Iron Absorption and Hepcidin (Hep-si-what?)

It's a race eve for me, and I had planned to sit down and write up a little mid-season racing report, but instead I got caught up in one of those interweb research black holes, chasing links around and shoveling my way through scientific papers, past those big research study words, looking for the little snippets of information relevant to me. (ME ME ME, right?)

It started with a rather innocuous statement on an iron supplement website talking about why their iron was better for athletes than other companies' iron. It talked about the hepcidin response to intense exercise, and how elevated hepcidin inhibits iron uptake. In other words, after a hard workout, a person is considerably less able to absorb iron.

I was floored by this. In all the years I've been dealing with my iron issues, and all my attempts to find the actual mechanism(s) responsible for my poor absorption, I'd never seen this little nugget before.
As it turns out, this is relatively new information, with what seem to be the best studies coming from 2014.

I'll spare you the details of the whole information chase, and cut right to the good stuff. (And again, in case you missed it the last 18 times I've said it in an iron-related post, I'm not a doctor or a scientist or a physiologist or whatever other kind of expert, just a person who can read, and thus this is my attempt to distill complex information of someone else's specialty down into basics usable for us common folk.)

When hepcidin is elevated, iron absorption goes down. Two things that elevate hepcidin are intense exercise and inflammation. (I realize there's some overlap there, in that intense exercise causes inflammation, but my point is that other sources of inflammation also cause elevated hepcidin.)

So for someone like me, with celiac and a natural tendency towards bad gut bacteria balance and intestinal yeast overgrowth, I'm getting hit twice. I'm always battling gut-related inflammation and I'm training.

Another important implication of recent studies (at least for me me me), is that the hepcidin elevation gets, at least to some degree, worse the higher your iron stores are. In other words, if your iron stores are low, your hepcidin response will be inhibited (by something or other), because your body knows you need some more damn iron. But if your iron stores are above certain levels, your body lets the hepcidin go up and do whatever it's supposed to do, while simultaneously wrecking your iron absorption.

I feel like that type of behavior might explain the way my ferritin would, after getting sent soaring into the 100+ levels by a dose of IV iron, start dropping steadily until it got all the way back down to where I started. I mean, yes, I'm using the iron up as I go, but why, when I'm eating a pound of chicken livers each week, couldn't my body get a toehold in at some higher level of iron and maintain that shit, right? Sheesh. I'd always suspected that the constant way way up and then plummet down cycle was making things worse in the long run, like my iron absorption mechanism just took a vacation and forgot how to do its job, and this new information seems to support that possibility.

One last point: the iron supplement that started my little information chase claimed that since its iron was completely heme-based iron, it was not affected by elevated hepcidin, and thus could be fully absorbed by the body, even after intense exercise. I did not find that fact substantiated in anything I read, so I don't know if it's true. In defense of the company in question, I couldn't get at all of their references, because they were behind paywalls and I wasn't willing to pay, so perhaps there is good evidence to support that claim.

And I don't know yet what, if anything, specifically this means for me me me. Maybe I need to try even harder on the gut-health angle? I'm not sure. I like understanding things more, though. Understanding is good.