Cocoa Pods

Iron treatment Intricacies, Blood Disorders, and the Promise of New Horizons

• Birth Center for Natural Deliveries Foundation • Season 3 • Episode 145

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Unlock the mysteries of iron and its pivotal role in our health, as Dr. Marwa Farooqui from the University of Illinois Hospital and Health Sciences System takes us through the latest in iron supplementation and blood disorder care. Grapple with the complexities of iron absorption in those with chronic conditions and peripartum individuals, and learn how certain dietary choices can enhance or impede iron uptake. Dr. Farooqui illuminates the re-emergence of iron dextran in IV treatments, the progress in oral iron therapy, and introduces us to ferric maltol—a game-changer with minimal side effects. Through her lens, we navigate the delicate balance of iron in the body and confront the risks associated with iron overload in specific diseases.

Transition with us from the cellular level to the comprehensive well-being of patients battling blood cancers. Dr. Farooqui underscores the crucial role of open dialogue, the undeniable impact of lifestyle choices on disease management and prevention, and the importance of family in patient advocacy. Together, we peer into the future of hematology, pondering the innovations on the horizon and the promise they hold. This episode is not just a conversation; it's a journey through the transformative landscape of survivorship care, offering empowering knowledge for anyone touched by these conditions.

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Dr Farooqui:

milk, coffee, tea. These are iron key leaders. So after you take your iron pill, if you take some of those dairy products, you're just wasting the iron.

Dr Sogade:

Welcome to Cocoa Pods podcast, a podcast of the Broad Center for Natural Delivery Foundation. We have Dr Marwa Farooqui from the University of Illinois Hospital and Health Sciences System Division of Hematology and Oncology. So basically, dr Farouki is a blood disorder and cancer specialist.

Dr Farooqui:

Now with terms of iron dextran. There was research, there was a little bit more research and information coming out on iron dextran. For a period we kind of went away from iron dextran because we were very worried about allergic reactions. And that was the older, larger molecules that created these allergic reactions. And we're seeing, with the newer formulations we don't see that allergic reaction as much anymore. And the advantage of iron dextran is it's generic, it's cheaper and you can give it at a one-time setting. So now we're starting to go back to iron dextran more. However, at my institution and I know at many institutions the limitation is we don't have enough iron dextran, so the supply is not there. So when we're doing IV iron supplementation, there has been a lot of advances that have been made, which is great, From just having one-time shots to having different formulations that were out of use and now they're back into use because of the change in the molecules. But from an oral iron standpoint too, there have been advances made.

Dr Farooqui:

Typically when patients come to me, I tell them to use oral iron whichever is the safest and whichever one you can tolerate the best. Now, how many times do you take it? There was a study that came out a few years ago, you know, started recommending taking iron every other day because of the way that the iron is metabolized and more iron is absorbed if you take it every other day. Now that study was only done in patients with chronic conditions. It was not done in patients who are peripartum, so really we cannot apply that to our patient population. In my practice I usually recommend you know you can take the iron oral iron supplement, whichever one is the cheapest and whichever one you're able to tolerate, up to three times a day. You know you can start slow, start with once a day, see if you can tolerate it, if you can go up to three times a day. Most patients are only able to tolerate one or two tablets daily, so we go to that Now. If they're able to tolerate it only every other day, something is better than nothing, so we go for that.

Dr Farooqui:

It's important to keep in mind the elemental iron portion is very important for the over-the-counter iron pills that are available, because not all iron is created equal and iron has to be absorbed in a more acetic environment. You have to make sure that you're not taking it as part of a multivitamin, which is one of the biggest issues that I have with our prenatal vitamins. Usually the iron is combined with calcium and vitamin D and calcium is an iron chelator. So you know, when we're taking prenatal vitamins that iron that you're getting is not enough. You do have to take additional iron supplementation on top of the prenatal vitamins that you're taking.

Dr Farooqui:

Also, keeping in mind milk, coffee, tea, these are iron chelators. So after you take your iron pill, if you take some of those dairy products, you're just wasting the iron. So, keeping all of those in mind, there is a newer formulation of an oral pill that has come out that is very potent and is supposed to be equivalent to the IV formulation. I'm trying to look for the name. I did mention it during my last podcast. I haven't used it primetime yet because it's not available in the United States, but internationally it has been used and the formulation is supposed to be more potent.

Dr Sogade:

Right, so you did talk about that may be an oral iron that is almost as potent as the IV iron. This is such a breakthrough because, like you said, women don't have to come in so many times for an IV infusion. They can take something that is almost as potent. So you talk to us about that.

Dr Farooqui:

So it is a newer formulation that was approved in 2021. This is called ferric maltol and that's something that can be utilized in an outpatient oral setting. It also has a lot less side effects compared to the other oral iron formulations that are available. The majority of the time patients are not able to tolerate the oral iron it's because of GI side effects, including nausea, vomiting. Some patients may get constipated or may have diarrhea, and GI side effects are real. No one wants to deal with severe constipation or diarrhea, so a lot of our non-compliance is coming because of that. With these newer formulations, we do have better compliance for the patients.

Dr Sogade:

And you said it was ferric, ferric, maltol, maltol. Yeah, thank you. Thank you, I just had a question. Is there a maximum absorption? I mean like whether you take iron tablets once a day or three times a day without the milk and all of that is there like a maximum amount of iron that your body can absorb on a daily basis?

Dr Farooqui:

So I can tell you that our body loves iron. Our body is a magnet for iron, so it loses about one milligram of iron on a daily basis and typically absorbs about four milligrams of iron. And you need to have routine supply of iron to be able to make red blood cells, and most of your iron is stored in your bone marrow and some of it is also stored in your red cells as well as your liver. However, if you start taking too much iron the body loves iron it will continue to absorb the iron and this iron can get stored in other organs besides the bone marrow and the red cells. It can get stored heavily in the liver as well as in the heart.

Dr Farooqui:

We see this often in patients with Thalassemia or sickle cell disease, and the reason for this in those specific conditions is because of the hemolysis. Iron is naturally made in our body in red blood cells and when the red blood cells break down, the hemoglobin component breaks down into the iron and that iron is stored. And on top of it, if these patients are getting chronic transfusions because of their underlying Thalassemia or sickle cell, that can also cause problems with iron overload. So you know you have to be very careful about iron supplementations in those conditions. In my practice, when I do follow these patients very closely and when they're pregnant or they have reasons for iron deficiency, that's when I do supplement iron.

Dr Sogade:

Thank you. Thank you for that. You know I want to talk about quality of life and survivorship. There's some women that have gone through blood hematologic disorders or actually cancer treatment, like you know, colon cancer treatment. What are some strategies for maintaining their quality of life and even if you can talk about their emotional well-being, and can you discuss survivorship care plans and the importance for these women who have completed their treatment?

Dr Farooqui:

So you know my field. Whenever I tell a layperson that I'm a blood and cancer doctor, it sounds very, very scary. However, it's very rewarding because I do get to follow these women for a long period of time. Having a blood disease, a blood disorder or cancer is not an easy diagnosis to deal with. You know, earlier we were talking about iron deficiency. That is something that is a simple fix. However, conditions such as thalassemia, sickle cell disease, some of the other bearer hematologic malignancies, leukemias, lymphomas, breast cancer, colon cancer all of these hematology and oncology problems, you know, while we have made a lot of progress in the last couple of decades, we have to really think about survivorship. I'm glad you asked me this question because you know we are often focused on the treatment and we don't focus on what happens after the treatment. So you know, right off the bat, when I'm meeting a patient, whether it's for a hematology problem or an oncology problem, and when I'm starting them on treatment, I will tell them you know I don't want the treatment to kill you First. Do no harm is our motto right in medicine. And then I also tell them you know you won't remember that I cured your cancer. You won't remember that this medicine made your blood disorder better, but you will remember the side effects the medicine I prescribed gave you. So you know, having that conversation early on, really an informed and a shared decision making, is important because the treatments that we're giving are not easy treatments to go through. Even if it's as simple as taking a pill such as Hydroxyurea on a daily basis, it's not something that's very easy to do in anyone. No one likes taking medications, no one likes getting chemotherapy for cancer, but it's just a necessary evil that we have to do to be able to get back to a good baseline health. So once we're able to accomplish that, especially in a cancer setting or in long term settings such as Thalassemia and sickle cell, you know, now we have bone marrow transplant, we have gene therapy. That has really been coming up and in the news since December All of these procedures and treatments do have long term effects. So you know, having that conversation with the patients early on so they know what to expect, having realistic expectations, is important. And then afterwards, having some kind of structure like a survivor group or like a patient support group is going to be very important. And then, as I continue to follow these patients after their treatment is complete or during their treatment.

Dr Farooqui:

You know, from day one, I emphasize lifestyle modifications, diet and exercise. Really that's what helps. That's a game changer. Exercise especially, you know, not significant, you know large weights, but you know, just get into a routine activity, structuring your day around how you're going to stay active. All of that really helps improve not just your disease itself, but it also helps improve your mood. It helps you get out of the house. If you go to the gym to exercise, it helps you just, you know, get in a better state of mind, and I really like to emphasize that with my survivors. So you know, to sum it up, important thing is having an open conversation with your patients, shared decision making as you're recommending treatment options, and then, you know, focusing on lifestyle modifications is the key for survivorship care.

Dr Sogade:

Thank you so much for that, you know, and now we're going to a little bit more to preventive measures, and I know you talked about it, but I like to emphasize some points. Are there any lifestyle choices or preventive measures that women can take to reduce the risk of developing blood disorders or cancer, and how does women's overall health, such as nutrition, exercise and mental well-being, impact their susceptibility to some of these conditions?

Dr Farooqui:

So you know I mentioned it a little bit ago diet and exercise is key. That is really prevention, not just for blood disorders as well as cancer, it's also important for your heart health. All right, and without the heart you can't function. The number one killer is not cancer, it's still heart disease. So you know, really going back to diet, exercise, lifetime modification and when I say diet I don't mean going on a crazy diet, I mean, you know, have a well-balanced diet, be mindful of what you're putting in your body, get used to reading the nutrition labels. If you're in a setting that you eat processed food, you know, fortunately, in the global health perspective, there's not as much processed food. So you know, on that ad, our lower to low-middle income countries are fortunate because they don't have to look into labels as much. However, access to quality food, you know access to clean food is important. Access to be able to, you know, having the time to be active, having the time to go out and do the work. You know where we're really at a disadvantage, especially living in North America where you know we're cooped up in our houses and this kind of weather and not getting exposed to sunlight. There's really not much activity. And now with the, with social media, screen time, tvs, tablets, ipads, we're really hooked on to devices and we don't enjoy the outdoors. So forcing yourself to go outside, you know, and being active, that really helps in terms of prevention of any diseases. And then specifically for cancers. You know I want to mention smoking. Smoking is something that you know that has come into light a lot in the last decade or two. However, if you think back to the 50s and 60s, you know mothers, pregnant women used to smoke and no one raised an eyebrow. It was a billion-dollar industry that we're slowly trying to dismantle the myths about. And now we've gone from cigarette smoking to other sources of smoking electronic cigarettes, we've gone to marijuana. This is like a multi-billion-dollar industry now that it's been legalized in the United States and most of the states. And you know people are just praying on the vulnerable population and introducing these folks at a very, very young age to smoke. Whether you're smoking marijuana, whether you're smoking cigarettes, smoke is smoke and that can damage your lungs. You're also seeing head and neck cancers and males I often let my younger males know, you know you'll see testicular cancer. So there's not a lot of stuff that's coming out about marijuana yet, but marijuana hasn't been legal and has widespread, cigarette smoking was. So I think as we grow, with this new legalization we'll start seeing what the effects that marijuana has had. There's hookah, there's vaping, there's you know, all these avenues of smoking are doing lung damage and they're also creating avenue for cancerous lesions.

Dr Farooqui:

The other aspect of, you know, our lifestyle that I want to mention is alcohol. Alcohol has been linked to multiple cancers in women, especially with breast cancer. You know it's recommended women don't have more than one glass of wine a week. You know, not a lot of women think about that, because a couple years ago there was a study that showed that alcohol is good for your heart health. Since then we've backtracked on that study. Yet that myth is still propagated amongst people that you know taking alcohol is good for your heart health. However, we forget that. You know this study has been discredited and we really know now that alcohol is linked to multiple cancers breast cancer, esophageal, colon cancer. So, really, staying away from, you know, excessive drinking, excessive smoking periods, staying away from smoking, you know those kind of things are going to be important.

Dr Sogade:

Thank you, Thank you so much for that. Just talking about supportive care and other resources, Dr Faroukhi, you have expertise in pain management and supportive care, which are often the most important issues for patients and their families. You highly value a team approach to the patient-physician relationship and you strive to help your patients understand their clinical diagnosis and treatment plan. Dr Faroukhi, you pride yourself on holistic care, so I have two questions for you. What resources and support services are available to women facing blood disorders or cancer, and how can they access these services? The second part of my question is how can family members and caregivers provide effective support to women undergoing treatment or living with a blood disorder or cancer?

Dr Farooqui:

So in terms of resources and support services, there's not enough right, which is why you have this podcast. I would recommend to the listeners that this podcast your podcast that you're doing itself is a resource for both patients as well as family members. In addition to that, there is a foundation for girls and women with bleeding disorders that provides patient resources and provider resources and that's really my go-to organization in terms of patient resources and support. Linking out to your hospital or clinical facilities, there is hemophilia treatment centers that will have structured support groups available. There's sickle cell centers that do have patient-related support groups available. There's the Sickle Cell Disease Association of America that has different chapters throughout the states. So within the United States, there are several different opportunities. I'm not very familiar with the global health perspective of things. However, with Zoom and with the internet, I feel like we really have. Globalization has helped in terms of opening avenues for support. So anyone from, let's say, nigeria who wants to communicate with a physician or an expert, a disease expert in the United States, they could potentially go on medical forums and get their questions answered. Now, that's not medical care, but that could serve as a resource. So, having internet and having easy access to internet and use legitimate resources, not Dr Google, but having going through proper avenues, major organizations such as Foundation for Girls and Women with Leading Disorders, american Society of Hematology, going through institutions that are accredited to get your information. That's really the sources I would recommend for both patients as well as providers to learn more information.

Dr Farooqui:

You asked about how can family members help to care for patients with blood or cancer disorders. The biggest thing is the presence of family members. Going through a major diagnosis or a minor diagnosis as minor as iron deficiency andemia during pregnancy is not something easy. It always helps to have extra ears and eyes. We are living in a world where there's way many patients than providers, so family members being an advocate for the patient really helps.

Dr Farooqui:

I myself am a physician. I know not everyone is able to be 100% all the time, so it really helps when family members come into the appointments or family members ask the key questions, or are there just the support for the patient, whether they need a ride to bring the patient or when a patient's dealing with a new diagnosis or treatment. Having that extra family member who's not emotionally distraught in the moment and able to hear what's going on really helps. So family members being present and asking questions. I highly encourage that, and that's the most support you can give to your loved one. Navigating through the healthcare system is not easy on your own.

Dr Sogade:

Thank you, thank you for that Next episode. So, looking at research and future outlook, what does the future hold in terms of advancement in the field of hematology? /Oncology, women bleeding..

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Dr Bola Sogade, MD FACOG, FAAFP

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