[HN Gopher] Why does iron deficiency cause fatigue, even in the ... ___________________________________________________________________ Why does iron deficiency cause fatigue, even in the absence of anemia? Author : panabee Score : 167 points Date : 2022-07-03 14:50 UTC (8 hours ago) (HTM) web link (twitter.com) (TXT) w3m dump (twitter.com) | Coolerbythelake wrote: | So things that can look like anemia can be other things! Case in | point, my wife was misdiagnosed for months with Anemia. What she | really has is several tick Bourne diseases. For 5 months her | doctors kept giving her blood transfusions as he hemoglobin | reading was around 4-5 and it should be 12-13 for a normal | person. Can't tell u how many specialists and emg room visits. | Finally found a female md that listened to her and gave the | approval to do a comprehensive tick panel. Sure enough rocky | mountain spotted fever, erlicheaosis, recurring Lyme fever and | regular old Lyme. The blood they were giving her was basically | like throwing gas on a fire. Almost was ready to make funeral | arrangements. Let me say tick diseases are going bonkers and a | lot of people don't know they have it. Plus a lot of doctors | won't believe or authorize tests. Advocate for yourself or you | might die! Not kidding ! | danachow wrote: | A hemoglobin for 4-5 is _anemia_ - the definition of anemia is | low hemoglobin concentration. If your wife had hemoglobin that | low, then she was correctly diagnosed with anemia. | | It is a bit odd though the apparent coinfection with multiple | tick borne illnesses from different species of ticks - A lyme | and ehrlichiosis coinfection is not surprising, but rocky | mountain spotted fever is a very different illness, often more | acute in presentation with distinctive signs and symptoms - but | coinfection with the other two would be quite rare. | | Also, those specific tick illnesses listed are unlikely to | cause that profound of an anemia by themselves, so there's | probably some other pathology going on - the tick borne | infection may only be a trigger. | | Any relatively young person that is otherwise healthy (no near | end state kidney disease) should definitely get referral to a | hematologist for hemoglobin of 4-5 if it isn't something | blindingly obvious like blood loss. | lkrubner wrote: | I had some illness for much of 20 years. Doctors were uncertain | about what it was. They eventually called it Lyme disease | because they weren't sure what else to call it. But I was stuck | taking antibiotics for 20 years. I tried several times to quit | the antibiotics, but I always got badly sick when I did. I | eventually managed to achieve a complete cure, by fasting with | only water for 2 weeks. I describe this whole saga in detail | here: | | http://www.smashcompany.com/philosophy/how-i-recovered-from-... | Gatsky wrote: | Small adjustment here... anemia is not a disease, it merely | describes the state of having reduced hemoglobin concentration | in the blood. It doesn't make sense to say things can 'look' | like anemia. It has myriad causes. It is never benign, and | should always be investigated thoroughly. | afterburner wrote: | Lyme disease is spreading northward, areas that would have | never thought about it 20 years ago need to exercise caution | when hiking on uncleared paths (or when diagnosing patients), | but the awareness isn't that huge right now. | xenocratus wrote: | It took years for me to be diagnosed with thalassemia when my | GP found some of my blood results suspicious. Got treated for | anaemia a few times before, and was refused for blood donations | as well without being able to explain what was wrong. My blood | tests said "anaemia", but my life experience said "all seems ok | to me...?" - luckily I have a mild form, I just need to watch | my diet a bit. | | My dad also found out through my diagnosis why he kept getting | those same signs in his tests... :) Eastern European medical | system at its finest. | ClumsyPilot wrote: | > Plus a lot of doctors won't believe or authorize tests. | Advocate for yourself or you might die! Not kidding ! | | Experienced this myself. So mant doctors behave like JavaScript | developer and I am another webpage | pojzon wrote: | At least in Eastern Europe thats because they dont really | have the time needed to help the patient. | | Its a business and you have 10m to do all paper work, check | patient and prescript something. | | Its horrible. Doesnt help that private doctors are super | expensive, dont care about you and dont believe you. | | Health became just another accommodity only super rich can | pay for. | InCityDreams wrote: | >Advocate for yourself or you might die! Not kidding ! | | Paid healthcare? As a europopulator i can choose to pay for my | healthcare. Rest assured, that when i do pay, i insist on | certain things. Like doing the tests i insist on... | | "Plus a lot of doctors won't believe or authorize tests." | | Surely, the money talks in a situation like this? I can pay for | any test i like and no (socialist, here) doc would ever say no, | nor would they actually give a crap. | pojzon wrote: | Not everyone can pay. Health should not be gated behind a | paywall. Life is not a microtransaction game. | brewdad wrote: | If insurance doesn't approve the test, it won't be paid for. | Insurance also means US prices for tests are elevated to 10x | what they "should" cost because providers expect insurance to | knock the price back down to a reasonable cost. As a result, | ordering a bunch of unapproved tests leads to huge out of | pocket costs for patients so only the wealthiest will ever be | willing to push for them. | | Ironically, that same population also is the most likely to | have insurance that will cover the tests in the first place. | So it goes. | robonerd wrote: | > _Let me say tick diseases are going bonkers and a lot of | people don 't know they have it. Plus a lot of doctors won't | believe or authorize tests._ | | The existence of Chronic Lyme disease is very controversial and | diagnosing it can get doctors in trouble (depending on the | jurisdiction.) Whether or not Chronic Lyme disease is real (I | don't know), I think the general consensus of CLD diagnoses | being quackery might bias doctors against diagnosing _any_ sort | of tick related disorders, particularly chronic ones. | joshgel wrote: | Err it's more that tick-borne diseases cause anemia. | | There are lots of things that cause anemia! And someone with | unexplained anemia deserves a complete work up (especially with | hemoglobin levels in the 4-5 range), including for tick-borne | illnesses, especially if they have been in an endemic area. But | lots of other things worth checking too, many more dangerous | than tick-borne illnesses. | Herodotus38 wrote: | Iron deficiency can also cause restless leg syndrome even without | anemia, it's sometimes overlooked. Better to take iron than | something that messes with your dopamine receptors. | | Also recent research has shown evidence that taking iron every | other day is better than taking it daily. | https://pubmed.ncbi.nlm.nih.gov/31413088/ | bpye wrote: | This was a surprise to me when I had a panel of blood tests and | my ferritin was very low, but haemoglobin was normal A few weeks | on iron supplements did lead to a notable improvement day-to-day | and reduced fatigue. I always find it surprising how much | difference this sort of thing can make. | lalwanivikas wrote: | Do you buy it over the counter? | bpye wrote: | At least here (BC, Canada) you have to talk to a pharmacist | to get it, but there is no prescription required. You should | also have your levels checked semi-regularly if you're taking | supplements to ensure that your levels aren't getting too | high. | PKop wrote: | Arguably we have a problem of too much iron, especially | supplemented in cereals and such, producing free-radicals that | damage cells: | | https://raypeat.com/articles/articles/iron-dangers.shtml | | Ray Peat advice for men is to donate blood periodically to remove | excess iron from our body. | Brybry wrote: | I'm unfamiliar with Ray Peat. | | Is there a reason Ray Peat advice should be treated differently | than say, Mehmet Oz advice? Or Linus Pauling advice? | | I couldn't seem to find much of anything published by him that | was peer-reviewed. | rvp-x wrote: | I've noticed the same. I'm a woman so bleed often, I'd feel the | fatigue but my blood work didn't show anemia, so my primary care | physician didn't feel the need to prescribe it yet. I decided to | take supplements on my own and monitor the ferritin levels to | make sure I don't over-do it. | | Note, if you aren't bleeding regularly, it's very unlikely you | need it, and iron might be harmful. Make sure to test your | ferritin levels before and regularly as you do it. | Faaak wrote: | How do you monitor ferritin levels ? Blood test ? I couldn't | find any auto-test where I live | rvp-x wrote: | From blood tests, yes | danachow wrote: | Frequent monitoring of iron/ferritin levels while on oral | iron supplementation is likely not necessary -- barring a | genetic disease, you're extremely unlikely to get iron | toxicity or overload at instructed oral doses. Periodic | monitoring is more to assess a positive response - since if | your levels are not going up on supplementation it warrants | further investigation. | | Oral iron is now recommended given only every other day to | avoid GI side effects and there is evidence that the response | is just as good to more frequent. | coredog64 wrote: | That's good news. Oral iron gives me an upset stomach | unless I have lots of recent carbs. | redtexture wrote: | Disolving tablets and consuming in liquid form is an | alternative. | r1ch wrote: | My partner takes Megafood's "Blood Builder" iron | supplement which seems to work well and avoids the GI | symptoms. | mirthflat83 wrote: | Listen to this person who is likely an actual MD | johnfn wrote: | This frustrates me. Right in this very thread are many | accounts of people saying that doctors won't listen to | you and will do only the minimal amount of work possible | to get you out of their office, and that you should do | your own research. Then like 3 comments down are posts | like yours, sarcastically putting down people sharing | results of that same research. | | So which one is it? | phkahler wrote: | And...? Did it help? | runjake wrote: | Is there any decent way to supplement iron? I've never seen any | pills in regular stores. | bpye wrote: | As I mentioned elsewhere, you can get supplements but at least | in BC you need to speak to a pharmacist to get them, though no | prescription is required. | Lammy wrote: | Supplement anecdote: I really like Floradix because it doesn't | make me puke like the over-the-counter Ferrous Sulfate tablets | always do: https://www.floradixusa.com/products/floradix-iron- | herbs-liq... | hkt wrote: | Supplemental supplement anecdote: I also really like Floradix | for its gentler GI effects. I was anaemic (from a long term | health condition) and well, now I'm not. Daily seems fine, too. | | I also use an app to check my haemoglobin levels. It is weird | that an app can do this, but I've calibrated it against less | frequent in-hospital blood tests and it checks out. See: | https://sanguina.com/anemocheck-mobile/ | ElSinchi wrote: | Annoying huge Twitter threads. | | Just. Write. An. Effin. Blog. Post. | | Long form reading on Twitter is very cumbersome | aaaaaaaaata wrote: | How do I one-click retweet my favorite two lines of a blog post | and get all my friends to do the same?! /s | Nowado wrote: | You're laughing, but there are popular plugins for doing | exactly that. | yellowapple wrote: | This is the first I'm hearing of polycythemia vera having | anything to do with iron deficiency, but considering the overlap | of symptoms (and the fact that the former involves making _way_ | too many blood cells) it makes a lot of sense. | hprotagonist wrote: | Too high isn't good either; the solution is downright medieval. | | https://www.mayoclinic.org/diseases-conditions/hemochromatos... | | https://www.webmd.com/men/features/too-much-iron-in-your-blo... | | So don't go gulping down the supplements all willy-nilly, either. | DelightOne wrote: | > Treatment includes regularly removing blood from your body. | | Just regularly donate, no problem. | seper8 wrote: | Donating apparently also removes microplastics from your | body... | SoftTalker wrote: | Any references for that? What about just drinking a lot of | water so you have to pee more often? | robonerd wrote: | If there are any synthetic textiles in your home, it's | probably a lost cause; plastic dust everywhere. Every | time you eat, drink or breath, you'll be taking more in. | cma wrote: | Are they just freefloating in blood? Capillaries are tiny | and I thought micro plastics were closer to 1mm than | 1micron, despite the name. Capillaries are 8-10microns. | CoastalCoder wrote: | I'm curious if the donated blood is processed in a way that | removes those microplastics. | plorkyeran wrote: | Probably not, but if you're in need of a blood | transfusion you have more immediate concerns. | hprotagonist wrote: | yup! | toast0 wrote: | If you're diagnosed with hemochromatosis, you may not be | permitted to donate; it seems to depend on your local blood | banks. There's some amount of concern that because the | donation is theraputic for the donor, they may not be | forthcoming about other factors that should disqualify them, | if present. | | Of course, if it hasn't been diagnosed and you're a regular | donor, that's a happy accident. | im3w1l wrote: | That kinda makes sense. If you allowed them to donate even | with disqualifying factors (but flushed it down the drain), | it would fix the incentives. May not give enough additional | blood to be worth the bother? | dhzhzjsbevs wrote: | I'd hardly call a regular trip to give blood "medieval". | | They're not giving out leeches. | hprotagonist wrote: | right; those are for cleanly healing scars. | | "your humours are imbalanced and you should be bled, you'll | feel better" is not far off from "your iron level is too | high", though... | robonerd wrote: | Medical leeches are used to encourage blood flow, | particularly after reconstructive surgeries; the benefit is | not from the leech sucking your blood, but from the | bleeding that continues after the leach is removed. (Their | saliva has anticoagulant and anti-inflammatory properties.) | [deleted] | yjftsjthsd-h wrote: | > "your humours are imbalanced and you should be bled, | you'll feel better" is not far off from "your iron level is | too high", though... | | The difference is that now we have both empirical evidence | that it works, when it works, what the side effects are, | and generally why it works. As opposed to cargo culting, | poor cost/benefit analysis, and inaccurate understanding of | what's actually happening. | hprotagonist wrote: | we have a much better model now, i agree. | phkahler wrote: | >> those are for cleanly healing scars. | | My go-to for that is Iodine. | metadat wrote: | I use those silicone scar strips. Wound healing | technology is nearly magical these days. | hprotagonist wrote: | the normal use is reduction of venous congestion at an | incision site after a major surgery, which i hope you're | not doing regularly enough to have a go-to! | treeman79 wrote: | Medical leeches are a thing. | | https://www.uhhospitals.org/Healthy-at- | UH/articles/2020/03/h... | armchairhacker wrote: | for a long time, until I started eating meat I had low ferratin. | Iron supplements didn't help and even some weird ferratin | supplements didn't seem to work. | | But iron is not ferratin (it's some kind of stored iron) and I'm | not sure if it really had any affect. I was low ferratin but | could I have been not low on iron? | | Either way iron deficiency is common in vegetarians and vegans, | but there are plenty who are just fine. They get iron from tofu | and spinach which is different from the iron from meat and maybe | affects their levels differently, but it seems to work out. | aaaaaaaaaaab wrote: | *ferritin | [deleted] | danachow wrote: | Ferritin is the protein that stores iron in cells in almost | every organism from bacteria to humans - but its exact | structure and mechanism do differ. As a blood test, endogenous | ferritin level gives an indirect measure of iron stores. | Ferritin <25-30 ng/mL is consistent with iron deficiency anemia | - levels higher than this are more difficult to interpret - | they don't rule it out. | | Whether or not consuming plant ferritin (when you buy | "ferritin" supplements that is what you're getting - usually a | pea plant) is an effective iron supplementation is another | question entirely. And as far as I know there is no great | evidence that it is non-inferior to typical oral iron products | (salts and saccharide compounds). The ideal treatment for iron | deficiency anemia is typically IV iron (or blood transfusion if | the anemia is profound enough to warrant it - but IV iron | replacement is one of those things coming back into fashion | finally after many years of being feared for reasons with poor | evidence. | morninglight wrote: | [deleted] | Pakdef wrote: | bilsbie wrote: | Could this cause dizziness standing up? | fiatjaf wrote: | That's B12 deficiency. | bilsbie wrote: | I take b12 but maybe I'm still not getting enough? | fiatjaf wrote: | How much are you taking? 5000~10000mcg per day may not be | too much, also there are no side effects or overdose risks. | | I think you should do a blood test and ensure you're at | least over 500 pg/ml. | petercooper wrote: | It's certainly worth checking B12 levels properly. It's | quite hard to be B12 deficient and a common reason to be | so is due to being unable to absorb it properly in the | digestive system (I think this is quite common with | celiac disease, for example). That's why injections are a | common approach. I went with sublingual administration | instead and it worked very well. | fasteo wrote: | Check this out [1] | | [1] https://my.clevelandclinic.org/health/diseases/9385-low- | bloo... | ravenstine wrote: | Iron is also needed in the electron transport chain as a | component of cytochrome C oxidase. If fewer iron molecules are | being prioritized for creating this enzyme, then less oxygen will | be reduced at a time. The rest of the Krebs cycle can be in an | optimal state but the cycle can only go as fast as the electron | transport chain will allow it. I imagine that given a deficiency, | the human body will prioritize iron formation in the blood over | creating new cytochrome C oxidase since transporting oxygen to | cells is more important than running the Krebs cycle at full | speed. | | I have no idea if this is really what's going on, and it's | interesting that this is not mentioned in the linked articles. | The reduction of oxygen is really the final step for oxygen | before it becomes a part of metabolic water, and throwing off the | timing of binding oxygen atoms with protons will slow everything | down. | adrian_b wrote: | Your hypothesis is plausible, but as you have said, whether it | is true or not depends on the order in which the availability | of iron for each of its many functions in the body becomes | affected when iron is scarce. | | Cytochrome C oxidase needs not only iron, but also copper. So | any symptoms caused by an iron deficiency to it, presumably a | decrease in the capacity for aerobic effort, should also appear | in the case of a copper deficiency. | phkahler wrote: | >> Your hypothesis is plausible, but as you have said, | whether it is true or not depends on the order in which the | availability of iron for each of its many functions in the | body becomes affected when iron is scarce. | | I just assume that every logical/plausible concept is at play | and evolution does its best to balance everything. Rarely is | anything absolute. | samstave wrote: | >> _...prioritize iron formation in the blood over creating new | _-_-cytochrome-_-_ C oxidase since transporting oxygen to cells | is more important than running the Krebs cycle at full speed._ | | https://en.wikipedia.org/wiki/Cytochrome | | Whats really interesting to me is the above statement related | to a longtime conspiracy-curriosity about the 'Russian kid from | Mars' ala an 'Indigo Child' and when back in the ~1990s or some | time when he was interviewed, he was ~10 years old and he said | that "Humans came from Mars, and after we got to earth, is when | we started to age - because Earth is oxigen based, and | breathing oxygen is what makes you age." | | And this crazy piece talks about the iron found in the martian | atmosphere: | | http://www.nuclearplanet.com/Martian%20Iron.html | | >> _The atmosphere of Mars is 95.7% carbon dioxide (CO2), which | is available everywhere at the surface and which can readily be | compressed. The Martian carbon dioxide can be, simultaneously, | a source of carbon monoxide (CO) and a source of oxygen (O2) | through the thermal decomposition reaction:_ | >>*2 CO2 - 2 CO + O2 | (20.2)* | | >> _Reaction Eq. (20.2) requires a temperature of about 1100C. | Note that the iron reduction reaction Eq. (20.1) can take place | at about 700C, but a higher temperature, such as 900C, would be | desirable._ | | --- | | What happens if a Nuke goes off in the Martian atmosphere? | xkbarkar wrote: | Was twitter really the right place for this? Very informational | piece, I liked it. But having to read it in 12 sections was | awkward. Disclaimer, I already dislike twitter. | yccs27 wrote: | It forces the writers to make every sentence count. No space | for fluff, people would just stop reading the chain. It results | in a much more condensed style than e.g. blog content. | greggsy wrote: | I like that each tweet/paragraph can have its own commentary. | Provided it isn't anything political or bait-ey, the | discussion following each tweet can be insightful, and are | more contained and targeted than those usually found at the | end of a blog post. | | It's important to remember that it's just a different medium | - you'll find blogs, Reddit and Facebook posts, memes and | infographics on this topic. | caymanjim wrote: | Except I stopped at the first sentence when I realized there | wasn't a link to any actual readable content. | amenghra wrote: | There's bots to unroll threads. Eg tag @threadreaderapp and | type unroll. Or just tag @UnrollThread. | bmacho wrote: | replace twitter with nitter: | https://nitter.it/tony_breu/status/1543311124560592898 | | since I don't use twitter, I've set up a userscript to do it | for me | Blahah wrote: | For a lot of people it's both the most effective way to | communicate atomic components of a stream of thought, and to | reach an audience. Very few other platforms offer the same | opportunity. | wrs wrote: | What I don't get is why it's good to communicate "components | of a stream of thought" as opposed to, you know, a complete | thought. | heavenlyblue wrote: | Probably for the same reason bible is separated into | verses. Easier to find more profound meaning in a small | atomic bit of a though taken out of context. | yellowapple wrote: | I'm suddenly tempted to tweet the entire Bible. | irrational wrote: | Somebody already did. | InCityDreams wrote: | Which version? | sieabahlpark wrote: | abandonliberty wrote: | fixed: | https://threadreaderapp.com/thread/1543311124560592898.html | danachow wrote: | I'm not the biggest fan of twitter but this is a practicing | internal medicine doc that is conveying information primarily | aimed at other doctors in training or practice - this is | information that is for the most part readily available, | nothing groundbreaking here, there are podcasts on the topic, | videos and other paid for sources of information. The novelty | is the medium - and if there are some that benefit from it and | the like the format I don't see the harm. | dclowd9901 wrote: | Not sure why people are defending this. It's not like | separating a page into paragraphs. This is so jarring it's | distracting. | hombre_fatal wrote: | On the other hand, I'm not sure I would have sat through an | entire blog post on the same issue. The tweet format is a | highlight reel, especially for subjects I don't even know I'm | interested in yet (this wouldn't go looking for long form | content). | dclowd9901 wrote: | Not sure why people are defending this. It's not like | separating a page into paragraphs. This is so jarring it's | distracting. I don't know what it is about the format, but | separating the piece like this makes it so I've completely | forgotten what the previous tweet was when I've gotten to the | next one. | greggsy wrote: | I don't have the same problem with long threat tweets, and in | many cases prefer them over blogs as they're forced to | include only the most salient points. ___________________________________________________________________ (page generated 2022-07-03 23:00 UTC)