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Iron Deficiency Anemia Is A Misdiagnosis

By Tyler Woodward

Iron is an extremely essential element that plays a vital role in human physiology. Iron is needed to create the protein hemoglobin, the predominant protein of our red blood cells. Without hemoglobin we wouldn’t be able to breathe or be able to use oxygen to make energy.

But iron in the body is also extremely reactive and can contribute to the development of reactive oxygen species (ROS) and inflammation. In fact, iron accumulation is linked to the development of the two most common neurodegenerative diseases, Alzheimer's and Parkinson's.

Iron in many ways is a double-edged sword. On one hand it’s absolutely essential for cellular metabolism or “breathing”, but on the other hand in excess it can be extremely toxic and damaging to the cells. For these reasons, iron metabolism is tightly regulated in the body to utilize iron for its oxygen carrying capacity, but preventing it from causing inflammation.

Contents:

What Is Anemia?:

What Is Anemia?

Anemia is defined as a deficiency in red blood cells. Without enough red blood cells your body cannot deliver enough oxygen to its tissues. Without enough oxygen your cells basically starve, as they require oxygen to break down sugar, fats and amino acids into energy. 

Anemia can cause a host of symptoms including:

  • Weakness
  • Fatigue
  • Lightheadedness
  • Pale Skin
  • Irregular Heartbeat

Among a host of other symptoms…

You may also not have known that there are a number of different types of anemia some of which are genetic like sickle cell anemia, but many of which have to do with nutritional deficiencies.

These include vitamin deficiency anemia from a lack of Vitamin C, B9, B12 and iron-deficiency anemia from a supposed lack of iron. But here’s the question… 

How can you be deficient in the second most abundant metal on Earth?

Iron is found naturally in some quantity in nearly every food on the planet including:

  • Eggs
  • All types of  meat
  • Seafood
  • Vegetables, particularly leafy vegetables
  • Beans & Lentils
  • Potatoes
  • Dried fruit
  • Nuts

And in lesser quantities in:

  • Fruits & Juices
  • Dairy Products

Not to mention, after WWII inorganic iron (iron shavings) have been fortified in just about every processed food seen in the grocery store including:

  • All types of grains
  • Cereals, breads & pastas
  • Cookies & pastries
  • Flour
  • Corn/Maize
  • Condiments
  • Rice

And if you don’t cook for yourself, you can almost guarantee that nearly 100% of the restaurants you’re purchasing food from are using ingredients like flour and rice that are fortified with iron. Additionally, many people often cook with cast iron cookware which also increases the amount of iron in our food. Last, but not least iron is also found in small quantities in tap water which can be absorbed both topically through bathing and drinking. 

Being that some quantity of iron is found in virtually every food you eat, it would seem nearly impossible to become “deficient” in iron. 

So the question becomes how come iron deficiency anemia is so common, affecting 25% of the world?

And the answer is that it’s not iron you’re deficient in… To understand the reasoning behind this we have to understand iron metabolism.

Read More: The Hidden Truth About Iron Fortification

Iron Metabolism:

Iron Recycling System

Iron is the central metal that makes up the main protein of our red blood cells, hemoglobin. The iron in hemoglobin binds to oxygen in the lungs and is then pumped throughout the body via the heart, releasing oxygen to tissues throughout the body. 

The average lifespan of red blood cells is about 120 days, so your body makes about 1 billion red blood cells everyday which requires about 20 mg of iron. In order to supply your body with adequate amounts of iron your body primarily relies on an iron recycling system, known as the Reticuloendothelial System (RES). To maintain this iron recycling system your body only needs about 1-2 mg of iron daily from food. 

When your red blood cells die, they pretty much explode or “lyse” in your bloodstream, causing the release of the heme proteins contained within them. The released heme proteins, known as “free heme” are extremely reactive and can create reactive oxygen species resulting in inflammation. To scavenge up these free heme proteins, a protein known as haptoglobin scavenges the free heme molecules and largely prevents them from causing oxidative damage. 

Haptoglobin then binds to the receptor protein CD163 in your cells, allowing it to enter the cell. The iron in free hemoglobin is then converted into ferrous iron by the enzyme ferroxidase which makes it much less reactive. This ferrous iron is stored in  ferritin, the iron storage protein of your cells.

From here when your body requires iron to produce new red blood cells, the protein ferroportin exports the iron from the ferritin storage back into the blood via the protein transferrin. Transferrin is transported throughout the body to all of the tissues that require iron for the production of hemoglobin or myoglobin, primarily the liver, muscle, and bone marrow. 

This likely seems very complicated at this point and I can tell you it’s a drastic oversimplification of iron metabolism, but we can gather that the recycling of iron is dependent on two proteins:

  • Ferroxidase - For bringing the heme iron into the cells iron storage protein, ferritin.
  • Ferroportin - For bringing the iron out of the cells to be recycled back into heme.

Both of these proteins rely on copper! Ferroxidase is a copper containing protein, meaning copper is required to produce it. Ferroportin on the other hand is rapidly degraded in the absence of copper. So without copper you can’t get the iron from the “dead” or lysed red blood cells back into the cells and you can’t get it out of the cells. Meaning that iron is stuck in your cells and can no longer be recycled!

You’re not deficient in iron, you’re deficient in copper! The iron therefore becomes stuck in your tissues and not in your blood where it needs to be! 

In fact, one study found that oral iron supplementation in women increased the storage of iron in their cells and decreased their absorption of iron. In another review of iron metabolism, Doctor Marianne Wessling-Resnick states that, “The evidence that supplemental iron can promote both infectious and chronic inflammatory diseases is clear”. Not to mention the array of common side effects that occur with iron supplementation including nausea, vomiting, constipation, diarrhea, hives, the list goes on…

Here are a couple of other known facts about copper:

Being that iron is found in virtually every food you eat and copper is found in almost none of the foods you eat, this begins to make a lot of sense.

Read More: The War On Micronutrients | The Battle You Never Knew You Were Fighting

Where Is Copper Found You Ask?:

Foods With Iron

Copper is primarily found in shellfish like lobster, oysters, clams, shrimp, ect, organ meats like liver, heart, and brain and citrus fruits or any wholefoods that contain Vitamin C (ascorbic acid, synthetic vitamin C does not contain copper).

It must all be mentioned that retinol (animal Vitamin A) is required for the synthesis of the active form of copper, known as ceruloplasmin. Retinol also has an effect on hemoglobin and a deficiency in retinol on its own may be able to cause anemia. Retinol is a fat-soluble vitamin that is found primarily in organ meats and the fat in animal products like butter, whole milk, ghee, tallow and lard. 

Ironically, the best food source of both copper and retinol are organ meats which almost the majority of people do consume today. In addition to the fear of saturated causing heart disease (it doesn’t), many people are not consuming adequate amounts of fat in their diet and are therefore also deficient in retinol. Plus animal products, especially organ meats, are densely packed with the B-vitamins a lack of which can cause anemia. A lack of dietary retinol, copper, and the B-vitamins is a literal recipe for anemia.

How Is Iron-Deficiency Anemia Diagnosed?:

The most commonly used marker to diagnose iron-deficiency anemia is serum (in the blood) ferritin. Ferritin is the cellular iron storage protein, it’s not produced in the blood and it should not be in high quantities in the blood! In fact, ferritin in the blood has actually lost most of its iron stores and is actually a sign of inflammation!

The most accurate measure of assessing iron stores is done through performing a liver biopsy, but this is rarely performed as it’s much more invasive than a blood test. Serum ferritin in the blood can be correlated to liver iron stores, but it’s often a very poor correlation. Serum ferritin is also correlated with a number of inflammatory biomarkers and it’s theorized that this inflammation may be as a result of the increased serum iron from the iron lost as ferritin enters the blood, but it’s unknown.

It’s also worth noting that none of the exams used to assess iron status measure the amount of iron stored in your cells, only what’s in your bloodstream!

While true iron-deficiency anemia is possible, it’s extremely unlikely due to the sheer amount of iron we’re subjected to on a daily basis. Iron-deficiency anemia is most commonly a misdiagnosis of anemia of chronic inflammation caused by a lack of copper.

In order to accurately assess your iron status I recommend a full monty Iron panel which tests for:

  • Ceruloplasmin (the pivotal copper protein of our body which  includes ferroxidase)
  • Ferritin (the iron storage protein)
  • Hemoglobin  (the iron binding protein)
  • Iron & Total Iron Binding Capacity (TIBC)
  • Red Blood Cell Magnesium content (low magnesium count in red blood cells is a sign of inflammation)
  • Transferrin (the iron exportation protein)
  • Vitamin A (as retinol)
  • Vitamin D
  • Zinc

What About Women?:

Women are much more likely to be diagnosed with iron-deficiency anemia than men because of menstruation and pregnancy. First, let’s discuss pregnancy induced anemia…

Pregnancy induced anemia is a normal phenomenon that does not require any external intervention. During pregnancy as the fetus develops, the mother donates more and more of her red blood cells to her offspring resulting in the anemia that ensues. This study performed on 115,000 pregnant women found that a failure of hemoglobin to fall below 105g/L resulted in an increased risk of low birth weight and preterm delivery. The study also found that the highest mean birth weight was achieved with the lowest hemoglobin concentration (85-95g/L).

For menstruating women logically it would see to make a lot of sense that consistent blood loss through your period would result in iron-deficiency anemia over time. Interestingly, when men are diagnosed with iron-deficiency anemia they are immediately assessed for internal bleeding via an endoscopy, as they do not experience consistent blood loss. Contrary to what you might expect, this study found that 86% of women experiencing iron-deficiency anemia also has internal bleeding of their upper gastro-intestinal tract likely contributing to their anemia.

In another interesting study titled, “Menstruation does not cause anemia…”, found a positive correlation between the size of endometrial lining, red blood cell count and hemoglobin concentration. Meaning that contrary to popular belief the thicker your endometrial lining suggests greater iron reserves and a reduced risk for anemia.

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Conclusion:

My goal in writing this article, as always, is to provide you with logically-based principles that you can use to form your own conclusions regarding any information you may come across within this subject. I really hope you found this article interesting and if you have anything to add to this article, or any comments or criticism, feel free to reach out to me on our facebook groups (The Thermo Diet Community Group, The UMZU Community Group) or on Instagram @tylerwoodward_fit. Also, please feel free to share this article with anyone that might be interested.

Thanks for reading!

Until next time… be good

~Tyler Woodward

Acknowledgements:

This blog wouldn't have been even close to possible if weren't for Morley Robbin of the Root Cause Protocol and the endless amount of hours he's poured into researching iron, copper, and magnesium metabolism. Morley is taking the natural industry by storm via his mineral first approach to a healthy diet. If you are suffering with anemia or are interested in learning more about mineral metabolism I highly recommend checking out Morley's website, his facebook group, and his newly released book CuRe Your Fatigue.