5

votes

Why am I still anemic?

Answered on August 19, 2014
Created May 27, 2011 at 7:57 PM

I've had issues with low iron my whole life. Also had issues of bruising easily and fatigue my whole life. I recently had more the first hemoglobin test since I started eating paleo, and was feeling all kids of smug about the results, thinking I would be normal for the first time ever and my doc would say, "This is a miracle!" Or something along those lines....

Imagine my surprise when I came back AGAIN with low iron. My levels are never above 11 or 12 and often lower. I have not been able to donate blood but for one time in the past ten years.

I am of middle-eastern decent and have tested negative for Thalassemia.

My typical diet is a late breakfast of two eggs with smoked salmon or bacon, maybe some blueberries. Lunch is normally a snack- small bowl of chili, turkey sliced wrapped around spinach and/or apple slices sometimes with cheddar, dipped in home made mayo or a small bowl of homemade yogurt that I make with heavy cream. Dinner is normally some protein and veggies. We eat beef a few times a week, shellfish or salmon once or twice and poultry the rest of the time. I eat a lot of tomatoes and kale, tons of spinach, brussels and broccoli, and I love salad greens. I cook 90% of what I eat in cast iron. I do eat dairy, but not a ton and I have really cut back on my coffee intake to one cup, three times a week or so.

Any clues? My doc wants me back on supplements, which I'm fine with unless theres an easier (read: cheaper) solution.

TIA.

A1774fb1fcb6c7a072a5e424544ef62e

(255)

on January 02, 2012
at 06:02 AM

I'm glad that this was of some help! Wishing you all the best :D

Aead76beb5fc7b762a6b4ddc234f6051

(15239)

on January 01, 2012
at 03:24 AM

this is great! thank you so much, LQ! i dont contract infections very easily- maybe one or two colds each year. i do have MS. never any idea if thats related to something or not. its such a weird disease. this is very helpful though. this kind of answer is exactly what i love(ed) about paleohacks. i appreciate it. -amanda

96bf58d8c6bd492dc5b8ae46203fe247

(37227)

on December 23, 2011
at 04:34 PM

This is a thoughtful, helpful answer. +1

D7b01bbfd0b91a12c4aea43fb20adf15

(574)

on November 09, 2011
at 09:51 AM

which type of thalassemia do you have heather? I have beta thalassemia minor..

F1b39d4f620876330312f4925bd51900

(4090)

on June 14, 2011
at 10:38 PM

I haven't forgotten you! I finally got ahold of my blood results. Not only did the Yellow Dock not work, the anaemia is even worse! Ah well, it was worth a try.

Fe29f6658ce67c1ecc4a22e960be7498

(2997)

on June 02, 2011
at 06:35 PM

The doc didn't even mention it when she called back, just a raised eyebrow over my cholesterol (typical 'paleo' numbers). But I did have a thyroid issue come up during the checkup, and the endocrinologist didn't even glance at the 'anemia' numbers but is instead talking about *surgery*. Pffft.

Aead76beb5fc7b762a6b4ddc234f6051

(15239)

on May 29, 2011
at 09:57 PM

very interesting! thanks, dexter!

1da74185531d6d4c7182fb9ee417f97f

(10904)

on May 29, 2011
at 02:00 PM

Liver pate is really easy to make. You can find recipes all over the net.

Ed983a42344945b1ff70fd9597a23493

on May 28, 2011
at 06:59 PM

If the problem is lack of digestion (which it usually is), rather than not ingesting enough iron, then, yes, hcl supplementation should help boost blood iron levels.

06d21b99c58283ce575e36c4ecd4a458

(9948)

on May 28, 2011
at 05:20 AM

Ask him on Facebook. Jack Kruse

44348571d9bc70c02ac2975cc500f154

(5853)

on May 28, 2011
at 04:53 AM

Eat some liver.

Ed71ab1c75c6a9bd217a599db0a3e117

(25477)

on May 28, 2011
at 03:17 AM

Cut dairy. Casein A1 is the likely offender.

Ed71ab1c75c6a9bd217a599db0a3e117

(25477)

on May 28, 2011
at 03:17 AM

Since you eat well and have not mentioned the usual suspects medically as causes to the low iron......my bet is malabsorption......the old issue of levee number six!

77877f762c40637911396daa19b53094

(78467)

on May 28, 2011
at 03:06 AM

does that mean that taking Betaine would be good for iron absorption if you have low hcl?

06d21b99c58283ce575e36c4ecd4a458

(9948)

on May 28, 2011
at 02:50 AM

That I do not know.

Aead76beb5fc7b762a6b4ddc234f6051

(15239)

on May 28, 2011
at 02:46 AM

why? is it high in iron? aids in absorption? helps repair the gut? or works in some other mechanism?

13c5a9f1678d75b93f269cdcf69f14d5

(2339)

on May 28, 2011
at 02:09 AM

J Clin Gastroenterol. 2002 Sep;35(3):228-33. A controlled, prospective screening study of celiac disease presenting as iron deficiency anemia. Ransford RA, Hayes M, Palmer M, Hall MJ. Source Department of Gastroenterology, County Hospital, Union Walk, Hereford, UK. [email protected] Abstract BACKGROUND: anemia is the most frequent presenting feature of celiac disease in adults using endomysial antibody (EmA) screening. Endomysial antibody screening of anemia may allow detection of celiac disease at an earlier stage of investigation and after a shorter duration of symptoms.

13c5a9f1678d75b93f269cdcf69f14d5

(2339)

on May 28, 2011
at 02:06 AM

THe trace amounts could be part of the problem. How's your vitamin d? Did you ever consider eating for celiac? Tis post has a checklist for who should consider testing http://www.celiac.com/gluten-free/topic/73755-i-really-need-help-badly/

Aead76beb5fc7b762a6b4ddc234f6051

(15239)

on May 28, 2011
at 12:17 AM

does he eat it for the iron? or so he can tell people about it?

Aead76beb5fc7b762a6b4ddc234f6051

(15239)

on May 27, 2011
at 11:48 PM

ah well! 13 is not really that bad. its just slightly under the cut off, so maybe youre right about the set point. thanks so much for updating though. does your doc want you on supplements?

Fe29f6658ce67c1ecc4a22e960be7498

(2997)

on May 27, 2011
at 10:58 PM

Well I'm going to eat (some of) my words: I *just* had my latest blood test faxed over for a different issue (thyroid) - and I'm STILL FREAKING ANEMIC. Sheesh I think the doctors either get tired of people who 'insist' on not getting better - or perhaps they don't worry about the 'abnormal' column unless it's way off?? RBC=3.9, HEMO=13.0, HEMAT=38.1, MPV=6.1. Why didn't the doctor mention it on the phone?? Shit! OK maybe this is "normal for me" and I should just follow my own damn advice :-)

Aead76beb5fc7b762a6b4ddc234f6051

(15239)

on May 27, 2011
at 10:43 PM

i read a recipe that had ground liver in meatloaf. that might be a good place for me to start!

Aead76beb5fc7b762a6b4ddc234f6051

(15239)

on May 27, 2011
at 10:43 PM

awesome post. thank you. my iron is low, but does not vary a whole lot, so that might be right. when i was pregnant and had anemia, i took supplements and they made me feel like a million bucks, but when im NOT pregnant i dont notice a big difference in how i feel when im on them. and you know i ordered that 23andme test when they were having a big sale over xmas and still have not done it! i really need to get on that. its SUCH a cool thing. my friend did it and LOVED it. she still gets updates to her profile as they develop new tests. neato.

Aead76beb5fc7b762a6b4ddc234f6051

(15239)

on May 27, 2011
at 10:39 PM

interesting! thank you!

Medium avatar

(39831)

on May 27, 2011
at 10:04 PM

Yeah, I have read that people increase their hemoglobin to a greater extent simply by supplementing vitamin C, without iron. Eating a couple red bell peppers per day would greatly increase your vitamin C intake without increasing fructose.

06d21b99c58283ce575e36c4ecd4a458

(9948)

on May 27, 2011
at 09:54 PM

Live doesn't have to taste bad. I hated it until someone said I was over cooking it in a frypan. Now I use coconut oil and heat with a couple of bay leaves in it, then discard the leaves, and add rosemary leaves, dried thyme and garlic salt and let those flavors course though the coconut oil, then I add butter and cook the beef liver to just medium rare and now I like it. It used to taste like bad rough shoe leather when it was overcooked.

Aead76beb5fc7b762a6b4ddc234f6051

(15239)

on May 27, 2011
at 09:21 PM

i dont eat very much liver. i cant stand the taste of it, but i am trying to find more ways to work it into my diet. i do love liverwurst, but the stuff without additives is kind of out of my price range right now. i realize that greens dont have as much iron as meat does, but the C in them aids in absorption and they do contain some iron, and i like them lots.

Aead76beb5fc7b762a6b4ddc234f6051

(15239)

on May 27, 2011
at 09:19 PM

wow heather. what is your hemoglobin, if you dont mind me asking? my doc recommended that i take supplements with OJ, and not within two hours of dairy or caffeine. im not on the iron now (i take slowFE when i do) but i had been taking it at night on an empty stomach before bed with a glass of emergen-c to aid absorption.

Aead76beb5fc7b762a6b4ddc234f6051

(15239)

on May 27, 2011
at 09:17 PM

i have not read that book, but its been on my list. im actually not taking supplements now, and only have done so with any regularity when i was pregnant which was a while ago. thanks!

Aead76beb5fc7b762a6b4ddc234f6051

(15239)

on May 27, 2011
at 09:17 PM

yes! please let me know how your results are! prior to pregnancy, i always thought my anemia was d/t my heavy periods, but ive had mirena IUD in for the past 15 months and have not had a period in a year. im luckily someone who does not get sick from the iron supplements- i hear they makae most people pretty ill! ill look into the yellow dock. thanks so much!

Aead76beb5fc7b762a6b4ddc234f6051

(15239)

on May 27, 2011
at 08:31 PM

thank you for your answer! maybe ill be going back to look at the numbers more closely- i know even if thyroid is low-normal, it can still cause some symptoms...

Aead76beb5fc7b762a6b4ddc234f6051

(15239)

on May 27, 2011
at 08:31 PM

yes to GF, thought im not super crazy about trace amounts or anything. no to the GI issues, at least not chronically. I had my thyroid tested at the same time (just the normal annual workup) and everything came back in the normal range, but i dont know the exact numbers.

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11 Answers

3
A1774fb1fcb6c7a072a5e424544ef62e

(255)

on December 23, 2011
at 04:13 PM

Hi akd. I know this question was from a while back, and I hope you've found out the cause of your symptoms by now (and receiving good treatment for it!). I just thought I would share my theories anyway, just in case they prove to be helpful :D

Iron deficiency as a result of insufficient dietary intake of iron is only ONE cause of anemia. As another user has already pointed out, malabsorption of iron in the gut may be to blame.

However, you mentioned "issues of bruising easily" all your life. This makes it sound as if there maybe some issue with blood clotting, which could be related to having a deficiency of PLATELETS in your body. Red blood cells, white blood cells and platelets happen to be produced in the same part of the body: the bone marrow.

There is a specific type of anemia called "aplastic anemia". It is due to the bone marrow not producing enough blood cells and platelets. This kind of anemia is NOT related to diet, so simply eating more iron-containing foods won't cure it. If this is indeed the kind of anemia you have, you need other treatments for it.

One question: Have you had a history of getting infections easily?

You may want to go back to your doctor and ask for a Full Blood Count to determine if you have low platelet numbers. And go from there.

Hope this helps!

(Disclaimer: Not a doctor; just learnt about anemia as a part of my degree :D)

96bf58d8c6bd492dc5b8ae46203fe247

(37227)

on December 23, 2011
at 04:34 PM

This is a thoughtful, helpful answer. +1

Aead76beb5fc7b762a6b4ddc234f6051

(15239)

on January 01, 2012
at 03:24 AM

this is great! thank you so much, LQ! i dont contract infections very easily- maybe one or two colds each year. i do have MS. never any idea if thats related to something or not. its such a weird disease. this is very helpful though. this kind of answer is exactly what i love(ed) about paleohacks. i appreciate it. -amanda

A1774fb1fcb6c7a072a5e424544ef62e

(255)

on January 02, 2012
at 06:02 AM

I'm glad that this was of some help! Wishing you all the best :D

2
Fe29f6658ce67c1ecc4a22e960be7498

(2997)

on May 27, 2011
at 10:22 PM

I'm a guy, and have been right at the low end (or below it) for 'normal' iron. At first I was officially in anemic territory, and spent several years trying iron supplements, getting tests - even a colonoscopy in case there was internal bleeding. Then later I heard that my iron was "on the low side of normal" - but have always suspected that my numbers stayed the same and some committee simply changed the standard!

Since my iron never seemed to change much no matter what I did, we pretty much decided this was "normal" for me, and to drop it. I've always been on the sleepy/tired/pale end of the spectrum, but suspect that's more SAD related than iron related.

So perhaps your level is simply 'normal' for you??

Interesting comment about your heritage - I just signed up for a genetic test here (I'll share my experience later) - and am curious if there's a link to some kind of genetic blood iron level in my family tree.

Edited to add: I'm not convinced by the "in & out" explanations, at least for me. My numbers were so stable that if it was about inputs (cacao, meat, supplements, I was a vegetarian for a while then not) and absorption (leaky gut, HCL levels, etc) and outputs then the levels would go up and down as those causes changed. But in my case they stayed level all the way through, which implied some kind of set point. THAT SAID, my weight always seemed to be the result of a 'set point' beyond my control, and it's changing so perhaps my iron can too.

Fe29f6658ce67c1ecc4a22e960be7498

(2997)

on May 27, 2011
at 10:58 PM

Well I'm going to eat (some of) my words: I *just* had my latest blood test faxed over for a different issue (thyroid) - and I'm STILL FREAKING ANEMIC. Sheesh I think the doctors either get tired of people who 'insist' on not getting better - or perhaps they don't worry about the 'abnormal' column unless it's way off?? RBC=3.9, HEMO=13.0, HEMAT=38.1, MPV=6.1. Why didn't the doctor mention it on the phone?? Shit! OK maybe this is "normal for me" and I should just follow my own damn advice :-)

Aead76beb5fc7b762a6b4ddc234f6051

(15239)

on May 27, 2011
at 11:48 PM

ah well! 13 is not really that bad. its just slightly under the cut off, so maybe youre right about the set point. thanks so much for updating though. does your doc want you on supplements?

Aead76beb5fc7b762a6b4ddc234f6051

(15239)

on May 27, 2011
at 10:43 PM

awesome post. thank you. my iron is low, but does not vary a whole lot, so that might be right. when i was pregnant and had anemia, i took supplements and they made me feel like a million bucks, but when im NOT pregnant i dont notice a big difference in how i feel when im on them. and you know i ordered that 23andme test when they were having a big sale over xmas and still have not done it! i really need to get on that. its SUCH a cool thing. my friend did it and LOVED it. she still gets updates to her profile as they develop new tests. neato.

Fe29f6658ce67c1ecc4a22e960be7498

(2997)

on June 02, 2011
at 06:35 PM

The doc didn't even mention it when she called back, just a raised eyebrow over my cholesterol (typical 'paleo' numbers). But I did have a thyroid issue come up during the checkup, and the endocrinologist didn't even glance at the 'anemia' numbers but is instead talking about *surgery*. Pffft.

2
149b995e86368f21dfa912f88dbaf12d

on May 27, 2011
at 08:35 PM

I do have thalassemia and even my iron is higher than that, especially since going paleo and the foods you listed are quite good. Did your doctor ever insist on taking your iron supplements with extra vitamin C (or prescribe FerranC)? If so, do you still supplement with vitamin C? Paleo suggests cutting back a lot on fruit which would have probably been your main source of extra supplementation.

Aead76beb5fc7b762a6b4ddc234f6051

(15239)

on May 27, 2011
at 09:19 PM

wow heather. what is your hemoglobin, if you dont mind me asking? my doc recommended that i take supplements with OJ, and not within two hours of dairy or caffeine. im not on the iron now (i take slowFE when i do) but i had been taking it at night on an empty stomach before bed with a glass of emergen-c to aid absorption.

D7b01bbfd0b91a12c4aea43fb20adf15

(574)

on November 09, 2011
at 09:51 AM

which type of thalassemia do you have heather? I have beta thalassemia minor..

1
06d21b99c58283ce575e36c4ecd4a458

(9948)

on May 29, 2011
at 02:06 AM

Ran across this posting by JP Fanton re: anemia

http://www.healthyfellow.com/309/lactoferrin-and-anemia/

Perhaps some help there.

And this on riboflavin b 2.

In a randomized study involving 119 moderately riboflavin-deficient women [erythrocyte glutathione reductase activation coefficient > 1.40], between the ages of 19 and 25 years, living in the United Kingdom, daily supplementation with riboflavin (2 mg or 4 mg) for a period of 8 weeks was found to be associated with an increase in hemoglobin status. Women whose riboflavin levels were the lowest at baseline (EGRAC > 1.65) were found to have the greatest increase in hemoglobin status as a result of riboflavin supplementation. No changes in iron intake or absorption were made during the study. The authors state, "Moderately poor riboflavin status can affect iron status: the lower the riboflavin status, the greater the hematologic benefits of improving status. The results also suggest that consideration should be given to raising the currently accepted EGRAC threshold for deficiency."

http://www.vitasearch.com/get-clp-summary/39743

Aead76beb5fc7b762a6b4ddc234f6051

(15239)

on May 29, 2011
at 09:57 PM

very interesting! thanks, dexter!

1
1f8384be58052b6b96f476e475abdc74

(2231)

on May 28, 2011
at 02:34 AM

bee pollen for what its worth

Aead76beb5fc7b762a6b4ddc234f6051

(15239)

on May 28, 2011
at 02:46 AM

why? is it high in iron? aids in absorption? helps repair the gut? or works in some other mechanism?

1
Ed983a42344945b1ff70fd9597a23493

on May 27, 2011
at 09:50 PM

Absorption would be the first place I would look. Anemia is often caused by low hcl, which prevents your body from breaking down proteins to get minerals from them. I would look into supplementing hcl and see if that helps.

77877f762c40637911396daa19b53094

(78467)

on May 28, 2011
at 03:06 AM

does that mean that taking Betaine would be good for iron absorption if you have low hcl?

Aead76beb5fc7b762a6b4ddc234f6051

(15239)

on May 27, 2011
at 10:39 PM

interesting! thank you!

Ed983a42344945b1ff70fd9597a23493

on May 28, 2011
at 06:59 PM

If the problem is lack of digestion (which it usually is), rather than not ingesting enough iron, then, yes, hcl supplementation should help boost blood iron levels.

1
F1b39d4f620876330312f4925bd51900

(4090)

on May 27, 2011
at 09:09 PM

I am still highly anaemic even with paleo. No doubt i have absorption issues due to leaky gut however, my functional medicine doctor thinks it might be mineral loss during my heavy periods. (I am also low in other minerals stolen by menses).Iron supplements of every single kind make me super sick. She is having me take Yellow Dock. It supposed to aid in Iron Absorption. I just had a second blood test tuesday, so I will find out if the last month of yellow dock has worked.

Aead76beb5fc7b762a6b4ddc234f6051

(15239)

on May 27, 2011
at 09:17 PM

yes! please let me know how your results are! prior to pregnancy, i always thought my anemia was d/t my heavy periods, but ive had mirena IUD in for the past 15 months and have not had a period in a year. im luckily someone who does not get sick from the iron supplements- i hear they makae most people pretty ill! ill look into the yellow dock. thanks so much!

F1b39d4f620876330312f4925bd51900

(4090)

on June 14, 2011
at 10:38 PM

I haven't forgotten you! I finally got ahold of my blood results. Not only did the Yellow Dock not work, the anaemia is even worse! Ah well, it was worth a try.

1
1da74185531d6d4c7182fb9ee417f97f

on May 27, 2011
at 08:43 PM

Have you ever read about Gut and psychology Syndrome? There's a theory that anaemia is caused by iron loving bacteria an taking supplements can actually feed them so they become even stronger. It's an interesting read and the diet is very paleo adaptable. It will seal your gut and change your gut flora composition.

Aead76beb5fc7b762a6b4ddc234f6051

(15239)

on May 27, 2011
at 09:17 PM

i have not read that book, but its been on my list. im actually not taking supplements now, and only have done so with any regularity when i was pregnant which was a while ago. thanks!

1
Medium avatar

on May 27, 2011
at 08:31 PM

Copper deficiency can result in anemia. Do you eat liver?

Additionally, I doubt that the "advertised" quantities of iron in greens are bioavailable to the same extent that iron in meat is.

Medium avatar

(39831)

on May 27, 2011
at 10:04 PM

Yeah, I have read that people increase their hemoglobin to a greater extent simply by supplementing vitamin C, without iron. Eating a couple red bell peppers per day would greatly increase your vitamin C intake without increasing fructose.

1da74185531d6d4c7182fb9ee417f97f

(10904)

on May 29, 2011
at 02:00 PM

Liver pate is really easy to make. You can find recipes all over the net.

Aead76beb5fc7b762a6b4ddc234f6051

(15239)

on May 27, 2011
at 09:21 PM

i dont eat very much liver. i cant stand the taste of it, but i am trying to find more ways to work it into my diet. i do love liverwurst, but the stuff without additives is kind of out of my price range right now. i realize that greens dont have as much iron as meat does, but the C in them aids in absorption and they do contain some iron, and i like them lots.

Aead76beb5fc7b762a6b4ddc234f6051

(15239)

on May 27, 2011
at 10:43 PM

i read a recipe that had ground liver in meatloaf. that might be a good place for me to start!

06d21b99c58283ce575e36c4ecd4a458

(9948)

on May 27, 2011
at 09:54 PM

Live doesn't have to taste bad. I hated it until someone said I was over cooking it in a frypan. Now I use coconut oil and heat with a couple of bay leaves in it, then discard the leaves, and add rosemary leaves, dried thyme and garlic salt and let those flavors course though the coconut oil, then I add butter and cook the beef liver to just medium rare and now I like it. It used to taste like bad rough shoe leather when it was overcooked.

1
3e3b1b75cb414c5c3dbed53e3c42edfa

(220)

on May 27, 2011
at 08:14 PM

Maybe you are having digestion/absorption issues? Are you gluten free? Any gas/bloating/constipation/diarrhea? Have you had your thyroid and adrenals checked? I was hypothyroid with a TSH of 2.34 which is subclinical and had low cortisol as measured via a saliva test. I started taking Armour thyroid and feel like I'm absorbing iron better. We'll see the next time I get my labs back.

Aead76beb5fc7b762a6b4ddc234f6051

(15239)

on May 27, 2011
at 08:31 PM

yes to GF, thought im not super crazy about trace amounts or anything. no to the GI issues, at least not chronically. I had my thyroid tested at the same time (just the normal annual workup) and everything came back in the normal range, but i dont know the exact numbers.

Aead76beb5fc7b762a6b4ddc234f6051

(15239)

on May 27, 2011
at 08:31 PM

thank you for your answer! maybe ill be going back to look at the numbers more closely- i know even if thyroid is low-normal, it can still cause some symptoms...

13c5a9f1678d75b93f269cdcf69f14d5

(2339)

on May 28, 2011
at 02:06 AM

THe trace amounts could be part of the problem. How's your vitamin d? Did you ever consider eating for celiac? Tis post has a checklist for who should consider testing http://www.celiac.com/gluten-free/topic/73755-i-really-need-help-badly/

13c5a9f1678d75b93f269cdcf69f14d5

(2339)

on May 28, 2011
at 02:09 AM

J Clin Gastroenterol. 2002 Sep;35(3):228-33. A controlled, prospective screening study of celiac disease presenting as iron deficiency anemia. Ransford RA, Hayes M, Palmer M, Hall MJ. Source Department of Gastroenterology, County Hospital, Union Walk, Hereford, UK. [email protected] Abstract BACKGROUND: anemia is the most frequent presenting feature of celiac disease in adults using endomysial antibody (EmA) screening. Endomysial antibody screening of anemia may allow detection of celiac disease at an earlier stage of investigation and after a shorter duration of symptoms.

0
06d21b99c58283ce575e36c4ecd4a458

(9948)

on May 27, 2011
at 10:04 PM

Cacao is high in iron. I have read that The Quilt eats a pound to 1.5 pounds of raw chocolate a week. Either power or nibs.

http://foodhighiniron.blogspot.com/2011/05/navitas-naturals-organic-raw-chocolate.html?amp&amp

06d21b99c58283ce575e36c4ecd4a458

(9948)

on May 28, 2011
at 05:20 AM

Ask him on Facebook. Jack Kruse

06d21b99c58283ce575e36c4ecd4a458

(9948)

on May 28, 2011
at 02:50 AM

That I do not know.

Aead76beb5fc7b762a6b4ddc234f6051

(15239)

on May 28, 2011
at 12:17 AM

does he eat it for the iron? or so he can tell people about it?

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