Anemia of Chronic Disease and Iron Overload

What’s the deal with iron overload (low blood iron and high blood ferritin) in the low-carb and global carnivore community? More and more influencers or nutrition famous figures are finding themselves dealing with iron issues.

It’s a bit strange to see low blood iron levels, considering that this is a diet rich in red meat and sometimes even organs. So what’s the explanation for this mysterious phenomenon and what’s the relation to diabetes?

When the body is dealing with active inflammation (infection, virus, stress, malnutrition, chronic disease) the body consciously reduces the iron available in the blood and transfers a significant portion of it to storage. In uncontrolled Type 1 diabetes or uncontrolled Type 2 diabetes, stress will often be interpreted as inflammation by the body. Therefore, it is not a coincidence that diabetics are subject to more iron problems and in particular to the development of anemia of chronic disease (ACD). Excess iron is directly related to inflammation.

Anemia and Excessive Iron

What is anemia? Anemia is a condition that develops when the blood has a lower than normal number of healthy red blood cells that carry iron-containing hemoglobin. Iron is one of the most important building blocks in the body, without iron there is no life. When the number of healthy red blood cells is low, the body does not receive enough oxygen-rich blood. This lack of oxygen can lead to a variety of physical symptoms such as: fatigue, weakness, brain fog, constipation, hair loss and decreased hormonal function.

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Excess Iron and Your Evolutionary Roots

I argue that if someone is dealing with excess iron on a low-carb diet or a ketogenic/carnivorous diet, it means that this diet is not suitable for that person and I will explain. Take Dr. Paul Saladino for example. If you have followed Paul Saladino’s story in recent years, you would have seen that he dealt with a condition that he shared with his followers – excess iron. How did Paul Saladino end up with excess iron?

Imagine my ancestors, or Paul Saladino’s ancestors, near the Mediterranean coasts in Europe, thousands of years ago, even tens and hundreds of thousands of years ago. Chances are they based their meals on large cattle and never had herds of buffalo or cows of any kind. They likely relied primarily on fish, chicken, eggs or raw milk.

Now what happens when you take a person, it doesn’t matter if it’s Dr. Paul Saladino, Tomer Pappe or maybe a Japanese man or woman living on the island of Okinawa and put them on a carnivore diet based mostly on beef? That person will experience all sorts of diverse health problems and in our case, we’re talking about iron problems. In our body, the balance of iron absorption and iron use, is maintained by delicate regulation. The body knows exactly when and why it wants to use iron or not use iron and when to move iron into storage. Iron is the basis for all life. Excess iron means that the body stores a greater amount than the amount the body needs to maintain proper daily function.

Excess Iron In the Blood – Easy to Store but Difficult to Get Rid of

The body stores its iron as ferritin (a protein solely in charge for storages of iron). The body knows how to store iron quickly, but it is very difficult for the body to get rid of excess iron. You could say that the body puts the iron into boxes (ferritin) very quickly, but most of the time the body will not take the iron out of the boxes for a long time, sometimes even years and decades. The fastest way to get rid of excess iron is by phlebotomy (bloodletting from a vein, a medical procedure), as we saw in the example of Dr. Paul Saladino, who experimented with phlebotomy. There are other ways, such as consuming a lot of raw dairy products or intense exercise, but they will be slower than phlebotomy.

Your Ancestors’ Diet Will Determine Your Iron Balance

Let’s take for example Dr. Paul Saladino, who is also a colleague of other influencers who have been guests on my podcast and other carnivore or ketogenic doctors. Saladino calls his diet “Animal Based”- a diet that is based on animal products and rich in organs, meat, fruits, honey and unpasteurized dairy products (Raw milk). I think it’s not a bad diet, but, and I want to emphasize: as we saw in the case of Dr. Paul Saladino and as I have seen with patients and colleagues – We need to put the evolutionary context in place. It doesn’t make sense to take a legacy of hundreds of thousands of years of basing 90% of the diet on chicken, fish, milk and some eggs, and switch radically to a carnivore diet based 100% on beef. Sounds extreme, right? Even if that carnivore diet is based only on high-quality beef with no processed additives.

Such decisions contradict the ancestral/evolutionary root of your own people. That ancestral-evolutionary root actually defines and codes your DNA and everything that is happening in your body right now. Your ancestral/evolutionary root will determine whether your body will absorb more iron or less iron, whether you will be able to handle dairy products or not, whether your body is able to handle a lot of grains or less grains – the level of tolerance of the body to any substance that enters it.

Now don’t get me wrong, this diet of Dr. Paul Saladino is still a natural diet based on real products, not processed food, and this is what I have been advocating for almost 8 years or more, with additional and important attention to the amount of daily carbohydrates I consume. Today I can say with confidence and now also in writing –

I will never go back to processed food, no matter what diet I choose, or how I might change my eating habits down the road.

What is certain is that iron overload is a common phenomenon, that only increases among those who follow the carnivore diet, a low-carb diet or any diet based mainly on animal products. The evolutionary context will determine the way the body will use iron and to a large extent, the way your body utilizes iron is also affected by inflammation and stress. So, we understood that many people today end up with iron overload. The body store iron into ferritin, because it does not want the pathogen (the maker of the disease) to receive free iron as fuel (that will enhance the pathogen’s activity).

Inflammation, Iron Overload, and Iron in Blood Tests

Any inflammation can cause the body to push iron into storage, it can be a strong fever, it can be malnutrition, and it can be exposure to toxins of any kind from food, cosmetics, environment or radiation. Therefore, we need to be really careful with iron and when we check our iron levels in blood, it is recommended to check a full iron panel- Iron, Ferritin, Saturation and Transferrin. You can start with these values ​​and then to seek a doctor who will look at your iron panel results with sensitively, and not by a quick look at available iron, which only tells a small part of the story.

Understanding why the Body Stored Iron in the First Place is Key

In situations of iron overload, we need to look at the whole picture and understand exactly what caused the body to store iron in the first place. That way we will know the root cause of the iron overload. Only after we know what was the root cause, will we arrive at the solution – for some people the solution will be phlebotomy, for some people the solution might be only changing the element in their life that caused the body to store iron, and for some people the solution will be a combination of treatment and changing their environmental. On that note, I would love to hear your experience with iron overload – a multi-factorial condition that each and every one might deal with slightly differently. Tell me on Instagram, Facebook or through the contact form down here in the contact form on my website.

The Biology of Anemia of Chronic Disease

Anemia of Chronic Disease (ACD), also known as anemia of inflammation, is actually a natural and genius defense mechanism that the body uses. Anemia of chronic disease is sometimes one of the consequences of a life-threatening illness. All living things, including bacteria and cancer cells, depend on iron to sustain life – just like humans and plants.

Low Hemoglobin and Anemia of Chronic Disease

We have already understood that when the body senses a potential threat, iron is transferred to ferritin. The body leaves only a small amount of iron available for the purpose of making red blood cells, with no excess iron to feed the harmful pathogens. A person dealing with anemia of chronic disease will see a moderate decrease in hemoglobin levels. This is an ongoing process, and hemoglobin values ​​will usually reach the low range and remain in the low-medium range until the problem is eventually resolved. If there is a disease that causes blood loss, that person will develop Iron Deficiency Anemia (IDA). ACD and IDA can be differentiated by a ferritin blood test. Taking iron supplements for anemia of chronic disease can be harmful and even fatal – it is important to accurately diagnose anemia of chronic disease.

Dr. Eugene Weinberg – Pioneer in Understanding Iron Balance in the Body

The exact mechanism of anemia of chronic disease is not fully understood by modern medicine. Dr. Eugene Weinberg, was a professor of microbiology at Indiana University and a member of the Medical and Scientific Advisory Board of the Iron Disorders Institute, a true expert on anemia of chronic disease. Dr. Eugene Weinberg has also written an excellent book on understanding iron problems in the body. Since the mid-1950s, Weinberg has studied in depth the changes that the body makes in iron metabolism during illness. As early as the 1980s, he first defined the body’s defense system that prevents available iron from threats and described how the human body treats iron as a potential health hazard. Iron is one metal that cannot be excreted by the body effectively, so extra precautions are taken by the human body to avoid over-absorption of iron. When a harmful bacterium invades the body, the immune system and white blood cells rush to the site of invasion to destroy the pathogen before it can reproduce. Inflammation develops as part of this natural immune response, and that inflammation then triggers the release of chemicals that signal the iron-regulating mechanism to go into defense mode.

Most doctors recognize a slight decrease in hemoglobin during the protective state of the iron regulatory mechanism. However, what most doctors miss, according to Dr. Eugene Weinberg, is that less iron is absorbed and free iron is collected by macrophages and stored in liver cells (hepatocytes). As a result, levels of ferritin in the blood increase. Hemoglobin values ​​may remain in a slightly low range, but levels can drop to values ​​that are too low. Hemoglobin levels depend on the severity of the inflammation and the duration of the current inflammation. Other tests such as C-Reactive Protein (CRP) can be performed to help differentiate between iron deficiency anemia – in which iron overload is one of the factors in its development – and anemia of chronic disease – in which iron supplementation is not recommended.

Diagnosing Anemia of Chronic Disease According to Dr. Eugene Weinberg

In adults, anemia of chronic disease is often caused by common illnesses in the elderly, such as urinary tract infections, head or chest colds, tonsillitis or strep throat, influenza, and bacterial infections. Anemia of chronic disease can also occur when there is an underlying autoimmune disease such as Type 1 Diabetes, Celiac Disease, Colitis, or Crohn’s Disease. Most of these conditions are treatable, and when the patient is stabilized, the anemia will usually correct itself. If anemia persists after the disease is stabilized, the doctor will probably want to investigate a secondary cause of anemia, such as kidney disease, a tumor, or cancer.

Special Conditions to be Aware of When Diagnosing Iron Overload

It is important to note that people with hereditary hemochromatosis (only 10% of cases of iron overload) will often have too much iron in their tissues but will develop anemia because of damage caused by the iron to the kidney, anterior pituitary gland, or bone marrow. The damaged kidneys produce fewer hormones essential for red blood cell production. An inflamed or damaged anterior pituitary gland can cause hypothyroidism, which can also lead to mild anemia. The bone marrow is as you probably know, where red blood cells are made. Hemochromatosis is diagnosed by genetic testing and should be discussed with your doctor.

In Conclusion: situation got to be diagnosed with great sensitivity, a full panel of iron must be conducted and the in-depth meaning of iron levels in the body got to be fully understood, and of course, evolutionary context must be taken into account (what our ancestors ate and how they lived). After accurately diagnosing the type of anemia (Anemia of Chronic Disease or Iron Deficiency Anemia), we will be able to understand the most suitable solution. It is recommended to consult a doctor who checks all elements that affect iron balance in the body and not rely only on blood iron test.

Good Luck!