Iron deficiency is a common issue amongst women, with many struggling to understand how to get their iron stores to rise despite taking high dose supplements.

Some will see a rise in their levels, but often struggle with the side effects of the most common iron supplements on the market. The price of replete iron levels doesn’t have to come at the expense of your gut health, and juggling the intricacies of why iron levels often refuse to budge doesn’t have to be rocket science.

I had the pleasure of being interviewed about how I approach this common concern in my clinic, on the Fx Medicine podcast. In this episode I discussed how iron is recycled in the body, factors which can affect absorption, which type of iron supplements to choose, and how to know if you truly need iron supplements, or whether it may cause you more harm than good.

If you would to listen to this episode you can do so here:

Find the original post, along with the transcript and resources here.

The post The intricacies of Iron Deficiency appeared first on Alison Mitchell Naturopath.

New research suggests that dysregulated iron has a role in the formation and progression of endometriosis.

It’s not uncommon for people with endometriosis to have been diagnosed with iron deficiency.

Several years ago, I wouldn’t have blinked an eyelid at the inclusion of an iron supplement in the regime of someone with endo, but given some of the emerging research, I am starting to be concerned.

While the research refers solely to endometriosis, it’s likely that this also relates to adenomysosis.

Here is a TLDR: Endometriosis is the presence of cells from inside the endometrium sitting elsewhere, where they shouldn’t be. This causes inflammation and pain. When the endotriosis cysts bleed in response to the hormones at that time of the month, iron escapes into the area. This iron contributes towards an inflammatory reaction that perpetuates endometriosis. If endometriosis is on the ovaries, where is commonly can be, this can affect the egg maturation and quality. You can have dysregulated iron because of a deficiency of other nutrients that regulate it. It is possible to feel iron deficiency symptoms and to have iron overload in the endometrial cells causing the inflammation.

Photo by ian dooley on Unsplash

Okay phew. If you’re still reading, let’s get a bit more detailed.

In order to understand this, I want to discuss the concept of ferroptosis.

If you remember much from high school biology, the term apoptosis or autophagy may ring some bells – it’s a type of programmed cell death that occurs. Well ferroptosis is similar, but this is a lot more inflammatory, as there can be an accumulation of lipid peroxides, which causes oxidative stress, worsening inflammation. Ferroptosis seems to be associated with a few other inflammatory conditions as well, but because it’s a newish concept, the understanding and research is still growing.

Ferroptosis seems to be worsened by dysregulation of iron in the body. This could look like not having the right co factors for iron to be used properly (copper and retinol)

In people with endometriosis, iron overload in the reproductive tissues, alongside the presence of altered iron homeostasis causes problems. Too much iron in the cells causes increased intracellular oxidative stress via the Fenton reaction, which worsens inflammation. Free iron in endometriosis cysts is significantly higher (100-1000 times) than in other types of benign cysts.

Iron may be high in these cells because of the bleeding of endometrial cysts that occurs in response to hormonal triggers each cycle. But when iron levels are dysregulated because of deficiency of co-factors, this will likely be much worse. Plus, you may also still feel the other symptoms of iron deficiency.

The cells in endometriosis cysts seem to form a resistance to ferroptosis. But unfortunately the granulosa cells (the cells in the ovaries) do not. Ferroptosis in follicular fluid has an association with poorer oocyte quality (egg), which may be part of the reason why fertility is impaired in those with endometriosis.

The research is still growing. It’s possible that modulation of ferroptosis is going to be a new treatment strategy for endometriosis. But for now, we can work on a few things. Reducing inflammation and oxidative stress e.g with ubiquinol and maybe vitamin e. And also making sure we’re not taking iron if deficient without the necessary co-factors.

By the way – head over to the GUIDES section on my instagram page and read through my iron information to help understand more about iron cofactors.

PMID: 37296777

PMID: 19165662

The post Got endometriosis? Approach Iron with care. appeared first on Alison Mitchell Naturopath.

A growing child and baby has a large requirement for iron as their blood volume increases so dramatically as they grow. It can be challenging finding foods that a fussy young one will eat, let alone ones that are a good source of nutrition.

My children have been a wonderful learning experience when it comes to feeding toddlers and children. I have helped many patients over the years to overcome fussy eating, and through my work built up a lot of skills, but when it comes to doing it for yourself that’s a whole different ballgame. 

Many parents are concerned about their children getting the right balance of nutrients, and if they are a fussy eater, then with each mouthful that doesn’t get eaten or gets thrown on the floor/wall/parent, that lays on a whole new type of stress.

Fussy Eating

Behavioural vs. Physiological Causes

For some children, there are physiological and/or behavioural reasons why they are fussy about eating. Physiological reasons can include:

• Nutritional deficiencies affecting their sense of taste (namely zinc)
• Digestive disorders, especially if they experience discomfort during or after eating
• Anxiety
• Behaviour changes related to the autism spectrum
• Pyrolle disorder
• Swallowing difficulties

For the physiological reasons, correcting deficiencies, reducing inflammation and supporting the nervous system with herbs and nutritional supplements can allow the child to feel more comfortable and willing to try new foods. For some children it is behavioural, and for some children it is a combination. When addressing the behavioural causes, I have found that a lot of it comes down to how you as a parent prepare the food and your actions around meal times.

If you do have a fussy eater, it is natural to be a little worried about whether your child is getting enough nutrients. A common worry parents express to me is whether their child is getting enough iron. 

Signs of low iron

Considering most parents are going to be keen to get their child to have a blood test to find out for sure whether they are low in iron, it may be helpful to look for some signs of being low in this mineral.

• Does your child appear to be tired and sleepier than usual?
• Does your child get infections (colds) more than you think they should?
• Does your child appear to be slow in their growth?
• Does the inside of your childs cheeks and eyelids appear pale?
• Does your childs skin appear pale, or have visible dark circles under their eyes?
• Does your child have more temper tantrums than usual?
• Does your child have difficulty concentrating?

How much iron does a child need?

Toddlers (1-3 years old) need 9mg iron daily

Children (4-8 yrs) old need 10mg daily

In the next article I will share some iron rich recipes for toddlers. Below are some tips that I have found have helped me personally with meal times, as well as with my patients.

Tips for reducing fussy eating behaviours

• Make the main meal times a stress free occasion, but with limits. Sit down together to eat (if you’re not eating at the same time then just sit with them) and give them your attention, and while you can chat about the food, don’t try to force them to eat. If you are worried about your child’s weight then it can be very difficult not to try to force food into them, but I believe you need to respect your child’s awareness of whether they are full or not. Having said that, I don’t think meal times should be a game. As a younger child, If Ash was to start to throw the food or play with the food, I would say something like ‘does that mean you’re all done?’ and if he continues to play/throw (I do try to stop his from actually throwing the food before it happens) the food I will then say ‘okay, you’re telling me you’re all done. Let’s clean your hands and you can hop down’. Since early days I have tried to teach Ash to sign ‘all done’ by waving my hands, but it was only after putting it in the context of this that he has started signing it back to me (Lara picked up on signing much more quickly). After a couple of times of doing this, Ash would then tell me if he was done by signing, or if he starts to look like he is losing interest and playing around I say ‘are you all done’  and he will tell me yes he is all done (by signing) or will keep eating.
• Both adults and children can often find new flavours and textures difficult to like. However research has shown that repeated exposure to a food, often in different  preparations is required to really be sure if a child doesn’t like the food. I recommend offering a new food to your child at least 10 different times (some of the research said 15 times was needed) before giving up on it.
• Make the food taste good. Overly boiled vegetables are something very few people enjoy so it’s not surprising children won’t enjoy this either. I try to cook Lara and Ash’s food to how I would like it, and have noticed that he eats the best when it is the same thing that I am also eating. Personally I chose to introduce solids to my kids using the Baby Led Weaning technique which advocates letting them eat the same things that you are eating, and at the same time so that you can model eating behaviours. From this I have slowly moved to giving them their own bowl, and it is usually a slightly modified version of my own food – less salt and no chilli.
• Make the food interesting. I found a crinkle cutter was an excellent addition to my kitchen as it made sliced cucumber, carrot and sweet potato much more appealing. For older kids, presenting the food arranged in the shape of a face or the like could be another version of this theme.
• For older children, having the discussion about how that food will make them feel better e.g. happier stomach, more energy for their sport, better concentration at school; is something not to be dismissed.
• Get older children to pick a vegetable from the grocery shop that they would like to try and help them involved in cooking.
• If you have the space try growing some veggies yourself and get your kids involved in the process. If they pick the veggies and eat it before they get cooked, that’s still a win. 
• An “Eat A Rainbow” chart where children can tick off their coloured vegetables can be another incentive for older kids to eat a broad range of vegetables.

The post Fussy Eating and Low Iron in Children appeared first on Alison Mitchell Naturopath.

Do you have heavy periods? It can be a sign of a deeper imbalance.

Whatever a woman is seeing me for as a naturopath, whether it’s anxiety and stress, tummy issues, weight loss or skin health, I always ask her about what her periods are/were like. That’s because just like the digestive system, the subtle variations of your period and cycle can reveal a lot about your hormonal status and this can have a big effect on overall health.

For instance: Did you know that your balance of progesterone and oestrogen can affect your immune system? And your sleep, your mood, and your digestion? It makes sense when you realise how much your hormones do in your body, that having imbalances in your hormone levels or not ovulating properly (such as in PCOS, amenorrhoea or when using hormonal contraception like the Pill) can have a big flow on effect to the rest of your health.

So if your period is not regular, goes for too long, or is too heavy, clotted or painful, this can be a sign that something is out of balance. Many women don’t realise that their heavy periods are not something they need to ‘put up with’, and that help is available to them. I have seen herbal medicine and nutrition work well with heavy periods, usually causing a big effect within the space of a few months. In some cases, there may be something more complicated going on (such as a clotting disorder, severe endometriosis or fibroids) which can benefit from conventional medicine alongside natural medicine.

What is a normal flow

Anything greater than 80mL of blood lost in a period (which equates to roughly 16 or more soaked pads or tampons) or a period longer than 7-8 days is considered to be a heavy flow. If you are using a menstrual cup, you can use the markings within this to count how much blood you are losing during your period, however if you are using pads and tampons you can count how many you are filling up. Many women with a heavy flow are put off from the idea of using a menstrual cup because they will have to change it during the day, or are worried about leaking, however this can be backed up with liners or absorbent underwear such as those from Modibodi. I have written about this before here.

If you experience any of these signs, you may have a heavy flow:

1. Having to change a pad or tampon every hour or less.
2. Filling 16 or more pads or tampons each period.
3. Leaking while wearing pads/tampons, despite using a high absorbency.
4. Bleeding for more than 7-8 days
5. Regularly passing clots that are larger than a 50c coin.
6. Needing to change your overnight pad once or more during the night, or leaking through onto the bedsheets.

If you need to back up your menstrual cup or tampon with a pad, consider using period absorbing underwear. They are designed with technology that helps to wick moisture and smell, and can be a much more comfortable option for women who dislike wearing pads. They’re also environmentally friendly!

Got Clots?

Why so heavy?

Iron deficiency

Oestrogen dominance

Clotting disorders

Some clotting disorders can cause a women to experience very heavy periods. If your periods are heavy from menarche (when you first got your periods) it is a clue you may have a genetic clotting disorder, for example von Willebrand’s disease. If you have a family history of this condition or you have had heavy periods from a teenager, it’s a good idea to get yourself screened by your doctor for this condition, as specific medication may be required.

Fibroids

Schematic drawing of various types of uterine fibroids: a=subserosal fibroids, b=intramural fibroids, c=submucosal fibroid, d=pedunculated submucosal fibroid, e=fibroid in statu nascendi, f=fibroid of the broad ligament

Fibroids are a non cancerous growth within or attached to the outside of the uterus that can range in size anywhere from the size of a pea to the size of a melon.
They are not fully understood but often will respond to hormonal treatment that reduces oestrogen excess, along with herbs that target the excess tissue growth.
Depending on the size and location of the fibroids they may need to be surgically removed, for instance if they are in a position that blocks the cervix affecting fertility. A lot of the time fibroids will not cause any significant problems and may not need treatment.

Menopause

All women experience menopause differently, and for some they may find that their periods become very heavy in the early stages of menopause. This may respond to uterine astringent herbs in addition to herbs to support the menopausal transition (commonly this may be herbs to help with stress and oestrogen balance).

What to do about it

Address the cause

It’s always a good idea to rule out serious issues first, so see your doctor for a pap smear, and potentially further testing such as an ultrasound and a blood test that can look for clotting issues, iron deficiency or other causes of heavy bleeding. Having identified the cause, you can begin to fix the problem with natural, and/or conventional medicine.

For some people the bleeding is SO heavy that an endometrial ablation may be necessary. This is when the lining of the uterus is destroyed and removed, so that a the periods are much lighter or absent. This is not ideal if you are wishing to have children, have had a caesarean section, or cancer of the uterus, cervix or endometrium.

Herbal medicine

CC BY-SA 2.5, Link

If you want to reduce your heavy periods without surgery or going on the pill, you can consider using herbal medicine. It’s best if you can see a herbalist or naturopath who can guide you through the process of addressing the cause of the heavy bleeding and can make a herbal formula specific to you. There are herbs that can help heavy periods such as Shepherd’s Purse, Beth Root, Tienchi Ginseng and Squaw Vine, can be helpful to reduce the heaviness of the bleed.

How long will treatment take

I find that heavy periods will typically respond to herbal medicine within the first cycle with a slight reduction of flow, however it may take a few months to achieve a more “normal” flow. This may be longer if the bleeding is caused by a condition such as endometriosis or fibroids.

The post Heavy Periods appeared first on Alison Mitchell Naturopath.