These days it seems like patients can almost be divided into two groups: those that have a tendency to iron overload and those that struggle most of their lives just to keep ferritin in the red…and what a struggle it can be. So many clients have spent years taking every form of iron there is in high doses, trying to improve their intake of dietary sources, working on their digestion etc etc but still those numbers can fail to really pick up.

First things first does the iron deficiency have a simple explanation? Lots of female patients in particular, tend to have very low iron diets, many without a real understanding about which food sources are really iron rich and how often they need to eat these to compensate for their monthly losses. “Do you eat meat?”… is often answered in the affirmative but turns out that means some chicken, ham in sandwiches and red meat once a month when they’re eating out. What about menstrual losses? Make sure you get an objective measure, as women often find it very difficult to judge whether their flow is ‘normal’ or otherwise….(compared to whom??).

Secondly make sure you’ve ruled out the list of usual suspects:

• Undiagnosed coeliac disease or other form of malabsorption

• Unchecked faecal losses e.g. parasitic infections, colon cancer, severe haemorrhoids

• Unchecked menorrhagia e.g. fibroids, peri-menopausal flooding

• Medication induced iron deficiency e.g. PPIs

• Copper deficiency

For those patients still on the iron deficiency merry-go-round, perhaps we should be rehashing a bit of old food knowledge. We’ve known for a long time that cooking in cast iron pots leads to significantly higher iron content of the meal due to leaching of iron from the cookware. A fabulous initiative in Cambodia that uses this knowledge but makes it more accessible to everyone is called the Lucky Iron Fish a therapeutic chunk of cast iron in the shape of a very cute fish that can be used in your dishes whenever you cook is improving iron nutriture! Cheaper than supplements, with good evidence of compliance and efficacy for increasing dietary iron content…maybe this sort of passive nutritional approach could be another aspect to our multi-pronged treatment for our iron deficiency patients here… Check out this link to the fabulous story of the Lucky Iron Fish  it really made me smile 🙂

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