UKH

Hi all,

I'm in a situation at the moment where I'm perilously low on iron - I know the reasons why, and that's being addressed - and I'm on superstrength iron tablets to build my levels back up.

I already eat quite a lot of iron-laden food (leafy greens, nuts, red meat), and I've done lots of clicking round the internet and reading the books I have on this sort of thing at home (Judith Wills' 'The Food Bible' being the main one) but I'd like to talk to someone in greater depth about my diet - anyone know where I can find impartial objective diet advice?

In reply to Tall Clare:

Dieticians are properly trained. You could ask your GP is you can be referred.

http://www.nhscareers.nhs.uk/explore-by-career/allied-health-professions/ca...

In reply to Tall Clare:

As well as eating nutrient rich foodstuffs, you should also eliminate the nutrient depleters, ie. refined foods and alcohol.

In soliciting advice you must be aware that there is conventional 'mainstream' advice and the more radical - fringe thinking. NHS advice is more likely to support the notion that your problem can be solved with external inputs ie. supplements while holistic advice will focus on absorption and co-nutrients ie. other minerals / vitamins which worktogether in the absorption.

Supplementation has moved along and it is now recognised that minerals must be chemically bound up to mimic the way nature presents them (eg. chelates etc) but I remain suspicious of most supplements and try to focus on dietary content.

In reply to Tall Clare:

You probably know all this anyways, but... Iron tabs are notoriously hard on the stomach and GI tract, so take care. They also don't make a huge amount of difference, at least not as much as you might expect and any improvements take time. The usual way to boost absorption is to have plenty of vit c from citrus fruits along with the tabs, if you can tolerate them as well.

Dieticians are your best bet, but my experience hasn't been great having seen 3 different ones - 1 private, and 2 NHS ones. All seemed to just tick boxes, and would be great if you are seriously obese and eating badly, but difficult questions have been met with... e.g. a recipe for carrot and coriander soup. You may be lucky but I wouldn't be holding my breath, not for greater in-depth make em think discussion.

My perspective is from having Crohn's disease, YMMV hopefully.

In reply to Tall Clare:

Wife was badly iron deficient after c section. Offered choice. Iron tablets for ages or blood transfusion. She went for the blood and never seen someone perk up so fast.

Bottom line was that blood transfusion apart there was no fast way to get iron levels up quickly she was told it would likely take 3 months.
If I was in a rush and had the money I know what I'd do....

In reply to beth:

Thanks for this - I'm aware of the vit C link, and also the stomach grief (I found that out today!). I've been on iron tablets before but nothing this strong. I picked up the prescription on Wednesday but haven't had chance to talk to my doctor about the test results so will do that tomorrow as a starting point (apparently my ferritin level is currently under 3, which might explain why I feel a bit spaced out at the moment).

That's good to know about dieticians. I suspect my best bet will be further research and fine tuning on my own...

In reply to alasdair19:

Blood transfusions? Blimey, I didn't think of that. I'll talk to the doctor tomorrow and find out more about what's actually going on - as I say, I know the reasons for the low iron so at least that's a start.

I've had a couple of friends who've received blood for various reasons and both said that they felt amazing afterwards, like they'd received a huge injection of energy.

In reply to marsbar:

Thanks for this - I could never remember which were the people who were in some way recognisably trained and which were woo practitioners between dieticians and nutritionists. A bit shameful really, as now I come to think of it, my grandma was a dietician.

In reply to LeeWood:

Thanks for this - I'd agree broadly normally but the spectacularly low level of iron at the moment means that I don't think diet alone will raise levels sufficiently particularly quickly.

In reply to Tall Clare:

I hadn't eaten red meat for 13 years. I was back on meat theoretically and a mate cooked me a steak; couldn't say no, ate it, and felt like Herakles on black bombers.

One of the odd bits in the Tyler Hamilton book -- not a book that's short on these -- is his description of receiving refrigerated blood in his blood-doping days.

Good luck with the iron!

In reply to Tall Clare:

My ferritin level was once similar and 3 months of iron tablets (600mg ferrous sulphate daily) did nothing to change that unfortunately.

In reply to ebygomm:

I'm on that sort of level of ferrous fumarate. How did your levels improve, if you don't mind me asking? (feel free to email me if you'd rather)

In reply to Tall Clare:

A friend of my sisters was one thats what reminded me.

Hope you get it sorted.

In reply to Tall Clare:

Well I spent about 7 years with just really low ferritin levels. My hemoglobin levels were always just borderline low so doctors not too interested in doing much (was largely symptomless).

Never managed to increase my ferritin until I gave up gluten (New gp suggestion), after my initial 3 months of tablets I'd been tested (blood only) for coeliac but that was negative and never investigated further.

In reply to alasdair19:


Can you get transfusions for things that aren't life-threatening (ie surgery and cancer)?

In reply to nufkin:

One of my friends who had one had it after various complicated heart problems relating to her diabetes.

In reply to Tall Clare:
For her last few years, my Gran used to go for a 'top up' blood transfusion every month or so. Afterwards she was fighting fit, but then slowly lost energy until her next appointment to get 'topped up' again. She used to really look forward to the boost it gave her.

In reply to nufkin:

If u go to Harley street you get what u pay for I suggest...

I'll ask the missus whats recommended for dogs if that's helpful.

In reply to alasdair19:

Er... where do dogs come into this?

In reply to Tall Clare:

Wife's a vet and fairly good at blood chemistry so it'd be interesting how she would solve an iron deficiency. What blood tests have you had? All others normal?

Sounds like a great excuse to perfect steak cooking!

In reply to ebygomm:

Forgot to add, underlying reason for the levels being low was never being treated so that probably had a bearing. If you are solving that problem then you may find the levels rise quite quickly with supplementation.

In reply to ebygomm:

Agreed - this isn't a problem that's been going on for several years, more like several months, and hopefully the underlying cause should be resolved soon (I'm seeing a doctor about that tomorrow, in fact!)

In reply to Tall Clare:

I wouldn't suggest blood transfusions if what you need is iron, and with a ferritin like that you might want to talk to your GP about an iron infusion.

These are generally well tolerated and a good way of getting the iron stores back to normal fast. There has been much discussion about the risks of iron transfusion: there is a risk of an allergic reaction to them, so they are generally done in hospital. The reactions are very rare indeed, but can be serious. I avoid them in patients with multiple allergies and certain other medical conditions. On the other hand there's nothing quite as good for getting the iron stores back to normal quickly.

Very happy to discuss by pm if that would help,

cheers

b

In reply to ben b:

Just had a chat with the doctor - we've come up with a plan for me to have one tablet a day until I get used to them and then go back to two tablets. We reckon that the underlying cause being resolved, and the iron tablets, mean I should be back to normal in three months or so. Bang goes me giving blood yet again!

I'm not at death's door, I just feel a bit spaced out at the moment, and I think a lot of that is to do with my workload, for which the end is in sight - roll on a relaxed May with lots of fresh air and exercise! The doctor was explaining that one can womble along with very low iron and without any alarming symptoms for quite some time as the body adjusts to the new situation - I didn't know that.

In reply to Tall Clare:

Sounds like a plan. The vit c thing does make a significant difference (although a glass of orange juice is just as good and considerably tastier!).

cheers

b

In reply to ben b:

Next challenge is to work out a sensible exercise plan to improve my fitness without wiping me out...

In reply to Tall Clare:



Dietary iron comes in two forms. Haem-iron is associated with haemoglobin and can only be obtained from meat. It is relatively easy to absorb because it's already in the oxidative state that we require it to be in. Non haem-iron comes from other foods (e.g., your leafy greens etc.) and also fortified cereal/bread. However it is much harder for us to absorb. Vitamin C helps with this (as you are already aware), but you also need B12 and folate, so it might be worth looking at whether you are getting enough of these. I have found that multi-vitamin supplements that contain these are much more effective that iron alone when I have been low on iron.

Iron-deficiency anaemia is also associated with running (something to do with all the pounding breaking down red blood cells I think), which I believe you have been doing a bit of recently. It might be worth finding a less aggressive form of exercise for a while?

In reply to kathrync:

Apparently B12 and folate levels are okay, which is good.

I haven't run for quite a while so at least that's one less thing to worry about <cough>.

In reply to Tall Clare:

Exercise is probably bad for you anyway

Maybe a nice steak, some dark chocolate and guiness is what you need?

If you must exercise I am sure the dog wont object to longer *whispers* walkies?

Must go take mine he is barking at another D O G out of the window. Doesn't seem to get that they are allowed to walk past.

In reply to marsbar:

Doggy's on very short lead walks at the moment after a shoulder operation - but as for your other suggestions, I've just found some Lindt dark chocolate on my desk

In reply to Tall Clare:

Oh get well soon to her. Enjoy the chocolate.

I need to move... I am feeling lazy today.

In reply to Tall Clare: Just thought, when a friend was on iron tablets post-pregnancy, she was told to avoid tea, coffee & dairy as they all reduced/prevented iron uptake and so negated the tablets. I assume you've already been told this, though?

In reply to owlart:

Yep. For a tea fiend, it's not good news...

In reply to Tall Clare: No, she liked her tea too

In reply to Tall Clare:

cut the wheat etc?

In reply to malk:

Could you expand on that?

In reply to Tall Clare:

You should read Nourishing Traditions by Sally Fallon.

Available online here

http://cista.net/books/Nourishing%20Traditions%20-%20Sally%20Fallon/Nourish...

In reply to Baron Weasel:

Tell me a bit more about why you think I should read it, particularly how it relates to the request in my OP.

In reply to Tall Clare:

Basically you only really need to read the 1st chapter, which is about nutrition. After that it is a cook book. It has been a while since I read it - but I think it has quite a bit about Iron and other minerals.

"The premise of this book is that modern food choices and preparation techniques constitute a radical change from the way man has
nourished himself for thousands of years and, from the perspective of history, represent a fad that not only has severely compromised his health
and vitality but may well destroy him; and that the culinary traditions of our ancestors, and the food choices and preparation techniques of healthy
nonindustrialized peoples, should serve as the model for contemporary eating habits, even and especially during this modern technological age."

In reply to Baron Weasel:
Thanks for that - I'm not short of iron-rich recipes and book advice, it's more that I was wondering how to find a reputable straightforward dietician who could help me to work with my specific health situation. Thanks anyway - I'll have a look.

In reply to Tall Clare:


I guess from another thread that he must be referring to William Davis's Wheat Belly, in which the author claims that eliminating wheat from your diet enhances the absorption of vitamins/nutrients (i.e. levels of B12, folate, magnesium, iron and zinc can increase when wheat is removed from the diet). Far from the only good reason to ditch this ghastly 'foodstuff', incidentally, as well as all of the other so-called 'healthy whole grains'.
http://www.amazon.co.uk/Wheat-Belly-Davis-William-MD/dp/1609611543

In reply to Tall Clare:

To add to the above, on his blog Davis says:

"Magnesium deficiency is worsened by wheat consumption, Wendy, so at least a few of the abnormal phenomena experienced by wheat eaters are caused by magnesium deficiency. This is due to the presence of phytates that reduce magnesium absorption by as much as 60-70%, iron and zinc absorption by 90%, even with the modest quantity of phytates contained in one bagel.

But it would be a big mistake to believe that all abnormal wheat-related phenomena are caused by magnesium deficiency. Anecdotally, way before I asked people to remove wheat, I asked them to supplement magnesium. Good things happened, such as modest reductions in blood pressure and relief from leg cramps, but nothing even close to the astounding changes that accompany wheat elimination."
http://www.wheatbellyblog.com/about-the-author/

But as Shani says on the other thread, do be aware that his position is not without some controversy. That said, I feel so much better and alert having given up wheat and other grains.

In reply to felt:
Thanks for this - all useful stuff, but partly because forums are so full of white noise and conflicting opinion, often without knowing the specifics of people's individual circumstances, I'm still looking for recommendations for sourcing a qualified impartial dietician .

In reply to Tall Clare:

I'm still looking for recommendations for sourcing a qualified impartial dietician .

Is there such a thing? The whole diet industry seems to consists of fads and charletons. I imagine you best bet would be via your GP rather than a forum, although I suspect even that route wouldn't be infallible.

In reply to Tall Clare:

As the second reply to your OP above (LeeWood) says, there's no such thing as impartial. The NHS and government bodies all recommend eating 'healthy whole grains'; Davis says they're akin to poison, and backs up his position with numerous references to the scientific literature that no one has collated to date. Who is the impartial one there?

You say "forums are so full of white noise and conflicting opinion", yet you ask for advice in one?

In reply to felt:


Er, yes. Because sometimes people can help. Even round here!

b

In reply to MG:

Anyone can set up as a nutritionist: even Harpie faced harridan Gillian McKeith. Or to give her her full title, "Gillian McKeith" (and thanks to Ben Goldacre for that joke which is always worth repeating - http://www.badscience.net/2010/07/and-then-i-was-incompetently-libelled-by-... )

On the other hand, registered dieticians are at least "dietitians who meet academic and professional requirements, including earning at least a bachelor's degree, and fulfilling a specially-designed, accredited nutrition curriculum, passing a registration exam, and completing a supervised program of practice at a health care facility, foodservice organization or community agency. " (Wiki)

I work in a tertiary hospital and university with a very strong dietetics department with a strong research output. Now some folk on here might automatically assume that they are part of some terrible food-based conspiracy but I see dedicated and hard working colleagues with a lot of skill and insight. And indeed if TC were local I would try and make an introduction; it is, however, a long trip to outpatients.

Cheers

b

In reply to ben b:

Er, you don't see the contradiction?

In reply to felt:

Given that vast swathes of the world's population eat grain as a staple diet and live long, healthy lives, classing it as "poison" is obviously nuts (sorry) I would say.

In reply to felt:

A fair point - but if I paid attention to everything on here I'd be raw vegan (which is working well for a friend, but it's not something I want to do)

In reply to felt:

Er, you mean I don't think that some people are able to read through a morass of often conflicting advice and draw their own conclusions? Perhaps someone, somewhere, might be able to give the name of a sensible dietitian?

Otherwise I have no interest in getting in to arguments about diet and nutrition. Hell, a mate and I once had an cheery argument about dehydrated mashed potato that made the walk from Culra to Dalwhinnie pass in the blink of an eye. Still no idea who won. I only have limited energy for that sort of thing now and it's all used up for the time being.

Cheers

b

In reply to MG:

Poison it is, certainly, a slow-acting type, like tobacco. Look at the difference between skeletons before and after humans introduced wheat into their diet (if you've got any such skeletons to hand, you'll find more osteoporosis, for starters). Ask yourself why diabetes was unknown in the Palaeolithic, and virtually unknown in the Neolithic until people starting eating Einkorn; or why eating two slices of wholewheat bread raises your blood sugar more than eating two tablespoons of sugar,

In reply to ben b:

Er, no, that's not what I mean at all. I mean someone wants to hold both 'a' and 'not a' at the same time, as they themselves have acknowledged: 'a fair point'. Anyway, this is all incidental to the main point!

In reply to felt:

My main thought on all this is that if I wanted people to suggest diets then that's what I'd have asked for! Anyway...

In reply to MG:


Life expectancy apparently dropped with the change to farming introduction of grains about 12000 years ago... which is a shame as I am rather fond of fermented malted barley water infused with hops.

In reply to MG:


Ah yes - but the preparation of those grains (to remove phytates), is what matters.

Remember, vast swathes of the world's population eat dairy, and yet dairy intolerance is widespread. Vast swathes of the world's population drink alcohol, and yet tolerance varies.

In reply to felt:

It is also possible that 'someone' was being polite, not in the throes of terminal cognitive dissonance



b

In reply to Shani:

This thread was about impartial advice. Using emotive terms like poison about some the world's most widely consumed foods immediately rules out impartiality in my view. Something like "eating grain for some people may have the effect of xyz..." or "some people due to genetics can't digest dairy efficiently with consequences abc..." would at least be worth considering as impartial.

In reply to MG:


True.

In reply to Shani:
I've read one of the major reasons we see so many problems with dairy is down to the pasteurisation process. It changes the milk so the body so doesn't so readily identify. Also Lactose intolerance is higher in pasteurised milk as it doesn't have the same amount of lactase as raw milk and many adults don't produce much / any lactase in their bodies and this is necessary to process lactose.

In reply to felt:

Just curious here but every time there's a diet evangalist on the telly or in your case, an internet forum I always want to know if this stuff is so bad for us, why are we living longer than we did in the neolithic era?

I eat bread, pasta, potatoes, rice, red meat, bacon, cheese, vegetables, fruit, margarine, sugar etc etc I drink beer and wine and tea and coffee and guess what? I'm not dying of diabetes and my bone density is fine.

In reply to 999thAndy:


From a physical point of view, we have better medicine and a safer environment. From a statistical point of view, less infant mortality (which greatly lowers the average life expectancy).


A couple of things here. First of all, survivorship bias. Just because you are ok it doesn't mean it is ok for everyone. Secondly, your diet doesn't look to be that bad. I'd get rid of margarine and pasta to start with, and limit sugar and beer, and keep an eye on bacon and beer. Other than that, red meat, vegetables, fruit, spuds, tea, wine and wine - all good!

Oh, and good bone density probably has more to do with impacts and weight bearing activity.

In reply to Shani:

Are you saying that our increased longevity is not linked to the food we eat?

I'd also bet that neolithic man did a lot more weight bearing / high impact stuff than I do.

In reply to 999thAndy:

Pretty much - or rather that the effect is small. I am saying that there is good evidence that paleolithic man lived a good three score and ten once they survived infant years.


Probably, but 'the dose' is important; that is to say modest load bearing activity has a beneficial effect on bone density (as does quality protein, vit D and calcium). By way of illustration, astronauts lose bone density very quickly.

In reply to 999thAndy:


I don't want to be drawn into the arguments for/against paleolithic diets, but I suspect the primary reasons for increased longevity are to do with vaccination, medicines (everything from antibiotics to pacemakers), better hygiene infrastructure (by which I mean sewerage systems, treated water, waste removal etc), and better midwifery.

In reply to kathrync:


I bet the paleolithics would have scoffed down bread like a shot - much easier than scraping around for roots or waiting for days in the rain for a careless deer to wander by


I've generally assumed people were always pretty robust, by and large, and had developed to cope with most hazards common to being alive, but was struck by the Pus, Pain and Poison programme a while ago by how fragile we used to be until the development of the things you describe. Lots of the problems were self-inflicted consequences of societal development, maybe, but still, I'm glad to be living now rather than 800 years ago

In reply to nufkin:


Given yhe opportunity, yes they would. ..and cola, Oreo's, pizza and cheeseburgers. Many would probably have taken up smoking, stayed up late watching TV and playing games. And without having to hunt or forage, they'd have suffered the same illnesses as modern people do.

In reply to 999thAndy:


That may have peaked with diet being a big reason for it dropping back again.

In reply to dissonance:

Diet is almost certainly linked to the early onset of disease in Western populations. Medicine can keep us alive long past the point where accumulated damage to our bodies should have taken us to our grave - regardless of our age.

In reply to MG:

i'm sure people who regarded tobacco/alcohol as poison were considered nuts in their time..