Dear Osa friends,

You’re doing a good job!

I have a sense that you don’t hear this enough, so I wanted to lead with that today. I am so fortunate to get to work with people like you who are curious about what they can do to improve their health, and brave enough to take ownership. I applaud you for that, and I am so excited that I get to do the work of supporting you along your path.

Happy fall from the Osa cave! The Bear Essentials was quiet through the summer months, and I have been looking forward to reconnecting with you all here. I’m popping into your inbox today to wish you a happy fall season, talk about new guidelines on iron, and share a few tips with you in addition to clinic updates. Let’s dive in.

Spotlight on Iron

When the days become shorter and colder, we can feel our energy falter. It can be hard to know if it’s simply our body’s response to the seasonal change, or whether there is something more going on. For this reason, fall is a good time to get some basic labs run to help inform you of what’s going on under the hood.

When it comes to energy concerns, I’m thinking about sleep, blood sugar control, thyroid function, mitochondrial function, and SO many different nutrients: B-vitamins, magnesium, iron, and vitamin D, to name an important handful. To get information about these with fairly basic bloodwork, here are some labs I like to see:

• Complete blood count (CBC)
• Complete metabolic panel
• Fasting insulin
• Red blood cell magnesium
• Iron panel (includes serum iron, total iron binding capacity, %saturation, and ferritin)
• Thyroid panel (not just thyroid-stimulating hormone (TSH)!)
• 25(OH)D

Ask your provider! If they are unwilling to order, many labs now offer direct-to-consumer testing, including Quest. I can also help you access labs by ordering through Fullscript: I send you the request, and you get the blood draw at a Quest or Labcorp near you.

Out of all the labs mentioned above, I’m shining a spotlight on iron because the guidelines for iron deficiency have just recently changed.

Why does iron matter?

Iron deficiency is a very common nutrient deficit that has a huge impact on quality of life.

We need iron for all the heavy hitting basic functions:

• oxygen transport
• energy production
• thyroid hormone synthesis
• immune cell functioning
• detoxification enzymes

Symptoms of iron deficiency include fatigue, lightheadedness or headache, decreased exercise tolerance, and hair loss/thinning hair. (Note that hair loss is most strongly correlated with iron deficiency in women, although it can be a factor for men also). There are also other visible signs which include a pale tongue and pale conjunctiva (the skin you see when you pull your eyelids down), and cracks at the corners of the mouth.

The American Hematology Society just recently released new guidelines for screening for iron deficiency. These guidelines are specifically about ferritin, the storage form of iron in the body. Ferritin is typically the first marker to change when iron is insufficient in the body, and other markers of iron-deficiency anemia–including small red blood cells and low hemoglobin–follow later. So ideally we catch and correct low ferritin before we see changes in blood cells that characterize anemia. These new guidelines raise the threshold at which providers should be flagging a patient for iron deficiency. Check out the graphic below:

If you haven’t had an iron panel in the past year, and especially if you are experiencing any of the symptoms I mentioned above, get yourself an iron panel! If you have a teenage female in your home, an iron panel is also a wise idea for her. Menstruating women are at increased risk for iron deficiency, and correcting it is so important for healthy growth, hormone production, mood, energy levels, and brain function.*

Fall Mindset🍁🪾🍂

After summer’s whimsical, carefree attitude and long days of sunshine, fall’s cooler weather and shorter days can feel like a real downer. But after I get over the jarring change of new school schedules and sports schedules and general family life chaos that ensues at the beginning of September, I remember that fall is about letting go, and that is something to celebrate.

As we see outside the bright greens and bold pinks of summer transform to stately browns and rusty oranges, we feel a change. That change becomes very apparent to me when the trees start to drop their leaves. It’s then that I remember a core teaching of this season: shedding what we no longer need.

Check in with yourself

I invite you to ask yourself what this could mean or look like for you. Can you identify anything that is like a dead leaf in your life, something that would make you feel lighter if you could release it from your hold and let it be carried away by the wind? How might this be possible for you? What would need to change?

These are important questions because an accumulation of “dead leaves” contributes to our stress load, and our stress load can bubble over and wreak havoc on even the most carefully laid plans for healing. When the body is stressed, it is not in a state to properly digest food or accept nutrients or grow muscle or heal damage.

Two arms of your nervous system

To be clear, I’m not talking about an absence of stress. We are made to flow in and out of “stressed” states. This natural oscillation involves the two arms of our nervous system: the sympathetic and parasympathetic. The sympathetic nervous system is that one we rely on to survive in a crisis, and also the one we engage during strenuous physical activity. I love this type of activity (in the right dose for you) because this is an important part of how we train our mitochondria to work their best, and this is what gives us stable energy and healthy metabolic function. (I’ve written more about that topic here). On the other hand, the parasympathetic nervous system is the one we rely on to digest our food, get rid of waste, repair our cells, and connect with our fellow human beings. I don’t need to explain to you why all of these are absolutely crucial for your health!

Take-home message

When we carry stress all the time, we are essentially training our sympathetic nervous system at the expense of our parasympathetic system. One way we can help to restore balance is by simply letting some things go. Recognizing that we can’t do it all is a crucial first step in making time for what matters most to you and to your health. (I’ve written more extensively about this here.)

What’s New at Osa?

In my practice, data makes such a big difference in personalizing care. My clients know that I like to see any lab work that they have or that they can get, whether through primary care or elsewhere.
Functional labs allow us to access insights that can meaningfully alter the interventions we choose. When we personalize, we can optimize, and this is what I’m all about. Here are a couple of labs that I’ve been finding really useful:

• 3×4 genetic testing: We now know that very few genes are deterministic of health outcomes–rather, our genes show predispositions or tendencies, our “Achilles’ heels” as well as our “ace(s) in the hole.” This test allows us to leverage your genetic information to create truly personalized nutrition and lifestyle interventions. Gene variants affect the levels and types of nutrients that your unique body needs to function its best. To give one example, those with a variation in the APOA2 gene have a tendency to gain more body fat on a diet containing more than 22 grams of saturated fat daily.
  
  Pricing info: This test is available direct-to-consumer for $299. I charge a $240 fee for interpretation, which is in addition to your 60-minute session to review the results and the personalized interventions. For insurance clients, the 60-minute session can be billed to your insurance as a regular nutrition visit, and you pay the $240 fee separately directly to me. The reason for this fee is to allow me the time it takes outside of session to interpret your results (using a vast database of genetic information) and prioritize recommendations that best fit your concerns, your goals, and your current overarching plan.
  
• Tiny Health microbiome test: There are many microbiome/stool tests on the market right now, and I think Tiny Health shines among them for a couple of reasons. My number one is that their focus is on health optimization across the lifespan. They have a test for anyone, from babies to teens to grandparents! They aren’t just looking at your microbiome but are considering it in the context of your age and your life exposures. And, their recommendations are focused on building resilience, not just getting rid of the “bad guys” in the gut. Their method of assessment is also important to me. They use “shotgun metagenomics,” which is more comprehensive than other methods including qPCR and 16s.
  
  Pricing info: Current pricing for this test is $249. The way this works is that I send you the recommendation for the test, you purchase the test, and we review the results and make a plan together in session. The price of this test includes a $50 interpretation fee, so your total cost is $249, plus the price of the session to review your results and plan, which can be billed to insurance or charged as a 45-minute follow-up (currently $150).

Wishing you a beautiful October!

Warmly,

*Disclaimer: This does not constitute medical advice and is for general informational purposes only. Please consult with your healthcare provider to determine whether diet or supplement changes are right for you.