Iron Not Only Bad In Excess, But Also Bad In Deficiency?

Gabriel

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I'd like to start a discussion on:

  1. The question if iron deficiency is as bad as iron excess.
  2. The connection between thyroid dysfunction and iron deficiency.
  3. Determining the optimal intake of iron (i.e. how much mg iron/day, optimal ferritin/transferrin saturation values? Intake by symptoms?)
  4. The question whether strict anti-absorptive strategies (e.g. coffee after eating meat/liver) are useful for maintaining health.
Here are references to start the discussion:

Ray Peat

  • Main article (link)
  • Toxinless Search on Iron (link)
  • Some E-Mail correspondence (link)
Studies showing that iron deficiency impairs thyroid function

Controlled Trials indicating beneficial effects of iron supplementation

Trials indicating deleterious effects of iron supplementation

  • Effects of routine prophylactic supplementation with iron and folic acid on admission to hospital and mortality in preschool children in a high malaria transmission setting: community-based, randomised, placebo-controlled trial.
    http://www.ncbi.nlm.nih.gov/pubmed/16413877
 

isabella83

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Thank you for this post! I have only recently become acquainted with Ray Peat's work and his unique perspective on nutrition but have to chime in that based on personal experience I believe deficient iron is almost worse than excess iron.

For years I have suffered from severe fatigue, hair loss, depression, heart palpitations, restless leg syndrome, extremely dark undereye circles, and bitterly cold hands and feet. I went Paleo - that didn't work, and most recently I adopted a more Peatarian way of eating and although I felt much better than when on Paleo, I still had all the complaints aforementioned.

On a routine visit to the doctor a blood test revealed my ferritin levels were ridiculously low (about a 7, should be around 45-70 ideally). Doctor prescribed iron pills twice a day. I was suspicious and worried about taking iron supplements - wasn't this supposed to be heavy metal suicide? Well, I decided to give it a shot, after all Ray Peat has to be taken in context.

After taking iron supplements twice a day I have never felt better. It truly is weird how just popping 65mg of iron twice a day has changed my life - my energy has increased tremendously, my skin issues have been resolved, my undereye circles ARE HALF GONE, no more heart palpitations, no more weird sensations in my legs, my hair is starting to grow back, and my hands are starting to feel much warmer than usual.

While I am a big fan of Ray Peat's work, I think its important to find out for yourself what works. Don't accept any moralistic attack on any nutrient or food without considering its context and your own personal biochemistry. While Ray Peat is fairly negative on iron, I've found that at least in regards to my own iron deficiency - supplementation has made a considerable and measurable difference in my quality of life.

Just my :2cents
 
J

j.

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Ray Peat said that iron deficiency is rare, but some people do have it, and he recognizes that.
 

Mittir

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isabella83 said:
On a routine visit to the doctor a blood test revealed my ferritin levels were ridiculously low (about a 7, should be around 45-70 ideally). Doctor prescribed iron pills twice a day.

I think you have not read his article on iron. Here is the link and a quote from that article.
He is simply saying that there are other causes of anemia than just iron deficiency.
Iron saturation index is the best test to measure iron storage, not blood hemoglobin.
Not even ferritin level, he mentioned ferritin level in an interview.
Clearly your doctor did not test for iron saturation index, but a good doctor
would test both ferritin and saturation index. It is unfair to criticize someone's view without knowing their
view. He also explains how anemia was cured by arsenic or iron.

Iron deficiency anemia does exist, in laboratory situations and in some cases of chronic bleeding, but I believe it should be the last-suspected cause of anemia, instead of the first. It should be considered as a possible cause of anemia only when very specific blood tests show an abnormally low degree of iron saturation of certain proteins. Usually, physicians consider the amount of hemoglobin or of red cells in the blood as the primary indicator of a need for iron, but that just isn't biologically reasonable.

If a large amount of blood is lost in surgery, a temporary anemia might be produced, but even then it would be best to know whether the iron stores are really depleted before deciding whether an iron supplement would be reasonable. Liver (or even a water extract of wheat germ) can supply as much iron as would be given as a pill, and is safer.
http://raypeat.com/articles/articles/iron-dangers.shtml
 

Gabriel

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The symptoms she described, including warmer hands, suggest that the additional iron helped her thyroid function. The second reference in my first post shows how thyroid function improves after correcting iron deficiency (http://ajcn.nutrition.org/content/52/5/813.short).

I'd also be curious if the doctor measured Transferrin Iron Saturation (TSAT). I agree with Mittir that this should always be checked in combination with Ferritin. By doing so you can differentiate between true iron deficiency or inflammation that causes "protective" iron deficiency (which is not related to not having enough iron but related to the body protecting itself from the damaging effects of iron that are greater in an inflamed body).

Also, I think it would be worthwile to see whether liver has the same (or better) effect than the iron supplements. In liver, iron is balanced with zinc, copper and other nutrients.

After around 6 months of supplementing, I'd try to get another lab panel with Ferritin + TSAT which will tell you if you are overdosing on iron or not.

Another thing I'd like to add: While not you Mittir or j appear to have problems understanding Peat, I have the feeling that many others misunderstand him in some aspects. One of it is iron, and people just start drink coffee with every iron-laden-food or avoid it completely without knowing whether they are not in fact iron deficient. I think for newcomers it's important to know that iron can also be a cause of thyroid problems (even though it's a less common cause than the medical public tries to make us believe).
 

isabella83

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Mittir - Doctor did test for % Saturation, which came in range at 22%. I was not criticizing Ray Peat's views, simply adding my own personal experience specifically related to having low ferritin blood test results and taking an iron supplement. I feel Ray Peat is likely in the 90th percentile "right" about most things, but we still have to sort out our own issues and no one has a patent on the truth.

Gabriel - Thanks for your response. I believe my iron issues began in college after a sibling of mine passed away unexpectedly. The intense stress, I believe, caused an issue somewhere along my GI tract that caused bloody stools - and by bloody I mean toilet bowls full of blood (sorry for the TMI). I lost quite a bit of blood, and shortly thereafter my hair started falling out in clumps. I am currently 5'10" and weigh around 156 lbs - in college I went down to a sickly 125 lbs at that point. Most of my health issues started after that. I wonder if just the sheer amount of acute blood loss coupled with heavy menses caused the deficiency.

I didn't realize the body could have protective iron deficiency in response to inflammation. How would TSAT reveal such a thing? Ultimately, while I am feeling much better on the iron supplements I hope I am not doing more harm than good in the long run and would appreciate any input.

On a sidenote, while TSAT was not included in my lab results, I did have unusually high testosterone for a female (65 H). Not sure if there is any relation.
 

isabella83

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Just wanted to post my full iron related blood test results in case these help with any other insights:

IRON, TOTAL: 88 (normal range 40-175 mcg/dL)
IRON BINDING CAPACITY: 402 (normal range 250-450 mcg/dL)
% SATURATION: 22 (normal range 15-50%)
FERRITIN: 7 (normal range 10-154 ng/mL)

Thanks again to both :)
 

Gabriel

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Thanks for posting it. Was this before or after starting the iron?

Iron deficiency has the following lab pattern (in brackets your results)
-Total Iron: Low (normal)
-Total iron binding capacity: high (high-normal)
-% Saturation: Low (low-normal)
-Ferritin: Low (Low)

Chronic inflammation that results in "functional" iron deficiency looks more like this:

-Total Iron: Low
-Total iron binding capacity: Low
-% Saturation: Normal
-Ferritin: Normal-High

In conclusion, your results suggest a mild iron deficiency so I think taking iron supplements is justified.
 

isabella83

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I wanted to post in this topic again to report some personal findings. Despite the positive effects iron supplementation had for me, I decided to stop taking it for awhile because I was really worried it was going to do more harm than good in the long run. I didn’t want to age prematurely or damage my body and thought I could get enough by drinking orange juice with meat instead of supplementing.

I really shouldn't have stopped taking the iron supplements.

I have developed vision problems and "spoon nails" {Koilonychia}, all of which might have been prevented if I had kept up with the iron supplementation. :(

I truly regret not sticking to my iron regimen. I suppose I am one of those rare cases of truly iron deficient anemia, but I’m not so sure I'm all that rare. I encourage anyone out there faithfully Peating & still not seeing optimal results to test their iron levels. As much as its bad in excess, as the post title suggests, its also really bad in deficiency.

A few days ago, I bought a bottle of Geritol Energy Support, which is a liquid iron supplement + some B vitamins. I already get a good dose of B vitamins from my diet & pure powder supplementation, so the following effects I am attributing to the liquid iron --> After the initial shock from the horrible taste of this stuff wears off, I feel great. Warm cozy hands/feet, energy, desire to be outside and doing stuff, all things I have not been able to achieve from thyroid supplementation (cytomel) alone despite consistent dosing & making sure I am eating well and getting correct level of other vitamins. I also have been using pregnenolone & progest e as recommended for awhile now. The positive effects last all day.

I wouldn't recommend the Geritol based on taste & inclusion of Benzoic Acid as an ingredient. I will be experimenting with some natural iron rich water I saw at Walgreens called Spatone, which consists of only iron & water and can be mixed with OJ. We’ll see how that goes.

Again, I’m posting this mainly for people that still have thinning hair and/or have been following Peat guidelines and supplementation yet something is still missing; energy is not up, warm hands & feet haven’t happened even after thyroid; you get the gist. Do yourself a favor - CHECK YOUR IRON LEVELS.
 

pboy

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this is a really interesting topic...thank you all for posting info. I wonder if being a girl you naturally need more iron than me, but its something ill keep in mind for sure to watch for...I probably only get 20% or so on an average day more or less, so I don't know if that's gonna lead to a problem in time or if im good. Its very nice and good manners that you've brought this to peoples attention though, probably even more so for the girls here
 

marcar72

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I've just recently realized that I've been iron deficient for awhile now, up to and including anemia I would guess. I was bruising way too easily.

I was struggling for a few months this summer with a recurring ear infection that I'm almost positive was being caused by living in a house with mold issues. I first thought to up my zinc status with oysters but that didn't seem to help much. I then realized my Vitamin A status was a bit low for awhile there as I was neglecting to eat liver that much. Most recently (couple weeks ago) I've realized that I was probably iron deficient all along and that compromised my immune system.

I would imagine that there probably are a few Peaties here and there that are deficient in iron. I wasn't eating hardly any red meat before Peating and took a multivitamin that had iron in it because of it. Since Peating (18 months) I've dropped the multivitamin w/ iron and still don't eat red meat a lot.

So as it currently stands with my situation, I feel that living in the moldy house increased my nutritional requirements that weren't being met. Yes the mold in a sense was messing me up. I feel though that if I was nutrient replete I might not have had any issue with mold at all living there. I'm still on the fence with the whole "environmental toxins/nutritional status" relationship and exactly how it works. :2cents

EDIT: So I'm supplementing ferrous gluconate for the last couple of weeks. I haven't had any iron levels checked and am still in the dark on how much/how long to supplement for.
 

Mittir

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RP mentioned hypothyroidism is one of the cause of anemia.
He specifically mentioned high TSH causing anemia, inflammation and
liver malfunction. He also added PTH can cause anemia.
In hypothyroid person both TSH and PTH are usually high.
 

marcar72

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Mittir said:
RP mentioned hypothyroidism is one of the cause of anemia.
He specifically mentioned high TSH causing anemia, inflammation and
liver malfunction. He also added PTH can cause anemia.
In hypothyroid person both TSH and PTH are usually high.

You know what else causes anemia Mittir? Neglecting to get enough iron in one's diet. Wow, who would have thought! Sometimes Mittir you scare me. You can't seem to think outside of the RP box. RP this, RP that. Like Mittir doesn't do the thinking in Mittir's head, RP does. The topic of this thread is Iron deficiency. It's like you don't even hear what people are saying and just spout off something that RP said. You come off as someone in denial. Like OMG, someone said something that goes against what RP said... THEY MUST BE WRONG! Please, show some common courtesy and interact with people a little more. CONTEXT Mittir, CONTEXT... :2cents

EDIT: YOU'RE GOOD Mittir, YOU'RE GOOD. I really do appreciate your depth of knowledge and sharing of it in this forum. I just feel sometimes people forget CONTEXT. So if you will, pardon my little outburst up there. I'm just at my wits end with feeling off kilter...
 

tara

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A Ray Peat Forum and a Ray Peat Debate area seems like just the place to make sure relevant parts of Ray Peat's pov are posted. I really appreciate Mitttir for consistently doing this.

FWIW, I used to always have lots of bruises, and the last few months I've had few. Either my nutrition/metabolism is improving and/or I'm just not knocking myself around so much. I suspect both. My hunch is K2 helped, but it could be the whole package, including more calm, less clumsiness, and less vigorous activity.

Isn't iron one of the easiest things to get tested, so you can know, and supplement in the small number of cases it is deficient? As has been said, it is one of number of causes of anemia, but maybe not the most likely.
 

marcar72

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Here's some context...

Ray Peat's articles are mostly aimed towards the general public and their tendency to eat too much of this or too little of that. This being a Ray Peat forum it's generally taken that someone that's been around here for a bit are mostly following Ray Peat principles.

So if one is pretty much eating according to Ray Peat's ideal foods, then one is already practically doing every thing already possible to avoid the excess iron. So that for some is eating very little ruminant meat, not cooking in cast iron, avoiding all iron enriched refined foods, etc., etc.

Even the Almighty Ray Peat gets things out of context, as evidenced by myself just now while reading his "Iron's Dangers" write up...

"Women absorb iron much more efficiently than men do. From a similar meal, women will normally absorb three times as much iron as men do. When pregnant, their higher estrogen levels cause them to absorb about nine times as much as men. Every time a woman menstruates, she loses a little iron, so that by the age of 50 she is likely to have less iron stored in her tissues than a man does at the same age, but by the age of 65 women generally have as much excess iron in their tissues as men do. (During those 15 years, women seem to store iron at a faster rate than men do, probably because they have more estrogen.) At this age their risk of dying from a heart attack is the same as that of men."

Ray seems to fail to consider that maybe those women went through menopause and guess what... Stopped menstruating. He seems to think it's somehow tied to that dreaded estrogen.

So if one is already following Ray Peat principles and came from a WOE that already was susceptible to iron deficiency for decades AND one fails to still eat enough red meat... then yes it is very possible to become iron deficiency anemic.

To think otherwise is foolish.
 

jyb

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marcar72 said:
So if one is already following Ray Peat principles and came from a WOE that already was susceptible to iron deficiency for decades AND one fails to still eat enough red meat... then yes it is very possible to become iron deficiency anemic.

A basic iron test should confirm it quickly. I think you are correct that a low iron diet like high dairy may eventually deplete iron stores, especially when avoiding what most people get such as enriched flour. What I find difficult is to estimate how fast, because it all depends on how many mg's of iron is lost daily. Is it 1mg, or is it 8mg like the RDA? It makes a big difference. Hence use of iron blood tests.

However, I believe even in low iron stores (blood rests out of the range), RP strongly recommends trying to replete with food rather than supplements. Liver and bone marrow are high in iron, eaten daily I guess they'd work as iron supplements.
 

marcar72

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jyb said:
However, I believe even in low iron stores (blood rests out of the range), RP strongly recommends trying to replete with food rather than supplements. Liver and bone marrow are high in iron, eaten daily I guess they'd work as iron supplements.

Well then how do we treat his article "Meat physiology, Stress, and Degenerative Physiology" then if we're to use foods (meat) to replete. About liver, again some of us are already living according to Peat principles and eat our liver regularly. I didn't for a couple months late spring/early summer but I did eat it somewhat still. I also didn't cook hardly any meat dishes if any during those couple months or so. We also know that eating too much liver (vitamin A) is anti-thyroid along the same lines eating PUFA is.

I guess I will be getting my iron levels tested. I'll continue to supplement for awhile and increase my meat intake. I read about people taking mega dose supplements for months to restore their iron levels to baseline, way more than food could ever provide. Maybe they're all just hypothyroid. I bruised my shoulder up just laying on my back on cement to do an oil change on my car. That's pretty bad.
 

marcar72

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Ray Peat "Iron Dangers"...

"Women absorb iron much more efficiently than men do. From a similar meal, women will normally absorb three times as much iron as men do. When pregnant, their higher estrogen levels cause them to absorb about nine times as much as men. Every time a woman menstruates, she loses a little iron, so that by the age of 50 she is likely to have less iron stored in her tissues than a man does at the same age, but by the age of 65 women generally have as much excess iron in their tissues as men do. (During those 15 years, women seem to store iron at a faster rate than men do, probably because they have more estrogen.) At this age their risk of dying from a heart attack is the same as that of men."

This whole paragraph is a logical quagmire or very ambiguous at the least...
 

pboy

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it makes sense, cause at age 50, woman have less...but somhow even out with men by age 65 even tho eating similar diet...he is saying that from age 50-65, woman store at a slightly higher rate, hence catching up to men by age 65, because of estrogen, he assumes.

TBH I have no idea...but I do agree that there is a potential for low iron on a Peat diet, though probably very small.

to answer jyb, we generally only lose 1 - 1.5mg iron a day unless youre bleeding. The recommendation for 8mg is because they assume ver low bioavailability in most food and are covering their tracks.

I can testify that low iron symptoms are nearly exactly the same as what happens when you are low thyroid, or on a low calorie diet, even when there is plenty of iron in the diet. It might just be due to weaker absorption of the necessary amount without a really high metabolism. Iron requires strong stomach acid apparently to be absorbed, and you need to be producing a lot of Co2 via thyroid hormone to have strong stomach acid

There is a chance, potentially, you are low in iron...but like jyb said, I cant recommend supplements. Ive tried iron supplement in the past, and its one of the worst GI offenders ive come across. It will threaten constipation, and give black tarry stools...keep in mind the gut brain connection, you don't want such an offense gliding over your nerves for half or the whole day

even a large sweet potato, or a large potato, peeled and cooked, has high iron bioavailability and each would give you like 30% RDA, or about 5mg...plenty on a day, you don't even really need to go to meat. If you wanted, shellfish are extremely high
 

tara

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pboy said:
it makes sense, cause at age 50, woman have less...but somhow even out with men by age 65 even tho eating similar diet...he is saying that from age 50-65, woman store at a slightly higher rate, hence catching up to men by age 65, because of estrogen, he assumes.
This is how I read it too.
If I've understood Peat right, after menopause women often get even worse estrogen dominance because while estrogen production goes down, progesterone production goes down too, and there can still be a lot of estrogen bound in tissues causing trouble for a long time when there isn't enough progesterone to deal with it.

Nobody is saying iron deficiency can't happen. I personally won't supplement again unless I test below the recommended ranges. I regret previous supplementation, advised by dr.
 
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