Chris Kresser: Okay. I’m going to go back to the questions that have been sent in. This next one is also from Nick, “Iron supplementation while pregnant.” Great question. “This is a patient who is pregnant at 34 weeks. [A] midwife did [a] CBC and [a] CMP, but not an iron panel. [The results were]: red blood cells 3.7, hemoglobin 11.6, hematocrit 34.4, MCV 93.2, MCH 31.4, MCHC 33.7, RDW 14.4, platelets 174. [She has] more fatigue than she recalls with her first and feels like he has to take breaks after a small task. [She] does not like clams, oysters, liver, or lamb. Would you supplement with heme iron, ferrous iron, or do an iron panel before supplementing?”
I would do an iron panel. Nick, you may remember this from the Healthy Baby Code, but for those who haven’t seen it, blood volume naturally expands at this point in pregnancy at 28 weeks to 36 weeks, and what that will do is dilute the concentration of hemoglobin in the blood, so the normal range for hemoglobin will drop. It’s crazy to me that OB/GYNs and even midwives don’t know this because you often see this sort of situation where hemoglobin drops at this phase in the pregnancy and then iron supplements will be prescribed without any consideration of that natural expansion of blood volume. That’s where the iron panel can be very helpful, but even just looking at the CBC, if you recall from the curriculum, MCV will often be low in cases of iron deficiency. Here, it’s not low; if anything, it’s high normal, which would argue against iron deficiency. I would get an iron panel, and in the interim, if she’s not willing to eat those iron-rich foods, then I would use [a] desiccated iron-rich supplement, [a] natural food supplement like the Ancestral Supplements or Dr. Ron’s liver capsules, so that’s just grass-fed desiccated liver in capsule form. Phenomenal supplement. It’s kind of like cod liver oil, and it’s really more of a whole food than a supplement. It’s just [that] you’re eating the liver in powdered form instead of in fresh form.
While we’re on the subject, Ancestral Supplements also sells spleen. Spleen is the highest food source of iron that you can get, period. It can be a very effective heme iron supplement for people who are actually iron deficient, especially if you combine it with iron. That’s a really good choice in this kind of situation. You could, as a precaution, give her some of that food-based iron because the body is better at regulating that, and then you can do an iron panel. Some people might say, “Well, okay, if hemoglobin is on the low end of normal, why not just bring it up a little bit because it’s nowhere near high, so we might as well give some iron and bring it up,” and I think that might be the calculus of some of the OB/GYNs and midwives. But the problem is that studies have shown that better outcomes happen in pregnancy when hemoglobin is actually at the lower end of the range at this stage in pregnancy. I believe I covered that research in Healthy Baby Code. It’s a good idea to test, not guess, which is one of our mottos, as you know, and [an] iron panel is readily available and cheap, so it’s worth doing.