The issue with repeated phlebotomies, especially in the presence of iron deficiency revs up erythropoietic response, thus stimuli of more RBC production as a compensatory for the lack of oxygenated hemoglobin. This is a common theme for a host of individuals that experience a constant elevation of their HH that repeatedly phlebotomizing while on a cycle or TRT. Ultimately this becomes a viscous cycle leaving them in a quandary state, of 'what to do'. Aside from iron loss during excessive phlebotomizing, we lose other trace minerals that are vital. There's not much for literature stating the potential for secondary deficiencies of other micronutrients (trace minerals) loss in routine therapeutic phlebotomies. So these questions are treading in the unknown without pulling specific blood markers. Under these circumstances, I'd suggest taking a good quality multivitamin with iron and zinc leading up to and after your phlebotomy. If by chance there is a copper deficiency, be sure to add copper to your zinc supplemention at a 10:1 ratio of zinc to copper. As for you to be pushing 58%, I'd have say there's another driver behind this outside of androgenic stimuli. Hypoxic-hypoxia from undiagnosed sleep apnea is another stimulus of erythropoietic response. I would dig deeper into ruling out OSA. Or lack of sufficient hydration and or the combination of undiagnosed OSA. Hard to say with certainty. Nonetheless. Here again, I suspect you may have mixed deficiencies. Generally MCV is elevated (macrocytic) in the presence of copper deficiency, as opposed to your microcytic status, although iron deficiency may over power showing signs of macrocytic. Although I would still consider asking your primary to assess the aforementioned immunoassays. The reasoning for my suggestions is that chronic digestive problems inconjunction with longterm use of PPI's and H2RA's can impede the absorption of copper, therefore hindering proper iron absorption. So it may be worthwhile to tease-out the possibility of a secondary deficiency is in place. Are you Rx'd the PPI's and was you diagnosed with GERD or similar? Or are you taking them primarily by your own decisions? If the latter, I'd suggest looking into substituting the PPI for betaine HCI and pepsin. If the former, I'd discuss the discontinuation of its use with your primary about switching to the use of betanie HCI/pepsin with each meal. Otherwise you may be facing an unbeatable battle to restore your Fe status. A majority of the time it's not 'too much acid secretion', as most people (and clinicians) believe. Rather it's related to lowered acid secretion (hypochlorhydria) in those with heartburn, gastric distress, acid reflux. By suppressing gastric acid, this isn't fixing a problem, it's exacerbating a losing battle you're faced with. So yes, PPI's have been associated with impaired nutrient assimilation. As well, there's suggestive evidence that prolonged use of PPI's could potentially lead to acute kidney injury and acute interstitial nephritis. So, I'd reevaluate using a PPI. There's some intriguing literature giving us fairly clear Information that iron deficiency acts as a prerequisite to a few different etiologies, e.g., cardiomyopathy (in more severe longterm cases), thrombosis risk through increased platelet aggregation- adhesion, cognitive impairment, impairment of our immune system, which is hypothesized to be a link between iron deficiency and some cancers. So, there's that. You may need some reorganization of your diet not only for your GERD, as well interactions of food-food, nutrients, drugs that may inhibit sufficient iron absorption. Outside of vitamin C to enhance heme based iron absorption, as does Lysine. As for nonheme foods, Alpha-GPC has been noted to enhance nonheme base iron absorption. Vitamin A is dose dependent that can act paradoxically with iron absorption. Too high of dosages has been noted as being inhibitory, in contrast to lower doses seems to enhance uptake. The incredible edible egg can do damage on iron absorption, as does several other foods. Ultimately in the end of all this gibberish. You really need to get to the root of why you've been struggling with regaining your Fe status. No Celiac or Crohn's disease?
.gif "IP Gear")
