of us As stated, this blog is not intended as medical advise and meant for educational purposes.
ReBoot Iron Recycling System
Now that you have a little more information about low iron, high iron and the awesome iron recycling system, I implore you to continue to education yourself. What this really comes down to is the inability for iron to move from the tissues, into the blood and ensuring you can digest and assimilate your nutrients. If you have low iron in the blood it's also important to check your pathogen load as this can bring great insight as to why maybe the serum iron levels are low.
Our ReBoot: GI-Map & HTMA may be the missing piece to many of your unexplained health concerns. This package reviews a detail analysis of your digestive capacity, along with your key minerals and heavy metals patterns. The suggested blood panel is a seperate peice of the package that we highly encourage you to run. You simply place the order for the blood labs and schedule your blood draw. (18 and older only) As you get your results - email them to us and we will review in detail along your HTMA and GI Map.
We invite you to discover our Reboot package to understand how balancing iron/copper and optimizing gut health can significantly impact your overall wellness
Resources
Book: Cu-Re Your Fatique, here
Bloodwork: Suggested Blood Chemistry, here
Test: Reboot: GI Map & HTMA, here
Our Approach
Functional Diagnostic Nutrition® is a science-based holistic approach to investigating and identifying the root cause of your health problems. Imbalances in your body can lead to symptoms such as digestive complaints, fatigue and weight issues. As a therapeutic partnership between client and practitioner, it is an evolution in the practice of nutrition that better addresses the health needs of our modern society.
Sources: PMID 24549403, PMID 89148951, PMID 9647667, PMID: 20384844, PMID: 11595384, PMID: 21161695, PMID: 23836822, PMID: 12641343, Book: The Cu-Re Your Fatigue