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Last updated January 1, 2014

Iron: Too Much or Too Little Can Cause All-Too-Familiar Problems

©2000 Melissa Kaplan

An article on iron deficiency and overload may seem like a funny one for a newsletter on chronic neuroimmune disorders (CND), but the fact is that both iron deficiency and overload can cause symptoms all to familiar to most of us: fatigue, memory problems, and more.

As part of the overall review my body's systems were being given this past year, my doctor identified a lot of things that weren't necessarily related to my CND - very low testosterone, excessively high estrogen, low DHEA, and uncomfortably high levels of mercury. I felt better after taking testosterone, something else to reduce my estrogen. I'm taking as much DHEA as I can without causing problems, and am going through mercury detox. But the unchanged fatigue was still a concern. The doctor knew that the iron testing normally done as part of a basic blood chemistry panel wasn't sufficient to detect certain iron deficiencies, and he had read an article relating these undetected deficiencies to fibromyalgia. So, even though the iron test I had has part of the chem panel showed I was okay as far as my iron went, he ordered a different test. And it turns out I am deficient.

I began eating animal protein a couple of years ago and switched to using cast iron skillets within the past year, but apparently they weren't enough to give me the iron I need. So I started taking iron supplements, staring with a 65 mg tablet, but quickly cut it down to a half, then a quarter. Let's just say, without getting to graphic, that severe nausea as a side effect would be preferable to the ones I was getting. So I stopped. (Okay, that was bad, but I have enough trouble getting through the day without making myself sicker!)

During this past month, I talked to one of our members who has a problem with iron overload - hemochromatosis. She knew little about it since, as a Kaiser member, they haven't done much for her other than to scare her ("well, there's nothing we can do until your organs fail" or some such nonsense&ldots;apparently it will take more than one $1 million dollar wrongful-death lawsuit to get them to understand that it make better business sense to properly diagnose and treat rather than not). In doing a little research for her, I found that there was indeed things that can be done&ldots;and that started me doing a little research on my behalf, to see if there was some other form of supplement I could take, or what I could do with food that would increase my iron intake and uptake. Both those research paths lead to this article. Much of the information here comes from, Tufts Nutrition Newsletter, and the Iron Overload Disease Assocation.


As part of the hemoglobin in red blood cells, iron transports oxygen from your lungs to every cell in your body which is why shortness of breath and overwhelming tiredness are two of the primary symptoms of iron-deficiency anemia. Too much iron can be just as bad as too little, as bacteria and cancer cells thrive in an iron-rich environment, reproducing fast and furiously. Too much iron causes free radicals to form, which have been linked to everything from cancer to heart disease to aging.

Iron Deficiency and Anemia
Two billion people around the world, mostly children and women of childbearing age, suffer from iron-deficiency anemia. Millions more suffer from lesser degrees of iron deficiency. In the United States, up to 6 percent of menstruating girls and women are anemic, and up to 11 percent are iron deficient.

Although the risks of anemia are well known, the impact of more marginal iron deficiency is less well-studied. Growing evidence, however, shows that even a minor depletion of iron stores can have a significant effect on health and well-being. "You don't have to be frankly anemic to manifest some of the early signs of iron deficiency," says Henry Lukaski, Ph.D., of the United States Department of Agriculture's Human Nutrition Research Center in Grand Forks, North Dakota.

Even marginal iron deficiency can impair memory and mental functioning. Studies have shown that iron-deficient young women score lower on tests of short-term memory, attention span and verbal learning than those with healthy iron stores. Although these effects are less obvious than the pallor and exhaustion of anemia, they are no less devastating, particularly in children and young adults who are still in school. In those already suffering from chronic debilitating illness, especially those in which fatigue and cognitive problems are impaired, iron deficiency symptoms may be contributing to the degree of impairment. Symptoms of iron deficiency include:

Paleness, especially in the hands and lining of the lower eyelids
Tiredness and weakness
Tongue inflammation
Rapid heartbeat
Appetite loss
Abdominal discomfort
Susceptibility to infection
Unusual quietness or withdrawal in a child
Cravings for ice, paint or dirt (pica)

Detecting iron deficiency can be difficult, as the symptoms are so vague and can be caused by several different conditions. Accurate diagnosis requires several laboratory tests, to measure not only the iron in circulation but also the iron in storage. Three of the most useful measures are:

Serum hemoglobin: A test of the body's iron-rich red blood cells. Although low hemoglobin is a clear sign of deficiency, a normal hemoglobin can be deceptive, since hemoglobin can be normal even when iron stores are not.

Serum ferritin: A measure of the body's iron stores. Serum ferritin values are one of the first laboratory measures to show a change when iron stores are depleted.

Transferrin saturation ratio: Transferrin is a protein that "transfers" iron from one place to another in the body. It's one of the most reliable indicators of the body's iron stores.

In general, iron deficiency (and even mild anemia) is best treated with an iron-rich diet. When iron supplements are needed, it is usually a short-term treatment.


Iron Overload (Hemochromatosis)
Worldwide, some 24 million whites of northern European ancestry suffer from a genetic disorder called hemochromatosis. Another 600 million carry one of the genes responsible for the disorder, and absorb up to 50 percent more iron than non-carriers.

People with hemochromatosis absorb three to four times more iron from food than normal, leading to an overload of iron, particularly in the liver and other storage organs. When this excess iron interacts with oxygen in the body, it produces the free radicals which damage cells and eventually lead to organ failure (like cirrhosis of the liver), heart attack, cancer and pancreatic damage.

Until recently it was thought that women were unlikely to have hemochromatosis, since men are five times more likely to show symptoms of the disorder. Scientists now believe that women are equally at risk, but the blood loss of menstruation and childbirth temporarily protects women of child-bearing age from the effects of excess iron absorption. After menopause, though, women with the disorder show symptoms at the same rate as men.

The symptoms of hemochromatosis tend to manifest themselves in middle age, because it takes time for the iron buildup to cause problems. Hemochromatosis can mimic many other ailments - including iron deficiency. The most universal symptoms include the following:

Arthritic aches and pains, including swelling and tenderness around the joints
Heart arrhythmias ("skipping beats")
Changes in skin pigment - most notably development of a bronze tone - that occur even without sun exposure and that don't fade with time
Impotence or loss of interest in sex
Late-onset diabetes (some 10 percent of diabetics may actually be suffering from iron-induced pancreatic damage)
Missed periods or premature menopause

Hemochromatosis is fairly benign if caught and treated early. Diagnosis can be difficult, however, as the symptoms of hemochromatosis are common across a wide range of disorders. The gene responsible for the condition was recently identified, and a genetic test should be available soon. Until then, the only way to diagnose iron overload is to evaluate the amount of iron in storage (by measuring serum ferritin) and how much is en route to the cells (through a transferrin saturation test). Any physician can perform these tests.

Screening for iron overload is not usually done unless the doctor suspects an iron overload problem. Researchers at Rochester General Hospital in New York State, who recently tested 16,000 people for the condition, believe that it should be routinely checked for. "At the very least, all white people should be screened with a blood test, once, in their twenties or thirties," said their lead investigator, Pradyumna Phatak, MD.

The Centers for Disease Control and Prevention (CDC) disagree, recommending that only high-risk groups, such as immediate family members of people who have hemochromatosis or those with early symptoms of the disease, get tested. (Perhaps the funding for iron research was also diverted to more important things like the CDC's travel budget or measles research or something&ldots;abnormal iron levels, after all, only affect child development, ability of an adult to work productively, and causes cancer, organ failure, and serious neurological disorders, and occurs in as many as one in every 200 people, making it more common than other diseases such as cystic fibrosis, Huntington's disease, and muscular dystrophy.)

Those in favor of widespread screening argue that it's a powerful way to save lives. "If you catch it early enough, your life expectancy is completely normal, because treatment for hemochromatosis is so easy and effective," says Dr. Phatak. "But if you let it go, the consequences could be severe: cirrhosis of the liver, heart damage, diabetes, impotence, even degenerative arthritis." Hemochromatosis throws off iron metabolism in such a way that the body absorbs too much of the mineral from foods. Since there's no way to for the body to naturally flush out the excess, iron floods the system, depositing itself in organs like the liver, heart, joints, and pancreas.

In its early stages, when people are in their 20s and 30s, the condition is often easily ignored - or mistaken for other illnesses - because the symptoms, such as fatigue or aches and pains in the joints, are so vague. But if the disease progresses unchecked, by the time someone reaches his or her 40s or 50s, the growing iron deposits damage and eventually destroy surrounding tissues, leading to organ failure and chronic disease. The blood test used in the Rochester study, called the transferrin saturation test, costs only about $15. "Given that the disease is so avoidable, and the consequences are potentially so tragic, I think that $15 for hemochromatosis screening is a good investment, even if you have to pay for the test yourself," says James C. Fleet, PhD, an iron expert at the University of North Carolina at Greensboro.

Fortunately, treatment for iron overload is simple: blood-letting, or phlebotomy, to help rid the body of excess iron and thereby stop any tissue damage in progress. Because iron is found in red blood cells, the blood contains a large portion of the body's stores. Blood is drawn frequently - about one pint a week until iron storage levels are reduced to normal and then three or four times yearly thereafter.

For more information on iron-related diseases, contact the following organizations or check out these websites:

Anemia Institute for Research & Education (AIRE)
151 Bloor Street West, Suite 600
Toronto, Ontario M5S 1S4

Australian Iron Status Advisory Panel
PO Box 2126, East St.Kilda, Vic 3182, Australia
Fax: +612 362 3744

Hemochromatosis Foundation
P.O. Box 8569
Albany, NY 12208-0569
518-489-0972 fax: 518-489-0027

Iron Overload Diseases Association, Inc.
433 Westwind Drive
North Palm Beach, FL 33408
Telephones: 561-840-8512, 561-840-8513; Fax: 561-842-9881

Anemia: An Approach to Diagnosis
Thomas G. DeLoughery, MD

Iron, Anemia and Hypothyroidism: A double-edged sword for anemic thyroid patients

Response of serum transferrin receptor to iron supplementation in iron-depleted, nonanemic women
YI Zhu and JD Haas, Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA.
American Journal of Clinical Nutrition, Vol 67, 271-275

Serum transferrin receptor (sTfR) concentration has been recognized recently as a reliable indicator of functional iron deficiency, but its response to iron supplementation has not been investigated in marginally iron-deficient women. In this randomized, double-blinded trial, 37 female subjects aged 19-35 y with iron depletion without anemia (hemoglobin > 120 g/L and serum ferritin < 16 microg/L) received an iron supplement or placebo for 8 wk. Iron status was measured before treatment, after 4 wk of treatment, and posttreatment (ie, after 8 wk of treatment). Iron supplementation of these iron-depleted, nonanemic women resulted in a progressive and significant decrease in sTfR and a significant increase in serum ferritin, and prevented a fall in hemoglobin. The responsiveness of sTfR to iron treatment indicated that sTfR is a sensitive indicator of marginal iron deficiency in iron- depleted, nonanemic women, even when their body iron stores were being replenished.




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