Month: August 2019

Note: This article is not one of my usual Science Made Simple posts, but a comment about something that occurred on social media yesterday.

Yesterday, I posted a photo on Instagram, Facebook and Twitter of some fresh chicken that I had bought and that I had cut up into legs and breasts. Real food is perfectly normal for a Dietitian to write about, right?

The photo I posted is above.

The caption under the photo indicated that this shouldn’t look foreign and that real chicken comes with a head, feet and bones (in contrast to chicken we buy in a supermarket that usually comes boneless or pre-cut, in Styrofoam trays, and covered in plastic wrap).

Presumably, someone found this  photo of chicken before and after cutting as being offensive and reported it to Instagram.  I was not notified that the photo had been censored, and it looks the same from my end, but several people that follow me told me that my photo was deemed to contain “sensitive content”.

To anyone viewing the post now, it now looks like this:

A physician posted the following comment about the censoring;

“I cannot believe a photo of food is blurred as “sensitive content”. It is absolutely mind boggling. But it’s totally fine to be constantly inundated with ads for crap that make us feel bad about ourselves, making us buy junk we don’t need.“

This physician is right! There’s a huge difference between real food and the processed food-like substances (“crap”) that we are encouraged to buy and eat. You can read more about telling the difference between these in this previous article.

The two photos of chicken that I posted before and after being cut up has been blurred on Instagram because “some might find offensive or disturbing“.

Do you know what I consider offensive and disturbing?

I find people having to have toes amputated because of uncontrolled diabetes offensive.

I find obese people trying desperately to lose weight, yet finding themselves unable to curb an insatiable craving for processed food that was deliberately created by its producers, disturbing.

I find the fact that many young children in Canada and the US (and likely in many other countries) think of chicken as something that comes boneless, deep fried in batter and packaged in small individual packages with various flavours of sweetened sauce to dip it in, disturbing.

I find pea protein isolate, industrial seed oil, methyl cellulose and a host of other processed ingredients masquerading in the meat counter, offensive.  But please don’t misunderstand…

I have absolutely no problem with vegetarians and vegans having a wide variety of plant-based food available to eat as alternatives to animal-based foods, but it should not be marketed to consumers as “meat”, but ‘better’.

It may be “better” or “ultra” or “beyond” for those who choose a plant-based lifestyle, but an ultra-processed mixture of pea protein isolate, canola oil, refined coconut oil, cellulose from bamboo, methylcellulose, potato starch, maltodextrin, yeast extract, sunflower oil, vegetable glycerin, dried yeast, gum arabic along with seasoning and flavourings is not ‘better’ or preferable to whole, real food with a single ingredient, “beef”.

These are choices…

…and people have the right to choose what they want to eat, without condemnation and judgement.

There is no one-sized-fits-all-diet and individuals who choose to eat meat, fish or poultry should not be vilified or censored for doing so.

To your good health,

Joy

You can follow me on:

Twitter: https://twitter.com/lchfRD
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Copyright ©2019 BetterByDesign Nutrition Ltd.

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the ”content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

 

 

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A migraine is more than just a really bad headache. While migraine is characterized by intense, debilitating headache, it also may include nausea, vomiting, difficulty speaking, sensitivity to light and sound, and may- or may not be preceded by an aura (sensory, motor, visual or speech symptoms that act like a warning signal that a migraine is about to begin). People with a reduced ability to clear the amino acid tyramine (which is called tyramine intolerance) often experience migraine, along with other symptoms including heart palpitations and GI issues, including nausea and vomiting.

In those who have insufficient amounts of an enzyme called monoamine oxidase (MAO), levels of tyramine can build up, and this is called tyramine intolerance.  A tyramine intolerance diet can be helpful in helping reduce people’s symptoms.

Tyrosine combines with other amino acids to form proteins, and just like the amino acid histadine breaks down to histamine (see this previous article on histamine intolerance), tyrosine breaks down to form tyramine. Normally, the excess tyramine is broken down by the enzyme monoamine oxidases (MAO) — in the same way that excess histamine is broken down by the enzyme diamine oxidase (DAO).  In individuals that take certain types of medications such as MAO inhibitors (used in treating some types of depression) and certain medications used for treating Parkinson’s disease, levels of tyramine will build up in the body because the enzyme that breaks it down is inhibited.

In those who have insufficient amounts of the enzyme monoamine oxidase, levels of tyramine can also build up and this is called tyramine intolerance [1].

Symptoms of Tyramine Intolerance

The body naturally responds to the presence of tyramine by making catecholamines such as epinephrine and norepinephrine which are neurotransmitters involved in the “fight or flight” response. If tyramine accumulates, too much of these chemicals are released, which leads to an increase in blood pressure and heart rate [2]. If these chemicals go high enough (such as is the case with those taking certain medications) this can lead to a very rapid and dangerous increase in blood pressure called a ‘hypertensive emergency’ which can result in bleeding in the brain (hemorrhagic stroke)[3] and rarely, even death.  At very least, the very high blood pressure can cause damage the body’s tissues and organs.

Those with a reduced ability to clear tyramine due to tyramine intolerance may experience migraine, heart palpitations or GI issues, including nausea and vomiting [2].

Tyramine Intolerance Diet

In those taking MAO Inhibitor medication or specific medications for treating Parkinson’s disease,  a tyramine-free diet is prescribed. Since the adverse effects of eating tyramine-containing foods can be so serious, strict adherence is needed.

For those with diagnosed tyramine intolerance, a low tyramine diet will be recommended, and for those with suspected tyramine intolerance a low tyramine diet may be trialed to see if symptoms improve. This is especially the case in people who experience migraine— as it has long been thought that tyramine may underlie the constriction of blood vessels that increases blood pressure associated with migraine[4].

Low Tyramine Diet — not as easy as following a ‘list’

Tyramine naturally occurs in small amounts in protein-containing foods, but as foods age, mature or ripen, tyramine levels increase.

Avoiding strong or aged cheeses, cured, smoked or processed meats, pickled, cultured or fermented foods (including many Asian condiments), nuts and nut butters and some seeds and seed butters, aged spreads such as Marmite and Vegemite, and alcoholic beverages [3,5] is a good place to ‘start’, however reducing tyramine in the diet isn’t as straight forward as simply following a “list’.

Knowing which cheeses, for instance have high levels of tyramine and which have moderate levels can be looked up, but some tyramine-containing foods may act as a trigger to migraine in one person, but not in another — so it is often unnecessary to restrict all tyramine-containing foods. Sometimes by me helping people systematically eliminate the most common tyramine triggers is sufficient to provide them significant relief — without them having to eliminate all tyramine-containing foods.  That’s where experience helps!

More Info?

If you have been diagnosed with tyramine intolerance or suspect you may be sensitive to tyramine, I can help.

You can learn more about the Histamine / Tyramine Intolerance Specialty Hourly Service here  and I also offer a migraine add-on option to the Complete Assessment Package which you can learn about here. If you would like information as to which is a better fit for your needs, please send me a note using the Contact Me form above.

To your good health!

Joy

You can follow me on:

Twitter: https://twitter.com/lchfRD
Facebook: https://www.facebook.com/BetterByDesignNutrition/
Instagram: https://www.instagram.com/lchf_rd
Fipboard: http://flip.it/ynX-aq

Copyright ©2019 BetterByDesign Nutrition Ltd.

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the ”content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

References

1. Joneja, J. Histamine and tyramine sensitivity — how closely are they linked? Food Matters, October 2017, https://www.histamine-sensitivity.com/histamine-tyramine-similaraties-10-12.html
2. Van Eaton J. Tyramine-Free Diets. Healthline, Feb 1, 2019, https://www.healthline.com/health/tyramine-free-diets
3. Hall-Flavin D. Mayo Clinic, MAOIs and diet: Is it necessary to restrict tyramine? https://www.mayoclinic.org/diseases-conditions/depression/expert-answers/maois/faq-20058035
4. Costa MR, Glória MBA. Migraine and Diet, Encyclopedia of Food Sciences and Nutrition (Second Edition), 2003, https://www.sciencedirect.com/science/article/pii/B012227055X007835
5. Skypala IJ, Williams M, Reeves L, Meyer R, Venter C. Sensitivity to food additives, vaso-active amines and salicylates: a review of the evidence. Clin Transl Allergy. 2015;5:34. Published 2015 Oct 13. doi:10.1186/s13601-015-0078-3

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NOTE: This article was written and posted on August 4, 2019, and was completely updated on November 7, 2025.

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Doctors are often hesitant to order blood tests for post menopausal women who report being more tired or having more hair loss than usual, simply because these women no longer have a period. While menstruation is the most common cause of low iron in younger women, there are multiple reasons why post-menopausal women and men over 50 years of age may be low in iron that warrant investigation. This article explains why iron levels are often low in older adults, what routine blood tests can be done to determine this, and various options available if results come back out of range. 

Why Low Iron Matters

Iron is essential for producing red blood cells and supporting energy and brain function. Low iron status can cause fatigue / feeling abnormally tired, weakness, a reduced ability to exercise, and excessive hair loss. These symptoms occur before someone develops full-blown iron-deficient anemia.

Microcytic anemia

Iron deficiency can lead to microcytic anemia, characterized by red blood cells that are smaller than normal. These smaller cells are less effective at carrying oxygen, which leads to feelings of fatigue, weakness, and even shortness of breath [3].

How Common Is Low Iron?

Current data indicate that iron deficiency anemia affects approximately 1 in 7 adults over the age of 50 (U.S. data). Fatigue, brain fog, and decreased physical performance are common early signs [2][11].

Why Low Iron Happens in Adults Over Age 50

Chronic Blood Loss

The most common reason older adults develop iron deficiency is slow, chronic blood loss, which can often be from the gastrointestinal (GI) tract. Sources of GI blood loss include ulcers, diverticulosis, colon or rectal polyps, and GI cancer. As outlined in this earlier article about hemorrhoids, when having bowel movements, internal hemorrhoids can bleed microscopically without detection, resulting in low iron status. Blood loss can be subtle and occur over months or years. For this reason, once iron deficiency is detected, older men and postmenopausal women may be referred to a colorectal surgeon for a colonoscopy to rule out polyps or cancer, or for further assessment if internal hemorrhoids are suspected to be the cause[4][5].

Poor Absorption or Dietary Intake

Another reason for low iron status is dietary, which is not exclusive to older adults. Vegans are often low in dietary iron because they avoid consuming all animal products, the main source of heme, the most bioavailable form. Ovo-lacto vegetarians who consume eggs and dairy but avoid eating red meat and seafood such as oysters and clams also tend to have low iron status because these are rich sources of heme. 

It is also not uncommon for older people to eat a narrower range of foods as they age, sometimes due to decreased appetite or a deterioration in their ability to chew, resulting from tooth loss. 

A common symptom of celiac disease is low iron status, which is why when I have an adult male client of any age with low iron status (without any obvious reasons for it), I request a routine blood test (IgATTG) to rule that out. Since men don’t menstruate/have “periods”, asking for a requisition for this test in men with low iron makes sense.  Since people with celiac disease may be asymptomatic, low iron in men of any age is often the only indication to test for it. One might assume that an older man without any symptoms would have already been tested for celiac disease at some point in his life, but sometimes a diagnosis is made only because someone requested the test. While a biopsy is needed to confirm celiac disease, an IgATTG test to screen for it makes sense in men with low iron lab results.

A Helicobacter pylori (H. pylori) infection can also result in low iron status due to decreased absorption, so requesting a test to rule out H. Pylori is reasonable if no other cause is apparent [5].

Acid-Blocker Medications and H2 Blockers / Antihistamines

Long-term use of Proton Pump Inhibitor (PPIs) medications, which are used to treat acid reflux, heartburn, ulcers, and gastroesophageal reflux disease (GERD), reduces stomach acid, resulting in decreased iron absorption [8].  Some common brand names of PPIs include Prilosec (omeprazole), Nexium (esomeprazole), Prevacid (lansoprazole), and Pantoloc (pantoprazole). In adults who have been taking PPIs long-term, a healthcare provider should monitor iron status (and bone status, which is a separate discussion!). 

H2 blockers, also called H2 antihistamines, are another class of medications that reduce stomach acid by blocking histamine receptors in the stomach lining. Some common brand names include Zantac (ranitidine), which has been discontinued in Canada for a while, Pepcid and Pepcid AC (famotidine), and Tagamet (cimetidine). Monitoring iron status in older adults who frequently take these over-the-counter medications is important, but if healthcare providers don’t ask if people take them, they won’t know. I ask.

Note: While H2 blockers are most commonly used for heartburn or mild GERD, they are also used in conjunction with a “regular antihistamine”, also known as an H1 blocker or H1 anti-histamine, for the treatment of Mast Cell Activation Syndrome (MCAS). MCAS is a condition where mast cells release excessive histamine, causing symptoms including hives, flushing, stomach pain, diarrhea, headaches, and very low blood pressure. The use of both an H2 antihistamine (such as ranitidine (Zantac) along with an H1 antihistamine (such as cetirizine hydrochloride, called Reactine in Canada, and  Zyrtec in the US) targets different types of histamine receptors, improving overall symptoms in MCAS. It is important to monitor iron status in those using H2 antihistamines long-term for MCAS.

Whether H2 blockers are used to reduce stomach acid or to manage the symptoms of MCAS, the reduction of stomach acid leads to decreased iron absorption, resulting in low iron status over time [8]. 

How Iron Is Tested

For adults over the age of 50 with symptoms of fatigue, weakness, shortness of breath, or increased hair loss, I will ask their doctor or clinic for a requisition for blood tests to assess iron status, including a Complete Blood Count (CBC), ferritin, transferrin saturation (TSAT) or serum iron, and Total Iron Binding Capacity (TIBC). If the results come back below lab normal values, then determining the underlying cause, or causes, is next. 

Treatment Options for Low Iron 

Determine the Cause 

When blood tests come back out of range, investigations will include ruling out sources of bleeding, such as internal hemorrhoids that can cause undetectable blood loss while having a bowel movement, ulcers, or whether they may have undiagnosed celiac disease or an H. pylori infection [4][5].

Iron Supplementation

Oral iron supplements are effective for treating low iron in most older adults, and there are many different forms of iron — some with better absorption than others. There are a few newer iron formulations that cause no stomach upset or constipation, and alternate-day dosing can increase absorption [7][10]. Oral treatment will usually continue for several months until ferritin levels (ferritin being the storage form of iron) reach adequate levels, not only hemoglobin levels, which are the iron in red blood cells. In severe cases of iron-deficient anemia, intravenous (IV) iron infusions will often be recommended [9]. 

Practical Tips for Adults Over 50

Final Thoughts

Doctors are sometimes hesitant to requisition blood tests to screen post menopausal women for low iron status because they no longer have a period; however, blood loss from menstruation is only one cause. Even in men or in post menopausal women who are not prescribed PPIs or H2 blockers, many regularly take over-the-counter antacid tablets that, over time, can affect iron status.

A colonoscopy is recommended for adults over 50 years every ten years to check for colon polyps or cancer, but unless specifically asked, most people won’t volunteer that they have hemorrhoids, which can bleed microscopically, resulting in low iron status. Since slow GI bleeding is often “silent” in older adults [11], having members of your healthcare team ask the right questions and request blood work when necessary is essential. I ask, and if there is an area that warrants further investigation, I will request routine lab tests to be sure.

To your good health. 

Joy 

 

You can follow me on:

Twitter: https://twitter.com/jyerdile

Facebook: https://www.facebook.com/BetterByDesignNutrition/

References 

 

1. British Columbia Women’s Hospital and Health Centre. Iron deficiency in adults. 2019. [https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/bc-guidelines/iron-deficiency]
2. Centers for Disease Control and Prevention. Data brief: Iron deficiency in U.S. adults. 2018. Available at: https://www.cdc.gov/nchs/products/databriefs/db519.htm. Accessed November 7, 2025.
3. Merck Manual Professional Edition. (2024). Overview of microcytic anemia. Merck & Co., Inc. https://www.merckmanuals.com/professional/hematology-and-oncology/anemias-caused-by-deficient-erythropoiesis/overview-of-microcytic-anemia
4. American Gastroenterological Association. Gastrointestinal evaluation of iron deficiency anemia guidelines. 2023. Available at: https://gastro.org/clinical-guidance/gastrointestinal-evaluation-of-iron-deficiency-anemia/. Accessed November 7, 2025.
5. British Society of Gastroenterology. Iron deficiency in adults: guideline. Gut. 2021;70:203–228. Available at: https://pubmed.ncbi.nlm.nih.gov/34497146/ Accessed November 7, 2025.
6. Medscape. Iron deficiency anemia guidelines. 2023. Available at: https://emedicine.medscape.com/article/202333-guidelines. Accessed November 7, 2025.
7. Weiss G, Goodnough LT. How I treat anemia in older adults. Blood. 2024;143(3):205–215. Available at: https://ashpublications.org/blood/article/143/3/205/494702/. Accessed November 7, 2025.
8. Ganz T, Nemeth E. Inflammation and iron metabolism in older adults. PMC. 2014;5:210–220. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4157323/. Accessed November 7, 2025.
9. Macdougall IC, et al. IV iron therapy in older adults. PMC. 2006;12:115–124. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10808247/. Accessed November 7, 2025.
10. Ashcroft DM, et al. Oral iron in older adults. Blood. 2024;143(3):225–234. Available at: https://www.cghjournal.org/article/S1542-3565(24)00410-5/fulltext. Accessed November 7, 2025.
11. Fairweather-Tait SJ, Wawer AA, Gillings R, Jennings A, Myint PK. Iron status in the elderly. Mech Ageing Dev. 2014 Mar-Apr;136-137:22-8. doi: 10.1016/j.mad.2013.11.005. Epub 2013 Nov 22. PMID: 24275120; PMCID: PMC4157323. Accessed November 7, 2025. [https://pmc.ncbi.nlm.nih.gov/articles/PMC4157323/]

 

Copyright ©2019 BetterByDesign Nutrition Ltd.

LEGAL NOTICE: The contents of this blog, including text, images, and cited statistics, as well as all other material contained here (the ”content”), are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis, and/or treatment, and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything you have read or heard in our content.