Thanks for joining us for episode 108 of The Ancestral RDs podcast. If you want to keep up with our podcasts, subscribe in iTunes and never miss an episode! Remember, please send us your question if you’d like us to answer it on the show.

Today we are answering following question from a listener:

“I recently found out I have low-ish hemoglobin within normal values but on the low end. I talked with my doctor and it’s probably due to my rather heavy periods. I already eat a moderate amount of red meat, apparently it is the best source. Can I safely increase my consumption of red meat or would it be better to take iron supplements?”

When finding low hemoglobin levels, generally the first line of defense is to reach for an iron supplement. But did you know that there are other factors beyond iron deficiency that can contribute to low hemoglobin?

Today we’ll be discussing various factors that can contribute to low hemoglobin and sharing how to increase your intake of iron from food when iron deficiency is the true culprit.  We also delve into the safety of red meat consumption and share which foods and nutrients affect the absorption of iron.

Here’s what Laura and Kelsey will be discussing in this episode:

• The safety of red meat consumption
• Reference ranges for functionally low hemoglobin
• Definition of hemoglobin and its function in the body
• Symptoms of low hemoglobin
• Health conditions that can contribute to low hemoglobin levels
• Nutrient imbalances that can contribute to low hemoglobin
• Iron deficiency as a cause of low hemoglobin
• The role of gastrointestinal malabsorption in iron deficiency
• Foods and nutrients that hinder the absorption of iron
• Why eating liver is preferred over iron supplementation
• The effect of inflammation on hemoglobin levels
• The importance of getting ferritin levels checked along with iron
• Dietary sources of heme and non-heme iron
• How vitamin C can improve the bioavailability of non-heme iron
• Recommended types of iron supplements

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Links Discussed:

• This episode is sponsored by Paleo Rehab
• Laura’s article “Hate Liver? Eat It Anyway With These Tips”
• Chris Kresser’s article round up “The Truth About Red Meat”
• Chris Kresser’s podcast “Does Red Meat Increase Your Risk Of Death?”
• Chris Masterjohn’s podcast “Why You Need To Manage Your Iron Status And How To Do It”

TRANSCRIPT:

Laura: Hi everyone! Welcome to episode 108 of The Ancestral RDs podcast. I’m Laura Schoenfeld and with me as always is my cohost Kelsey Kinney.

Kelsey: Hey everyone!

Laura: We’re Registered Dietitians with a passion for ancestral health, real food nutrition, and sharing evidence-based guidance that combines science with common sense. You can find me, Laura, atLauraSchoenfeldRD.com, and Kelsey over at KelseyKinney.com.

Over the next 30 to 45 minutes we’ll be answering your questions about health and nutrition, and providing our insight into solving your health challenges with practical tips and real food. Stick around until the end of the show when we’ll be sharing updates about our businesses and personal lives.

Kelsey: If you’re enjoying the show, subscribe on iTunes so that you never miss an episode. While you’re there, leave us a positive review so that others can discover the show as well! And remember, we want to answer your question, so head over to TheAncestralRDs.com to submit a health-related question that we can answer on an upcoming show.

Laura: Today on the show we’re going to be discussing what to do if you have low hemoglobin levels including further testing and dietary treatment. But before we get into our question for the day, here’s a quick word from our sponsor:

This episode is brought to you by Paleo Rehab, a five week online program designed to help you recover from HPA axis dysfunction, also known as adrenal fatigue. Is your perfect Paleo diet and lifestyle leaving you exhausted? Now is the time to start feeling the health and wellness you know you deserve. If you’re sick and tired of feeling sick and tired, and are ready to take back your health, then head over to MyPaleoRehab.com to get your free 28 page e-book on the 3 step plan for healing from adrenal fatigue. That’s www.MyPaleoRehab.com

Laura:Welcome back everyone! Here’s our question for today’s show:

“I recently found out I have low-ish hemoglobin within normal values but on the low end. I talked with my doctor and it’s probably due to my rather heavy periods. I already eat a moderate amount of red meat. Apparently it is the best source. Can I safely increase my consumption of red meat or would it be better to take iron supplements?”

Laura:There’s a couple of different things that we want to cover in this question. There was something I was going to save until later, but I actually feel like I want to cover it first because I think it’s important that we deal with this wording of the question.

This person obviously is a menstruating female. We don’t know her age, but we can guess that she’s in her 20s to 40s. I mean certainly she can be younger than that, but most of our listeners are not teenagers. When she says can I safely increase my consumption of red meat, to me that indicates a level of fear around red meat as a food and its health effects.

Anytime somebody asks if they can safely do something, you’re assuming that there’s a level that it’s then unsafe. For this person, it sounds like she feels a certain amount of red meat intake would then be unsafe. I have noticed in a lot of my clients, and Kelsey, I would assume you have to, that there does tend to be a lot of fear around red meat in general especially people in the 20s to 40s range. Well, I’d say older than that too.

Kelsey:Yeah.

Laura:But anyone who grew up with the food pyramid and the little triangle at the top that’s like eat sparingly red meat and stuff like that because it’s bad for you. It’s just this kind of insidious belief that red meat is unhealthy. There is this underlying concern about red meat that I don’t necessarily think is warranted. I would be curious to know what this person is afraid of if she does eat “too much” red meat.

There are some thoughts that excessive red meat would cause heart disease, cancer, inflammation, lots of different types of chronic disease. I know sometimes there’s been studies that are like “too much red meat causes diabetes,” which I think is just total BS.

There’s a lot of these correlative studies where they look at populations, red meat consumption, and then they correlate it with different conditions. Sometimes it’ll show an increased risk of certain long term conditions. However, that is not enough information to actually suggest that red meat is unhealthy to eat in high quantities.

The other question is even if it was unhealthy for certain populations to overeat on red meat, which there definitely are some that shouldn’t be overeating on red meat, that doesn’t mean that this young menstruating woman is one of those people that is actually at any sort of elevated risk for health issues.

I’m not going to go into a ton of detail about who would benefit from lowering their red meat consumption and who shouldn’t worry about it at all. There’s an article round-up kind of thing and a podcast on Chris Kresser’s website that we’ll link to in the show notes. One is a report on red meat called “The Truth About Red Meat” that kind of goes into details about different articles that explain why or why not red meat is a problem, what these reports are really showing when they do these reviews of population data. That’s a really great resource.

And then Chris also has a podcast on red meat called “Does Red Meat Increase Your Risk of Death?” If you’re thinking about safely eating red meat and there’s a concern that eating too much red meat will kill you, that would be a good podcast to listen to. Like I said, there may be some people could benefit from a lower red meat intake and maybe at some point we’ll do a show on who those people are, but a young woman with heavy periods and low hemoglobin probably isn’t one of those people.

Kelsey:Right.

Laura:Anything to add there, Kelsey?

Kelsey:Yeah, I just agree. I think people get very concerned about this idea that red meat can be harmful to their health, but I think it’s really important to remember that there’s distinct differences between different types of populations and how they are going to respond to red meat. Like you said, a young menstruating female who is at risk of iron deficiency, she’s not somebody we’re going to be worrying about typically.

Laura:Once we’ve kind of moved past the question about safely increasing red meat consumption, I think we should talk about first of all when we’re looking at hemoglobin and low hemoglobin as being a problem, first we want to know what symptoms or what issues can low hemoglobin cause and then also what could be actually contributing to low hemoglobin beyond just iron deficiency. Because I think iron deficiency is definitely cause in the general population, but for somebody who is eating a pretty healthy diet, eating iron rich foods like red meat, it may not be that their iron is too low. We want to talk about the different nutrients that can contribute to low hemoglobin so that way they’re not just over focusing on iron and not thinking about what else can be contributing.

The person who asked this person didn’t give us an exact number of her hemoglobin, but it’s possible that her levels, even though they’re in the normal range, that they would actually be considered functionally low. Functionally low just means within the reference range but possibly low enough to cause suboptimal functioning or symptoms.

The laboratory reference range typically is for men and women is between 12.6 to 17.7 grams per deciliter. That does depend on the lab. Some labs do give sex different ranges, but that’s kind of the general range that listed. For functional reference ranges, men would be between 14 to 15 grams per deciliter and women would be 13.5 to 14.5 grams per deciliter. If a woman, say this girl has 13.0 grams per deciliter as her hemoglobin, even though that’s within the reference range, it is functionally low and could cause some problems. If you’re checking your hemoglobin and you’re a woman and it’s below 13.5, you may want to make some of the adjustments that we’re discussing today.

If you don’t know what hemoglobin is, just to give you a very brief overview, hemoglobin is the protein molecule in red blood cells that carries oxygen from the lungs to the body’s tissues and returns carbon dioxide from the tissues back to the lungs. Basically when you breathe in oxygen, oxygen gets into your bloodstream, the hemoglobin is what attaches to that oxygen and then delivers it to the rest of the body, and then it exchanges that oxygen for carbon dioxide when the tissues have used it, and then it brings it back to the lungs for exhalation.

Hemoglobin is made up of four protein molecules that are called globulin chains that are connected together. Each of those globulin chains contains an iron containing porphyrin compound called heme. That’s why it’s called hemoglobin. Heme is what contains the iron and that iron atom is crucial transporting oxygen and carbon dioxide in the blood. The iron contained in the hemoglobin is actually what’s responsible for the blood’s red color. Hemoglobin is basically the molecule that carries the oxygen and the carbon dioxide between the tissues and the lungs.

Hemoglobin also plays an important role in the shape of the red blood cells. If you are low or high in hemoglobin it can affect the kind of donut shape of the red blood cells and make it harder for those to carry the gasses that they’re supposed to carry.

When you do have low hemoglobin it’s typically one of the major forms of anemia and it can cause symptoms like general fatigue, weakness, pale skin, shortness of breath, dizziness, cravings for things that aren’t food – so things like dirt, ice, or clay – a tingling feeling in the legs, swelling of the tongue or sore tongue, cold hands and feet, fast or irregular heartbeat, brittle nails, headache, and the list goes on.

But those are some of the more common symptoms, which is interesting because I think a lot of things can cause any of these symptoms. But if you are having a bunch of them and then you also get your hemoglobin checked and it’s low, I think fixing your hemoglobin levels is a good place to start with those.

There is a good amount of information about iron in general in Chris Kresser’s training program for practitioners called The Kresser Institute. I think the reason that it has a lot of stuff on iron is because Chris has done a lot of stuff on iron overload in the past, but he does have some information in there about iron deficiency and low hemoglobin.

Low hemoglobin can be caused by iron deficiency but it can also be caused by just normal pregnancy. Having a drop in hemoglobin is common in pregnancy. There are certain nutrient imbalances that we’ll talk about that can lead to low hemoglobin that are not just iron. Lead poisoning, which I don’t think is super common, but certainly if you were exposed to lead, that could cause low hemoglobin. Something called ineffective erythropoiesis, which just means that you’re not creating red blood cells and that then lowers your hemoglobin levels. Hemolytic anemia, hypothyroidism, chronic kidney disease, liver disease, chronic inflammation, certain bone marrow disorders, porphyria, and I forget exactly what that is. But there’s vasculitis, hypopituitarism, hypergonadism, and certain drugs.

As you can see, lots of different things can cause low hemoglobin. We’re not going to talk about all of these because some of these are outside of the scope of a podcast, but there are some nutrient imbalances and other issues that can contribute that we will talk about. With the more common causes of low hemoglobin, I do think that that nutrient imbalance issue tends to be one of the more common things.

Again, iron deficiency can definitely be a cause. It’s probably one of the more common causes in the general population that doesn’t eat red meat, or is vegetarian, or isn’t eating a very healthy diet, or eats a lot of grains and things that might block the absorption of iron.

Kelsey:This woman it sounds like maybe because she’s scared of red meat, I would guess she’s probably not eating a whole lot of it right now.

Laura:Yeah. I mean moderate is kind of vague. Moderate can be once a day or moderate can be once a week. I don’t know what she means by moderate, but I think most people think eating red meat more than three times a week is dangerous. That’s generally the number I tend to see. Then there’s people in the Paleo community that eat it every day. It’s one of those things that everyone is going to have their own interpretation of what moderate is. But if you’re not eating it at least three to five times a week, I would say that’s a low intake of red meat.

Red meat isn’t the only thing that contains iron. There is iron in other meats, and shellfish, and some plant foods. But it’s not very well absorbed from plant foods, which is why meat tends to be a better source of it. But if you’re iron deficient, usually that is going to come from an inadequate dietary intake which we were just talking about. There could be some gastrointestinal malabsorption which is super common especially in people with celiac disease.

Kelsey:Yeah.

Laura:If you have undiagnosed celiac and you’re eating gluten even occasionally, that can cause inflammation of the gut lining and then you’re not going to be absorbing any minerals very well. Iron is definitely one of the more common ones that you don’t absorb.

That’s not the only thing that can cause GI malabsorption. You can also have things like IBD, like Chron’s or ulcerative colitis that make it harder for your body to absorb that iron, or just IBS, or gut dysbiosis, that kind thing. And then especially with people with ulcerative colitis with general bleeding in the gut, so blood loss if you’re getting blood in your stool, you might be losing iron that way. Or if you have a heavy period, that’s another place that people tend to lose a lot of blood for obvious reasons. But it’s more blood than what would be normally lost during the menstrual cycle if you have a heavy period. That’s three more typical causes of iron deficiency. Kelsey, are there any that I missed?

Kelsey:No, I mean not that I know of. But I would just say for the GI stuff in particular, if you have any degree of gastrointestinal symptoms like even if it’s just bloating or excessive gas, it’s something that you really think a lot about, but you having really any type of nutrient imbalance or deficiency that you’re seeing, I would definitely get checked, do a full workup really for gut issues. Being tested for celiac disease, taking a stool test, maybe doing a SIBO test as well, just covering your bases to make sure that there is nothing that is impeding absorption of these nutrients. Honestly I think it’s more common than people think. They feel like they have to have some major issues gastrointestinally to prevent the absorption of nutrients, but I don’t think it has to be horrible for people to not be absorbing their nutrients as well as they could.

Laura:Right. I think if you combine mild malabsorption with lightly low dietary intake, it’s kind of like a perfect storm for having deficiency of certain nutrients. It’s not like you have to be vegan or have an insane parasite or something to have iron deficiency. Now certainly that will make it a lot lower. You’re probably going to see actually clinical low hemoglobin, but there’s a lot of things that can affect your absorption and intake of iron in general.

Don’t think that just because you eat a Paleo diet and you eat red meat a few times a week that you’re covered. There are some ways that you may be not getting as much as you think you are.

Kelsey:Right.

Laura:Some of that can just be from eating too many foods that are going to impact absorption of iron. If you’re not eating a lot of iron rich foods, you eat a ton of plant foods, a lot of that iron that you’d be getting from the plant foods you may not be absorbing. You think you’re getting a lot of iron potentially, but then you’re not if you’re eating lots of high antinutrient content foods, which unfortunately most plant foods except for fruits and starchy vegetables tend to be high in antinutrients.

Kelsey:Yeah.

Laura:And then the other nutrient imbalances that tend to be an issue would be most of the B vitamins in particular folate, B6, and B12. If you’re deficient in any of those, that can cause low hemoglobin.

The other mineral that can be lead to low hemoglobin is copper. Copper is one of those nutrients that a lot of people worry about getting too much copper, but you could potentially be getting not enough copper in your diet and that would cause some low hemoglobin as well.

Those nutrient imbalances are really the main ones that are going to contribute to low hemoglobin. I think it’s important here to note that the easiest dietary source of all of these nutrients, so all three of those B vitamins, iron, and copper, is liver. For anyone who does have low hemoglobin, or iron deficiency anemia, or any kind of anemia really, they should try to be eating at least 4 ounces of liver per week on top of other iron rich foods.

If you’re eating red meat, that’s great, but you might want to get something that’s a little bit stronger in those nutrients and going to be a lot higher dose of those things that we need a lot of. Four ounces of liver a week is not a ton. I mean I hate, well I shouldn’t say hate. It’s a strong word. I am not a big fan of liver.

Kelsey:I hate liver.

Laura:It’s not easy necessarily to get that in, and if you can’t eat it, there’s other things you can do like supplements or liver shots or whatever. I can link to an article that I’ve written called “Hate Liver? Eat it Anyway With These Tips.” I think that would be helpful for people to check out if you are afraid or you hate liver and don’t want to eat it.

But this would be where I would start with someone if they are potentially either iron deficient or just worried about nutrient deficiencies in general. I’d much rather see someone either eat liver or use desiccated liver supplements as opposed to going straight into those high dose iron supplementation recommendations that a lot of doctors will recommend.

High dose iron is potentially constipating which is not comfortable for a lot of people. And if you already have a GI issue, that’s really not going to be helpful. And the question is, is having a high dose of a super easily digested iron source actually safe in the long term?

Kelsey:Right.

Laura:If people are worried about eating red meat, I would be more concerned about taking tons of iron over the long run. You’re not necessarily getting those other nutrients that help you use that iron appropriately. That’s why I think liver tends to be a better option than doing an iron supplement.

Kelsey:Just to note on those iron supplements too, you might see some out there that say that they’re non constipating, but I will tell you that I’ve had so many clients try to take iron supplements that claim that and for most people it’s actually not true. They still get even if it’s a little bit less constipated, it’s still enough. You guys know that I work with digestive clients for the most part, so for people with constipation, even if it’s less constipating, it’s enough usually that it’s going to be a problem.

Laura:Yeah. To be fair, the dose will affect how much of a problem that is. If you’re taking a 10 milligram iron supplement, that’s going to be way different than…I think saw a client that was using like 70 milligrams at one point.

Kelsey:Gosh!

Laura:That amount is going to definitely impact your constipation.

Kelsey:Yeah.

Laura:If you do need some iron, we’re not anti iron supplementation 100%. I want to be clear about that. Some people will need some iron supplementation if their iron is very low. But I think a liver supplement is definitely a better way to start. Really if somebody is super low in iron, normally they’re going to get an infusion anyway. They’re not just going to use pills because you’re not going to get as much of a quick benefit from that.

Whenever I see somebody on a super high dose iron supplement, I do wonder not only what impact that has on their body over the long run from an inflammatory state, but also iron feeds pathogens.

Kelsey:Right.

Laura:If you’re doing a ton of supplemental iron, that could potentially be contributing to a gut infection. Getting down a bit of a rabbit trail right now, but there’s a lot of things to think about.

Kelsey:There is.

Laura:You don’t want to just be taking a ton of iron supplementation because you have low hemoglobin when it may not even be related to iron. Again, there is a couple of other things, like the ineffective erythropoiesis is usually genetic. I think sometimes exercise and oxygen exposure can affect your erythropoiesis. If you’re in a low oxygen environment, I think that actually ups your erythropoiesis. That’s why people that train for marathons often train in high altitude areas. But most of the time erythropoiesis is related to genetic issues. You’re not really going to be in a state where you’re not getting enough erythropoiesis because you’re getting too much oxygen or something like that.

And then hypothyroidism can definitely be a problem. Iron deficiency can actually contribute to hypothyroidism, and then the enzyme called thyroid peroxidase is dependent on iron. So that can be something that either if you have any sort of hypothyroidism issues or if you are not getting enough iron in your diet, that can contribute to hypothyroidism, and then that can reduce your hemoglobin production. It’s kind of like a roundabout way of getting iron deficiency causing low hemoglobin, but it could just be that you have a thyroid issue and your thyroid hormone is not high enough.

And then chronic inflammation, again tends to be a much more common reason for people to have low hemoglobin. There is something called anemia of chronic disease and it’s pretty common with a lot the inflammatory conditions like some kind of malignancy or cancer, autoimmune disease, inflammatory bowel disease, any sort of chronic immune activation, metabolic syndrome. Any time there’s going to be a lot of inflammation going on, there’s going to potentially some anemia.

If you are having any sort of elevation of C reactive protein or any other inflammatory markers, what happens is your body starts to store iron and ferritin. So you can have high levels of ferritin, but then it starts to decrease iron absorption to try to prevent iron from being available to pathogens. Like we said, iron can feed bacteria and if you have a chronic infection, your body may start to try to keep that iron away from pathogens which can then lower hemoglobin.

Again, if you’re under a lot of inflammation or oxidative stress, that can increase ferritin production which is shuttling a lot of the iron into ferritin as opposed to hemoglobin. Most of the time if you’re getting your iron checked, you should also be checking your ferritin as well because there’s a big difference between iron deficiency low hemoglobin and chronic disease and chronic inflammation causing a shift from hemoglobin to ferritin. You definitely want to get your ferritin checked as well.

And then if you are interested in learning more about how chronic inflammation and iron storage issues can affect your hemoglobin, we would strongly recommend checking out a podcast by Chris Masterjohn called “Why You Need To Manage Your Iron Status And How To Do It.” He has a lot of information about not only what to look for when you’re testing your iron levels, but also what causes high or low iron status, and then how to fix that if you do have a problem. That’s going to give you way more information about this than what we just talked about, but I just wanted people to be aware of the fact that having low hemoglobin isn’t always indicate low iron intake. It could just be that your body is pushing iron into different areas to prevent more oxidative stress, or more inflammation, or overgrowth of pathogens.

Kelsey:Right. And that’s why I think it’s really important that whoever you’re working with, whether that’s your doctor or a different healthcare practitioner, that they’re really thinking about all the underlying reasons why you might come back with a functionally low hemoglobin level or even a truly low hemoglobin level.

I recommend not just looking at hemoglobin itself. Like Laura was just saying, you should definitely at the very least be looking at your ferritin as well, but I would say a full iron panel would be a great idea. That includes things like hemoglobin, ferritin, total iron binding capacity, unsaturated iron binding capacity, iron saturation. That would also cover if you’re on the other end of the spectrum too. If you are prone to iron overload as well. That would kind of check out that side of things too.

But the point is you really need to think about what could be causing this because if it’s due to heavy periods, then fine, you can just work on increasing your levels of absorption and eating more iron in general. But if it’s due to something like a lot of oxidative stress, or a lot of inflammation like Laura was just talking about, just eating more iron in your diet and focusing on better absorption, it could be counterproductive even.

That’s why you really need to make sure that you’re healthcare practitioner is thinking about this stuff because they may just assume that you’re not getting enough iron. A lot of practitioners or doctors who don’t really dive into it, they may just write off the bat recommend an iron supplement rather than even thinking about this stuff. At the very least, you want to ask for a full iron panel. And then as Laura was talking about before too, there are other nutrient imbalances that can lead to low hemoglobin. You want to be taking a look at those as well.

Chris, in his podcast that Laura just mentioned, talks a lot about this stuff as well. Again, just a reminder if you want to dive deeper into this stuff, he has a really excellent podcast on the topic and it’s just more complex than we can get into here and he overviews it very, very well.

Now of course like I said, if your low hemoglobin is simply due to heavy periods, then you do want to focus on increasing your iron consumption and your absorption of that iron. Laura had mentioned previously that there are different types of iron. There’s heme iron and non heme iron. Heme iron is in animal products and non-heme iron is in both animal and plants. But it’s the only type that’s found in plant food. You can’t get heme iron from plant foods.

What we’ve seen in the research and just how the body works is that heme iron is much better absorbed than non-heme iron. Liver, as Laura said, is a great option, clams are actually a really great source of heme iron, and of course the infamous red meat that this person is a little bit worried about. Those are the greatest things that you can include in your diet to be getting a lot of iron overtime and as you’re eating every single day and making sure you’re getting a lot more than this person maybe is getting currently. Because like I said before, I think it sounds to me even though she says moderate, just the language she’s using, and again we don’t know this person or haven’t talked to her and seen her dietary intake, but I would guess that’s she would probably be eating a low amount of red meat in my eyes. I probably wouldn’t consider it moderate. But again, we don’t know her.

The best sources of non-heme iron are things like legumes, greens, seaweed, and potatoes. Because this person’s iron levels aren’t super low theoretically, she’s just got functionally low levels of hemoglobin,  so let’s just say we’re assuming for the sake of this podcast right now that it is truly just due to heavy periods and not getting enough iron. She definitely needs to make sure that she’s getting at least a couple servings of clams, liver, and red meat on a regular basis.

Laura mentioned before the four ounces of liver per week. I’d say, yeah, four to six ounces of liver per week would be great. And then on top of that, it’s hard to say because of course we don’t know exactly how low her hemoglobin level is, but I would say at least three servings of red meat and maybe a serving of clams per week. Or she could swap out the clams for maybe another serving or two of red meat if she didn’t want to eat that regularly. But essentially getting up there in the red meat consumption somewhere between at least half your day’s of red meat and then if she’s not eating clams every week, maybe adding another two or three servings. That’s almost a daily intake of red meat at that point in addition to the liver.

That’s going to of course depend on her actual absorption of it too. Like we talking about before, gastrointestinal issues could certainly play a role in preventing her from absorbing it well. If she was my client, I would definitely look into any signs of GI issues and do some testing in relation to those symptoms to make sure that she’s absorbing things well. Because if she’s not, then we’re going to want to clear up any GI issues so that she’s absorbing better, potentially right now as she’s dealing with that stuff, give her even more iron so that hopefully she can get a little bit more out of it in terms of her absorption.

The other piece of this too is just improving absorption of iron in general. There are some things that you can do just from a food combination standpoint that can make your absorption a bit better. One of the things you can do is try to eat your iron rich foods away from calcium rich foods because calcium locks iron absorption essentially. Let’s say you’re somebody who tolerates dairy, you eat dairy on a regular basis, if you’re going to eat a serving of liver, you probably want to not eat dairy with that meal because again, that calcium contained in the dairy is going to block the absorption of iron. You just won’t get as much out of eating that liver. If you’re working hard because you don’t really like liver in the first place to get really get that into your diet, it’s just going to not give you as much benefit if you’re eating it with dairy.

As Laura mentioned previously too, she was talking about the fact that iron absorption is blocked by things that are called antinutrients in plant matter. These include things like polyphenols and phytates. If you are trying to get a lot of your iron intake from fruits and vegetables, you’re going to have a little bit more trouble because these things, the polyphenols, phytates, all these kind of antinutrients that are contained in plant foods are going to inhibit your non-heme iron absorption.

But what you can do to help this a little bit is to add vitamin C which improves the bioavailability of non-heme iron in the presence of those antinutrients. You want to supplement with vitamin C to help increase your absorption of iron from fruits and vegetables. You don’t necessarily even have to supplement I would say, but you could also just think about combining high vitamin C foods with high iron foods. That would be something to consider. But if you really wanted to get the most bang for your buck, I’d say a vitamin C supplement is certainly not a bad idea.

Laura:That’s only with plant iron.

Kelsey:Exactly.

Laura:That won’t affect if somebody has liver and they want to have orange juice with it, it’s not going to increase their absorption of the liver.

Kelsey:Exactly, yeah. It’s really going to help you if you want to increase your iron absorption from plant foods in general, but I would say it’s especially important if you are trying to get most or even half of your iron from eating a lot of plant foods. It can be useful, but if you’re planning on getting on the majority of your iron from heme sources which are the animal sources, you don’t need to worry about that quite as much.

One thing Chris Masterjohn talks about in his podcast, so I won’t go too much into detail with it here but I do want to mention it, is that Nrf-2 stimulating supplements can help to inhibit your ability to heal from anemia as well. That includes things like milk thistle and green tea extract. If you’re taking supplements that are meant to stimulate Nrf-2, you’re certainly not helping the situation if you do have anemia. I would recommend that if you are interested learning more about that that you definitely listen to Chris’ podcast. Of course he dives into the whole pathways and everything that make this an issue. So if you want to learn the why behind that, definitely take a listen to that.

We were talking about supplements before, so I do want to come back to that because like we said, we’re not opposed to supplements whatsoever. There are definitely some people who need them and who would benefit from them if they are iron deficient. They can be useful. Like I said before, the one thing to consider if you have GI issues, especially if you have constipation, is that they do tend to be constipating even if they are not supposed to make you constipated. When you take them in smaller amounts it’s typically not a huge deal, but I’ve certainly had clients who even in the lower doses for a seemingly non-constipating supplement, they still have issues. I would just be careful with that if you suffer from constipation in any degree.

This is also something Chris mentioned in his podcast, he says that, Chris Kresser has a few supplements that he recommends. One of them is Iron Smart Liposomal Iron. The other is Proferrin ES Heme Iron. If you’d like to take an iron supplement, you can check out either of those. They are some of the better supplements on the market when it comes to iron supplements because there’s a lot of really bad iron supplements out there. Mostly it’s because they are constipating, and they’re not using the right forms, they’re probably not well absorbed as what Chris is mentioning here.

If you need to take a supplement or if you have been recommended a supplement, definitely take a look at it. It should say that it’s hopefully non-constipating. It should have some good forms of iron. You can see from the ones that Chris recommends, one of them is a heme iron and one of them is a liposomal iron. You can just tell right off the bat just from those names that they’re going to be better absorbed than probably most typical iron supplements.

Just be careful with your iron supplementation. I would say a lot of the times because when doctors are recommending iron supplements, they’re typically not the greatest at least from what I see from my clients. I don’t know, Laura, if you see the same thing when they get a recommendation from their doctor, and honestly sometimes a pretty high dose, it’s not a great form. I would imagine it’s going to be pretty constipating. I would at least ask about these other options with your doctor. Say you’ve heard about these two other options, would they be willing to let you do that.

Of course as we said before, if you have really low iron oftentimes you’re actually going to get an infusion to help bring up your iron levels rather than supplementation because that can take a lot longer.

I personally like to recommend food sources over supplements whenever I can. Like Laura said before, even if you have to go to a liver supplement prior to jumping on board with an iron supplement, that can be a really great idea as well.

Laura:I feel like we covered this pretty well. And again, Chris Masterjohn’s podcast is way, way more detailed about this. If you are interested in learning more, we would definitely recommend going to his website which is ChrisMasterjohnPhD.com I believe. We’ll link to that in the show notes so again if you wanted to get a much more detailed look into this topic, that’s where you want to go.

But hopefully this gave everyone a good overview and gave you some food for thought if you have any issues with anemia, a low hemoglobin level, or anything like that. Of course if you have high iron, this is going to be something that doesn’t apply to you and you may be one of those people that wants to limit red meat or things like liver. Again, Chris covers that in his podcast. Definitely go check it out if you have any questions about iron status. But anyway, up next is our updates!

Kelsey:Welcome to the update section! Like we’ve been talking about in our previous episodes or last couple episodes, we are trying this out. Again just as a reminder, if you guys have any strong opinions on whether or not you like our updates at the end or at the beginning, let us know. You can leave a comment, you can write to us on the contact tab on our website TheAncestralRDs.com. But we always love to hear from you and we’d especially love to hear from you in regards to what you guys prefer. With that, Laura, what’s going on with you?

Laura:Well, I know everyone’s totally tired hearing about my wedding.

Kelsey:Maybe they’re not. Maybe they love it.

Laura:I don’t know. Some people I’m sure are sick of it. I know sometimes I’m sick of it, so I wouldn’t blame you if you’re sick of it. But just based on when this podcast is scheduled to publish, this will actually be my last episode as a non-married person.

Kelsey:Ahh! Crazy!

Laura:I know, it’s weird. It’s far enough in advance that doesn’t feel like it’s that close to when we’re actually recording it, but now that my schedule has been creeping into June, I’m just like oh my gosh! I actually have to make my schedule fit around my wedding and my honeymoon.

It’s kind of like a weird very surreal thing because it’s still several weeks away at this point. But it’s definitely exciting and I’m sure if you guys follow me on social media, you’ll be seeing stuff about it over the last it seems like a million years, but over the last couple of weeks just as far as getting ready for it, and how soon it’s coming up, and being excited.

Kelsey:What are you working on right now? Where are you at currently?

Laura:I’m getting close to paying. I’ve put deposits on everything so now paying for everything is going to be coming up.

Kelsey:Fun.

Laura:I did have my first dress fitting after they’ve done some alterations this past weekend, so that was definitely more enjoyable than I expected. I feel like both the dress shopping experience and this try on experience were better than I was expecting.

Kelsey:That’s good.

Laura:I personally, I hate trying on clothes because most of the time they don’t fit me very well. But there’s something nice about…like I feel like my physique is definitely more dress friendly and then the fact that it’s being fitted to me exactly I think is a nice experience and it’s not like I’m squeezing in in certain areas or it’s too baggy in other areas.

I was super excited when I got to see it for the first time. There’s definitely some adjustments that’s it’s going to need. I bought my dress off the rack so there’s more adjustment that it would it needed had I gotten one that was custom made for me.

Kelsey:Right.

Laura:You didn’t get a custom dress right?

Kelsey:I got it a completely off the rack dress. I didn’t do anything to it actually.

Laura:But I think wasn’t the dress you got supposed to be bought that way?

Kelsey:Yes. I mean I’m sure people do alter it slightly. I bought a very like cheap dress that I ended up loving and I bought it kind of last minute, which was surprising because I had bought a different dress and I just realized I don’t think I love this. I just wanted something different so I ended up buying something just like from an online website and luckily it fit perfectly. It was great!

Laura:I think the ones that are designed to be bought off the rack do end up having a little bit more stretch to them that’s been what I’ve heard. They just tend to allow for more I guess shape differences.

Kelsey:Yeah, for sure.

Laura:Whereas the ones that are designed to be actually fit to you really are quite structured. Mine I got it off the rack and it was probably at least a size bigger than it should have been, maybe two sizes. I don’t really remember honestly what the size was. I think it was somewhere around like 8 to 10 range and I think I’m a size 6 now. I honestly have no idea. But it needed a significant amount of taking in and then there’s just some areas of it that don’t fit perfectly because of the fact that I got it off the rack. The bust area doesn’t totally fit because it’s just designed for a larger person so there’s some things that needed to be adjusted still. But I’m really excited about it. I think it looks really pretty. It’s super comfortable.

Kelsey:I’m excited to see it!

Laura:I know, I know! Hopefully I’ll have pictures fairly soon after to show people even just a little preview or something. It’s just funny because when I was telling my fiancé that I was going, he was like oh you should send me pictures so I can see what it looks like. I’m like ha-ha, very funny!  Obviously he’s joking.

But anyway, it’s been an interesting couple of weeks because I tend to vacillate between being very happy with my fitness and eating routine and then just this level of pressure of looking a certain way on your wedding day tends to kind of sneak in there. Coming up to the dress fitting, I was like I really hope it looks good. I just don’t want to feel like not pretty in it. When I was trying it on, I was actually like really glad with how it looked.

That’s how I felt when I bought it. It just seemed like it was just fit really well for me and like I said it’s super comfortable and just kind of exactly the style I was looking for. I was very happy with it when I bought it, but there’s always that fear that you’re going to try it on and be like this isn’t what I thought it was going to be! Because I’ve seen too many of those TLC “Say Yes To The Dress” shows where people are like I hate it! It’s like why did you buy it if you hate it?

Kelsey:I think it’s weird too especially with wedding dresses because you leave it there. It’s not like you have it at home and you can try it on again and you’re like I do love this, I don’t know what I’m driving myself crazy about. But when it’s not with you or they’re hanging on to it, you can’t just go try it on necessarily. I feel like that plays into that fear a lot.

Laura:You’d think that, but I bought my dress in October and I took it home with me. I brought it home in the car from the place in Savanah that we bought it. I don’t think I tried it on at all between then and trying it on at the first tailor session. I brought it to a tailor locally to get it taken in and stuff. I just didn’t feel like trying it on.

I don’t know, it’s weird. I don’t think I’m the kind of person that would really like a dress and then hate it later. Usually I’m pretty immediately not into it if I’ve tried it on. This one was the opposite experience. I tried it on and I was like this is really nice, I like this! It wasn’t like I fell in love with it and I was like falling all over myself, but I do think it’s what I wanted, so I feel good about it. There’s always that little bit of anxiety about trying it on and it not fitting or if your weight has changed at all. I personally hate the fact that I feel like I have to be maintaining a certain shape at this point.

Kelsey:Right.

Laura:It kind of stressful, but it’s not that big of a deal because my dress is not the kind of dress that needs to be super tight. If it’s a little loose, it’s not that big of a deal. I think I’ve had some give if I gain some weight, but I don’t really see why I would gain weight. I think most people tend to lose weight before their wedding because of the stress. Anyway, that was one of the more recent things that I did. Again, this episode is literally days before my wedding, so I was trying this on well before then. I’m not that big of a procrastinator.

But then there’s just been some other things I’ve been kind of updating like certain guest count things. We thought a certain number of people were going to come and now the number is changing, or the people that we didn’t think we’re going to come that are going to come and have certain dietary restrictions, that kind of thing. I have gluten free people, I have vegan people, I have like strict, strict kosher people. Just trying to managing all those things is interesting just because I think the people that are in my gluten free or Paleo type eaters are going to be totally different than my uncle who eats vegan.

Kelsey:Right.

Laura:It’s just like kind of complicated, but luckily my catering company is really good at managing dietary restrictions. We have to make some decisions about the cake. I’m trying to think if there’s anything else major. Literally it’s most just paying for things, which I think had been one of my biggest stressors recently just making sure I had enough money for everything because it’s just a lot of money.

Kelsey:Of course, yeah.

Laura:It’s kind of scary to write that large of checks multiple times in a row.

Kelsey:It’s like this is horrifying.

Laura:Yeah, like multiple four figure checks. Luckily none of them were five figures.

Kelsey:That’s good.

Laura:But certaintly four figure checks are scary. And just dealing with getting a lot of RSVPs. I will say there’s a fun part about RSVPs that you just get mail every day, like actual mail and not junk mail. That’s been kind of fun to just see little cards in the mail. Although it is sad when you see people that you wanted to have there that can’t come, which is understandable, but also kind of a bummer when you’re excited to see certain people and then they can’t come.

Kelsey:Yeah, I loved getting those in the mail and people would write little notes, like I’m so excited to come! It feels so great.

Laura:Yeah.

Kelsey:There’s something to be said about getting stuff in the mail every day. It’s exciting.

Laura:I know. It’s very silly because it’s not like I don’t know all this stuff is coming. It’s just I like to check my mailbox every day now. I think that’s pretty much everything that I’m planning on with the wedding right now. It’s just I feel like we’re in the crunch time or at least we’re getting into it. It’s far enough away that there’s still time, but close enough that I need to start getting on the ball with things.

I feel like there is this little cloud over my head about feeling like I’m not doing something that I’m supposed to be doing, which may or may not be true, but it’s just that anxiety that I’m like missing something. Luckily I have a day of coordinator that I’m going to be meeting with in I guess a week or two. I don’t remember the exact date, maybe two weeks. But she’s going to help with organizing everything and making sure I have done everything that I’m supposed to do.

Kelsey:That’s good.

Laura:That’s probably going to be helpful I feel like somebody else helping me because it’s really hard to do this on your own and then also run a business which is you’re doing everything yourself for that as well.

It’s definitely an experience and I’m excited about it. I am going to be glad when it’s over because it’s just an extra level of stress. It was funny when you were talking about your program creation that you’ve been doing recently and kind of finishing up with, I’ve had my own program idea on the back burner for a long time. I feel like once the wedding stuff is done and once all of the major…how do I describe this?…I guess life combining that needs to happen once my then husband moves in with me and brings all of his stuff that we need to kind of like go through and combine. We do have to help him move from Ohio, so that’s going to be its own effort.

Kelsey:Right.

Laura:But once all of that’s done, I do want to start working on a program. So I’m kind of excited for the wedding to be over because of that because I feel like I’m in a bit of a holding pattern from a business perspective because I just don’t have the time to do more than what I’m doing. As you were saying last time, it is a ton of work.

Kelsey:Yeah.

Laura:Trying to plan a wedding, and run a busy one on one practice, and then adding a program creation onto that just isn’t possible, or smart, or desirable, or anything positive. I’ve just been putting it off for good reason. It’s not just procrastination. It’s literally like I would die if I tried to add another thing onto my plate.

I have kind of dabbled in some preprogram creation surveys and that kind of thing for my audience to see what people to get a sense for what I should be doing, but I think the real bulk of the creation is probably going to start toward the end of the summer once things have kind of settled down, we have our house kind of in order, and our animals are getting along, and all that stuff.

Kelsey:Oh yeah, that’s a whole other thing to think about.

Laura:Yeah, it’s a lot. I forget to who I was talking to, I think I was talking to one of my friends recently about how I feel like weddings are stressful enough when you live in the same town as your fiancé or you may live with the person before you get married and you’ve already done all of the life combining stuff, but basically the month of June is going to be insane for me.

Kelsey:A life overhaul.

Laura:Other than having a baby, I don’t really see how it could be any more drastic than what it’s going to be for me.

Kelsey:Yeah!

Laura:Basically going from living alone, having a phone based relationship with my fiancé, having an hour or so phone conversation on a nightly basis and that being my interaction with him for the day, having my dog but not having to worry about his relationship with another animal, and just trying to figure out how my daily work schedule is going to change. Because there are days that I’ll be on the phone with clients from 10 am until I think most recently I finished with a client at like 8 pm. That’s not going to be able to happen frequently when I’m married because that’s just ridiculous.

Literally even details like I have a queen bed and we’re going to have to upgrade to a king bed, and rearrange the furniture, and I’m going to have to get rid of some clothes because I have kind of fully infiltrated all the closet space in my townhouse now. It’s just like so many things.

I’m trying not to get overwhelmed by it because obviously I want to enjoy the day, I want to enjoy my honeymoon, I want it to all be very in the moment. But there are all these other things that are going to be happening around that time that it’s just like I feel a little bit…I don’t know how to describe it. I don’t feel paralyzed, it’s just kind of like waiting for that stuff to happen. I know it’s coming and it’s probably like I said like having a baby for the first time where you’re like you know it’s coming, and you’re life is going to be totally different, and you’re preparing for it as best as you can, but there’s only so much you can prepare for before you just have to do it.

Kelsey:Yeah.

Laura:Anyway, that’s kind of my update. Oh, I don’t want to go on too long because I know I’ve already been talking a lot, but I wanted to say thank you for everybody who was wishing me well for my 30^th birthday which was recently. It was awesome! I had a really good weekend. I had been a little down because I didn’t think my fiancé was going to be able to get in until late on the Friday night, which my birthday was on a Friday. He ended up surprising me and getting a red eye the night before and getting there in the morning.

Kelsey:So cute!

Laura:Yeah. One of my friends had set up a coffee date with me. It was funny because I was coming from the gym and I was originally was just going to go straight from the gym, but I was like I have like 15 minutes. I can put some deodorant on and take my hair out of the ponytail, use some dry shampoo,  wash my face a little. I was like I should look a little presentable going to a public space like this. And then of course she like totally bait and switched me and my fiancé showed up instead. I was like sobbing my face off because I was so happy that he was there. I was just feeling really down that I didn’t think he was going to be able to spend more than, I think it was 44 hours total for the weekend. I hadn’t seen him for a month and it was just kind of getting stressful.

It was really good. He and my best friend’s husband, who my best friend has the same birthday as me which is super fun, they coordinated a bunch of activities. We went out to dinner at this new restaurant. It’s really funny, it’s called Brewery Bhavana and it’s a brewery/dim sum/flower and bookshop.

Kelsey:Wow!

Laura:Yeah. I feel like belongs in Brooklyn or something.

Kelsey:Yeah, it sounds like it.

Laura:It’s got a really cool vibe. But anyway, so we went there for dinner and then we met up with a big group of people for dessert. I didn’t have any clue that any of this stuff was happening.

Kelsey:That’s so fun!

Laura:I never had a surprise done for me like that before. I was really happy and we had a really good time and got to check out some cool places around Raleigh that I haven’t seen yet like a whisky bar that’s in walking distance to my house. I’m like this could be really dangerous for my budget and my liver maybe. But it was really good.

I got some messages after the podcast saying happy birthday and congratulations on making it to 30, which is really no different than being 29. Thanks everybody for your well wishes! Like I said, I had a great birthday so now next up is the wedding!

Kelsey:That’s awesome! He’s obviously a keeper.

Laura:Yes, yes, definitely a keeper. It’s just funny it’s like I feel like I should have business updates, but I’m just so distracted.

Kelsey:Your life is being completely changed.

Laura:I know. And to be fair, I do work a lot. Just so you know, I’m still working with somewhere in the 15 people per week average. It’s not like I’m not doing anything with my business. It’s just I’m in kind of cruise control mode right now as opposed to doing any major changes. But again, hopefully once all this insanity in my life settles down I can then kind of shift gears and start focusing on a program because I really, really want to do it. Hearing you do it and talking about how you felt doing it makes me more motivated.

Kelsey:Good, I’m glad to hear that. You’ll get to it. I felt the same way last year. I was just like I’m just holding on for dear life until this wedding is over and then I’ll feel like I will have more time to focus on my business and how I want to see it change and progress. Now you’ve seen that progression and it did actually happen, so it will happen for you as well.

Laura:Yes. I just need to like you said, get through the hurricane. Alright, well that was my life update. Hopefully that wasn’t super boring. Next time, well actually maybe not next time. We’ll see. At some point I will be talking about how amazing my wedding was, how amazing the honeymoon was. But that will be a couple episodes from now. Anyway, thanks for listening everybody and we will see you here next week!

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