Today, we explore the promise and the perils of iron — why too little (or too much) of it harms health. But first, a quote from Iron Man, speaking in the film Avengers: Earth’s Mightiest Heroes:

“J.A.R.V.I.S., make a note. Remind me not to wake up in the morning ever again.”

Iron Man is in for a rude awakening when a villain starts the day on the wrong side of the bed. And when Iron Man doesn’t get his beauty sleep, he’s not thrilled about it, either.

So, after finally defeating the villain of the week, Iron Man gets a little help from his artificial intelligence J.A.R.V.I.S. to make a note. There’s nothing better than a long night’s rest after saving the world again.

What is Iron?

Iron is an essential dietary mineral, one that is primarily used by our red blood cells (erythrocytes). Iron is central to hemoglobin, the substance that gives red blood cells their color. Hemoglobin delivers oxygen to all of the cells in our body.

The extraordinary French physiologist Claude Bernard elucidated the role of hemoglobin in the blood. He also originated the term milieu intérieur and the associated concept of homeostasis.

Hemoglobin is a word derived from heme plus globin. Each hemoglobin subunit is a globular protein with a heme group at its center. The heme group has one iron atom that can bind one oxygen molecule. Human hemoglobin has found such subunits.

Max Perutz, an Austrian-born British molecular biologist, shared the 1962 Nobel Prize for Chemistry with John Kendrew for their studies of the structures of hemoglobin and myoglobin.

Iron — Dietary types

There are two forms of dietary iron:

• Heme iron: Heme is found only in animal flesh like meat, seafood, and poultry. Heme iron is absorbed more easily than non-heme iron.
• Non-heme iron: Non-heme iron is found in plant foods like whole grains, nuts, seeds, legumes, and leafy greens. Non-heme iron is in animal flesh (given animals eat plant foods containing non-heme iron) and fortified foods.

Those who have too little dietary heme are at risk of iron deficiency. For example, vegetarians have a high risk of suffering from a deficiency of some nutrients, such as vitamin B12 and iron.

Women have a higher risk of being iron deficient. Did you know that iron deficiency is the world’s most common mineral deficiency?

In summary, iron is an essential dietary mineral that is critical to the transport of oxygen to all of our tissues. Certain populations, including vegetarians, women of childbearing age, and children five and younger, are at higher risk of iron deficiency.

Regulation of iron stores

Iron levels are closely regulated, as iron is an essential nutrient to many of our basic body functions. We need small amounts of the mineral for health. On the other hand, too much iron is potentially toxic.

Our body regulates iron levels by adjusting how much we absorb through our digestive tract. Hepcidin is an iron-regulating hormone that can suppress iron absorption.

When we have high levels of iron in storage, hepcidin levels rise, and iron absorption drops. On the other hand, if our iron stores are low, hepcidin levels decrease, and iron absorption increases.

Physiology, Hepcidin

Hepcidin is a peptide hormone produced in the liver that plays a crucial role in iron homeostasis. Iron is an essential…

www.ncbi.nlm.nih.gov.

Disorders that suppress hepcidin can lead to iron overload, while ones that stimulate hepcidin formation may cause iron deficiency.

In addition, our iron balance is influenced by how much iron is in our diet. If we chronically have a low iron intake, we may develop iron deficiency; too much dietary iron can lead to iron poisoning.

Iron deficiency

Our bodies need iron for several biological functions. We use iron to make hemoglobin and myoglobin. In addition, cell regulation and proliferation processes require iron, as does D.N.A. synthesis and electron transport in our cellular powerhouses, the mitochondria.

Nearly two-thirds of our iron is in the hemoglobin in our circulating red blood cells. We store the remaining third in our liver, bone marrow, spleen, and muscle tissue as ferritin. The iron is delivered, as needed, throughout the body via transferrin (a blood protein that binds to iron). A healthcare professional may evaluate blood levels of these two components if a low red blood cell count (anemia) is suspected.

A ferritin test measures your blood levels of ferritin, the blood protein containing iron. If your ferritin level is too low, it indicates that your iron stores are low and you have iron deficiency. You may have anemia because of this lack of sufficient iron.

On the other hand, if your blood levels of ferritin are higher than normal, you may have a condition that results in your body storing too much iron. Alternatively, you may have hyperthyroidism, liver disease, rheumatoid arthritis, or another inflammatory condition.

Sideropenia (iron deficiency) is a state in which total body iron stores are insufficient to support the body's metabolic activities.

It is easy to miss iron deficiency without anemia; the symptoms can be vague and easily missed. We clinicians must be vigilant when we suspect a chronic iron deficiency in a patient with normal blood counts but symptoms similar to anemia and low ferritin. Iron deficiency may be present, and we should ask about blood loss.

Here are some populations with a higher risk of suffering from iron deficiency:

• Individuals with cancer. Upwards of six out of ten individuals with colon cancer have iron deficiency at diagnosis, likely due to chronic blood loss. Approximately 30 to 45 percent of other cancer types will have iron deficiency. Primary causes are anemia of chronic disease and chemotherapy-induced anemia. Others suffer from chronic blood loss or nutritional deficits (for example, a cancer-induced lack of appetite).
• Frequent blood donors. In the United States, adults may give blood as often as every eight weeks, which can deplete iron stores. Approximately 25 to 35 percent of regular blood donors develop iron deficiency.
• Pregnant women.
• Infants and young children.
• Women with heavy menstrual periods. Women of reproductive age with abnormally heavy bleeding during menstrual periods are at increased risk of iron deficiency.
• Those with heart failure. About six in 10 patients with chronic heart failure have iron deficiency. Chronic iron deficiency is associated with increased early mortality for those with heart failure.
• Individuals with gastrointestinal disorders (such as ulcerative colitis, Crohn’s disease, or celiac disease) or gastrointestinal surgery have a higher risk of iron deficiency.
• Elderly — Those with poor nutrition or chronic inflammatory diseases can lead to anemia.
• Vegetarians — Individuals who have a diet without heme iron from meat, fish, or poultry may develop iron deficiency anemia if they don’t include adequate non-heme iron foods. Because non-heme iron is not well-absorbed, greater quantities of these foods may be needed, or attention given to how they are consumed to improve absorption (consuming vitamin C-rich foods while avoiding eating calcium-rich foods, calcium supplements, or tea).
• Endurance athletes — Running can cause trace amounts of gastrointestinal bleeding, leading to so-called “foot-strike” hemolysis that breaks down red blood cells faster. Female endurance athletes who are menstruating have the greatest risk for iron deficiency anemia.
• People with chronic kidney failure on dialysis

Untreated iron deficiency can lead to cognitive impairment, poor quality of life, fetal brain maturation problems, and low birth weight. Maternal problems can include depression, systemic infection (sepsis), and a higher risk of death.

Iron deficiency anemia can cause fatigue and weakness; gastrointestinal disturbances; impaired cognitive functioning; poorer immune function, impaired body temperature regulation, and exercise or work impairment.

Iron deficiency anemia can lead to psychomotor and cognitive abnormalities and (left untreated) learning difficulties in infants and children.

Iron deficiency treatment

Those with uncomplicated iron deficiency without other significant health problems should receive treatment with oral iron therapy. Oral iron is readily available, cheap, effective, safe, and convenient.

Gastrointestinal (GI) side effects can be reduced using chelated forms of iron. Enteric-coated tablets lead to poor absorption and are not viable options. Selected patients may need intravenous (through a vein) iron treatment.

Interactions with medicines

Iron can interact with certain medications, and some medications can lower iron levels. Here are some selected examples: Iron-containing dietary supplements may lower levels of levodopa (a treatment for Parkinson’s disease or restless leg syndrome).

Levothyroxine is used to treat thyroid cancer, hypothyroidism, and goiter. When taken at the same time as iron, the effectiveness of levothyroxine may drop in some patients. Some drug product labels advise against taking levothyroxine within four hours of iron supplementation.

Proton pump inhibitors (such as lansoprazole (Prevacid®) and omeprazole (Prilosec®)) can be associated with suboptimal responses to iron supplementation.

Fortunately, iron deficiency is typically easily managed, and an excellent prognosis for those with uncomplicated cases and no significant medical problems.

Too much iron

Adults with normal intestinal function have a very low probability of suffering from iron overload secondary to dietary sources. If you take high-dose iron supplements, you may get gastrointestinal side effects. These problems can include gastric upset, nausea and vomiting, constipation, abdominal pain, and diarrhea.

Taking iron with food may help minimize gastrointestinal toxicities. Some develop more serious problems, including gastritis. Gastritis is a general term for a group of conditions with one thing in common: Inflammation of the stomach lining.

Supplements with 25 milligrams (or more) of iron can reduce zinc absorption and blood zinc levels. Finally, acute intakes of over 20 milligrams per kilogram of iron (about 1,365 mg iron for someone weighing 150 pounds) can lead to fluid and blood loss, tissue damage, shock, and organ failure.

Poisoning can occur when people, typically young children, overdose on iron supplements.

Hemochromatosis, a disease caused by a mutation in the hemochromatosis (H.F.E.) gene, is linked to an excessive buildup of iron in the body. Without treatment by regular chelation or removing blood, those with hereditary hemochromatosis often develop signs of iron toxicity by their 30s.

If untreated, hemochromatosis can lead to liver cirrhosis, hepatocellular carcinoma, heart disease, and impaired pancreatic function. The American Association for the Study of Liver Diseases recommends that hemochromatosis management include avoiding iron and vitamin C supplements.

Iron — Recommended iron

As we discussed, meats, seafood, and poultry are rich in heme iron. Do you want non-heme iron? Try some nuts, seeds, vegetables, legumes, and fortified grains. Heme iron is absorbed better than non-heme iron.

Vitamin C and heme iron taken at the same mean can optimize non-heme iron absorption. On the other hand, bran fiber, large calcium intake (such as from supplements), and some plant substances such as phytates and tannins can inhibit non-heme iron absorption.

Here is a source for the recommended intake levels:

Office of Dietary Supplements – Iron

This fact sheet is for health professionals. For a reader-friendly overview of Iron, see our consumer fact…

ods.od.nih.gov.

The maximum daily intake (unlikely to cause harm) for iron is 45 milligrams daily for all males and females ages 14 years or older. For younger ages, the maximum is 40 milligrams.

Heme iron sources

The Harvard T.H. Chan School of Public Health offers these sources of dietary iron:

• Oysters, clams, mussels
• Beef or chicken liver
• Organ meats
• Canned sardines
• Beef
• Poultry
• Canned light tuna

Sources of non-heme iron:

• Fortified breakfast cereals
• Beans
• Dark chocolate (at least 45%)
• Lentils
• Spinach
• Potato with skin
• Nuts, seeds
• Enriched rice or bread

If you want more specifics on the amount of iron in given foods, please check out this nice overview:

Office of Dietary Supplements – Iron

This is a fact sheet intended for health professionals. For a reader-friendly overview of Iron, see our consumer fact…

ods.od.nih.gov

Iron can be dangerous in excess. Fortunately, unless you have an iron overload disorder, it is unlikely that dietary iron will hurt you.

On the other hand, please be careful with iron supplements — they benefit those with iron deficiency but may cause harm for those without iron deficiency. Avoid supplements unless a valued healthcare provider recommends them for you.

Finally, there is low-level evidence (in the form of observational trials) that a high intake of heme iron may increase colon cancer risk. The association between red meat and cancer is debatable. While some plausible mechanisms could explain this association, most of the evidence is based only on observational studies.

Thank you for joining me in this look at how too much iron (or too little) puts your health at risk.

The post How Too Much Iron (or Too Little) Puts Your Health at Risk appeared first on Medika Life.

What is iron-deficiency anemia?

Iron-deficiency anemia is the most common type of anemia, a condition that happens when your body does not make enough healthy red blood cells or the blood cells do not work correctly.

Iron-deficiency anemia happens when you don’t have enough iron in your body. Your body needs iron to make hemoglobin, the part of the red blood cell that carries oxygen through your blood to all parts of your body.

Who gets iron-deficiency anemia?

Iron-deficiency anemia affects more women than men. The risk of iron-deficiency anemia is highest for women who:

• Are pregnant. Iron-deficiency anemia affects one in six pregnant women. You need more iron during pregnancy to support your unborn baby’s development.
• Have heavy menstrual periods. Up to 5% of women of childbearing age develop iron-deficiency anemia because of heavy bleeding during their periods.

Infants, small children, and teens are also at high risk for iron-deficiency anemia. 

What are the symptoms of iron-deficiency anemia?

Iron-deficiency anemia often develops slowly. In the beginning, you may not have any symptoms, or they may be mild. As it gets worse, you may notice one or more of these symptoms:

• Fatigue (very common)
• Weakness (very common)
• Dizziness
• Headaches
• Low body temperature
• Pale or yellow “sallow” skin
• Rapid or irregular heartbeat
• Shortness of breath or chest pain, especially with physical activity
• Brittle nails
• Pica (unusual cravings for ice, very cold drinks, or non-food items like dirt or paper)

If you think you may have iron-deficiency anemia, talk to your doctor or nurse.

What causes iron-deficiency anemia?

Women can have low iron levels for several reasons:

• Iron lost through bleeding. Bleeding can cause you to lose more blood cells and iron than your body can replace. Women may have low iron levels from bleeding caused by:
  • Digestive system problems, such as ulcers, colon polyps, or colon cancer
  • Regular, long-term use of aspirin and other over-the-counter pain relievers
  • Donating blood too often or without enough time in between donations for your body to recover
  • Heavier or longer than normal menstrual periods
  • Uterine fibroids, which are noncancerous growths in the uterus that can cause heavy bleeding
• Increased need for iron during pregnancy. During pregnancy, your body needs more iron than normal to support your developing baby.
• Not eating enough food that contains iron. Your body absorbs the iron in animal-based foods, such as meat, chicken, and fish, two to three times better than the iron in plant-based foods. Vegetarians or vegans, who eat little or no animal-based foods, need to choose other good sources of iron to make sure they get enough. Your body also absorbs iron from plant-based foods better when you eat them with foods that have vitamin C, such as oranges and tomatoes. But most people in the United States get enough iron from food.
• Problems absorbing iron. Certain health conditions, such as Crohn’s disease or celiac disease, or gastric bypass surgery for weight loss can make it harder for your body to absorb iron from food.

How is iron-deficiency anemia diagnosed?

Talk to your doctor if you think you might have iron-deficiency anemia. Your doctor may:

• Ask you questions about your health history, including how regular or heavy your menstrual periods are. Your doctor may also ask you about any digestive system problems you may have, such as blood in your stool.
• Do a physical exam
• Talk to you about the foods you eat, the medicines you take, and your family health history
• Do blood tests. Your doctor will do a complete blood count (CBC). The CBC measures many parts of your blood. If the CBC test shows that you have anemia, your doctor will likely do another blood test to measure the iron levels in your blood and confirm that you have iron-deficiency anemia.  

If you have iron-deficiency anemia, your doctor may want to do other tests to find out what is causing it.

Do I need to be tested for iron-deficiency anemia?

Maybe. Talk to your doctor about getting tested as part of your regular health exam if you have heavy menstrual periods or a health problem such as Crohn’s disease or celiac disease.

How is iron-deficiency anemia treated?

Treatment for iron-deficiency anemia depends on the cause:

• Blood loss from a digestive system problem. If you have an ulcer, your doctor may give you antibiotics or other medicine to treat the ulcer. If your bleeding is caused by a polyp or cancerous tumor, you may need surgery to remove it. 
• Blood loss from heavy menstrual periods. Your doctor may give you hormonal birth control to help relieve heavy periods. If your heavy bleeding does not get better, your doctor may recommend surgery. Types of surgery to control heavy bleeding include endometrial ablation, which removes or destroys your uterine lining, and hysterectomy, which removes all or parts of your uterus.
• Increased need for iron. If you have problems absorbing iron or have lower iron levels but do not have severe anemia, your doctor may recommend:
  • Iron pills to build up your iron levels as quickly as possible. Do not take any iron pills without first talking to your doctor or nurse.
  • Eating more foods that contain iron. Good sources of iron include meat, fish, eggs, beans, peas, and fortified foods (look for cereals fortified with 100% of the daily value for iron).
  • Eating more foods with vitamin C. Vitamin C helps your body absorb iron. Good sources of vitamin C include oranges, broccoli, and tomatoes.

If you have severe bleeding or symptoms of chest pain or shortness of breath, your doctor may recommend iron or red blood cell transfusions. Transfusions are for severe iron deficiencies only and are much less common.

What do I need to know about iron pills?

Your doctor may recommend iron pills to help build up your iron levels. Do not take these pills without talking to your doctor or nurse first. Taking iron pills can cause side effects, including an upset stomach, constipation, and diarrhea. If taken as a liquid, iron supplements may stain your teeth.

You can reduce side effects from iron pills by taking these steps:

• Start with half of the recommended dose. Gradually increase to the full dose.
• Take iron in divided doses. For example, if you take two pills daily, take one in the morning with breakfast and the other after dinner.
• Take iron with food (especially something with vitamin C, such as a glass of orange juice, to help your body absorb the iron).
• If one type of iron pill causes side effects, ask your doctor for another type.
• If you take iron as a liquid instead of as a pill, aim it toward the back of your mouth. This will prevent the liquid from staining your teeth. You can also brush your teeth after taking the medicine to help prevent staining.

What can happen if iron-deficiency anemia is not treated?

If left untreated, iron-deficiency anemia can cause serious health problems. Having too little oxygen in the body can damage organs. With anemia, the heart must work harder to make up for the lack of red blood cells or hemoglobin. This extra work can harm the heart.

Iron-deficiency anemia can also cause problems during pregnancy.

How can I prevent iron-deficiency anemia?

You can help prevent iron-deficiency anemia with the following steps:

• Treat the cause of blood loss. Talk to your doctor if you have heavy menstrual periods or if you have digestive system problems, such as frequent diarrhea or blood in your stool.
• Eat foods with iron. Good sources of iron include lean meat and chicken, dark, leafy vegetables, and beans.
• Eat and drink foods that help your body absorb iron, like orange juice, strawberries, broccoli, or other fruits and vegetables with vitamin C.
• Make healthy food choices. Most people who make healthy, balanced food choices get the iron and vitamins their bodies need from the foods they eat.
• Avoid drinking coffee or tea with meals. These drinks make it harder for your body to absorb iron.
• Talk to your doctor if you take calcium pills. Calcium can make it harder for your body to absorb iron. If you have a hard time getting enough iron, talk to your doctor about the best way to also get enough calcium.

How much iron do I need every day?

The chart below lists how much iron you need every day. The recommended amounts are listed in milligrams (mg).

Source: Adapted from Institute of Medicine, Food and Nutrition Board

*Vegetarians need more iron from food than people who eat meat do. This is because the body can absorb iron from meat better than from plant-based foods.

What foods contain iron?

Food sources of iron include:

• Fortified breakfast cereals (18 milligrams per serving)
• Oysters (8 milligrams per 3-ounce serving)
• Canned white beans (8 milligrams per cup)
• Dark chocolate (7 milligrams per 3-ounce serving)
• Beef liver (5 milligrams per 3-ounce serving)
• Spinach (3 milligrams per ½ cup)
• Tofu, firm (3 milligrams per ½ cup)
• Kidney beans (2 milligrams per ½ cup)
• Canned tomatoes (2 milligrams per ½ cup)
• Lean beef (2 milligrams for a 3-ounce serving)
• Baked potato (2 milligrams for a medium potato)

Do I need more iron during pregnancy?

Yes. During pregnancy, your body needs more iron to support your growing baby. In fact, pregnant women need almost twice as much iron as women who are not pregnant do. Not getting enough iron during pregnancy raises your risk for premature birth or a low-birth-weight baby (less than 5 ½ pounds). Premature birth is the most common cause of infant death. Both premature birth and low birth weight raise your baby’s risk for health and developmental problems at birth and during childhood.

If you’re pregnant, talk to your doctor about these steps:

• Getting 27 milligrams of iron every day. Take a prenatal vitamin with iron every day, or talk to your doctor about taking an iron supplement (pill).
• Testing for iron-deficiency anemia
• Testing for iron-deficiency anemia four to six weeks after childbirth

Do I need more iron if I am breastfeeding?

No, you do not need more iron during breastfeeding. In fact, you need less iron than before you were pregnant. The amount of iron women need during breastfeeding is 10 milligrams per day for young mothers 14 to 18 and 9 milligrams per day for breastfeeding women older than 18.

You need less iron while breastfeeding because you likely will not lose a lot through your menstrual cycle. Many breastfeeding women do not have a period or may have only a light period. Also, if you got enough iron during pregnancy (27 milligrams a day), your breastmilk will supply enough iron for your baby.

Does menopausal hormone therapy affect how much iron I need to take?

It might. If you still get your period and take menopausal hormone therapy, you may need more iron than women who are postmenopausal and do not take menopausal hormone therapy. Talk to your doctor or nurse.

Does birth control affect my risk for iron-deficiency anemia?

It could. Hormonal birth control, such as the pill, the patch, the shot, or the hormonal intrauterine device (IUD), is often used to treat women with heavy menstrual periods. Lighter menstrual periods may reduce your risk for iron-deficiency anemia.

Also, the non-hormonal, copper IUD (Paragard) may make your menstrual flow heavier. This raises your risk for iron-deficiency anemia.

Talk to your doctor or nurse about your risk for anemia and whether hormonal birth control may help.

I am a vegetarian. How can I make sure I get enough iron?

You can help make sure you get enough iron by choosing foods that contain iron more often. Vegetarians need more iron from food than people who eat meat. This is because the body can absorb iron from meat better than from plant-based foods.

Vegetarian sources of iron include:

• Cereals and bread with added iron
• Lentils and beans
• Dark chocolate
• Dark green leafy vegetables, such as spinach and broccoli
• Tofu
• Chickpeas
• Canned tomatoes

Talk to your doctor or nurse about whether you get enough iron. Most people get enough iron from food.

Can I get more iron than my body needs?

Yes, your body can get too much iron. Extra iron can damage the liver, heart, and pancreas. Try to get no more than 45 milligrams of iron a day, unless your doctor prescribes more.

Some people get too much iron because of a condition called hemochromatosis that runs in families. You can also get too much iron from iron pills (if you also get iron from food) or from repeated blood transfusions.

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