Iron Overload or Hemochromatosis
As I discussed in the iron deficiency article, iron is a vital nutrient needed to support essential biological processes in the body.
Whereas iron is an essential mineral, it is super important for the body to systemically regulate iron homeostasis as excesses of it is potentially toxic and a risk factor for enhanced morbidity and mortality.
Since the body excretes very little iron, iron absorption is closely controlled particularly by the iron regulatory hormone hepcidin that blocks dietary iron absorption, promotes cellular iron sequestration and reduces iron bioavailability. Then, in a normal condition, when body iron stores are sufficient to meet requirements the body reduces iron absorption through the intestine to prevent levels from rising too far.
Hemochromatosis or iron overload is an iron storage disorder or deregulation of intestinal iron absorption from diet and other sources such as multivitamin supplements with iron that the body cannot excrete.
As always balance is needed then, overexposure to iron has evident consequences on health and disease states.
What happens is that the extra iron can gradually build up in the body’s tissues and organs, affecting particularly the liver, heart, pancreas, joints, and endocrine glands. Besides it, if left untreated iron accumulation may over time cause organ failure, and eventually be fatal.
Therefore, iron overload or excess iron storage affects about 35 million people worldwide. This number is significantly less common than iron deficiency but, still a lot misdiagnosed and usually not even tested by conventional physicians.
Hemochromatosis diagnosis is extremely simple, as is the treatment, but a late diagnosis can be fatal.
To make it simple to you understand below are listed the main facts about iron overload or hemochromatosis.
1 - The most commom causes of iron overload disorder are either primary or secondary:
1.1 – primary, or classic hemochromatosis are caused by:
. "inherited genetic defects, and mutations in the HFE gene (accounts for up to 80 percent of cases).
. the HFE gene helps regulate the amount of iron absorbed from food
. the two known mutations of HFE are C282Y and H63D
. the C282Y defects are the most common cause of primary hemochromatosis
. people inherit two copies of the HFE gene (one copy from each parent)
. most people who inherit two copies of the HFE gene with the C282Y defect will have higher-than-average iron absorption
. not all of these people will develop health problems associated with hemochromatosis
. 31 percent of people with two copies of the C282Y defect developed health problems by their early fifties
. men who develop health problems from HFE defects typically develop them after age 40
. women who develop health problems from HFE defects typically develop them after menopause
. people who inherit two H63D defects or one C282Y and one H63D defect may have higher-than-average iron absorption
. however, they are unlikely to develop iron overload and organ damage
. rare defects in other genes may also cause primary hemochromatosis
. mutations n the hemojuvelin or hepcidin genes cause juvenile hemochromatosis
. people with juvenile hemochromatosis typically develop severe iron overload and liver and heart damage between ages 15 and 30
1.2 – secondary hemochromatosis (when is not inherited)
. frequent blood transfusion in people with severe anemia
. sickle cell anemia
. excess iron supplementation
. chronic liver disease
. chronic hepatitis C infection
. alcoholic liver disease
. viral hepatitis
. G6PD (glucose-6-phosphate dehydrogenase)"
2 - The most at risk population to develop iron overload or hemochromatosis include:
. people with primary hemochromatosis that mainly affects Caucasians of Northern European ancestry
. about four to five out of every 1,000 Caucasians carry two copies of the C282Y mutation of the HFE gene
. about one out of every10 Caucasians carries one copy of C282Y
. is extremely rare in African Americans, Asian Americans, Hispanics/Latinos, and American Indians (HFE mutations are usually not the cause of hemochromatosis in these populations)
. women in menopause (women lose blood (which contains iron) with period then, women with the gene defects that cause hemochromatosis may not develop iron overload and related symptoms and complications until after menopause)
. adult men (since they accumulate iron since they born because they have no period)
. increased heme iron intake and/or loss of iron homeostasis might also increase the risk of chronic disease in individuals free of genetic disorders
3 - Iron overload symptoms vary from mild to severe, and may include:
. joint pain
. extreme fatigue, or feeling tired
. unexplained weight loss
. high blood sugar levels
. hypothyroidism or low thyroid function
. abnormal bronze or gray skin color
. abdominal pain
. loss of sex drive
. hais loss
. skin becomes bronzing
Not everyone with hemochromatosis will develop these symptoms.
4 - Complications most often associated with hemochromatosis are:
. neurodegenerative disease
. liver damage
. enlargement of the liver
. cardiovascular disease - irregular heart rhythms or weakening of the heart muscle
. erectile dysfunction
Again, as I mentioned in the iron deficiency article, it is really important to understand that the dietary iron is present in two specific forms (heme iron and non-heme iron). Thus, they have different forms because they are absorbed by the intestinal mucosa completely different from each other.
Heme iron is the iron form that is easily absorbed by the intestine and is the key source of dietary iron that is primarily found in animal products such as meat, fish and seafood and poultry.
Non-heme iron is the iron form found in both plants and animal products (animal products contain a combination of the two types of iron: heme and non-heme).
Whereas, non-heme iron has its bioavailability inhibited by other substances commonly consumed in our diets such as coffee, tea, dairy products, supplementary fiber and calcium. Also, by the consumption of unproperly prepared grains and seeds.
Non-heme iron is the form of iron found in our diet in seeds, grains, legumes (properly prepared), salads, vegetables, fruits, and also, found in animal products, eggs and dairy products
5 - Then, if you have iron overload, it is crucial to understand that the highest sources of heme iron (or the type of iron that is easily absorbed by the body) are:
. chicken liver
. beef liver
. beef chuck
, duck breast
. lamb shoulder
. pork shoulder
Knowing that, you must limit in your diet the highest sources of heme iron.
6 - Next, you need to decrease the consumption of substances that increase iron absorption such as: (mainly try not to consume these substances with your meals)
. c vitamin
. beta-carotene – apricots, beets, carrots, collard, red grapes, red peppers, spinach, tomatoes, etc.
. hydrochloric acid – HCL supplements
. sugar - fruits, honey, etc (sugar can increase iron absorption as much as four times in some cases)
. alcohol - in moderation and avoid consumption of alcohol with meals
7 - Additionally, you must increase in your diet the consumption of substances that decrease iron absorption such as:
. calcium sources of foods - those inhibit absorption of heme and non-heme iron
. eggs – contain phosvtin, which inhibits iron absorption
. oxalates – spinach, kale, beets, nuts, chocolate, tea, berries, some spices/herbs
. polyphenols – cocoa, coffee, teas, spices, berries, walnuts, some spices
. phytate – walnuts, almonds, sesame, dried beans, lentils and peas, cereals and whole grains
. high doses of zinc – limit to 20 mg per dose, taken between meals
8 - Also, to prevent iron overload keep in mind:
. to avoid iron supplements unless followed by a doctor, and after doing an iron panel that confirms that you really need it
. if you are in the most at risk population for iron overload, regularly ask your doctor for an iron panel to check all your iron markers
. if you are an adult man or a menopausal female, consider donating blood one to three times a year as a precaution
. stop the use of cast iron cookware because it interacts with the food
9 - The treatment for Iron overload or hemochromatosis include:
. therapeutic phlebotomy - Therapeutic phlebotomy is the removal of one unit of blood, about 200 to 250 mg (it is not a blood donation because you cannot use this blood loaded with iron)
. chelation therapy - Chelation is rarely used in clinical practice because the drugs have nasty side effects
. use a supplement called Apolactoferrin by Life Extensions 300 mg 2 times a day between meals – a supplement produced in breast milk that has antimicrobial properties that suppresses the growth of iron-dependent pathogens
. dietary changes, reducing iron intake in the food – limit the intake of the most iron- rich foods such as shellfish and organ meats, decrease consumption with your meals of substances that increase iron absorption, and increase consumption with your meals of substances that decrease iron absorption as you read above (facts 5,6,7)
. stop the use of cast iron cookware because it interacts with the food ncreasing the amount of iron available
. treatment for complications (if you have any of the complication listed above in the fact 4) I recommend you, as prevention, to ask your doctor an iron panel to see if may be iron that is at the root cause of your health problem)
10 - Is it important also for you to know that iron supplementation side effects are:
. gastrointestinal irritation
. nausea and vomiting
. diarrhea or constipation (stools darker in color)
If you truly need supplementing with iron take it with food to avoid gastrointestinal symptoms
This is important to be aware of because almost all my clients that are dealing with iron imbalances have also gut problems that are exacerbated by the use of supplements.
11 - Then, be aware that iron supplementation may interfere with the absorption and efficacy of certain medications including:
. drugs to treat osteoporosis
. drugs to treat hypothyroidism
. drugs to treat Parkinson’s Disease symptoms
Also, be informed that “accidental iron overdose of iron-containing products is the single largest cause of poisoning fatalities in children under six years of age.”
12 - The symptoms of acute toxicity may occur with iron doses of 20 to 60 mg/kg of body weight and is an emergency situation because the severity of iron toxicity is related to the amount of elemental iron absorbed. Symptoms are:
. nausea, vomiting
. abdominal pain
. tarry stools,
. weak and rapid pulse
. low blood pressure
. difficult breathing
. failure in the organ system such as: cardiovascular, kidney, liver hematologic and central nervous system
13 - People with hereditary hemochromatosis or other disorders of iron overload, as well as people with alcoholic cirrhosis and other liver diseases, may experiment with adverse effects at iron intake below the UL.
Then, the tolerable upper intake level (UL) for iron depends on age as follow:
Infants 0-12 months - 40 UL (mg/day)
Children 1-13 years – 40 UL (mg/day)
Adolescents 14-18 years – 45 UL (mg/day)
Adults 19 years and older – 45 UL (mg/day)
14 - If you are curious to know how iron is behaving on your own body or, have symptoms listed above, I suggest you ask your doctor to do an iron panel.
These are the needed iron markers to be included on your blood test (because serum iron test can be normal while other iron markers may be out of range):
. serum iron test – measures the level of iron in the liquid portion of the blood
. transferrin saturation test – directly measures the level of transferrin in the blood. Transferrin is a protein that transports iron around in the body
. TIBC (total iron-binding capacity) test - measures the total amount of iron that can be bound by proteins in the blood
. UIBC (unsaturated iron-binding capacity) test – determines the reserve capacity of transferrin also, reflects transferrin levels
. serum ferritin test – reflects the amount of stored iron in the body
. sTR (soluble transferrin receptor) test – used to detect iron deficiency anemia and distinguish it from anemia caused by chronic illness or inflammation
Also, remember that ALWAYS RETEST to confirm iron overload.
15 - For more information on this topic you can click in the links available in this article, read the iron deficiency article, send me a message or email or, look for organizations that are supporting this disease such as:
Iron Institute Disorder
American Hemochromatosis Society, Inc.
I hope that this article was helpful to you, and please, I would love if you leave a comment below.