IRON DEFICIENCY ANEMIA COMPREHENSIVE GUIDE—Fatigue and Hair loss

welcome back this is Dr Jen sung we're at clinical Excellence meets excellent results today we're going to talk about iron deficiency anemia some of the signs and symptoms what are some of the causes and then in part two we're going to go over the differential Labs that can diagnose you with iron deficiency as well as going over remedies treatment options that are available to improve iron levels for yourself okay so we're going to go right into it let's go into eye deficiency anemia hair loss fatigue Etc right there are a lot of signs and symptoms for iron deficiency anemia so what are some of the reasons why someone who may be iron deficient one is the lack of intake or the lack of absorption of iron so you might be taking in a iron but not absorbing it correctly or you might be lacking the amount of iron that is necessary so number one is malabsorption why would we have malabsorption right some disease process or autoimmune processes will damage our gut lining to the point where it does not absorb nutrients very well iron being one of them so when we look at things like Crohn's disease irritable bowel disease celiac disease or even ulcerative colitis you're going to have malabsorption of nutrients and you can develop iron deficiency anemia because iron is one of those things that's necessary for proper oxygenation right another is antacids so antacid use is very high here in the United States whenever you have a reflux sign or burning they give you an antacid but what patients don't really realize is that antacids should be used short term not long term so sometimes patients come in and they're on antacids for two years three years even 10 years so why is antacids creating malabsorption basically you need stomach acid to break down your Foods right your fats your proteins your carbohydrates if you cannot break down your fats and carbohydrates Etc and the asset that you need is lowered because of antacids then you will not break down the components and not absorb it correctly so you may lack B vitamins you may like lack iron right so antacid will create malabsorption of your nutrients other things there are surgeries right surgeries like gastric bypass or small bowel dissection because of let's say Crohn's disease so definitely surgical procedures can contribute to malabsorption syndromes the other is consumption is low or low consumption what that means is for a lot of children here in the United States they grow up on cow's milk and what happens is rather than eating food as they get a little older right they start to just drink milk right four five six seven bottles a day and they're getting their calorie intake they're getting the vitamin D and calcium but they're not getting their iron right so kids would drink a lot of cow's milk can develop uh iron deficiency now if cow's milk is very different from breast milk where breast milk would provide all the necessary ingredients or nutrition for the child but as they start to wean off and they're on cow's milk for a long period of time they will develop ironing deficiency the other one is vegans and vegetarians and we're going to discuss this in detail next time but basically vegetarians or vegans they're taking in non-heme Iron basically right and it doesn't absorb as well as animal based products such as red meat or even seafood Etc so vegans and vegetarians are notoriously low on iron and b12 and B9 Etc so it's very important for vegetarians and vegans to check their iron levels correctly and then supplement as necessary okay so there's another reason it's loss of iron right we call it hemolysis or hemoralgia basically you are either breaking down your red blood cells too quickly or you're losing your blood somewhere okay here are the causes heavy menstruation so when women get into the age where they're menstruating about 10 of those people will actually develop iron deficiency right because of irregular menstruation heavy menstruation right uh endometriosis is another reason large hemorrhoids or multiple hemorrhoids that cause a lot of bleeding can lead to anemia GI bleeds so GI police can occur due to ulcers right or like things like Paris esophagus where it starts to erode things but um NSAID usage right pain medications aspirins ibuprofens right they can cause damage to their GI aligning if you're using it for long periods of time and then it would have a slow GI bleed that you are unaware of and lose iron right also cancers nosebleeds so people who get frequent nosebleeds for whatever reason will tend to develop some form of iron deficiency another one that people don't really realize is that urinary loss people have blood in their urine they don't realize that right it could be from a bladder infection a small kidney infection so you could lose blood in the urine so you should check your urine to see if there's any blood loss and make sure to rule these things out increased use of iron right so when we have child development as you're growing rapidly you're going to use more iron right because you need to grow so growth and development is a big thing and also when the mother gets pregnant so the mother is providing the baby with the fetus with all those nutrients and basically you're feeding two people and if the mother is not on a proper diet and they're not supplementing at times especially in the third trimester of pregnancy they can be iron deficient another one here is increased Usage Now this could be somewhere else over here but parasites people don't realize that parasites love iron they can also create a little bit of bleeding more ulcers so let's say h chloride helical back to chloride if you have a h pylori infection that's significant enough in your stomach you can create ulcers causing a GI bleed and two H pylori likes iron so you have a double Wham in there right and then if you have GI symptoms as of H pylori because of H chloride because of the ulcer you get reflux Signs Now they might give you an antacid that you might take for a year or two years and then that depletes more iron for malabsorption so all these things can interplay and you can have more than one of these conditions that can create iron loss okay so when we look into different signs and symptoms when we have a patient come in we have a questionnaire we ask questions about how they're feeling right one of the telltale signs is fatigue now fatigue is a general term right it could be due to chronic fatigue syndrome thyroid issues ETC but iron deficiency certainly can create fatigue power right your skin becomes pale and white your nail beds become white if you look under your eyelids inside it becomes White so if you look at the patient's physical appearance you can tell if they're a pallor okay decrease in cognitive function let's say you start studying in about 10 15 minutes into it you become fatigued you can't think as well you can't absorb the material as well the reason that happens is because of lack of blood flow studying takes enormous amount of energy glucose and oxygen to make it happen so cognitive decline if a child is struggling at school and they can't focus right you should actually check for iron deficiency in those children dizziness or lightheadedness right dizziness because just lack of oxygen and lightheadedness because you're not getting of oxygen when you get up too quickly or you bend forward you get up and you feel light-headed right it's oxygenation issues patient may feel cold all the time right they don't look cold and pretty warm outside they can feel cold though right again that can be related to thyroid Etc but when you feel cold and then you have cold hands and feet right first you got to rule out thyroid but you also got to rule out issues with anemia or eye deficiency anemia and then you can also get headaches because of lack of blood flow like things like migraines is a vascular episode right where it creates issues with the headaches so iron deficiency can also create headaches because of lack of oxygenation or blood flow brittle hair and nails poor oxygenation you're not getting the nutrients to where it needs to be and your hair starts to fall out get brittle and your nails become brittle and more advanced cases you're going to get spooning of the nails right so right there spooning of the fingernails canker sores can be a possibility with iron deficiency also or sometimes vitamin D deficient vitamin C deficiencies uh RLS restless leg syndrome so restless leg syndrome is very common with um iron deficiency in other cases it can be neurological um because there are certain parts of the basal ganglion that play a part in breastless leg syndrome increased heart rate your heart will pump harder to get blood flow to the area because of lack of oxygen so the heart constantly pumps trying to get more oxygen to a certain area shortness of breath same thing oxygenation issues right Pica Pica is a condition where a patient might crave um dirt they want to eat dirt right or ice cubes they just want to Crave these weird things because they have a lack of iron chest discomfort all goes with heart rate and shortness of breath and chest discomfort but you can see that there are so many signs and symptoms that can be associated with this right in our office my patients come in we have a a thermometer a surface thermometer where we check the temperature between their forehead their hands and their feet to determine you know what kind of temperature difference is there right now if your forehead is let's say 98 Degrees and your hand is 95 degrees but your foot is 80. you could have a circulation issue you can have reynos you could have a thyroid problem or you can have iron deficiency another way we can check is to check heart rate obviously in the office if someone has a really rapid heart rate cold hands and feet then you can start to say hey maybe this patient has issues with iron right so those are simple ways we can check and you can also get a pulse ox and look at the oxygen saturation right the oxygen saturation should be above uh 98 and in some people it will not be okay so on my next video we are actually going to go talk about the lab tests that are necessary to determine someone determine if someone has iron deficiency and then two how do we Rectify these matters right how what natural therapies can we use what supplements can we use for patients who have iron deficiency and what underlying mechanisms can you correct in order to help with iron deficiency so stay tuned for part two today we're going to talk about iron deficiency anemia last week we spoke about all the signs and symptoms of iron deficiency anemia but today we're going to talk about lab markers how do we distinguish someone who has iron deficiency anemia versus let's say a megaloblastic anemia but today our focus is going to be lab markers for iron deficiency so let's get right into it so the first marker we look at is red blood cell next one is hemoglobin hematocrit MCH MCV MCHC and RDW so what does this all mean right so when we look at this we have red blood cells and red blood cells have a concentration of hemoglobin in them right so hemoglobin is the hemoglobin in the whole blood and then you have hematocrit which is a fraction of blood volume uh that's intact in red blood cells MCH or me copascular hemoglobin is the average number of hemoglobin in a single red blood cell so there's many hemoglobin in the red blood cell okay MCV is MI corpuscular volume mean coppuscular volume means the size of the red blood cell and what that indicates is when it's very small it's iron deficiency if it's very large it's a B12 or B9 anemia right so mean corpuscular volume in size means different things MCHC is many copuscular hemoglobin concentration and that is the average volume with red blood cells and then RDW Red Cell distribution width and that's the abnormal variation in size of the red blood cell so the width is basically from small to large The Wider it is there's an indication that there are a lot of immature red blood cells and mature red blood is also the width of the red blood cells or the uh the variety of red blood cells is very large okay so when we look at these numbers here the numbers in red are indicative of uh lab ranges so if you're outside of the lab ranges it's considered quote-unquote pathologies abnormal right so anything out of these red areas is a clinical concern the ones in the brown over here this is an indication of a male and that's a female and the ranges are different from men to women so when we look at red blood cell men is 4.2 to 4.9 and female is 3.9 to 4.5 so the brown indicates ranges for optimal levels so you can pick up subtle iron deficiency earlier on when you look at the functional ranges in Brown versus the red ranges in the lab so it's a good way of distinguishing or teasing out early iron deficiency when we look at the brown markers okay so iron deficiency anemia and lab testing so these are just a lot of names right but at the end of the day what does it all mean and how do we put it together right so when we look at iron deficiency we just looked at what we call the CBC right a complete blood count we looked at all the different red blood cell markers MCV and all those things that are related to red blood cells there are other markers called iron markers so we also have to look at do we have enough iron serum iron and then this ferritin percentage saturation total iron binding capacity transparent these are all different Iron markers and there's also a percentage transparent saturation number two but when you look at this same thing we're looking at lab ranges and then we're looking at functional ranges and they can be a little bit different from men to women so when we look at serum iron it's the circulating iron bound to transfer ferritin is the storage iron right when a ferritin is very low it indicates iron deficiency if it's high it can indicate an acute phase reactant meaning there's inflammatory processes that are going on and the ferritin number can go high right and then total ion binding capacity is the amount of transparent right the one that binds to the iron itself transparent in itself is the primary extracellular protein that transports iron and is produced through the liver right that's an important fact because liver function is very important to actually iron levels so when we look at iron deficiency the technical term is called microcytic hypochromic anemia right big words basically iron deficiency anemia so what do we see we just mentioned a bunch of different lab tests and what do we see when we have iron deficiency anemia right so you can have a low serum iron you can have low percentage saturation you can have an increase in total iron binding capacity because basically your body is trying to bind more iron so The Binding capacity goes up when we have ion body in the capacity that's elevated we start to think about maybe that could be a GI bleed or issues with iron loss so we can look at reticulocyte count and what we can do is um a reticulocyte count goes up we're looking at maybe a bleed somewhere right a GI bleed or something else so the reticulocyte count is basically immature red blood cells so the numbers keep going up your body keep producing more reticulocytes ferritin will also be low red blood cell will be low hemoglobin will be low hematocrit MCB or mean copuscular volume will be low MCH will be low MCHC will be low increase in Red Cell distribution width and the increase in transparent and a decrease in transparent saturation so these a lot of different numbers right so in my next video we're going to do is try to break it down and to see what is early signs of iron deficiency moderate signs of iron deficiency and severe loss right basically if you have everything here it's pretty Advanced uh iron loss right so iron deficiency anemia so we're going to discuss that in our next video and then after that we're going to discuss how do we improve iron absorption what can we do what can we take or supplement wise to enhance our iron absorption and improve our our iron levels okay my name is Dr Jen sung we're a clinical Excellence meets excellent results and we'll see you guys next week on the healthy side have an awesome day today we're going to go ahead and summarize the different causes of iron deficiency anemia and what lab markers do we look at when we have different stages of deficiency I'd like to thank Dr corazia for this little PowerPoint chart that he provided and let's go into detail about what is going on with dietary intake so causes and stages of iron deficiency one a diet low in iron how can that happen typically with children when they're drinking a lot of cow's milk and they're not eating a lot of food so they're drinking four five six bottles of milk yet they're not eating much of the nutritious Foods right then they can develop our deficiency Eating Disorders obviously there's problems with malnutrition and then countries where they have poor nutrition right growth of tissue this can occur where iron is being utilized in other areas so when you have pregnancy and you're feeding the fetus especially in the third trimester you can develop iron deficiency another is fibroids in women right fibroids will grow with iron and fibroids is one of those main causes for iron deficiency in women obviously things like cancer colon cancer could be a a factor for a deficiency absorption poor iron absorption right how can that happen hypochlorhydria or low stomach acid or The Chronic use of antacids right when you use antacids it's meant to be used for a short period of time but many people are on antacids for years or sometimes decades and then that creates an environment where the stomach acid is too low it does not break down the foods and does not or absorb your nutrients including iron but B12 B9 and other nutrition such as protein right so hypochlorideria is a big problem H chloride or helicobacteri is a GI infection it creates an environment that's more basic and also it creates inflammation so inflammatory processes and then H pylori likes iron leaky gut or celiac disease now celiac disease is an autoimmune condition related to gluten what happens with celiac disease is that it starts to damage the gut lining and then absorption will be altered so you have to look out for celiac disease parasites hookworm pinworms roundworms right these parasitic infections uh can create a an iron deficiency state iron loss versus intake you're taking in enough iron but you're losing more than you actually take it and the way that can happen is with GI bleeds or ulcers right or colon cancer okay or abnormal bleeding somewhere that's not detected so when we looked at the different stages of iron deficiency we looked at stage one so if we look at the different causes this kind of correlates with the severity so from here down we'll create these types of deficiencies and it will get worse as we get down into this chart so stage one could be just low iron intake or growth or tissue issues where they're sucking up iron right so stage one iron deficiency all you might see is a low ferritin which is your storage iron you might have low ferritin but you have normal iron saturation a complete blood count total ion binding capacity and transferring so everything might be normal but you're going to start to see a a low ferritin number okay in stage two it gets more severe so you're gonna have low ferritin low iron and low iron saturation and then you're going to have an increase in total ion binding capacity transparent but you might still see a normal CBC things like red blood cell hemoglobin hematocrit Etc as we get more advanced in stage three as we discussed in the prior video you're going to have low hemoglobin hematocrit red blood cell MCV MCHC MCH and then you might see an increase in Red Cell distribution with a decrease in ferritin decreasing iron decrease in Iron saturation increase in total ion the iron binding capacity and increase in transfer so what I'd like you to do is basically have this or a snapshot of this look at your blood work and see if you have any of these numbers right if you have one of these numbers you might have low uh in the first stages if you have more than one you might have stage two iron deficiency if you have all of them you're in stage three and it will correlate with this chart right in here where you have low intake growth of tissue with fibroids and pregnancy Etc poor absorption and then obviously Frank bleeds for iron loss due to bleeding right this is a great little chart and I like to talk uh thank Dr k for this chart and I would like you to wait for the next video where we're going to talk about the different ways we can improve iron absorption and what types of iron we can take to improve absorption in the gut okay excellent results today we're going to talk about iron deficiency and how do we improve iron absorption iron deficiency is pretty rampant here in the United States and there are many different causes and if you'd like to know about the different causes and symptoms go back to my first video where we discuss a lot of these signs and symptoms of iron deficiency today we're going to discuss how do we improve absorption okay so how do we improve iron deficiency anemia one you have to reduce inflammation right inflammatory markers like CRP cow protectant of the gut or ESR can be evaluated to see if we have inflammation inflammation will cause issues with iron absorption so finding the underlying mechanism for inflammation is very important so that leads to number two is correcting the underlying problems right there are a lot of different causes like I said and if you went back to our other videos you can see the different causes however if you look at it things like heavy menstruation fibroids ulcers autoimmune disease like Celiac Crohn's or ulcerative colitis can all Impact iron deficiency so it doesn't matter how much iron you give these individuals you have to correct or help the underlying mechanisms right if you have celiac disease you can't have gluten if you have Crohn's disease it's an autoimmune disease so you might have to modulate your immune system to dampen the autoimmune process so you have to go after the underlying mechanisms here before you can give a patient a lot of iron so the iron levels can come up right uh one little clinical tip is that fibroids can be helped with things like green tea extracts right vitamin D and Resveratrol so if you have fibroids you might want to use some of these ingredients or products to help with fibroids and improve iron absorption so ulcers are cause due to stress it could be due to h-pylori infections so you gotta correct the underlying mechanism there okay you have to improve your diet right there are a lot of vegans and vegetarians who do it incorrectly and they become iron deficient so taking in fortified iron is very different from taking in proper heme iron from animal products so we recommend some sort of animal protein right heme is better absorbed and it's found in Seafood clams oysters red meat organ Meats especially so having proper levels of iron in food is very important now if we're a vegetarian and you're adding mostly plants grains Etc you're going to have non-heme iron right and then there's also oscillation phytic acid in there and what happens with it oxalates is that it binds to the iron um and it gets excreted out so there is some issues with that now if you take green leafy vegetables which is high in iron and you boil it then you're going to reduce your iron levels so the best thing to do is probably steam your veggies and not boil them you need to take in green leafy veggies dried fruits raisins prunes or apricots pumpkin seeds black beans and there are other things that have iron in them but again if you want the highly absorbable form you need to have some sort of animal protein or you may need to supplement at the end of the day it's not the worst thing you have to supplement some iron right and number five right over here how do we improve absorption right once we get to the underlying mechanisms is the correct inflammation and some of the autoimmune disease processes and so forth how do we improve absorption right one way we can do it is you take a teaspoon of apple cider vinegar and you put it in water and you can drink it before your meal right that improves the acidic environment in your stomach and helps to absorb iron better so apple cider vinegar is one way okay another is taking some extra vitamin C so vitamin C is known to help improve iron absorption right in the form of ascorbic acid and then taking certain forms of iron is better than others right so the typical prescription for iron is iron sulfate and they tend to absorb okay but have more GI symptoms associated with iron intake so we like to recommend a ferrous Biz glycinate chelate right it's a form of iron and it creates less GI upset so less issues with digestive problems or constipation and those types of things so we would like to recommend that liver extract and then hydrochloric acid right hydrochloric acid again is basically improving the acidity of the stomach and helping your digestive process to improve absorption it's not going to just improve iron levels but it may also help protein absorption B12 B9 Etc so nutrient absorption is important oftentimes what you find is companies will make supplements or packets of supplements with these products in them right it helps to absorb nutrients better so if they've done some studies where they've taken um the ferrous by glycinate chelate supplements right and you took it and you compared it to iron sulfate and you can take less of this type of stuff right in here okay then you take iron sulfate so they compare 25 milligrams of the ferrous form right in here Allah against um iron sulfate at 50 milligrams and the 25 milligrams did just as well as 50 milligrams of the typical prescription iron right now there are other forms of iron such as iron aspartate and epicominate that can be utilized also but the one we like to use in our office is this one it seems to work very well gets the iron levels up and then you have cofactors that help improve iron absorption right and that there are many factors for iron deficiency anemia but you have to get to the underlying mechanism and then try to improve absorption of iron okay my name is Dr Jin sung we're a clinical Excellence meets excellent results and we'll see you guys next week on the healthy side have an awesome day

Channel: Dr. Jin W. Sung

Views: 66,347

Keywords: iron anemia, iron deficiency anemia, fe anemia, fatigue, hair loss and anemia, Ulcers and anemia, leaky gut and anemia, iron deficiency lab markers

Id: bjz845GfSy4

Length: 33min 34sec (2014 seconds)

Published: Sat Feb 18 2023