Transcription
Is your hair getting thinner, drier, not quite the same since you've gotten over 40? And maybe you've been told your thyroid's fine, your hormones feel pretty good, and yet you're still losing a lot of hair. In fact, you feel like you're losing as much hair as the family dog. Well, it could be your iron. Have you checked your iron? I mean, have you really checked your iron the proper way? And that's what I want to talk about today.
You see, hair loss and iron, even suboptimal iron, they go hand in hand. But a lot of women are just getting a CBC, which is a complete blood count, and told it's normal. And I put normal in air quotes, but they're still losing a ton of hair, and not really sure what's going on. But the problem is you're not getting iron where it counts, which is at the hair follicle. And iron plays a big role in your hair follicle. So today I'm going to show you what's going on with iron. How do you test it? What are the symptoms? What are the causes? What do you do about it? And then I'm going to touch on at the end other reasons for hair loss. Because of course you can have more than one thing happening at the same time. So if you're over 40 and you're losing hair more than you're losing your patients, listen up. Let's get going.
First and foremost, symptoms of low iron. I I just want to jump in with that before we get into labs. Symptoms. Fatigue is a big one. Now, you might be thinking, "Fatigue covers so many things." I know. But here's some others. Shortness of breath. You notice that all of a sudden you go to walk up a hill and you're like panting. You go to run up your stairs, panting. Working out at the gym, you're like short of breath. And you're not at a high level. You're not on a mountain. You're you haven't like changed anything. Like, you know what I'm saying? You didn't go from, you know, being at sea to being up high and high altitude. You're just at your house. You're just at your normal gym. You're just at normal. And all of a sudden, you're like, "Why am I so out of breath?"
You may notice you're more pale. So, your skin is more pale. Or if you have a lot of melanin, then you may notice the palms of your hands when you pull down on your eyes. Those are that's the conjunctiva, more pale. Maybe your tongue is more pale. Your gums are more pale. Just enough that you're like, "That's interesting. I wonder what's going on." Again, hair loss, that's a big one. Dizziness, headaches, especially when working out. Restless legs, brittle nails. Yes, all of these could be an indicator of low iron. Iron is really important for a lot of things, but it helps is part of moving oxygen all around your body. So, if any of those symptoms have got you thinking, wait a minute, yeah, I have been having more of that lately, or I just thought it was getting older. I just thought it was part of pmenopause. It could be iron.
So, how do we test it? CBC is the first thing everybody runs. Complete blood count. This is where we look at your red blood cells and your white blood cells, which is great. If you are full-blown anemic, it's going to show up there. If you're fighting an infection, it's going to show up there. Now, if you're not fullblown anemic, but you're just like kind of low iron, it may not show up there. And a CBC is very cheap to run. and it's generally completely covered by insurance. And so that's the screener test. Now, unless you show up with any of these other symptoms or unless you show up with heavy bleeding, that's what you report to your health care practitioner. They may not run the additional markers. They may just stick with the CBC and go, "Yeah, it's normal." But we want to look a little bit more than that.
So, we want to look at again a full iron panel. But specifically, I want to look at things like feritin. Now, feritin is a marker, let's say, of like iron storage. And feritin tends to decline first when you're losing iron or your body is moving iron, like hiding iron. Feritin long has had a very wide reference range. The reference range, depending on the lab that you use, but on average, the reference range would be from about 15 nanogs per ml all the way up to 200. I'm not kidding. Which means I would have women come to me and say, "My feritin is 16. I was told I was normal." Well, 15 was the cutoff. Now, on the way other end of the spectrum, I've had women tell me, well, I was at 190 and 200 is the cut off, and I was told that was normal. I'm like, neither of those are normal. I mean, sure, they're in the reference range, but like, come on now.
So, I've long maintained that feritin should be much higher than 15. And here's what's interesting. The American Gastroeneric Association along with the American Family Physicians said, "Yeah, it should probably be higher than that." So, they changed it. and they made the guidelines to say above 45 is ideal. Under 45 and we're looking at an iron problem. Sometimes you will see less than 30 as an iron problem, but labs haven't caught up yet. So if you're using your regular old lab at your hospital, Quest LabCore, like the big ones, they will probably still be 15 when the guidelines are changing to be more like 45. This is a big gap because if you are between 15 and 45, that's not good. the that those two associations are saying, well, you probably have an iron problem. So, I think a lot of women I don't think I know a lot of women have been missed in their iron for decades and decades. And it's something I've long been saying when a lot of push back because I would see somebody with a fair of 16 or 20, 22, all the symptoms, they're super tired, they're losing hair, their nails are brittle, they have restless legs, they're weak, they're short of breath. We get them on iron, we get their iron back, we address the cause, and they're like, I feel so much better. Thank you. But yet, maybe their primary care pushed back and said, "I don't understand. Their CBC is fine. Their feritin is normal for that reference range." And it's so frustrating.
Now, we can add in other markers. You can check literal iron. The iron is part of the iron panel. So, we can see what your iron is doing. We can check something called a TIBC, total iron binding capacity. We can check what's called a percent saturation. And these just give us more data points to figure out what's going on with your iron. How bad is it? What else might we be looking at?
Now, there are other forms of let's say anemia. You could be B12 anemic. You could be folate anemic. You could be anemia of chronic disease. There are a lot of other forms of anemia. Oftent times you you hear people say I'm anemic or I was diagnosed anemic. I was told I was anemic. We sort of umbrella term generically the word anemia to mean iron. But do know that the word anemia does encompass other forms of anemia. You don't have to be full-blown iron anemic to have suboptimal levels of iron in your body. You could be less than 15. I have absolutely had people at a nine or a five or a four. God bless them. Like woof. Were they tired and were they losing hair? So, we start there when we're looking at a full-blown iron panel. So, make sure if you have any of those symptoms, you're kind of concerned about your iron, ask. Oh, the other symptom I didn't mention, bruise easily. I can't believe I forgot that one. Bruise easily. So, if you are having the shortness of breath, you're having the weakness, the fatigue, the hair loss, brittle nails, bruising easily, restless leg, even a faster heart rate, start to, you know, things that make you go, hm. Get your iron checked. Get the whole thing checked.
Now, let's talk about causes. What might cause you to have low iron? Well, obviously, if you're not eating it, if you don't eat meat, you don't eat iron rich foods, it's totally possible you're just not getting it in, especially if you're not supplementing or eating other types of food to help get more iron into your body if you are not absorbing it. So, let's say you have H. pylori, which is a a a bacteria that can live in your in your stomach and get in the way of absorption. Let's say you have celiac disease or you've had celiac disease and you just recently found out. Let's say you have SIBO, small intestinal bacterial overgrowth, ulcerative colitis, Crohn's, you just happen to have poor o overall absorption. You just don't absorb foods very well because your, you know, guts been a mess for a while and you're working on that. Well, that's a good reason. Your iron is probably pretty low.
There are certain medications that can cause iron to go low. So definitely look up like, "Oh my gosh, is it possible I'm on any of these medications that might block the absorption of iron." If you're taking iron at the same time that you're taking like fiber, for example, or calcium, then they those can knock each other out. They can block each other. Antacids are another great example. If you're taking ant acids, you know, at the same time that you're taking you're eating iron rich foods or maybe you're taking your iron supplement, you've got to be careful.
Now, another reason is bleeding, which is super common for women. Are you bleeding? Do you have heavy periods? Now, you maybe didn't have heavy periods growing up, but once you hit pmenopause and your hormones went chaotic, you're like, "What in the heck?" It is a gusher all the time. Or maybe you're having two periods in a month. So, your bleeding is expected. It's not like that heavy, but it's twice a month, and that's like, well, annoying for one, but two, that's a lot more blood that you're losing. So, you could be transitioning into low iron just because the shift in permenopause is causing you to bleed more. If you have hemorrhoids that are bleeding, like we have to get that evaluated because that's blood leaving your system. If you have ulcers, ulcers can cause bleeding. If you have certain chronic disease, you know, depending they can have low iron. Now, typically they have normal or high feritin, but we have something called anemia of chronic disease. And so this is why I mentioned earlier there are more than one types of anemia and we can't just blame everything on iron. We have to work it all up because it's also possible you have two things happening at the same time. You could have anemia of chronic disease and be iron deficient at the same time because you know your periods are heavy or whatever. You're vegan or vegetarian or you just found out you're celiac disease and shouldn't be eating gluten so your absorption has been bad for a while. So when we look at these reasons, do you know you can have more than one, right? You for sure can have more than one symptom. You can have more than one cause and this is why the lab part is important. This is why understanding why what's going on is is so critical.
Now how do you address it? Do you just take an iron supplement? Do you go get an iron infusion and get your iron up there again? Well, the answer is maybe. And it depends how low and bad things are. Also, it depends why it's low. So, first and foremost, we want to address the cause. If you are having super heavy periods, and remember, heavy periods can be due to permenopause like I mentioned, but they can also be due to fibroids or polyps or hyperplasia, you know, god forbid. So, we want to make sure I'm figuring out the why. Why are you bleeding so much? If you're bleeding out the other end, I'm like, is it hemorrhoids? Is there something else going on? Is it from your stomach? Do you have ulcers? You might want, you know, how's your stress been? Have you been like living on ant acids because your stomach hurts all the time? Is it because of malabsorption? I had a doctor friend of mine tell me recently that she got a bunch of blood work done, found out a lot of her nutrient markers were super low, iron included. Turns out she said, "I can't do gluten." She she found out this whole time, her whole life had no idea that she couldn't do gluten. And what happens especially in celiac disease is celiac disease will shear down and impact your intestines's ability to absorb nutrients. So instead of having these lovely flowy finger-like projections that like suck nutrients in so you can absorb them, they get sheared down. They're very flat. They're not like finger-like projections and then you can't absorb. So not only you're not going to absorb iron, but you don't really absorb much else. And the same goes for people who were like, "Yeah, ulcerative colitis, Crohn's, even significant IBS, irritable bowel uh syndrome." While it's not the disease part, you ulcerative colitis and Crohn's are called IBD, inflammatory bowel disease, IBS maybe is just so bad, so like so in so inflamed itself, so leaky that you're not absorbing any of these nutrients. So you can see like how, you know, Carrie, can I just go on iron? I'm like, well, maybe I but I have to figure out your cause first. And as usual, you can have two things happening at the same time. You could have three things. You could have hemorrhoids and you know, like, yay. And then you could have heavy periods, like what? And at the same time, you may find that you have like stopped eating iron rich foods. Maybe you used to eat meat, beef, steak all the time, and whatever reason, you've cut way back and you're not really doing that anymore. So you can see all of a sudden we can have an iron issue build up very quickly.
Now let's talk about other reasons because as I said iron is just one of them and I want you to be able to be aware. Yes, you're going to get a full iron panel. Yes, you're going to look at your feritin. Yes, you're going to make sure your feritin is above 45 for sure. But like what else could be going on? Okay, thyroid is a big one. Now I mentioned in the very very very beginning some of you are like my thyroid is fine. Make sure you do a full thyroid panel as well. So TSH, thyroid stimulating hormone, free T4 and freeT3. Free T3 is very, very important. It's what makes things go round. It does the thing. It's in the hair follicle saying make and grow the hair, activate, do it. So sometimes TSH is the only thing tested and then T4 will sometimes be tested and nobody really tests free T3 unless you understand how freeT3 works and the importance of it. So push for a free T3. So if you have even suboptimal thyroid, even if your TSH is normal, but your free T3 is low, you can have hair loss because the free T3 is the one that does it's the show pony. It's the one that does the things.
Other reasons, androgens, think of like testosterone, DHT, dihydrotestosterone, DHEA, which will turn into these things. These are the androgen family. And when you have higher levels, actual higher levels or perceived higher levels, guess what? At the hair follicle, you can have hair loss. Interestingly, you can have hair growth though in places you don't want. So, it can stimulate hair loss on the head, but hair growth on the chin or down the neck or on the upper lip. Like, who thought of this? Like, what? Okay. Yes, it's true. So, PCOS is the most common polycystic ovary syndrome. However, a lot of women head into pmenopause and their ratio between testosterone and estradile becomes off. They become more androgen sort of dominant. So, they're not PCOS just to the body. The body's like, "Whoa, where did estrogen go?" So, but there's a lot of testosterone left over and that can cause hair loss on the head for some women if their hair follicle is really sensitive. So do know these big hormone changes in pmenopause for sure can impact the hair follicle. Not everybody goes through these changes but like a lot enough that I want to bring this up this this change this perceived change because remember your testosterone may not decline at the same rate as your estrogen. You may have perfectly fine levels of testosterone as your estradile plummets. Well that's that's a big you know change between the ratio. So the body's like ah hair loss. sorry, you get hair loss and that's what can happen.
Now, another reason, of course, cortisol or stress usually takes about three months for that to happen. So, if you had a big stressor three months ago, you had a big project, you, you know, god forbid were going through a divorce, somebody was sick, you were sick, there was something major, moving, some big upheaval, change of jobs, whatever it was. About threeish months later, women start to say, "I'm shedding a lot." Like a lot, a lot. That's different than low iron. And two things can be true at the same time. You can have low iron and have gone through a major stress and like boom boom you have all this hair loss. So do know cortisol absolutely plays a big role in hair loss.
Hair products. Have you switched hair products recently? Have you moved or changed your water recently? Hair products. Changing hair products. Your shampoo, your conditioner, your mousse, your gel, your hairspray, your thick, whatever you've got. Maybe you're using a new salon. Maybe you're getting, you know, your hair done with a different person. Maybe you've moved homes and so the water in your old home was fine but the water in this new home is harder or softer or has more minerals or less minerals or you know whatever is on well water but you weren't on well water and all of these can impact the hair follicle hair follicle is like h this is a change I don't like this and you can have hair loss so evaluate that if you have any kind of decline in minerals minerals play a big role in the health of your hair follicle so make sure you're getting in enough minerals obviously we've been talking about iron but like you have a whole lot of other minerals that play a role in the like the health of hair also the health of nails right like we talk about hair skin and nails kind of together they they definitely work as a team so to speak.
Medications certain medications can impact hair loss the big one being of course chemotherapy but if you're like no I haven't had chemotherapy think of things like anti-depressants certain anti-depressants for example if you've recently gone on or shifted your dose of Prozac or Zoloft in noticed any hair loss, that actually can do it. If you've gone on or off or changed the birth control pill, that can do it. It's a big shift in hormone. Uh so that that could potentially change it. Even if you went off the birth control pill and had an IUD inserted or if you were on a certain type of birth control pill and they switched you to a different type of birth control pill, that shift in hormone can do it. Or maybe you're like, I don't want to do this anymore. You went off the birth control pill and started hormone therapy. That shift can do it as well. Now again the whole goal is like with these shifting the fair follicle will calm down but sadly the hair follicle does not work at the speed of light. It doesn't work how fast you would like it. You are probably type A overachiever. Get things done quickly. Your hair follicle is not. It it's it's definitely type B. Takes its time. So it's going to take some months to get over the change that has been happening.
Other medications are like steroids. Uh predinazone is a big one. So if you had to, let's say you got stung by a bee or you have an autoimmune condition and you had to go on a prennazone pack for something, anything that would have you on either a short or even a long course of steroids, it can affect hair as well. And then lastly, testosterone. So if you went on testosterone, maybe you went on a lot to start, it's possible it could shift that ratio I talked about earlier and can cause hair loss. So, if your prescriber jumped you into a lot of testosterone and you were like, "Oh my gosh." It doesn't mean you can't do testosterone. It just means you probably need a way lower dose to start and then sort of work yourself up because the hair follicles like whoa. I will also see this if women do testosterone. Like if you need testosterone and estradile and you opt just to start with testosterone, I will see hair loss a little more with that because again you shift that ratio in favor of testosterone over estrogen and then they'll be like, "Oh, I don't like testosterone. I got hair loss." I'm like, "Oo, you still might benefit and need testosterone, but we have to rethink the order that it is prescribed and used in." And some women, that's why they like do it at the same time or they'll start with estrogen first and add testosterone in second. So, just be mindful. Um, and again, I don't want to worry anyone with with testosterone because a ton of women go on testosterone and have no hair issues whatsoever. Um, however, if you are not that person, if you were thinking, "Nope, that was me. I went on testosterone, hated it, lost hair. Possible it was too much, possible it was the wrong order relative to estrogen and caused that kind of crazy shift in up in the hair follicle.
So hopefully that helps you understand hair loss and iron. You're going to ask for your ferotin to be checked. You want your feritin to be over 45. You're probably going to ask for a full-blown iron panel. What's your feritin and what is your iron? Your TIBC, your percent saturation. You're still going to get a CBC, complete blood count, because that's usually always the basic of what they run. You're going to look at causes. Is it possible you're not eating it, you're not absorbing it? You're bleeding a lot. Are you on any kind of medications or things that would block absorption? Like, what's going on that you don't have a lot of iron? Where's it going? And then it's not always iron. It might be iron for sure. It might only be iron. But now you're going to look at these other reasons for hair loss. Is it possible it's androgen issues? Is it possible it's thyroid issues? Is it your products? Is it your water? Have you changed hairdressers recently? Have you moved? Is it minerals? Is it stress? Is it the any of these medications that could do it? Have you recently started or stopped anything in the last three to four months that could bring on hair loss that you are not we're not anticipating?
Hair loss is a big deal. Remember that hair loss in especially in relation to stress. Hair is not seen as critical. I think it's critical. I am a big fan of hair. I'm a big fan of my hair on my head. Thanks to my father, I have very thick hair and I'm hoping, knock on wood, that I get to keep this very thick hair. But when there are major stressors, major changes to the body and the hair follicle perceives those big-time changes, hair growth is not the priority. things are going to get rerouted to other more important things like your heart, your bones, your your brain, your liver, like your organs. Like those are where the resources are going to get rerouted to. This is why people get so frustrated and I fully understand when somebody says, "Why can't I just grow hair?" I'm like, it's it's possible. It's possible because it's not a priority. The body is rerouting for survival. So, we have to address all of these things. we have to turn over all of these rocks and figure it out when it comes to hair. Hopefully that helps you give you a starting point where to ask your healthcare practitioner what to order, what to look under, what rock to look under, and then all the other things besides iron that it possibly could be because I know hormones feel like hurting cats. And that includes hair and iron and all the things that go with hair loss.