Hepcidin is the master iron regulating hormone

Have you considered the role of hepcidin in regulating your low iron levels?

Hepcidin is the master iron-regulating hormone.

Hepcidin binds to and blocks ferroportin, an iron export protein, blocking it from iron and preventing its absorption. In simpler terms, it changes the amount of available iron receptors in the small intestines that can absorb iron.

Hepcidin rises in response to non-heme (plant-based) iron sources and supplementation, this elevation may last for over 24 hours. Due to this, it's worth considering alternative day supplementation. Aiming for your supplement to move through the small intestine when your iron receptors aren’t blocked and they are available to uptake iron. Keep in mind heme forms of iron such as red meat and beef liver aren’t thought to produce this same effect and may be a better option.

Hepcidin is also elevated in response to the presence of inflammation, the stimuli for this elevated is through inflammatory cytokines such as IL6. The key here is to reduce the inflammation before supplementing with iron as increased intestinal iron that isn’t able to be absorbed can also produce further inflammation creating a worse outcome.

Infections also increase hepcidin, but this is a protective mechanism as many infections use iron as a fuel so if you can limit the amount of iron being absorbed we limit the amount of fuel we provide to the infections and you hopefully heal faster. This is a major issue with chronic infections. If you can’t figure out why you're not absorbing iron it's worth considering an infection. On the other hand, if an infection has limited your iron absorption and you take iron to counter the deficiency you might make the infection worse.

Another issue with high hepcidin is the prevention of iron recycling. As our red blood cells age, they get broken down and the iron component gets sent off to be recycled. This process provides over 80% of your iron requirements. To put this into perspective less than 20% of your iron requirements are met from your diet or supplemental intake. Wouldn’t it make more sense then to consider what other factors are needed to assist in this iron recycling process?

Copper is needed for iron absorption, transportation, hemoglobin production, iron recycling, and anti-oxidant protection. That being said please don’t go off and buy a copper supplement. I’m suggesting you test and find out if copper deficiency is a part of your problem.

Some finer points about hepcidin are that it has a diurnal rhythm with its lowest point in the early morning and at night and highest during the day. This means if you are supplementing and want greater chances of absorption take your product in the morning, on an empty stomach if you can tolerate it. As non-heme iron and most supplements are non-heme iron, battle with other minerals for absorption and can be bound to food-based anti-nutrients such as tannin and phytates preventing them from reaching their receptors.

Hepcidin is also increased by emotional stress and resistance exercise.

I’ve met so many women in my career who have been taking iron long term and are still anemic or have had multiple iron infusions and nothing much changes. There are reasons why this could be happening, continuing this pattern may only make the problem worse. It's time to stop and think about why.

Hopefully, I have given you a few more suggestions to consider why your iron levels aren’t optimal but before I sign off I wanted to give you a few good reasons to stop adding more iron into your body if your body isn’t utilizing it.

One is that too much free iron in the digestive system leads to iron overload within the mucosa and this damages intestinal tissues and can lead to further digestive complications like dysbiosis, increased intestinal permeability, and inflammatory bowel disease.

In regards to excess iron infusions, the extra iron in the blood may produce reactive oxygen species, potentially causing free radical damage, mitochondrial damage, and cellular damage with excess potentially being stored and causing organ damage. I’ve had 2 iron infusions, they can be life-saving, so please don’t think I’m anti-infusion. Infusions should be used if needed but if they don’t change the needle stop as you have missed something.

You won’t know what you have missed if you don’t thoroughly test.

Additional testing.

I like to do a stool microbiome test. This looks for dysbiosis, hidden infections like H pylori, digestive inflammation, intestinal bleeding, and more. It is interesting to see the research looking at prebiotics helping to increase iron absorption, reduce hepcidin, and decrease digestive inflammation. I can’t emphasize how important it is to investigate your digestive health with low iron levels.

I also look at blood tests, I like to see a full iron panel, full blood count, inflammatory markers like CRP and ESR, copper, zinc, vitamin D, folate, and vitamin B12

It's worth mentioning that vitamin D can help regulate hepcidin levels, so you want to make sure you have optimal Vitamin D levels.

Also, read

Iron deficiency anemia in peri-menopause

 References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4438303/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8469827/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7193469/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3999603/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9697168/

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0228766

https://www.sciencedirect.com/science/article/abs/pii/S0304394015000130

https://www.fxmedicine.com.au/sites/default/files/Iron_Matters_FX-INFO_HR.jpg

If you're facing challenges related to iron or other mineral imbalances, I invite you to schedule a discovery call with me. Let's explore how I can assist you in addressing these issues.

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