How To Manage Low and High Iron with Dr. Christy Sutton: Rational Wellness Podcast 360

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Dr. Christy Sutton discusses How to Manage High and Low Iron 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 I am excited to be having a second interview with Dr. Christy Sutton on the importance of iron and iron overload. Part 1 was episode 347, and we focused mainly on the importance of iron, the problems with having too much iron as well as how to do the proper detail testing to be able to diagnose either low iron or high iron with an emphasis on the hemochromatosis or high iron. But we didn’t have time for treatment. So today we’re going to focus on how to treat patients with low or high iron.

                                Dr. Sutton is a doctor of chiropractic who’s an expert at genetics. Her first book was on genomics, Genetic Testing: Defining Your Path to a Personalized Health Plan. Dr. Sutton is also an expert at diagnosing and treating iron problems, especially high iron or hemochromatosis as well as anemia. Her new book is The Iron Curse: Is Your Doctor Letting High Iron Destroy Your Health?  Dr. Sutton finds that hemochromatosis or high iron is more common than most people think, and it’s often undiagnosed. High iron is also a topic that is really discussed in the functional medicine world and may be an underlying problem with patients suffering from liver, cardiovascular, or neurological problems. On the other hand, iron is an absolutely essential mineral is needed by nearly every organ in the body, nearly all the cells. In fact, I was just listening to a podcast by Dr. Peter Attia on my drive in here, and he mentioned that 2% of the human genome encodes for iron-related proteins, which is staggering amount, and that 6.5% of all enzymes in the human body are iron-dependent.  Dr. Sutton, thank you so much for joining us again today.

Dr. Sutton:          Thanks for having me.

Dr. Weitz:            Good. So as I mentioned, in part 1 we discussed the consequences of low or high iron. We talked about the genes that increase the risk of high iron and how to test for iron status. So today I’d like to focus on how do we manage patients with either high or low iron and perhaps maybe go through a few examples.

Dr. Sutton:          Okay.

Dr. Weitz:            Great. Why don’t we start with iron deficiency anemia? And we’ll spend most of the time on high iron. So iron deficient anemia is too little iron which can compromise brain health. Women often will have problems with not having enough iron during pregnancy, and this can lead to higher risk of developmental brain issues with children including ADHD, lower IQ, autism.

Dr. Sutton:          Yes, so there’s certainly a plethora of negative health consequences related to low iron, anemia. So technically, anemia doesn’t mean just low iron. It means you just don’t have enough healthy red blood cells or hemoglobin. There’s multiple different types of anemias. You could have adequate iron but still be anemic because you have low red blood cells or low hemoglobin. But if we’re just going to talk about iron deficient anemia, that is a common problem and it can look like fatigue. It can create cardiovascular issues because your heart’s having to work harder. Any anemia can make your heart have to work harder because now your heart has to pump faster basically to get enough oxygen to your brain and your arms and legs and your whole body because there’s not enough healthy red blood cells, not enough oxygen being carried. And so it can really just wreck your life, long-term health consequences and short-term.  And unfortunately, it’s I think being also misdiagnosed a lot. It could create a depression-type problem, and then maybe your doctor treats you with an antidepressant rather than… Just like low thyroid could create a depression-type problem and then you get mistreated. These are common issues that slight tangent of subject here, but in my opinion, psychiatric medicine could maybe have some room for improvement with ruling out other diagnostic issues rather than just using SSRIs or antidepressants, but that’s a tangent. But low iron is one of those things that can create a lot of neurological issues.

                                And if we want to focus on the treatment piece of that, then the hardest part of that piece is figuring out why you’re anemic. If you have iron-deficient anemia, why? And then ultimately you have to fix that and then increase, change your environment so that you fix the why on top of getting your iron levels back up. And so the why is the wild card.  And the most common reasons for low iron are blood loss, which is one reason that females tend to become anemic. So much more common than men. Although men can become anemic. If a man’s anemic, especially if they’re eating red meat, then you have to rule out do they have a malabsorption issue, a GI bleed, are they over-exercising? Even over-exercising in men doesn’t tend to create anemia type issues if they’re eating iron, but certainly vegan vegetarian diet will cause iron deficient anemia because the most absorbable iron is heme iron, which is only found in animal products. So this is why I could eat a pound of spinach and not get as much iron as I would and a couple bites of a steak because it has more iron in the steak and it’s more absorbable. That’s key.

                                So it’s not just the absorption. And you have to look at does somebody have… A big one now, it’s people that are taking PPIs, like proton pump inhibitors and they’re not absorbing iron or really other nutrients, period, because it’s all the acids being depleted in their stomach. That’s a big problem that causes low iron and low copper and other minerals and low protein and just malabsorption period. And then having any type of a GI bleed will cause low iron, whether it’s in your stomach. Do you have an H. pylori infection in your stomach that can cause it? Do you have a GI bleed anywhere in your digestive system, which is common? Do you have maybe a malabsorption issue from celiac disease that’s undiagnosed and untreated? That’s a common issue as well, which is one reason that I talk about the celiac gene and celiac disease in my book and talk about that. And then-

Dr. Weitz:            Even dysbiosis and SIBO will decrease absorption of nutrients?

Dr. Sutton:          Yeah, just I mean any digestive issue. Having part of your bowels removed or having the… It’s not as common now that people are losing weight other ways, but in the past when a lot of people were getting the bypass surgery to lose weight where they just kind of bypass the first part of your small intestine, that will cause low iron, low copper, low minerals because minerals are absorbed largely in the first foot of your small. So if you bypass that part, you’re going to have a lot of problems, which is one reason that they have so many issues.  And then certain medications like bile sequestering. Not a lot of people take those, but they will bind to iron. So there’s just a lot of factors. But probably the most common reason that I see low iron is because of heavy periods, malabsorption, fibroids. Women that just, they have uterine fibroids and they’re bleeding heavily. It’s just really hard to get enough iron to make up for this chronic blood loss that you’re experiencing.

Pregnancy is a great way to become low in iron because making a human being is very nutrient dependent, including iron and pretty much every other nutrient, which is why pregnancy doesn’t just create low iron but creates low everything. And then that low everything ultimately is a big part of the pregnancy complications and postpartum issues and even developmental problems in the baby.  Another side tangent. I wish that OBGYNs did a better job with the nutritional part of pregnant women. And I experienced that firsthand. I’ve seen that countless times in my own patient population. And they seem really focused on, are you getting enough folate? Which is important, but it’s like, “Well, there’s a lot of other nutrients that we need here too.” And me personally, when I was pregnant, I did become anemic and I went into pregnancy with, I think my ferritin was maybe in the 60s or 70s, which for me is a solid ferritin because I kind of have fought a low iron issue. So 60s or 70s is pretty good going into pregnancy. I knew it was going to go down. I didn’t know how fast.  So I took iron throughout my whole pregnancy, but around, I want to say week eight or week nine, I just did some labs on myself and I was like, “Oh, I’m getting lower. I need to take more iron.” And then a couple weeks later, the doctor did some labs on me and I was even lower, and they said, “Okay, you need to start taking 30 milligrams of iron now.” And I’m like, “I’m already taking 90 milligrams of iron.” So I think I ended up taking 150 or 180 milligrams of iron a day for most of my pregnancy, and my husband would have to just sit there and force me to swallow these pills because I was like… Because these iron pills smell so bad and I just couldn’t make myself do it. But his job was, I had this bag of vitamins I had to swallow every day. And it literally took another human being making me to do it because I was not otherwise going to do it. So anyways, but I’ve seen that time and time again with pregnant women.

Dr. Weitz:            One of the important things you just highlighted there is it’s often that a patient may be going into pregnancy, she might get tested once for iron and then just told to take iron as part of a prenatal, but rarely will they get tested again to see if it’s actually working or to what extent it’s working. So as we know in the functional medicine world, we’re big on testing. And the reason is because we need to see exactly what’s going on. We need to see the underlying cause. And then if we make an intervention, we need to see if it’s actually working, is it working too much, is it not working enough. And in order to try to save money, doctors tend not to retest.

Dr. Sutton:          Yeah. And unfortunately with iron in pregnancy, it can go down fast into a dangerous zone. And that’s where often women end up needing iron infusions, which an iron infusion is where they just inject iron into your blood, which is different than a blood transfusion. So a blood transfusion is where you get somebody else’s blood, there are red blood cells, hemoglobin. There’s iron in there, but you’re also getting the red blood cells and everything and the blood rather than just iron. And so a lot of pregnant women, they’ll need either an iron infusion or a blood transfusion depending on their situation. And there’s side effects to both of these, right?

                                So with a blood transfusion, you’re at risk for getting whatever. If somebody was taking a medicine or has a disease or toxic in something, then you just got their blood and now you have that in you. That’s obvious. We know about that. With the iron infusion, there’s side effects that are a little bit less known. People that have gotten iron infusions, some of them, they don’t feel a problem, but often they’ll have a bad reaction and they’ll feel really bad. And iron infusions always cause a lot of oxidative stress in the body because it’s unbound iron, it’s just free iron. And unbound iron is particularly damaging because iron is very reactive and it will go out and oxidize things and steal electrons. And it doesn’t do that if you absorb iron through your digestive system and then your digestive system binds that iron to a protein so that it’s protecting you from this potentially problematic iron that we need, but the body has figured out how to use it in a protective way.

                                And so the iron in the body without being bound to that protein is very reactive and creates a lot of rust oxidative stress in the body. So one thing that people need to do for the treatment part of this talk is if they are going to get an iron infusion, they really need to do a lot of antioxidants, vitamin C, glutathione, in my opinion, if you’re giving somebody a iron infusion, then give them some glutathione too or vitamin C later or before or whatever. Just vitamin E. All of these antioxidants have been shown to be protective from iron-induced damage. But circling back to other causes of low iron, we talked about-

Dr. Weitz:            So we’re talking about adding iron to somebody who’s low in iron. Is there a form of iron you like and then what other nutrients can be added or what can be done to increase their likelihood of absorbing the iron?

Dr. Sutton:          Yeah, that’s a good idea. So there’s lots of different types of iron. The one that I use in my practice the most is a ferrous peptonate form. The company that makes it is a company called Nutri-West. It’s called Hemo-Lyph. Why I like it is that it’s very absorbable and patients feel better. We’re using it. It doesn’t create as many GI issues. It doesn’t create the stomach pain and constipation like a lot of the other ones. And part of that is because of the form and because it’s highly absorbable.

Dr. Weitz:            What about the ferrous bisglycinate?

Dr. Sutton:          Hold on. I have to tell you the cons of the Hemo-Lyph first.

Dr. Weitz:            Oh, okay.

Dr. Sutton:          The cons of the Hemo-Lyph is that they do put folic acid in there, so you’ll want to take some methylfolate with it just to protect yourself from that folic acid.

Dr. Weitz:            Oh, okay.

Dr. Sutton:          But that’s kind of a side note. I don’t know why they do that. It’s weird, but you know. I have looked for and not found another one that I like more. And if I find one I like more, I’ll change to that. I don’t profit at all from that Nutri-West, like whatever. I think it’s a good company. It’s a family-owned company that makes good products, but I’m more than happy to change to another company if I find a better product. I just haven’t yet.  Now the ferrous bisglycinate, I’ve seen ferrous bisglycinate and used it in patients because sometimes people will want a non-animal source of iron. And the hemolyte does have some animal source in there, and that’s probably why so absorbable. So there is a ferrous bisglycinate product that I have used in some hardcore vegan vegetarians, and they do not do as well with it. So I have used it. It’s not my preferred. My preferred is the ferrous peptonate Hemo-Lyph. What I don’t like, which is most commonly found on the shelves and prescribed, is ferrous sulfate, which is not very absorbable. But okay, so-

Dr. Weitz:            That’s the one most often prescribed I think by AMDs.

Dr. Sutton:          Yeah, exactly. And so that’s the type. Okay, so then the second part of it, this question is, “Well, how do you take it?” Okay, the biggest problem people encounter when taking iron is it causes them either constipation or stomach pain. And then that is the number one reason that they don’t follow instructions for taking iron. So if you take iron with food, it is less likely to create that stomach pain. If you start getting constipated, then just lower to a lower dose. Sometimes people start getting constipated even with a really good iron source just because they’re getting too much of it, okay?  And if you’re going to take iron, then don’t take it around the same time as things that are going to bind to iron like calcium. Calcium binds to iron, this is one reason that young kids eat a lot of calcium tend to be anemic. But don’t take calcium around the same type of iron. Don’t take curcumin around the same time as iron. Any supplements that bind to in lower iron, alpha-lipoic acid, silymarin, don’t take those at the same time as the iron. Even vitamin E can do that to some extent because it can bind to the iron and render it less absorbable.

                                Don’t drink coffee or tea around the time that you’re consuming iron supplements or an iron rich meal because that will decrease iron absorption. If you’re taking a medication to lower acid or a bile sequester or something that’s going to lower iron absorption, try to take that medication away from your iron supplements, iron rich meal, that type of thing if possible. Or better yet, if you can fix the underlying problem, fix it. Why are you on a PPI for 20 years? Maybe that’s something that needs to be looked into.  So the when you take it and how you take it is very important. And then fixing the underlying problem, like are you a celiac patient that is going to chronically be low in nutrients if you don’t just get on a gluten-free diet or whatever? So that’s crucial. Was there anything that I left out there? Oh, some people get low in copper and that copper deficient anemia can cause iron deficient anemia too, which is becoming more well-known as people talk about it more. But in some cases people will need to take some copper with or in lieu of iron to help absorb iron better because if you’re low in copper, you’ll become low in iron.

Dr. Weitz:            Which is why I think you see some combination iron products designed to help improve red blood cell production. Include copper. Usually they throw in some vitamin C. Usually they throw in-

Dr. Sutton:          Yeah, I forgot to talk about vitamin C. But yeah, vitamin C will increase iron absorption. You’re totally right. That’s a great point. I have tried the products that have copper in them that Hemo-Lyph doesn’t have it in it, and they caused more problems in people. And then I tried it on myself and I had problems and I was like, “Forget about it.” But you have to find what works for you. And then taking vitamin C around the same time or eating vitamin C-rich foods, that’s a well-known way to increase iron. And then NAC can also do that, so N-acetylcysteine. If you take NAC around the same time as iron, then that can increase iron absorption as well.  And then just, I mean, I think really eating as much iron-rich food as possible. The best way to get your iron levels up is through your diet, you’re going to absorb that the best. And then it’s just a matter of if you’re a vegan or a vegetarian, are you willing and able to eat more iron in your diet that’s absorbable, which is probably going to mean veering away from that vegan vegetarian diet? And some people do that and other people are not willing to, and then you just try to walk the line. But it’s certainly can be a challenge for a lot of people, mostly women, mostly women in childbearing years because they’re menstruating. Postmenopausal women tend to not have as many issues with high low iron. And that’s where you see a lot of hemochromatosis women that say, “I have been low in iron. I can’t be high in iron.” I was like, “Well, yep, you’re not menstruating anymore. Sorry.”

Dr. Weitz:            So let’s go into high iron, which is I think fascinating topic. I had no idea there were as many people who have problems with high iron. And you mentioned in your book that at least 31% of people have at least one of these hemochromatosis genes, and that’s only referring to two of the genes, and there’s a third gene that’s usually not even mentioned. So we probably have more than 30% of the population as a propensity to absorb and store more iron.

Dr. Sutton:          Yes. Yeah. Have you started looking for high iron more or looking iron labs more?

Dr. Weitz:            Yeah. In fact, I just recently had a woman and her daughter and the mother is a vegan. She’s not a lifelong vegan, and her iron was sky-high, so were her hematocrit and hemoglobin. She was shocked and nobody even looked at that for her.

Dr. Sutton:          As a vegan, so does she have those genes?

Dr. Weitz:            We didn’t check the genes. I asked her to send me her 23andMe, and she was having a tough time getting the raw data because 23andMe is having all these problems with being hacked. Everybody’s getting hacked. So I don’t know, but her daughter also has a propensity for storing iron.

Dr. Sutton:          Yeah. Then statistically speaking, there’s a good chance. And you have to rule that out because the question is, why is this happening? And so yeah, that’s interesting. But yeah, as clinicians really start looking more, I think their eyes open to like, “Oh, this is a common problem that maybe hasn’t been on my radar and I haven’t really been looking at it properly.” And so as a clinician, it’s kind of like to me an easy fun thing because this is easy. And we get to catch something that could really damage your health and even your family’s health if you have that gene. And we get to catch it hopefully before it does. Or if it has already created issues like, “Well, we get to work on the steps to help support your health so that you get better” and you don’t have to actually find answers rather than just more diagnostic codes and more medications.

Dr. Weitz:            You [inaudible 00:26:02] complex the problem is this. I have an eighty-year-old woman who was having fatigue and her red blood cells and hematocrit were low. So the doctor right away said she needed iron, but he couldn’t put her on any iron because he had to send her to a hematologist. And that took months to get an appointment. And so I just put her on some iron and her iron came up, and then I realized her iron shot up really high. I looked back and I had her bring in her labs. For a while, she had a keratin level of 1,200 and nobody was seeing anything. So this is somebody who has a propensity to store iron. And now she’s had lower iron and nobody asked why. So we just did a stool test and she’s losing iron in her stool. So there’s an underlying problem. And this is, I think, the real message of functional medicine. Let’s search for the underlying cause and not just treat the symptom.

Dr. Sutton:          Yeah, totally. It would be interesting that ferritin could also be high from inflammation. That’s where you have to look at the full iron panel. I think we talked about that last time, but I’ve slept since then, so I will not go back to that. I’ll focus on the task.

Dr. Weitz:            Okay. Yeah, so let’s talk about… so we have a patient with high iron, and so the options of things to do involve therapeutic phlebotomy, changing the way they eat. And then you go through a bunch of supplements. And some of those supplements, you also have some great clinical pearls that I want to mention when we go through them.

Dr. Sutton:          Yeah. Do you want to start with the therapeutic phlebotomy or do you want start-

Dr. Weitz:            Sure.

Dr. Sutton:          Okay. So in the Iron Curse, I have the Iron Curse protocols, which is basically like five steps that you can learn about and use to help lower iron regardless of if it’s hereditary hemochromatosis or iron loading anemia, like a hemolytic anemia or a thalassemic anemia. If you have high iron and you want to lower it-

Dr. Weitz:            By the way, for anybody who doesn’t know what Dr. Sutton just said, that thalassemia or hemolytic anemia means you have some condition where your red blood cells are breaking apart and spilling iron.

Dr. Sutton:          Exactly. Exactly. And so those people can have low red blood cells, but be high in iron, and that’s called an iron loading anemia. So thank you for clarifying that.  So step one of the Iron Curse protocols is remove blood if you can. Not everybody can remove blood. So for example, if you have low red blood cells, low hemoglobin, you don’t want to remove blood because you’re anemic and you will only become more anemic if you remove blood.  By the way, I’m seeing this a lot. People are coming to me and they have low ferritin and their person they’re working with is telling them to go donate blood to help mobilize the iron, and then their health crashes afterwards. I don’t think it’s a good idea to be donating blood if you have a low ferritin. I think that’s counterintuitive. And there’s a reason that people’s health crashes after that because now you were already struggling and now you just made it worse. So as long as we’re talking about donating blood, I just felt like I needed to put that little pearl in there. There is a school of thought out there.

Dr. Weitz:            [inaudible 00:29:45]-

Dr. Sutton:          There is a school of thought out there that… And I’m having more people coming and asking me about this, and I’m like, “I have no idea why you would donate blood when you’re low in iron. That doesn’t make sense to me.” And the proof is in the pudding, tasting of the pudding, and you felt worse afterwards. So there you go. It wasn’t a good idea.  Okay. But donating blood for people with hemochromatosis or not even donating blood, just removing blood. So if you have hemochromatosis hereditary hemochromatosis-

Dr. Weitz:            What’s the difference between removing blood and donating blood?

Dr. Sutton:          Okay. So if you go to a hematologist and have a blood removal, it’s basically the same thing as if you go to the blood donation center and have a blood removal if you donate whole blood. The difference is the advantage to the hematologist is that they can remove as much as they want, they can remove more or less. The hematologists are also much more specific about testing the full iron panel and the CBC before removing blood. Whereas if you go to the blood donation center, they’re not looking at the full iron panel, they’re just making sure like, do you have enough red blood cells in hemoglobin? If you don’t, they won’t let you donate blood. So the hematologist is just looking at it more specifically for hemochromatosis patients, which is why it’s really a better option.  The downside is, as you mentioned, it’s hard sometimes to get into a hematologist, especially if it’s your first visit. It’s also much more expensive. If you don’t have a great healthcare plan or haven’t met your deductible, it’s going to cost a lot more. Whereas if you can donate blood, that’s free. But if you have some type of an STD or you’re taking a blood thinner or there’s some reason you cannot donate blood, then you can have blood removed to lower iron either by going to the hematologist and having them do it and then disposing of the blood, or getting a doctor to sign a form called a therapeutic blood phlebotomy form. And that allows the blood donation center to remove blood, and then they just dispose of it rather than give it to somebody else.  So it’s basically the same thing. It’s just if you go to the hematologist, it’s going to be more specific for hemochromatosis patients. Whereas the blood donation center, they’re not treating you, you’re a good Samaritan removing blood unless you go with that signed therapeutic phlebotomy and then they’ll remove the blood and throw it away. But you have to have a doctor sign that. They also-

Dr. Weitz:            What if you have a vampire doing it?

Dr. Sutton:          Yeah, I haven’t researched that. I’ll have to look up vampire on PubMed and hemochromatosis.

Dr. Weitz:            Sorry to throw you off.

Dr. Sutton:          But I bet it would work really well. But then you have the risk of an infection in your neck and you might have to take antibiotics because of the wound from the fangs.

Dr. Weitz:            Oh, yeah, there you go. Thanks.

Dr. Sutton:          So donating blood, removing blood, whatever, that’s going to quickly lower iron because there’s a lot of iron in your blood. And so when people first get diagnosed with hemochromatosis, whether it’s hereditary or non-hereditary, because diagnosis is so poor, they often are really sick. Their ferritin is over a 1,000, sometimes over 2,000 or 3,000. And then they go to the hematologist, which unfortunately it takes forever to get in. And usually, they’ll have blood removed if possible and they’ll try to remove blood as frequently as possible. So if you go to the hematologist, they can remove blood more frequently. Whereas if you go to the blood donation center as just a donator, you can only remove blood like every six weeks unless they sign a form. Your doctor signs a form that says you can go more often in a two-week interval or whatever.

                                But regardless of how you’re getting that blood removed, at some point in time, if your iron’s really, really high, you will be limited by getting the lower iron by not being able to remove more blood. Because at some point in time your iron’s still going to be high, but you’re going to become anemic because you just removed so many red blood cells and hemoglobin, but you still have so much iron stored in your body. And then you have to wait, well, this is without step 2, 3, 4, 5, you have to wait for your hemoglobin and red blood cells to come back up before you can remove blood again. And so because blood donation is like the primary tool used by hematology and they’re not using these supplements, they talk about don’t take vitamin C, don’t take iron, things like that, but they don’t really dig into using the supplements, which I think is a huge disadvantage to their patient population. And I hope that my book helps to change that.  So anyways, blood donation is a very useful way. I think it always needs to be used in tandem with diet, supplements, lifestyle. If you go to the hematologist, they’re probably just going to be using the blood donation. In some rare cases, they might use a pharmaceutical chelation, which they have a lot of side effects. And the research that I put in my book shows that the nutrients actually work better without the side effects and have positive health promoting side effects, health promoting benefits. So-

Dr. Weitz:            Let’s go through some of those nutrients.

Dr. Sutton:          Okay. So the nutrients are, the most common one that I use is curcumin because it’s anti-inflammatory. I’m a chiropractor like you. A lot of people, my hemochromatosis patients, have a lot of joint pain from high iron and other reasons too, but part of it is the inflammation from the iron. And so the nice thing about the curcumin is that it can lower iron, but it also decreases inflammation and can help with some joint pain related to that. And then the patient feels better. That gives them… Because some of these people-

Dr. Weitz:            Curcumin is an amazing supplement. If you look at the anti-cancer properties, the brain protective, heart protective, curcumin is an amazing supplement. So it’s definitely one of my favorites.

Dr. Sutton:          It is one of my favorites. As a low iron person, I wish somebody would invent a curcumin that lowered inflammation without lowering iron. But I don’t think that exists. Because I have Crohn’s and even I’ve had a gastroenterologist say, “Curcumin is great for that.” In fact, I remember the conversation vividly, it was years ago before I wrote the book, he was like, “Curcumin is great for inflammatory bowel disease. For some reason it lowers iron, but we don’t know why.” I’m like, “Well, actually we don’t know why it binds iron, but that’s okay. It’s still good information.” So yeah, curcumin is a great one.

Dr. Weitz:            And one of the clinical pearls, actually, I’m going to mention two clinical pearls that you just happen to mention that I’m not sure everybody’s aware of that is really interesting is turmeric can cause kidney damage, but curcumin does not. So the patients who come in and say, “Well, I’m taking turmeric,” I usually inform them that turmeric is very poorly absorbed and even curcumin is not absorbed so we have to use a specialized form of curcumin. But that’s interesting that turmeric can have some possible other side effects, especially if you’re trying to use it at a high therapeutic dosage. And number two, you mentioned that curcumin interacts with tamoxifen and can increase its efficacy in the treatment of breast cancer and can even prevent, tamoxifen, cancers from growing and reduce the toxicity of tamoxifen. And tamoxifen is an estrogen-blocking drug often used as part of a protocol for patients being treated for breast cancer. So extra benefit of curcumin.

Dr. Sutton:          Yes. Yeah, that’s great. I forgot about those little things. Good job.

Dr. Weitz:            And to reduce iron, we have to use a relatively high dosage of curcumin, correct?

Dr. Sutton:          Yeah. I mean, I feel like the most common dosage I see for that type of an equation is a 3 gram a day, which most the curcumin that I use is 500 milligrams per pill, which is a-

Dr. Weitz:            Which one?

Dr. Sutton:          I use… So it’s Epigenozyme, which full disclosure is my brand, but that’s Epigenozyme Inflam-Redux Turmero. And I use six pills a day of that for if it’s like an acute situation. Whether it’s acute pain. I really like to have an iron panel on anybody I’m putting curcumin on because I don’t want to cause them to be anemic. If they’re anemic, I’m probably not going to give them curcumin even if they’re in pain and it’s inflammatory pain because I don’t want to create a problem. Let’s figure out how to fix this without causing another problem. But for a high iron person, 3 grams a day, which is about six pills a day. Now one limiting factor is in some people it can cause some loose stools. And so sometimes you just have to dose up to your bowel tolerance. Spreading it out throughout the day helps and taking it with meals can help as well.

Dr. Weitz:            Do you take it after the meal, with the meal, before the meal?

Dr. Sutton:          I would say with, with the meal, because the meal is where the iron is, and so it’s going to have the biggest effect there. It’s also less likely to create gastric issues, if so.

Dr. Weitz:            Okay.

Dr. Sutton:          So taking it with a meal is a good idea. And then I just wanted to add, the reason that turmeric causes kidney issues in some people is because it’s high in oxalates, whereas the curcumin is not high in oxalates. When you’re doing something therapeutically, it’s really important to make sure that you are consistent and you’re able to measure what you’re doing to know if it is or is not working. And so while if a patient just wants to do turmeric, it’s like, “I don’t know how much turmeric you’re taking on a daily basis in your diet.” I’m not saying don’t eat turmeric. There’s a lot of good things about turmeric. I just don’t think if you’re going to be using curcumin therapeutically to turmeric as a good option, just for the same reasons you mentioned, so yeah.

Dr. Weitz:            And the next nutrient you mentioned in your book is silymarin from milk thistle.

Dr. Sutton:          Yeah, silymarin’s great too. So before I say anything about silymarin, I think it’s worth mentioning that there is some research that shows that silymarin, curcumin, some alpha-lipoic acid, some of these iron binders, they have been shown to decrease stored iron in the brain, the liver, the spleen. I think that’s really valuable information. I don’t really have this problem with my hemochromatosis patients, but I have seen on a lot of the Facebook groups, like people that say, “Oh, I have this joint pain and my iron levels are normal.” And it’s like, “Well, either you’re not fixing the underlying cause of the joint pain. It could be something else. It could be rheumatoid arthritis. I don’t know. You’re not my patient. I don’t know what’s going on with you.” But really adding that curcumin helps with a lot of unresolved joint pain in these hemochromatosis patients because I think it’s getting the iron out of the joint.

Dr. Weitz:            That’s fascinating. And we also know that amyloid plaque, one of the reasons why it’s laid down in the brain, which is related to Alzheimer’s disease, is to protect the brain, the neurons, against heavy metals. And too much iron can be a heavy metal that can damage the brain, so…

Dr. Sutton:          Mm-hmm. Yeah. Yeah. So that’s worth knowing. And then silymarin, it also binds to iron. Well, curcumin is very good for the liver. silymarin is particularly one of its better attributes if an herb can have an attribute, is that it’s really good for the liver. So silymarin is the extract from milk thistle. So because hemochromatosis is quite ruthless and unrelentless to the liver, it is very nice to have something that will both lower iron and protect your liver. It is in the ragweed family, so if you’re super allergic to ragweed, then it might not be your best option.

Dr. Weitz:            You also point out, another clinical pearl, that silymarin, this is for men, can increase the number of sperm, and we know sperm counts are going down. And it can reduce BPH, benign prostatic hypertrophy. I didn’t know that. So that’s another…

Dr. Sutton:          Yeah. Yeah, that’s good. I forgot a lot about these clinical pearls honestly. There’s a lot in this-

Dr. Weitz:            There’s a lot of them.

Dr. Sutton:          There is a lot in this book.

Dr. Weitz:            You threw in there and I was like, “Whoa!” 

Dr. Sutton:          I know. I need to go back and read it, but honestly I never want to read it. I’m so tired of looking at it, so thank you for helping me remember.  Okay. And then the next one is quercetin. I do use a lot of quercetin. Quercetin does not bind to iron, but rather it increases hepcidin, which lowers iron absorption. The problem with people that have hereditary hemochromatosis is that they do not have enough hepcidin. They’re naturally low in hepcidin. That’s what the genetic change does to their body. That enzyme that makes hepcidin, it just makes less hepcidin. So if you take quercetin, it can boost the hepcidin production and decrease iron absorption. And then quercetin just has a lot of other wonderful antioxidant health-promoting effects as well. Lowers histamines, so it can help with allergies. Quercetin-

Dr. Weitz:            You mentioned also in your book that one of the side effects of high iron can be mast cell activation and high histamine.

Dr. Sutton:          Right. Yeah. Yeah. So that’s a good one. And then of course with the pandemic, quercetin kind of got its heyday with it being a… It can help drive zinc into the cell.

Dr. Weitz:            Exactly.

Dr. Sutton:          And then there’s berberine. I don’t use as much berberine because we will talk about what berberine does. It also increases hepcidin. And there’s a lot of good research that shows berberine’s great for the liver and lowering cholesterol and the heart. However, I had one patient that she took berberine and her liver enzymes went high. And it kind of made me uncomfortable using the… I had to rethink berberine because if you have a hemochromatosis patient, their liver enzymes might already be high. Maybe you need to hold off on the berberine because if somebody has high liver enzymes already because hemochromatosis and you give them berberine, you might not know if their liver enzymes are going high because of the hemochromatosis or the berberine. So in my opinion, and this is a newer opinion, is if you have hemochromatosis and you want to lower iron, wait until your liver enzymes are in a normal range and you’re in a more managed range before you consider adding the berberine.

Dr. Weitz:            Just my clinical experience, whatever that’s worth, I use a lot of berberine. I love berberine, I use it for blood sugar lowering. It’s one of the few things that’s been able to reverse atherosclerotic plaque. Berberine is… I’ve not seen any patients who had an increase in the liver enzymes from taking berberine. Berberine is like a natural form of metformin.

Dr. Sutton:          Yeah. No, I love berberine. I’m not willing to take it off the table, but I feel like I needed to tell that story so that maybe berberine is not used at the very beginning. Maybe you wait until the liver enzymes are normal because then if it does cause them to go high… And I think this lady just had something else going on that was like-

Dr. Weitz:            Well, a lot of times patients are doing multiple things, you know?

Dr. Sutton:          Yeah, I mean she was pretty certain it was berberine and I couldn’t say otherwise. But there is some research that shows that berberine can increase liver enzymes, but then there’s other research that shows that it lowers it. So berberine is a great thing.

Dr. Weitz:            [inaudible 00:48:06]. Another clinical pearl in your book you mentioned berberine is useful for autoimmune patients because it suppresses pro-inflammatory responses to Th1 and Th17 and increases T-regulatory cells.

Dr. Sutton:          Oh, that’s great. Can you just read that chapter to me?

Dr. Weitz:            I always listen to my own podcast and my wife goes, “Why are you listening to yourself? “It’s because sometimes I find out stuff that we forgot to edit, and so it’s important.

Dr. Sutton:          Uh-huh. Yeah. It is good. I cannot listen to myself. And apparently I cannot read my own writing.  Okay. And then the next one is glutathione. Glutathione does not lower iron, however, it’s essential for everybody, particularly hemochromatosis patients because it protects the whole body, liver, brain, heart, spleen, pancreas, joints, everything from high iron and iron-induced damage. And it protects from ferroptosis, which is where high iron causes damage to the cells and then the cells die. So you know if you have high iron, you’re going to be low in glutathione. And then the best thing to do is to just supplement with extra glutathione. And I like the liposomal glutathione. That is liquid. So if you’re a pill person, the S-Acetyl L-Glutathione is a good option as well. What you don’t want to do is you don’t want to do N-acetylcysteine while your iron levels are high because that can increase iron absorption.

Dr. Weitz:            You mentioned a really high dosage of glutathione. I know the form of liposomal glutathione that I like, which is the Quicksilver one comes in 100 milligrams strength, and you mentioned taking 1,000 milligrams. So with that one it might be hard to get it up to that level.

Dr. Sutton:          10 pumps a day.

Dr. Weitz:            Oh, okay.

Dr. Sutton:          It’s not that hard.

Dr. Weitz:            Okay.

Dr. Sutton:          It might be expensive, but it’s not that hard.

Dr. Weitz:            Yeah.

Dr. Sutton:          Yeah. Yeah.

Dr. Weitz:            Good.

Dr. Sutton:          And in acute situations is where you need the higher dosage. As somebody gets into a more managed range, you can adjust and lower or remove as you desire. But if somebody has a high ferritin, their iron ranges are out of range, then that’s an acute situation and you are definitely protecting yourself from damage by taking extra glutathione.

Dr. Weitz:            That’s great. You mentioned CoQ10 and resveratrol as well.

Dr. Sutton:          Yeah, so CoQ10 does not lower iron. However, it’s analogous to glutathione and that it helps to protect from iron induced damage. People that have high iron tend to be low in CoQ10. And low CoQ10 not only make you feel bad, but it is really bad for your heart and your health. So that’s an important way to protect.

Dr. Weitz:            And there’s two forms of CoQ10 on the market, ubiquinone and the ubiquinol. Ubiquinol is much more expensive and is marketed as more highly absorbed. You mentioned that, another clinical pearl, is that the ubiquinol is actually better absorbed.

Dr. Sutton:          Yeah. In my opinion, and I think if you really ask some of these supplement companies and they’ll give you an honest answer, they’ll agree with me. Ubiquinol is a scam. It’s a scam. It’s a way to get people to pay more for the “activated form.” And the reason it’s a scam is because it’s, one, it’s not shelf stable. So they might put ubiquinol in that supplement, but it has converted to ubiquinone usually by the time you take it, okay? And if it is ubiquinol, then it will convert to ubiquinone in your digestive system because ubiquinol is not absorbed well in the digestive system. Ubiquinone, the cheaper stuff, is well absorbed. And once you absorb it, it will get converted into ubiquinol.

Dr. Weitz:            Cool. And you mentioned resveratrol. You mentioned in your book that it suppresses iron overload, induced heart fibrosis and improves cardiac function. I didn’t know that about resveratrol.

Dr. Sutton:          Yeah. Resveratrol for the heart and people with any heart issue. It’s also really good for the brain. But because if you have high iron, you’re more likely to have fibrotic heart, heart disease, heart failure, heart issues, resveratrol is very protective against that. It does not lower the iron, but it’s very protective against the iron-induced damage in the heart, which is valuable.

Dr. Weitz:            Cool. Great. Maybe you can give us one example of a patient that you were managing with higher iron and then we can wrap.

Dr. Sutton:          Okay. Well, yesterday I talked to a lady who I’ve had maybe four visits with her. She found me. She did, I think the Iron Curse workshop because I think she kind of knew she had some high iron issues that the doctors were not looking at. I don’t know how she found me or the workshop, but she took the workshop and she started using some of that information to make some changes. And what she did was really valuable is she got the genetic testing and the labs. She did the best she could. And then she made a couple appointments with me.

                                So she has one C282Y gene. The first appointment with her, she was still pretty high in ferritin. I might be on the numbers here, but I think her ferritin was in the 500s, but had come down from the 700s with the work that she had done, and she basically diagnosed herself. She wanted to talk to me for confirmation. Yes, she had a high iron saturation, like 55, and then she had a high ferritin, but nobody else cared. She figured out herself. And then she came to me and we just talked about it and she wanted my confirmation. I’m like, “Yeah, you do have a problem. You really do need a hematologist.” And she is in the process of trying to get one, but their finances are pretty rough right now for multiple reasons, and I don’t know if it’s going to happen.

                                So anyways, so what we did was she had kind of started a couple supplements, but you know what I’m talking about. People come in and they hear about something, and then they start it and then they hear about something else and they start it. And they’re just, by the time they come in, they have 30 different things and they have this bag, and it’s like, “Well, these are good in theory, but this isn’t what you need. If you just want to wing it, and a lot of these things, they’re kind of working against each other and the quality might not be there.” And so what we did was we just-

Dr. Weitz:            [inaudible 00:56:00] just combination products that have things that are good and things that aren’t.

Dr. Sutton:          Yeah, exactly. And so what we did was we tailored down her supplement list to more specifically her needs, which her biggest problem was not just the high iron, but she has an Alzheimer’s gene too and was dealing with a lot of brain fog. And so what we did, what she started taking was she started taking… I just saw her yesterday, so this is all fresh in my head, but I’m not looking at it so I might be wrong a little bit. She started taking a higher dose of curcumin. So I think she was taking two. We tried to put her on six, but she could only tolerate four. And then she couldn’t do the silymarin and she did not tolerate the resveratrol at all. It caused digestive issues, so we couldn’t do that. We put her on the quercetin and she got on a good DHA fish oil for her brain. She got on something called cognitive complete, which has a lot of vinpocetine and huperzine and ginkgo biloba. And that is really what fixed her brain fog, because that got more blood to her brain.

                                And then we did follow up labs, and she had come down to 150 on her ferritin using just the supplements. No, she donated blood once. She donated blood once and she took those supplements. And then she couldn’t donate blood again after that because her red blood cells were not in a range. That was really a good idea. And then she stayed on the supplements and on the lower iron diet as well. And the next time she did the labs, I think her ferritin was like 112, so it continued to come down. And we’re going to get another one. I just ordered more labs on her yesterday, so we’re going to get another one here soon. But-

Dr. Weitz:            Your goal for her ferritin, you want to see it where?

Dr. Sutton:          Well, she’s got one of those hemachromatosis genes and she’s postmenopausal. So ideally I’d like it to be probably below 60 so that she’s got a buffer to protect her from it going high. But 112 is exponentially better than 700.

Dr. Weitz:            Of course.

Dr. Sutton:          And it was going in the wrong direction. What we talked about yesterday, I guess this is why I wanted to tell this story now I’m realizing, is she was so appreciative because yesterday we talked about her granddaughter who is six years old and we were looking at her granddaughter’s genes in labs. Her granddaughter has a celiac gene, has a hemochromatosis gene, is having a lot of health problems. Her iron levels were actually normal, but she was low on vitamin D and low on B vitamins and had a high inflammatory CRP. So we talked about we really need to either get more labs to see if this girl’s a celiac, gluten-sensitive child or put her on a diet. She couldn’t afford the labs, and so they’re going to put her on the gluten-free diet. But here’s the reason that this is so important, is she was like, “I think God sent me to you because I needed to get better to take care of my granddaughter because her mother is an alcoholic that has a 40% chance of surviving the next year.”

Dr. Weitz:            Wow.

Dr. Sutton:          And now she feels good now. Her granddaughter hopefully will start feeling better soon, but she now feels good. She has energy, she’s clear-headed. She’s going to hopefully live a longer, healthier life and be able to take care of her granddaughter who desperately needs her. And so I guess that sometimes it’s not like that one person we’re helping, but the circle around them that is so meaningful.

Dr. Weitz:            Yeah, that’s great. That’s a great story.

Dr. Sutton:          Yeah. Yeah.

Dr. Weitz:            So tell listeners how they can find out about getting you books. You have some courses that are available.

Dr. Sutton:          Yeah. So the Iron Curse workshop is at ironcurse.com. And then if you go to christysutton.com, pretty much everything I have is there. And I have that Iron Curse workshop, which is me verbally going through everything as far as hemochromatosis, anemias, everything that’s in the book, and then just more kind of discussion.  And then I have other workshops. I have one on brain health, Alzheimer’s, Parkinson’s, cognitive decline. I have one on celiac, gut issues, one on age-related macular degeneration. I have one coming up on heart health. And then I have another one, oh, the MTHFR one, which is just methylation. And then I think I have another one, but I can’t remember. Anyways, they’re all at that website.

                                And then my books, I have my first book, the Genetic Testing: Defining Your Past to Personalized Health Plan, which is a decent book and a lot of people love it and my greatest critic, and I will call it decent. But if you’re looking into the hemochromatosis part, don’t go there. Go to The Iron Curse. The Iron Curse is, I would say, a really good resource for iron related issues. The first book has a lot of different genes. I wrote that a long time ago, and I think it’s an important piece of information. But if you’re interested in the iron piece, don’t go there. Go here to The Iron Curse book.

Dr. Weitz:            Awesome. Thank you, Christy.

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 appreciate it if you could go to Apple Podcasts or Spotify and give us a 5-star ratings and review.  If you would like to work with me personally to help you improve your health, I do accept a limited number of new patients per month for a functional medicine consultation. So many areas I specialize in include helping patients with specific health issues like gut problems, neurodegenerative conditions, 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. Please call my Santa Monica White Sports Chiropractic and nutrition office at 310-395-3111, and we’ll set you up for a new consultation for functional medicine. And I look forward to speaking to everybody next week.