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Hemoglobin levels are a marker for diabetic health, but the healthy direction is usually down, not up. Here are three simple interventions for diabetes to get iron and hemoglobin into healthy ranges.

Iron issues and high hemoglobin levels are far more important to diabetics than most diabetics and their doctors know. Anyone can lecture diabetics about all the foods they eat that they shouldn’t. Helping diabetics find the keys to managing their appetites takes a little more compassion, and a lot more science.

Diabetes Involves Errors in Iron Metabolism

The definition of diabetes is strictly in terms of blood sugar levels. If your blood sugar levels test above 126 mg/dl (7.1 mmol/L) when you are fasting or above 200 mg/dl (11.1 mmol/L) two hours after you eat, you have diabetes (or more specifically diabetes mellitus, distinguishing it from an unrelated disease, diabetes insipidus). Any successful treatment of diabetes involves lowering your blood sugar levels. The driving force of diabetes, however, is inflammation. And one of the driving forces of inflammation is iron.

One of the ways a diabetic’s body deals with inflammation is to create a protein called ferritin [1]. This protein serves as a kind of “jail” for iron. When iron is bound to ferritin, it can’t generate free radicals that damage cells all over the body, but especially the insulin-making cells of the pancreas and the appetite-regulating cells in your fat mass.

Why Diabetics Should Fear Ferritin

In diabetics, excess ferritin causes another problem. It generates insulin resistance. It also can more than double the bloodstream concentration of a protein called high-sensitivity C-reactive protein, or h-CRP.[2] Even worse, there is a growing body of evidence that ferritin increases appetite. Scientists have observed that children who have high levels of ferritin have stronger appetites. They constantly want to eat more. [3] At least in laboratory studies with animals, when iron is bound in ferritin in ways that it can’t be released to the fat cells that need it, those cells lose their ability to generate leptin. This hormone that fat cells use to send a message to the brain that you have eaten enough [4].  When overweight diabetics don’t have enough available iron, their bodies can't burn fat to make heat. This contributes to their difficulty with weight loss [5]. Add to these facts that insulin resistance results in higher levels of insulin in the bloodstream, and those higher insulin levels keep fatty acids locked inside fat cells where they cannot be burned and cannot be released, and iron becomes a central problem in diabesity, that persistent, nearly impossible to manage, almost universally problematic facet of type 2 diabetes. The problem just gets worse and worse. High ferritin levels generate insulin resistance. Insulin resistance keeps fat locked inside fat cells. When fat cells actually are able to release their fatty acids for muscles to burn them, this also increases insulin resistance. [6] And just as high ferritin levels can cause insulin resistance, insulin resistance can cause high ferritin levels [7].

How can diabetics possibly break this cycle. One way is to encourage the body to use some of the iron imprisoned in ferritin for something that helps burn fat, like high hemoglobin. Higher hemoglobin levels help the body circulate more oxygen and burn more fat at the same time.

How Diabetics Can Put Iron In Its Place

Diabetics don’t need more iron. They need for the iron they have to be used to make hemoglobin, not to make ferritin.

It’s generally a very bad idea to try to treat diabesity by taking iron supplements. In fact, excess iron is a major risk factor for diabetes [8]. Iron levels almost never need to go up. Ferritin levels almost always need to go down. How do you accomplish that?

  • Don’t take iron supplements unless your doctor prescribes them after giving you a blood test to measure iron. Too much iron is far more likely to be a problem than too little. Then make these changes in your diet.
  • Avoid iron-fortified flour. If you actually had an iron deficiency, you would get a faster response to iron supplements rather than iron-rich food [9]. You don’t need the carbohydrates from white flour, and you don’t need added iron from flour, tierh.
  • Don’t be afraid of dairy products. If you aren’t lactose intolerant, small amounts of dairy products stimulate insulin secretion in type 2 diabetes By “small,” I mean one or two servings a day. Eating those small servings of dairy with carbohydrates reduces increases in blood sugar levels after meals.  [10]  Especially in men, dairy products help reduce iron accumulation [11].

And for a bit of advice most diabetics will follow, avoid strenuous exercise until you have your iron levels in control. Exercising to the point of pain and inflammation causes iron levels to soar even higher if they are already high, but doesn’t increase them if you have normal or even slightly low iron. You’ll make more progress with less inflammation if you get diet in control and blood sugar levels in control before you try to increase your fitness level. 

Iron issues are far more important to diabetics than most diabetics and their doctors know. Anyone can lecture diabetics about all the foods they eat that they shouldn’t. Helping diabetics find the keys to managing their appetites takes a little more compassion, and a lot more science.[12]

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