The first nutritional “fact” most Americans learn is that iron builds strong and healthy bodies.1 The beef lobby, cereal manufacturers, bread makers, and drug companies have bombarded the public with iron being the cure-all for fatigue and “iron-poor blood.” People have been mislead by drug companies pushing iron supplements and by old-fashioned ideas about iron, the magical nutrient of strength. Even the cartoons of the past pushed iron as the secret ingredient in Popeye’s spinach.
Television advertisements used to urge people to “perk” up their “tired” blood with a liquid iron supplement called Geritol, but the Geritol ad was illegal. The Federal Trade Commission began an ineffective seventeen year battle with J.B. Williams Company, the original makers of Geritol, in 1959. In 1965, the company was ordered to stop airing its fraudulent ads. Americans saw the advertisements for six years before the stop order was given. By that time, there had been much damage to lots of people.
The company continued to broadcast ads that stated that Geritol could make you feel better, improve your sex life, and marriage. Five out of eight of its new ads showed the transformation of a tired worn-out housewife into a “tigress.”
In 1970, the Justice Department filed a $1,000,000 suit against the J.B. Williams Company, charging that they did not stop their deceptive advertising as ordered by the Federal Trade Commission. In 1973 a judge gave J.B. Williams Company a total of $812,000 in fines. This was the largest ever for a Federal Trade Commission violation.2
Even today breakfast cereals are fortified with 25 – 200% of Federal Drug Administration’s recommended daily intake of iron. Iron is also added to multivitamins, pastas, breads, and other processed food. Iron supplements are meant to prevent anemia, a condition in which blood is not able to carry the required amount of oxygen.3 Only two to six percent, mainly women and children, ever develop anemia.
Human body contains about 2 to 5 grams of iron. Sixty to seventy-five percent of the iron is present in the form of hemoglobin. The center of the hemoglobin molecule is iron. Hemoglobin is found in the circulating red blood cells. Each red blood cell lasts about 120 days. Specialized scavenger cells in the liver, spleen, and bone marrow take up the old red blood cells and recycles the iron, fat, and protein.
Iron is treated as “gold” by the blood. This careful recycling of iron means that our daily requirement of iron from food is quite small. The human body loses about 1 milligram of iron a day in the form of sweat, urine, and the natural sloughing of cells in the intestinal wall, hair, skin, and nails. Premenopausal women do not need more than one-half of a MacDonald’s hamburger or a small bowl of Kellogg’s corn flakes to prevent anemia.
The iron stores are like water in a camel’s hump. The human body can draw from them at any time. Most humans could live for long periods of time without iron from the diet. Premenopausal women, that lose 1.6 milligrams of iron per day, could last for three to seven months without depleting their iron stores of 200 – 300 milligrams of iron. Most men and postmenopausal women could go on without iron for two or more years. This assumes an average daily iron loss of one milligram and iron stores of at least 600 milligrams.
The iron is transported and stored until needed. The extra amounts of iron are stored in the protein ferritin that is found inside the cells. In a normal person, the small intestines only absorb iron from food when the iron stores are low. If the body really becomes iron deficient, more iron is absorbed from food. As the body’s stores of iron increase, the absorption of iron by the intestinal walls decreases.4
Some research shows that the intestinal cells do not have a way to decrease the percentage of meat iron absorbed from food when the iron stores are sufficient. The iron sneaks in because it is chemically attached to the heme in red meat. Only two to ten percent of the iron from fruits, vegetable, and grains is absorbed. Several studies show that vegetarians have lower iron stores than people who have large amounts of red meat in their diet. Phytic acid found in whole grains, binds to iron preventing it from being absorbed.
People need to be concerned about excess iron in the diet. In the last five years, thirty-four children have died from eating iron pills. One hundred sixty others were severely ill. Iron is also deadly to people who have hemochromatosis, an inherited disease.
About 1.25 million Americans have hemochromatosis that causes them to absorb and store too much iron. Hemochromatosis is a defective metabolism for iron. It is not a blood disease. The body cannot stop the intestines from absorbing excess iron from a regular diet. The main site for regulating iron absorption is in the cells of the duodenal mucosa.5 In a person with hemochromatosis, all the iron would be absorbed. The extra iron would be stored into various organs. Over time, this iron build-up would actually deteriorate a person’s organs causing death.
Below is a list of the most common places that the extra iron is stored. The list also includes the diseases the extra iron can cause:
Liver – cirrhosis and liver cancer.
Heart – enlarged heart that causes the body to retain salt and water that backs up into the lungs; sometimes produces congestive heart failure.
Pancreas – damage to insulin producing cells can cause diabetes.
Joints – Arthritis caused by the deposit of iron in the joints.
Pituitary Gland – damages the brain’s anterior gland that decreases the secretion of hormones needed for sexual function.
Hemochromatosis is the most common genetic disease among Caucasians. Many of these people are from a Celtic (Irish-Scotch) origin. Hemochromatosis is more common than Cystic Fibrosis and Down’s Syndrome. In a 1988 “New England Journal of Medicine” article, the results of an analysis of blood samples from 11,065 presumably normal donors showed that one out of every two hundred people had hemochromatosis.6 Cystic fibrosis has an occurrence of one in twenty-five hundred while hemochromatosis is one in two hundred. More people in the United States are affected by this disease than cystic fibrosis, Huntington’s Disease, and muscular dystrophy combined. One out of eight carry a single gene and one in two hundred carries both genes.
Many genes are involved in the genetics of hemochromatosis. It is known that the genes for ferritin are found on chromosome eleven and nineteen. The genes for transferrin are found on chromosomes three and nine. It is known that chromosome 6 is involved with hemochromatosis, but no details are known at this time.7
First recorded mention of the disease was in 1865 by a Frenchman, Trousseau. He thought the disorder was a triangle of diabetes, liver cirrhosis, and pigmented skin; His first patient was a twenty-eight-year-old man with severe diabetes. Trousseau wrote: “From the time his man came into the hospital, I was struck by the almost bronzed appearance of his countenance…” At autopsy the liver was found to be very large. “The entire surface of the organ was granular; it was of a uniform grayish-yellow color; it was very dense, resisting pressure so much as to prevent penetration by the finger. It creaked under the scalpel, and the surface of the cut was granular in place of smooth.”8 The hemochromatosis word was coined in 1889 by von Recklinghausen. In 1936 Joseph Sheldon wrote a famous article that discussed the disease as an inborn error of metabolism that resulted in multiple organ damage. He explained the disease as being genetic.
Common symptoms are lethargy, abdominal pain, impotence, menstrual irregularities, and inability to think clearly. Symptoms often do not appear until the fourth or fifth decade of life.9 The symptoms are so vague and the damage is so similar to that of other diseases of middle age, that many doctors fail to recognize hemochromatosis while the extra iron continues to wreck the body to the point where the damage is irreversible.10
Doctors often overlook hemochromatosis because blood tests reveal low iron when actually the body has a great deal of iron, not in the blood, but in the organs. With the tests in mind, many doctors suggest to their patients to take iron supplements. With this added iron, extra amounts go straight to the organs. Over time, this iron will begin to destroy the organs.
In 1988, the Iron Overload Diseases Association surveyed its members: 33% had consulted more than 11 doctors before getting the right diagnosis. In addition, 25% reported that they were slightly anemic.11 Anemia and iron deficiency are not the same thing. Iron deficiency is one of many causes of anemia12. Most people discover that they and others have hemochromatosis after a family member dies of it.
William Sartor as a physically active 42-year-old when he first complained of fatigue. When his blood sugar tested high, his doctor told him he was diabetic. As a result, he quit smoking and went on a diet. Two years later, he complained of joint pain. This time, another doctor diagnosed him as having arthritis and gave him cortisone pills. After a series of blood test, he learned that his liver enzymes were elevated and was told to stop drinking. Sartor did not drink.
Over the next six years, Sartor saw six doctors with complaints of indigestion and difficulty in swallowing. He as given ulcer medication and vitamin supplements with iron for his fatigue. His blood test continued to show high liver enzymes. He continued to grow weaker and eventually developed heart disease. Sartor died of congestive heart failure.
When an autopsy was completed, it revealed huge iron deposits in his pancreas and heart. The cirrhosis of his liver had been caused by large iron deposits. Sartor’s eldest son was tested and found to have the disease also. He is undergoing treatment to prevent the medical problems that his father had the last years of his life.13
In 1990, a study of 167 cardiac patients showed that their iron stores were in the hemochromatosis range (500 milligrams or higher). Only eleven of 167 patient’s doctors or 6.6 percent had considered the connection between the heart disease and hemochromatosis.14
Testing for iron levels did not appear until 1925.15 These tests were for serum iron only. They were not much help, but better than nothing. Testing for Total Iron Binding Capacity (TIBC) did not appear until 1944 and testing for ferritin did not appear until 1956.16 The normal limits were set too high which meant that people that thought they were normal were actually at an unsafe level. If any of the symptoms are present, a doctor should run the following blood test:17
Serum Iron
Total Iron Binding Capacity
Percent Saturation
Serum Ferritin
This group of test cost from $75 to $100. The patient should request a copy of the results to make sure they are properly interpreted. The Serum Iron (SI) is divided by the Total Iron Binding Capacity (TIBC). The normal value should be 12% – 50%.18 The serum ferritin readings should be 5 to 150. If the test results are high, treatment needs to begin immediately. If the test results are low, the doctor needs to look for the following:
an internal blood loss like ulcers
a cancerous tumor
an infection.
Cancer cells and bacteria require iron for growth. These cells remove iron from the circulation and result in low saturation. At the same time ferritin (the storage iron) may increase greatly, indicating cancer or infection.
Some doctors do not want to test for hemochromatosis. Below are some of the statements doctors will say when a patient asks to be tested:19
“You don’t have iron overload.”
“You’re too young to have iron overload.”
“You are a premenopausal woman, so you don’t have it.”
“You are a woman and women don’t get iron overload.”
“Iron overload is rare, I’m sure that you don’t have it.”
“You don’t have any symptoms, so why should I test you?”
“I can’t test you for this disease as your insurance doesn’t cover the tests because the tests are not medically “indicated” in your case because you do not have any overt symptoms.”
“Don’t worry about iron overload, you don’t have it so I refuse to test you for it, besides iron is good for you!”
“You need to worry about being iron deficient more than you need to worry about being iron overloaded.”
If a patient runs into any of these comments, another doctor should be found that will run the blood test. No one can tell if a person has hemochromatosis without these blood tests. Twice as many people are iron overloaded as compared to those who are iron deficient. Men, women, and children of all ages can have hemochromatosis. Once many of the symptoms appear, the disease is in its advanced stages and damage to the body has been done.
If the blood tests indicate hemochromatosis, some doctors require a liver biopsy, which costs a lot, before beginning any treatment. In a liver biopsy, a sample of liver tissue is removed with a large needle and stained with Prussian Blue to reveal the iron.20 Additional information about the liver will be known, but it will not change the decision about the treatment. If stored iron was essential to for life and its removal was dangerous, this might make sense. Since stored iron is not essential for life and the removal from the body is not dangerous, this may lower the risk of heart attacks, cancer, and other diseases even in people without hemochromatosis.21 Some patients do not want the liver biopsy and treatment is not started because the doctor insists on the liver biopsy.
The logical treatment for hemochromatosis is phlebotomy, or bloodletting, but it was not thought of until the 1950’s. In 1951, Dr. William H. Crosby was refused permission to treat a patient with phlebotomy.22 In 1958 in a medical meeting, someone shouted “barbarism” during a discussion about the treatment.
The removal of a pint of blood gets rid of 200 milligrams of iron. The blood loss creates a mild anemia.23 The bone marrow cells respond by speeding up the production of red blood cells. In some cases, erthropoietin can be injected to boost red blood cell production.24 This treatment is expensive and not needed for most patients. The iron is removed from the storage sites in the liver and other overloaded tissues.
The doctor writes a prescription for phlebotomies good for a year. This is kept on file at a local blood bank. The patient keeps a copy of the prescription to use when traveling. In the beginning, a patient needs weekly or twice weekly phlebotomies. Before each treatment, the hemoglobin must be ten or the hematocrit must be thirty-five percent.
After the iron stores are depleted, the patient must go on a phlebotomy schedule for life. Most doctors experiment with two to six times a year for the first year. After that time, adjustments to the schedule are made.
A West German study determined that iron overload victims without any signs of cirrhosis of the liver could live a normal life time if phlebotomy was begun immediately.25 Even if the liver has cirrhosis, there was a seventy-five percent chance the patient could survive with treatment. The study also showed improvement in heart conditions, liver spots, and liver function. Diabetic conditions and arthritis improved in some patients.
People with hemochromatosis are not the only ones that need to take some precautions against iron overload. Following are some suggestions for all people to consider:
Know your iron level – reduce iron intake if test show iron stores of 150 or above
Eat less red meat – will reduce both cholesterol and iron
Monitor supplemental iron intake – switch to cereal and vitamins with no iron fortification; anemic patients should not stop taking supplements without consulting a physician and asking for test to check their iron stores
Give blood – can reduce ferritin to a safe level of under 50 in men and under 25 in women
Bibliography
1 Chazin Suzanne, “Is iron making you sick?” Reader’s Digest, October 1995: pp. 139-143
2 Hennessy, Tom, ironbk.html, [online]. Available: World Wide Web: http:// www.nucleus.com/, Directory: /watchman /, File: ironbk.html
3 Chazin Suzanne, “Is iron making you sick?” Reader’s Digest, October 1995: pp. 139-143
4 Hennessy, Tom, ironbk.html, [online]. Available: World Wide Web: http:// www.nucleus.com/, Directory: /watchman /, File: ironbk.html
5 Rouault Tracy. “Hereditary Hemochromatosis.” JAMA. June 23: 1993, pp. 3152-3154
6 Hennessy, Tom, ironbk.html, [online]. Available: World Wide Web: http:// www.nucleus.com/, Directory: /watchman /, File: ironbk.html
7 E. Beutler, “A strategy for cloning the hereditary hemochromatosis gene,” Blood cells, Molecules, and Diseases, November 15, 1995: pp. 207-216
8 OMIM Staff, “*235200,” [online]. Available: World Wide Web: http://www3.ncbi.nlm.nih.gov/, Directory: /Omim/, File: {inline}
9 Rouault Tracy. “Hereditary Hemochromatosis.” JAMA. June 23: 1993, pp. 3152-3154
10 Chazin Suzanne, “Is iron making you sick?” Reader’s Digest, October 1995: pp. 139-143
11 Matson Mandy, “Do you have iron overload?” Parade Magazine, Sunday, August 4, 1991: p. 8
12 Matson, Mandy. “Can too much iron kill you?” Women’s Day, May 16, 1995: p.86
13 Chazin Suzanne, “Is iron making you sick?” Reader’s Digest, October 1995: 139-143
14 Chazin Suzanne, “Is iron making you sick?” Reader’s Digest, October 1995: 139-143
15 Thomas, Sandra. (1995, December 30). Hemochromatosis [e-mail to KGMQ01A],[online]. Available
e-mail: [emailprotected]
16 Thomas, Sandra. (1995, December 30). Hemochromatosis [e-mail to KGMQ01A],[online]. Available
e-mail: [emailprotected]
17 Iron Overloaded Diseases, Hemochromatosis Fact Sheet, By Sandra Thomas. North Palm Beach, Florida: 1993
18Iron Overloaded Diseases, Hemochromatosis Fact Sheet, By Sandra Thomas. North Palm Beach, Florida: 1993
19 Thomas, Sandra. (1995, December 30). Hemochromatosis [e-mail to KGMQ01A],[online]. Available
e-mail: [emailprotected]
20 Rouault Tracy, “Hereditary Hemochromatosis,” JAMA. June 23: 1993, pp. 3152-3154
21 Sullivan Jerome, “Liver biopsy before treatment? No!” Ironic Blood, July 1995: pp. 1-2
22 OMIM Staff, “Hemochromatosis, Treatment to Alleviate Injury,” Arch Intern Med, Volume 146 – October 1986: pp. 1910-1911
23 Matson, Mandy. “Can too much iron kill you?” Women’s Day, May 16, 1995: p. 86
24 Sullivan Jerome, “Liver biopsy before treatment? No!” Ironic Blood, July 1995: pp. 1-2
25 Hennessy, Tom, ironbk.html, [online]. Available: World Wide Web: http:// www.nucleus.com/, Directory: /watchman /, File: ironbk.html
