You Can’t Out-Coffee a Mineral Deficiency: The Iron Crisis Hiding in Plain Sight with Dr. Paul Maximus, ND
Off The Charts Podcast
Hosted by Dr. Bobby Parmar
[Dr. Bobby Parmar, ND] (0:00 - 0:10)
So many women are like, I'm really tired. My hair is falling out. I'm cold.
I'm in pain. My brain is foggy. Fill in the blank.
A female experience.
[Dr. Paul Maximus, ND] (0:11 - 0:19)
How are you going to out coffee or out sleep a mineral deficiency? How many divorces have happened because of iron deficiency? Hospitals don't give a fuck.
[Dr. Bobby Parmar, ND] (0:20 - 2:11)
That's the problem in the first place. And just because the system doesn't emphasize this doesn't mean it's not a big deal. Okay, so we're talking today about iron.
You might be like, this is going to be the most boring podcast episode ever. And it's actually not. It's one of the most riveting things that we think is important for us to talk about.
And Paul and I have been training like a whole bunch of doctors, almost 200 doctors and other people to offer iron infusions has become a huge part of our practice. We have a bunch of clinics that offer them. So it's a big deal for us.
And we kind of want to explain why it's such a big deal and why you should pay attention to this kind of shit. Okay. I want to talk first about why there's a problem in medicine with who gets to be told they're iron deficient.
There's this issue that we have that so many women particularly are like, I'm really tired, or my hair is falling out, or I'm cold, or I feel like I'm in pain, or my brain is foggy, fill in the blank, a female experience. And they usually go to a doctor. And they're like, I have all these problems.
You're supposed to help me. The doctor runs a bunch of labs. Okay, let's figure this out.
We're gonna house the shit out of you. I will figure you out. And then they either never hear back from their doctor.
Like ever, they just cannot get a text back at all. Or they do get a call back and they're told everything is fine. Then that person goes, okay, I think I'm gonna talk to somebody else.
Like my girlfriend saw Paul. Maybe I'll go talk to Paul. And then they make an appointment with you.
And then they say this whole try to see Bobby, but the three month waitlist kind of blocked that. I mean, we're trying to fix that. The one or two week waitlist was a lot.
[Dr. Paul Maximus, ND] (2:11 - 2:11)
Yeah.
[Dr. Bobby Parmar, ND] (2:12 - 2:15)
So what do you say to them? Why is that even a thing?
[Dr. Paul Maximus, ND] (2:16 - 3:12)
You want the technical answer? Can I give you now I'm going to give you the technical answer because I'm obsessed with technical answers. So the life labs in BC, Canada, the LifeLabs ref, the legend underneath your result in the reference range says under 15 is diagnostic of iron deficiency.
15 to 30 is probable iron deficiency. Above 30 is unlikely iron deficiency. And 100 is normal.
Square that for me. Now under 15 is definitely a problem. Over 100 is not a problem.
Totally normal. But above 30 is probably not a problem. How does that first probably make any sense?
Patients come to me and they're like, do I look at the 100 and cry or do I look at the 15 and celebrate because I'm a 35? How do you interpret that for patients first? And then I want to get to like the lab technicality of how those ranges are even made.
[Dr. Bobby Parmar, ND] (3:12 - 5:36)
I mean, if patients want to know, I explain by saying it's a ratios game that you're more likely to be iron deficient. And the rule of iron deficiency, which is not well known in both medicine and regularly, is based on your bone marrow. So basically the way we tell that somebody is iron deficient is whether or not your bone marrow, like this, has any iron in it.
And the only way you can tell is through a biopsy. And ain't nobody going to get a biopsy on their bone marrow because that's obviously too much. Basically, instead of digging a needle into your femur, we have approximations.
And when somebody is above 15 on that ferritin cut off, it is 100 percent of the time you have no iron in your bone marrow, which means you have no reserve of any kind to give your blood in case it ever needs it on a day that you went plant-based. No offense to plant-based people. It's hard to get iron.
I'm vegetarian. So the second is are there people who have some iron in their bone marrow up to a 30 ferritin? It's like, yeah, but there's a lot who don't.
And there's a lot of people who feel symptoms at that point that are not explained by another condition. So then they're just like, OK, so maybe we could raise the cut off from 15 to 30. That just kind of happened recently in a lot of places.
And doctors like to obey guidelines. And until a guideline comes out that says it's now 30, they don't really like to use this. Oh, but like studies do say that it could be that you're tired at a 27, but well, maybe take some iron for a couple of months and like, will you feel better?
And like that whole thing. The third is do people still feel symptoms up to like a 50 or 100? It is possible.
It's probable below 50. That's why they say it's probable. It's a likelihood.
It's a ratio game. It's possible up to 100 and that after 100, it's impossible. There's no way unless you have a disease of some kind that is responsible for what you think is a symptom because your femur is full of iron.
That's how I explain it.
[Dr. Paul Maximus, ND] (5:36 - 5:51)
But like, I mean, who wants to hear that? There's a lot of different labs in the world. There's a lot of different ways that they come up with these reference ranges.
And there's clinical reference ranges and there's laboratory reference ranges. So what Bobby's pointing to is the clinical reference range of like levels of bone marrow.
[Dr. Bobby Parmar, ND] (5:51 - 5:54)
Are you about to put the bore in laboratory?
[Dr. Paul Maximus, ND] (5:54 - 8:16)
Yes. The laboratory reference ranges are based on when that test was initially being formulated, however many decades ago, and they collected everybody's ferritin and then they effectively asked them like, how symptomatic are you? And from those and I was reading one paper that I think was Roche initially, where there have to be at least 60, 60 people worth contributing data. That's not a lot of people.
You'd think these reference ranges are based on thousands and thousands of people and they're constantly updated and they reflect the best available evidence for symptoms. They're often this nugget of just, yeah, we tested a bunch of people decades ago. We got random people who showed up to the office that day.
And even then, those were 95 percent of presumably healthy people. In other words, they don't have any symptoms. It's likely that a lot of the laboratory reference range actually included iron deficient women so that that threshold is really highly skewed to be this wide threshold.
Then doctors who don't understand the difference between a lab threshold and a clinical threshold will look at that, see no bold writing and be like, oh, therefore you're fine, even though you don't check all the boxes, you're not fine. And so doctors, I think, have to understand better that just because the lab threshold isn't bold doesn't mean the patient in front of you is lying or it's something else. There's a difference.
And this is why, well, like Bobby was saying, the threshold got changed from 15 to 30 because of a lot of lobbying on the doctor's part to be like, hey, this lab reference range is actually inaccurate for our use and we're the ones who are using it. Hey, lab, can you please update this? And then the lab eventually comes around to be like, yeah, OK, fine, we'll update it.
So it's not that that's made by doctors first and foremost based on patient samples. It's like real clinical cases. These are kind of like multi input decisions that are very conservative, very slow.
And even then who wants to be within the 95 percent of normal? Wouldn't you? Oh, and this is a question that we're going to get to.
But as NDs in particular, because we're in private pay, we have the time and the ability and patients often have the resources to seek out an optimal ferritin, not just an acceptable or not needing a transfusion level of hemoglobin or ferritin.
[Dr. Bobby Parmar, ND] (8:17 - 10:13)
Also, like so many people in medicine are toeing the line that if a specialist isn't going to bring this up, then why would a GP bring this up? Because that must mean that the people who are saying, because I've been in practice almost 20 years, we've been oh, I don't look at them. Yeah.
What's your secret? Iron? Two decades of my experience, I've been in the know of this, like, oh, people need more iron than what conventional medicine is saying or what just the zeitgeist is saying that you need.
And so it's been like try to get above 100. Women are then predominantly women, right? Are then like, oh, my God, my hair stopped falling out when I got to the hundred that you said.
And it's like, yeah, because you needed to be about that. And you kind of want to overshoot. And there's a reason why, because iron deficiency can be complicated.
We call it complex iron deficiency, where if a person has like if they're a little overweight or obese and a lot of people are or if they have another disease, let's say they have colitis or let's say they have rheumatoid arthritis or even psoriasis, you can be like inflamed in a way that makes your iron act like it's inappropriately being dumped in your blood from your liver where it's stored, which then it's like a false idea of how much iron you actually have because it's just kind of being dumped as part of this like inflammation process.
And then that makes your iron look even more inappropriately normal to somebody because they didn't account for the fact that you have this. They never wasted your inflammatory markers. They are just looking for bold.
They don't see bold, you're fine. And that is another issue that we don't do enough broad understanding of what could be influencing your iron.
We're so caught up on the bullshit of black tea and coffee and red wine.
[Dr. Paul Maximus, ND] (10:13 - 10:14)
And vitamin C even.
[Dr. Bobby Parmar, ND] (10:14 - 12:19)
Yeah. You have to get vitamin C. It's actually way overblown.
Why don't you have your iron supplement with a shot of kiwi juice to finally make it work? It's like it's not going to work. People having vitamin C with your iron or with your salad is not going to make that dramatic of a difference when you're hemorrhaging every month because your period is too heavy and that's why you got there.
Or you have unbeknownst to you celiac disease or some kind of absorption issue that doesn't allow for you to absorb anything anyway. Or you have a bacterial infection like H. pylori, my favorite, that blocks it from actually getting into your body as well because you're not able to absorb stuff because of the impact of the infection.
But like so many different reasons that we don't investigate when a person is iron deficient that then they're just left to float like a fatigued floaty person in this world figuring this is just my life. I guess it's just who I am. This is how life is meant to be.
And they never actually get to realize what they're supposed to feel like or what they could have because they didn't ever feel any different. And so they don't go back to the doctor to complain again because they don't have a complaint anymore. They've just been lulled into this.
I guess this is how life is supposed to be and how ultimately horrible that we do that to people. And it's all baked in on this like the lab stuff and like the ranges. Okay you didn't do well on Theramax.
Okay my girlfriend did really well on Spatone. So then maybe I'm going to use this like Scandinav Spatone. It's nuts.
It's really nice. Terrible. It has no iron in it.
Put it on my eyes. Yeah but that's a problem. We have these people who are like oh I'm going to try this really great natural sourced iron that came from the glacial mountains of um Andes.
And then they're just like this is going to work for me. No girl. The reason it's so good for your stomach and it's not going to constipate you and your girlfriend loved it so much is because there's nothing in it.
There's nothing in it. There's five milligrams but it's supposed to be 300 milligrams.
[Dr. Paul Maximus, ND] (12:19 - 12:29)
I literally had a patient last week who came in and brought me her iron pills and it was 11 milligrams a day. And her ferritin was 14. And that's what she was given by her doctor.
[Dr. Bobby Parmar, ND] (12:30 - 12:41)
Paul's favorite thing in the world is to tell people how many hamburgers they need. You tell people milligrams they have no idea what you're talking about. So just 11 milligrams.
It's like, “Okay. talk about your burger thing.”
[Dr. Paul Maximus, ND] (12:41 - 13:14)
Yeah okay. So the average woman is made of 3,000 milligrams of iron. That's 1,500 hamburgers of total iron.
A baby costs about 350 hamburgers to 500 hamburgers depending on if you're delivering vaginally or by c-section. C-section is more. It's almost double.
Each blood donation is 500 milliliters of whole blood which is about 250 milligrams of iron which is about 125 hamburgers each blood donation.
[Dr. Bobby Parmar, ND] (13:15 - 13:24)
Okay. Imagine every month you lose a blood donation to the toilet because you're getting a period.
[Dr. Paul Maximus, ND] (13:24 - 13:38)
The average period blood loss is 10 hamburgers per month which is about 20 milligrams. That's like five times but still that's possible. That happens.
Heavy menstrual bleeding you could be losing 20, 30, 40 hamburgers a month.
[Dr. Bobby Parmar, ND] (13:38 - 17:11)
Do you know how many more people have other reasons like they're your plant-based eaters now right? Like me. My ferritin is always around like between a 75 and 100.
It just floats there. For some reason my gut absorbs iron from my diet. My boyfriend and I have the exact same diet.
We eat predominantly the same. He's the cook. So every night I get his gourmet food and he and I should have the same ability to absorb our iron.
We should have that. We don't bleed. Why would we be different?
We're both men and yet every couple years. Oh sorry for outing you Rob. Look every couple years I have to measure him because I'm always still about 100 and he's a 14 or he's a 10 and then we can tell because it starts feeling things that way.
Imagine adding bleeding every month on top of that. Imagine now me floating around with my hundy and now I'm having to donate blood to the garbage every month on top of that. The ditch you dig on this eventually that you can't get out of because you're so busy having an orange OJ with your spinach salad.
No. Like that is crazy and like you know 30 to 50 percent of women up to the age of 50-ish are iron deficient in some capacity. So what's a woman to do?
So like that's the reason we're doing this because it's like it's kind of important. We ask ourselves how is this not more screened? How is it not more understood?
So then you'll come into the office and you'll say, “Yeah. I have joint pain. It's because I fell off a horse 15 years ago and my back has been hurting since my hips are hurting since.” I was like that's weird. Why would that injury cause that kind of thing to happen?
Or you'll say I'm just frozen all the time but that's because I'm a girl and that's what girls are. We're just frigid. And then you're like really?
I didn't know that was true. Then you say like what was your last iron and you're like oh that was checked five years ago. It's always been fine.
I don't have to worry about that. We measure and it's in the pits. It's in the pits from any angle that you look at from any many threshold.
Or my classic example nowadays is women in perimenopause. Women in perimenopause are getting really weird periods. They're irregular.
They're heavy. They're cloddy. You have fibroids.
You're way more likely to have different cycles that make you lose more iron. So it's this perfect opportunity for you to blame some other hormonal issue. It's my hormones you guys.
Test my hormones. And then you're just like can we make sure that your iron is okay? And most people are just like what are you talking about?
That was tested five years ago. I'm fine. Let me just humor myself.
Let me just take your blood a little bit more. A little bit more of this apple of your blood. And then we'll take it and it's how many how often is it in the pits?
All the time. All the time. And then you fix that.
We are an infuser group. We love infusing iron to get rid of it as a problem. Just get rid of it as a problem.
Just remove it. And then within a month you'll be like all the things that you blamed. It was my hormones, you guys.
Or like all the things you blamed were on the horseback accident. Or all the things you blamed on being just a woman. They go away.
And then you have this new crazy understanding of like Jesus Christ that was all iron the entire time. But nobody bothered. It's unhinged.
Paul, how many problems could be solved by ultimately a single infusion of iron?
[Dr. Paul Maximus, ND] (17:11 - 18:11)
So much. It's a mineral. How are you going to out coffee or out sleep a mineral deficiency?
We have an amazing resource about this called ironrxuniverse.com. We'll put it in the show notes. ironrxuniverse.com.
That was such a podcast thing to say. Yeah. Put it in the show notes.
If I was watching the podcast I would want it in the show notes. So anyway it's in the show notes. So go take a look.
But on the IV iron page of that website you'll see a video. Watch that first video. Inside it you'll see a graphic about all the symptoms that start to pile up the lower your ferritin gets below 100.
So in order if your ferritin is like 75 and below you run into fatigue, insomnia, anxiety, depression. Actually restless legs was one of the earlier ones too. Restless legs at a ferritin of 75 should actually be brought up to 100 or 150.
See if it goes away. Fatigue is really common at ferritin, even upper double digit ferritin.
[Dr. Bobby Parmar, ND] (18:12 - 18:44)
We've had people with a ferritin of 65 and we give them an infusion. We'll give them an infusion. Like we won't get into the nuances of what we do there.
I'm not sure. Yeah we'll give them an infusion and they come back and you can placebo domingo this all you like but that's not what is happening. They'll come back and say you changed my life.
You changed my life. I didn't even realize what I was feeling before you changed my life. My hair, like the hair thing is like a ferritin of 40-ish.
[Dr. Paul Maximus, ND] (18:45 - 18:57)
There's libido. It’s ferritin of 50 or less. How many divorces have happened because of iron deficiency? Because you look at your partner and you're like I just couldn't.
Iron deficient of course evolution shutting down your libido.
[Dr. Bobby Parmar, ND] (18:57 - 19:05)
And what are we doing? Like all the medications for a person's libido are to get more blood to our parts.
[Dr. Paul Maximus, ND] (19:06 - 19:11)
Like we're getting more blood to our parts. Let alone the neurotransmitters. You need iron to produce dopamine.
[Dr. Bobby Parmar, ND] (19:12 - 19:32)
How is that going to work for your desire right in your drive? But how is trying to take a drug to make more blood get to your bits? Especially like the lady bits.
When the oxygen is the point. Circulation is to bring flow of oxygen to your tissues. You can't bring flow of oxygen to your tissues without any iron because that's what it's carried on.
[Dr. Paul Maximus, ND] (19:33 - 19:55)
And hemoglobin carries it in the blood but myoglobin catches it in the muscle. And so you could have normal hemoglobin. It doesn't mean that you have enough for the cytochromes in your brain or the myoglobin levels in your muscles.
But meanwhile you look at your hemoglobin your doctor looks at their hemoglobin. They're like what are these gravity guys talking about? Of course you have enough oxygen in your blood.
What about your muscles? What about all the jobs needed by iron in the brain?
[Dr. Bobby Parmar, ND] (19:55 - 20:57)
And they will say that we big up iron infusions because we own iron infusion clinics. And let's talk about that. That's so crazy to me.
If it isn't the people who figured it out who start offering the service. Who is it? If it isn't the people who are like this is a problem but nobody else is doing this.
Hospitals don't give a f**k. Like nobody cares. That's the problem in the first place.
Are we supposed to sit on our hands? And we can't afford it. Yeah.
Are we supposed to sit on our hands and be like let's just wait until somebody else offers this and then not charge a person for it? Are you joking? No, we're going to offer a service.
And yes it's private pay medicine but that's the whole point. We're offering a way out so that the system doesn't have to feel this enormous burden of infusing millions of women through a hospital system that already can't handle it. Like we're not supposed to add more to GPs plates.
We're not supposed to add more to the conventional systems plate. We're supposed to try to take it away. That's like one of our jobs.
[Dr. Paul Maximus, ND] (20:58 - 21:08)
That's why we've got the scope that we've got in OEC because we've seen a fifth of British Columbians don't have a doctorate. So you step in and okay great we'll take it from here.
[Dr. Bobby Parmar, ND] (21:08 - 21:47)
And we live in Shangri-La. Like we live in Vancouver. We live in Shangri-La for God's sake.
Imagine what it's like in the rest of the world. Never mind what's happening in places where there's predominant vegetarian populations. India, South Asia, big populations of black and brown women in areas around the city where there's a more predominant population that doesn't get screened because this problem still exists but they need to be screened even more.
It's just wild. So we offer the service because it's so important and we try to get other people to start offering the service. So we trained almost 200 doctors and other providers.
200 almost.
[Dr. Paul Maximus, ND] (21:47 - 22:01)
From the Caribbean to the UK. Anyway we'll talk about that at another time. We'll talk to the doctors another time but back to the patients.
So patients have the option of oral iron and when it doesn't work then they seek us out maybe for an IV.
[Dr. Bobby Parmar, ND] (22:01 - 22:42)
The other thing I wanted to bring up was the whole point of taking oral iron before you get an infusion. That blows my mind that we force people to take one of the most ineffective ways of overcoming your deficiency. We'll blame all kinds of herbs for their side effects but we will turn the other cheek for iron every time it bloats the shit out of you.
It shits the shit out of you. You can't take a shit. You are in pain.
You get hemorrhoids. You can get fissures that make you bleed more as a result of the constipation it caused.
[Dr. Paul Maximus, ND] (22:42 - 23:14)
And yet despite all of those you need to fail oral iron before you're offered an IV and even then in Canada only if you're anemic which is another thing we've got to talk about because nobody really properly understands the difference between anemia and iron deficiency. Yes, iron deficiency anemia is a thing. Anemia means it's the last stage.
It's the final stage. If you don't have anemia you can still be iron deficient. Who wants the last stage of anything?
Anemic. Who wants stage four of anything? Exactly.
So just because you're not anemic that doesn't mean you're fine. Your ferritin should be a hundred.
[Dr. Bobby Parmar, ND] (23:14 - 24:08)
What if we made it go away like athletes all the turkey trotters that were outside today? You know 20-30 percent of them are iron deficient wearing their little turkey outfits gobble gobble and they're still plugging along being like I'm doing great you could do so much better. Like as an athlete there's so many athletes out there who also how many fucking gold medalists have you infused so that they could get a gold medal? Lots and lots of people need to fail oral iron in order to get the IV.
It just pisses us off because why are we doing that to people? You're spending money every month $50, $60 on a high absorption iron that you're now taking every second day because every day apparently wasn't very good to absorb and it caused more side effects so take it every second day. Okay commit that to memory and then do three months of it.
Nobody retests you because nobody bothers.
[Dr. Paul Maximus, ND] (24:08 - 24:14)
That's the thing years later somebody would be like I was told I needed iron years ago. Well did you ever check? Did you fix it?
[Dr. Bobby Parmar, ND] (24:14 - 25:20)
Took it for three months. No, I still have the symptoms. There's a clear issue: there's a flaw in this thing that we created that first line therapy is oral.
I get it if you don't have access to infusions that's all you have as your option. Or if you're Ferdinand's 80. But if that's the only option available to you I would suggest that you push your doctors to offer you infusions even if you aren't in a place that readily offers them like we have or you find somebody who does pay for it privately because it's going to change your life and we need to really make iron infusions first line.
We have to stop making it the second thing. Pregnancy where you're infusing pregnant women who are on top of their pregnancy that's stealing the shit out of their iron. The baby is an iron just sieve and it's just not impossible.
It's literally impossible after week 30 to get back to non-iron deficiency when you've been iron deficient. Impossible. You can't lose the loss that you're getting from week 30 like seven milligrams a day.
[Dr. Paul Maximus, ND] (25:21 - 25:26)
Baby is taking. You can't do that with oral iron. You're not going to, you're not going to make up for what you lost and overcome.
[Dr. Bobby Parmar, ND] (25:26 - 25:57)
That's a fact and yet we still like to take oral iron and if you bleed out in your delivery or if you have a c-section and you lose that much blood you'll take iron after the delivery when you're already. Postpartum is then My god this is crazy that we're already putting a burden on top of already burdened people that is it's unacceptable actually. So which is why we're so impassioned by this, which is why I think it's so important for people to like to know this kind of stuff.
[Dr. Paul Maximus, ND] (25:57 - 27:04)
Let's talk about cost because when you say private pay people immediately assume like I can't afford that. If you have benefits god it's a shoe-in. It's a total shoe-in.
The vast majority of benefits programs cover either the whole thing or the majority of it and iron is expensive, not as expensive as burgers. I like to compare this to burgers when somebody's like oh my god that costs a lot. For a 1000 milligram dose which is 500 hamburgers worth of iron the iron drug itself costs about 550 dollars.
That's a dollar and ten cents per burger. You think that you're going to get a better deal than that anywhere but let alone even if you had to pay for that out of pocket 500 and 550 dollars or whatever out of pocket. Insurance usually covers either the whole thing or like 50 to 80 percent of that.
You're getting it for 50 cents a burger. You're going to beat that and any other means like no so the cost of don't think about the cost also the lost lost productivity right you take oral iron supplements nobody's going to pay you back if they're not covered by drug benefits you have to retest six months later you lost six months worth of spending on coffee
[Dr. Bobby Parmar, ND] (27:04 - 27:14)
sleeping in snoozing this is your life this is your life this is your life you're not going to pay a dollar a burger and just because the system doesn't emphasize this doesn't mean it's not a
[Dr. Paul Maximus, ND] (27:14 - 27:54)
big deal it's a huge deal because somebody's MD didn't say it because the reference range because of economics because of all the other variables if an MD didn't say it it's not real or it doesn't exist that look at the look at the literature on our website ironrexuniverse.com slash they'll go to the for doctors page we'll put the link down there okay if you're a doctor listening to this read that whole page and come up with rebuttals we're open to learn we want to learn we want to be called on our ship check out the resources there because this is in plain sight we've known about this for years we've been offering iron infusions we're training doctors we have this conversation on a daily basis we're gonna have to do a whole nother podcast episode
[Dr. Bobby Parmar, ND] (27:54 - 28:08)
on infusions like side effects and stuff like that unless today is just about get tested know your number don't ignore the number ask for it and then fix it just fix it
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