Iron Curse Part 1 with Dr. Christy Sutton: Rational Wellness Podcast 347

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Dr. Christy Sutton discusses the Iron Curse, part 1 with Dr. Ben Weitz.

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Podcast Highlights

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Dr. Christy Sutton is a doctor of chiropractic who published her first book in 2018 on genomics: Genetic Testing: Defining Your Path to a Personalized Health Plan.  She then diagnosed her husband with hereditary hemochromatosis, and high cortisol from a pituitary tumor, which she believes high iron contributed to.  Her new book is  The Iron Curse: Is your doctor letting high iron destroy your health, about the risk of high iron or hemochromatosis and the health consequences that can result from it.  Her website is DrChristySutton.com.

Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure.  Dr. Weitz has also successfully helped many patients with managing their weight and improving their athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.

 

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Podcast Transcript

Dr. Weitz:            Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates, and to learn more check out my website drweitz.com. Thanks for joining me, and let’s jump into the podcast.

                                Hello, Rational Wellness podcasters, today we have an interview with Dr. Christy Sutton on The Iron Curse: Is Your Doctor Letting High Iron Destroy Your Health? Dr. Christy Sutton is a doctor of chiropractic who published her first book in 2018 on genomics, Genetic Testing: Defining Your Path to a Personalized Health Plan. She then diagnosed her husband with hereditary hemochromatosis and high cortisol from a pituitary tumor, which she believes high iron contributed to.  Her new book is The Iron Curse: Is Your Doctor Letting High Iron Destroy Your Health? about the risk of high iron or a hemochromatosis and the health consequences that can result from it. Dr. Sutton finds that this condition is more common than most think, and it is often undiagnosed. I have to say that I’ve only diagnosed this a few times, so I assume I may potentially have missed it in patients, while I’ve seen many patients who have had iron deficiency anemia. So high iron, I think, is an important topic that’s rarely discussed, so Dr. Sutton, thank you for joining us.

Dr. Sutton:          Thanks for having me.

Dr. Weitz:            So perhaps we can start by discussing some of the negative health consequences of having chronically high iron. I think a lot of people realize iron is an essential nutrient and it’s very important, but I don’t think people realize that it can potentially contribute to poor health as well.

Dr. Sutton:          Yes, absolutely. So like you said, iron is so essential that the body has very few ways to get rid of it. The body really likes to store it, almost like a hoarder. And the problem is that some people are genetically, and for environmental reasons, very good at absorbing more iron and getting more iron and storing that iron. Just like some people are genetically good iron stores and hoarders, other people, they have a hard time keeping enough iron in their body for one reason or another.   So some of the risk factors with increasing your iron levels and getting high is that the body first stores it in the liver, that’s the natural first place to keep that iron, and that makes sense because the liver has a great regenerative detoxifying pathway, there’s lots of glutathione, and the liver can protect itself from the oxidative stress or rusting that iron can cause. So the liver is a great storage place, it’s like the big storage closet for the body.

                                The problem is once iron levels get high enough, then that iron’s going to spill out into other parts of the body. And there’s certain parts of the body, ultimately the entire body can be damaged, but there are certain parts of the body that tend to get damaged first. So the ones that tend to get damaged first are the organs that are particularly sensitive to high iron, that iron seems to have more of an affinity towards damaging, and one is the pancreas. So people that have hemochromatosis are sometimes called bronze diabetics because the high iron will damage the pancreas, causing type one or type two diabetes or insulin resistance, basically damaging the insulin producing cells in some way, shape or form, and then they also get this bronzing of their skin.  So before we had really good and accessible lab testing, one way that this condition would be diagnosed is the doctors would say, “Hey, your skin’s getting very bronze and you have diabetes, this could be hereditary hemochromatosis.” Now we hopefully don’t allow people to get to that point, because that’s a preventable point, but this is an example of-

Dr. Weitz:            On the other hand, how many people who have high blood sugar necessarily get their iron levels even checked?

Dr. Sutton:          That’s a really good question.

Dr. Weitz:            I would venture most of them don’t. It’s not part of a standard lab panel, and unfortunately insurance companies control the labs that are acceptable, and they’ve been stingier and stingier, and so doctors have been ordering fewer and fewer labs. So iron levels are typically not ordered unless there’s some reason to suspect a problem.

Dr. Sutton:          This is one of my biggest pet peeves that you really just immediately jumped us into, which thank you for that. A full iron panel is maybe $40, and it is not an exotic, expensive, complicated lab to run. You can get this done anywhere, it’s not like you have to go to a specialty lab, this is any Quest, CPL, Labcorp can do this easily. Every doctor has the ability to order these labs easily.  Having said that, they are not normally a part of routine testing even though high and/or low iron are common problems. And often doctors will maybe just order a serum iron, or maybe if they’re really on top of things a ferritin, but rarely do they order the full iron panel. The most common labs, as you know, but maybe your listeners don’t know, the most common labs that we see doctors ordering are a lipid panel with cholesterol, a CMP, which has your liver enzymes and electrolytes and stuff, kidney function, and a CBC, which has the red blood cells, hemoglobin, hematocrit, white blood cells.

                                So here’s the problem, a lot of people have elevated liver enzymes and their doctor is not looking for the iron, which like my husband, the high iron was, and this is very common, high iron destroys the liver, it’s very common to have elevated liver enzymes because of high iron. So you would think, oh, if we’re looking at the liver, and maybe the liver enzymes are high, wouldn’t it then be a natural step to then look at the iron? But no, that’s not the natural step that you would think.  The other thing is in that CMP it also gets the fasting glucose. So if somebody has a high fasting glucose wouldn’t you think, oh, let’s order the hemoglobin A1C in the iron panel? No, that’s not often the case. And with the CBC, you get the hemoglobin hematocrit red blood cells. With high iron sometimes, as in my husband case, and many other patients cases, the high iron will cause high red blood cells, hemoglobin and hematocrit. So you would think, oh, let’s get the iron panel. With anemia it’ll cause low hemoglobin and hematocrit red blood cells, you would think, oh, let’s get the iron panel.  Because really, if you want to be a good diagnostician and really know what’s going on, you have to have that full iron panel with the CBC, and I think you need the CMP too just to see what’s going on with the liver, and altogether that lab work is inexpensive, easy, this is not an exotic thing to happen. Can I go back to the original question about what does it do to your body?

Dr. Weitz:            Sure, let me just point out one more problem with this whole situation is that when you look at lab tests, what they call normal, that’s what the typical doctors go by, is based on what the average American has. So liver enzymes actually have been going up in a normal range. So I was looking at a patient who had labs from UCLA, and their ALT was 60 and I thought, oh wow, you have elevated liver enzymes. But then I looked down at the bottom and it said normal now was up to 70. So as a result of Americans getting fatter and drinking more, maybe partially because of the pandemic, average liver enzymes have been going up, so we just change what the acceptable range is by calling a higher level normal, which is even scarier. So now you got even more patients with high liver enzymes that aren’t being flagged as high because they’re not red on the test and the average doctor just doesn’t even pay attention.

Dr. Sutton:          Yeah, that’s a really good point, yeah. So the bell curve is, basically they’re looking at the bell curve, and if you get 10,000 people and you look at their labs and you say, okay, where are most of them? Then that’s where they decide the normal quote on quote range is. Well, if most people are failing the test because their health is poor, which is unfortunately the world we live in, then it’s just basically this lowest common denominator healthcare system where the bar just keeps getting lower and lower and it’s like, well, we’re not really getting sicker because look, statistically speaking not more people have higher elevated liver enzymes, or whatever. But actually, if we were to look at the same range from a decade or even five years before, we would be statistically much worse.  And you don’t just see this with labs, you see this also, I’m slightly going to go off-topic here, but in the last year a lot of the developmental milestones for kids were changed, and this is a result of the pandemic, basically so many kids lost all of this developmental, these key developmental windows were ruined because of the pandemic.

Dr. Weitz:            Wow.

Dr. Sutton:          So they actually, they took crawling, they removed crawling as a developmental milestone.

Dr. Weitz:            Really?

Dr. Sutton:          Yes, yes.

Dr. Weitz:            Wow.

Dr. Sutton:          They removed crawl, one of the most important developmental milestones of all time, they removed it, and they also basically said, “You have a lot longer before you need to be able to speak,” and all of the developmental milestones were pushed back so that you wouldn’t have this explosion of kids that are missing their developmental milestones. Now it’s like, oh, we’re not missing developmental milestones, it’s the same, but really they just changed the way they’re grading the test. Which is stupid because the body hasn’t changed, the neurology hasn’t changed, the biology hasn’t changed, it’s just the grading system has changed because it might not look good for some people if suddenly all these kids are failing the tests, you know what I’m saying?

Dr. Weitz:            Wow.

Dr. Sutton:          Yeah, but good point, good point.  So the other thing I want to say about this most recent point about the lab ranges is when you look at hemochromatosis this is particularly important, not just because you want to look in a functional range and not a sick person range, but also the ranges that labs allow are not at all accurate. For example, for hemochromatosis, you have to have a combination of a high iron saturation combined with a high ferritin. Now I order a lot of labs through Labcorp, and they allow that iron saturation to go up to 55% before they flag it. Having said that, with hemochromatosis the cut-off is 45%, so a lot of people are not getting flagged even though they are over the range that the hematology societies have decided is the cutoff. So this is not just an issue of the doctors having the bad range, this is actually an issue where the labs are misleading people away from what the hematology society say the cutoff is, which is 45% for the iron saturation.

                                Now the other part of that equation is the ferritin, which is a extremely important marker, it gets high with high iron and/or with inflammation. And if you have a high ferritin combined with that high iron saturation, that’s hemochromatosis. Now you can have a high ferritin not because you have high iron, just because you have inflammation. But a really big problem is many people allow ferritin to go extremely high before it’s flagged, and really, for many people, I don’t think anybody’s ferritin should be over 100, but hemochromatosis patients, when they’re being managed correctly, their doctors like to keep them basically below 75, some below 50 on that ferritin, and many labs do not flag a ferritin until it’s 175 or 200 or 300 or 400, they’re really all over the place. I’ve even heard some doctors say, “As long as you’re below 1000,” which kind of makes me want to vomit in my mouth.

Dr. Weitz:            Wow.

Dr. Sutton:          Because it’s like, okay, let’s just wait until our patient has permanent damage and is one foot in the grave before we say anything.  So the lab ranges are important to know and understand and not be misled, so that’s one thing I wanted to say.  Now, circling back around to the really important question at the beginning about what does high iron due to your body?  So we talked about diabetes, but high iron also has a particular affinity for the brain and the pituitary gland. So if you have high iron you’re more likely to have Alzheimer’s, neurodegenerative diseases, Parkinson’s, bipolar, depression. Pretty much any neurological problem, you are more likely to have that with high iron.  And then the pituitary gland, which is a part of the brain, the pituitary gland, particularly the anterior pituitary gland, not so much the posterior pituitary gland, is at a very high risk for damage from hemochromatosis.  And the pituitary gland is where it secretes the hormones that control your growth, your testosterone production, your estrogen, progesterone, thyroid, cortisol, this is the part of the nervous system that’s really important for being able to have healthy hormones and be healthy.

                                The iron also likes to go and destroy the gonads, so it’s very common for ovaries and testes to be damaged, decreased fertility in men and women, significantly decreased sperm count, unhealthy sperm because of all that damage. The high iron also likes to go to the heart, increasing your risk, and not just the heart, but the whole vascular system, kind of rusting the whole body, the vascular system, creating inflammation, increasing your risk for clotting, increasing your risk for an acute heart attack, increasing your risk for cardiovascular disease, calcium deposits, atherosclerosis, fatigue, increased heart rate, decreased heart rate variability. These people tend to just be tired often, and they can’t exercise because their heart is so stressed out.  And then ultimately the iron likes to go throughout the whole body. Once it’s filled up all those places and created damage, then it’ll deposit in the skin, increasing your risk for skin cancers, skin disorders. It really will deposit everywhere, but that’s just a little window into some of the problems that it can create.

Dr. Weitz:            That’s pretty scary.

Dr. Sutton:          Mm-hmm.

Dr. Weitz:            Okay, so let’s go through some of the labs and enable us to better understand how we should be analyzing our patients. So let’s go through a whole detailed iron panel.

Dr. Sutton:          Okay.

Dr. Weitz:            Can you start with iron saturation levels?

Dr. Sutton:          Yes. Okay, so iron saturation is really you’re looking at the TIBC. So there’s… First let’s talk about what’s in a iron panel.

Dr. Weitz:            Okay.

Dr. Sutton:          Okay, so the iron panel has a TIBC, a UIBC.

Dr. Weitz:            So a TIBC is total iron binding capacity.

Dr. Sutton:          Yes, so the TIBC is total iron binding capacity, and that’s basically the number of transferrin that your body is creating to move iron from one place to the other throughout the body. You can think of transferrin as these planes that your body is making to have iron hop onto the plane, and then transfer it basically from usually the digestive system where it’s being absorbed to another tissue, to the liver. Wherever the body needs the iron, the transferring is necessary. So if you have high iron, then your body is basically saying, stop bringing the iron planes. We don’t need any more iron, shut it down, I don’t need any more planes, stop making the planes, and then the TIBC goes down. Because basically even though your iron levels are high, you see a low TIBC because your body’s trying to shut down the transportation of iron.  On the opposite side of that coin is if you have low iron you’re going to see that TIBC go high because your body’s saying, we need more iron, you need to figure out how to make more of these planes to get the iron to ourselves because we’re starving for iron. So these are confusing to a lot of people because a lot of people say, “I can’t be high in iron, I’m low on labs.” It’s like, you’re low on the TIBC, which is inverse of the iron levels. Okay?

Dr. Weitz:            Okay.

Dr. Sutton:          So then the UIBC, the UIBC is unsaturated iron binding capacity, and you think of the UIBC as the open seats on the planes. So, okay, with high iron all of those seats are full because you have all this iron, and the planes that are flying around the body, the iron’s already hopped on the seat, and now there’s not a lot of unsaturated or open seats. And so the number of open seats, unsaturated seats, on the planes is very low, so the UIBC goes down as well with high iron. And as with the TIBC, this is confusing because a lot of times people with high iron will have a low UIBC and they’ll think, I’m fine, I don’t have an issue because I’m low on labs. But actually that’s, in many cases, an early warning sign that your body has too much iron and it’s shutting it down by having a low UIBC and low TIBC. Okay?

Dr. Weitz:            Okay.

Dr. Sutton:          And then the serum iron is just the amount of iron that is actually collected in the blood at the time of the blood draw. So if you have high iron, if you have hereditary hemochromatosis or hemochromatosis that’s non-hereditary, then it is common to have high iron in your blood because you just have high iron everywhere, so yeah, it’s going to be high in the blood too. If they were to measure the amount of iron in your liver, you’d be high there too. So the serum iron is just looking at the iron that’s actually in the blood at the time of the blood draw. And then-

Dr. Weitz:            What’s the important numbers you like to look at for the serum iron?

Dr. Sutton:          With serum iron I tend to just let the lab range dictate it, because I don’t have as photographic as a memory as I’d like, and I really tend to focus on the iron saturation and the ferritin. Those are the two that I tend to really focus on. And with different ages the serum iron will vary greatly. Basically I don’t worry about the actual range as much, I tend to say, okay, you’re within range. The people who tend to have high iron, they’re going to be pretty high regardless of the range, is usually the problem. They don’t always have high iron on labs, but if you see any of these labs out of range that I’m talking about, then you need to go and look for a hemochromatosis gene. And if you have one of those hemochromatosis genes, then the key piece of the puzzle is there, now we know why you’re out of range, and we know where this is going and it’s not going in a good direction.

                                So then you have the iron saturation, which is just an equation that looks at the serum iron and the TIBC, and then it gives you a percentage. And like I said, you always want to be below 45%. So anybody that has a percentage over 45%, then the next step is look at the ferritin, so you’re always looking at the ferritin. And the ferritin is the stored iron, and whenever the body has too much iron and/or is inflamed, it will store that iron as ferritin. So like I said, I never like to see ferritin over 100, I’m always putting up flags in my head, there’s a problem, this person’s either inflamed or has high iron, and then I look at the other labs to figure out, is this inflammation? Is this an inflammation driven high ferritin, or is this a high iron driven ferritin? And sometimes-

Dr. Weitz:            And as far is low ferritin, is 50 the cut-off, or what do you like to see?

Dr. Sutton:          It depends on the person, honestly. So if I’m dealing with a person that struggles with anemia because of whatever reason, pregnancy, heavy periods, malnourishment from digestive issues, GI bleed, then I’m comfortable with them having a higher number. But those people struggle to get higher, and so I’m not focused on keeping it lower, I’m focused on, I’d like to get this up into the 60s and the 70s, that would be a great buffer for you.

Dr. Weitz:            Right, but when does that trigger you to look for anemia? If you see a ferritin of 30 or 40 do you go, “Well, that’s okay,” or do you go, “Well, I should be worried about that”?

Dr. Sutton:          I never like ferritin to get below 30 in anybody. Now, if it’s like a hemochromatosis patient that they’ve been treated and their ferritin’s gotten below 30, I’m not going to tell them, “You should increase your iron intake,” because they’re going to pop back up anyway, that’s just where their body’s naturally going.

Dr. Weitz:            Right, but let’s say you have a vegan and their hemoglobin is on the low end, and their red blood cells are on the low end, where do you want to see the ferritin?

Dr. Sutton:          I would like to see it around 60 or above for them.

Dr. Weitz:            Okay.

Dr. Sutton:          And if you’re looking at the person in their whole environment as far as their diet, their history, then a lot of times it’ll be very easy to see, oh, this person, their ferritins on the lower end, their red blood cells are low, or their hemoglobin’s low, or their TIBC is high, or just one of those things maybe. And then if I get this picture of, oh, this person has a history of being low in iron, maybe they’re now in an even higher risk category because they’re pregnant or whatever, then if I see any lab out of range in those categories then I’m often thinking, okay, we need to get this higher, we need to get this ferritin higher.  Especially with women, I don’t want women going into a pregnancy with anywhere lower than a 60 on their ferritin, ideally even higher, because pregnancy is going to rapidly deplete iron. And there’s a lot of good research, and I talk about this in The Iron Curse, is there’s a lot of good research about how when you’re pregnant, if you’re iron deficient anemic, your child is more likely to have ADHD, severe learning disabilities, lower IQ, serious issues that are often not correctable later in life just because you miss this window of opportunity for brain development which iron is crucial for. So you have to live with the whole picture with each person.

Dr. Weitz:            You mentioned in the book that you had to take pretty high levels of iron during your pregnancy.

Dr. Sutton:          Yeah, yeah. So me, personally, it’s a little bit ironic that I wrote this book that focuses on high iron, and I had to include information about low iron within there and have some specific chapter focused on low iron because I have struggled with low iron. I have Crohn’s, I have celiac, I had part of my intestine removed. I’m a very complicated person as far as my health goes and I struggle with low iron, especially during pregnancy, I had to take a massive amount of iron, like 130 milligrams a day. I didn’t start out with a low ferritin, I started out in the 60s with my ferritin, but then it was remarkable to me how quickly I dropped down low. But the only reason I caught it as early as I did was because I was doing extra testing outside of what the OB GYN was doing.

Dr. Weitz:            There’s another example, you’re going through pregnancy and they’re not actually measuring your iron as you’re going through it.

Dr. Sutton:          They are not measuring it as closely as they should and they really let you get very anemic before they say anything, which is disturbing because when you’re pregnant you’re going through a massive amount of iron depletion every single day, and if your doctor waits until you’re really anemic to say anything about it, it’s virtually impossible to pull yourself out of that hole. And then this is where a lot of women end up having to get iron infusions or blood transfusions. And iron infusions, they create a large amount of oxidative stress to the body because when you give somebody an iron infusion you are putting straight iron into their blood, and the body hates that. The body knows that iron is this toxic substance that it needs and it has to have, but because unbound iron is so bad for the body, the body never allows iron to be unbound, and that’s why iron always has a chaperone.  So when you absorb iron into your system, it is immediately put onto this transferrin protein, and the transferrin protein then takes it throughout the body, those are the little planes that take it throughout the body. The body does this because it knows that that iron is like a naughty child, and if you let it just go out without a chaperone it’s going to go cause damage. And so it makes sure that iron has that chaperone to prevent the iron from causing damage before getting to the tissue that it needs to go to.

                                If you give somebody an iron infusion there is no chaperone, you just put a bunch of naughty little children into the blood and they’re going to wreak havoc, they’re going to create massive amounts of oxidative stress. This is why a lot of women that get iron infusions, they have these horrible histamine responses and it can severely damage their health. Of course their doctors are trying to play this balancing act where they’re like, I don’t want you to die of low iron, but you’re having bad problems with the infusions too.  And so I talk about ways to mitigate that in the book, but the most important step for mitigating that is finding and correcting the underlying cause of the iron disorder. Whether it’s high iron or low iron, you always have to find the underlying cause of it and fix it. Is it a GI bleed? If it’s pregnancy it’s like, okay, this is just a finite period of time where we’re going to have to massively boost your iron intake and make sure your gut’s as healthy as possible. If you have high iron, do you have this gene that’s causing you to have high iron? We need to know that, because that means that your body can be battling this for potentially the rest of your life. And most people that have high iron don’t get diagnosed, the people that do get diagnosed, it tends to take decades and many doctors. So the lucky few that do get diagnosed, they’ve usually had this condition, permanent damage by the time they get diagnosed.

                                I recently read a story, this Scottish lineage royalty lady, extremely wealthy, we’re talking about princess, recently died at the age of 59 of undiagnosed hereditary hemochromatosis. It’s not that she didn’t have the money or the resources, it’s just that medical systems, even in Scotland where this gene is very common, are not screening for this like they should, and they’re trying to change the NIH system there so that they’ll screen for everybody with hemochromatosis. And even there, where they have the highest percentage of people in the world with the hemochromatosis gene, they cannot change the medical system to add this inexpensive lab.  It’s crazy because they would save a fortune if they just… Think about, if you can prevent liver cancer, liver disease, heart disease, dementia, this is one of those things where an ounce of prevention is worth an elephant, tons of tons of prevention. But even there they can’t change it, and they have literally the highest percentage of people in the world with this gene. In Ireland they have 60% of the population has this gene.

Dr. Weitz:            Wow.

Dr. Sutton:          Mm-hmm.

Dr. Weitz:            Okay, so let’s finish going through the labs and then we’ll go into genetics. So next, I guess, we want to look at the CBC.

Dr. Sutton:          Yeah, okay, so perfect. So when you’re looking at the CBC, then you have, of course all of it is important, but the parts that are most influenced by… Well, we really need to talk about multiple parts. So the red blood cells, hemoglobin and hematocrit, they tend to get higher when people have high iron, because the body is trying to find a way to store that iron. Whereas with low iron they’ll often get low, red blood cells, hemoglobin and hematocrit. Now, it’s extremely important to have that CBC with the iron panel because you can have something called iron loading anemia, which is where you’re actually, you have a high ferritin, you have high iron saturation, you have hemochromatosis, but you’re anemic at the same time, because what anemia means is it means you don’t have enough hemoglobin and red blood cells.

                                So you could have low hemoglobin, low red blood cells, and have high iron. That’s called iron loading anemia. That’s a more complicated situation because in order to lower iron in those people, blood removal is not an option, and blood removal is one of the fastest ways to lower iron. So you’ve got to figure out, okay, what’s going on here? Why does this person have low red blood cells, low hemoglobin, and simultaneously lower the iron? And that’s a little bit more complicated a situation. That’s where you can’t use blood removal, you’re really going to have to look at diet, nutrition, lifestyle, those type of things.  The other parts of the CBC that are really important-

Dr. Weitz:            Well, why would somebody end up having that high iron anemia?

Dr. Sutton:          Well, there’s multiple different reasons. One is if you have a lot of hemolysis, so if your red blood cells are breaking apart because, for example, if somebody has a thalassemia gene, or a sickle cell gene, that means that their red blood cells are not shaped like they should be shaped, and then as they go through the capillaries they get stuck and then they break, and when they break it releases a lot of iron into the body. And then they get a high iron saturation, and if they’re really absorbing a lot of iron, then they’ll get a high ferritin too. So this is where you can have a high iron issue with low red blood cells, low hemoglobin.

                                You could also have a cancer, a blood cancer where you’re not making enough hemoglobin red blood cells. With hemochromatosis genes, you could have a really great ability for absorbing iron, but simultaneously have a GI bleed or something where you’re bleeding out, but your body has so much iron stores that it’s not enough to really create, you’re not low in iron yet. That’s where you really have to look at the genes and understand why is this happening, there’s a lot of different reasons. And those are sometimes the most complicated cases because things don’t always match up really easily. Does that make sense?

Dr. Weitz:            Yeah.

Dr. Sutton:          Just a straight hereditary hemochromatosis patient that has a hemochromatosis gene, high iron saturation, high ferritin, high red blood cells or hemoglobin or hematocrit, that’s not complicated as far as a diagnosis goes, or even really a treatment, that’s not a complicated thing. Which is why it’s such a tragedy it’s not being diagnosed properly, this isn’t even that hard. The iron loading anemia is more complicated, that requires really figuring out why are you not making enough red blood cells and hemoglobin to keep up while your iron levels are high?

Dr. Weitz:            Right.

Dr. Sutton:          But you need that. And here’s the other thing, A lot of doctors will just order that CBC and they’ll say, “Oh, you have low red blood cells, low hemoglobin, you need to take iron.” And then they don’t order an iron panel. And then you go order an iron panel and it’s like, oh, no, no, no, no, you don’t need to take iron, you are high in iron, but you are anemic. This is not an iron deficient anemia, this is another type of anemia, there’s a lot of different types of anemias, and I go through all of them in The Iron Curse. But we have to be better diagnosticians than just saying, “Oh yeah, you’re low on red blood cells or hemoglobin hematocrit, you must just need iron.” No, we have to order that iron panel. We have to, yeah. So that’s a part of the CBC.  The other part of the CBC that is also very important is looking at the white blood cells. So, for example, if you are going through an acute infection or even a chronic infection. But with an acute infection you tend to see the white blood cells pop up, maybe the neutrophils or lymphocytes will pop up, and you have to know that, okay, the body’s going through an acute infection and that is going to make that ferritin go higher, but it will also cause the iron saturation to go lower temporarily. Because when you have an infection the body is really wise and it knows that iron feeds infections, and it feeds parasites and viruses and bacteria.

                                And so the body says, okay, we are sick, we’re going to take away the fertilizer, we’re going to take the iron out of the blood, and we’re going to store it. And then the ferritin goes up, but the iron saturation goes down. And that’s like an anemia of inflammation type thing where you could see a low iron and a high ferritin, much lower iron than normal, much higher ferritin than normal, that’s anemia of inflammation. And a clue that that’s the problem is the high white blood cells, high neutrophils, high lymphocytes, any of those.

Dr. Weitz:            We also need to look at the size of the red blood cells, correct?

Dr. Sutton:          Yes, yes. So the size of the red blood cells is really crucial too. So if you have a high MCV, you’re going to be looking at somebody that has two large of red blood cells. And this can create a hemolytic anemia too because those red blood cells are too big they cannot get through the capillaries and then they break. And that can create the high iron saturation, all that, while you have this MCV, which is the red blood cells are too large. And that’s usually, there’s a couple different reasons for that. One of the reasons, the most common reason, I’m not going to say the most common, but a very common reason for that is low B vitamins, low B12, low B9, low B6. Okay, that’s a pretty easy fix, you just have to give them extra B vitamins and watch that MCV come down, the red blood cells get smaller. Because when red blood cells are-

Dr. Weitz:            That’s what we call macrocytic anemia.

Dr. Sutton:          Yes. But there’s another type of megaloblastic anemia, which is macrocytic anemia, which is it’s caused by liver damage. So in some people, they might have plenty of B vitamins, but they have a problem with their liver, and then that is stopping them from being able to have the proper size red blood cells. And these tend to be people that are abusing their liver with alcohol, is the most common issue, which is very common.

Dr. Weitz:            So these people will also have elevated liver enzymes?

Dr. Sutton:          Sometimes, sometimes. It’s weird, it’s weird, some people the liver enzymes are very indicative of how much abuse and damage they’re putting on their liver. Other people it’s like, how are your liver enzymes this good? The damage tends to show up in other places.

Dr. Weitz:            Is there some other test that we’re not running for those patients?

Dr. Sutton:          So, well-

Dr. Weitz:            Would GGT be better than ALT and AST for those patients?

Dr. Sutton:          Oh, I would always include a GGT on there because that is another liver enzyme that for some reason is not always included. But I think if you’re really being thorough, because for some people, yeah, that GGT is the high one, and it’s just because everybody is different as far as how their body’s reacting.  There’s another test, which normally this test, the AFP, is high when the liver enzymes are high, but the AFP is alpha-fetoprotein, and that’s a really good liver health indicator. Basically anybody that has high liver enzymes, anybody that has been diagnosed with hemochromatosis, they need to get that AFP done, because if you have that high AFP, you are at a higher risk for liver cancer, and you want to watch that come down as your liver heals up.

Dr. Weitz:            And I don’t think that test is normally run in adults other than in pregnancy really.

Dr. Sutton:          No, it’s not very common. I mean, the main reason I order it for people is if they have liver damage.

Dr. Weitz:            Okay.

Dr. Sutton:          Yeah.

Dr. Weitz:            All right, so… Go ahead.

Dr. Sutton:          Another thing that I wanted to mention before we move on is in some cases people will have, with the infection piece, if they have a chronic infection, then you’ll see often low white blood cells, low lymphocytes, low neutrophils. You don’t have to have all three of those happen, but you’ll see one or multiple of those happening with a chronic infection. And that’s just because your body has been fighting this war for so long, it’s given everything it can and it’s really tired, it can’t keep doing this. And in those people you will often see also a high ferritin lower level of iron, and they tend to get more serious low in iron with a high ferritin because their body has been fighting this infection for so long, and that’s also a complicated situation.

Dr. Weitz:            What about patients with mold and mycotoxins?

Dr. Sutton:          Yeah, that’s never a fun situation, although it’s very common and easy to not diagnose. Mold and mycotoxins can affect the red blood cells, hemoglobin, hematocrit, and really mess up that CBC as well. I’ve also seen, me personally, having lived in a moldy environment unknowingly and then figuring it out and watching my CBC, I have learned that my neutrophils would go up and stay high when the mold levels were high, and then when we got the mold levels lower my neutrophils were able to come back down. But I tend to be more of a high neutrophil autoimmune T2 person. So for me, that’s as much about my immune system’s flaring, but mold was a big trigger.  But it will, also you’ll see in combination with that low red blood cells, low hemoglobin, hematocrit, lower levels of iron, and mold is just a toxin that messes up your ability to make healthy red blood cells and iron absorption is affected. Lead too, lead can create a lot of anemia, and then copper deficient anemia can create low neutrophils, and you could also see in some cases a low ceruloplasmin, various… I have really good tables in the books that have all the labs,

Dr. Weitz:            You do, you have excellent tables, yep.

Dr. Sutton:          I probably need to study them more myself.

Dr. Weitz:            Yeah, no, so copper is super important for utilization of iron, and some patients actually have a copper deficiency anemia. The interesting thing is copper is supposed to be in this ratio with zinc, and because of the last three years, all these people have been taking, a lot of people, I shouldn’t say all these, a lot of people have been taking extra zinc, and some are taking massive levels, and I think I heard Huberman mention that you need to take 100 milligrams of zinc to really charge your immune system to fight off some of these viruses, and that’s going to lead to a copper deficiency.

Dr. Sutton:          100%. And copper, you need copper to absorb iron, so if you don’t have enough copper then this enzyme called hephaestin is not going to work, and that enzyme allows you to absorb iron from your digestive system. So you become low in iron, but also you get iron loading in your tissue sometimes because copper is also required for this enzyme ceruloplasmin, and that enzyme basically carries the iron from one cell to the transferrin. So the transferrin is like the plane that escorts iron throughout the blood, well copper is holding your hand from the door and taking you to the plane so that the plane transferrin can take you to wherever you’re going. And then once you get to wherever you’re going and you land, then the ceruloplasmin, which requires copper, will take your hand and take you into that cell. So if you don’t have enough copper, you get too much iron in your tissues, but also you get iron deficient anemia. So yeah, we need to make sure we have plenty of copper.

                                Simultaneously though, some people can become high in copper, whether because maybe they have a Wilson’s gene, which is a genetic issue where you don’t remove excess copper very well, or more common I think is if you have some type of a liver bile issue where you’re not secreting bile like you should, then a big way that the body gets rid of extra copper is through the bile, the ceruloplasmin will go into the bile. But if you have a bile obstruction, or unhealthy liver that’s not making enough bile, then you’re going to have a harder time excreting that excess copper and then it’s more likely to clog up in the liver creating liver issues. So I’m not-

Dr. Weitz:            Or you have copper pipes in your house.

Dr. Sutton:          Mm-hmm, yeah. But if you have copper pipes in your house, then maybe you should take extra zinc just to protect yourself from it. That would be a cheap solution rather than moving or redoing the pipes.

Dr. Weitz:            So let’s go into the hemochromatosis genes.

Dr. Sutton:          Okay. Okay, so there’s three hemochromatosis genes, and the first one is the highest risk. I’m going to go from top risk to lowest risk. So the top risk one is… They’re all HFE, so before I go through each of them I want to explain what they do first. So all of them increase iron absorption, and it’s just some of them increase iron absorption more than others. So the way that they increase iron absorption is they cause a decrease in this protein called hepcidin. So your liver makes this hepcidin, and then the hepcidin will affect iron absorption. So people that have these genes, the hemochromatosis genes, they make less hepcidin, which means that their body’s going to absorb more iron.    Now there’s also some genes that cause you to make more hepcidin, and then those people are more likely to be low in iron. I have one of those genes. I’m not sure exactly how much it affects my iron absorption, but it certainly doesn’t help. So the three genes are, this is where my photographic memory is going to fail me, but the first one is HFE C282Y, and that is the highest-

Dr. Weitz:            That was pretty good.

Dr. Sutton:          Well, I might need your help on the other two, because I always mix up words.

Dr. Weitz:            I have them written down.

Dr. Sutton:          Okay. I’m partly dyslexic and mixing up of letters is hard for me. So the HFE C282Y is the highest risk hemochromatosis gene because that’s the genetic mutation that increases the iron absorption the most out of the three hemochromatosis genes. Now you can inherit one or two hemochromatosis genes, depending on if one or two of your parents have a hemochromatosis gene. So if you have one hemochromatosis gene you’re at an increased risk for high iron. Some people like to say you’re just a carrier, that’s a myth, ignore that. If you have one hemochromatosis gene, you’re at an increased risk for high iron. If you have two, you’re at an even higher risk for high iron hemochromatosis.  And some people say only people that have two genes develop hereditary hemochromatosis, ignore those people, they’re wrong, they’re confused, if you want the data look at my book. My husband was diagnosed with just one gene, I’ve seen so many patients that have high iron with just one gene, it’s a myth that you need two. So if you have two of these HFE C282Y genes, you are at an extremely high risk for getting increased iron absorption, high iron hereditary hemochromatosis. When I say hereditary hemochromatosis, that means that you have at least one hemochromatosis gene plus high ferritin, high iron saturation.

                                Now there is non-hereditary hemochromatosis, which is where you don’t have a hemochromatosis gene, you just have hemochromatosis from environmental reasons. You’ll have high iron saturation, high ferritin, just because this usually is something that happens in men, not as common in women, because women are menstruating and childbirth, they tend to get rid of iron almost too much. Now, nonhereditary hemochromatosis is more in men, and then you just have to figure out why, are you just absorbing too much iron? Whatever. And then the good thing about that is you can fix it and they now don’t have that gene that’s going to make them go back up quickly. Whereas the people that have one or two hemochromatosis genes, they’re going to go back up likely quickly.

                                Now, not everybody with a hemochromatosis gene’s going to develop high iron, but you’re at a higher risk. If you have a hemochromatosis gene and you have high iron, no surprises. If you have a hemochromatosis gene and you have low iron, there’s something wrong. You’re either a vegan/vegetarian that’s not eating any iron, you’re heavy periods, GI bleed, malabsorption, there’s a problem, you should not have low iron with a hemochromatosis gene because your body is naturally really good at absorbing it. The only people where that would make sense really is females that are maybe not eating very much iron and having heavy periods and pregnancy.

                                I see it a lot in pregnant women that have a hemochromatosis gene, they’ll become low in iron, and that’s because iron is just used so much in pregnancy, and in fact, the reason this hemochromatosis gene exists in such a large percent of the population is because it has protected people from death from low iron during pregnancy, death from low iron during famines, death from low iron during injuries. This is a protective shield for many people, it’s just now we live in a world where you can pick up a hamburger at McDonald’s any time of the day, and iron is in supplements and iron is in food and it’s fortified, and so now we live in a world where a lot of people are getting too high in iron because we live in an iron rich environment.  If we lived in a low iron environment, this is like a warrior gene. This is a gene that really is going to fortify you and get you through a really tough battle, whether that’s a famine or a pregnancy, or whatever. But now we live in this world that it’s not helpful for a lot of people. So anyways.

Dr. Weitz:            By the way, what’s the best way to test for these genes? I noticed in your book you mentioned 23andMe, but recently patients have been unable to get their raw data from 23andMe, they’ve blocked them from it because of some problems they’re having.

Dr. Sutton:          Yeah, so they can still get the raw data, but they have to message 23andMe and ask for it. They have temporarily disabled the downloading feature, which is obnoxious and annoying, and hopefully that’ll come back. But they did get hacked, and the way that they were hacked was people got into accounts they shouldn’t have got into using the password that somebody had. So they didn’t get in through the back way, they got in through the way that it was designed to get in, and because of that, that’s why you’re seeing the two factor authentication blow up. Everything is two factor authentication now, and it’s obnoxious and it’s annoying, but that is because the hackers were able to penetrate the designed way to get in, so now you have to have the two-factor authentication.  Now that 23andMe has that two-factor authentication, hopefully they’ll allow the downloading feature to come back. In the interim, you can still get your 23andMe raw data, you just have to message the company and then within a couple of days they’ll give it to you. It’s just another hindrance, it’s annoying.

Dr. Weitz:            I see, okay.

Dr. Sutton:          But you can still get it. That’s a good question, yeah.

Dr. Weitz:            Okay.

Dr. Sutton:          So 23andMe is one way. I know there’s a lot of people that don’t like 23andMe, and I’m not trying to defend them as a company, just like I’m not trying to defend a lot of companies out there that I use, whether it’s, whatever. But I think the reason that I have used it so much is because, first of all, a lot of patients come in and they’ve already done it, which is really nice because then I already have that information without having to wait for it. Secondly, it is really hard to beat the amount and quality of information you get for the price that they offer.

Dr. Weitz:            $100, yeah.

Dr. Sutton:          And I live in a world where a lot of my patients are working very hard to try to take care of their health on their own dime, and often I’m looking for the most cost-effective way to do it. Now, if you can’t do 23andMe, if you don’t want to do 23andMe, if you want another option, there’s other options. Probably, honestly, the best option outside of that right now is just if you can ask a doctor to order a hemochromatosis genetic panel through Labcorp or Quest, or whatever, that will give you the information.  Having said that, a lot of doctors are not willing to do that for some reason. So if you want to get it yourself without your doctor’s help, 23andMe. If you want your doctor and insurance to be involved, you can get the Quest or the Labcorp, either way. I don’t really care how people get the information, but I think it’s really important to have the information, whether it’s the hemochromatosis gene or many of the other genes I talk about in the book.

Dr. Weitz:            Okay.

Dr. Sutton:          Okay, so the second hemochromatosis gene is, I always get the letters backwards here, HFE H63D. Is that right?

Dr. Weitz:            Yeah.

Dr. Sutton:          Okay, so that’s the second hemochromatosis gene. This gene, it dramatically increases iron absorption, but less dramatic than the C282Y. So you can have one of these, you could have two of these, you could have a combination of one of these with a C282Y, that’s called a compound heterozygote. Basically, if you have one or two of these, or one of these with a C282Y, or the other hemochromatosis gene we’re about to talk about, you’re at a higher risk for high iron because of this gene.

                                Actually my colleague, I tell the story of my colleague’s daughter who has two of these, HFE H63D hemochromatosis genes, and she, at the age of five, what happened was she got very sick, and then coming out of that sickness she had a lot of neurological deterioration. She reverted back to wearing diapers, her mom would have to carry her. So they work with the pediatrician while she’s simultaneously trying to figure this out to accelerate the figuring this out, because her daughter is rapidly declining. So she goes and she takes her in, she orders her daughter all these labs and she takes her in, carries her in to get all these labs done, that she ordered herself because she’s a doctor and she’s, while working with the pediatrician, also going to do her own thing because she’s not going to go at their pace.

                                And so she carries her daughter in to get all these labs done, and then she calls me later that day and she’s like, “It’s the weirdest thing, that afternoon after the blood work, she really perked up.” And I’m like, “I think your daughter has hemochromatosis.” Because we already knew that she had the gene, but this young girl who had a lot of blood drawn, that was enough to make a significant difference for her, because she’s a small body. So getting all these labs was enough, that was like a blood donation for her, basically. The labs confirmed hemochromatosis. She goes to the pediatrician, gives them the labs, they’re like, “Okay, you’re right, this is hereditary hemochromatosis, we’ve never seen this before.” And I think it’s just because they’re not running the labs to diagnose it.

Dr. Weitz:            Of course.

Dr. Sutton:          They’ve never seen it before. So then they refer her to the pediatric hematologist, which is very hard to get into. This is not just hard for pediatric cases, but also it’s very hard for me to get my adult patients in with hematologists. They’re very busy, it’s hard to get in.

Dr. Weitz:            Right, so it takes months to get in, and meanwhile the patient’s suffering.

Dr. Sutton:          So my colleague, what she does is we talk about it and give her supplements to lower iron in the meantime. So she gives her a large amount of curcumin, and she does this for months. She finally gets an appointment with the pediatric hematologist, takes her daughter, they do labs there to go over with her, and they’re like, “You know what? Your daughter’s fine. Her iron levels are fine, she doesn’t have hemochromatosis. But why don’t you just, we’ll check them again in a couple months, and then if it pops back up, then bring her in and we’ll treat her then.” Actually, I have these emails in the book if you’re interested, it’s kind of unbelievable, I had to put the emails because nobody was going to believe me.

Dr. Weitz:            Right.

Dr. Sutton:          And so a couple months late… Oh, also important, the hematologist says, “Take her off of that supplement, it’s not helping her lower iron.” And so my colleague, she dramatically lowers the dose but doesn’t take her off it all the way because she’s like, that makes me nervous. She dramatically lowers the dose, redoes the labs in a couple of months, and her daughter, the iron levels have popped back up to the point where they’re at the threshold that the doctor said, “If they go back up to this point, let us know and we’ll deal with it then.”

                                So she reaches out to the doctor’s office, she says, “Hey, we have met your threshold,” basically, “Will you please help me manage this with blood removal?” Because you can’t take a child to the blood donation center, they need a pediatrician to help remove that blood. Blood donation centers will not… There’s no way, it’s very hard to manage this in a child without a doctor helping them. So the hematologist nurse responds, this is in writing in the book, and the nurse responds and says, basically, “You need to go back to the pediatrician that referred you, and we don’t know why your child is tired, but she doesn’t have anemia, so we’re not sure why she is tired,” and basically, “We’re not going to deal with this, and usually people that have hemochromatosis are males in their 50s,” and just totally gaslights them.

                                And so she goes back to the pediatrician, and basically now she’s dealing with it herself with supplements, massive amounts of supplements. And she’s noticed the iron going up correlates with the deterioration in her daughter’s cognitive function, even, I don’t know if you check for primitive reflexes, retained primitive reflexes, but primitive reflexes tend to come back whenever the brain is in an unhealthy state, and her daughter will develop, retained primitive reflexes will come back when the iron’s high and then go away when the iron gets lower, which is a sign that this is really messing up her brain.

                                So I tell that story because one, she had that genotype of the two HFE H63D genes, but two, really it’s a warning about how kids are not being diagnosed properly because pediatricians are not screening for it. And ultimately there’s this window of time for females where once her daughter starts menstruating, she’ll probably be okay when she’s losing blood, but until she starts menstruating it’s going to be hard to really control that hemochromatosis. Okay, I digressed major there.

Dr. Weitz:            That’s okay. I’m starting to run low on time.

Dr. Sutton:          Okay.

Dr. Weitz:            I was just texting to see if my staff is here, but I do have a patient, but we haven’t gotten into how to treat at all yet.

Dr. Sutton:          Okay. Well, we also didn’t talk about the third hemochromatosis gene.

Dr. Weitz:            Oh, yeah. So let’s go through that, and then is it possible we could wrap and maybe do a part two?

Dr. Sutton:          Yeah, yeah, yeah.

Dr. Weitz:            Okay, okay.

Dr. Sutton:          Okay, so the third one is HFES, what is it? S5?

Dr. Weitz:            S65C.

Dr. Sutton:          Okay, S65C, okay. This is an interesting one because up until a couple years ago, this was not included on a lot of the hemochromatosis panels. A lot of people were told, “Oh, you have one hemochromatosis gene,” because they were only looking for the C282Y and the H63D, the two main ones, when in fact they had the second one that they were not looking for, but is statistically a risk for hemochromatosis. So even to this day, many people will think that they have one hemochromatosis gene when in fact they have two because their doctor didn’t check for this third one, which is a hemochromatosis gene, and moving forward that will stop. And even 23andMe doesn’t always sequence it. I’m sure they’re going to change that, because they have to, because now Labcorp, Quest, the hematology associations have decided we have to look at this third hemochromatosis gene, but a lot of people think there’s only two hemochromatosis genes.  And so when I did the research for the book I realized that basically when I say 30% of the tested global population has a hemochromatosis gene, they’re only looking for the two that I talked about first, C282Y and H63D. They didn’t even include this third one, which means actually many more people than we think have a hemochromatosis gene. We don’t really know, we don’t know, but wouldn’t it be nice to figure that out?

Dr. Weitz:            And interestingly, one more thing, you mentioned that having red hair increases your risk?

Dr. Sutton:          Yeah, the reason that red hair increases your risk is because the hemochromatosis gene originated in a Celtic Viking ancestor thousands of years ago, and they must have had red hair for a large percent of their population. And they largely, this is why Northern European countries, especially the UK, there’s a huge amount of hemochromatosis gene there. And so just because you have red hair doesn’t mean that you’re going to have a hemochromatosis gene, it just means that statistically speaking you might have one of those hemochromatosis genes because you are closer in lineage to the Celtic Viking ancestor where this originated thousands of years ago.

Dr. Weitz:            Great. So this is incredible information, we’re going to have to do a part two of this podcast to go over how to manage patients with either high or low iron.

Dr. Sutton:          Yeah, absolutely.

Dr. Weitz:            So for this podcast, give everybody your contacts so they can find out more about you if they want to work with you, or if they’re a practitioner and they want to learn about your courses and your books.

Dr. Sutton:          Yeah, so my main website is drchristysutton.com, D-R-C-H-R-I-S-T-Y-S-U-T-T-O-N.com, and that has pretty much everything I’ve created as far as my books and my workshops. If you’re really just interested in this iron piece and not the other workshops that I’ve taught or the other book that I wrote, then ironcurse.com is a great reference because that gives information about the book, the Iron Curse book. And then also I have an Iron Curse workshop, which is a really valuable tool. It’s a five module workshop that is a valuable tool that helps to really break down the information and make it easy to assimilate and understand, and I add additional little clinical pearls in there. But that’s a video workshop. So ironcurse.com or drchristysutton.com, and then I’m on social media, Instagram, Facebook, all that.

Dr. Weitz:            What’s your Instagram?

Dr. Sutton:          @DrChristySutton.

Dr. Weitz:            Great.

Dr. Sutton:          Yeah.

Dr. Weitz:            Excellent. Thank you so much.

Dr. Sutton:          Thank you.

 

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Dr. Weitz:            Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would certainly appreciate it if you could go to Apple Podcasts or Spotify and give us a five star ratings and review. That way more people will discover the Rational Wellness Podcast.   And I wanted to let everybody know that I do have some openings for new patients, so I can see you for a functional medicine consultation, for specific health issues like gut problems, autoimmune diseases, cardiometabolic conditions, or for an executive health screen and to help you promote longevity and take a deeper dive into some of those factors that can lead to chronic diseases along the way. That usually means we’re going to do some more detailed lab work, stool testing, sometimes urine testing, and we’re going to look at a lot more details to get a better picture of your overall health from a preventative functional medicine perspective. So if you’re interested please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at 310-395-3111, and we can set you up for a new consultation for functional medicine. I’ll talk to everybody next week.