In the middle of my four-part series on subclinical iron deficiency [Part 4 appeared in the March 12 issue], a new patient came in; I will call her M.She was 22 years old and desperate. Her presenting complaints were: pain in her arms and legs, especially her left leg and right arm; burning pain in both feet; headaches, dizziness and loss of balance; and neck, upper, middle and lower back pain.
As I started to take M's history, she said, "My regular doctor said I have nerve problems and sent me to a neurologist. The neurologist said I have muscle problems and sent me to a rheumatologist. The rheumatologist said I have fibromyalgia. Both of my legs just kill me and my friend said it's sciatica and gave me your name."
She then began to get emotional and said, "I've been getting worse for two months and I feel like I'm losing my mind." She teared up and went on, "Before this happened, I had three jobs. Now I'm too tired to even have one. I feel that the doctors think I'm a head case because they say that there's nothing wrong and that all of my tests are normal." Then, as her voice began to break, she asked, "Am I crazy?"
I thought a was a great time to break the ice, so I answered, "I think you're as kooky as a loon, and nutty, too!" She paused, her eyes got wide, and she was unsure how to react until I winked. Then she began to giggle and the tension melted. I told her we would either figure this thing out or find the person who could. I pitched the idea of a nutritional, but abandoned it when I discovered she barely had the money for a co-pay, let alone cash for 1-2 hours of my time. So, I did what most of us do from time to time: I worked for almost nothing.
I asked her what tests had been done. "Blood tests, this EMG thing that hurt a lot, and three MRIs. They were all normal." We sent for the reports and I learned she had a brain MRI for headaches, a cervical spine MRI for right-arm pain and a thoracic spine MRI for back and leg and arm pain. She also had a complete blood count, a chemistry panel and additional tests on TSH, serum B12, folate, antinuclear antibody, creatine phosphokinase, C reactive protein and Rh factor. All were negative and/or in normal ranges. The hemoglobin and hematocrit on her CBC were optimal.
I asked if there were any other complaints and she said no. I started my review of her problems, starting with her low energy. M was no longer able to exercise due to shortness of breath. I asked, "Do the other doctors know about this?" She said, "I told the last guy and he said it was caused by the fibromyalgia." I asked how her sleep was and she told me it had been poor for over 10 weeks and that the third doctor said it too was caused by the fibro. I then asked how her energy was before the sleeping problems started. She said it was OK.
"Are you sure?" I asked. So you had all this energy and then bam, you couldn't sleep enough and lost the pep in your step?" "No, it wasn't like that," she answered. "It was kinda going down but not as bad as the last two months." A series of questions revealed her energy had been on the decline for at least four months prior to her sleeping problems and the steep drop.
There are countless causes of low energy. Luckily, the majority of problems are not due to the esoteric causes promoted by the nutrition industry to sell supplements. In women, sleep, low iron and a slow or underactive thyroid are involved in a high percentage of problems.
In M's case, the sleep deficiency appeared to be the last straw which indicated it was related to whatever had been lowering her energy over the previous six months. I asked her about her periods and she told me hers were like clockwork and totally normal. I inquired about her flow and her face got red and she said it was very heavy and (with additional questions) had been so for a year. I then asked if she ate red meat. "Oh yes, on a regular basis." But further questioning revealed "regular" was only around three times a month.
I asked about the other common signs and symptoms of low iron. (See "Subclinical Iron Deficiency Part 3," Feb. 12 issue) She didn't have all of them, but she did have cold hands, cold feet, brain fog and was very sleepy in the afternoons. She had already complained of headaches and poor exercise tolerance. When I asked if she noticed any hair loss, she said, "Oh my God, I have been losing so much hair lately it's been freaking me out!"
I told her some of her symptoms could be caused by an iron deficiency. "But my primary doctor said I was fine!" she said. "Well, did she ask you the same questions I did?" "No, and neither did the other two," she replied.
I told her I wanted her to try some iron. She asked, "How long will it take for me to feel better?" I replied, "Many women feel better within 3-4 days, but if you don't feel anything after seven days, we will stop." I explained that there were other causes of her symptoms and since her initial bloodwork indicated no deficiency, the short trial would solve the dilemma.
I sent her home with an iron product that also had vitamins B12, C and folic acid. When she returned to the office two days later, she said, "I have more energy today than I've had in four months!" Her energy continued to improve over the next few weeks and some of her complaints (brain fog and hair loss) resolved. But she continued to have the polyneuropathy, muscle pain, body aches and burning feet. This leads us to the next article, which will discuss two more deficiencies that were missed, how I found them, and how they responded to treatment.
Click here for previous articles by G. Douglas Andersen, DC, DACBSP, CCN.