Did you know, it is impossible for anything to rust without iron?  Iron helps to create the protein, hemoglobin, so it is a very important part of blood volume and oxygen transport.  Iron and oxygen are supposed to be in every cell of the body.  Iron is a heavy metal.  Iron also causes oxidative stress… corrosion… inflammation… rust.

It is easy to visualize what can happen in your body when you imagine what rust does to a cast iron skillet that hasn’t been well managed.  The cast iron skillet might be essential to your meals, but it takes a lot of care to keep it clean and free of rust. Just a few hours of sitting wet in the air and you’ll have rust. Maybe you don’t event put corrosive foods in your cast iron to keep it pristine.  Imagine, then, what happens to each iron-rich cell of your body when iron and oxygen, and antioxidants, are imbalanced.

It is important to eat a variety of iron-rich foods.  Heme is a prefix used in medical terminology that derives from the Greek word, “haîma,” which means “blood.”  Therefore heme-iron is iron that comes from blood (animals).  The more blood there is in the part of the food you eat, the more heme-iron you will get.  Likewise, non-heme iron is iron that comes from food sources that don’t contain blood: a variety of dark leafy greens, cruciferous vegetables, beans, legumes, nuts, seeds, and some other plants.

Generally, heme-iron is considered more absorbable and more highly concentrated than non-heme iron.  However, the non-heme iron found in plants has a higher concentration of antioxidants, like Vitamin C, and more detoxifying properties, like fiber and chlorophyll, which help prevent inflammation that can be directly caused by iron over-consumption.

When you consume iron, especially without enough antioxidants, inflammation is a result.  When inflammation is present, the more iron you consume, the less you absorb or access.  The liver produces hepcidin, a hormone that regulates iron absorption, storage, and transport to cells.  You could consume red meat every day, take an iron supplement, or get an IV iron infusion and potentially decrease the iron you have access to because of the inflammation high iron consumption causes.  Balance is always the key.

You need iron to give strength and size to your red blood cells.  But you need a lot of other nutrients, like B9 (folate), B12, Vitamin C, and other antioxidants to reduce inflammation so the liver doesn’t stop you from absorbing the iron.  This is one of the reasons why testing hemoglobin alone is never an adequate way to assess iron levels or prescribe iron supplements.  Iron is one element inside of hemoglobin, but having low hemoglobin is usually, first, the result of low antioxidants, hydration, and an imbalanced microbiome which creates inefficient digestion.

The best way to assess anemia (low blood volume or maybe better understood as malnourished blood) is to run multiple venous-blood tests, or at least do a deep look at your diet.  Your diet should be rich in whole foods, dark leafy greens, and brightly colored fresh vegetables and fruits.  These foods reduce toxins, increase antioxidants, and improve iron absorption, as well as transport.  Sometimes, these fixes aren't quick or easy.

Sometimes, in pregnancy, we take simple supplemental approaches and have to leave the big changes for pre-conception. It isn't just about assessing the anemia, but assessing the lifestyle and what is possible for this person, this pregnancy, this moment in life.  It also depends on the time frame we have to work on the root-cause.  When we only see iron insufficiency, we can approach therapy with whole-foods, or digestive-friendly iron supplements in small doses, every other day, to increase absorption by helping to reduce inflammation.  We also need to recognize that iron absorption significantly reduces in the first trimester, so your pre-conception iron consumption needs to be top notch.  With balanced lifestyle habits, iron absorption increases exponentially in the 2nd trimester, which helps with the necessary blood volume expansion required by the third trimester.  Then, the third trimester your body works at giving your baby the iron stores they'll need for their first year of life, but may not be able to absorb much at that point.

Which labs should I test for anemia?

First, I want to say there are always a lot of tests that could be assessed to get a more full picture.  Understanding digestive history, stress loads, food pairing, and exercise routines can give you an idea of how iron absorbs and moves through the body.  But three important things we must remember are:

1. Hemoglobin is NOT Iron
2. A spot-check hemoglobin with a HemoPoint, HemoCue, Talquist Scale, or Massimo OR only looking at the hemoglobin number of a CBC is NOT adequate at all for assessing Iron
3. Serum Iron OR Ferritin alone are generally not adequate for assessing iron or supplementation/treatment needs

CBC with Differential

We can see the kinds of red and white blood cells present with a CBC. We can also see the size and shape of red blood cells, which help to determine if anemia is present and if it might be caused by either oxidation (mixed nutrient deficiencies) or low iron. In all anemias, increasing antioxidants help and you can add in these whole foods without full iron labs.

Serum Iron

This tells us how much iron is floating around in the blood, usually from recent iron consumption. It can be falsely elevated if you’ve eaten iron-rich food, taken an iron supplement, exercised, or had stress in the past 48-72 hours.

TIBC/UIBC/% Saturation

This tells us how much iron can be transported through the body by transferrin.  Total Iron Binding Capacity is the amount of "seats on the Transferrin Ferry" that are bound with iron.  Unbound Iron Binding Capacity is the amount of "seats on the Transferrin Ferry" that aren't bound with iron.  And the % Transferrin Saturation is a calculation of TIBC to total Serum Iron which gives you an idea of how much of the iron in your serum blood is actually being moved around.

Ferritin

This indicates iron taken up and stored, mostly in the liver.  With stress, too much iron consumption, or inflammation, the liver releases the hormone hepcidin which prevents iron absorption and transport.  This helps to prevent oxidative stress.

Transferrin

This glycoprotein (sugar-attached protein) transports iron to the cells.

CRP/Homocysteine/ESR/Inflammation

Testing for inflammation can help determine if iron levels can be improved by reducing inflammation and increasing antioxidants, or if iron supplements are truly needed.