A mysterious deficiency that evaded more natural remedies changed her long-standing view that food could fix everything.

By Natalie Rizzo, MS, RD
April 11, 2018
Photo: David Malan / Getty Images

Eight years ago, I quit my full-time job in ad sales for a major media company to go back to school and pursue my passion-nutrition. I was 26 at the time, and the education took five years in total. It was an extremely tough process, but I never wavered in my desire to become a registered dietitian, because I believed that food is an extremely powerful health tool. If you asked me back then what I thought of supplements, I probably would've said something like, "Ditch 'em! Food has all the nutrients you need." This perspective stems from some people using supplements as replacements for foods they aren't eating or to undo an unhealthy diet. This can be seen as the easy way out of poor nutrition choices, or as a misidentified cure-all, when, in reality, supplements are supposed to supplement your diet during instances when you can't get enough of a nutrient from food.

But a lot has changed since then: My own life experiences have caused a shift in my opinion on supplements, and I now realize that things aren't so black and white.

I have a vivid memory from 2014, in which I'm sitting on the subway on my way home from a night class, and I'm craving a glass of ice. I had become accustomed to sitting on the couch at night, watching TV, chewing on ice cubes. I don't know why or when I started doing it, but I knew that I couldn't stop. Once I realized that this wasn't normal and something might be wrong, I did what any 20-something with a health problem would do-I Googled it. It turns out that eating ice is a form of PICA, a psychological urge to chew on something non-nutritive. And PICA is a symptom of iron deficiency.

Getting to the Bottom of My Iron Deficiency

I'm no stranger to iron deficiency. A genetic blood disorder called thalassemia minor runs in my family, and I tested positive for it as a baby. That means I have a mutated gene that drastically lowers my levels of hemoglobin (a protein that's responsible for carrying iron throughout the body). The kind of condition I have is not serious, but it can sometimes cause slight anemia. I battled with anemia as a kid, and my pediatrician told my mom to feed me iron-rich foods like watercress. If you've ever had watercress, you know that not many kids would get excited about eating it. (Although, apparently watercress is great recovery food for athletes.)

Flash forward to 2014 (my ice-craving days), and my iron deficiency was rearing its nasty head again. I went to the doctor for blood work, and my levels of stored iron were extremely low-just 2 ng/mL compared to the healthy range of 12 to 300 ng/mL. While I have lower levels of hemoglobin, these carriers are larger than normal for me, so they can still hold enough iron, but my body just wasn't storing it properly. I was prescribed heavy-duty iron supplements, in the form of 325mg of ferrous sulfate twice daily. To put that into perspective, the recommended daily intake of iron is 18mg, and I had to take 36 times that amount!

This discovery and treatment hit me like a ton of bricks. I felt like such a failure as a nutrition student and soon-to-be RD. So many thoughts went through my head. "I should've known how and what to eat." "Maybe I shouldn't have chosen to be a vegetarian." I just didn't get it. Isn't a healthy diet supposed to be enough? With my thalassemia and iron deficiency, I decided to see a hematologist, a doctor specializing in blood disorders. She was the first person who really seemed determined to get to the root cause of my iron deficiency. She asked me about some common culprits. Did I have heavy periods, she asked. Nope. Did I experience gastrointestinal issues? No, again.

After drawing more blood, the hematologist determined that I also had a vitamin B12 deficiency, in conjunction with my iron deficiency. You've got to be kidding me! I bombarded her with questions: "Should I start eating meat again?" "Is running marathons causing this?" She assured me that eating eggs should give me enough vitamin B12 and that there's no research to show that running can cause nutrient deficiencies. Nonetheless, I began coming to her office almost daily for the next two weeks to receive the necessary B12 injections. At the time, I had a full-time job, was super tired thanks to all my vitamin deficiencies, and just felt defeated with the whole process. But I went through with it: I took all the iron supplements, got the B12 shots, and, soon, my levels were back to normal. I was able to stop the supplements and made an appointment for six months later to follow-up with the doctor.

As luck would have it, my levels had crept back down, so I was quickly put back on the supplements. This time, I was prescribed oral B12, so I didn't have to go to the doctor every day. But my hematologist also suggested I get an endoscopy to rule out celiac disease. (Too bad they didn't have the blood test option to test for gluten sensitivity back then.) One of the main symptoms of the disease is vitamin deficiencies. I had no symptoms other than that, but I was desperate, so I went to yet another doctor to get an endoscopy. They found no evidence of anything wrong in my upper GI tract or stomach, and the mystery of the deficiencies raged on.

After that, I underwent other unpleasant tests, like more blood work to really determine whether or not I had thalassemia (confirmed), and a stool sample to see if there was any blood in the stool (negative). The next step was a colonoscopy to determine if something was wrong in my lower GI tract, but I was really dreading it, so I put it off. I continued to take my supplements on and off for a while, but then I started my own business and pushed my health to the sidelines. I was acutely aware that was a bit ironic since I'm a dietitian who preaches the importance of health on a daily basis.

When I Couldn't Put It Off Any Longer

I still continued to eat healthily and exercise, and I felt good for a while. But this year I realized I couldn't ignore it anymore. It was the middle of winter, I was chewing on ice like it was candy, when another unfortunate side effect arose-restless leg syndrome.

One night, I woke up at 4 a.m. with this terrible achy feeling in my legs, like something was crawling on my skin. I got up and tried to walk it out and then went back to bed. When it happened the next night and the next, I thought I was going crazy. "Is restless leg syndrome really a thing that a 34-year-old woman can get?" I thought. Turns out, it is a thing, and particularly a thing if you have iron deficiency, and boy, is it terrible. Sleepless and desperate to see a doctor, when I finally got in for an appointment, I was put back on ferrous sulfate and B12 supplements, and I couldn't have been more thankful.

It was only after the more than two weeks of waking up in the middle of the night with restless legs and mild exhaustion setting in that I had a complete change of heart regarding supplements. I'm beyond grateful that the pill form of these nutrients exists. They give me what I need when my body seems to be rejecting them from all other sources. And believe me, I tried it all: eating eggs daily for B12, introducing salmon into my diet for iron, eating iron-fortified oats and spinach every day. None of it did what the pills and injections could do. Yes, maybe eating meat would've done the trick, but I know I'm not alone when I say that I just feel more comfortable taking a supplement than eating meat.

I no longer feel like a failure in the nutrition world, and I've come to understand that sometimes food can't fix all your problems. In some instances, supplements truly are the answer-they are the answer for me. I finally scheduled an appointment for a colonoscopy, and if we still can't find and treat the root cause of my deficiencies, I'm okay with taking these supplements for the rest of my life. They make me feel healthy and strong, and they have taught me a valuable lesson. Nutrition recommendations aren't one-size-fits-all, and some people will be exceptions to a long-taught rule. On a personal level, I've learned that it's okay to change your opinion and grow from experiences. Now if people ask me if they should take a supplement, I won't be quick to say no. Instead, my answer will be, "Well, let's talk it out."

Comments (3)

April 16, 2018
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April 12, 2018
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April 12, 2018
Thank you Natalie for your candid article regarding the need to supplement your diet with supplements that YOUR body needs! The key here is knowledge about what your body needs, making informed decisions! Dr. Christopher Campbell D.O. in Newport Beach and Rocklin California is board certified in Integrative, Anti-aging, Functional and Regenerative Medicine. There is SO much bad press about supplements! He test over 40 factors, including genetics for all of his patients to determine their needs and only then works to optimize nutrition, vital hormone function (using bio-identical hormone replacement) and supplement where needed, he then re-test at 60 days! He patients are there to get a better handle on their health. (He also treats insulin resistance prior to the progression of type two diabetes)! Oh, and congratulations on your becoming a Registered Dietitian!