Iron Out Your Energy: Tackling Iron Deficiency in Perimenopause

Sarah McLachlan: 0:03

Hey there, I'm Sarah McLachlan. Thanks for joining me on the Chaos to Calm podcast, a podcast designed for women over 40 who think that changing hormones might be messing with their mood, metabolism, and energy and want to change that in a healthy, sustainable, and permanent way. Each episode will explore topics related to health and wellness for women in their 40s, like what the heck is happening to your hormones, what to do about it with nutrition, lifestyle, and stress management, and inspiring conversations with guests sharing their insights and tips on how to live your best life in your 40s and beyond. So, if you feel like you're in the midst of a hormonal storm and don't want perimenopause to be horrific, then join me on Chaos to Calm as I share with you how to make it to menopause without it wrecking your relationships and life. Hello, and welcome back to the Chaos to Calm podcast, where we talk all things perimenopause to make your journey through menopause as smooth as possible. This is episode number 34. You're with me, Sarah, The Perimenopause Naturopath, and today we will talk about the black cloud on even the sunniest days.

Sarah McLachlan: 1:28

It's one of the most common nutrient deficiencies that I deal with at Perimenopause Naturopath HQ. It is iron deficiency, right? It's that thing keeping you exhausted, impatient, angry, unfocused, overwhelmed, with no mojo, no motivation, and a massive contributor to heavy bleeding. So, for many women I talk to and work with, it's a problem they either can't get rid of or may not know they have. And you know, I've seen some incredibly low iron stores in clients, and I am amazed at how they pick themselves up and keep going. And I think a lot of that is because we are told, oh, that's normal, you're tired, you're a mum, you're a busy mum, you're working mum, you're going through perimenopause, you're getting older all those things that we hear which aren't helpful and dismiss that there is actually a problem underneath. So, as I said, iron is the most prescribed supplement here at the perimenopause naturopath. We don't prescribe much, but we do prescribe a lot of iron. So it is a problem. It's actually a really big problem. World Health Organization lists iron deficiency as a major problem worldwide, especially in developed countries. It shouldn't be because we have enough food available, but it actually is. So it tells us this: maybe not all about the food.

Sarah McLachlan: 2:59

So I'll introduce you to Carly. She was a client of mine. She was a busy working mum in her 40s, like you, like lots of women I talk with, and yeah, she came to me feeling exhausted, like totally wiped out all the time, and she'd just been told, eh, you know, you're a mum, you work too, that's normal. But she did have a lot of flags for iron deficiency. So she struggled with heavy clotty periods and extremely exhausted brain fog. Her meals often were just kids' leftovers. A big flag for her was she'd recently been diagnosed as a celiac. So she knew she had some gut health issues needing support and resolution. And one of the ways that they'll often diagnose celiac or get a flag that celiac is happening is low iron and iron stores.

Sarah McLachlan: 3:50

So you know, Carly did know she was iron deficient like lots of you are, but she couldn't get rid of it. You know, she was just the symptoms of heavy bleeding, fatigue, muscle weakness, mental fog, and no motivation. They're the symptoms she was dealing with. They're the common symptoms; yes, there can be multiple reasons. That's why it's super important to dive and understand whether iron deficiency contributes to your feelings or if it is something else.

Sarah McLachlan: 4:22

Because you know, like for Carly, she tried so many different things, like diet changes, exercise, all of the stuff. Everything persisted for her. She did eat well when she made meals for herself. She was really conscious of eating iron-rich foods and all of that sort of thing, but she was really caught in a loop of iron deficiency. She'd done heaps of supplements, got lots of constipation, tried lower dose ones, tried infusions. They made her feel really sick, so it wasn't something she wanted to keep doing, but mostly, she saw a little change, and it's because her underlying symptoms, or the underlying driver of why she was feeling that way, weren't being addressed. So when we worked together, yep, fast forward a few months, she was feeling a lot better. We increased her ferritin levels by four times 400% in just a few months. So ferritin is your iron storage protein there which meant that period, and we're not so heavy or draining anymore there as well.

Sarah McLachlan: 5:23

So iron deficiency can be something that creeps up on you, and you don't realize just how tired and worn out you are until you really stop and think about it or someone draws attention to it, and then no. For Carly, that was the case. She knew she was tired. She didn't realize how tired she was, though, and how it was impacting her, until we got her levels back up again, and she could see what she'd been putting up with as normal was really abnormal, so her story is certainly not unique, as I've said.

Sarah McLachlan: 5:54

So, let's explore the risks or the symptoms of iron deficiency. So what puts you at risk of iron deficiency, what the symptoms are, and why it can be a bit prevalent in perimenopause. So I think it's again I want you to know what your risk factors are, and I also. When we're talking about what you can do about it, we're gonna, of course, dive into how we resolve the underlying issue. That's what we wanna do for that long-term change in your health, and that benefit there. So, for iron deficiency, who's at risk? Well, there are lots of risk factors, and the most common one that women see and that I see in my clients is pregnancy. Yes, probably lots of us are past that, but I've helped plenty of women who have just recently had a baby and are now, in perimenopause. It can start in your mid- 30s, so it's not like pregnancy was that long ago for many of you, and it can take about 12 months to replenish your stores after pregnancy. If you've had a hemorrhage or some other complication, or if you're not getting enough iron then, or maybe you've had pregnancies close together, that'll put you more at risk of low iron and low stores.

Sarah McLachlan: 7:09

Low ferritin, so heavy periods. This is something that's really common in the early phases of perimenopause, and unfortunately, it's the one time that our body is not the well-oiled and wonderful machine that I always rave about. When you are low in iron, when you're low in your iron stores in ferritin, you will actually have heavier periods. I know when you need that iron the most, you actually lose more, and then you know it becomes a vicious cycle. Low iron, heavy bleeding. Heavy bleeding lowers your iron further, and it can be really difficult to keep up your iron supplementing- wise. If that's the case, you really need to address that heavy bleeding. We'll talk some more about that in a minute.

Sarah McLachlan: 7:57

Vegetarian, vegan diets, you know. So not taking enough in that can be a problem. High- stress levels: why high stress? Is this just a ploy for me to get this in conversation so early in the episode? Well, no, it's not a ploy, but you know stress really alters our digestive function and the fire in your guts, so it impacts how much you can get out of the food that you're eating and how much you absorb. The same goes with celiacs, especially if you're undiagnosed or if you're not avoiding gluten Non-celiac gluten sensitivity. Those peeps will also be at risk because of the inflammation in your gut and reduced function there.

Sarah McLachlan: 8:40

Going on restrictive diets frequently and skipping out on iron-rich foods or not eating enough will impact your iron stores and other gut health issues. You know, if you've got an imbalance in your microbiome, maybe you've got a parasite or back you know, some other dysbiosis or bacterial overgrowth or intestinal blood loss. So you always have a look when you wipe and when you go, and if it's like bright red blood, well, probably hemorrhoids, sister, or a tear or something like that. If it's darker blood, please do follow. You know, either way, follow it up with your primary care doctor, that's. You need to get it looked at. If it is dark blood, though, please. It's really important.

Sarah McLachlan: 9:26

So, lots of factors that women have in their 40s as well, and a thyroid condition, hypothyroidism, will put you at risk of low iron because of the way it impacts your digestive system and your iron metabolism. So, I just want to touch on why iron is so important because it does a lot in our bodies. It's involved in our energy production, our thinking, our focus, and our concentration. It's part of that because it's involved in neurotransmitter production, those brain chemicals that make us particularly dopamine, that give us our mojo and motivation, get us up and going and doing the things that we need to do. And also, dopamine is our feel- good or pleasure hormone neurotransmitter. So it's also, if we're, you know, you can see why you might have a low mood if you're low in that transmitter and you're low in iron, making you have low levels of dopamine.

Sarah McLachlan: 10:23

Iron is really important for your immune function, inflammatory processes, and thyroid hormone levels, as I said. So that's just some of the things that it does, and so totally not a surprise then is it that there are lots of different symptoms of iron deficiency. You know, you might be thinking about lethargy, or you know, fatigue and exhaustion, getting short of breath really quickly when you say climb the stairs or go for a little walk, yeah, that commonplace that reduced stamina, hard to recover from exercise as well maybe feel some muscle fatigue and heaviness. Restless legs are a big giveaway, but it can be other things as well: low mood, and there's a talked about depression, and poor digestion. It can be slowed, and it feels like food sits like a brick in your chest and you struggle to digest. Things like hair loss, falling sick more frequently, and then not being able to get rid of it. So a lingering infection, if you like, just have to eat ice, that compulsive eating and crunching of ice. That can be a sign of iron deficiency. It's called pica Sores around your mouth or a red sore tongue, pale skin color if you're not normally that pale or pale tongue, and inside your eyelids. So spooning or flattening your fingernails and some markings on them, like the lines on them. It can be not diagnostic but is an indication that you might need some more iron and dizziness there as well. So, okay, there are lots of different signs and symptoms. Maybe some of those are there for you, but I just want to touch on how you know because some of those things could be related to other nutrients or other dysfunction in your body.

Sarah McLachlan: 12:21

So, let's talk about iron deficiency diagnosis. How do you get it? Well, first of all, I'm going to just grab out my soap box, and I am going to have a little rant about the lab ranges. So if you have a blood test to test if you're iron deficient, well, those lab ranges are pretty cruddy. They are going to. They're so low that you'd be feeling rubbish well before you get outside the normal range. So you could be symptomatic for weeks or months with iron deficiency symptoms and still be normal or fine, you're fine, and you're feeling rubbish still. So my blood test decoder has the optimal ranges for your red blood cells and your full blood count, your B vitamins and your iron studies, and they're the blood tests that I want you to get done. But I also want you to use those optimal ranges because that's what we should be aiming for, and that's what we deserve, which is actually to be in our optimal state of health, not just an 'Oh well, you're fine'. Like you know, you're not. There's not a disease or disorder going on right at this moment, but yeah, you're probably feeling really rubbish in between them.

Sarah McLachlan: 13:44

So full blood count and iron studies, including ferritin and a decrease in ferritin will often come before other signs of deficiency. That's why I love testing it because we get to see it before. The other markers in your blood might show that your iron stores are getting low. B vitamins like B9 and B12 are important, too, because they can contribute to anemia. It might not just be iron; it could be your B vitamins and your inflammatory markers, too, because we know that inflammation can make your iron levels look high when they're actually not really because your body will try and hide iron away from bacteria or something else. In the case of inflammation, it tucks more iron from your blood into ferritin and hides it away so that those bacteria or microbes can't use the iron to replicate Our bodies. They are really clever, they're really awesome. Like I said, we just got that little blip with the heavy bleeding, but otherwise, you know, they're amazing.

Sarah McLachlan: 14:44

So, for some cases, they might want to look at other blood, like your zinc and copper, which influence your iron metabolism as well. But you know, at a baseline, that's what you'd be looking for. Your doctor may or may not want to do those, depending on your history, but you can always get them done via a naturopath or a nutritionist like myself. They won't be bulk-billed, but you can always pay for them, and they're not too expensive. Especially when we use them from a functional perspective, as we do, we get a broader idea of what else is happening in your body there as well, and they allow us to make inferences or really good estimates of what's happening in the other systems of your body. So go download the blood test decoder, grab out your past blood test results, or go see a GP and get your annual test done. Compare them and let me know where you sit.

Sarah McLachlan: 15:36

I want to know what your iron levels are. Are you deficient? If you're not deficient in that, I bet you're deficient in vitamin D. There's a whole other podcast, right? So now we know why you might be iron deficient, what your symptoms are, and what your risk factors are.

Sarah McLachlan: 15:55

How are we going to change it? Well, first of all, we're not going to just take a chemist supplement like Ferrograd or Multifer. Why? Because they don't work for most people and all they'll do is give you constipation, and that's why, a lot of the time, you might stay deficient, because you stop taking it, because it gives you bloating, constipation, black stools and you just feel really rubbish, and that's because the iron is not being absorbed from your intestines into your bloodstream. There are a couple of reasons at play: it's the form of the nutrient that isn't great for the body and isn't well absorbed, and also the dose is too high, and your body very tightly regulates your iron metabolism, except in the heavy bleeding scenario. But anyway, iron running wild in your digestive system will cause damage and inflammation, not what you want, not what your body wants there as well, and unfortunately, it slows down the getting rid of it because it gives you constipation and bloating.

Sarah McLachlan: 16:59

Alright, so let's talk about what will help instead. I want you to. Well, I'm gonna assume you're gonna go to a naturopath or a nutritionist, and you're gonna talk to them about an effective iron supplement that won't constipate you. Maybe your health food shop has a naturopath on the floor that you can talk with there if you want. Some chemists do as well, and they have some nice practitioner strength or therapeutic strength products. Or I should say, in the case of iron, they'll have some lower dose ones in a much better form that you will absorb more iron from them. So then you're going to take your supplement every second day, and you're gonna take it at bedtime. And also, I just want to add here, please, I'm not giving you personalized health information. I'm not giving you a prescription. You need to work with a naturopath, nutritionist, or your GP to sort out what is right for you. This is just general advice.

Sarah McLachlan: 17:58

So, yeah, so there's a gatekeeper in our body, in our intestines, that prevents too much iron from entering our system. This is why we get constipated and bloated with those really big doses. So when you take an iron supplement, that gatekeeper it's called Hepsidon, is increased for 24 to 48 hours, even if your body is desperate and starving for iron. So it takes 48 hours for that to come back down. So if you take a dose every day, you're just going to keep that gate shut, and it's going to sit in your intestines and bother you. If the dose is too big, if it's over 48 milligrams of equivalent iron, it's going to shut the gate, and it's going to stay in your gut and irritate you. So, a small dose every second night is what I tell my clients. Okay, so we need to support your gut health.

Sarah McLachlan: 18:46

I did talk about that. You know, it's not just about how much you consume, and I think Carly's story and many women's stories there as well, where they're taking supplements or having infusions and all that sort of thing, and it's not sticking, it's not building their ferritin stores or their levels, and we know it's. Something else is going on, and we know, you know, you hear me talk about it all the time, we need to address the underlying causes or drivers of those symptoms for long- term resolution. So, gut health, we know it's not just how much you take, it's how much, how much you can break down and absorb and utilize, and that magic all happens in your gut. So you need good acid levels in your stomach and robust enzyme levels in your intestines, and of course, you need to eat enough of it to build your levels there as well, or regularly enough.

Sarah McLachlan: 19:39

Now I want you to be careful with coffee, and because you know, maybe you heard that you shouldn't have lots of tea around your iron supplements or iron- rich meals, because it binds the iron and makes it unavailable to your body. But also coffee does similar. It's been shown to inhibit iron absorption by up to 90%. So the important thing is that when coffee or tea is drunk around your meal or your iron supplement, you are not going to absorb it. So what you want to do is have your food and then have your coffee or tea at least 60 minutes after your iron supplement or meal, and it doesn't. Do not have it an hour before your meal. Don't work the system that way, because that is going to increase your cortisol levels and adrenaline and leave you more stressed, hungry, and shaky for the day, especially at 3 pm. It's also going to influence your gut, irritate your gut, and reduce your gut function. So it's going to work against you. Please don't. Coffee, you know, after food in the morning is much nicer for your body than that harsh jolt that first up. Okay.

Sarah McLachlan: 20:53

So yeah, there's no point in having an amazing diet if you're not able to break down the food and get the nutrients out of that food and absorb it into yourself. A lso, there are lots of factors, cofactors, vitamins, minerals. They need to be at good levels for iron absorption, assimilation, and use. So you know those strategies are essential for maintaining your energy, your overall health, and your iron levels. But, as I said, you do need to address the common underlying factors, like the estrogen highs that can come with perimenopause.

Sarah McLachlan: 21:29

T hyroid dysfunction, hypothyroidism, and Hashimoto's can significantly impact your iron levels, and there may be other causes like heavy bleeding. And so finding out what is contributing to that heavy bleeding besides your low iron stores, which you could argue are just a symptom of that, what else is contributing to what's going on there, and that's why, you know, it's one thing to do your basics on your own, but working with a professional who has experience and can see it out on the outside looking can make it so much more efficient. And if you're already feeling foggy and lethargic from low iron, it's really difficult to think through all the information that you may find on the internet. So, yeah, do check in with someone who is passionate about helping you find the underlying cause or driver of what is happening to you. So, my friends, that is all for today. Thank you so much for joining me as we talk through iron deficiency in perimenopause, and I hope that those tips are useful for you. Don't forget to check out my blood test decoder guide and also the Chaos to Calm masterclass. Both of those are free. They'll give you more insights on blood testing, my thoughts on it, why I love doing it for my clients, and why you should love doing it too, and the optimal ranges for your best state of health. So, thank you so much for joining me.

Sarah McLachlan: 23:01

Next time, we will be debunking common myths about life in perimenopause after 40. I hope you'll join me for that. I look forward to doing some myth- busting. I love it. In the meantime, have a wonderful week. Thank you again for joining me, and I hope that you can find your calm in the chaos of perimenopause. It's really common for women over 40 to experience the chaos of changing hormones, mood, metabolism, and energy, but I hope you know now that it doesn't have to be normal for you or them. You can help others understand they aren't alone in feeling this way, and that perimenopause doesn't have to be horrific by subscribing, leaving a review, and sharing this podcast with other women in their 40s and beyond. Thanks so much for listening and sharing your time with me today in this chaos to calm conversation.