Iron Overload transcript

Written by Christopher Kelly

Oct. 22, 2015

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Christopher:    Hello and welcome to the Nourish Balance Thrive podcast. My name is Christopher Kelly. Today, I'm joined again by Dr. Tommy Wood. Hi, Tommy.

Tommy:    Hi.

Christopher:    Today, we're going to talk about something that's been popping up an awful lot in the testing that we've been doing recently, and that's iron overload. Before we get into that I wanted to tell you about an interview that Tommy is about to do with pioneering functional medicine practitioner Chris Kresser. Tommy, I think there's going to be a live event in London, right? Do you want to tell people about that?

Tommy:    Yes. So he's coming to London. He's actually going to be on holiday in the UK and wanted to do some talk because I think he has a very big following in the UK understandably. So there will be two days back to back. It will be Saturday, the 31st of October, and Sunday, the 1st of November. The first one will be all about your personal Paleo code type stuff. So trying to work Paleo around your health problems or just looking for better health. The second day will be sort of a primer to his clinician's training course. So more sort of aimed at clinicians and how they can start to work some of these functional medical ideas and some of his ideas into their work. First day, mainly for the general public. Second day, mainly for some practitioners or people who work with clients. I think that the level of information will be perfect for almost anybody that's interested in his work on both days.

Christopher:    Cool. I think it's been Primal Docs, isn't it?

Tommy:    Yes. So it's being run by Refined Health which is associated with Primal Docs because of Chris Armstrong who runs Primal Docs founded Refined Health.

Christopher:    Cool.

Tommy:    Yes. So he's in association with all of that.

Christopher:    Well, I will link to that in the show notes so people -- especially if you're in the UK, that's going to be really relevant. Of course, look out for Tommy's interview on the Eat Better podcast. I will link to that as well in the show notes for this episode.

Okay. So before we get into the iron overload, just one more thing, I thought it would be good to start with why, like why would you even care about iron overload or any of the stuff that we're about to talk about.

So let me tell you a bit about my racing that's been going on recently. I won't bore you with a really long and detailed race report or anything. At the moment I'm racing cyclo-cross. For those of you who don't know, cyclo-cross is a 60-minute event so it's really quite intense. It's like short track mountain bike racing so it's off-road, lots of corners, lots of sprinting. Usually you have to get off the bike. You have to jump over obstacles, a little bit of running, a little bit of bunny hopping over barriers and stuff like that. It's really fun to watch.

I've never really done very well at that sport because I'm super slow twitch. I just don't have a good sprint. So if there are 100 corners in each lap then I'm just not going to be able to put out the watts to be able to accelerate out of each of those corners.

I think I had really good results recently. Maybe last Sunday was perhaps my best result ever. I placed sixth in the elite race which is pretty good for a guy that's nearly 40, I think. I'm racing against 16-year-olds and people who actually have talent and maybe a future in cycling. Even better than that, my sprint come from nowhere. Suddenly I have a sprint.

Normally at the start of a cyclo-cross race I get dropped, never to be seen again. People are just much faster off the line than me. At the end of the race if it comes down to a sprint, which it did in this occasion, I won it. It was a three-way sprint with a guy that I've never beaten before. He weighs over 200 pounds and probably has a really good sprint. I outsprinted him. It was so cool, so much fun.

I think the reason I've been able to achieve this is not through training. So in years gone by I've done pretty good on doing 15, 20, even 25 hours a week of training. I just looked at my Strava log this morning. I've been averaging less than 10 hours a week at least since August. Last week I needed seven hours of training. So it's really not about the training and the testing. Understanding the biochemistry and some of the work that I've been doing with Tommy I think is the reason. That's why I'm doing so well.

It kind of makes sense when you think about it. You get to nearly 40 years old and you've been training for a long time. What more do you really hope to achieve with training, right? I'm sure that a lot of you listening to this have already reached the ceiling. If you're going to see any benefit -- and when you're not looking for that much more benefits, then now I'm less than 2% within the time of the winner in the cyclo-cross race -- the biochemistry, I think, tweaking that, running a blood test, that stuff is going to get you really great results where maybe more training won't.

I think I might have mentioned this on the podcast, I'm not sure, but now you have the opportunity to run the blood chemistry through me and have me and Tommy look at the results, and recording the program O2 Boost -- we've already done a webinar with Tawnee Prazak of Endurance Planet -- again, I'll link to the replay for that webinar in the show notes.

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If you're interested in finding out if you have iron overload or whether maybe you can boost your blood naturally and get better results in cyclo-cross or triathlon or mountain biking, then that's now possible with our O2 Boost program. Come to the show notes. It's o2boost.nourishbalancethrive.com. I'll put the link on the show note so you can find it.

Maybe we should start by explaining about iron and why we even need it in the first place.

Tommy:    Yes. So iron in this context particularly, so we could start with that, is the essential cofactor for hemoglobin which people properly have heard of, is the protein that binds through oxygen in the lungs and then takes it to wherever it needs to go. Particularly if you're trying to go fast in cyclo-cross, then it takes it to your muscles. And then the oxygen, it is taken up. It goes into the mitochondrion and it acts to basically be the end acceptor of electrons that are generated in the Krebs cycle which is the main sort of power generating cycle in the mitochondria.

Christopher:    Okay. So when I'm generating energy on my bike, my muscle fibers, which are really the cells, are contracting and my neurons are doing what neurons do and all the rest of that. The iron is an essential nutrient for producing that energy. Without the iron I wouldn't be able to produce energy. There would be no life.

Tommy:    Yeah, pretty much. We don't just need iron to deliver oxygen for that final step because actually there are a couple of steps in the Krebs cycle itself where the enzymes that are converting those intermediate molecules one to the next day. They also need iron as a cofactor. So having enough iron is really important just for normal mitochondrial function and producing enough energy for the cells.

Christopher:    Yeah. We can actually measure this. This is pretty cool. There are some enzymatic or enzymes that are protein catalysts that convert one thing into another. Sometimes they depend on nutrients. In fact very often they depend on nutrients. There are a couple of them in citric acid cycle that depends on iron. We can actually measure those steps in the organic acids test which I think is pretty cool. That may be another way that you could confirm or deny an iron deficiency. It's all evidence, isn't it? There's no one marker that is the definitive diagnosis of whether or not you have enough iron.

Tommy:    Yeah. Absolutely. It's all about looking for patterns which we'll probably talk about as we go along. It's the same with everything in this kind of field is that one specific marker usually doesn't tell you that much, and you have to look at our full patterns which is why it's really nice to look at blood and urine.

Yeah. If you're looking at a urine organic acids test and your citrate is higher or your succinate is higher, then it suggests that those are enzymes that require iron to metabolize those. And then maybe you have a problem with iron, you don't have enough, and you can't metabolize, you can't move those molecules through this Krebs cycle because of it.

Christopher:    Yeah. I think it's kind of crazy what people do sometimes. They think that it can diagnose a problem with a single marker. I would say that's a little bit like taking your car into the garage, into the mechanic with the engine check light on and say, "You can only look at the engine check light, that's it. You don't have to do a full diagnosis." This is crazy. You'd never do that. It's just ridiculous. Some people try and do it with just a single blood test. They just look at ferritin or ceramide, for example. It's just not fair and it's not realistic.

My history with iron is the opposite of what we're about to talk about today, and that's I had low iron. I actually ended up -- history of GI problems. I actually ended up in the hospital having iron put in through an intravenous drip. I can remember it quite well because it wasn't very much fun and cost me a small fortune. The bill was enormous when it came through even though I had insurance.

I think a lot of athletes know that they're in danger of becoming anemic and maybe deficient in iron. Do you think that athletes are particularly vulnerable to being low on iron or there's no correlation?

Tommy:    Yes. There is something called sports anemia which actually was hotly debated back in the '90s. People really haven't talked about it that much since, I don't think. Particularly in endurance athletes, so somebody like yourself. There was evidence of lower hemoglobin or hemoglobin would go towards the lower end of the normal range or maybe just below the normal range. People would sort of argue back and forth about what caused this.

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    I think in general what we think happens is that as you train you actually expand the volume of the blood and then that sort of dilutes down your hemoglobin which sort of make it look like you're anemic but actually it's just a normal response to endurance training.

Something that I think you obviously talk about a lot and we've talked about in the webinar is that the gut is really susceptible during endurance exercise. In long endurance efforts, particularly in runners, it looks like you can precipitate a bleed in the gut so then you start to lose blood through the gut. So if you're doing that frequently, then it's definitely possible that you could be exacerbating or creating an anemia because of that. I think that people who are doing a lot of ultra marathon runs and things potentially could be putting themselves at risk of an anemia because of that.

Christopher:    So look after your gut when you go and do endurance exercise. Don't dump a bunch of alcohol into it the moment you finish. I think that's a terrible idea.

Tommy:    Absolutely.

Christopher:    Okay. Let's talk about the opposite then, the iron overload. Why would that be a problem? Usually the consequences of having too much of a nutrient are not that severe, right? For example, too much vitamin C. What's the worst that's going to happen? Maybe it will send you running to the bathroom. That's not true of iron, is it? So let's talk about that. Iron overload is definitely a problem.

Tommy:    Yeah. Absolutely. It's interesting because one thing that people should read -- there's a really good article on Free the Animal which is written by Richard Nikoley recently which sort of try to tie together reasons why maybe iron overload it is a common causative underlying factor for sort of the metabolic syndrome and obesity and potentially cancer that we're seeing in the Western world.

As sort of levels of iron in the body increase, there definitely seems to be a relationship with dysregulated blood glucose, insulin resistance, potentially increase risks of cancer, probably because iron, when it's not tightly bound to a protein or it's not doing its job and you just got sort of extra iron lying around as it were, it can generate a lot of oxidative stress, and it usually ends up inside the cells and can increase DNA damage and mitochondrial damage and things like that. Unlike vitamins C where if you take too much of it, generally you'll probably just pee it out.

Some people are predisposed to getting in more iron or absorbing more irons. Normally your body is very good at regulating these things but some people have a propensity to store iron due to mutations in various genes. Actually in sort of an evolutionary context if we look at things in that way, having something which allows you to store more iron is probably useful if you are out hunting or fighting or you bleed frequently because then it sort of gives you a bit of a buffer because you need the iron to make new red blood cells.

Actually it was probably an evolutionary advantage at some point particularly for people who are actually out there doing whatever it was that we did. Probably we got injured very frequently and lost blood fairly frequently. But now that doesn't really tend to happen. So it's become another one of those genes where maybe it gave us an evolutionary advantage before but now it's causing a problem in modern society.

Christopher:    Okay. So people can find out then -- if you listen to this and you've done the 23andMe Saliva Test, then you can look at that result. I don't think you'll get it -- in fact I know you won't get it just from 23andMe. You'll have to run it through some other report engine to look at the -- HFE gene seems to be the most relevant gene to look at. I know that the MTHFR Support tool that generates a nice PDF report -- I'll link to that in the show notes too. That just shows mutations in the HFE gene. It's kind of clever though. They figured out which is the mutation that leads to iron overload. You really have to watch out for this.

Before we did this podcast I did some research with that Dr. Jamie Busch who is the CEO Nourish Balance Thrive. She talked to a hematologist. We started poking around and reading some research. Initially we found this article on Medscape. You've been probably been to Medscape at some point in your life. It's like one of those websites that's search engine optimized to answer the questions of those seeking advice from Dr. Google. That's what it does. I'm sure doctors use it too.

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What I thought was interesting was the information that was on Medscape. It looked like it's been plagiarized from one of the papers that I'd read. In plagiarizing it they'd also introduced an error. Maybe I should not get into the details of this because it's too complex. Just know that the information on Medscape is wrong and, really, you need to find a better source of information than that.

Tommy:    It was wrong in this case. I'm sure there is some good stuff on there before their lawyers come knocking on your door.

Christopher:    Okay. I must admit. I didn't get in contact with them to tell them that it was wrong either. So maybe we should get into which blood markers people should be looking for. Ceramide is the most obvious one to start with but maybe that's not the most reliable indicator. Why is that? Why do you not see much ceramide that's floating around in the blood work? It could be measured on the blood chemistry.

Tommy:    Ceramide is basically where you take a blood draw and then you're sort of measuring the -- and it's essentially free iron that's floating around in that blood. The reason why that's not necessarily -- that's probably the easiest test that you can do just like if you're checking potassium or your sodium on a blood chemistry.

Christopher:    Super cheap, very basic.

Tommy:    Yeah. The problem with that is that less than 1% of your body's iron will be found in the serum. 65% is found in your hemoglobin, roughly 30% is found as part of storage protein. So hemosiderin and ferritin, which are the ones we'll probably talk about a bit more, ferritin particularly there, basically intracellular, so inside the cells' storage proteins for iron. The reason that your body does that is that your iron is either going to be in hemoglobin or in enzymes where it's doing something useful or is going to be stored because of the problems that it causes in terms of oxidative stress in your body. It basically holds iron locked up so that it's only there when you need it and it's not sort of causing havoc the rest of the time.

Christopher:    Okay. I really have seen that as well already in the test results on several occasions actually where you see low serum iron but then other evidence. So there is in fact too much iron.

Tommy:    If we take an example, we have one person that came to us basically to look, just make sure we could see anything to sort of tweak performance. This guy had low serum iron or it was within the normal range but towards the lower end, but his ferritin, which is that storage protein, was actually quite high. It was above the top end of the normal range. It was 356 when we'd ideally like to see it closer to 100 or even below in the normal range depending on the lab. It's probably up to about 200, 250, 300. So it was definitely above that.

So even though his serum iron was low, his ferritin was high and his total iron binding capacity which is basically you're looking at the amount of iron your body can still take up because it sort of has a certain amount that you can totally store, and you don't want it to be full all the time. You need a bit of a buffer either way. So we look at something called the total iron binding capacity, and that was low which basically suggest that he had a lot more iron on board than he essentially needed.

Christopher:    I know there is some connection here with liver problems. So what markers do you look at?

Tommy:    Yeah. You mentioned those genetic mutations essentially. So in the HFE gene -- and they predispose it to something called hemochromatosis which is just iron overload that ends up depositing in organs and causing some kind of disease. In those people who have the most common mutations -- so the most common mutation is the C282Y mutation. We see that in about 1 in 200 Caucasians in the US. There's a big study looking at just sort of an average population going to their family practitioner. In the Caucasian population about north .5% of people had this double mutation, so the homozygous. Everybody has two copies of every gene. In order to have true hemochromatosis you need to have both copies mutated.

So in these people up to 2% will get some real end organ damage. They'll deposit so much iron in those organs that those organs would actually start to fail. So you'll see something like diabetes if it goes into the pancreas or cardiomyopathy, so basically the heart stops working properly if it gets deposited in the heart, or liver cirrhosis. Basically your liver gets fibrosed and dried up and crusty essentially, and then that doesn't work properly.

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So basically this iron can go anywhere. We talked about adrenals, thyroid, can go to the gonads. Particularly in men, you might see low testosterone, pancreas, heart, liver and joints. So a lot of people have joint pain. They get sort of arthritis because the iron deposits in the joints.

There's one thing that I read. So if we're looking at that same mutation, the main one, the C282Y mutation, is responsible for the 85% to 90% of the case of hemochromatosis. One in 10 people probably have one mutation in this gene. That doesn't necessarily mean that you'll end up with severe iron overload that will cause actual organ failure but your ferritin probably will go up or is likely to go up.

I was reading -- this is on a hemochromatosis support website. They were saying mild symptoms of hemochromatosis such as lethargy, joint pain and weakness unlikely will develop the full disease. You can't say that "Well, it's okay because they didn't get full liver failure. It's only joint pain. It's only lethargy." I think people would still want to try and deal with that even if they're not ending up with severe and organ failure.

Christopher:    Yeah. Exactly. Especially the type of people that are likely to be listening to this podcast. I said at the beginning of the show my goal is to kind of bridge that gap between what a doctor or a hematologist in this case would be interested in, and what it's going to take to win your next bike race or your next triathlon, your next whatever. Lethargy, that doesn't sound good for winning races, right? If the problem is iron overload and you can fix that, then I'd say that's a major win not just for your competition but also just for life and longevity in general.

Tommy:    Yeah. Absolutely.

Christopher:    Okay. Let's say we've looked at some of the blood markers and maybe we've even looked at some mutation to the HFE gene. I'm pretty sure I've got iron overload. What should I do next?

Tommy:    That's a good question. So if we're talking about true iron overload and this person, say it's you, your ferritin is high -- and people with severe hemochromatosis that we think is going to end up causing real disease, and your ferritin might even be over 1,000 but that doesn't mean that, even if your ferritin is low, that you won't see problems. If your ferritin is that high, then you should absolutely go and see a specialist. Go and see a hematologist particularly because of those problems you can get down the line, and you actually are likely to need treatment to get rid of some of that extra iron because of the problems it can cause.

Christopher:    Yeah. So I've got this nice chart. Maybe I'll link to this in the show notes. It's by the Iron Disorders Institute, irondisorders.org. They have a chart in there that tell you there's like the serum ferritin chart, and then they tell you what you should be doing next.

Something you can do which is and fairly noninvasive and maybe a nice thing to do anyway is to just go give blood. You can do that in the US every 58 days, I believe. You just go give blood, and that will reduce your ferritin. Some studies have shown it's been quite an effective therapy for reducing blood pressure and reducing hemoglobin A1c. It's super interesting. Who would have thought that bloodletting would be making a comeback?

Tommy:    Yeah. Absolutely. So if you see a hematologist and maybe you have evidence of liver damage -- well, that's all they particularly look at. There sort of will give you an ultrasound of the liver or they'll check for your liver function test to see how they're doing. If you have any evidence of iron deposition in any organ or they think you're at risk of that, then they will essentially just take blood from you. If you have very high levels of hemoglobin or you have very severe hemochromatosis symptoms, they won't let you give that blood to somebody else. Other people could just happily donate blood.

If people who have a mutation of some description, if they give blood, then it improves their insulin sensitivity, it reduces their overall mortality. If your metabolic syndrome, these are people who don't necessarily have mutation, those with metabolic syndrome in randomized controlled trials, giving blood reduces blood pressure, reduces fasting glucose, reduces H-A1c, improves lipids, particularly something like your HDL to LDL ratio. If you have fatty liver disease, then giving blood improves your liver function.

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In just the general population, they've done a couple of really big studies. One of the biggest was in Scandinavia looking at Swedes and Danes. They looked over 1 million blood donors. They saw that basically if you donated from one to four times per year, there was a linear decrease in your mortality. So basically the more blood you give, the less likely you are to die. There is a little bit of a confounder there because if you're somebody who likes to donate blood, then you're also likely to think more about your health and health of others.

There are a lot of potential benefits. The kind of people who donate blood are probably likely to be healthier for other reasons as well, but even adjusting for that, they still think they saw basically the more you donate blood the longer you live was what they thought which is quite impressive.

Christopher:    It is. I wish people would stop doing that. Epidemiology is ruined by people doing more than one good thing at once or more than one bad thing at once. Can people just like either smoke or just do one thing at a time please, and then we can figure out the cause and effect? It would be really helpful.

Tommy:    Yeah. Because we really want all the vegetarians to be sedentary smokers.

Christopher:    Exactly.

Tommy:    Otherwise it's just making vegetarians look good, not enough as a vegetarian.

Christopher:    Another thing I think that is really interesting in this is we know that bloodletting is going to reduce your hemoglobin A1c and may improve your carbohydrate intolerance. I wonder if a lot of people are coming to a low carb diet to manage that problem when really the underlying issue is something else, right? Your house is on fire. You're not tolerating carbohydrates well. Yeah. Okay. Stop eating the carbs. That makes sense. But don't just leave it to be a mystery. Don't just let that be the end of it.

You've got to figure out why you became carbohydrate intolerant. I mean it could be something genetic but if it's something like this, then obviously that's something you're going to want to deal with. Who knows? Maybe if you have to eat carbs again in the future it would be okay.

Tommy:    Yeah. Absolutely. I think carbohydrate restriction in the face of metabolic problems, we know it works on, and it's probably where people should start. But what I really think people should remember and people should be more cognizant of is that just because carbohydrate restriction fixes the problem doesn't mean it caused the problem in the first place. It works really well. So if something else has made you insulin resistant or caused carbohydrate intolerance, then obviously the sensible thing is to remove carbs from the diet, but there are plenty of things such as iron overload which could be causing the problem in the first place. So you're kind of doing the typical -- the functional medical world often makes fun of traditional medicine by saying, "You're just treating symptoms." So in a case like that, then that's what carbohydrate restriction is doing.

Christopher:    Yeah. That's a really good point. That's why I love the testing. You can't just leave it with that, can you? This is like a hedge fund as well. If your computer program didn't work and it sent in a load of buy orders when they're supposed to be sell then you can't just say, "Okay. I may be okay tomorrow." You're going to figure it out.

Tommy:    Yeah. Absolutely. You've talked to Jimmy Moore multiple times about how he can improve his health. Based on previous blood test results and blood test results after he stopped giving blood suggests that he's at risk of iron overload because his hemoglobin goes very high and his iron stores go very high if he doesn't donate blood. In the middle he was probably overdoing it almost, donating blood too often which can cause his own problems, but it could be the part of the issues. Again, he's just a good example of somebody who maybe part of his problem is with insulin resistance, which he talks very openly about, was due to his propensity to store iron.

Christopher:    Yes. So when I first ran a blood test on Jimmy it was obvious that he was deficient in iron. The reason for that was he being told by somebody in the past that he had iron overload. So he was on a regular schedule of going to donate blood which is a good idea in general but I think he overdid it. He ended up really quite anemic. He then stopped doing the bloodletting. I don't think he took any iron supplements. Anyway, within three months the whole situation completely rebounded in the opposite direction.

[0:30:08]

He's doing the 23andMe genetic test to see if he has mutations in his HFE gene. I think it's extremely likely that he does. I think that could be a major reason why he's had so much trouble with his health over the years.

Tommy:    Yeah. Absolutely.

Christopher:    So let's talk about diet then. We're all about red meat here at Nourish Balance Thrive. We love a good steak. I think that's a really nutrient dense source of food but maybe that's not the best choice if you have iron overload. So what would you recommend to someone that's been diagnosed with iron overload? How should they change their diet?

Tommy:    Yeah. So we have a few things that you and I discussed absolutely connected to that. There's, again, another good blog post. There are some good ones out there surrounding this that people should read. Did you see that Denise Minger wrote a blog post in defense of low-fat diets that came out yesterday?

Christopher:    Yeah. I've kind of got a bit bored of Denise Minger, actually. She's built an audience and now she's just playing devil's advocate just for fun. I was talking to Vinnie Tortorich yesterday. I didn't mention Denise specifically. Vidal Sassoon has this saying which is if you don't look good, I don't good. Denise doesn't really have any skin in the game here, right? She sits in her ivory tower writing blog posts playing devil's advocate. It's not like she has to get up at 6:00 AM in the morning and talk to someone that's still not losing weight or still doesn't feel good, right? Yeah. I kind of got a bit bored of her. That doesn't mean that this is not a great place. So yeah, she talked about it.

Tommy:    People should read it just because it will stimulate thoughts. That's all I'm saying. Basically I don't think everybody should start doing a low-fat diet after reading this blog post. That's certainly not where I'm going. There are multiple clinicians in the past who have gone very low fat and often very refined carbohydrate diets with people and have had dramatic improvements in most of the patients in terms of reversing type II diabetes, completely losing all the excess weight in obese patients. I know that she's going to do another post which basically talks about the mechanisms behind this.

I was thinking that there are multiple potential mechanisms, particularly taking red meat out of the diet which a lot of them did because they were trying to reduce fat. So many are getting no iron intake. There were also things like maybe you'll be affecting glucagon release and you're doing methionine restriction which we know extends lives. So those are definitely benefits.

What all of these diets have in common is that they've completely removed iron, particularly heme iron for meat. If they did have meat which is reintroduced eventually, then it was very lean meats. We know that the fat in meat can help you absorb the iron.

Where I was going with that is basically I think one of the potential mechanisms of why those diets work in people with metabolic problems is mainly because you're during reducing the iron load in the body which we know cause all those metabolic problems.

Christopher:    Interesting. That was an interesting idea.

Tommy:    So there are plenty of people who have hemochromatosis or a tendency towards iron overload who manage it either by donating blood or with some lifestyle modifications, diet modifications. Calcium is a very good inhibitor of iron uptake. So you could either take that as a supplement or you could just have calcium rich dairy. If you're somebody who eats dairy and have that when you're eating iron rich food with red meat --

Christopher:    Do you not worry about that? Is that not going to mess with stomach acid?

Tommy:    It shouldn't as long as it's not something you're doing all the time. If you're somebody with hemochromatosis it doesn't make any sense to have steak for every meal but then do all these things to try and mitigate the iron uptake. I don't see any point in that. If you have a steak once every couple of weeks and maybe you have some cheese or something with it. I think that's the kind of realm that we're talking about.

Christopher:    Leafy vegetables are a really great source of calcium. Would those count too?

Tommy:    Yes, they would count. People seem to think that you need maybe 200 to 400 milligrams of calcium which is actually quite a lot. You need to eat a lot of nuts or leafy greens to get that. If you're somebody who could pour all of those into a green smoothie, then that will absolutely be a possibility.

[0:35:05]

One of the good things about using leafy greens is that phytates obviously inhibit iron absorption. If you're eating lots of spinach or kale, there's a good amount of phytate in there. That will inhibit some of the iron absorption. Actually one of the potential treatments or supplements that people could take if they have iron overload is inositol hexaphosphate which is another name for a type of phytate.

Christopher:    Interesting. I looked at that supplement. Maybe I should link to that. I Googled it real quick. It reads like the reverse Paleo diet. It's like that. That compound is like all of the things that we're trying to avoid, and you can buy it in a supplement. It's awesome.

Tommy:    Yeah. Absolutely. The phytate thing is really interesting because what they've shown is that people who eat a lot phytates, your body compensates and manages to do better absorbing the minerals that your phytate is supposedly inhibiting the absorption of. Also they seem to act in a way to actually improve some things that require mineral absorption. In people that eat a lot phytates, they actually have stronger bones than people who don't eat a lot of phytates. You think that the phytate is stopping me absorbing my calcium so then I won't get enough calcium in my bones but the studies actually show the opposite. So I think this real kind of demonization of phytate doesn't have as much evidence behind it as we initially thought.

Christopher:    Everything comes back to balance. Every word and feedback loops just comes down to balance.

Tommy:    Absolutely. A couple of other things. Tannins in red wine, coffee and tea, they can sort of bind to iron and stop you absorbing it. The anthocyanins which are in blue berries or purple berries or any kind of colored berry, the darker the color of the berry the better, really. It's also important to avoid fructose, table sugar, sucrose or anything else with fructose in it because that's going to improve the absorption of iron. Vitamin C is also very good at improving the absorption of iron.

So if you can kind of balance all of those things and maybe you focus more on if you're going to eat red meat you could maybe eat liver because then you get a lot of other beneficial micronutrients with it. When you're going to eat iron rich things you make sure that you're going to get as much good stuff from them as possible. So I think if you can balance all that stuff, then there's definitely a possibility that you won't need to do the continuous bloodletting but it would obviously depend on how high your ferritin or how high your iron overload to start with.

Christopher:    Yeah. I think the thing to do here is just to do the test and then try something and then do the test again and see whether it worked. If it didn't work you can try something else.

Tommy:    Yeah. I think that's where we are with a lot of this stuff. If it looks like you have hemochromatosis, you should definitely get genetic testing and you should definitely see an expert. If you're just kind of trying to maximize things and it looks like maybe your ferritin is a little high, then it's not a particularly expensive test, and you do a bit of tinkering. You can sort of see what works for you.

Christopher:    Cool. Let's talk finally about lactoferrin because that's another really interesting molecule. Julie knew quite a lot about it because it's a glycoprotein that's found in milk. Julie is a dairy scientist. This was one of the things they were trying to pull out of the milk because it's quite a useful molecule. First of all, what is lactoferrin?

Tommy:    It is basically a transport protein for iron. Where they extract it from is cow's milk. You'll often see on baby formulas something like 300% more iron than breast milk or something like that. They sell it to you as a positive because basically there is this lactoferrin and there's iron bound to it, and then that's basically a way to give iron to the growing calf.

It has a lot of interesting things that's also associated with gut immunity and all those kind of things as many of these things are. So it's basically an iron transport protein, very similar to ferritin. Now we're talking about ferritin. The important thing to remember with ferritin which we forgot to talk about earlier is that it will become an acute phase reactant or an acute phase protein. So basically when we're sick or have some common inflammation, then those inflammatory cytokines, those proteins that are molecules that are white blood cells essentially used to communicate with each other, they increase production of ferritin.

If you have sort of a chronic inflammatory disease, then your ferritin can also increase. Basically what your body is doing is storing excess iron. The what I think about it is the fact that you got this chronic disease, it's stressor on the body, the body was to make sure it's got enough iron for the long term so it kind of hoards it all in ferritin. Ferritin can go up but the available iron in the rest of the body can go down. That would cause something called anemia of chronic disease.

[0:40:27]

So that's one thing that ferritin, if it's very high and you've been sick recently, then that doesn't necessarily mean you've got iron overload. It might just be as a result of that.

Christopher:    Yeah. That's amazing. So lactoferrin is another glycoprotein that can bind iron but it has a greater binding affinity than ferritin. So ferritin versus lactoferrin, lactoferrin wins.

Tommy:    Yeah. So this is something that they've been using. In people with iron overload, you can give oral lactoferrin which will sort of bind some of excess iron and bring down -- that's what some people are recommending as a way to reduce iron overload.

It's interesting because -- I'll send you this study yesterday. They basically took some obese patients in Japan. They gave them lactoferrin. It was a placebo-controlled trial. In those that got lactoferrin -- again, these weren't people who had defined hemochromatosis. They were giving it because they said that lactoferrin alters lipid metabolism, fat metabolism which it does do. Again, my theory is likely that you're actually potentially reducing the iron load in the body. So they saw a drop in BMI and a drop in visceral fat which is that fat around the middle that sits around the organs but we think is associated with insulin resistance and all those sort of parts of the metabolic syndrome. That's just by taking lactoferrin for eight weeks.

It might alter lipid metabolism. It might improve various aspects of gut immunity. All those things are important but it might also be because it's reducing the iron load in the body.

Christopher:    Yeah. That's amazing. I will link to that in the show notes. It's a paper that was in the British Journal of Nutrition, potent anti-obesity effect of enteric-coated lactoferrin. What about lactoferrin as an antimicrobial? Do you know anything about that?

Tommy:    Yeah. Because it binds iron so tightly -- a lot of bacteria obviously need iron for their own enzymes. Lactoferrin will basically steal it away and then stop -- obviously you basically killed these bacteria just by getting rid of the iron which means that they can't do any of the normal metabolic processes. I think that's part of the reason why it's beneficial to say it's part of breast milk or something in cows is because it could have that antimicrobial action.

Christopher:    So that's what you need to do. If you have iron overload the first thing you need to do is get the test done, right? It's not that hard to do. I will link to this in the show notes so you can place an order via my website. The next thing that will happen is you'll be sent a PDF requisition form. So there's no need for you to go to a doctor for this. You can just go directly to the lab which in this case is LabCorp. You can search online to see whether there's a LabCorp near you. If there isn't, then I can send you a test collection kit which you can take to any place where they draw blood.

The magic keywords are specialty collection kit, and then suddenly they know what to do. They just draw the blood and they spin it. I think FedEx comes and picks it up and takes it off to the lab. And then the results come back electronically. Tommy can have a look at it. Then I can get you back on the phone and explain what you need to do next.

I hope this has been helpful. Thank you so much for your time, Tommy. I really appreciate it.

Tommy:    It's always a pleasure. It was a whistle stop tour in random directions. Hopefully people got some good news out of it.

Christopher:    Yeah. I spend some time on the show notes now. If you come back and have a look at the show notes, I'll structure this nicely so that it's kind of a bit easy to understand. There's also a transcript as well. We always want to make this clear in the podcast. I pay someone to do a full transcript. So if you heard us say something like the C282Y on the HFE gene, you can just search for that inside of the transcript and you'll find the details quite quickly.

Also, I think I've mentioned this before, but I'll mention it again anyway. The Spritzer app is a really good way of zooming through these transcripts really fast. You'll find it easy to do 400 words a minute. It shouldn't take you 25 minutes to read a 10,000-word transcript. It's pretty cool.

Until next time. Let me know if you have any questions about iron overload or any other subjects that we should touch on. I'm really keen to know what you think, and that will help us shake the podcast in the future.

Cool. All right. Cheers then, Tommy.

Tommy:    Cheers.

Christopher:    Bye-bye.

[0:45:01]    End of Audio

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