Hannah Aylward (00:00.088)
So at that point we have to stop asking, how do I get in more iron through my food, through my diet, through supplementation, and start asking why can’t my body store this iron? Why can’t my body utilize this iron efficiently? Because I am supplementing, because I am eating red meat, because I am eating these foods that are rich in iron and I’m looking at recipes and I’m eating lentils and I’m doing XYZ, but my body can’t like hold on to this stuff and use this efficiently. So that’s the better question that we want to start asking here.

Hannah Aylward (00:35.161)
Welcome to the Nutrient Dense Podcast. I’m your host, Hannah Aylward, holistic health coach, functional gut health practitioner, and the founder of HAN. So many people are continuously failed by conventional and alternative health care. We are here to do it differently. Alongside my team of functional registered dietitians, I’ve helped hundreds of women around the world overcome their chronic digestive issues when nothing else worked.

I’ve learned a thing or two about what it really takes to transform your health from the inside out, and I’m here to share it all with you. Please keep in mind that this podcast is for educational purposes only and should never be used as medical advice. Now, let’s dive in. Your transformation is waiting. Hello, hello, my dears, and welcome back to another episode of the Nutrient Dense podcast. Today we have a big topic in front of us.

I was prepping for this episode and I was like, I have 30 pages of notes. So we’ll see. We’ll see what we can do here. Today we’re gonna be digging into the topic of low iron. So this is something I really wanted to dig a bit deeper into with you because every time I post about it on social media, it gets tons and tons and tons of engagement. So it’s very clear to me that many women or people are struggling with this. We see this pattern in clients.

quite frequently as well, and there’s a reason for it. So there’s so much that goes into the topic of iron, low iron, excess iron, inflammation absorption. We’re gonna be kind of getting into most of that today. I don’t think we’ll be able to cover like every little itty bit of everything here. So I’m gonna try to kind of walk you through like the major concepts you need to understand.

That can help explain why your iron levels may not be budging. So there’s once again, like there’s a lot to it. This podcast, you know, we’ll probably go for an hour or so. I’ll go as quickly as possible, but just keep in mind, you know, sometimes I can’t fit like literally every single detail into these episodes, but we’re gonna get into a lot of it. And if I take it like two in the weeds, it’s just gonna feel confusing and overwhelming with like lots of big words. So there is a lot to to this story. So let’s kind of dive dive into it today.

Hannah Aylward (02:50.841)
And make it make it as approachable as possible is always my goal. So many women that we see that we work with that contact me, that we speak to all the time are dealing with low iron, chronically low iron, right? So they may have tried supplementing with iron for months. You go to your doctor, they tell you you have low iron, you have low ferritin, and they’re like, here, take this iron supplement. And maybe you’ve even increased red meat intake or you’ve done some research online. So you’ve like added vitamin C to your iron to enhance absorption.

You’ve tried switching, taking other forms, different supplements. maybe even tried spacing it out every other day, because there was research shown that that can help absorption, right? Not taking the iron supplement every single day, but spacing it out every other day. You’ve done a lot of this stuff, but your ferritin level is not budging much. So, or maybe, maybe also you’ve seen it improve a little bit, but then you kind of like check back in a couple months later and then it’s already back down to where it was. So at that point, we have to stop asking.

Only, you know, how do I get in more iron through my food, through my diet, through supplementation, and start asking why can’t my body store this iron? Why can’t my body utilize this iron efficiently? Because I am supplementing, because I am eating red meat, because I am eating these foods that are rich in iron, and I’m looking at recipes and I’m eating lentils and I’m doing XYZ, but my body can’t like hold on to this stuff and use this efficiently. So that’s the better question that we want to start asking here. And

To no surprise at all, the gut plays a huge role in this for many, which is why if you do follow me on social, you’ll see me, you know, say things like low iron is is often a gut issue. It’s not just an iron issue. And we’re gonna kind of break down why that is today. But it can, there’s a lot that goes into it, right? So we’re gonna we’re gonna be be diving in. But when your iron levels won’t budge at all, there are usually kind of four main categories that we want to dig into. So

This is the simplest way that I can put it. Number one is you’re losing too much iron. And we’re gonna break down like how that happens. Think like heavy periods, internal bleeds. The second thing would be you’re not absorbing it efficiently, which we see very frequently, especially with someone with chronic gut and digestive issues. The third one could be inflammation is actually blocking access to the iron. And then the fourth could be that your body’s struggling to transport and use it efficiently.

Hannah Aylward (05:10.076)
So today we’re going to be walking through each of these categories so you can better understand what your iron panel may be actually trying to tell you. I’ll also be walking you through at the end of the episode markers to ask for from your doctor if you’re getting blood work run, or this is this is gonna go much deeper than like just checking ferritin or just checking serum iron, right? So this is it’s going to be a bigger panel. I’m gonna give you those details at the end of the episode if anyone is like, cool, I need to look into this a bit more.

but if you’ve had recent blood work and you want to understand better what it means, you know, you’ll learn some of that in this episode too. So before we get into these main four like low iron root cause buckets, we have to understand that iron levels and I your iron status depends on much more than just how much iron you you eat throughout your diet, right? Your body has to consume it, you have to digest it, you have to absorb it efficiently, you have to transport it, recycle it, store it, release it when it’s needed.

And then replace whatever is lost as well. So most of the iron used each day comes from internal recycling. The body actually naturally has its own system called the iron recycling system. And it can recycle roughly 20 to 25 milligrams of iron each day, while only around one to two milligrams is typically absorbed from the food that you’re eating. So a lot of this iron is like your body’s recycling it.

Which of course, if we need to increase those levels, we can get more into our diet. Yes, that can be helpful. But we also have to kind of dig into like where what’s happening with the iron that’s already in the body. Now, diet still does matter because it’s going to help replace those smaller amounts that we lose more regularly through something like a blood donation or your cycle menstruation or pregnancy, childbirth, other things like skin and intestinal cell turnover.

Or any other sources of of bleeding, right? Blood is full of iron. So taking in more iron through your diet does help to replete these stores, but we have to make sure that everything’s kind of balanced all together. So you can kind of think of it like your budget or like your money flow. If you have, if you have too much spending, there’s too much going out. If you’re not making enough, there’s too little coming in. And or if your account’s frozen or like you lose your debit card, you can’t access what you actually have. So that’s concept is similar to

Hannah Aylward (07:33.118)
How we to our iron status overall and how we can utilize iron. Now, when it comes to ferritin, because a lot of women will say that they have low ferritin, ferritin alone is not gonna tell you the whole story. Now, when we work with clients, we do a much more comprehensive panel. And once again, I’ll break that down for you guys at the end if you are interested, because ferritin is only one little tiny piece of the puzzle. To no surprise, right? There’s no way that we can tell everything about your iron status by one single marker. Ferritin is that primary storage protein for iron.

A clearly low ferritin generally indicates depleted iron stores. However, ferritin can also rise with something like inflammation or liver disease or other forms of cellular stress, even in an infection. So two people can have low circulating iron, but they can have different, like for different reasons, right? Different various root causes. So you can have

One pattern that’s like absolute iron deficiency, your stores are depleted. So it could look like low ferritin, low serum iron, low transfer in saturation, eventually low hemoglobin, eventually low MCV. It’s kind of depleted all over the map, right? Now you can also have a functional iron deficiency pattern where you may have low serum iron. So iron can be present in the body, but it is not adequately available in to the bloodstream or the bone marrow. So you can have low serum iron.

Low transfer and saturation, low or normal total iron binding capacity. You could have normal or even elevated ferritin. And you could also see possibly an elevated CRP, which is a marker that we’ll commonly use to check in on inflammation levels. However, that marker can change quickly too. So it’s just important to take into note. If you have one elevated CRP, yes, that could signal elevated inflammation in the body, but I always say, you know, check in on it, especially if it’s like scary high.

retest and see what it looks like after that. The other pattern that you can have is you can have both these things at the same time, right? So you can have depleted iron stores and inflammation simultaneously, and you can have a poor ability to actually recycle it. So low ferritin is basically telling us that your storage tank is becoming empty. And normal or high ferritin does not always mean that iron is available because inflammation can actually keep iron locked inside storage. So

Hannah Aylward (09:51.379)
Let’s break down these four main categories. From from this first piece, once again, I know it can get kind of like a little a little heady if it’s new information to you. It’s kind of a lot. So just keeping in mind the biggest takeaways from that are like ferritin does not tell your whole picture. There are multiple varying root causes of low iron. and we’re gonna kind of break break those down now. And you can also have fine ferritin, and your other iron markers can be off.

You can also have low ferritin and your other iron markers could be off or normal. So we just need to do a more comprehensive panel here to really kind of see thoroughly what’s going on. Okay, the first bucket that can lead to chronically low iron levels is going to be loss, right? So is iron leaving your body faster that it can actually be replaced? So someone can consume plenty of iron through their diet, through supplementation, right?

And absorb it reasonably well, but their levels may still remain low if we have an ongoing blood loss that’s not addressed. So this is like there’s more going out than there is coming in or than there is that we are recycling, usually due to a bigger loss. So one of the main things that can contribute to this is like heavy menstrual bleeding, right? Menstruating women, this is a very more like more common root cause of chronically low iron and low ferritin. So if you have really heavy

cycles, really heavy menstrual bleeding, that is contributing to more of a loss than someone that has a lighter period, right? So if menstrual losses repeatedly exceed the amount absorbed through the food that you’re eating or the supplements that you’re taking, the body begins to use stored iron and ferritin can fall first, and then we can see anemia develop after that. So every time blood is lost, iron is lost with it. Now it’s

It’s important to have a monthly cycle. It’s important to have a monthly bleed because we want to dump some of that excess iron because we can also have excess iron accumulated and stored in the tissues, which can also cause issues. We’re going to talk a little bit about how elevated iron can cause some issues too. So it’s really like this balance that we want to strike here. But if you have really painful, heavy periods.

Hannah Aylward (11:57.569)
Time and time and time again, it’s possible that we just have more going out than we do coming in or that we do that we have being absorbed, right? So bleeding more than seven days, bleeding through clothing or bedding, going through like a super tampon in like 30 minutes, that kind of stuff. You can feel unusually weak or dizzy during your period. If you have really heavy blood clots, this is awesome stuff that you want to look into. Of course, it’s not fun to live with or kind of go throughout your life with, but this can be an underlying root cause of low iron.

But of course, we always want to dig deeper into why these cycles are super heavy in the first place, right? So are there fibroids? Is there endometriosis, adenomyiosis? Do we have really elevated estrogen levels? do we have thyroid issues? There’s a lot more to look into here to kind of dig into those root causes of those really heavy, painful periods. So you can’t, this is like a loss issue, right? You can’t refill a bucket that has holes in it. So a bucket with holes in it would be you just having a

a too heavy of a monthly bleed, and then you’re trying to like supplement, supplement, supplement. But if it’s always going out, then that can lead to low storage issues. And of course, heavy menstrual bleeding is really just the result of other things going on. So the goal is not just to simply replace this iron, but to investigate, you know, what’s at the what’s at the bottom of all of that too. The second thing that can play a role here is gastrointestinal blood loss. So this is why if you have chronic gut and digestive issues,

And you also have chronically low iron. This is why hopefully your doctor, your PCP, or your gastro wants to do something like a colonoscopy or an endoscopy to see what’s going on because we can have bigger issues in the gut, the more severe stuff, right? Things like polyps, things like even gastritis, irritable bowel disease, gastrointestinal cancers, internal bleeds. This can be leading to a loss.

Without you even knowing about it, potentially, not to not to scare you, but that’s this is one of the many reasons why it’s important to go for colonoscopy to check in on what’s going on in there, right? Now, if you’ve gone for the colonoscopy, you’ve gone for the endoscopy, and you have digestive issues and your irons are always low, you know, come see us. We can dig into that and and dig deeper into the root causes of all of that. But that

Hannah Aylward (14:11.369)
Never ever ever means just completely ignore the need for a colonoscopy because that’s where we could find, you know, the big, the big kind of more scary stuff. So gastrointestinal bleeding, it doesn’t always produce obvious red blood in the stool, right? So you can lose very small amounts of blood over a long period of time and gradually deplete your iron stores. But this matters because, you know, this is another, this is another loss, right?

So we can’t quite fill that bucket up if we’re continuing to lose it through something like a gastrointestinal bleed. So if you have severe iron deficiency, if your levels are always falling, if you don’t really have super heavy periods and you’re like what, but you do have digestive issues, if you have a lot of digestive issues present, if you have a family history of gastrointestinal disease, this is when you want to go talk to your doctor about this. Typically they will run this, but you know, you will always want to we always want to make sure they will.

So if you are experiencing, once again, chronic GI issues, chronically low iron levels, go for your colonoscopy. If you haven’t already, go talk to your gastroenterologist about that. And some things that you may see or you could look out for is like blood in the stool, vomiting, blood, difficulty swallowing, unintentional weight loss, severe weakness.

Shortness of breath, significant bowel habit changes. This is gonna be kind of that more severe stuff. Also, sometimes the stools can be black as a result of this, too, that blood from the internal bleed. So that’s the stuff you would want to go talk to your doctor about. Now, another underlying root cause here can be pregnancy and childbirth. So pregnancy significantly increases your iron requirements. Iron is needed to support in increased maternal blood volume, fetal growth, placental development.

Red blood cell production, blood lost during delivery. So postpartum depletion can persist is if you already had low iron to begin with, if prenatal iron wasn’t tolerated very well, because a lot of people get tummy issues when they do supplement with iron. if the supplement wasn’t absorbed very well, if you had digestive issues before getting pregnant, if your pregnancies work very closely together, that can be another issue. If you had a lot of postpartum bleeding that continued, all of these things can contribute to

Hannah Aylward (16:17.035)
That loss as well. So pregnancy can deplete your iron sores, right? And childbirth can have an additional kind of be an additional piece of that puzzle if you had a lot of loss after that too. So that’s gonna be, those are kind of the biggest buckets that we can look at when we’re talking about loss. Like why are levels low? Is there too much going out? More that’s going out than there is coming in. And then what are those potential root causes, right? We can think heavy menstrual bleeding, we can think gastrointestinal blood loss.

We can think potentially pregnancy and childbirth there too. So it’s really important. We see a lot of women that want to work with us before they get pregnant, before they start trying, that kind of thing. It’s a good idea. Your gut microbiome, you’ll give it to your to your baby, right? You also just have a smoother experience in pregnancy if you’re just feeling good, if you don’t have those chronic digestive issues. And then, of course, to make sure your nutrients are looking good too. And then of course, on top of all that, like the

All of this new these nutrients and things like iron and things like thyroid health and gut health have an impact on fertility. So it’s always it’s all connected. It’s nice to do some of the steeper work before that. The next kind of bucket that we want to dive into here, so the second one, is gonna be that you’re just not absorbing enough iron. And this is what we see very commonly, along with like poor recycling issues, which we’ll get into next. This is what we see a lot with clients. So

The question is, is enough iron making it from your food or your supplement actually into your bloodstream? So you can consume iron consistently, but only absorb a small amount of it due to deeper gut issues, things like low stomach acid, things like Helicobacter pylori infections, things like gut barrier issues. So this is where the gut, of course, plays a huge, huge role in this, right? there’s a lot that I could say here, but we it it’s no surprise to me when someone comes in to work with us.

They have low B12, they have low iron, they have low vitamin D, and they have chronic gut issues. It’s like, yeah, all of these things tend to go together and then come the thyroid issues and then comes the period pain. It all goes together, maybe some skin breakouts too. So this absorption piece, nutrient absorption piece, plays a huge, huge role. So first off, yeah, sometimes we just don’t have enough intake in the food that we are eating. That can happen, right? I would say that’s like typically more rare.

Hannah Aylward (18:35.559)
unless we are super restricted and we don’t eat a lot of foods. But low intake is technically different from poor absorption, but it kind of fits into this category because we just we have too little iron actually entering the system, right? So people that may be at greater risk for low iron is going to be or like not enough in in through your food that you’re eating, vegans and vegetarians, people who eat little meat, people that are following very restrictive diets.

People that just don’t eat enough, they under eat, right? You chronically under eat. So you’re just like not getting enough of anything into your diet. We can also see people with eating disorders where there’s just not enough coming in, and people also that rely on just like lower calorie foods. There’s just not enough coming in into the body through the diet. And a supplement usually can’t override all of that. But this would just be kind of a low, a low level. We’re not taking in enough. So there is heme iron versus non-heme iron. And heme iron is found in animal foods.

And it’s generally speaking absorbed more efficiently. This is heme iron found in animal foods, better, more bioavailable. We’re going to absorb it more efficiently. Then we have non-heme iron, and that’s found in plant foods and fortified foods, and its absorption is more affected by other things like phytates, vitamin C, calcium, coffee, tea, meal composition, that kind of thing. So the amount of iron that’s actually listed on the back of a food, or if you put in a quick Google search of like how much iron is in this food.

Is not necessarily the amount that your body ultimately absorbs. So it’s going to be more bioavailable in animal sources, highly bioavailable. And you may have issues absorbing it in plant-based sources. Plant-based sources can absolutely still be utilized, but it wouldn’t be my number one, the number one thing I would rely on to increase my iron stores. But you can pair it with

Something like vitamin C. So you’ll see people pairing iron-rich foods like spinach with something like lemon to add vitamin C so you can better absorb it. That would be one example. You just want to eat adequate protein overall. So it can be plant-based sources, yes, but I would recommend personally bringing in some animal-based sources there too, avoiding under-eating overall, right? And

Hannah Aylward (20:45.707)
Then, of course, getting a bigger panel to kind of see what’s going on here. But I would say you’d really need to eat a lot of these plant-based sources because it is less bioavailable to the body. So that’s kind of one of these underlying root causes. Then we have something like low stomach acid or just impaired digestion. So this is what we see very, very commonly, especially with specific infections. So stomach acid helps release iron from food and it supports the chemical environment needed for non-heme iron absorption.

So when you have lower stomach acid, less iron can become available for absorption in the small intestine. This is what we see very frequently. What can contribute to low stomach acid? PPIUs, proton pump inhibitors, acid blockers, things like TUMS, other things like a Helicobacter pylore infection, something like a gastric surgery, autoimmune gastritis, chronic stress, all of these things can contribute to lower stomach acid levels.

Poor vagal nerve tone would also, we could also, you know, throw that in that category. That can lead to low stomach acid, which can then lead to low iron. So if you want to dig into stomach acid kind of more comprehensively, I have a whole episode on this, on this topic. I’ll make sure to put that in the show notes for you below. It’s a big topic, but low stomach acid will cause a ton of.

digestive issues, it will cause something like recurring SIBO, but it’s also going to directly impair your ability to absorb nutrients from your food. And iron is a big one here. Stomach acid levels naturally decline as we get older, kind of just happens. Supplementation can be helpful as we age, but I’m talking like, you know, not like 30s aging, like 60s, 70s, 80s, that kind of thing. It will slowly start to lower our natural production will. So some support can be helpful there. So if we have low stomach acid,

We’re just not getting in the iron. We’re not absorbing the iron from the food that we’re actually eating. So we always have to dig deeper, like what is causing that low stomach acid there? Things that we’ll often see coinc coinciding with low stomach acid would be like feeling full very quickly, reflux, nausea, upper GI issues, upper abdominal discomfort, recurring SIBO, like I mentioned, an inability to tolerate meat. So you’d feel really heavy and full after eating meat because it’s full of protein. Stomach acid helps to break down proteins.

Hannah Aylward (23:03.459)
we’ll also see B12 deficiency and bloating after meals, very common with that low stomach acid picture. So once again, if you want to dig deeper into that, we’ll pop that episode. I do a deep dive in another episode for you. I’ll put that in the show notes below. So you can eat iron, but your stomach

still has to free that iron from the food that you’re actually eating so your intestines can absorb it. So your small it can be absorbed into that small intestine. So anytime we have poor digestive function, we will it will likely lead to nutrient deficiencies, which is one of the many reasons why our gut health is just overall so important. Another thing that can be contributing to poor absorption, I kind of mentioned already, would be that Helicobacter pylori infection, right? So H. pylori is one of the most relevant gut-related contributors

contributors to consistent iron deficiency. And I actually recently just did a whole episode on H. pylori. So I’m putting a note for my need pop pop that in the show notes below too, because you can hear all about it there. But H. pylori, long story short, can cause things like gastritis. It can alter your stomach acidity. It can increase inflammatory signaling. It will reduce your iron absorption and it can compete for available iron. It can also just damage your stomach environment.

And it will also lead to more bacterial overgrowth. So that will then, you know, cause issues with your gut barrier. So it’s a it can absolutely be contributing to chronically low iron levels, this infection in the gut itself. So overall, H. pylori can interfere with your stomach’s ability to prepare iron for absorption while also contributing to inflammation in the stomach and even the upper small intestine. And it could also even possibly contribute to small amounts of blood loss as well.

Hannah Aylward (24:50.721)
We are big fans of eating enough protein over here on Team Han. Protein is essential for muscle repair, a strong gut lining, balanced blood sugar levels, and so much more. For most of our clients, we like recommending around 100 grams of protein per day to start, and adding in a good quality protein powder can be super helpful for hitting those numbers. It’s an easy add-in, you can throw it into a smoothie or even add it to oatmeal. Choosing the right protein powder can feel so overwhelming.

Half of them are full of fillers and crap ingredients, and the other half honestly just taste bad. Equip protein is one of my go-to recommendations for our clients and one of my personal favorites. We love it because it only has a small handful of ingredients. It’s 100% carefully sourced, real foods, no additives, allergens, chemicals, fillers, or other junk. It’s gluten-free and it contains 21 grams of protein per serving. Equip’s Prime Protein also offers

a complete amino acid profile. It’s also independently tested to make sure that the protein powder is free of harmful amounts of heavy metals and toxins like glyphosate, which is honestly super hard to find. Equip prime protein is a grass-fed beef protein. So it is animal based, but it’s dairy free, unlike whey or casein protein powders. Grass-fed beef protein is packed with collagen, gelatin, and micronutrients that your body needs.

We also see that it’s typically much better tolerated in our clients with chronic gut and digestive issues over something like a plant-based protein powder. In addition, some of their flavors do contain natural flavors, but they’re distilled vapors from natural and organic compounds or fruits like vanilla, coconut, and strawberry, and are processed without any chemicals, fillers, binders, or artificial ingredients, which once again is incredibly hard to find. Personally, I buy both the chocolate and the vanilla.

Flavors of the Equip Prime Protein, but honestly, they have like so many other incredible flavors out now. If you’re interested in trying out Equip Prime Protein, you can use the code HANNAHAYLWARDHHC at checkout for 15% off. And we’ll pop that code in the show notes of this episode for you as well. So once again, you can go to equipfoods.com, choose the flavor of protein powder that you want, and then use code HANNAHAYLWARDHHC for 15% off.

Hannah Aylward (27:07.242)
The next contributor here to poor absorption would be something like celiac disease. So iron is primarily absorbed in the duodenum and the upper small intestine. And these are the same areas of the gut that are often damaged when it comes to something like celiac disease. So when a person with celiac disease consumes gluten, right, we get that immune system response and it damages those intestinal villi.

This then reduces the surface area available for absorbing iron and other nutrients. So if you have been diagnosed with celiac disease, what we could be seeing is iron deficiency as a result of poor absorption there. We always want to kind of take a deeper, deeper look at the gut microbiome in the case of celiac disease as well. Doing some soothing for the gut barrier, doing some repair for the gut barrier can also be helpful here. And then, of course, just like completely eliminating gluten from the diet.

But anything that’s going to damage that those intestinal villi or the in of in that gut barrier can contribute to issues with absorption of nutrients overall, but absolutely including iron. So just kind of another thing of note, if you feel like when you eat gluten, you have a severe reaction. If you’ve had chronically low ferritin, if you’ve had things like fatigue, hair shedding, headaches, constipation diarrhea, maybe issues with fertility, you also have a lot of digestive issues.

You know, it you if you haven’t been tested already for celiac disease, that could be a good next step for you too. The next root cause that could be impairing absorption here is inflammatory bowel disease or significant intestinal disease. So people with Crohn’s disease, ulcerative colitis that can interfere with iron through more than one mechanism. So you can have reduced absorption. You could also have intestinal blood loss. So you’re like you can’t absorb what’s coming in, you’re also losing it due to this inflammation and

And blood loss in the intestines. You also may be eating less because things really trick you tick you off. You also may have effects from certain medications. So when it comes to IBD, inflammatory bowel disease, that could also be one of those underlying contributors to something like chronically low iron or even low ferritin. I think most people will kind of know if they have IBD, but some some clues that you want to look out for and take seriously are like blood in your stool, mucus in your stool.

Hannah Aylward (29:24.46)
nocturnal bowel movements as well. So bowel movements like during the night, recurrent iron deficiency, if you have a family history, if you have any unintentional weight loss, you may want to get checked for IBD. This will usually be done through a colonoscopy, right? So if you’ve already had one of those and they’re like you’re good to go, then you should be good. If you haven’t had one and you’re like resonating with a lot of what I’m saying, it could be a good sign to go and

And get one done to make sure that everything looks good and we’re not dealing with that severe inflammation that does take place in ulcerative clitis or Crohn’s. So basically, what’s happening is with significant intestinal inflammation, you can absorb less iron, also at the same time while simultaneously possibly even losing more of it if we have something like that really big severe inflammation. So that intestinal barrier and an inflammation in the intestines does play a role here too.

Now, another thing that I wanted to note on the like gut side of things before we kind of move on is this idea of candida overgrowth. So iron can actually feed candida overgrowth as well. And what we can see in some research is that when we have this iron, these iron-rich environments can actually feed candida or fungal overgrowth in the gut, which can then contribute to tons of digestive issues, brain fogs, skin breakouts, rashes.

Oral thrush, recurring yeast infections, that kind of thing. There’s also some research on how Candida adapts to both iron-poor and iron-rich environments, suggesting that excess iron, excess available iron, can actually increase fungal overgrowth just as much as not enough iron can also contribute to that. So this organism is smart and can actually feed on iron. Iron is known to kind of feed pathogens. So

When we see a lot of our clients with consistent digestive issues supplementing with a lot of iron, we tend to take a different approach here to reduce the possibility of feeding further infections, pathogens, and overgrowths in the gut. So just something that I wanted to note here, because I do think it is important. And it kind of makes me think of a client that we had a couple of years ago, and she stands out because she was told that she had anemia. She was diagnosed with that.

Hannah Aylward (31:43.47)
by her doctor, I want to say it was like 15 years she had been dealing with this. And then she went through my healing guts and changing butts program. So we did a lot of gut work with her. We also did a lot of nutrient work with her too. So really supporting her body, supporting absorption of nutrients, supporting repletion of nutrients, getting rid of any overgross in the gut, that kind of thing. When we ran her lab, she did have high levels of Candida on her functional stool test. After we took her through our process.

She went to her doctor for routine blood work. And then we got the message from her, and she was like, I am no longer anemic. And I have been anemic for 15 years. So this is just one client example, of course. Everyone’s root causes are different. The path that everyone needs to take to get better can look different, right? One person’s root cause is not necessarily your root cause, but it just makes me think of this client because we tested her. She did have the high candida. Once we worked on all of the deeper gut work with her.

Then it was like, now her iron levels have normalized for the first time in 15 years. So pretty amazing, if you ask me. The next thing that can contribute to poor absorption is gonna be like medications and then timing of adding in supplements. So sometimes oral iron is just poorly absorbed because of what it’s taken with. Iron absorption can be reduced when taken with like coffee or tea or calcium supplements, even things like dairy, something like antiacids or proton pump inhibitors, because you need that stomach acid to actually utilize that iron, right?

Certain medications can play a role in this as well. So sometimes it’s just like the medication is interfering with your absorption. And or when you’re taking the supplement, you’re taking the oral supplement, you just don’t want to take it with something like coffee or tea or calcium supplements. So just another thing to kind of note. I think most people are told that and they’re aware of that, but figured I would throw it in here anyway. So if iron is not entering the bloodstream, taking more of it through supplement or diet.

just may not work and it may also just increase the digestive side effects without actually solving the reason that the absorption is impaired in the first place. Because as you know, if you’re listening to this, you know iron supplements can kind of mess with your tummy, right? They can cause more digestive issues. So it’s like if you’re supplementing, your levels aren’t even going up and you’re just ending up with more digestive issues, there’s just more to the story. And and we got to dig a little bit deeper to see fully what’s going on here. Now the next bucket here that can be contributing to

Hannah Aylward (34:04.052)
Low iron. So the next bucket that we want to look into here when it comes to chronically low iron is inflammation that can actually be restricting iron access. So just to do a quick recap, we had poor absorption, which we just covered. And then we also had just more going out than what was coming in, right? We had like a loss, like a heavy period or an internal bleed or something like that. That’s depleting those levels. The next thing being we’re taking it into our diet, we’re taking it in through our supplements, but we’re not absorbing what we are taking in.

Which is typically a deeper gut issue going on. Sometimes it’s as severe as like celiac, IBD, and a lot of times it’s not as well. Like with the clients that we see, it’s like stomach acid, infections, bacterial overgrowth, fungal overgrowth, and gut barrier issues. And once we repair that, we can see those iron levels kind of return to normal. So this next bucket would be inflammation, right? So the next question we want to ask is: does the body have actually have iron?

But it refuses to release it. So this is where, and I’m gonna try to keep this as simple as possible because this can get a little, a little heady for us, but this is where hepcidin and functional iron deficiency start to become important. So what is hepicidin? Hepsidin is a hormone made primarily by the liver and it acts as the body’s iron gatekeeper. And hepsidin helps to regulate ferroportin, which is the protein that allows iron to leave your intestinal cells.

Macrophages that recycle old red blood cells and certain storage cells. So when hepcidin rises, it binds to ferroportin and causes it to be removed and degraded. What can happen next after this? Less dietary iron enters circulation, less recycled iron is released. We have iron remaining trapped in storage cells, less iron reaches the bone marrow, and red blood cell production can suffer from this. So hepcidin kind of closes the iron gate. So if we have issues here, your body can have iron.

But it may not be allowing it to be released well. As I mentioned before, pathogens need iron to survive. So when we have an infection or we have inflammation, the body can actually intentionally lower circulating iron in an effort to keep it away from these microbes. So this problem can arise when inflammation becomes chronic and the iron gates remain partially closed. Deeper root causes of this would be like chronic infections.

Hannah Aylward (36:19.55)
Autoimmune conditions, inflammatory bowel disease, chronic kidney disease, significant metabolic inflammation, other chronic inflammatory disorders. So we have this high inflammation that’s contributing to the body not being able to use the iron that it does have. So functional iron deficiency means iron can be stored in the body, but it’s not adequately available for use. So something we’ll commonly see on labs are like low serum iron, low transferrin saturation.

Normal or elevated ferritin, possible elevation in CRP, that inflammation marker. We can also see low or normal total iron binding capacity. With absolute deficiency, the storage tank is like empty. You just don’t have enough of it. With a functional deficiency, the storage tank can contain iron, but the exit of the iron is actually being restricted. So ferritin can tell us how much iron appears to actually be stored.

But inflammation can make that storage marker rise even when there’s very little iron that’s reaching the tissues that actually need it. So you can have a normal borderline normal ferritin level in this case, but maybe you’re dealing with excess inflammation. So you’re still like feeling like crap, right? You’re you may be having hair loss, you may be having fatigue, brain fog, that kind of thing, feeling winded like walking up the stairs. So there’s just, you know, a bit more to the story here.

So if inflammation is contributing here and it’s kind of closing that iron gate, simply just supplementing with more iron is not gonna solve the problem, right? The inflammatory driver also needs to be identified and addressed in this case. So that’s kind of that third bucket. We have that inflammation piece. Now, this fourth bucket comes down to the iron recycling system and iron transport. So your body is struggling to transport or use iron overall.

So the question we want to ask ourselves here is once iron is actually entering the body, can it can it be used, right? Can it be transported? Can it be delivered and incorporated into these healthy blood cells? And iron does not work alone. So it depends on specific transport, proteins, enzymes, hormones, kidney signaling, and several different nutrient cofactors here too. So one of these underlying root causes can be something like copper or a copper deficiency.

Hannah Aylward (38:30.368)
Because copper is required for enzymes involved in iron transport. So when we have a copper deficiency, iron may not leave the cells efficiently. Iron transport may be impaired in this case, anemia can develop, and red blood cell production may decline due to a lack of bioavailable copper here. This can happen if you’re using too much zinc over a period of time. This can happen in people with malabsorption, low intake in the diet, severe dietary restriction.

if you’re on long term long term like restrictive diets, you’ve taken a lot of things out of your diet, or if you have more so significant intestinal disease, copper can start to get depleted in these cases. High dose zinc can contribute to this, right? Because high dose zinc can reduce copper absorption. So zinc and copper go together. So if you’re someone that like takes zinc for skin issues or when you get sick, I in my in my opinion, it’s fine for you know, when you’re sick. If you’re taking it for a week, no problem.

But if you just continue to take it for a really long time, it can lead to lower copper levels. So if you have been, it’s just a good, it’s just a good reminder to kind of like get your levels checked and make sure everything looks good. So ferroportin helps iron leave the cell, but copper-dependent enzymes help prepare that iron to attach it to its transportation protein. So I know that can sound, once again, kind of like a lot like a mouthful.

Just know that you need copper to effectively utilize the iron that you that you do have in the body. Other things that can contribute to kind of a breakdown in the recycling system and in transportation would be something like B12 and folate deficiency. So iron is needed to produce hemoglobin, but B12 and folate are required for DNA synthesis and normal red blood cell development. Another thing that can happen is a vitamin A deficiency. So vitamin A plays a role in.

Red blood cell production, iron mobilization, immune function, maintaining intestinal tissue, broader iron metabolism. So vitamin A, like you’ll hear it used in, you know, it’s great to take if you’re if you’re fighting a cold, if you’re sick. However, you don’t want to supplement too high for too long, right? Cause it can lead to bigger issues for sure. So don’t just increase your vitamin A intake through tons of supplements after hearing this. But a vitamin A deficiency can impact thyroid function. And vitamin A, as I mentioned, is good to take when you’re like sick.

Hannah Aylward (40:48.448)
It’s also gonna support your iron recycling system. And vitamin A is another great nutrient that we’ll use when looking to repair the gut barrier. So vitamin A deficiency may coexist with iron deficiency. And basically it’s like making it harder for your body to use stored iron effectively. So once again, we’re in this fourth bucket here that’s like iron recycling and iron iron transport can’t work as well as it needs to. So if we’re getting it enough through our diet,

And we have solid digestive function, you’re we’re absorbing the nutrients from the food that we’re eating, and we don’t have any major losses. Well, then we need to look at basically cofactors, right? What the body needs to actually utilize the iron that it has. So we want to look at B12 and folate, like I mentioned. We wanna look at copper, we wanna look at vitamin A. This is the stuff that we’re testing for when we do blood work with our clients. It’s never just ferritin, right? We’re looking at

All of this, we’re always pairing it with a gut panel, too, to really get down to those deeper root causes that can be contributing to the chronically low iron. The other thing that is just kind of important to note here when it comes to vitamin A is vitamin A is a fat-soluble nutrient. So you need proper bioflow to actually absorb and utilize these fat-soluble nutrients like vitamin A and vitamin D, vitamin E, vitamin K.

So you can have lower levels of vitamin A if you’re just not eating enough of it, but also if you have deeper liver and gallbladder issues and you’re not producing adequate bile, which I just did an episode on the topic of bile as well. So you can have low levels, even if you are getting in enough through the food that you’re eating, because you’re not able to, you know, absorb those nutrients from these healthy foods that you’re eating because you don’t have proper bile flow, which will then further cause digestive issues. So

Vitamin A is a is a big deal. We also get a lot of vitamin A through dairy. So when I really dug into this research years ago, I was like, it’s kind of hard to get in enough vitamin A if you’re not eating any dairy. And what’s very common with people that have chronic digestive issues is they can’t tolerate dairy or they’ve been told not to eat it, right? No gluten, no dairy, no sugar, blah, blah, blah. But we we get in great sources of bioavailable vitamin A in the form of retinol through.

Hannah Aylward (43:03.318)
Dairy. So we can kind of more easily become depleted in this nutrient if we’re not eating enough of it through the food that we’re taking in. Vitamin A is high in other plant foods. Like you’ll people will say carrots, right? Carrots are high in beta-carotene, which is a form of vitamin A, but your body has to convert that into retinol to properly use it. Not everyone’s body can do that efficiently. So once again, the animal sources are going to be more bioavailable.

You can eat less of the animal sources than you’ll need of the plant foods. And some people won’t even be able to convert beta-carotene into retinol efficiently because there’s like a genetic component to it. They just won’t be able to do it as well. So they can that can also lead to low vitamin A, which will then impact your ability to recycle iron. So what I’d like to kind of end cap this section with here before we move on to the other, the next underlying root cause is just kind of

widen the lens and remember anytime there are consistent digestive issues, you are going to be dealing with poor nutrient absorption. All of these nutrients are going to are are required for your body to do many different things, right? Liberty Talks is a nutrient det dependent process. Iron recycling requires specific nutrients.

So when you are low in certain nutrients, your body does not have the raw materials that it needs to do its job, which will then lead to more issues. Your thyroid requires a ton of nutrients, right? Zinc, selenium, iron. Iron plays a huge role in thyroid hormone conversion. So just like digestive issues that happen for years and years and years, they should not go

looked over, they should be taken seriously because it’s impacting your nutrient absorption. That’s then just gonna impact like literally everything else. So it’s going to, you know, it I think it’s helpful to just take get into the nitty-gritty a little bit and then step out of it and realize like, okay, chronic digestive issues, chronic bloating, gas, constipation, diarrhea, whatever it is, impairing my absorption of nutrients, going to lead to a lot of other issues, which is why I love this gut work and why people tend to feel better.

Hannah Aylward (45:10.594)
Full spectrum when we dig into the gut work as well. Because these nutrient deficiencies can play a role in, you know, many, many things, but including iron recycling and your ability to actually use the iron that you are taking in. There is a connection with the thyroid here too. So the thyroid and iron relationship is bidirectional. Iron is needed for normal thyroid hormone conversion, and thyroid dysfunction can also contribute to iron deficiency.

Through things like heavy menstrual bleeding, reduced gut motility, reduced appetite. Sometimes we’ll see, you know, autoimmune conditions coexist. So there could be celiac and Hashimoto, something like that. So the connection here is really bi-directional. But one of the things that we’ll look for, you know, if someone’s feeling exhausted, they’re feeling constipated, their hair’s falling out, we want to check iron and we also always want to check the thyroid because the thyroid needs iron for normal thyroid hormone conversion.

So just something to note here, the thyroid is playing a role in all of this too. Thyroid dysfunction can actually increase iron deficiency risk indirectly through that loss with like heavier menstrual cycles, digestive issues, because it impacts your gut motility, can lead to things like SIBO, and potentially even overlapping autoimmune conditions. So those are really our four buckets, right? We have this iron transport and recycling piece to it.

We have a the loss piece to it. There’s more, we have blood loss, right? So there’s more iron going out than there is coming in. We have the absorption component to it as well. And then we have that inflammation component to it. So you can tell pretty quickly why just like checking your ferritin and supplementing and getting nowhere. There’s just like so much more to the story. We have to take a more comprehensive approach if we really want to get you feeling better.

So here are some of the labs that we will run with our clients to assess kind of your iron recycling system as a whole. And then we’ll pair it with other labs. So first one would be serum ferritin, then we’ll check serum iron as well. We’ll check total iron binding capacity, serum transferrin, hemoglobin. We’ll also check copper. So we’ll check serum ceruloplasmin and serum copper. We will check magnesium. We’ll check zinc. We’ll check vitamin A, vitamin D, and we’ll also check uric acid.

Hannah Aylward (47:27.722)
Most often. And that’s going to give us a more comprehensive picture of like what’s going on. Where’s the breakdown in the chain? Do you have what you need to actually utilize the iron that you’re taking in? What’s going on? Kind of a deeper dive into your iron picture. We can also check CRP, that marker of inflammation, to see if inflammation is playing a role in your case. And then, of course, doing a deeper dive on gut health. So doing something like a functional stool test to see how that could be contributing.

To your chronically low iron levels, we will nine times out of 10 find something there, let me tell you. That’s like, yeah, no wonder you have chronically low ferritin, your hair’s falling out, and you’re exhausted. It makes sense now. And you also have chronic digestive issues. Like it’s not, it’s not that crazy, you know? not to diminish how horrible it feels. It’s just like, yeah, we have to dig a little deeper. And then we’ll also, you know, sometimes run a full thyroid panel with this too to see how iron is impacting the thyroid, how the thyroid could be impacting iron as well. Cause if the thyroid is like slowing down.

that gut motility, contributing to constipation, contributing to maybe that bacterial overgrowth picture, then we’ll wanna know that too. So just to recap that, we’re gonna do like a more full iron panel, we’re gonna run a functional gut panel, we’re gonna check CRP. We’re also going to check that full thyroid panel. If I didn’t already s already say that. So that’s kind of what we’re looking for, which is once again why if you feel like you go to your doctor and they just check like

Ferritin, there’s just so much more that we can look into that will help your story make more sense. You’re not crazy and there’s nothing like wrong with you. You may have poor absorption due to gut issues. You may have a bigger lawsuit of something you don’t know about yet. You may be low in these different nutrients that you need to actually utilize the iron that you’re taking in through the food that you’re eating, right? So there’s a lot more to story. You also may have a lot of inflammation. We’ll see it with like mold cases. Like we’ve got higher inflammation levels.

It’ll also impact bile. Bile will impact vitamin A absorption. So then you won’t have the cofactor. So there’s there’s a lot going on kind of underneath the surface. So working with someone that knows the ins and outs of all of this can be really helpful. But just a little kind of review here, questions you want to ask yourself. Am I losing iron? Like, do I have super heavy periods? Do I have gastrointestinal bleeding? Hopefully not. Was I just pregnant? Did I give birth? Like these can kind of plummet these levels a bit.

Hannah Aylward (49:40.995)
But of course, after you give birth, like these levels, we should see them normalize after your body has some time to recover. Second question, am I actually absorbing iron? I would say this is where we see a lot of the breakdown for many people. Of course, we are seeing people with chronic GI issues. So maybe that’s why I see more of it, but a lot that we can do here. Third thing is inflammation blocking my access to iron. So the iron that I do have is inflammation impairing my ability to use it.

And then that fourth question being, can my body actually transport and use the iron? Do I have nutrient deficiencies that are contributing to my body’s ability to properly use the iron that it already has? Because once again, it’s recycling the majority of the iron that we have, like 95% is being recycled and only 5% is coming in through the diet. So it’s less likely, I would say, that we’re like just simply not getting in enough through our diet if we’re eating a healthy whole foods diet.

It’s more so there’s there’s another piece to the puzzle that we’ve got to kind of dig into here. So I hope that this episode was helpful. I know it kind of covered a lot. Iron is not, low iron is not always, you know, solved by simply adding more iron, supplementing, getting infusions, that kind of thing. Especially I was talking to someone the other day and she was like, I got an infusion and I felt good. And then, you know, a month later, my levels are tanked again. It’s like, okay, why? We gotta we gotta dig deeper into that.

Sometimes you’re losing it faster than you can replace it. Sometimes your digestive system is playing a role. If you have chronic digestive issues, I can almost guarantee it. Sometimes inflammation, and sometimes you’re just lacking those cofactors. So the goal is not just to like supplement, supplement, supplement and potentially feed more pathogens in the gut, especially if you have gut issues. The goal is to dig a little deeper and see like where’s the breakdown in the chain.

And when we understand where that breakdown is occurring, we can stop just chasing like a single lab marker and begin addressing the deeper root causes to why your iron levels just won’t budge. So I hope that this was super, super helpful for you. If you’re interested in doing a deeper dive into your iron, into your gut health, your chronic digestive issues, your thyroid health, your skin issues, we would love to help you. We are currently accepting clients into our one-on-one coaching program.

Hannah Aylward (51:50.051)
We will put the application to work with us in the show notes below. In these programs is where we do we do all this, right? We’re looking at functional labs. Sometimes we’re bringing in thorough blood work, especially if you have chronically low iron. We’re looking at thyroid health, and we’re really repairing from the root up using things like targeted nutrition, customized supplement interventions, and lifestyle strategies too. Cause stress, of course, plays a role in all of this too.

To no surprise. and other things as well. Circadian rhythm can be supportive, the vagal nerve toning can be supportive. We get into all of that inside of our programs with our clients. So if you’re interested in just kind of like looking under the hood and digging a bit deeper, we’d love to help you. And you can apply to work with us in the show notes of this episode below. And until next time, I’ll see you next week. We have a lot of really juicy episodes coming up. I was, I was planning them all out this today. Was it yesterday? I was planning out the next like six weeks. So stay tuned. We have some juicy ones coming up.

And big hugs. I’ll see you soon. Bye.

Thanks for joining me for this episode of the Nutrient Dense podcast. If you found this episode valuable, don’t forget to subscribe, leave a review, share with a friend, and come back next week for a new episode. See you then.