#44 - What women in perimenopause need to know about iron deficiency with Maryann Jacobsen, RD

Iron deficiency is by far the most common nutrient deficiency among women, but the chances of being low in this VIP mineral increase in perimenopause. And as Maryann Jacobsen RD and I discuss, you don't have to be clinically anemic to feel the effects of low iron. We discuss why ferritin isn't the only measure we need to be paying attention to in our bloodwork, why the reference values for ferritin may be too low and the symptoms that women in midlife should be on the lookout for.

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Transcript

Jenn Salib Huber  0:02  
Hi and welcome to the midlife feast the podcast for women who are hungry for more in this season of life. I'm your host, Dr. Jenn Celine Huber. Come to my table. Listen and learn from me. Trusted guests, experts in women's health and interviews with women just like you. Each episode brings to the table juicy conversations designed to help you feast on midlife. Hi there. Welcome to this week's episode of the midlife feast. My guest today is Marianne Jacobson. Like me, Marianne is a dietician. She's a family nutrition expert. She's the author of several books. And while the first part of her career was very much focused on the developmental stages that kids go through and working with families and nutrition, the last few years have really brought her interest around to midlife nutrition, partially because she's in midlife herself. And she'll explain a little bit about that. But I was really intrigued to have Mary Ann on the podcast to talk about iron. And so she had posted something on social media a while back about iron deficiency without anemia. And I talked about iron a lot, because it's something that you know, women in general, and people with periods in general are more prone to have less of or be at risk for deficiency. And maybe even a little bit more so in perimenopause, because our periods can get so heavy. So I wanted to have Marian on to talk about iron deficiency, iron deficiency with him without anemia. And what are some of the things that we should know about when we're going in to have these conversations with our health care providers? And just so that we can, you know, feel our best through these years because iron deficiency is no fun at any time, but especially when you layer it on to perimenopause.

Jenn Salib Huber  1:45  
Okay, welcome, Marianne, I am so excited to be talking about one of my favorite topics, which is everything to do about iron. So, tell us a little bit about how you got interested in working with women in midlife. And you know, you've kind of become, I'd say, a recent advocate for this conversation around iron. So tell us a little bit about that.

Maryann Jacobsen  2:09  
Well, I'm, I consider myself a family nutritionist. So I deal with like, all different ages. And when my kids were little, I didn't know a lot about childhood nutrition. So I started researching, I love to write and I'm like, Well, this, I can do this while having kids. And I really learned about developmental stages. So you know, a growth and you know, infancy is as high rate of growth toddler it slows down affects eating. So parents flip out when their toddler doesn't eat. And you know, all those problems start. And then puberty, I wrote a book for my daughter. I'm like, here you go about how our bodies changing. And I learned I love learning new things. And right, since I'm an older mom, I had her at like, 37.

Maryann Jacobsen  2:54  
I started going through perimenopause during that time, and I'm like, I need to attack I need to, I started having these symptoms. And I just felt like going you know how it is you go online, and it's like, I got on this Facebook group. And there's everyone's recommending this supplement. It just seems like it's so fragmented, you know? So I started researching, I thought, oh, a year, usually a year or two to write a book. It's been three plus years. And I'm really, really enjoying myself. So and then I found about about iron. So you know what we're going to talk about today that a lot of my symptoms were due to that and not necessarily perimenopause. So. So yeah, I mean, yeah, I'm really easily.

Jenn Salib Huber  3:40  
So I think it was about a month ago, that I think maybe a little more than a month ago that you posted about iron deficiency without anemia. And I, you know, reached out to you and I said, I really want to talk to you about this. And since then, as is always the case, it's like you buy a blue car, and everybody has a blue car. But like since then it feels like this has become really front and center of you know, the discussions that I'm having with people, although iron has always been on my radar for anybody who has a period as I describe it. But tell us a little bit about what you have learned and you know, kind of why this has become such an area of interest for you.

Maryann Jacobsen  4:23  
So I started I am prone to anxiety. So all of a sudden it like 47 I had these horrible anxiety attacks that were very similar to when I was about 30. I had trouble swallowing my heart rate would go up, I'd sit down and watch TV end of the day. And it's like, I'm like, Oh my gosh, you know, I had a weird shortness of breath. Not really when I exercise because I exercise a lot. And so it was like this must be anxiety. Oh yeah. perimenopause. And, you know, I would go to the doctor every two, three years, and they never said anything about my book. I'd levels and I didn't really think about iron. And I don't know why. I mean, I know amount of for infants and the importance of pregnancy, but I just I wasn't thinking about it and which is, you know, I regret it now. And then I decided to try half marathon again. It's been many years. And I did this half marathon and I felt so horrible. I was like, Why? Why did I ever? This is like, horrible. And it wasn't too long after that, that I got, I went to the doctor, I had some shortness of breath while I'm running. And they're like, Oh, you're anemic. And I was like, Oh, my gosh. And it was like, when I go through something, I just started to research. How did this happen. And I looked past in my labs, I realized that ferritin is, if they want to take in my ferritin. The problem is, they may have said it was normal, even though it wasn't, but I never had a ferritin and I keep all my labs, not my pregnancy labs. So I don't, I never have had a ferritin. And this was right about 50. So I was I went basically five years with low iron, which is really sad. I, I was fatigued. I mean, I felt okay, you know, it's like a lot of women, you're just oh, I have kids I work on. And so I realized that if they had just checked my ferritin, if I had been aware I had all these, there is a one blood marker called biomarker, red cell distribution with and when that goes up, that was high, that was high for two times, that's a sign of either iron b 12, or folate deficiency. So you should never let that you know, I have a biomarker guide to help women read their labs, because you cannot rely on doctors. And granted, these weren't gynecologist and maybe, you know, these were just primary care doctors, but so I, you know, been suffering. And if I didn't get anemia, I would not have known because they only screen most of the guidelines are screened for anemia, even in pregnancy, which is a whole nother topic, we're talking about midlife. But I was a classic case, I was having regular pretty heavy periods. They weren't like crazy, you know, I could handle them. I exercise a lot. My diet was fine. It's you know, I eat all foods. And I was you know, the exercise and the running just kind of that increases your needs. So usually there are the four areas you look at for iron deficiency. And I have three out of four. So, you know, someone should have caught it. But more importantly, I should have caught it.

Jenn Salib Huber  7:32  
Well, let's talk a little bit about iron deficiency without anemia versus iron deficiency with anemia. So anemia, just for the listeners, and anybody who doesn't know is kind of defined when your hemoglobin drops basalt below, kind of the norm, the normal reference value, which you know, depending on the lab is going to sit somewhere around like 120. And for most people who have anemia, there is often a cause. So it may be dietary, maybe they've had, you know, a source of blood loss. So like after childbirth, for example, or there's also chronic disease, people who are undergoing, you know, cancer chemotherapy, you know, there's all different kinds of reasons why you can have anemia. And when you're anemic, you feel very tired, you're short of breath, you're pale, there's some really kind of clear symptoms. But what we're talking about today is iron deficiency without anemia, which is when all or most of the usual markers. So you know, in particular, hemoglobin, all of those markers are normal, but iron levels, and in particular, the stores of iron, which is ferritin are sub optimal. So and I think that that's the key, because when we're talking about the reference range for normal I, you know, correct me if I'm wrong here, but depending on the lab, it's going to be somewhere between 10 and 200. But when we're talking about iron deficiency without anemia, producing symptoms, we're even talking about people who have fare buttons in the 20s and 30s. Right.

Maryann Jacobsen  9:06  
Yeah, I mean, if you think about it, you have money in the bank, right? I mean, do you start getting nervous when it starts getting down to the, you know, you have I don't know, I don't want to put a number on it. But you know, so your body, think about your body, it senses the stores are going down. And iron is not just about transporting oxygen, it also plays a role in your thyroid health, your brain. It's involved in 180 biochemical reactions. So what happens is, it turns off, it doesn't work as well in these areas, but it prioritizes the hemoglobin and that's why anemia is a very final stage. So that's why you feel fatigue, you might get dizzy, you know all these symptoms, palpitations or classic a lot of midlife women get them I got them really bad swallowing problems. Your nervous system gets churned up your blood flow you know your heart rate increases. So the problem is the stores, everyone's might be different, you know, someone with, you know, a ferritin. So, the World Health Organization will say 15 or less is iron deficiency. Well, and a lot of people say 30, based on a study 1998. But a lot of this newer research is showing levels of 50 are when menstruating women hepcidin is a hormone, when that starts to go back up, because usually it goes down to increase absorption. But right around 50 A recent study showed is when it you know, so this, this 50 number seems to have, you know, emerging research, we need more, of course, but what's most important isn't the number, it's how you feel. And you know, if you're menstruating especially, you know, this idea that heavy bleeding is HTML, you know how that it's 16 sanitary products, that a recent study showed that the average because they used in the past, they use indirect measures, now they have those silicone cups to track menstrual flow, that the average is 80 ml of blood loss, that's considered heavy. So that's one study granted, so the high was 160 ML, and this is fluid, it's, it's not all blood, but it's menstrual fluid. And so I don't think I think we've been under estimating how much blood women lose. And in definitely during you know, every pregnancy, you get your ferritin goes down, it takes two years to go back up. So if you had a couple pregnancies, then you got on birth control, let's say you got your tubes tied, then you go 10 plus years of these periods, you're exercising, you're, you know, you're probably going to be low. I mean, unless, you know, you might take a multivitamin, but it's not absorbed well. So you have to think about it as your body needs a certain amount of stores. And when it doesn't have that it's going to you're not going to perform as well. And it can affect your health too. You know?

Jenn Salib Huber  12:04  
Yeah, and I think it's so important to talk about those kinds of normal reference ranges. So, you know, I work primarily with Canadians, and so the lab in Nova Scotia, you know, defines anything is under 10, for a ferritin as low, I can tell you that, you know, what I tell people is that if your ferritin is less than 30, you're probably only one or two periods away from being, you know, kind of clinically anemic, or, or deficient. And, you know, and then often people will say, Well, I've never had a ferritin over 30. Never in my life, not when I was pregnant, not when I was a teenager. So my question is always are we have we set the bar too low? You know, or why, you know, why is it that most people and I'm actually one of them, I'm someone who has had chronic iron deficiency in and out of anemia, the highest ferritin I've ever had was 44. And that was when I was pregnant, and I was taking so much iron that it's a wonder that I could actually have a bowel movement. But I was pregnant with twins, and I was committed to not becoming anemic. You know, and so I've had to work really hard at him. So I always kind of question is that, is it that we set the bar too low? And how do we start to shift the conversation away from, you know, we don't want people to be anemic when they're diagnosed, we want to catch them before they're anemic. Because when you're anemic, you're feeling awful. Like you have no stamina, no reserves, you really, you know, can't function in the way that you you want to so what's the research telling us about how we're screening people? And you know, what can we do differently? And what can we do better?

Maryann Jacobsen  13:51  
I mean, we're not doing a very good job. I mean, it depends on where you are. I've looked at all the recommendations that you know, from health organizations from around the globe, and most are more than five years old, if not 1015. Even the World Health Organization is based on data, I just went digging the other day, that's how obsessed I am like, where did they get this? 2003. So it really depends on the doctor. So now I have a doctor that she checks ferritin, but I've never had mine screened at all. But what I've heard from women, since I've written about this, they write in and they're like, my ferritin was 15 and three different doctors told me I don't don't need iron. Someone had, like 20 told you're fine, even though they have these symptoms. There is a great route view by SSIP. He's an internist out of I think, Finland, and he talks about a fair anything 100 or less, because sometimes ferritin can be high because of inflammation. So ferritin wasn't perfect. You want to check your labs, like you know, even your hemoglobin. Do you see it going down? Like when I look back, I could see you No my hemoglobin going down by my MCV, which is the size of my, my red blood cells started getting smaller. And so you can look at these trends too, along with a ferritin. I wish I had a baseline in my 20s. And I know, okay, you know, we should all women should have a baseline ferritin. Just like with cholesterol, I think we should know about our iron, it's so important because an even in like, restless leg syndrome thing, or anything 75 or less. If you look at fibromyalgia, a high percentage of iron deficient according to now, guidelines, if we took that number higher, it might be 100%. But it's like 60%, according to one study, so a lot of these mystery illnesses, someone that's vertigo, and they go from doctor to doctor, you know, consider iron really honestly. But one of the things you asked is, if you've gone a long time with iron deficiency, it's going to take a lot longer. So um, my levels went up pretty fast. I mean, I was about five years. But you know, you don't need as much iron, we can talk about that too. Like research shows taking it every day, you don't absorb hepcidin goes up, when you take high levels. So you're better off now research is showing taking it every other day. And not such high doses. So that's something that I usually recommend, because so many women will get these gi like 60% have these side effects, so then they stop, and then they can't get their levels up. Also, IV iron is a consideration if you're not responding. IV iron is a lot safer than it used to be. It might be something you need initially until, you know your body can you know if it's gone many years and a low iron state, you should definitely push for that as a consideration. I think it's like one in 200,000 severe reaction. So it's it's a pretty rare, you know, they have better formulations, but a lot of doctors are still like so I think, yeah, we're I don't think we're doing much at all to really, to, you know, I just think there's just there's not enough information there based on old guidelines. Most doctors are drilled into them about anemia. So

Jenn Salib Huber  17:16  
yeah, it's, and let's back up a little bit. So I mean, obviously I talk a lot about midlife health. And that's because that's kind of the population. And that's my interest. And that's your interest right now, too. But, you know, I think one of the things that we're not really putting together for for people is that in perimenopause, you are more likely to have heavier periods, because estrogen, you know, is often trending higher. And estrogen is what you know, fertilizes the grass, so to speak. And then you have progesterone that's trending down. And Its job is to kind of keep the grass trimmed. It's kind of like the lawn mower. So you have a perfect storm to have heavier cycles. And you're also more likely to have cycles that are happening more often meaning that instead of a 28 day cycle, you're having a 24 day cycle, or 25 day cycle. So for several years, you're having heavier periods that are coming more frequently. And if you're someone who has always been challenged to keep your iron up, or has, you know, had been prone to iron deficiency, this is a period of time in your life when you really need to be on top of it. And so my kind of my clinical experience is that headaches are one of the number one sign so I always tell people that if I was a betting person, if a 40 something year old woman comes in with chronic headaches, that are just kind of this dull ache that get you know, they wake up with them, and they get worse over the day, dollars to doughnuts, my favorite thing, my hands involved in some way. And it's kind of magical, actually how like, I'll tell them start some iron even before we get your ferritin back, because there's probably no harm in that for you because you're having a period all the time. You know, and it's kind of it's kind of magical, how often just the iron will start to shift those chronic headaches, it may not be the only thing that's giving them a headache, but it's a frequent common cause that's overlooked way too often. And it's it's straightforward and simple. When you kind of in hindsight, obviously, what are some of the other symptoms that people might be looking for? So we've talked about headaches and you had fatigue, and you couldn't run your marathon? What are some of the more common symptoms that people might keep an eye out for?

Maryann Jacobsen  19:35  
I think that heart palpitations, I've, I've met women that have you know, they're going to the doctor, their hearts fluttering the cardiologist. That's actually what I did when I was 30. I went to see a cardiologist, and they didn't check my iron either. I mean, heart disease and iron are very closely linked heart failure is they were a lot of people with heart fail. Like your habit, but there's some studies showing that if you if you have low iron for for many years, it could, you know, of course we need, your heart is pumping harder and your sympathetic nervous system gets turned on. So anxiety, I'm not seeing the research doesn't say a clear cut relationship but again, they're using these really low levels. Whenever they do a study that I know for me, that anxiety was, you know, if you feel a little short of breath, you're gonna, and you already have, you know, you're going through perimenopause, glow, the hormones always play a role. But if you're, you know, really anxious, you know, your heart rates up, you know, we mentioned restless legs, you know, swallowing problems lump in the throat, that's not, that's something some people, especially anxiety, like, they change their whole diet around that. And, you know, it could be iron or iron plays a role. So if you think about all the different things, if you know, check your thyroid, make health, make sure because it's, it's definitely linked to thyroid dysfunction. And we know that that hypothyroid patients do better on iron, when they bring their ferritin levels up closer to 100. Their thyroid function improves. So the fact that you know, so I think it's really, you know, kind of any part of your, you know, almost all symptoms that you have that are very similar to perimenopause, right, I mean, not hot flashes. But maybe, well, that's

Jenn Salib Huber  21:30  
that there is so much overlap, right. I mean, between fatigue, and mood changes, and heart palpitations, I mean, those are all things that can happen in perimenopause outside of someone who's iron deficient. So I think it's just another good reason for people to you know, be having those conversations and like you say, you kind of tracking their iron. And I absolutely recommend that everybody who's in perimenopause, have it measured, you know, at least every year or two, depending on your history. So I measure mine twice a year. So here in the Netherlands, we actually have like at home iron tests, which is kind of neat. So it's like a fingerprint test. It's like a COVID test for iron. And so if you get two lines, your ferritin is above 25. And it's just a kind of nice way for me to monitor, you know, kind of her my above or below. But yeah, I think that we need to be talking about it more, because it really affects how we feel. It's not just our long term health, it's kind of how are we feeling today? And how are we coping with some of those other symptoms, like not sleeping well, and you know, maybe your energy is lower, and all of those things may be improved. If we've you know, we're kind of keeping an eye on iron for sure.

Maryann Jacobsen  22:41  
Even if you're menopausal, it usually will take about five years when your period stop. So you could still have low iron. But then also, you know, if you feel tired, and later, there's also something called functional iron deficiency, where your ferritin levels are normal or high, but you're available iron is low. So it's money in the bank, you can't get you know, so that's actually a study out of Europe found that 64% had functional iron deficiency of age 48 to I think, 69 people. So, you know, as we get older, we might have low level inflammation, which affects our ability to absorb iron, and instead it gets shuttled into iron stores. Not your typical iron stores. But um, and so that's something, you know, I had a 66 year old write me, she's like, I have all these classic symptoms, my doctor, my ferritin, 3047, she that her transparent saturation was below was 11%, which is low, and that's your available iron. So my point is, even if you're post menopause, make sure you're still on top of the iron because, you know, if your heavy periods it takes, you know, around five years, to get them back up, if you're if you're not taking any iron. So that's just something to consider too.

Jenn Salib Huber  24:07  
That's great information. So but let's talk about iron because there are lots of different types. And you know, the feedback that I always get is, oh, I've tried iron before and I just can't take it. It makes me constipated. It upsets my stomach. So what are you know, I mean, you mentioned about how the newer research is suggesting every other day dosing, which which I agree with and seems to work just as well and definitely reduces the likelihood of side effects. But what are some of the different types of iron? And what kinds of things should people consider when choosing iron?

Maryann Jacobsen  24:42  
So I think it depends on you know, if you haven't tried anything yet, and you're, you know, a ferrous sulfate is pretty cheap, and it's been used in studies and it works well. There's ferrous fumarate. Those are you know, pretty well absorbed, taken with You know, at least 200 milligrams of vitamin C, watching the, you know, I think between 60 and 80 milligrams is a good starting place, unless you're really low, you can go higher. But a lot of doctors still recommend three times a day, it's found to be best in the morning, like one to two hours between eating versus later in the day. And so, you know, try that every other day and see, like, you know, I was fine on that, you can try a probiotic too. So some research is showing that, that, you know, vitamin A, that that can help, if you're having trouble tolerating, there's iron Baikal estimate, which is, is tolerate it better. So if you, usually it's lower amounts of iron, but people seem to do well, on that research shows, it might be a little gentler form. And so, you know, I would just recommend trying it, you know, I think a lot of the, you know, problems people have are from just taking too much to, you know, like three times a day, you know, take it once, because that hormone increases, and it blocks the absorption. And it leads to much, you know, one of the problems with iron is we don't want a lot in our GI tract, it can cause you know, microbiome changes, and, you know, it can hurt the villi. And so that's really the, you know, we don't want like I've heard some women say, I've been taking iron 20 years every day. And, you know, I probably wouldn't want to do that, you know, I do a maintenance dose now, once a week, and I found that, that, and now my periods are getting lighter, has kept my levels up. But sometimes I'll get symptoms back and, you know, very slight, you know, I might increase it, and I get my levels checked to twice a year or so. And one time, a little lower, but

Jenn Salib Huber  27:01  
I am really it like iron supplementation definitely is trial and error. You know, I've had people you know, like we talked about, you know, take the $5, ferrous sulfate, you know, iron and be perfectly fine. And then I've had other people say that they've tried that, and they haven't been able to poop for a week. So I think that it's also kind of knowing what you're, you know, if you're prone to constipation, you may be better off learning some of the more gentler irons, whereas if you have a GI tract that kind of moves every day, no matter what you do, you may have a little bit more tolerance for it. But ultimately, it's just about getting a regular dose of iron in without needing to kind of go big or go home all the time. And with iron, though, you know, you're gonna pay more for the gentler forms. And so that's always a consideration to that if you're going to be taking iron longterm, trying to find I think, the most cost effective option, but I want to kind of end talking about food. So if we can talk about, you know, vegetarian or non heme sources of iron. So, what are some of the biggest myths that you might be able to talk about or kind of dispel? Regarding iron? So, you know, for example, spinach, someone will say, Oh, I eat lots of spinach. I don't know when my iron is low.

Maryann Jacobsen  28:18  
Yeah, I mean, they did a study that showed that we absorb, so that the conventional wisdom, so you know, how this works in nutrition, we're out there doing some for years and years, and someone's like, well, what's research and they're like, there was a study back in 1950. Now, that 18% of we've absorbed about 18% from a mixed diet, so that means we're eating animal and, and plant foods and, but a study in 2015 shown that that might be more like 15%, which is not, you know, we're iron is just tricky, because, you know, calcium, magnesium, like in a multivitamin, but also in our diet, you know, if we drink dairy products, it's going to decrease the absorption, but things like vitamin C will increase. And if you you know, phytates will decrease but if you're adding, you know, if you have like turkey chili, you have the beans, the meat and vitamin C and the tomatoes, you know, it's, it's really, overall, I think you go crazy to try and like manipulate your whole diet. But when they when they look, overall, they do find that meat is the only thing linked to higher ferritin not super high ferritin. But teamie food is just, it's just more absorbed. It doesn't have to be, you know, in your stomach. It doesn't have to be switched at the Ferris State like plant foods do. So and it's not another thing to consider as if you're taking proton pump inhibitor or anything that decreases stomach acid. You're not going to be absorbing iron as well. So that's another risk factor. A lot of times women in midlife have gi problems. They'll take these over over the counter from their doctor. And so that can be an issue. Yeah. So I think, you know, if you don't want to eat animal foods, you don't have to, and you know, you can get iron, definitely from your diet. But it's, you know, it's iron is a tricky, you know, the absorption is just going to be lower and vegetarians. You know, I would recommend getting your irons checked, you know, being, you know, on top of it, especially if you're also an athlete, you know, there's other, you know, risk factors and males might, that usually aren't at risk, but if they're vegetarian and an athlete, so yeah, I mean, there's lots of different factors, but iron is just one of those, as you know, it's, you know, the absorption is, that's why in multivitamins, it's not very, you know, it's just not absorbed that Well, I mean, a little bit is, and if they take out the calcium and magnesium, it's absorbed better, but I prefer just to take iron separately from food. You know, taking it once a week, and even like an adolescent girls, I know, this doesn't, you know, apply, but just taking ferritin wants ferritin just taking iron once a week, 65 milligrams, move their ferritin from a 20, I think 26 to a 45. Just taking it once a week. I mean, if you're vegetarian, I mean, you can do that. It's not that much iron in your system. You know, so I think we don't need a lot. And the diets definitely important. But I think for most people to try and manipulate everything and keep, you know, certain foods out to increase the absorption might be too much.

Jenn Salib Huber  31:44  
Yeah, I often say I'm all about a food first approach. But if your ferritin is on the low side of normal, or you know, under normal, it's virtually impossible for us to bring the stores off and plug the hole. You know, we're just kind of, you know, because I mean, even the dietary requirement of, you know, 18 milligrams a day, that that's a challenge, I think, on a regular daily basis for most menstruating people. That, you know, we're more likely to fall on, you know, to fall short. And so if you're, if your diet is short, and your ferritin is low, trying to bring it back up without a supplement is a big ask, I think of your body.

Maryann Jacobsen  32:27  
Yeah, and there's also some, like men have, you know, their ferritin levels are supposed to be higher. But there's some, you know, talk right now that why is that when they they're at lower risk, but their parents like they would be, I think they're fair tins, like 25 versus women. Also, their hemoglobin higher, that that's just because traditionally they are higher, because they don't have periods. That actually women maybe we, you know, we need to up our levels. I mean, we have higher iron recommendations, but most women, like you said, aren't meeting them? Yeah, yeah.

Jenn Salib Huber  33:06  
So, thank you so much for this discussion on our and I know that it's going to be, you know, very much appreciated. So I always end by asking my guests, what do you think the missing ingredient is in midlife?

Maryann Jacobsen  33:21  
The missing ingredient, I think it's, it's women not having all the information so they can make best decisions for them. So you know, just having really good solid information. And that's, you know, with talking about iron today, I hope, you know, just having this information that then women can go out and advocate for themselves. Because if we don't have that, you know, as you know, there's so many all these messages coming at women and it can feel really daunting. So it's not about do this do that. It's like, here's the information. And I like really good information. So I'll dig forever.

Jenn Salib Huber  34:06  
I agree, I agree 100% that we need information. So if people want to learn about you and your projects and what you're up to what's the best place for them to find you.

Maryann Jacobsen  34:17  
Um, well, social media I new ish account mid life dot strong. And I have a private Facebook page as well. And my website is Maryann jacobson.com. En or you can get their raise healthy eaters too. And so there if you want to sign up for my I have a biomarker guide that kind of goes through, you know, all these labs that we get when we go the doctor things they can ask for always, I don't know, you know, in different places. I know sometimes insurance doesn't cover so you always have to be careful but just you know, if certain levels are low, then I help women say okay, I'm going to ask for this I'm an iron is included in that. So

Jenn Salib Huber  35:04  
that's great. And I'll have all those links in the show notes. Okay, thank you so much for your time and expertise. I've really enjoyed this chat and I know that the listeners will as well. Have a good day everyone. Hey there. Thanks so much for tuning in to this week's episode of the midlife feast. Just remember that the midlife feast community membership is now open for registration and it is the perfect place for you to gather, grow and nourish with other people in midlife who know exactly what you're going through. You can find a link to join this monthly membership in the show notes. We'd love to have you join us as you feast on midlife. And if you found this podcast episode helpful or any of the episodes on the midlife feast, just a reminder that the best way to help others find us is to rate and review the podcast wherever you tune in