WEBVTT - Why Your Iron Supplements Might Not Be Working, and the Collagen Truth Every Woman Needs to Know 0:00:02.640 --> 0:00:04.920 Have you had low iron before? Have you taken your 0:00:04.920 --> 0:00:08.440 iron supplements? Then notice that your iron levels never actually improved. 0:00:08.840 --> 0:00:11.799 On today's episode of The Nutrition Couch, we deep dive 0:00:11.880 --> 0:00:15.360 iron supplementation and discuss the factors that impact how well 0:00:15.400 --> 0:00:17.240 your iron is absorbed in the body. 0:00:17.760 --> 0:00:18.840 Hi, I'm Leanne. 0:00:18.560 --> 0:00:21.040 Ward and I'm Sissy Burrow, and together we bring. 0:00:20.880 --> 0:00:22.800 You The Nutrition Couch, the weekly. 0:00:22.520 --> 0:00:24.800 Podcast that keeps you up to date with everything that 0:00:24.840 --> 0:00:27.320 you need to know in the world of nutrition as 0:00:27.320 --> 0:00:30.360 well as all things iron absorption. We also talk the 0:00:30.440 --> 0:00:33.880 trend of fibermaxing. We have a brand new Woolli's meal 0:00:33.960 --> 0:00:36.559 on the go to review, and our listener question is 0:00:36.640 --> 0:00:41.000 all about the evidence and truth behind collagen supplementation. But 0:00:41.120 --> 0:00:44.159 to kick us up today, Susie, we are chatting fibermaxing 0:00:44.280 --> 0:00:46.080 and it is quite the trend. I've seen it all 0:00:46.120 --> 0:00:49.440 over social media, all over TikTok, all over Instagram, and 0:00:49.600 --> 0:00:52.240 I don't mind it. And you will rarely ever hear 0:00:52.320 --> 0:00:55.680 me saying that I don't mind a social media nutrition trend, 0:00:55.960 --> 0:00:58.560 But this is one of those ones that I actually 0:00:58.640 --> 0:01:02.960 quite like because basically, what the fibermaxing trend is is 0:01:03.000 --> 0:01:06.520 it's deliberately trying to encourage people to actually increase their 0:01:06.560 --> 0:01:11.559 fiber intake by adding more things like legumes, whole grains, vegetables, fruits, 0:01:11.600 --> 0:01:13.960 nuts and seeds to their meals and to their day. 0:01:14.440 --> 0:01:16.800 So you know, this is actually a very real problem 0:01:16.840 --> 0:01:20.039 when we look at the nutrition landscape, Ninety something plus 0:01:20.080 --> 0:01:23.440 percent of people in Australia are not eating enough vegetables 0:01:23.720 --> 0:01:26.320 and they're very likely not eating enough fiber either, so 0:01:26.360 --> 0:01:30.480 we know that fiber intake needs improving. The fibermaxing trenders 0:01:30.520 --> 0:01:33.959 I think basically talking about how to increase your fiber 0:01:34.000 --> 0:01:37.040 intake as much as you possibly can, But there are 0:01:37.120 --> 0:01:39.720 some little nuances to that that I just wanted to 0:01:39.720 --> 0:01:41.679 talk about on the podcast because I do think that 0:01:41.720 --> 0:01:45.000 people need to deliberately increase the amount of vegetables they eat, 0:01:45.080 --> 0:01:48.040 whole grains, legumes, nuts and seeds. So I think most 0:01:48.120 --> 0:01:50.800 dieticians actually agree with this trend because we do fall 0:01:50.840 --> 0:01:53.440 well short of our recommended fiber intakes, and we know 0:01:53.520 --> 0:01:56.640 that fiber is really important from a gut health perspective. 0:01:56.840 --> 0:02:00.120 It helps to manage cholesterol, blood sugar control, and theres 0:02:00.120 --> 0:02:02.120 actually a lot of research in terms of people who 0:02:02.200 --> 0:02:04.840 have adequate the whole food. Fiber intakes can help prevent 0:02:04.920 --> 0:02:08.320 some long term chronic diseases as well, but more fiber 0:02:08.639 --> 0:02:13.040 isn't always better, particularly for those people with quite sensitive tumbies. 0:02:13.080 --> 0:02:15.600 And I believe that the average Australian gets in around 0:02:15.680 --> 0:02:18.119 sort of fifteen grams of fiber. So if you're trying 0:02:18.160 --> 0:02:20.720 to go from fifteen grams of fiber to like fifty 0:02:20.800 --> 0:02:23.680 grams of fiber overnight, that is not. 0:02:23.600 --> 0:02:24.320 Going to end well. 0:02:24.400 --> 0:02:26.360 I can promise you that you were going to be 0:02:26.520 --> 0:02:30.560 very bloated, very uncomfortable, probably quite gassy, and not wanting 0:02:30.639 --> 0:02:32.680 to be in a contained room with other people. So 0:02:33.160 --> 0:02:35.080 you've got to go low, and you've got to go slow. 0:02:35.120 --> 0:02:38.160 You've got to start with your fiber and gradually increase 0:02:38.200 --> 0:02:40.880 it slowly, and then you need to add enough water 0:02:40.960 --> 0:02:42.920 in because if you're adding a ton of fiber and 0:02:42.960 --> 0:02:45.520 you're not adding enough water in, you are going to 0:02:45.560 --> 0:02:46.880 be very, very uncomfortable. 0:02:46.919 --> 0:02:49.040 You're probably just going to make things worse. 0:02:49.360 --> 0:02:51.520 So that is the first point I really really want 0:02:51.560 --> 0:02:54.360 to drive home for our nutrition catch listeners that yes, 0:02:54.400 --> 0:02:57.960 fiber is super important, but do not increase it too quickly. 0:02:58.120 --> 0:03:01.000 Do not go from you know, ten, twelve, fifteen grams 0:03:01.000 --> 0:03:03.680 of fiber up to fifty overnight, it will end badly. 0:03:03.720 --> 0:03:05.680 I promise you that, and make sure that you have 0:03:05.840 --> 0:03:09.160 enough fluids. Now, the type of fiber also matters, because 0:03:09.160 --> 0:03:11.399 I believe Susie was it. A few episodes ago we 0:03:11.400 --> 0:03:14.920 reviewed one of the fiber wraps and it had like 0:03:14.960 --> 0:03:18.600 sixteen grams of fiber in a tiny, small, mini white wrap. 0:03:19.000 --> 0:03:21.680 Like not a great idea. So really make sure that 0:03:21.680 --> 0:03:24.440 that fiber is coming from whole food sources as much 0:03:24.480 --> 0:03:27.400 as possible. Yes, you can use things like celium hust 0:03:27.440 --> 0:03:29.920 meta musle to get that fiber intake up, but I 0:03:29.960 --> 0:03:32.120 certainly would not be getting in you know, thirty grams 0:03:32.160 --> 0:03:34.639 of celium husts and then you know increasing, you know, 0:03:34.680 --> 0:03:36.920 a tin of beans and legumes, a couple of slices 0:03:36.960 --> 0:03:39.480 of grainy bread, you know, four queue fruits. 0:03:39.200 --> 0:03:41.400 All in one day. Because you're not it's just it's 0:03:41.440 --> 0:03:42.240 gonna bad leave. 0:03:42.760 --> 0:03:46.640 I think what I say with fiber is people have 0:03:46.760 --> 0:03:50.320 incredibly low amounts one day and then super lowd the next. 0:03:50.480 --> 0:03:53.960 So forgetting that, it's about consistency with digestive healths. So 0:03:54.000 --> 0:03:56.480 a classic example is when you go traveling and all 0:03:56.480 --> 0:03:59.000 of a sudden, you get terribly constipated because you've gone 0:03:59.040 --> 0:04:02.200 from eating your regular diet with fresh food and fresh fruits, 0:04:02.200 --> 0:04:03.880 and you're on a flight for twenty four hours and 0:04:04.240 --> 0:04:07.080 eating plain food which was notoriously low in dietary fiber. 0:04:07.080 --> 0:04:09.080 It's stop people using the bathrooms too much, so you've 0:04:09.120 --> 0:04:12.480 got lots of white rice and playing chicken kind of meals. 0:04:12.520 --> 0:04:14.520 And then the snacks are things like potato chips and 0:04:14.520 --> 0:04:16.560 biscuits and ice cream, so you're not getting that fresh 0:04:16.640 --> 0:04:19.560 food bulk, and then you become dehydrated and of course 0:04:19.600 --> 0:04:22.800 not moving. And that's the tree ad for terrible gut health. 0:04:23.279 --> 0:04:25.760 And what I see with busy people is similar. You know, 0:04:25.800 --> 0:04:28.479 they're good on the days they're at home and having vegetables, 0:04:28.520 --> 0:04:31.400 and then suddenly they're at an event and they're all 0:04:31.440 --> 0:04:34.400 at a conference or traveling or at an early morning flight, 0:04:34.440 --> 0:04:37.200 and they skip their regular whole grain bread and cereal 0:04:37.240 --> 0:04:40.240 for something like a protein shake or just coffee. They're 0:04:40.240 --> 0:04:42.960 having catered lunches, which is sort of notorious for low 0:04:43.000 --> 0:04:46.760 fiber options like sushi or white bread and white wraps 0:04:47.480 --> 0:04:50.040 on cakes and biscuits as the snacks, not a lot 0:04:50.080 --> 0:04:52.640 of fresh food or at the Quantus club with the 0:04:52.720 --> 0:04:55.720 cheese and crackers, and then you know the dinners are 0:04:55.760 --> 0:04:57.719 eating out, and when you go to a restaurant or 0:04:57.720 --> 0:05:00.919 even catered food cannot past the mostly low in fiber. 0:05:01.040 --> 0:05:03.160 So all of a sudden, your poor gut goes from 0:05:03.200 --> 0:05:05.360 having a certain amount to very low, and we wonder 0:05:05.400 --> 0:05:07.560 why everything slows down. And on top of that, we 0:05:07.640 --> 0:05:11.760 drink alcohol because we're socializing or traveling, not drinking enough fluid, 0:05:11.760 --> 0:05:14.000 and we're not doing our regular exercise. And again, these 0:05:14.000 --> 0:05:16.200 are the three things, and what I often see with 0:05:16.240 --> 0:05:18.200 my clients is that they're all of a sudden stressed 0:05:18.200 --> 0:05:20.720 because they're not going to the bathroom as frequently. They're bloated, 0:05:21.120 --> 0:05:23.719 and then then they super load the fiber as you describe, 0:05:23.720 --> 0:05:25.600 so they're having four Kiwi fruit and then they're having 0:05:25.640 --> 0:05:27.599 a bowl of bran and a bowl of vegetable soup 0:05:27.640 --> 0:05:30.120 and all these beans, and it just compacts in and 0:05:30.120 --> 0:05:33.040 nothing's working. So you're much better to do it consistently. 0:05:33.480 --> 0:05:36.200 And one thing I've always done when I travel, funnily enough, 0:05:36.760 --> 0:05:39.360 is that I'll always have brand when I go away, 0:05:39.560 --> 0:05:41.360 Like I'll just start with the cereal when I get 0:05:41.360 --> 0:05:43.400 there to stop getting clogged up. I try not to 0:05:43.440 --> 0:05:45.039 eat a whole lot on planes because I find it 0:05:45.080 --> 0:05:47.200 makes it worse. I always have a soup before I go. 0:05:47.320 --> 0:05:49.720 So there's certainly some strategies that you can implement when 0:05:49.720 --> 0:05:52.400 you are traveling, but just being mindful that it's those 0:05:52.440 --> 0:05:54.920 three things you require. It's not about more and more 0:05:54.960 --> 0:05:57.360 and more. It's about getting the right types of fiber. 0:05:58.120 --> 0:06:00.479 Keeping in mind there's different types of fiber in cooked 0:06:00.560 --> 0:06:04.000 vegetables versus raw vegetables. Making sure you're getting the high 0:06:04.000 --> 0:06:06.200 fiber fruits, making sure you're getting a lot of fluid, 0:06:06.720 --> 0:06:09.760 and some good quality type of brand or whole grain 0:06:09.800 --> 0:06:12.520 bread cereals, not just loading up on beans for example, 0:06:12.520 --> 0:06:15.159 a whole mix of options. But you need to have 0:06:15.200 --> 0:06:17.200 plenty of fluid, and sometimes the best thing is going 0:06:17.200 --> 0:06:18.600 to the gym or going for a run to get 0:06:18.640 --> 0:06:22.160 everything moving. So it's the three tiered approach rather than 0:06:22.200 --> 0:06:25.480 just I've got clients who definitely just super loads. So yeah, 0:06:25.560 --> 0:06:27.760 I think it's a really interesting trend, but I would 0:06:27.760 --> 0:06:29.880 prefer people to just be consistent with it and be 0:06:30.000 --> 0:06:32.320 mindful that when you're going to a cafe, you're not 0:06:32.360 --> 0:06:34.800 getting much fiber from a sour dough bread. When you're 0:06:34.800 --> 0:06:37.239 picking up food on the run and you're having fish 0:06:37.240 --> 0:06:39.839 bowl which is incredibly popular at the moment, or you're 0:06:39.839 --> 0:06:42.040 having wraps or you're having salads away from the home, 0:06:42.080 --> 0:06:44.880 you're often not getting that great quality fiber. So if 0:06:44.920 --> 0:06:47.960 you haven't had a fiber rich meal at lunchtime, making 0:06:48.000 --> 0:06:50.080 a concerted effort to add a soup in or have 0:06:50.160 --> 0:06:52.960 cooked vegetables at night are just things we automatically should 0:06:52.960 --> 0:06:55.880 be doing, because I would much rather somebody have twenty 0:06:55.880 --> 0:06:59.240 five grams of fiber every day than fifty one day 0:06:59.400 --> 0:07:01.680 and twenty your ten the next. And that's what I 0:07:01.880 --> 0:07:04.719 notice tend to happen, particularly over the weekends when people 0:07:04.760 --> 0:07:07.600 are having the bunting sausages or the cannapas, the pizza. 0:07:07.960 --> 0:07:11.120 The fiber intake goes from good to really low really quickly, 0:07:11.120 --> 0:07:14.640 and that will absolutely have an impact on your digestive 0:07:14.680 --> 0:07:15.720 health and regularity. 0:07:16.160 --> 0:07:18.000 Yeah, and people notice it on Monday, you know, we 0:07:18.040 --> 0:07:20.200 always get comments from clients saying, my bowels are all 0:07:20.240 --> 0:07:22.480 over the place, what's happening? And it is just that 0:07:22.720 --> 0:07:26.360 consistency with weekend eating. So as dietitians, we are certainly 0:07:26.480 --> 0:07:29.040 very supportive. We want all the strains to eat more 0:07:29.080 --> 0:07:31.320 fibers and all of our listeners to eat more fiber. 0:07:31.720 --> 0:07:34.600 But rather than fiber maxing, we want to call it 0:07:34.680 --> 0:07:37.920 being fiber smart, don't we being fiber consistent. We want 0:07:37.960 --> 0:07:40.800 you to focus on more plants, more legumes, more nuts 0:07:40.800 --> 0:07:44.160 and seeds, more variety, more water, more whole foods, and 0:07:44.240 --> 0:07:47.000 build it up gradually and do it consistently and your 0:07:47.000 --> 0:07:49.440 gut will thank you rather than hating you from going 0:07:49.480 --> 0:07:51.760 from ten grams to fifty grams back down to ten 0:07:51.840 --> 0:07:52.520 grams a day. 0:07:52.760 --> 0:07:54.600 And we've forgot the most important thing that we talk 0:07:54.600 --> 0:07:57.680 about all the time. The fiber in formulated food is 0:07:57.720 --> 0:07:59.960 not the same. So when you see these mega rab 0:08:00.480 --> 0:08:03.840 with this process fiber or even snack bars packed full 0:08:03.840 --> 0:08:06.680 of chickory root and what are the others that they 0:08:06.720 --> 0:08:07.320 stick in there? 0:08:07.600 --> 0:08:11.880 Inulin and the tapiocre starch, And yes it has some benefit, 0:08:12.160 --> 0:08:14.440 but really, when you look at the research around the 0:08:14.480 --> 0:08:17.040 health benefits and the reduction in chronic disease and the 0:08:17.080 --> 0:08:21.040 support that you get from a gut microbio perspective, it's 0:08:21.120 --> 0:08:23.760 really it's the whole foods. It's the legumes and nuts 0:08:23.760 --> 0:08:26.320 of seeds like actually add some beans into your dinner. 0:08:26.480 --> 0:08:28.600 If you're making a spaghetti, put a tin of lentils in. 0:08:28.640 --> 0:08:31.360 If you're making Mexican, add some black beans. That is 0:08:31.400 --> 0:08:33.240 the type of fiber that you want. We don't want 0:08:33.280 --> 0:08:35.840 twelve grams of fiber coming from a protein bar or 0:08:35.880 --> 0:08:39.120 fifteen grams of fiber from your breakfast granola. It's probably 0:08:39.200 --> 0:08:41.680 going to do your gut, you know, worse than could 0:08:41.760 --> 0:08:43.680 because you're going to be so bloated and gassy for 0:08:43.760 --> 0:08:46.760 so many people. So focus on real food when it 0:08:46.800 --> 0:08:49.800 comes to increasing your fiber and you will be a 0:08:49.800 --> 0:08:50.679 lot happier for it. 0:08:50.880 --> 0:08:52.880 And if you're seeing these products like the wraps we 0:08:52.960 --> 0:08:56.000 talked about that have got you know, ten, twelve, fifteen grams, 0:08:56.040 --> 0:08:58.120 it's too much in one sitting and straight away we 0:08:58.160 --> 0:09:00.920 know that's process fiber and not as good for you. 0:09:01.040 --> 0:09:03.960 So just stick to the natural sources all right ly. 0:09:04.000 --> 0:09:06.319 And we're excited, aren't we? Has dieticians. We don't get 0:09:06.320 --> 0:09:08.720 that excited very often. It's actually in my career, because 0:09:08.720 --> 0:09:11.120 I've worked a long time now, it's very. 0:09:11.040 --> 0:09:13.480 Rare that I see something that excites me. It's very rare. 0:09:13.520 --> 0:09:15.520 I see research and I'm like, oh, yeah, that's new 0:09:15.640 --> 0:09:19.400 and this I had actually not seen this before, which 0:09:19.480 --> 0:09:22.120 is I probably should have but super interesting. But I 0:09:22.200 --> 0:09:24.400 came up on Instagram because at the moment, my feeds 0:09:24.440 --> 0:09:27.920 filled with all things iron deficiency, and it was actually 0:09:27.920 --> 0:09:29.760 something I hadn't seen before. I thought it was fascinating, 0:09:29.760 --> 0:09:31.200 as did you when I sent it to you. So 0:09:31.240 --> 0:09:34.040 we desperately wanted to talk about it on the Nutrition 0:09:34.120 --> 0:09:36.280 Couch because we've spoken a few weeks ago about iron 0:09:36.280 --> 0:09:40.480 and low ferritin and this is a fascinating study that 0:09:40.520 --> 0:09:43.480 will make things a little bit clearer why perhaps you 0:09:43.520 --> 0:09:45.720 have supplemented with iron before and perhaps not had the 0:09:45.720 --> 0:09:48.520 best results. So it's a study published in a very 0:09:48.559 --> 0:09:53.040 reputable journal, the Lancet Hematology, way back in twenty seventeen, 0:09:53.080 --> 0:09:55.840 so this certainly isn't new. And the title, I'm going 0:09:55.920 --> 0:09:57.840 to read it because it's a very strong study, and 0:09:57.880 --> 0:10:01.400 it's called iron absorption from oral iron supplements given on 0:10:01.600 --> 0:10:06.880 consecutive versus alternate days and as a single morning dose 0:10:07.120 --> 0:10:12.120 versus twice daily split dosing in iron depleted women to 0:10:12.280 --> 0:10:15.480 open label randomized control trials. So this is a very 0:10:15.679 --> 0:10:19.360 very well designed study and to put it into Layman's terms. 0:10:19.400 --> 0:10:23.600 It's basically comparing the effect of iron uptaking the body 0:10:23.679 --> 0:10:27.080 of a group of women who had low, extremely low 0:10:27.120 --> 0:10:27.880 ferretin levels. 0:10:27.920 --> 0:10:29.400 So we spoke about this the other day. 0:10:29.640 --> 0:10:31.800 So their ferretin I think was under twenty five and 0:10:31.840 --> 0:10:35.600 I think the ranges like fifty to two hundred, So 0:10:35.640 --> 0:10:38.520 they were way way low in ferretin. And that's my 0:10:38.600 --> 0:10:41.240 concern when I see women who are particularly low in ferretin. 0:10:41.800 --> 0:10:45.960 And basically what they were looking at was the effective absorption. 0:10:46.559 --> 0:10:51.160 So given quite high amounts of iron sixty milligrams at 0:10:51.200 --> 0:10:54.520 a set time each day on consecutive days for fourteen days, 0:10:54.880 --> 0:10:56.960 and the other group was given the same dose but 0:10:57.040 --> 0:11:00.200 on alternate days for double the amount of time, and 0:11:00.240 --> 0:11:03.319 it was randomly controlled. So it was all a very 0:11:03.400 --> 0:11:07.720 very well designed study. Now, what the study is looking 0:11:07.720 --> 0:11:09.240 at and what I actually want to talk about, we'll 0:11:09.240 --> 0:11:13.320 talk about the results in a second. Basically, Physiologically, what 0:11:13.520 --> 0:11:17.960 happens when the body is trying to absorb iron, A 0:11:18.000 --> 0:11:19.760 lot of it comes down to the role of a 0:11:19.800 --> 0:11:27.880 peptide hormone called hepsidon hepsidon hahgp hepsidon hgpc id I 0:11:28.000 --> 0:11:30.400 in hepsidon. I call it Leam would say hepsidon. She 0:11:30.440 --> 0:11:32.880 is from Queensland. They pronounce things slightly differently, but it's 0:11:32.880 --> 0:11:36.040 the same thing. And it's basically produced by the liver 0:11:36.320 --> 0:11:40.800 and it acts as the master regulator of iron homeostasis, 0:11:40.840 --> 0:11:45.400 so it's basically managing our iron levels. And interestingly and 0:11:45.520 --> 0:11:48.600 people with hemochromatosis they don't have that, and hence they're 0:11:48.600 --> 0:11:52.040 more likely to iron overload, which is fascinating physiologically they're 0:11:52.040 --> 0:11:55.240 missing it. So basically it's telling the liver how much to. 0:11:55.360 --> 0:11:56.319 Absorb or not. 0:11:56.960 --> 0:12:00.520 But it's got a couple of mechanisms that can impact 0:12:00.600 --> 0:12:05.040 the way that we absorb iron, so basically all different things. 0:12:05.080 --> 0:12:08.280 If you've got infection, for example, it can block it 0:12:08.320 --> 0:12:11.160 to allow the cells to be without ion so that 0:12:11.200 --> 0:12:15.280 it replicates too quickly. But in the case of supplementing, 0:12:15.400 --> 0:12:18.480 so when you've got a female who has very very 0:12:18.480 --> 0:12:21.560 low ferrihin levels and she suddenly takes a really high 0:12:21.679 --> 0:12:24.760 elemental dose as you would see in pherograd ce or 0:12:24.800 --> 0:12:27.320 in multipher they are the supplements we use here in Australia. 0:12:27.960 --> 0:12:31.560 When you take a very very high amount, basically this 0:12:31.720 --> 0:12:37.160 peptide hepsidem. It triggers a temporary spike in that that 0:12:37.280 --> 0:12:40.200 lasts for about twenty four hours and acts as a 0:12:40.360 --> 0:12:44.560 block to subsequent doses, and it's like a protective mechanism 0:12:44.600 --> 0:12:45.920 to prevent iron overload. 0:12:46.320 --> 0:12:48.920 So suddenly the body is like not like, oh we're low, 0:12:49.080 --> 0:12:49.960 I need more and more. 0:12:50.520 --> 0:12:53.800 The basic physiology is, oh, you've got a huge amount 0:12:53.840 --> 0:12:56.360 come in. Sixty million romes is huge, and I think 0:12:56.440 --> 0:12:58.960 multiphas even more. I think multiphus like isn't ferrograd c 0:12:59.080 --> 0:13:01.520 like one hundred one hundred ye, so super high amounts. 0:13:02.360 --> 0:13:05.480 Keep in mind our idea is like fifteen eighteen or something. 0:13:05.920 --> 0:13:08.560 So you're having amounts three, four or five times that 0:13:09.000 --> 0:13:11.400 coming in. The body goes or hang on. I need 0:13:11.440 --> 0:13:13.480 to be careful with this because I don't want to 0:13:13.480 --> 0:13:15.760 have too much because that's also damaging to the body cell. 0:13:15.840 --> 0:13:18.760 So it basically blocks it for twenty four hours. And 0:13:18.800 --> 0:13:21.840 hence the recommendation from a number of GPS and rightly 0:13:21.920 --> 0:13:25.480 so that if you are supplementing with iron and you're 0:13:25.600 --> 0:13:28.240 very low, you need to only take it on alternate 0:13:28.320 --> 0:13:31.040 days to avoid this reaction where you're taking it but 0:13:31.080 --> 0:13:34.160 it's not being absorbed and actually being blocked. So back 0:13:34.160 --> 0:13:37.319 to the results of the study, which were so interesting, 0:13:38.160 --> 0:13:41.280 so interestingly land and not surprising given now we know 0:13:41.360 --> 0:13:42.280 how that peptide. 0:13:42.320 --> 0:13:43.599 Is it a peptide? What did I say it was? 0:13:43.640 --> 0:13:44.960 It was a it's a hormone. 0:13:45.600 --> 0:13:46.640 It's a hormone now. 0:13:46.800 --> 0:13:52.319 So basically the differences in the alternate day group was 0:13:52.840 --> 0:13:58.960 the total iron absorption was seventy one point four compared 0:13:59.000 --> 0:14:02.240 to one hundred and ten, So basically, as we would expect, 0:14:02.240 --> 0:14:06.199 it was significantly better in the group who had alternate 0:14:06.280 --> 0:14:10.960 day supplementation. So I thought, it's not groundbreaking in the 0:14:11.000 --> 0:14:13.360 sense it makes sense, but it also is a reminder 0:14:13.360 --> 0:14:16.080 as why if you've been taking iron supplements too frequently 0:14:16.120 --> 0:14:19.040 when your levels of ferretin are low, that you might 0:14:19.080 --> 0:14:21.840 not have had the response that you were looking for. 0:14:21.920 --> 0:14:25.480 And certainly it's better to split to have the dose 0:14:25.560 --> 0:14:28.480 on alternate days for maximum absorption. 0:14:28.680 --> 0:14:31.120 And I think, did it say it's better to split 0:14:31.160 --> 0:14:31.800 it as well? 0:14:32.200 --> 0:14:33.680 No, it's just alternate day, it's. 0:14:33.600 --> 0:14:36.960 All turnate days. So yeah, so that's basically why. Because 0:14:37.000 --> 0:14:38.800 of that, So if you're on social media, you would 0:14:38.800 --> 0:14:41.680 have seen a lot of people writing about absorption. So 0:14:41.720 --> 0:14:45.000 the question I have leanne Are you still then better 0:14:45.080 --> 0:14:49.120 to orally supplement versus getting in fusion? And that's I 0:14:49.160 --> 0:14:53.680 think a question because I think if iron supplements don't 0:14:53.720 --> 0:14:56.520 agree with you, you know, you get an upset stomach 0:14:56.560 --> 0:14:59.120 from them, you find that it's really harsh on the gut, 0:14:59.400 --> 0:15:02.280 You're probably better to get an infusion. But for whatever 0:15:02.320 --> 0:15:04.240 reason you have difficulty getting it, you don't want to 0:15:04.240 --> 0:15:06.520 pay because it can be an elective choice. The doctors 0:15:06.560 --> 0:15:09.960 recommending against it. Certainly the best advice has been to 0:15:10.000 --> 0:15:14.840 supplement and scientifically on alternate days at a reasonably high dose. 0:15:14.920 --> 0:15:18.200 I prefer multi for myself, Like if I was recommending 0:15:18.240 --> 0:15:20.160 a supplement for clients, I would go that over fair 0:15:20.200 --> 0:15:22.320 grad Sea, but I've had some people who use ferro 0:15:22.360 --> 0:15:25.080 grad CEA. I think that it's more important to do 0:15:25.120 --> 0:15:28.120 it occasionally, like every second day, at a good dose, 0:15:28.160 --> 0:15:30.200 to bring the levels up, and then you ultimately want 0:15:30.200 --> 0:15:32.880 to be checking to make sure that it's been uptaken 0:15:32.920 --> 0:15:34.920 by the body because for a range of different reasons, 0:15:34.960 --> 0:15:37.280 sometimes iron won't be well absorbed. You might have an infection, 0:15:37.840 --> 0:15:40.400 you might have some other things going on. You might 0:15:40.480 --> 0:15:42.160 consume a lot of tea or coffee, that you hadn't 0:15:42.160 --> 0:15:45.240 thought about. All those factors do have impacted the way 0:15:45.240 --> 0:15:47.600 you're consuming it because it can block it. And I 0:15:47.640 --> 0:15:51.680 had a listener question come up about timing of oxalates 0:15:51.680 --> 0:15:53.800 as well, which we're going to cover in a future episode. 0:15:54.000 --> 0:15:56.120 So yeah, I think it's just most important that you're 0:15:56.160 --> 0:15:58.000 doing that follow up a month or two later to 0:15:58.040 --> 0:16:00.240 make sure that your stores have been brought up back 0:16:00.280 --> 0:16:03.360 to regular levels and then make a decision rather than 0:16:03.440 --> 0:16:05.680 assuming that it's okay, because I do notice a lot 0:16:05.680 --> 0:16:08.480 of people will come in on iron, they'll start some supplements, 0:16:08.480 --> 0:16:10.080 they feel a bit better, and then they let it go. 0:16:10.440 --> 0:16:12.520 But you forget, you've got to build the stores right 0:16:12.600 --> 0:16:15.000 up again back to normal and make sure that you 0:16:15.080 --> 0:16:18.400 maintain them with it an adequate oral intake or if 0:16:18.480 --> 0:16:20.640 you know your ideal is to take a low dose 0:16:20.680 --> 0:16:22.840 supplement long term whatever, you've got to have a plan 0:16:22.880 --> 0:16:24.520 for it. Basically, you don't want to just hope it's 0:16:24.600 --> 0:16:25.800 up there because you feel a bit better. 0:16:26.400 --> 0:16:29.560 Yeah, it's super super interesting, and you know, as dieticians, 0:16:29.600 --> 0:16:32.720 and you know, many gps have always recommended every second day, 0:16:32.800 --> 0:16:35.080 you know, for iron supplementation, but it's good to actually 0:16:35.120 --> 0:16:37.000 have the research to come back to you. Like you said, 0:16:37.000 --> 0:16:39.000 it's not new. The study has been around for a 0:16:39.000 --> 0:16:42.080 long time. It wasn't a huge, huge, huge study. 0:16:42.120 --> 0:16:42.920 It was a great. 0:16:42.880 --> 0:16:45.120 Design study, but there was only nineteen women, so it 0:16:45.160 --> 0:16:47.920 wasn't huge, So it is worth a good discussion with 0:16:48.040 --> 0:16:51.040 huge GP. But certainly, many of the gas show introlgists 0:16:51.080 --> 0:16:53.480 I've worked within the past have always recommended second day 0:16:53.520 --> 0:16:56.920 aren't absorption. So basically the practical implication that the study 0:16:57.000 --> 0:16:59.600 was recommending was they're sort of saying, instead of taking 0:16:59.600 --> 0:17:02.200 a hundred milligrams of iron every day, it may actually 0:17:02.240 --> 0:17:04.640 be better to take two hundred milligrams of iron every 0:17:04.680 --> 0:17:07.720 second day. That's a whopping dose as well, because they're 0:17:07.720 --> 0:17:11.320 saying that the alternate day dosing improved iron absorption by 0:17:11.359 --> 0:17:14.760 around forty to fifty percent, and that is absolutely massive. 0:17:15.040 --> 0:17:16.800 But the big question I had when I read this, 0:17:16.880 --> 0:17:19.399 SUSI was well, what are the GI side effects, because 0:17:19.440 --> 0:17:22.639 surely two hundred milligrams of like elemental iron is a 0:17:22.760 --> 0:17:26.080 huge amount every second day. But interestingly, there were no 0:17:26.400 --> 0:17:30.280 like hugely significant differences in the GI side effects between 0:17:30.359 --> 0:17:33.239 both groups. So the most common side effects from a 0:17:33.240 --> 0:17:38.280 gashuintestinal perspective was nausea and epigastric pain for both doses, 0:17:38.320 --> 0:17:40.680 So in both groups there were a few women who 0:17:40.720 --> 0:17:43.119 both experienced a bit of nausea and a bit of pain, 0:17:43.640 --> 0:17:46.120 but it was no worse in the two hundred milligram 0:17:46.160 --> 0:17:49.560 dosing versus one hundred milligram dosing, so quite similar. And 0:17:49.640 --> 0:17:51.439 I think one of the ladies had a case of 0:17:51.480 --> 0:17:55.359 some vomiting as well, So basically the difference between the 0:17:55.440 --> 0:17:59.320 amounts were similar from a side effect perspective, which would 0:17:59.400 --> 0:18:01.600 for me as a dietician, if the GP was on 0:18:01.640 --> 0:18:04.040 board and happy, I'd probably be recommending the high dose 0:18:04.080 --> 0:18:06.560 every second day. But then we also know that iron 0:18:06.600 --> 0:18:09.400 can be quite constipating for some people as well, so 0:18:09.440 --> 0:18:13.200 that there brings the fiber fluid physical activity thing back 0:18:13.240 --> 0:18:15.840 into play as well. So a few things to manage, 0:18:15.880 --> 0:18:18.399 I think, but certainly worth a trial, I think if 0:18:18.440 --> 0:18:21.119 you're someone who's consistently had low iron or you know 0:18:21.200 --> 0:18:23.239 it takes a really really really long time for that 0:18:23.359 --> 0:18:25.720 eriton to come up on the blood test as well, 0:18:25.720 --> 0:18:27.080 But just really really fascinating. 0:18:27.520 --> 0:18:29.920 Yes, And I will say the single dosing, not splitting 0:18:29.920 --> 0:18:32.760 the dose is important too, because that impacts the peptide 0:18:32.800 --> 0:18:36.439 that's impacting it all. So yes, single dosing, even if 0:18:36.440 --> 0:18:40.040 it's every second day, don't split it all right, Lenn, Well, 0:18:40.080 --> 0:18:42.440 these have got a new ready made range of meals 0:18:42.600 --> 0:18:43.840 and I did have you noticed this? 0:18:44.280 --> 0:18:45.919 I have noticed them. I haven't tried them, but I 0:18:45.920 --> 0:18:47.600 have noticed them. I had a client try them. 0:18:47.880 --> 0:18:48.160 Well. 0:18:48.200 --> 0:18:49.840 I have to be honest, so I've been talking about 0:18:49.880 --> 0:18:51.680 this for a while now. I have loved what Coals 0:18:51.680 --> 0:18:53.920 are doing in this space for a while. Unfortunately we're 0:18:53.960 --> 0:18:56.040