This is the tricky part. Iron deficiency actually
presents very similarly to hormonal fluctuations
and changes. Because especially for women in
our 40s, everything falls down to either burnout
or it's perimenopause. And one of the biggest
factors is an iron deficiency and anemia. That
sounds serious. And a number is not a number.
So just doing a set of bloods and saying, oh,
everything's in the black is not always desirable.
or optimal. If you're a woman in your 40s who's
constantly tired, struggling to focus or feeling
like your energy just isn't what it used to be,
then this episode is for you. Because for so
many of us, we're quick to blame hormones, stress
or the chaos of midlife. But there's one piece
that often gets overlooked and that's iron. Low
iron doesn't always show up as full -blown anemia.
Sometimes it looks like brain fog, breathlessness,
poor sleep, low mood or that feeling of dragging
yourself through the day, even when you're doing
all right. And in your 40s, with changing periods,
shifting hormones and busy lives, your iron source
can quietly take a hit without you realising
it. Today we're diving into this with Dr Tash
Morando, menopause lead and lifestyle medicine
specialist to unpack why women in their 40s are
especially vulnerable to iron depletion, what
symptoms you should stop ignoring and how to
rebuild your energy properly, not just patch
it up with coffee and sheer willpower. Before
we get into it, if you're finding value in these
conversations, please do like this episode, share,
follow, and subscribe wherever you listen to
The 40s Formula. It genuinely helps more women
like you find us. And don't forget, we created
a free guide packed with practical insights from
some of our incredible guests. You can download
our free ebook via the link in our show notes.
It's such an easy way to start making small changes
that actually move the needle. Hi, Dr. Tash.
We're so excited to welcome you back to the Fortin's
Formula. A two -timer. Thank you so much for
having me back. believe it's been two years oh
my gosh neither can we neither can we you're
one of our ogs and we're always grateful to you
for that thank you and congratulations and everything
you've achieved over the last couple of years
fantastic thank you so much right so we wanted
to get you back because the conversation we want
to have today is about iron and i feel like people
talk about it people hear from their doctors
oh your iron is low but i don't know if they
really take it seriously why do women need to
listen to this conversation today Fundamentally,
iron is our oxygen transporter system. I mean,
that sounds serious. It does sound serious. So
think of having a whole heap of taxis in the
body, taking that oxygen from the lungs all the
way from our head to our toes. And if we have
less of a transport system, we end up with less
oxygen. And if it's less oxygen in the brain,
we end up with brain fog, fatigue. issues with
cognition, we're going to feel more tired, you
may feel breathless, the impact on your gut health,
and also exercise tolerance reduces. I mean,
that one makes sense to me. You know, can't lift
iron with no iron. But the gut health, what's
that about? A lot of our neurotransmitters need
iron as a core factor for the enzymes to create
what is needed. And that's the conversation between
the gut and the brain as well, including dopamine,
adrenaline, noradrenaline, all of these. Which
is why for me, 70 % of the body's function is
in the gut. So we need to look after our gut
as well. Yeah. I never even connected though,
iron and the gut. I kind of have because, so
I do. suffer from low iron i am a meat eater
i you know i feel like i'm doing the right things
but every few months i'm like oh god it's time
for time for another iron infusion because something's
not right and then the only thing i can think
of is something's going on in my gut because
it's an absorption absorption problem and not
a lack of iron ingestion problem and this is
where when you break it down a low iron in the
body can be as a result of not having enough,
not absorbing enough, or you're losing more than
you can actually consume or have. That's what
I'm pretty sure is my issue, by the way. I think
I lose more than I could possibly keep topped
up. But what's the difference? I learned today
about the difference between on your blood work,
how low iron is going to show up, right? So there's
the ferritin number, there's the iron number,
and there's the transferritin. And these can
all be... put together, they can give you a different
equation, right? What are the differences in
those blood markers? So this is where it's important
not to just test one thing, right? Because if
we were only looking at hemoglobin, for example,
which is our anemia marker, it takes a long time
for that to drop. So think of ferritin as our
iron store. So we want that jar to be full. Otherwise,
what happens is as soon as that gets depleted,
that's when we end up actually being anemic.
So a lot of women will have an iron deficiency
sometimes even years before they become anemic.
But the symptoms can start when they're actually
iron deficient rather than waiting until they're
anemic. It's funny because a lot of the symptoms
that you mentioned, the brain fog, the tiredness
and the lack of sleep, that all sounds very similar
to perimenopausal symptoms. Now how, obviously
testing is, is that the only way that they can
figure out whether it's perimenopause or if it's
an iron thing? Are there other signs that might
kind of help guide as to what's going on? This
is the tricky part because especially for women
in our 40s, everything falls down to either burnout
or it's perimenopause. Whereas for me as a family
physician, first things first is we rule out
organic causes. We don't just assume. Because
iron deficiency actually presents very similarly
to hormonal fluctuations and changes. But if
we don't correct the iron deficiency or the anemia,
There's no amount we can do from a hormonal management
point of view to have that patient feeling as
optimized as possible. So it's really important
to look at other things that could be causing
it. And one of the biggest factors is an iron
deficiency and anemia. Have you had a patient
whose iron was the problem, you corrected it
with an iron infusion, and they had relief of
those symptoms? Is that a common pathway of treatment?
So a low iron level, yes. Anemia, yes. It doesn't
mean they automatically need an iron infusion.
Because iron infusion is a medical treatment.
So it needs to be for the right person at the
right time. So who would the right person be
and what is the right time? What is the right
time, sure. So this is where we have to look
at the person as an individual. Is this, as I
mentioned earlier, is this an absorption issue?
Is this, are they losing more than they can actually
keep up with? And what is their tolerance to
actually first -line treatments, like looking
at the nutrition piece, which usually comes under
maintenance, but it's also oral supplementation.
Because a lot of people don't tolerate oral iron.
So you end up with symptoms like nausea, constipation,
and not forgetting black stool. Yeah, that's
what pops in my head. Which is manageable, right?
It's just something you notice and we just let
someone know so they don't worry about it. Yeah,
you don't freak out. It's like eating beets.
You're like, oh, I'm dying. No, it's just beets.
So it's really looking at tolerance and then
looking at numbers. And a number is not a number.
So you've got your reference range, which a lot
of the times is just far too big, for example.
So just doing a set of bloods and saying, oh,
everything's in the black. is not always desirable
or optimal. So we have to be clear with that.
So we were speaking earlier about ferritin. Ferritin
is a marker of iron store, right? And that's
really, really important. But if you look at
it from a reference range point of view, for
it to be low, you're looking at something like
15 or 20, depending on the reference range you
use. So depending on the reference range, right?
Whereas to really... optimize it we want that
number to go above 50 to 70 i've now changed
my tune where i'm even looking at over 80 to
100 see that really that is such a big difference
yes can you explain to our listeners why the
reference range and the optimal range is so different
and it's a hard one because labs have their reference
points because it's looking at a population level
and looking at sort of the norms of that. But
each person is different. If you're pregnant,
there are other things to look at, right? The
dilutional effect. When you're in perimenopause,
going into that late perimenopause -menopause
transition, especially with heavy bleeding. you're
losing a lot of iron you're losing blood so how
do we then stay on top of that so that the symptoms
that are coming from an iron deficiency iron
deficiency anemia and the anemia is usually a
later stage plus your perimenopausal symptoms
so it's very tricky how about for women with
endometriosis typically accompanied with heavy
bleeding is that do you see more iron deficiency
or functional iron deficiency in those women
The difficulty here is in endometriosis, there's
significant inflammation. Ferritin is also what's
called an acute phase reactant. So it goes up
in inflammation because the body is trying to
retain its iron stores. So the ferritin shows
up as high. It's showing up as high, but is it
actually high? Exactly. So this is where we couple
it with an actual inflammatory marker, which
is CRP, to see is this... a true depiction of,
oh, I've actually got really good or extra iron
stores, or is this inflammation related? So we
have to look at that overall picture. So we could
be misleading, is what you're saying. For women
with endometriosis, their ferritin number might
not be telling the whole story. And it's just
inflammation in general. And as we age, inflammation
is part of that. So that could be someone who
might have arthritis or any other forms of inflammatory
conditions. Yes. could have a normal looking
ferritin, which isn't actually normal. Or even
a higher ferritin. And that's what we usually
see is a raised ferritin from a reference range
point of view. But then we need to decide, is
this a true depiction of ferritin or is this
an inflammatory process? Is this a general sort
of across the board thing? Or is this a... What
I'm trying to say is if a woman went to her...
standard gp um you know who sees i don't know
20 patients in a day i don't know it's 20 a lot
20 yeah any test doctor says no i'm like that's
insane no you're right there's a big difference
between seeing 40 60 patients a day versus you're
really looking at precision medicine yes right
really looking at the person sat in front of
you N equals one. How do I get this person optimized
for them as an individual? And that's the difference.
Standard panels may not include things like ferritin,
which is why it's important to look at that bigger
picture. That's also the other reason we shouldn't
be just going and getting blood test panels,
looking at the results, going, oh, everything's
in the black. I'm good. But why do I still feel
so? crappy yeah because that's the big thing
in the u .s now right there are all these services
now offering ad hoc blood work so you just you
order it online they i'm not sure exactly how
they do it i guess you go to a lab and get it
drawn but the point is like it's it's a middleman
service with no physician So you get results.
No, exactly right. So it's like you just get
all these reference range results and you're
just left kind of, I don't know, chat GBTing.
I'm not sure what they do with them, honestly.
But again, this is where AI definitely plays
its part. And I'm a huge advocate for my patients
taking charge. looking at things and going but
why yeah because that's what we need to get down
but why the but why the root cause of the problem
yeah and how do we how do we actually manage
it so i actually enjoy patients coming in and
saying actually i have chat gpt this and this
is what it says great let's look at it together
how do we break it down even further because
80 is the history yeah right we can do every
test under the sun yes however The person sat
in front of us knows themselves better than anyone
else, and it's that listening bit, which is also
the fun part. Yeah, it is. And I think with chat
GPT or just AI interventions generally, I think
you're absolutely right. I think it's a way to
empower yourself with the next question. I think
that's the best thing about chat GPT or whatever,
is that they prompt you for what you then might
want to ask, and you're like, oh, I should know
this. But what you were just talking about, for
example, the interplay of inflammatory markers
and iron. That's something that is, you need
a physician, you need a professional there to
even suggest that level of nuance. And then when
you know the questions to ask, you get better
information. Exactly. And it's also finding that
right person who's thinking in that 360 way.
Yeah. Right. As I said, yes, women in their 40s
and older. It's not just about hormonal shifts
and changes. I know that's coming from me. But
it's also looking at the bigger picture because
we can so easily miss things. And the two big
ones for me, it's an iron deficiency plus or
minus with an anemia, which is where then the
hemoglobin is dropping as well, which then has
this more of a systemic effect and symptoms.
and thyroid dysfunction. So these two, we miss
these two, and then other vitamin deficiencies,
including vitamin D, B12, folic acid. These are
things we can correct. They're organic causes.
Correct that. It might not be the only factor,
but at least you're looking at root cause issues
and moving on from there. Yeah, you're not left
wondering so much. Are you seeing then there's
an overlap between these conditions when you
are presented or when a female who's in her 40s
comes to you? And, you know, it's not just the
perimenopause and it's not just the thyroid and
it's not just the iron, but it's kind of like,
actually, I'm really sorry, but it seems to be
everything. And that is predominantly what we
see. And that's the beauty of being a practicing
clinician is I'm seeing this day in and day out.
So you're looking at. data points you're looking
at trajectories you're looking at that bigger
picture and coming up with the plan for that
person sat in front of you and that's going to
change from person to person but you're constantly
learning and then you're looking into the research
you're reading up you're finding ways and a lot
of women don't tolerate oral iron but it's finding
we have various options so it's how do we find
what works for you And if it's not something
that's working, then we have the option from
a medical management point of view to utilize
the iron infusions. So does that mean that men
tolerate it better? We don't need to use it as
much in men, right? Because they're not bleeding.
But yes, I mean, this is where actually, and
also from a hormone point of view, that's why
if you look at a standard reference range, even
for hemoglobin, The reference range is higher
for men. And this is very much hormonally driven.
Interesting. I never would have thought that.
I would have just assumed that women needed to
be higher because, oh my God, that's, wow. Mind
blown. All this talk about reference ranges and
ferritin and hemoglobin and stuff. What would
you say to the listener? And we get this patient
a lot, which is why I'm asking, I know this person
exists in volume. That's like, oh, you know,
I want to come in and tell you about my symptoms,
but I don't want to do all the blood work stuff
like, you know, or I had my blood work done last
year. So, you know, it's fine. Like how how would
you encourage someone to get more investigative
with their health? I think start with the history.
Right. Always start with the history. Then comes
the examination and then come up with the plan
together. Right. Look at. historical data because
you can see trends i love to see trends and i'm
you know hoping one day we have a full -on dashboard
that i can look at 30 years worth of data just
sat in front of me and yes we're working on that
but i think once patients are on board and they
see these trends and they hear it in a way that
makes sense to them they will be on board to
actually get what needs to be get needs to get
done at the end of the day it's about feeling
as good as possible forever That for me is gold,
quality of life. And that's probably what it
is, too, is that they need somebody to tie together
those pieces of their history so that it feels
relevant. Because if we just keep saying, oh,
you know, like, yeah, reference changes aren't
always correct. And, you know, you need to get
X, Y, Z on your blood work and make sure that's
all there. Then it's like people tune that out.
But when you're like, hey, actually, if you look
at the trend over, let's say, the past 30 years,
if we had that wonderful. And then this is how
you felt and this is how you changed it. Then
there's value. Exactly. And it's also about that
feeling. Right. You know when you feel good and
you know when you don't. Sometimes you can't
quite put your finger on the why. And that's
where then we go digging. Yeah. Would you say
that then women in their 40s are more vulnerable?
Is that like the most vulnerable time or does
it just vary based on time of life and what's
happening? And this is throughout our life cycle.
Right. Starting periods, depending on a background
of endometriosis. heavy bleeding, what happens
if you're pregnant, postnatally, if there is
bleeding there, nutritional deficiencies, then
coming into perimenopause, bleeding irregularities,
fibroids, endometrial polyps, especially with
the fluctuations in hormones that can happen.
And very interestingly, I was at the Aging Research
and Drugs Development Conference in Copenhagen
in August. And two PhD students presented a paper,
a poster, on looking at biomarkers, blood test
markers, that they looked retrospectively at
women in perimenopause and then postmenopause.
And they compared. So say there were over 100
biomarkers. Everything got worse postmenopause,
including inflammation, your blood sugar, cholesterol,
etc. The only couple that got better, iron and
hemoglobin. Ferritin is up and down because as
we get older, inflammation goes up, so that ferritin
can go up as well. But when we stop bleeding,
those two markers get better. Everything else
gets worse. Women expect the worst except for
you. Yeah, except it might not be anemic anymore,
so bravo. Oh, man. I mean, okay, this is a show
about iron, but I do have to ask, is there anything
that women can do for other markers to improve?
What would you say has the biggest impact on
overall improvement other than stop bleeding?
As a lifestyle medicine physician, I have to
talk about the six pillars of lifestyle medicine,
right? Number one is sleep. Got to aim and prioritize
that sleep. Quality, aiming for, I'm going to
say, seven to nine hours. However, I appreciate
how difficult this is. But it's about routine
and consistency. Number two is nutrition. Focusing
and prioritizing protein and fiber. Not forgetting
fiber. We're going back to gut health here, right?
Number three, movement. And that is key. It's
building muscle, building strength, resulting
in endurance. And that helps to reduce inflammatory
markers, reduces insulin resistance, gives you
a lot more energy, which means you can do other
things. But unfortunately, if you're not eating
right and sleeping sufficiently, you can't exercise
your way out of this. Also managing stress, having
the right group of people around you, not smoking.
I have to say not drinking, but again, it's looking
at really minimizing. And then not doing drugs.
I mean, I feel like you've just basically told
us everything that we need to know. We can stop
this conversation now. All I'm hearing is just
stay in the gym. Make your social connections
there. Won't be smoking or drinking alcohol in
there. So, you know, just stay in the gym. You'll
be fine. That's my strategy up to this point.
So Amanda, you know how I've been on this journey
about improving my sleep? Oh, you have been obsessed
about it lately. Well, I have found something
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That's saying a lot because you are really picky
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They keep me cool all night. Oh, and I've been
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over $50 ship free. And did you know you can
get your biggest ever discount, 41 % if you use
code TFF today. So head over to CozyEarth .com
and use that code TFF today. Right, so you mentioned
our favourite thing, which is protein and fibre.
And I think this brings us really nicely into
our next segment, which is called Fuel Your 40s,
and it's sponsored by The Meat Club. And The
Meat Club provides sustainably sourced... Protein
and produce. Yeah. Both. So you can get your
protein and your fiber in direct to your door.
And if you use code TFF20, you can save $20 off
your first order. And they actually have a question
for you. And that question is, from your experience,
how significant is dietary iron from red meat
supporting ferritin levels in midlife women?
And can women use food strategically to help
treat their iron stores long term? Absolutely.
Whole foods. As a lifestyle medicine physician,
I will advocate for, yes, predominantly plant
-based whole foods. However, it also needs to
be in a way that is sustainable for you. We also
need to think about planetary health, obviously.
Looking at it from animal sources versus plant
sources, when it comes to iron, you've actually
got heme iron. and non -heme iron. And the absorption
is very different. So if we're looking at it
from an animal -based, you're getting that heme
iron, which actually gets absorbed, broken down,
utilized, probably up to 30 % more, because it's
coming from the hemoglobin and myoglobin from
animal sources. You're looking at your lean meats,
seafood, as well as... poultry so does it does
it matter then how it's cooked and i'm wondering
like should i be eating a bloody steak or you
know could i have um you know a well -cooked
chicken breast you know like does it matter like
in terms of how you get your your protein or
where you get your protein from not where yeah
asking for the liver king right yeah should we
be eating straight beef liver or can we cook
it yeah this again comes down to gut health i
don't have a straightforward answer there are
people who tolerate meats cooked one way others
who do the other way But it's also looking at
the non -heme sources through your plant -based.
Because in order to actually digest and process
all your protein, you need to make sure you're
getting your fiber, right? We've got to protect
our gut. So being smart about it. Yes, everyone
talks about spinach. And as soon as I saw your
note about that, I went, oh, Popeye. That's always
posed into my head. It's like, you know, he downed
those spinach. Muscles up. But it's looking at
your... your legumes, your nuts, vegetables,
fruits, and also fortified cereals. But from
an absorption point of view, that non -heme isn't
actually giving us everything we need. So we
can be smart about it. So this is why it needs
to be sustainable. Think of having lentils. Add
some bell peppers. You're getting that vitamin
C, right? Have a kiwi after. And then when you're
also looking at things like tannins, your tea
and coffee, calcium -based foods as well, it
reduces the absorption. So this doesn't mean,
oh, you have to do this, you have to do that.
Do what is sustainable for you and make it count.
Be smart about it. We're all living really busy
lives. I now look at it as build your bowl plant
-based and then use your topping as your meat,
your fish, so your seafood and your poultry.
And do it in a way that works for you. I'm a
big bowl builder. We got bowls in the fridge
right now, actually. We do, we do. Waiting for
us. So it's funny, you mentioned tea and coffee.
Now, actually, one of the things when I kept
having depleted iron stores was I looked into
why could that be? And I was told that, you know,
tea and coffee does deplete. not deplete it um
it reduces the absorption that's right yes and
i was like oh that's interesting because after
i eat especially not so much in the evening but
sort of you know my earlier in the day meals
i will always have a tea and coffee afterwards
and i was like oh no i now need to change my
tea and coffee habit has it made a difference
No, because I keep. If I have done that, maybe
perhaps. I thought I didn't, you know, see it
through. I was like, I'll just get the infusion.
I mean, but the other part of this is also as
we age, we end up with changes in stomach acid,
right? So if you then take something to reduce
the stomach acid, that reduces the absorption
of iron. because we need our stomach acids for
the absorption side of things. Inflammation also
increases, which changes the gut health, which
means the absorption there, from a microbiome
point of view, changes as well. Stress plays
a huge factor, right? We're in a sandwich generation,
so you're managing aging parents and a lot of
the times young families. probably working full
time having to manage that managing home life
as well it's a lot and then have to think about
oh hold on i need to get my x amount of this
in my nutrition i need to make sure i add my
vitamin c i can't have this with this it's a
lot of processes so make it count for you as
an individual don't over complicate it I feel
like it is. I feel like life is complicated,
isn't it? It is and it isn't. You know, I feel
like this is something that comes up so often
in working with clients is that they're like,
oh, yeah, there's too many things to think about.
But I'm just thinking about what you just said
about lentils and a kiwi. OK, so let's say you
are vegetarian. You get a lot of non -heme iron
sources. You need to make sure you're absorbing
them fully. So you just have kiwis on execution
at your house. You have a bowl of kiwis. You
grab one before you leave for work every day.
like this doesn't have to be a whole freaking
thing it's like you learned this one thing now
i have kiwis on you know in a bowl at my house
and that's it and then that you just do that
forever meaning like it's not like oh next week
it's going to be bananas and then week after
that it's like no that will always have vitamin
c like from today until the day we die right
and if you are enjoying you know your non -heme
sources of iron you then just have that which
you know is a verified vitamin c source And make
it a habit. And then it's like you don't ever
think about that again. I think the barrier to
entry is often the first step and not the actual
execution because it's really not difficult.
But it's not difficult for us because we've been
doing it. It's now part and parcel of what we
do. Very true. It was absolutely an issue for
me even a few years ago. It is about that habit.
And then when you notice things getting better,
you're feeling better. So I normally break things
down into three monthly blocks because you can
never get everyone doing everything all at the
same time. It's mind boggling. So true. So choose
one, two, maybe three things at the most. Three
monthly blocks. Come back, reassess how you're
feeling. Do we need to do any actual physical
biomarkers to check, to show you that you are
feeling better? And oh, look, it's showing in
your numbers as well. you just mentioned that
yeah looking at your biomarkers oh you are feeling
better is that a thing then does someone come
in and say oh I feel fine you show them their
numbers and be like actually your numbers are
like ridiculous I don't know how you're you're
basically surviving the day and then they're
like oh I do feel shit and then vice versa and
I feel really rubbish but you're like wow but
your iron is optimal yeah yeah so do people see
their results and and kind of just Be like, oh,
I feel this way or I don't feel this way. Are
they influenced by this? Yeah. I think this is
also where we sometimes don't actually know how
good or not so good we're feeling. That's being
that intuitive, right? We also do take a lot
of things for granted. And I think we feel like
we have a lot more store than we do. especially
when we're juggling so many things yeah i can
imagine as a woman you're like no i'm fine you
know i i can do all of this stuff and maybe even
a high achieving woman like i bet she always
feels great you know yeah but it's also until
you feel better yeah yeah you won't actually
know where your starting point is because we
just get so used to doing and going And feeling
a certain way, we just think, yes, I'm functioning.
I'm doing everything I need to do. I'm performing
fine at work. I'm getting through my sports,
my exercise. I'm sleeping all right. But it's
that optimization piece, right? There's normal.
Yeah. And then there's how do we go for gold?
Well, you just said getting through. Like if
you, if every time you work out, you feel like
you're just getting through your workout. Like
I would argue that you're probably not optimized
in something. And it could be sleep. It could
be iron. But getting through is like. It's like
the surviving versus thriving. It's like, I don't
want to just get through my day. I want to feel
good. But it's feeling that difference, though.
A lot of us don't. And there are so many things
going on that you don't have the headspace to
actually sit and think, can I actually feel better?
Until somebody sits you down and has a conversation.
Look at the number. You can do better. Okay,
all right. All right, someone's come to you.
They are feeling shit. They're very aware that
they're feeling shit. their blood biomarkers
have confirmed that their iron levels are low
can they just eat steak and and start feeling
better instantly like how much time do you have
to give it to start to feel the effects of you
know like how long does it take for your ferritin
levels to come up if you were to go down the
nutrition route so whether it's having spinach
or whether it's having steak or having spinach
steak and kiwi together This again is very individual,
right? You're looking at it. So the red blood
cell, the turnaround of a red blood cell is 120
days. That's a long time. Yeah, that is. So this
is why we also need to look at when we do these
tests and checks. With ferritin, depending on
whether it's nutritionally and looking at topping
up that store. versus an iron infusion iron infusions
obviously work quicker yeah but it is a medical
management and i want to make this clear because
this isn't just a fad where you just go oh i
need an infusion let me go get it so you can't
just get a wellness trend yeah sorry i'll get
my iron infusion done this is about because there
are also you know there are reactions that can
happen as a result of it and if we just go and
get an infusion without a proper conversation
and knowing why we're doing it and then monitoring
and tracking after There can be side effects.
There can be issues that happen also in the future.
From a nutrition point of view, I find nutritionally
that is more from a maintenance point of view.
We need to look at the cause of why we don't
have enough iron stores. And if we're anemic,
correct that. We need to get to the root cause
of the problem. Once we've corrected it, we've
got our levels to a certain point. That's where,
for me, nutrition plays a huge part. I would
agree so much. I mean, we just had a client in
today, right? We were looking at her blood work
from July to now, which is November, the time
of this recording. And, you know, her iron was
slightly lower than it was in July. And she was
like, oh, well, you know, the week leading up
to the blood test, I didn't eat any red meat.
And it was like. It's not that it's like that
week without your red meat was not actually what's
doing that. You know, it's, it's a long, much
longer term. And again, she was, she was testing
the waters without supplementation was the whole
point from July to now. And so we said, if, if
it continues this downward trajectory, it's going
to be time to supplement. And she's like, Oh
no, it's just because I didn't eat any red meat
that week before. It's not that, you know? So
I think there is maybe an over connection, over
connection. Great. Between what I just ate and
what my iron levels are. And I think, When you
just said about it's really the maintenance solution
once the actual levels are topped up. But it's
first knowing what that level needs to be, right?
A lot of us will run a lot lower than we need
to be. And there's a difference between the amount
of activity you're doing as well. And research
shows an iron deficiency alone impacts athletic
performance. 100%. Right? You know that. 100%.
I know that. We do. Lifting while pregnant? My
iron's never been lower. For me, I needed the
medical treatment of an iron infusion after delivering
because compound lifting through pregnancy with
the increased blood volume followed by the blood
loss, no question. For me, that was a definite
and obvious thing that I needed, but I think
a lot of women can connect those three things,
activity, pregnancy, postpartum, blood loss.
It's looking at that bigger picture. So basically,
if you are exercising, working out on a regular
basis, you need to really monitor your iron levels.
It's funny, isn't it? Because you wouldn't, again,
connect. You wouldn't think, oh, my iron will
get depleted by exercising. No, you think I'm
like building it somehow. Yeah, like I have a
bigger muscle, so there must be some iron in
there. And also one of the other things you mentioned,
you were talking about reactions with the iron
infusions. I actually do. I get a rash. I have
to take antihistamines because I get a rash.
And one of my friends, she went in for an iron
infusion. I actually don't know what happened,
but she had some big, I don't know, looked like
burns, but black patches. Tattooing, yes. Oh,
is that a thing? Can you tell us about that?
Yeah, so this is, and this is why I said this
is a medical management. We do a lot of counselling.
before we send someone in for an iron infusion.
There's a lot of conversation. There's a doctor
on site. There are nurses watching. We do a little
test run. We make sure you're okay. And because
it can, that the iron itself can result in changing
the pigmentation of the skin, which may not go
away. Yeah. She was getting laser done to try
to remove it. Wow. Which is why I said we need
to have the proper conversations. There's a written
consent form, a discussion that comes with it,
and monitoring after. So who is then the right
candidate for an iron infusion versus actually
just taking supplements? Looking at it from an
absorption point of view, so are they actually
absorbing nutritionally? Yes. Are we able to
maintain? Yes or no. are they losing blood quicker
than they can actually supplement? A lot of women,
a lot of people actually don't tolerate oral
iron. You get that, as I mentioned earlier, the
nausea, constipation. So it's looking at all
of that, looking at the numbers, looking at the
symptoms, also looking at are they anemic? Because
the majority of, we're talking about women here,
will have an iron deficiency. for a long time
before it impacts the actual blood clout, their
hemoglobin. Because at times, if they are losing
that much blood, they may even need blood being
given back to them, right? Rather than just being
an iron infusion. Wow, so like a blood transfusion.
Blood transfusion. Wow. Okay, so this is where
we need to look bigger picture, right? And it's
a conversation. I have a lot of women who actually
sat there going, you need an iron infusion. They're
like, no, thank you. Fine. How do we make this
work for you? Oh, yeah. Right. I have others
who don't need one. And we're coming down the
door for it. So then it's going through the risks
versus benefits and deciding together for that
person sat in front of me. what is in their best
interest that's funny you know talking about
blood transfusion did you know i'm a universal
blood donor i didn't but my kids are oh negative
yeah so i made some which is great because i'm
not so my um so my husband and the twins are
b negative so that's obviously quite a rare blood
group and i was like okay well you know at least
You know, there's three of them. And then myself
and Kyan, my eldest son, are O negative. So I
was like, right, we can give to everybody, but
only the two of us can give to each other. And
now I know your kids are. Yeah, my kids. We have
a good supply over here. Should your patients
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you talked about anemia. How does that, how does
that show up in comparison or, you know? differently
to low ferritin like if someone had full -blown
anemia what would they be feeling like what would
they be seeing how is it different this comes
down to whether it's an immediate or acute anemia
because somebody's losing significant blood or
whether they have a chronic anemia okay chronic
means their level has been running low for a
long time And therefore the body has adjusted
and adapted. So very similarly to where you don't
know how good you can feel until you feel it.
Whereas others, when it's acute, meaning it happens
quicker, you go, ooh, yes, I'm feeling tired.
I'm not sleeping. Not just tired, it's exhaustion.
The brain fog that comes with it's very similar
to perimenopause. And it can impact the heart.
So you can feel shorter breath. can get palpitations.
By the time the skin starts to look pale, I mean,
your levels have dropped pretty significantly.
And I know we're specifically talking about iron
deficiency here, but this is something we can
correct then pretty quickly. This is very embarrassing.
But if you've heard this, then maybe it'll be
less embarrassing. Did you guys ever have, when
you were in school, the anemia test? Where if
you take a copper penny, this is now sounding
very American as I just said it. You put a copper
penny on your skin and if it leaves a mark, you're
anemic. Really? I'm going to try this. Any American
listeners, please somebody reach out and back
me up on this. But it was like a schoolyard trick.
It's like you do the penny and then it was like,
you're anemic, you're anemic. Like we even knew
what it meant. And also like that's even a thing.
How did that even come up in conversation? But
it was a thing. It was like a penny on the, again,
Americans, old Americans like myself, please
tell me you've done this or heard this. Is this
a thing or is it just like? the leggies you know
like oh you've got the leggies is that what it
was i think it's a fake thing but like how would
we even connect that to anemia like how would
we connect a copper penny and anemia that we're
gonna have to yeah this is gonna be like a snopes
.com situation i feel like i missed out yeah
i'm gonna try it out now that the penny's been
uh you know it's not being manufactured anymore
then look if it works that means i don't need
to have a blood test that's what i'm saying so
how valid is the penny test oh this completely
defeats our conversation today One of the things
that we like to do on the show is a little segment
called Hot or Hype. Now, we want to throw out
some trending topics or some things that we've
heard about. And we want to find out from you
whether you think it's hot or hype. Sure. All
right. So first thing is... Penny test. The penny
test. Hot or hype. Had to think about this. Well,
you're going to check in and let us know about
that one. What about beef liver supplements?
Can you use that as a natural iron booster? Hot
or hype? So I'm going to say hot, but with a
caveat. Okay. Purely because beef liver is actually
one of the most potent team sources you can have.
However, it's not something everyone enjoys.
No, yeah. And also we need to think of it from
an overall health benefit point of view, digestion,
absorption, gut health. and this is where that
supplement side plays a part for me a supplement
is to supplement not instead of right so it's
really looking at that so say you're vegetarian
you're vegan And then how do you really optimize?
But you still may not want to take a beef liver
supplement. Yeah, I mean, I guess if you're vegan,
you will. So that's where the caveat is, is absolutely
from a heme source point of view. My goodness,
the hemoglobin and myoglobin you get from beef
liver is fantastic. But it's very individual.
I wish I could eat it. I wish I honestly wish
I could take down some liver and just enjoy it.
But I don't. I get it encapsulated. No, encapsulated
for sure. But I mean, I wish I could eat beef
liver like my husband. Like he's fine with all
the organs, all the beef. Yeah. I just, I like
literally. I have, so I tried to get it, chop
it up and put it into spaghetti bolognese because
I thought that could be a way. But you still
taste it, right? It's still liver -y. I can taste
it. Yes. And you know, like I'm just, I just
don't like offal. I've tried, I've tried so hard.
I want to like it, but again, I can't. Particularly
liver because of that metallic liver -y taste.
It is, it's very individual. Yeah. If you've
grown up with it, if it's part and parcel of
your... natural taste was. I really wish it was,
genuinely. But it's also about how much you're
having, right? Because you have to think of it
from an overall... benefit point of view yeah
and not overdoing it so again back to the liver
king we don't need to take a live raw beef liver
on air and take it down but you know what i can
eat though is liver pate because i guess you
know it's pork liver or chicken liver chicken
liver yeah i still think it's beef liver yeah
i think scrap that right what about menstrual
support gummies you know like you can get these
these really cute little sweet tasting gummies
do they help to rebuild your energy levels i'm
going with hype you said you you had hype as
soon as you said gummy yeah right yeah and that
sweet tasting you just don't know what's in it
that sugar content probably just sugar isn't
it to be honest it's really looking at what works
for you yeah um try and looking at it from a
nutrition whole food base first as your maintenance
rather than having to supplement with something
like a gummy because we really don't know how
much is actually in it and what's in it. A lot
of supplements, that's the issue we have is we
actually don't know what's in it because nothing
is, not many supplements are actually, what's
the word? Not many supplements. Third party tested.
Third party tested, right? So from a supplement
point of view, it's looking at what has been
third party tested and what works for you from
a digestion point of view as well. So don't get.
caught up in their pretty packaging. Right, I
know we can't expect about this, but iron infusions
as a wellness trend, hot or hype? Hype. It's
life changing for the right person, but it needs
to be part of medical management. So just make
sure you see your doctor, have a conversation
and get what you need as an individual. This
is not about your friend or your sister, sibling,
family member. This is about you at this point
in time. and what is in your best interest. What
about the, well, I don't know if it's a fact,
but plant -based sources are inferior to animal
-based sources for iron. Hot or hype? I have
to say hot because it's biologically true, right?
Because we spoke earlier about non -heme iron
and heme iron, and how actually the non -heme
from plant -based sources, you're probably getting
about maybe 2 % to 10%. Yes, we can optimize
it as best as possible with the vitamin C sources,
whereas with the heme iron sources you get from
animal -based sources, you're getting probably
about 20 -30 % for you. So double, triple, quite
a bit more. What about someone who says, right,
I have fortified cereal in the morning with a
big old... Glass of orange juice. Who's a glass
of beef liver? Big old beef liver on the side.
Is that optimal, would you say, in order to get
your iron -vitamin -C combo? Comes down to what's
actually in the fortified cereal. Okay. Plus
the amount of orange juice you're having. Big
old glass. Exactly. Different people. will have
their glycemic index when it comes to the orange
juice as well so it's knowing whether it's suddenly
spiking your sugar not And it's not just about
orange juice as vitamin C. I haven't even mentioned
orange juice, right? We were talking about bell
peppers and kiwis. We were. Purposely. Because
I hear it a lot, you know, like people are like,
oh, I need to have my iron supplements. I'm going
to have it with a glass of orange juice. And
I'm like, oh, you know, maybe the orange juice
isn't the best option. I hear that all the time,
by the way. And it's also with that fortified
cereal, if you're adding dairy into it, you're
adding yogurt, that's your calcium. Best way
really for an iron oral supplement is on an empty
stomach. with the vitamin C source. But that's
where that discomfort can often come in, right?
And that's why a lot of people don't talk about
it. So what you're saying is cereal with orange
juice, not the milk. No cereal, no orange juice.
Let's come up with something better that has
better protein sources and fiber. There you go.
I like that. I hope I haven't offended anyone.
No, not at all. Right, so... i know we kind of
did touch upon it with when amanda spoke about
you know grabbing your kiwi but a lot of the
times like you said you know it's about building
in habits but women are busy you know we like
you mentioned we're the sandwich generation we're
working we're looking after kids we've got loads
of shit going on rather than going for the three
monthly iron infusion which obviously is not
a wellness trend that we now know about How can
we how can we do it in a way so that it's sustainable
and we can actually optimize? Yeah. What are
our pro iron choices on a day to day basis? It's
about routine. Right. We were talking about building
habits. It's looking at what you enjoy. So plant
based wise, we've got the legumes, you've got
your nuts, your vegetables, your green leafy
sources. Yes, your fortified cereals, your fruits.
How do you build that in to your day to day?
Right. Whatever time you break your fast. So
say you have three meals a day. Build it plant
based first and use your lean meats, your poultry,
your seafood as your topping. And it's being
organized. The last thing and it's really hard
because meal prep is boring. Right. But when
it's done and you've got it in place, it makes
a huge difference because it's grab and go. So
you don't have to think all the time. And it's
having that routine and consistency, which then
also means your body knows what it's getting
and when it's getting it. And we live in Singapore
where, yes, we have access to more help, which
makes a big difference. We've also got meal prep
services. And actually, you can really be smart
about going out and having a meal. I always say
just take a step back and go, right, what do
I normally not have? What's green? What's protein?
How do I build this meal? But you need that extra
millisecond to think about it, especially when
we're busy. And as a family, we should all be
doing the same thing. This isn't about, oh, the
kids are this, I'm this, my partner's this, or
we live with extended family members, they will
have this. It's getting everyone on board so
that it makes life a lot easier. Yeah, I mean,
I always say, I'm like, the kids are going to
eat what we're going to eat. My sister was talking
about we're going to be going out for a meal
when we're in the UK for... this should have
already happened this i can say it for like for
my dad's birthday and um and you know she was
like oh you know will the kids eat a race dinner
i'm like yeah they're gonna eat what we're eating
like they're not gonna get chicken nuggets and
chips i'm sorry guys you know if you want to
set set your kids up for better health in the
long run get them eating what you're eating and
that also means don't eat chicken nuggets and
chips and the planning aspect you know i i hear
like i hear you on the busy mom thing the busy
the sandwich generation i hear it i live it I
get it. But I will argue and I will always counterpoint
that the busier you are. the more streamlined
your processes have to be. So when you're telling
me you're too busy to meal plan, you're not busy
enough then because I am so damn busy that I
live and die by my plans, right? Meaning I have
to have my meals executed on repeat to maintain
the level of execution and professionalism that
I demand out of my life. And that's just what
it is. So it's like when I hear I'm too busy,
what I hear is like, you're not streamlined enough
because truly busy people have that shit on lock.
Yeah, because they need to. Otherwise, they won't
get through their day, right? That's it. Or their
week. And, you know, like I take time out on
a Sunday. Like on a Sunday, I'll sit there and
I'll plan the week. And it'll be like, right,
we're having this protein on rotation, these
vegetables on rotation. And then everything's
done. The shopping is done. I mean, I've got
a meat club subscription, so I don't have to
think about the food delivery. So, you know,
there's all of that stuff sorted. So, again,
everything's streamlined and I don't have to
waste time thinking about things. And how much
time does that take you? Like realistically?
How much time are you devoting to what you just
said? I mean, the thing is, obviously, I've been
doing it a long time. It doesn't take that long
because I'm like, all right, chicken. This is
what we have with chicken. This is what we have
with beef. So it's literally a few meals that's
on rotation. But, like, even more than 30 minutes.
No. There you go. Like, I mean, you can definitely
find 30 minutes on a Sunday where you are bullshitting
on your phone. Yeah. Oh, God, yeah. Real talk.
Like, you know, like, I think, again, the perception
of, like, you know, putting together the bowl
of kiwis. Like, it's literally buying a bag of
kiwis, carrying them to your house, putting them
in a bowl. Like, the reality of that execution
is two minutes. But everyone's at a different
phase. So it's fine. that from you know where
that where each person is and working with that
yeah it's when you get used to it and you are
where you are in your action maintenance phase
fantastic But when you're still in pre -contemplation.
That's where I am with beef liver. Liver King's
like, why can't you just get a beef liver? And
I was like, I'm not there yet, King. Pre -contemplation.
So this is where I'm actually really working
out. Because I can't sit with someone who has
no concept or is not ready and say, it's this
easy to do. because it won't work they're never
coming back fair point right so it's really going
okay what do you think you're in a position to
think of and do one thing first thing start with
one anything that's it and then we build on that
and it takes time yeah right it all of this takes
time we were all somewhere we are now where we
are yeah and yes we can push ourselves to do
even better in the future, you've got to start
somewhere. That's why I love when you earlier
made your point about moving in kind of three
-month or 12 -week increments. You know, thinking
about the year in quarters is really helpful
for health habits because it gives you kind of
an extended timeline, a gentle on -ramp to get
that first thing mastered. and then it's not
that short -term thing either you know where
you're like i need it i need it now things gotta
change in two weeks yeah 30 days of xyz ah i'm
ready you know it's gonna be the new year soon
i'm ready for all the the quick fixes to come
banging down our doors right we've done this
before and we're gonna do it again now and that
is us asking you dr tash what is a your 40s formula
what would you say to our listeners who want
to thrive in this decade what is What is your
mantra? What is your go to? So I had to really
think about it this time, actually, compared
to what what we were talking about last time.
So I'm going with listen, investigate and optimize.
Right. So listen to what your body is telling
you. You know yourself better than anyone else.
Don't let anyone tell you otherwise. Investigate
the root cause with proper testing. and don't
just patch symptoms this is the sort of princess
and the pea scenario right we don't need 100
mattresses we just need to take the pee away
oh god that would have been oh my god okay that's
like genius and finally it's optimize and this
is about looking at medical management but really
it's that foundation of what we are in control
of which uh which is actually our lifestyle yeah
And how do we then go for gold when it comes
to quality of life? Feel as good as possible
forever. And that's it. That is what we all want.
Yes. And it's funny. I'm going to go back to
your princess and the pea mattress. No, because
it really took me back to when I was a kid because
I used to love that story. But you know why I
loved it? Because I thought, God, that. Bed sounds
so comfortable. I love those odor mattresses.
Thank you so much for joining us again, Dr. Tash.
It was such a pleasure having you on the show
again. Thank you so much for having me. It's
been great being back. Thank you. Thank you.
My eyes are going like this. Oh my God. This
is why now we need to make sure we put it in
there. So I just read it and I'm reading it and
it's more natural. Versus like the thinking.
Bad morning to have done leg day. My legs are
still shaking. We will not make you stand or
jump or anything like that. You need to put your
legs up or anything like that.