Why is everyone so tired?
Many, many, many of the patients we see are tired. It's not always the main reason they see us, but we always ask our patients about their energy and it is quite rare for someone to say "just great thanks! 10/10!" (oh how I love those rare birds!)
There are a MULTITUDE of reasons why someone can be tired. Over the next few months, I'm going to do a series of blog posts outlining the most common reasons I see in my practice.
I decided to start with one of the first things I look for in tired patients - an iron deficiency.
Iron is one of the most essential nutrients we consume, but it’s also one of the most likely nutrients for us to be deficient in - so it's really important to address it. Iron sits inside our hemoglobin proteins in our red blood cells and helps carry oxygen molecules from our lungs to every other cell in the body, so we can make energy and complete all the other functions of our cells (eg helping the heart to pump, the muscles to contract, the brain to think, and the immune system to attack bugs).
Those most likely to be deficient are women (because of the loss of iron during menstrual cycles or from giving birth and breastfeeding), children, people who don’t eat meat, or those with a chronic digestive disease causing poor absorption.
What happens when we don't get enough iron?
Anemia i.e. the body can't make enough red blood cells to carry oxygen to all other cells
Fatigue / tiredness
Hair loss and weak nails
Weird non-food cravings e.g. chewing on ice chips or indigestible items (often seen in kids)
Heavy periods (which then leads to further iron deficiency, starting a downward spiral)
Poor thyroid function – you need iron to make the thyroid hormone, and thyroid hormone to absorb iron. Another nasty cycle!
Are you yawning all the time because your body is trying to get more oxygen to its cells?
Frequent questions I get from patients . . .
Why do I have all of these symptoms but my doctor tells me my “iron is fine”?
There are 2 common reasons for this:
1) Some medical doctors test only your red blood cells and hemoglobin, and as long as they’re normal (no anemia), they assume your iron is normal too. Newer standards of care dictate that measuring ferritin (iron storage protein) is a more sensitive way of assessing iron deficiency before it progresses to anemia.
2) Many medical doctors just check the standard reference range for ferritin, which is quite broad (eg 12 - 300 ug/L). Often they report iron levels as ‘fine’ when patients are in the low end of the normal range (eg. 13 ug/L) and headed towards anemia, but aren’t in the critical range - yet. Optimizing ferritin levels can prevent anemia, restore energy, and improve many other functions in the body. We take a thorough look at your blood work to make sure we're seeing the whole picture and treating proactively.
Those iron pills make me feel AWFUL!
Some of the older iron supplements that are generally prescribed and sold at pharmacies cause such bad constipation and nausea that many patients refuse to take them. Thankfully, newer formulas have been developed that are much more absorbable, making them more effective with fewer side effects. We use these formulas only and have had great results.
Can I just eat more red meat?
Good food sources of iron include meat, sunflower and pumpkin seeds, molasses, some nuts, dates, and some green veggies (beet greens, chard, parsley). Animal sources of iron are absorbed 10X better than plant sources, because the iron is already in a “heme” molecule and ready to get built into hemoglobin. This is why eating a vegetarian diet (while healthy for many people) can lead to an iron deficiency. It’s also why kids are at higher risk of iron deficiency – they are often very picky eaters who somehow survive on cheesy noodles!
Cooking in a cast iron pan is another way to get iron in your diet!
If you’re already iron deficient, or have sub-optimal iron, it’s very hard to raise your levels by just increasing your intake. This is particularly true for menstruating women, breastfeeding moms, people with thyroid conditions, or people with poor digestive function, because they either keep losing the iron they eat or they’re not absorbing it in the first place.
Should everyone take iron just in case?
Definitely NOT. An excess of iron in the body creates more inflammation and can damage organs, increasing the risk of heart disease and cancer. It is not wise to take an iron supplement (or a multivitamin containing iron) unless you’ve been advised to do so by a medical or naturopathic doctor. Like many things in the body, it’s all about balance!