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A new wrinkle on fatigue: Flat Iron

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As part of the complete physical exam we do on our patients in the office, we routinely do blood tests.  Even in asymptomatic patients we often can find hidden clues to their health (see our post on Stress Alarms).  In reviewing our recent patients, we note that a great number have low levels of ferritin, in other words low iron.

Iron is one of the key building blocks of your next batch of red blood cells.  These cells last only about three months, and are constantly needing replacement by the marrow.  If our iron levels fall, then we can end up anemic, and, commonly, fatigued.

While most iron deficiencies have been seen in women of menstruating age, it can occur in men as well.

Here are some considerations if you have low iron in your blood test:

1. INTAKE:  Iron is found in foods that are green (like fresh vegetables, including Popeye's famous spinach), and also in foods that have red blood (meat, fish, chicken).  If you are vegan and don't eat green veggies or beans, then it is easy to be deficient in your intake.  If you are a junk food fan, remember that most of these high carb processed foods are useless for iron. Check this link for more info:  http://familydoctor.org/online/famdocen/home/common/blood/009.html

2. ABSORPTION:  Certain kinds of stomache or intestinal conditions make it difficult to absorb iron, even if enough is presented in one's diet.  This can be seen in cases of malabsorption, including patients with surgically shortened intestines.

3. OUTFLOW: Two major sources of blood loss to consider;

    a)  Vaginal loss: heavy periods, or constant slow leaks throughout the menstrual cycle can lose more blood than the body can produce. If this is the case, it is not something to put up with, it should be investigated by your doctor.

     b) Rectal loss:

          -Visible loss of blood is an obvious cause of low serum iron for men or women.  Remember that blood can be black if it comes from higher up in the stomache or upper intestines, or it could be bright red, if it comes from a hemorrhoid .  These are very important to investigate.

          -Invisible loss of blood:  A slow daily leaking of trace amounts of blood in the stool can indicate important problems inside the colon. One way to screen for this is with the home kits for Fecal Occult Blood, which comes with a stick, and a fold-over place to put the stool sample.  To read more about this test, click this link: http://www.health.gov.on.ca/en/ms/coloncancercheck/public/fobt/fobt_hometestkit.aspx .  If any hidden blood is detected, then colonoscopy comes next.  This gives the doctor a clear view of any bleeding polyps, which are often fixable on the spot.  Through the colonoscope, it is also possible to biopsy and photograph any other pathology, such as inflammatory diseases like colitis or diverticulitis.  

Once the cause has been determined, then a solution becomes clear.  In cases where the problem lies in low intake, one needs more iron in the diet, or an iron supplement from your doctor.  In cases where there is an excessive loss, one must plug the leak, or at least have one's doctors solve this. In all cases, remember to recheck your blood after three months, to make sure your body is back on track.

In any case, this is just another reason to check the silent signals in your body, to make sure you stay as bulletproof as possible.  Its a stressful world out there, and we all need to be in our best shape!

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