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Iron Deficiency Anemia and Hashimoto’s- Understanding your Iron Labs

Iron Anemia/Iron Deficiency- More Common in Woman with Hypothyroidism and Hashimotos Then Once thought

When you’re hypothyroid, metabolic activity can come to a major slow down and lower your bodies red blood cell production. This low red blood cell count can lead to anemia and low Iron. Hashimoto’s patients are also often deficient in iron because of Gut inflammation, Gut malabsorption and bacterial overgrowth common in people with autoimmune thyroid disease.

Hi Dr Hagmeyer here and Iron deficiency anemia is one of the most common minerals deficiencies seen in people with low thyroid and hashimotos– especially woman.

  1. In today’s video, I’ll discuss why iron deficiency anemia Is so important to people who suffer with thyroid disease and Hashimoto’s
  2. I’ll talk about how iron deficiency anemia influences mental health and Neurotransmitter function- really important if you suffer with depression, Insomnia, Anxiety,
  3. I’ll talk about the 3 main ways iron deficiency anemia develops
  4. What testing and blood markers you should have done if you suspect Iron deficiency Anemia.

So lets unpack this and jump right in…..

If you are woman suffering with fatigue, Depression, Restless legs syndrome (RLS) and Brain fog-

I want your very next thought to be- Did my Dr order a complete iron panel– If not- well then I am disappointed in your doctor.

Iron Deficiency

As the name implies, iron deficiency anemia is due to insufficient iron levels in your blood or stored in your Liver.

Without enough iron, your body can’t produce enough of a substance in red blood cells that enables them to carry oxygen (hemoglobin). As a result, iron deficiency anemia may leave you tired and short of breath.

You can usually correct iron deficiency anemia with iron supplementation. Sometimes additional tests or treatments for iron deficiency anemia are necessary, especially if your doctor suspects that you’re bleeding internally.

To help you see how this happens, I want you to look at this picture.

Symptoms of Iron Deficiency Anemia

  • Your body can’t produce enough red blood cells
  • Without enough iron, Your RBC can’t carry oxygen to the tissues in your body
  • You won’t be able to produce energy, so you experience fatigue, shortness of breath from walking up or down the stairs,
  • You experience brain fog, confusion, disorientation, headaches
  • You experience depression or anxiety- Iron is a key cofactor in the making of neurotransmitters, chemicals in the brain including serotonin, norepinephrine, and especially dopamine. Dopamine plays a role in focus, concentration and is one our “feel good” neurotransmitters.
  • Without enough iron, When you get sick, it takes longer for you to bounce back you develop Recurrent infections- coughs, colds and flu like symptoms
  • Without enough iron, you also develop Brittle nails and hair, you get headaches, mouth sores, and you have low Thyroid hormones.

Now that you know about the Symptoms of Iron deficiency Anemia, Let’s talk about how you develop Iron deficiency Anemia-

When someone develops iron deficiency anemia- It’s one thing to take Iron pills, and at times taking Iron pills is critical, but correcting the cause of Iron deficiency anemia is really what the goal of care is going to be all about and that will require some investigation.

Three Reasons for Iron deficiency Anemia in Hypothyroidism and Hashimotos

  1. One reason is due to blood loss from the GI tract- blood loss could be coming from the upper GI or it could be coming from the lower GI. In some cases, your doctor may order a stool test to check for blood coming from your lower GI tract- this could be caused by (IBD) Inflammatory Bowel Disease like Crohn’s or Ulcerative colitis, it could be something like internal hemorrhoids.
  1. If you are having symptoms like acid reflux, burping, belching, burning pain above your belly button or you have had a past history of H.pylori which is a bacteria in the stomach, Your doctor may order a test called an endoscopy or an EGD- these test can identify problems in upper part of your GI tract such as your esophagus or stomach.
  2. Another common cause of Iron deficiency anemia due to blood loss deals with the menstrual cycle- If you are a woman who has endometriosis or fibroids or your cycle is shorter than 28 days or you are heavy bleeder- these problems will also lead to iron deficiency.

Iron deficiency symptoms

Outside of Iron deficiency anemia being caused by blood loss, another potential cause for Iron deficiency after bleeding, is due to malabsorption.

Malabsorption often occurs when the contents of the stomach lean towards alkalinity rather than acidity.

Your stomach by design has to be acidic in order for you to break down proteins, break down fats and absorb vitamins and minerals. Any change to PH of the stomach away from acidity will cause malabsorption.

Things like Celiac disease, SIBO or small intestinal bacterial overgrowth, Leaky Gut, infection with H.Pylori, infection with Giardia- which is a parasite, antacids, birth control pills, are just a few causes of malabsorption induced Iron anemia.

A third common category for an iron deficiency anemia after blood loss, after malabsorption is related to diet.

If you don’t eat red meat, for whatever reason- Maybe it’s religious reasons, maybe it’s because you are a vegan, or vegetarian diet or because you have eliminated red meat because you were told that Red meat is bad for you- then this is also a possible cause of Iron deficiency anemia induced by diet.

With that being said, I want you to realize that not all Iron is created equal. Just because you eat a diet high in vegetables- that does not mean you are not at risk for iron deficiency anemia and here’s why.

The Iron that is found in red meat is called Heme Iron and The iron found in vegetables is called non heme iron.

The reason why non red meat eaters (non carnivores) are more prone to iron deficiency anemia is because the kind of iron found in Red meat (Heme-Iron) is better absorbed than the iron found in vegetables or (non-heme Iron).

Also, if your diet is high in phytates and lectins, which vegetarian based diets are, these chemical block and bind up the absorption of Iron uptake in the gut and no amount of soaking your lentils, beans, nuts and seeds will get rid of this.

So let’s jump into what Iron deficiency means to a person with Thyroid disease or someone with autoimmune Hashimoto’s and then I’ll talk about blood markers that make up a complete Iron panel. With any chronic metabolic disease, there are numerous minerals and vitamins important for normal function- when it comes to thyroid health- it is no different, certain vitamins are minerals can be real deal breakers when it comes to how that gland will work when faced with a mineral or vitamin deficiency.

Vitamin A, Iodine and selenium are three of the more well-known vitamins and minerals involved in the formation of thyroid hormone but an iron deficiency impairs thyroid hormone production by reducing thyroid peroxidase activity.

When we talk about TSH and T3 and T4 levels- Thyroid peroxidase is the main player here. Thyroid peroxidase is the enzyme that plays a role in thyroid hormone production you can’t make T3 and T4 without thyroid peroxidase. Incidentally, this is also the enzyme that is destroyed when someone has Hashimoto’s disease.

Hashimotos attacks TPO enzymes. In case you are wondering, this is why we measure TPO antibodies. To see if the immune system is attacking this enzyme causing low thyroid hormone levels.

When studies have been done looking at the role Iron plays, Studies in humans have shown that even a moderate-degree of iron deficiency significantly lowers both T3 and T4 and reduces TSH responsiveness This can be double trouble for someone who has Hashimoto’s and here’s why.

Iron deficiency + Hashimotos is a Double Edge Sword

Remember what I said just a moment ago, In Hashimoto’s, the immune system is attacking and destroying the thyroid gland and the enzyme TPO. It’s not uncommon to see low Thyroid levels, when the immune system has turned on the Thyroid gland. While the immune system might be the primary reason for the low thyroid hormone levels, having low iron can further suppress TSH, T3 and T4 levels. (Learn more about Autoimmune Triggers here)

That’s the icing on the cake for someone who already has low thyroid levels. If we were playing baseball- this is like strike three!

So far we talked about the effects that low Iron has on the body, we talked about the reasons someone develops iron deficiency anemia (blood loss, malabsorption, diet related), we talked about how iron deficiency can affect TSH, T3 and T4 levels.

Iron markers that make up a complete Iron panel.

If you recently had blood work done- now is a good time to pause this video go pull out your blood work so this will make more sense.

The first three makers you want look at are

  1. RBC
  2. Hemoglobin
  3. Hematocrit

These are part of the panel called a CBC- Complete Blood count. This is very basic blood work. What you will find in the case of Iron Anemia is that these will either be flagged as low on reference ranges or they will be low normal. Low normal is the marker didn’t get flagged as being low, but when you look at the range, the value it’s at the very bottom of the range. That’s called Low Normal-

Additional Blood Markers that are Important if You Have Iron Anemia

  1. Total Iron
  2. Ferritin
  3. Iron Saturation
  4. TIBC

The next marker you want to look for is the Total Iron.  This measures the amount of iron in the blood.  The average reference range is 45-160 mcg/dL, But I like to see the total Iron levels between 85-130.

The next marker is Ferritin.  Chances are you doctor did not run this test. Yet, This is one of the most important markers that will indicate a need for iron supplementation. It is also the marker that will need to be retested every few months, in order to see when you should stop supplementing with iron pills. If total iron is the amount of iron available in your blood, Ferritin is like your Iron bank account. It’s the reservoir of iron. When this gets low- you are in trouble. That’s why it’s so important. Labs report normal levels anywhere from 10-all the way up to 232 – I like to see ferritin levels around 100.

I have seen Ferritin levels as low as 5 and this again is where you will really be struggling with fatigue, brain fog, shortness of breath, depression, and it might be the reason why your thyroid levels continue to be low- You are feeling like a Zombie when levels get low.

Another marker that is not often run unless your doctor ran a comprehensive iron panel is the Iron Saturation. Iron saturation or percentage saturation, tells us how much serum iron is actually bound to a protein called transferrin.  Transferrin is like a Ferry boat- it take Iron around the body.

If transferrin is like the ferry- iron saturation is like the number of people on the boat. For example, let’s say you are looking at your blood work right now and your iron saturation says 30%

this means that 30% of the iron-binding sites of transferrin are being occupied by iron. So if you are looking at your iron saturation or % saturation and it is less than 30% you are low. I like to see these values from 30 to 35%. The last marker important in understanding Iron deficiency anemia is your

Total iron binding capacity (TIBC).

When iron moves through the blood it is attached to transferrin- TIBC measures how well transferrin can carry iron in the blood. A high TIBC means that the iron stores are low.  The lab reference range is usually between 250-450 mcg/dL. Anything over 350- I start thinking early iron deficiency.

A Few Reminders About Today’s Video

  1. Please remember that when you are dealing with Anemia- it’s not just a matter of taking iron pills- If you take Iron pills and you don’t need them- You can cause a lot of damage to your body.You must Test and monitor every month to every three months- depending on how low your levels are.
  2. While taking iron is a necessity when your iron levels are low, don’t forget about getting to the root cause of the iron deficiency anemia while you take your iron pills.
  3. The root cause of Iron deficiency anemia could be tied into the gut, your diet, certain medication, malabsorption causes by gut problems or a bleeding disorder.
  4. If you need help reading your blood work or just need a second opinion as to why you might have Iron deficiency anemia, I will leave a link in the description that will take you to a page on how you can submit your blood work for my review.


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