Too Much Iron

Symptoms of fatigue are often thought to be from too little iron in the body.  But, fatigue may also indicate too much iron in the body. Iron is brought into the body from the small intestine. In the blood stream the iron is transported to be used for making our red cells and to perform other functions in the body.  Usually, all we need is a milligram a day, a very small amount. We often eat foods high in iron including raisins and red meat, fortified cereals and vitamins.  Wine, both red and white, is also fairly high in iron.

The healthy body will only take up 10% of the iron eaten. In certain people, the body absorbs up to 20% of the iron eaten.  Overdosing on iron either from absorbing too much or eating too much iron can cause many health problems.   The body stores most of the excess iron in the liver.  When the liver is full then the liver starts making storage chemical containers for the iron.  One of these storage containers is called ferritin: protein plus iron.  Ferritin can sit undisturbed floating in the cells of the body.  When there is a large amount of ferritin, it forms globs of a substance called hemosiderin. This is not a friendly concoction. It causes hemochromatosis, the disease of iron overload.

Too much ferritin and hemosiderin make the cells of the liver, heart, pancreas, pituitary gland, intestines and adrenal glands to become brittle and fragile and inflamed.   Sometimes the inflammation is enough to cause cancer of the liver.   It is not known whether diabetes is cause or effect of too much iron absorption.  I suspect that there is an interaction in which one makes the other worse.  When heart muscle has to store the iron in these packages it becomes weak and can even quit working.  In those past puberty, loss of underarm hair can be a sign of iron overload. 

While many may carry a gene that could cause the body to absorb much more iron than is needed, most have no disease consequences.  However, for some, two recessive inherited codes cause the disease to become manifest.  The marker is on Chromosome 6.  Inflammation of the small intestine and /or pancreas, from infection, alcohol, or other diseases may make the body absorb even more iron.  The excess iron stores deposited in the hormone producing cells of the intestine and pancreas again cause more inflammation and more absorption of iron.   In those who are under siege from iron, taking high dose Vitamin C can make matters even worse.  Vitamin C encourages the absorption of iron.  

Though hemochromatosis is not considered a common disease, it is found locally.  Further, there seems to be an increase, lately, in those diagnosed with hemochromatosis.  More men than women are affected by hemochromatosis.  It is thought that menstruation helps unload the iron and so the women are protected until menopause.  The ratio of men affected to women affected is 20 to 1.  Adult men and menopausal women should avoid iron-fortified vitamins to reduce the risk of hemochromatosis.

When a state of hemochromatosis exists, immediate treatment is essential. Drawing off blood, sometimes twice weekly for a while, helps unload the excess iron. Phosphates (soda), and acid reducers such as Zantac, and Pepcid can help reduce the absorption of iron.  Sometimes a chelating chemical that will bind the iron is needed.  Monitoring the ferritin level and iron level in the body will help mark the success in these interventions.

A recent medical review article wondered if all children should be screened for this illness.  The cost benefit did not seem to be there.  However, for those at risk or with signs of hemochromatosis, certain blood tests and other diagnostic tests could be of help.

For those who have been diagnosed with hemochromatosis it is appropriate and needed to test related family members.  Dr. Carol Blanc, MD (Gettysburg Pediatrics) is a pediatric genetic specialist who is a great resource.  Her office phone number is 1-717-334-7681.