Back to Basics (a.k.a. Things I Didn't Learn in Nutrition School)

Hey all!

Didja catch the news story not long ago about the kid who subsisted solely on graham crackers and chocolate milk, and whose doctors ran a kazillion expensive and fancy-schmancy tests only to finally, finally figure out this poor little guy had scurvy? SCURVY, for crissake. In the United States of America, circa 2016. This didn’t happen on some British Royal Navy ship 200 years ago, where all the sailors started having bleeding gums and a ship’s doctor realized lemon and lime juice seemed to put a quick & easy end to that. It happened here. Now. (All I know is, as a Nutritional Therapy Practitioner, the second I saw “bleeding gums” in the headline, I said to myself, “scurvy.” I read the whole article only to confirm what I already knew.) I can only imagine if this boy’s diet was so absolutely devoid of vitamin C to the point that he landed in the hospital with freaking scurvy, that there are probably several other essential nutrients he’s deficient in. I would love to write a scathing post about child nutrition someday, but that will have to wait. (Plus, since I don’t actually have any children, I sort of figure I’d be attacked like crazy for daring to even suggest that I have thoughts on the matter, so I’ll hold off for now. [But really, what does that even matter, anyway? What makes someone an “expert?” There are lots of male OB/GYNs. They don’t even have vaginas! But I digress…])

Since we’re on the topic of the most basic, obvious, fundamental aspects of nutrition, let’s talk about something I am an expert on: ME!

Funny story:

I am a proud carrier of O-negative blood, which makes me a “universal donor.” This means that anyone with any other blood type can receive my blood and be good to go. (Unfortunately, the reverse is not true: O-negatives can receive only O- blood. Heaven forbid I were in some sort of accident and needed blood, stat, if I got any kind of A, B, or AB blood, I would quickly face some seriously fatal juju. As an O-, my blood is in serious demand in blood banks, hospitals, and vampire drive-thrus. (Also, mosquitos. Those things love me. My blood must taste something FREAKING DELICIOUS to them, because if I’m outside for more than four seconds without being covered in a protective coating of industrial-strength DEET, I will receive no less than 8 to 10 mosquito bites. But I digress. Again.)

My point: I am a regular blood donor at the American Red Cross. As someone who is not routinely engaged in heroic acts nor generally doing anything positive whatsoever for mankind (unless ranting on my blog counts), donating blood is probably the single most important and satisfying thing I do. (Plus, as they say, “The life you save could be your own.”)

SO: I went to donate a blood several weeks ago and I got rejected because my hemoglobin was too low. (Not hemoglobin A1c, just regular hemoglobin.) This was the second time this has happened this year, and probably the third or fourth time overall. According to the Mayo Clinic, the “normal” range for hemoglobin in adult women is 12.0 to 15.5 g/dL. In order to be eligible to donate blood, the American Red Cross requires that you be at or above 12.5 g/dL. During this attempt to donate, the first reading was 12.0. They ran it a second time, taking the blood from a different finger, because, well, the human body is just funny like that sometimes. The second reading was even lower: 11.5.

Seriously?

Seriously?   

Me?

Low hemoglobin?

Um, it’s not like I’m a vegan or anything. I eat plenty of red meat. I don’t eat a ton of it, but I certainly don’t avoid it. So I was pretty stunned when I left the office with all my blood still inside me, and without my free cookies and juice. (KIDDING, of course. I usually just take water and then leave. No need to load up on liquid glucose when you’re pretty well fat-adapted. [See here.]) As far as I knew, I had no signs or symptoms of low hemoglobin, but considering it had happened a few times before, something had to be up, and I wanted to know what that something was.

Micronutrients

Naturally, I did what any intelligent person would do when seeking information about health and nutrition: I took to the interwebz! But instead of using it to consult Dr. Google, I asked some of the smartest people I know. People who really know what they’re talking about when it comes to this stuff. One was Ted Naiman, MD, who is basically the best doctor in the Pacific Northwest and one of my favorite people on Twitter. (His Facebook page, Burn Fat, Not Sugar, is also excellent.) The other person I asked was the RN who goes by “Woo,” whose brilliant and truly unique insights I introduced you to here.

As always, Woo had quite the rational explanation. She basically reminded me that low carb and ketogenic diets are more restrictive than we sometimes realize. Even if we’re eating mostly whole, unprocessed foods, and even if we eat a good variety of foods, it’s not impossible that we could still come up short on a few micronutrients. (This is even true of eating grassfed meats, pastured pork and poultry, and organic vegetables and fruits. Yes, we’ll probably get more vitamins and minerals from those foods than from their conventional counterparts, but with soil mineral depletion and all that jazz, it’s not out of the question that even the “best quality” foods [however we might define them] are not quite as micronutrient-dense as the same foods were a hundred years ago.)

Plus, a very astute point Woo brought up is that, in intentionally avoiding the vast majority of processed crap, some of us might actually be getting fewer nutrients than people who eat any damn thing they please. Remember: all those breakfast cereals, fiber bars, toaster pastries, and stuff like that, are fortified with vitamins and minerals. Sure, they might not be the most bioavailable or bioactive forms of those nutrients, but they’re better than nothing. They’re not toxic; they just might be a little less potent than the “activated” forms.

A third issue worth noting is that, due in part to the increased satiety many of us experience on a low carb diet (not everyone, but many of us), our total food intake tends to be much lower than it was back in our SAD/higher carb days. I know mine is. Let me tell you, back in the day, I could pack some food away, man! I still have a pretty good appetite sometimes, but when I think about how much I used to be able to put away in a sitting, I rarely come close to that anymore. Less food means fewer nutrients, regardless of whether you eat crap or you eat the most pristine, anointed LCHF, keto, or Paleo diet.

So we’ve got several different ways in which even a “well formulated” low carb diet can get people into trouble, nutrient-wise. (And no, I do not at all believe that thing where people claim that any diet that requires supplementation is obviously a “bad” diet, or the “wrong” diet for you. Maybe there's a blog post in that someday.)

The low hemoglobin thing was quite a surprise, because I had no signs or symptoms of it. (According to Mayo, “In many cases, a low hemoglobin count is only slightly lower than normal and doesn't affect how you feel.” People don’t typically experience problems unless or until hemoglobin gets really low.) I also have none of the medical conditions nor take any of the medications that can cause low hemoglobin (except maybe the low thyroid issue). The Mayo Clinic lists “frequent blood donation” as a cause, but I wouldn’t call my donations “frequent.” (Maybe my body would, though. ;-) )  Another cause listed is “heavy menstrual bleeding.” I don’t have that. I do have to confess, however, that the day I tried to donate blood and my hemoglobin was too low, I was at the tail end of my cycle. (Or I guess I should say the beginning, since the first day of bleeding is “day 1,” right? So I was probably at about day 4. So yeah, sure, this was probably a contributing factor, and it’s one I’m a little embarrassed to admit I hadn’t considered until I was on my way back home. [But I definitely don’t have “heavy” bleeding.]  Nevertheless, the low hemoglobin still seemed like something…well, like something that just shouldn’t be, in someone who eats the way I do.)

Iron

Not knowing what the exact cause of the issue was, I was a bit hesitant to start messing with things. That being said, I figured it couldn’t hurt to try some supplementation and just see what happened. I’ve always been hesitant to mess with iron supplementation, because if you don’t know what you’re doing, you can get into trouble supplementing with iron – especially if your copper and zinc levels are a little off, too. These three sort of modulate each other and need to be in the right ratios, kind of like calcium & magnesium, and sodium & potassium. But, never being one to shy away from using my own body as a chemistry lab (case in point: the funny-smelling chicken I ate last night, half-wondering if I’d end up with food poisoning and/or salmonella [I’m fine, tyvm]), I started an iron supplement. I am fortunate to work for Designs for Health, where I have access to some of the finest quality and best-researched formulations on the market, and they have an iron supplement I felt good about trying after reading up on it.

Results: I FEEL BETTER!

Now, the thing is, I didn’t feel bad before. I certainly wasn’t experiencing any fatigue that would have been characteristic of iron-deficiency anemia. In fact, while I had gone through a very terrible and prolonged bout of depression, I had no physical complaints, aside from some icky chronic constipation, which I mostly attributed to low-ish thyroid. But being that I started to feel…I dunno, just a little more pep in my mental & emotional step, I looked a little more into what iron does. Much in the way I had my mind blown about the link between insulin and Alzheimer’s disease, my mind has now been blown about iron and some of the “stuff” I have experienced.

Now, the funny thing is, I learned these things after I had started the iron supplement and was already feeling noticeably better. But I think this only hammered the points home more.

There’s a fantastic (and expensive!) book that is a huge wealth of information, and I find myself going back to it again and again. It’s Nutritional Medicine, by Alan Gaby, MD. In reading the iron section, two things stood out to me immediately – two things I had no idea were connected to iron:

1. Among many other issues included in a table of conditions for which iron “may be useful for preventing and/or treating” in the case of deficiency was: dysthymia.  DYSTHYMIA!! HELLO??!!  That is exactly what I had during the depression. This description from Psychology Today includes some of the symptoms I mentioned in the depression post: low self-esteem, feelings of hopelessness, and it even says exactly what I said about not feeling suicidal. On the other hand, it says anhedonia (loss of the ability to feel pleasure)—which was the feeling that worried me most—is not typically associated with dysthymia, and is more characteristic of actual depression. (So maybe I was somewhere in between the two. And then again, that paragon of knowledge, Wikipedia, says dysthymia is a type of “chronic depression” – longer lasting, but less severe than major depression.) ToMAYto, ToMAHto … Either way, seeing that getting more iron could help dysthymia, and having already experienced that for myself, you can imagine why my mind was blown a little. I mean, iron? For depression? Who knew?  It’s so fascinating to me, especially because I didn’t have the most classic sign of iron deficiency, which would be fatigue/anemia.
2. I’ve always assumed that my tendency toward depression is related to low thyroid. Well, here’s  what the Gaby book has to say about iron, thyroid, and mood in general: “Iron is required for the synthesis of thyroid hormone and for the conversion of tyrosine to dopa and dopamine.”

ARE YOU KIDDING ME??!! You need IRON to make THYROID HORMONE and DOPAMINE? And the slew of supplements I started taking several months ago that got me out of the depression hole include a few that are specifically designed to support the pituitary and thyroid glands, AND DOPAMINE! (One of them is even called DopaBoost™, for crissake!) So I knew I was low on this stuff; I just didn’t know why.

Tied with the Gaby book for my number one favorite source for truly reliable information on micronutrients is the Linus Pauling Institute’s Micronutrient Information Center (LPI-MIC) from Oregon State University. So after having read about iron and thyroid—again, a connection I had never heard about before—I went to see if the folks at the LPI-MIC had anything to say on the matter.

WELL: indeed, they did:

“Severe iron-deficiency anemia can impair thyroid metabolism in the following ways: (1) by altering the thyroid-stimulating hormone response of the pituitary gland; (2) by reducing the activity of thyroid peroxidase that catalyzes the iodination of thyroglobulin for the production of thyroid hormones; and (3) in the liver by limiting the conversion of T4 to T3, increasing T3 turnover, and decreasing T3 binding to nuclear receptors.”

WHAT?!  Iron? And the thyroid?!

I mean, iodine, yes, of course. Selenium, yes, of course. But iron? Why has this been missing from every book and every article I’ve ever read about thyroid function?

All I can say is, I’m not kidding when I regularly tell you on this blog that I learn new things about all this stuff damn near every day. (And yes, it seems I usually learn it the hard way, while trying to help myself. But hey, if what I happen to discover for the purpose of making myself feel better ends up helping someone else out there, then I’m all for it.)

UPDATE: I went to give blood again about 2 weeks ago, and my hemoglobin was 13.5 g/dL. (Yay!) Dr. Naiman said I should stop giving blood because I “need it for myself,” but what can I say? It really is the most selfless thing I pretty much ever do, and it makes me feel good knowing I might literally save someone’s life. And if I need to pop an iron pill once in a while or up my red meat intake to keep making that happen, well, I can think of worse predicaments to be in. (Such as area hospitals running out of O-negative blood during a mass trauma situation…) And as I am still a little iffy with taking iron daily, I’ll probably cut back to every other day, or maybe just on days when I don’t eat any red meat or something like that. Even while experiencing the unexpected and awesome benefits of increased iron, I’m still a bit wary.

Now: before we move on, I’d just like to point out that nothing ever suggested I had “severe iron-deficiency anemia.” I’ve never had a blood test that indicated any problems there. (Except the low hemoglobin, of course. But that wasn’t crazy low. More on this at the end of the post. We’ve got one more thing to cover.)

Potassium

The second fascinating thing I’ve come across in the past few weeks regarding basic, fundamental nutrition is potassium. Yes, kids, boring ol’ potassium.

I came across the potassium stuff the way so many cool things in life happen: total serendipity. I found it while I was reading about something completely unrelated. (Or so I thought.) I had finally gotten around to reading Fiber Menace, a book I’ve been meaning to get to for years. (Highly recommended, except with tons of caveats, such as the book is quite repetitive and the author bashes low carb diets pretty hard. Except for that, it’s pretty great, especially for anyone living with IBS, IBD, colitis, Crohn’s, hemorrhoids, and any other colon/rectal/intestinal issue.)

The author kept going on about potassium. Potassium potassium potassium! Being that I have dealt with chronic constipation for … well, longer than I care to tell you … I again turned to the trusty Gaby book and the LPI-MIC. (Just like the depression, I had always associated my constipation with the slow thyroid, as constipation is a symptom of that, and as I explained here, constipation can make someone depressed, so it’s all one nice horrible circle.)

The Gaby book offered me very little. In fact, it said extra potassium can be helpful for treating/preventing HYPERthyroidism – pretty much the dead opposite of what I would want. But it also said that large doses of potassium can cause diarrhea. I took that to mean that more moderate doses might “get things moving,” but not cause me to need an emergency change of pants, if ya know what I mean...

I was even more hesitant to mess with potassium supplementation than I was about iron, because wacky potassium levels can get you into the kind of trouble (or so it seems) that makes regular ol’ run-of-the-mill potassium supplements a maximum of 99 mg per pill. In minerals that are typically measured in micrograms (for example, iodine and chromium), 99 mg would be a HUGE, insane dose. But for potassium? 99 mg is basically nothing. The “adequate intake,” which we know tends to lowball things, is 4700 mg/day for adults. 4700 mg. Over 4 grams, and  over-the-counter supplements are (by law, I think, in the U.S.) allowed to go no higher than 99 milligrams?  What-evs!

Now, the thing is, potassium supplementation can definitely cause some serious stuff, such as heart arrhythmias and lots of other muscle and heart-related complications, largely due to potassium’s involvement in the sodium-potassium pumps that maintain the electrochemical gradient across cell membranes.

So I was really wary of taking potassium. But after reading Fiber Menace, I evaluated my diet, and I realized that I was probably freakishly low in potassium. The foods conventional nutritionists most frequently cite as good sources of potassium are bananas and potatoes: two things I basically never eat. (I do have home fries or hash browns once in a great while if I’m out for breakfast, but it’s a rare occurrence. And it certainly wouldn’t be enough to meet my ongoing/daily potassium needs.) The potassium-rich food low carbers typically point to is avocado. Well, I seem to be the only person on earth who can’t stand avocado. Not even in guacamole. Yuck. So I’m not exactly chowing down on a lot of potassium on a regular basis.

Most vegetables and fruits are good sources of potassium, but in my dispassionate assessment of my diet, I realized that I was really not eating a whole lot of those. I eat almost no fruit anyway, and for a while, I guess I had been skimping on vegetables far more than I realized. It wasn’t that I was purposely avoiding them; I think I had just gotten out of the habit. (Or maybe even I had fallen victim to feeling like I could eat as much fat as I wanted and lose weight, and so I didn’t need to worry much about vegetables. I was wrong. For me. I fully support the people who feel their best on “zero carb” and who avoid foods from the plant kingdom as much as possible. I seem to do a little better with lots of low carb veg in the mix. To each their own, yes?)

So: Bottom line: I figured I was probably low on potassium. Not low enough for overt hypokalemia to be interfering with my quality of life … OR WAS IT?

Now, according to the LPI-MIC, “Low dietary intakes of potassium do not generally result in hypokalemia.” But, also according to the LPI-MIC, symptoms of hypokalemia include “intestinal paralysis, which may lead to bloating, constipation, and abdominal pain.” Well, I never had abdominal pain, but the bloating and constipation? HELLO!! And the “intestinal paralysis? Well, um, yes, if the muscles in your intestines are “paralyzed” and not contracting and relaxing properly to move digested food through the GI tract, then you will be constipated. (And bloated.) And I often felt like I had “intestinal paralysis.” I didn’t know the term at the time, but I felt like the food was just sort of sitting there, not moving along like it was supposed to. For days at a time.

So, armed with that little tidbit (plus what I’d read in Fiber Menace, and my own assessment of my low dietary potassium intake), I decided that it would be worth it to play around with supplementation. And thanks again to Designs for Health, I had access to higher dose supplements than the ho-hum, probably-won’t-even-do-anything-for-me 99mg. Keeping in mind that the adequate intake is 4.7 grams, I started with what I thought was a relatively high (but safe) dose. Because of the risk for wacky stuff, I divided the dose and took it 2-3 times per day, with food.

WELL!

Again, I FEEL BETTER!

I still don’t think I’m “going” as often as I “should,” but I. AM. GOING. And that, my friends, is wonderful. Most nights now I don’t take the combination of magnesium citrate and vitamin C that had been working for me before. I don’t seem to need it. Maybe I was low on potassium all along, and all the Mg + C did was mask the issue by at least still allowing me to “go” once in a while. (I still take Mg + C sometimes, usually in a homemade electrolyte beverage I drink after sweating profusely after a workout or long walk in the 90 degree heat & humidity of a Virginia summer. But I don’t take it every day, and I still seem to be “going” just fine. Better, even. I actually have the urge to go several times a week, rather than “having” to go only because I took a high dose of Mg citrate intentionally as a laxative. If you have never been chronically constipated, you cannot appreciate what a huge deal this is for me.)

At this point, it’s all wrapped up together: Maybe the iron is helping my pituitary & thyroid. And if my pituitary & thyroid have come back to life, then the dysthymia/depression is mostly going away, and better thyroid function also means less constipation, particularly when coupled with the potassium supplementation. And since I know (at least for me) that chronic constipation exacerbates depression/dysthymia, then having more regular BMs also makes me feel better. Honestly, I still have a ways to go before I’ll feel the way I really want to feel, but compared to how I was six months ago, I’m basically a different person. (People who know me “in real life” have confirmed as much. I'll say it again, because it has proven to have that big an impact on my emotional wellbeing: If you have never been chronically constipated, you cannot appreciate what a huge deal this is for me.)  :D

So: iron and potassium. Of all the things, right? Of all the friggin’ things! All the fancy-schmancy programs and protocols, all the specialized lotions and potions, and it came down to iron, and potassium. (At least, for now. My body looooves to keep me on my toes!) We’re always looking for “the next big thing.” The thing with the long, fancy, science-y name. As I said on Twitter not long ago (including the replies), we overlook and ignore the basics to our detriment.

So, it all comes back to the scurvy thing I began this post with. With the exception of the low hemoglobin when I went to give blood, I have never had any blood tests that ever indicated any abnormalities with iron or potassium levels. (It is debatable, of course, whether blood is the best way to assess certain nutrients, but alas. My hemoglobin has never been low on a doctor-ordered test; only in the American Red Cross’s office.) So I want to point out that we need not be deficient in a vitamin or mineral to the point of an actual, overt “deficiency disease” in order to experience signs & symptoms of insufficiency or “sub-optimal” levels. You don’t have to have freaking beri-beri to be low in thiamin, or have full-blown pellagra to have sub-optimal levels of niacin, know what I mean? You don’t have to be bow-legged and exhibiting signs of all-out rickets to be low in vitamin D, or have a giant goiter to need more iodine.

So if you feel like something just ain’t right, take an honest assessment of your diet (and supplements, if applicable), and see if there’s something very basic that might be missing—and something that is very easily, simply, and inexpensively corrected. I am honestly starting to wonder how many of all our nagging little “issues” are actually just basic micronutrient insufficiencies. (That could be a whole post on its own, actually. Perhaps it will be, someday.)  For example, is it possible the semi-epidemic levels of hypothyroidism and depression we see these days are really just sub-clinical iron deficiency? (Nah. I'm sure there are a bunch of other factors, but this iron thing has been eye-opening.)

Sorry for this huge ramble. Like I said, maybe this will help someone out there. (That’s kinda why I go to the trouble of writing these very long posts. It seems like they’re all about me, me me, but what they’re really about is sharing with you the discoveries I make about nutrition and health, and it just so happens that some of these discoveries occur because I was trying to find out why I wasn’t feeling my best.

And maybe you don’t need iron or potassium. But maybe you need something, and it could be something as readily available as vitamin B₆, or B₁₂, or CoQ₁₀, or DHA. (Or vitamin J.) If you don’t feel your best, don’t give up!

P.S. Interesting little tidbit: iron supplementation often results in constipation. Not for me, haha! Designs for Health’s iron is formulated to prevent this, but maybe people who experience that with other brands just need more potassium, hehheh.  ;-)

Disclaimer: Amy Berger, MS, CNS, NTP, is not a physician and Tuit Nutrition, LLC, is not a medical practice. The information contained on this site is not intended to diagnose, treat, cure, or prevent any medical condition and is not to be used as a substitute for the care and guidance of a physician. Links in this post and all others may direct you to amazon.com, where I will receive a small amount of the purchase price of any items you buy through my affiliate links.