251: Why You Should Balance Iron + Copper w/ Amanda Montalvo, RD

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Many of our readers and listeners have heard me talk about the zinc and copper relationship. Have you delved into how copper is involved yet? My guest today shares everything from the importance of minerals to how the iron recycling system works.

Today's guest, Amanda Montalvo, RD, is a women’s health dietitian that helps women get to the root cause of hormone imbalances and have healthy menstrual cycles. Amanda started off her education in nutrition with the traditional route, but after dealing with her own health problems after getting off hormonal birth control she quickly realized the value of functional medicine.

After healing her acne, balancing her hormones, and learning the value of her menstrual cycle, Amanda found her purpose—to help women create a body in balance and not settle for anything less.

Join us as we discuss minerals and WHY so many get iron wrong.

Have you been told you're anemic and want to look into your copper or Vitamin A status? Tell me about it in the comments!

Or, listen on your favorite app: iTunes (Apple Podcasts) | Spotify | Stitcher | TuneIn | Subscribe on Android

In this episode:

  • How mineral imbalances affect the whole body
  • How do copper + Vitamin A regulate iron?
  • Organ meats – are supplements equal to eating organ meats?
  • Beta-carotene versus retinol (active Vitamin A)
  • Thoughts on hair mineral testing (HTMA) to check mineral levels
  • Different labs to ask your doctor for


“Iron is in our tissues. We need to get it into the blood. How do we do that? We have different proteins that are moving it around, but those proteins need enzymes. Those enzymes are just making a reaction happen and that's where the minerals come in, right? Minerals are spark plugs for reactions in the body for enzymes.” [6:56]

“As estrogen goes up, hepcidin will also increase, and then that means we have less iron absorption in the gut. So, you can look anemic when you have high estrogen, but in reality, you're actually storing a lot of iron. So, hormones can definitely impact our iron status as well.” [20:06]


Connect with Amanda Montalvo online

Follow Amanda on Instagram

Find out if you’re at risk for Mineral Imbalances with her FREE mineral quiz HERE

Healthy Skin Show ep. 163: Iron Deficiency Skin Rash

Healthy Skin Show ep. 169: Why Is Zinc So Important For Your Skin?

251: Why You Should Balance Iron + Copper w/ Amanda Montalvo, RD FULL TRANSCRIPT

Jennifer Fugo: Amanda, I'm so excited to have you here on the show. I'm glad this worked out. You're going to talk to us today about minerals. I've been having these sprinklings of mineral conversations, I feel like, over the past eight to 10 months, and I love what you bring to the table because just such another perspective, an important perspective on understanding minerals. So thank you so much for being here. I really appreciate it.

Amanda Montalvo: Thanks for having me. I'm excited. It's a fun topic that we're going to dig into with the copper and iron stuff. It can be a little confusing, but we're going to try to keep it very simple.

Jennifer: Perfect. So tell us a little bit first off so we can kind of set the stage here, for those who may not fully understand why minerals are important, what is the reason behind why we're having … because why would we have this conversation if they weren't important, right?

Amanda: I know. It's so funny, because people are like, “Well, you're a hormone healing RD so why are you telling me I should do a hair test? Why are we focusing so much on minerals?” But I think they're honestly important for everyone and minerals, they kick off different reactions in the body. So if we think about having certain deficiencies or imbalances or excesses of different minerals, that's going to impact the different systems that we have. So the more imbalances we have, that eventually that's when symptoms are going to pop up. So we need minerals to make energy, we need minerals to fuel our metabolism, hormone production, detox, digestion is huge with minerals. So they really kind of touch every different system and that's why it's such a big focus in my work.

Jennifer: Exactly. I love too that we can all work on different specialties and yet this information can be applied to so many different issues, conditions, health problems, symptoms, et cetera. It's just so universal, which is really great on one hand, how important minerals actually are. You mentioned we're going to talk about copper and iron today. What is specific that somebody might not know about why copper and iron? What's the deal with the two of them?

Amanda: Okay. So when I think of iron, I think a lot of … I come from the functional medicine space. I feel like you do as well and a lot of people listening are probably somewhat familiar with this idea of functional medicine, more holistic, whole body approach. Iron is the one thing in that where I'm like, “I feel like we're not doing this the justice that it needs and we're still simplifying it.” Right? A lot of people will have their or iron levels tested and maybe it's serum iron, maybe it's ferritin. I'm sure we'll talk about ferritin because it's not the best measurement of iron, but it's a huge focus in the functional medicine space. So we take this topic of iron, we simplify it into being high or low and that we need more iron. Right?

Amanda: Iron is so much more complex than that. It's not like our other minerals in the body. It's tightly regulated. We have a whole iron recycling system that controls it and certain nutrients then control how that system works. So that's where copper comes in, but it's just so much more than the iron levels itself. Then if we think of iron, if it accumulates, it can impact estrogen, inflammation, digestion. I mean, literally every system in the body. So it's one of those areas where I feel if we all had a better understanding, then we wouldn't have this usually around like, “Do I need a supplement with iron? Why is my iron low?” We would understand like, “Oh, maybe it's a copper issue. Maybe it's vitamin A,” and I'm sure we'll get into all that.

Jennifer: Well, so let's start with … can we start with copper since I feel like I've had a number of conversations about zinc on the show, because there's a lot of benefits specifically for the skin when it comes to zinc. But my audience is aware that you do have to be careful with the zinc because you do need to keep it in balance with copper. That's pretty much what they know. So what else do they need to know about copper?

Amanda: So copper is just a very underrated mineral. When I think of copper, I think of even just how important it is for energy production. It helps us take oxygen, turn it into energy, and it does that with magnesium as well. So if we don't have enough copper, we're going to have energy deficiency, fatigue, whatever you want to call it. Then, of course, that's going to impact the other systems of the body. So copper is really important for overall energy. It's important for collagen. It works with vitamin C for thyroid hormone. It does so many different things in the body, but it also regulates iron. That's why it kind of comes up over and over in that iron conversation. I also feel like most people don't get a lot of copper in their diets now because a lot of us don't eat organ meats. I mean, maybe people that listen to this show are eating organ meats.

Jennifer: I think it's hit or miss. I will acknowledge I don't … I'm a hard pass on the organ meat.

Amanda: Or they're supplementing with it, you know what I mean? But this is something that we traditionally had in our diet for a very long time, and now we don't. So it's one of those foods that I feel like are nutrients in foods that we don't get as much of.

Jennifer: That's very true and it's also not found in many multivitamins. It's actually hard to find supplements that have copper in them. So you really have to look for them, unfortunately. Most zinc supplements do not have copper in them either. So you, a lot of times, are really not balanced at all in any way, shape or form. So copper seems like it's kind of a little bit of the manager of iron.

Amanda: Yes.

Jennifer: So how would you describe iron? What do people need to know beyond it helps you because it's a part of hemoglobin, which is in your red blood cells, it moves oxygen and carbon dioxide around the body appropriately. I know a lot of women too listening to this might go, “Well, I have heavy periods, so I tend to be more iron deficient.” Beyond that, what would they need to know about iron specifically?

Amanda: So copper moves more oxygen than iron actually in the body.

Jennifer: Does it really?

Amanda: It does so, but iron's … I mean, it is important and I feel like when I talk about copper and iron, people then want to demonize iron. Like, “Oh my gosh, I never want any iron and we need to be so careful with iron.” It's more that we just want this system working properly. I think that's the key, right? So I think if you can understand that our iron recycling system … so it's basically iron's in our tissues. We need to get it into the blood. How do we do that? We have different proteins that are moving it around, but those proteins need enzymes. Those enzymes are just making a reaction happen and that's where the minerals come in, right? Minerals are spark plugs for reactions in the body for enzymes.

Amanda: So copper helps those enzymes work properly and then that allows iron to be in motion. I think if people only take one thing away from the podcast episode about understanding this whole iron thing, it's that we don't want iron stuck, right? If iron is stuck, it's going to accumulate and that's when we create more inflammation, and then that's also when we can look deficient, right? We can look like we have iron deficiency anemia on our labs, but in reality, we are deficient in copper or vitamin A because vitamin A helps us use copper. Copper gets all the glory, but if we don't have vitamin A, then the copper doesn't actually work. So a lot of people will focus a ton on copper, but I think vitamin A efficiencies are way more common and so that's usually the main driver for a lot of people. But basically we have to get the iron recycling system going with copper and vitamin A. If we don't have those nutrients, it's going to accumulate, can lead to more imbalances and inflammation in the body.

Jennifer: Okay. So in terms of the iron recycling systems, so the idea is that we obviously … So for women who are menstruating, you are going to lose some iron every single month, assuming you menstruate, although some pills, I think you kind of don't for period of time. That was before my time of being on birth control. Those pills 20 years ago did not do that. They didn't offer that. I think it's Seasonale or whatever it is, where you just don't get your period at all. So we have this one aspect that we're losing copper monthly, we'll just say, or excuse me, iron monthly. Aside from that, so do you worry less about the absorption of iron in terms of … or do you worry about both?

Jennifer: Like, A, are they able to absorb iron out of their diet, say your patient or client, and then are they able to recycle it? So recycling essentially, I think for someone listening to this, would look your body being smart enough to be able to hold on to what it needs and let go of what it doesn't. Would that be an accurate way to describe it to somebody?

Amanda: I think the recycling system is more of just using it. It's just can we actually use the iron that we have and yes, women do bleed. Obviously we bleed every month, unless you are menopausal, which we can definitely talk about because iron is one of the biggest things I focus on with my menopausal clients and avoiding that accumulation of it. But we also absorb a lot of iron. Women absorb a lot more iron than men. I think of pregnancy, you go nine months without losing any iron, but then somehow your third trimester, you're anemic, which is not really the case. It's usually a vitamin A deficiency. So yes, we have that iron recycling system. We can lose iron, we want to replace it, but one thing with the iron recycling system is we actually make 24 milligrams of iron every 120 days.

Amanda: So basically if we think about how the system works, we're making this iron and then that is going to our bone marrow. That's making red blood cells. Those last for about 120 days. Hopefully if you're super stressed, they will not last as long. Then the process begins all over again. Obviously if someone's having an absorption issue, it's worrisome because they're probably not absorbing other nutrients as well, not even just iron, but I'm usually more concerned with the recycling system because if iron is not showing up on labs, say they look like they're anemic, my first concern is like, “Do we have enough copper? Do we have enough vitamin A? What's their nutrition history with those foods? Were they vegan or vegetarian in the past?”, which is typically going to be really low in vitamin A and kind of digging into that a little bit more.

Jennifer: Yeah. I think it's really, at least in my practice, it's very common for people to be low and vitamin A especially … and I just assume that it's because if … “I don't eat organ meat.” Liverwurst, when I found out what liver … I don't know what I thought liverwurst was made of and then my sister ruined it for me and I was like, “Oh no, I can't eat that.” But anyway, the point is that my diet is probably not very high in vitamin A and for those who I find who are low in vitamin D ,a lot of times they're also low in vitamin A. That's usually a good kind of red flag, and especially then if they're not eating organ meats, they're not eating liver, which is the best source of vitamin A. Too many people, I think, depend on beta carotene as a source of vitamin A. What's your thoughts on that in terms of beta carotene and converting that sort of plant-based form of precursor to vitamin A and to the active form?

Amanda: I just prefer that people only focus on the active form, the retinol. Some people, kind of depending on your genetics, you are not going to be able to convert it as well. So it's one of those things, and then how much are you converting? The percentage is lower. The amount that you would need to eat is a lot and then also too much beta carotene isn't good for us either. So it's kind of this balance of like, “How can we get enough of that retinol genetics wise?” But then how much beta carotene would you have to eat and then what other downsides are going to come from that if you're eating too much? But retinol, it just acts differently and the body's a powerful antioxidant that can protect us from excess iron if we are having iron accumulation and everything.

Amanda: So that's what I typically focus on when people, and if they don't want to eat it, then dairy is a good source, egg yolks, good source. Obviously you're not going to get nearly as much as you would get in something like liver, then supplementing is better than nothing. There's so many great beef liver supplements out there now that I feel like a lot of people could do that instead.

Jennifer: Yep. So in terms of testing, because I think that's going to be the question for people who are listening to this going, “Well, my iron levels have been a little low,” but I think it's very infrequent that a doctor is willing to run a serum copper. I don't think that's probably even a great way to identify a copper issue. What's your feelings on conventional labs looking at an iron panel, copper, vitamin A versus you had mentioned the hair mineral tissue analysis.

Amanda: I mean for iron, I like both. I think you get the best picture. Blood work, you can get a lot of information for iron though. So serum iron is a great place to start and that's telling you more of how efficiently you're using iron in the body. Morley Robbins, I love how he describes it as your miles per gallon of iron, how efficiently your body is able to make it, recycle it, use it. So it's a good place to start. If that is low, so optimal's a hundred, if that's low, then you want to understand like, “Okay, do I have …” My first thought is vitamin A. Unless you're someone, especially if you have a history with vegan/vegetarian or not eating organ meats, I would typically think most likely you have depleted vitamin A levels.

Amanda: You can ask to get retinol tested. If you say vitamin A, your doctor's probably going to order beta carotene, so I just say ask for vitamin A, specifically retinol. I've had so many women get that blood work from their doctor with no issue. Then the other one's hemoglobin. That's a great marker for iron. 70% of our iron is in hemoglobin, so that's another one that you want to look at. 13.5 is optimal for women. So if it's the below that, then again, I would think retinol, copper, which blood work gives you a … it's better than nothing, but for things like copper, I really hair testing because you get to see inside the cell and then just your picture of stress.

Amanda: It shows you the last three months of time, your current stage of stress and overall mineral levels, which I feel helps you better understand where are you at in this whole healing journey with how much stress your body's under, how's your body coping with stress? What is that potentially going to look for you for a timeline, which can be so helpful when you're in the thick of things and you're wanting to understand like, “How long is this going to take?” Or like, “Why aren't things moving quicker?” Say you do a hair test and you see that you have really low mineral levels, that's going to make a lot more sense as far as progress and stuff. So I combination of hair testing, blood work to get the full picture of iron, but I do think you can do a lot from blood work as well.

Jennifer: Okay. What about ferritin? You had mentioned that

Amanda: Earlier. Okay. Okay, ferritin. So ferritin, everyone says it's stored iron and it does store iron, but it's supposed to be inside the cell. So we don't actually want to see high ferritin levels and in my functional nutrition training, high ferritin is a sign of inflammation. Right?

Jennifer: Correct. Yeah, me too. Me too.

Amanda: So it's like, “Okay, so that's a sign of inflammation,” but if ferritin is not high enough, then that can be a sign of low copper, but 20 to 50 is plenty for ferritin. I mean, I remember learning how if people have hair loss, they need to have at least 80 or higher. But then if it's above 100, it's a sign of inflammation. So it's like, “Then what is it?” So when we look at what ferritin actually is, it's supposed to be stored in our cells and so when we see it getting dislodged more into the blood, that's a sign that we actually have plenty of iron stores, but there's inflammation in the body, so that ferritin's getting displaced.

Amanda: There's two types of ferritin. So it's heavy chain, light chain. The light chain is the one that we see on the blood work that is not storing iron. The heavy chain stores a lot more iron and we need copper to get the iron into the ferritin. So ferritin is, I would say, my least favorite measurement for iron. I'd rather look at serum iron, hemoglobin, vitamin A.

Jennifer: Let me ask you one other question, at least I've noticed with hemoglobin, is that hemoglobin tends to drop later than the iron values. So you could have … though, sometimes I'll see somebody who has … they'll just go by a CBC panel, their doctor's like, “Oh, you look fine,” but then when you look at their iron panel, everything's low, low, low, low across the board. I have noticed clinically that hemoglobin tends to drop slower. Do you think it's because of the recycling system?

Amanda: I do, because if you think about it, that's really where it's all going and because it's … I mean, hemoglobin is just a great representation of your iron stores. So you can have low serum iron and normal hemoglobin. I see that all the time. Again, it just kind of comes back to what is the actual cause of it though, and that's why we never just want to throw iron on something if we don't really, truly need it. When I think of people that would actually need iron supplementation, it could be really poor digestion, lots of hormone imbalance issues, vegan/vegetarian history where they just weren't getting it. But even then it's usually still so much important to have other nutrients. Or someone that's had major blood loss. But those are pretty rare cases for most people. Even donating blood can actually help kick start your iron recycling system.

Amanda: So even when we have a lot of blood loss, when people talk about heavy periods, I'm like, “But you're just going to be recycling more.” So there's still a deeper issue of what's actually at play here. It's not that you're deficient in iron. Why are your period so heavy? Right? Is it an estrogen thing? Where is the imbalance there?

Jennifer: Oh, you mentioned something, and I apologize, I'm not recalling which mineral it was, but you mentioned something about estrogen in the beginning. Was that connected with copper or iron?

Amanda: With iron. So as estrogen goes up, hepcidin will also increase, and then that means we have less iron absorption in the gut. So you can look anemic when you have high estrogen, but in reality, you're actually storing a lot of iron. So hormones can definitely impact our iron status as well and that's just another thing to keep in mind.

Jennifer: So if somebody is in an estrogen dominant state, would they be more likely to have something like this going on?

Amanda: I would say they're probably more likely to look anemic on their blood work, but I will tell you what I see so many high irons, like serum iron. I see high iron saturation a ton on blood work, and so it's one of those things where it could just be because of their … I hear a lot from people, “Oh, I've been told I anemic,” because they have fatigue and they were never tested and their doctor's like, “You're probably anemic. You probably need more iron.” I know. It's terrifying. So it's one of those things where it's like, “Are you actually anemic, and are you still that way?” Because it could have been something else when you were younger. But yeah, so hormones can definitely impact it. It's one of those things where it's like we just want to understand what's below that root cause, though. I look at iron imbalance as a symptom, right? So what's actually causing that symptom?

Jennifer: Yeah, and iron issues, some people will recall I did an episode on iron and skin issues and so low iron levels can actually cause for some individuals to have really itchy skin and they don't exactly know why, but the same can be for zinc. So it's just interesting to see how the minerals can impact this outer barrier of your skin that's so important. I'm going to ask you a question. I've thought of this before, but I don't know if you know the answer and if you don't, it's fine. So years ago I remember I was working with this Ayurvedic practitioner and she used to drink water that would sit overnight in a copper cup. Have you ever heard of anybody … Because it would infuse. The copper ions would go into the water. Have you ever heard of anybody using that to maybe help to get more copper into their system?

Amanda: My concern with that would be too much copper and not enough vitamin A. So the other thing, copper's also nuanced where we want enough copper, but we also need enough vitamin A, so when we don't have enough vitamin A, we can have an excess of copper. That's not available for you. So it's not like we have all this extra copper to make a ton of energy and make our metabolism stronger. We have this copper that will then accumulate … similarly to iron, it can accumulate in the liver. A lot of iron recycling and iron metabolism occurs in the liver and so if that builds up, you have lots of … usually signs are sluggish liver, acne's a huge one with iron accumulation, skin issues.

Amanda: So copper can do the same thing and copper can really impact your mood, your mental state, and then of course, then if you eat high copper foods and you have super high copper, then you don't feel great. So people with really high copper that eat beef liver feel terrible typically. So I would just be weary of getting too much copper. I would think that most people need more vitamin A.

Jennifer: Vitamin A. It all comes back to vitamin A.

Amanda: You must talk about that a lot with skin.

Jennifer: I have many podcasts where we talk about vitamin A for sure, but this is the first time where it's discussed within this little trio.

Amanda: Have you seen the studies with thyroid? Vitamin A and thyroid is amazing. So it can help lower TSH, it helps turn on our thyroid receptors, similar to how it works with vitamin D and there's so many studies using vitamin A. They're in animals, we need human studies, but it literally lowers TSH. People get off medication. It's amazing. So I always think vitamin A, when I think of those clients that are deficient, they usually have thyroid issues, skin issues, metabolism issues, everything kind of goes together.

Jennifer: Yeah. It's also interesting that there's so much fear mongering around vitamin A. Like, “Oh, you're going to end up with a excess of vitamin A. Beware, beware.”

Amanda: But we give people Accutane.

Jennifer: It is very true. We do use it therapeutically on the skin, internally as Accutane, but yet we worry about it if you take a vitamin too much. So in terms of in general, just to pull back for a second and get to that 2000 foot view, the idea here, and I think that's one thing that I really appreciate about a lot of your posts on Instagram and whatnot, is showing that this is really about the relationship between different nutrients and understanding that it's not just one thing that's going to fix you. Would that be an accurate description?

Amanda: Yes. We love to simplify things. Even vitamin D and stuff like that, it's like, “Well, magnesium converts vitamin D and we need vitamin A for vitamin D to work properly as well.” Especially with nutrients, I think in our minds, because we can supplement with it, we want it to just be like, “Oh, it's low. I need this.” But in reality, especially with minerals, they're synergistic. You were talking about copper and zinc, they're all synergistic. So we just have to keep that in mind. It usually means that less is more and hopefully that makes people feel at ease, of like, “Oh, if I'm anemic or if my doctor tells me I'm anemic, my iron is low, I can take something beef liver instead of an iron supplement and that should help with the issue.”

Jennifer: Well, unfortunately there's plenty of … Well, I don't organ meats and I can't swallow pills. So that's where I am doomed.

Amanda: How do you get your vitamin A?

Jennifer: A liquid vitamin A. It tastes awful, but whatever. That's the best I can do.

Amanda: Cod liver oil's another one that's all vitamin A.

Jennifer: Oh, no. No, my dad used to put it in orange juice and make us drink it when I was a child. I was very scarred.

Amanda: Oh, man. But you're a lucky kid. A lot of people are … they don't have any and then they have all these deficiencies.

Jennifer: I know. I got scarred early in life and it just is what it is. So the moral of this short section is, for everybody listening, don't be like me. Don't be like me and we all have things we don't and it's life, and you just got to find a way to work around it and do what you can do. But don't anticipate beta carotene to save you from your vitamin A woes and don't fixate on just zinc, because we need the copper and then don't fixate on just iron because we need the copper too. We need them all.

Amanda: One quick note about zinc that I feel like you'll think is very interesting. So I see low zinc a lot on blood work, but it's usually really high on a hair test, meaning that it's leaving the cell, you're using up a lot of it. That is typically a result of low magnesium, because they're very synergistic. So magnesium, I feel like that becomes depleted so easily. It gets depleted whenever we're stressed, it's hard to get from food, not everyone supplements or takes enough, and then that depleted magnesium then leads to the use of zinc. So whenever I see low zinc, I'm like, “But do you really need more magnesium,” is the question.

Jennifer: Well, yeah, and a lot of times with skin issues, plus the doctor … well, the doctor usually only tests serum zinc, which is not the greatest marker for zinc status. Although there is research that does show that they have seen more severe atopic dermatitis or eczema cases associated with low serum zinc, but it's still not so great of a value, but the red blood cell erythrocyte zinc tends to be the better one, but it's so rarely run. A lot of times doctors are like, “I didn't even know you could run that. I don't know what that is.” It is very frequently I've seen it low in clients who have a lot of skin problems.

Jennifer: So that is a really great little tidbit to leave off with. I appreciate it and I appreciate you for here and sharing this because I know that not everybody is super into … it's kind of a biochemistry kind of a conversation, but it's like this is how real life happens. We have to look at the symphony of nutrients and figure out what's the best combo for us. It also exemplifies the type of work that you do and the type of value and benefit that you obviously bring to your clients and patients. So thank you so much for being here. You also have a great podcast. You want to share where everyone can find you and mention your podcast as well?

Amanda: Yes. Thanks for having me. It was a fun conversation. So my podcast is called Are You Menstrual? You can find that on Apple Podcast, Spotify, anywhere podcasts are played, YouTube. Then I'm really active on Instagram. I'm @hormonehealingrd. That's where I probably share the most content, but I do have a weekly newsletter where I spend a lot of time in there too. So those are all three great places. If you're like, “I'm into this, I want to learn more about minerals,” I would definitely consider following me.

Jennifer: Perfect. Thank you so much, Amanda, for being here and I hope you can come back sometime.

Amanda: I definitely will.

“Iron is in our tissues. We need to get it into the blood. How do we do that? We have different proteins that are moving it around, but those proteins need enzymes. Those enzymes are just making a reaction happen and that's where the minerals come in, right? Minerals are spark plugs for reactions in the body for enzymes.”