Iron Deficiency: More Than Tired Blood

Iron deficiency is the most widely recognized nutritional disorder in America, occurring in upwards of 20 million of us, especially women and growing children. Enrichment of flour with iron, 25 mg per pound, has failed to eradicate the problem and in the 1970's there was a serious move to double the amount of iron in flour. This was averted by the efforts of a very few physicians who realized that the less well known danger of iron overdose was equally great as the problem of anemia—or "tired blood."

Iron deficiency has been known since ancient times and there is a reference to it in the Ebers Papyrus that dates back 3500 years. Iron overload has only been recognized in the past century, coming out of studies of a hereditary disease, hemochromatosis, in which excessive iron absorption leads to accumulation in tissues, eventually overloading the natural defenses of the body and causing damage to key organs, such as liver, heart, joints, endocrine glands, kidneys and brain. While the full-blown disease is rare, occurring in only about 5 per 1000 of us, milder forms (recessive type) are not uncommon and there may be as many as 10 percent of us who have this trait for excess iron absorption, i.e. over 20 million people.

This may be the most compelling reason to moderate our intake of red meat, since that is the most efficient dietary source of iron. The evidence is certainly sufficient to warn against self-medicating with iron-containing vitamin pills unless there is an actual iron deficiency. Meat contains only 3 grams of iron per usual serving (about 1/4 pound). Vitamin pills usually contain 6 times that amount, since 18 mg is the RDA for women and women do most of the purchasing of vitamins. Only liver, of all our common foods, comes close to that amount and few people eat liver every day. Vitamin pills, however, are usually taken on a daily basis.

Accumulation of iron is not likely to occur in women of childbearing age. Menstrual blood loss is sufficient to prevent accumulation and pregnancy also soaks up the reserves. Men however have no natural means to excrete iron. It does not leave the body in urine, saliva or stools. Therefore if a man does have iron deficiency, bleeding is always suspect, especially from the intestines.

Deficiency of iron causes a type of anemia in which the blood cells are rather small sized. This occurs because when iron is deficient, the blood pigment, hemoglobin, cannot be manufactured. However, before the anemia appears, symptoms of low energy and mood depression are common. The diagnosis may be missed unless specific blood tests for iron transport proteins, such as transferrin and ferritin are done.

There are also other symptoms that occur with iron deficiency. Low back pain is one of the most common early signs. Iron is a catalyst to vitamin C in the formation of the connective tissue, collagen, that gives our tissues strength. The lumbar spine takes more mechanical stress than any other part of the body because so it is one of the first tissues to complain. Weak fingernails along with cupping of the nail shape also point to iron deficiency. Cracked lips and sore tongue occur because iron is a catalyst for riboflavin (vitamin B2), which produces nucleic acids for cell repair. Resistance to infection also declines when iron is unavailable to catalyze production of hydroxyl ions, one of the chief weapons of the antibacterial white blood cells (neutrophils).

The slogan "tired blood,” related to iron deficiency is somewhat misleading. Yes, anemia does occur. But the fatigue is usually caused by loss of iron activation of cytochrome enzymes that are the ultimate releasers of energy from the foods we eat. In addition iron is required as a catalyst to the production of adrenalin-like substances by nerve cells. Without iron, poor mental concentration and low mood are usual. In children, irritability, hyperactivity and learning impairment have been traced to iron deficiency in many cases.

It is clear from these facts that iron deficiency is a common, treatable and preventable medical disorder. But that has been appreciated for a long time. On the other hand, iron excess causes a host of symptoms that are even more damaging and equally treatable and preventable. The fact of iron overload is still so new that it has not reached full awareness in either the public or medical mind. A recent study found that even the classic cases of hemochromatosis are incorrectly diagnosed in almost half the cases for at least 5 years after symptoms have become severe!

It is now well known that excess iron is a major cause of oxidative damage to unsaturated fats. Free iron acts as a free radical to induce peroxidation of cell membranes, which contain unsaturated fatty acids. This can damage or destroy cells, particularly in the blood vessels, causing atherosclerosis, the heart muscle, causing heart failure, the liver, causing cirrhosis, and the brain and endocrine glands. Loss of sex drive, probably due to damage to the pituitary gland, is an early symptom of iron overload. Men are likely to notice that sensation is intact but erection is too weak to qualify.

Prevention is the best treatment because once symptoms have occurred it is not always possible to reverse them. It is wise, therefore, to avoid taking iron supplements unless iron deficiency is verified by your doctor. This is critically important for men and post-menopausal women, since there is no natural way for the body to get rid of excess iron in these situations.

The challenge to the doctor is to make the diagnosis of your iron status before irreversible damage is done. For example, a 1988 report by Dr. Richard Stevens, et al of the National Cancer Institute showed a thirty percent increase in cancer incidence over a ten year period when comparing those with low versus high iron levels. Increased incidence of coronary heart disease has also been linked to iron excess. In fact, this may be the reason why women do not get heart attacks until after menopause, when they no longer lose blood and iron through menstruation. It is even possible that the beneficial action of fish oil and also aspirin is that both are anti-coagulant, thus permitting microscopic blood loss, particularly through the bowel.

Dr. Blumer in Switzerland performed intravenous EDTA chelation therapy as a preventive feature in his practice for many years. After 20 years there was a 90 percent reduction in cancer and a 50 percent decline in heart attacks in his patients as compared to a non-chelated group in the same small town. This dramatic benefit was probably due to removal of toxic metals, such as lead, cadmium and aluminum by the treatment; but excess iron is also removed. Chelation therapy as a preventive method of detoxification remains controversial in America. However, blood donation at a blood bank is a practical means of helping others as you help yourself. Statistics indicate a 10-year increase in life span amongst regular blood donors.

Your doctor can use a routine blood count to diagnose the presence of anemia but this does not by itself identify the iron status. Additional tests, such as transferrin saturation, reflect the amount of iron in transport, and ferritin, tells something about the amount of iron in liver storage.

When copper is low, taking iron and vitamin C together causes complication, such as copper depletion, anemia. This occurs because copper and iron share absorptive mechanisms so that extra iron blocks copper uptake. The lower copper cuts back the volume of SOD enzyme; hence cell membranes are more vulnerable to oxidant damage.

Iron attracts oxygen: that is why iron rusts and that is why blood cells, which contain 2/3 of the body's iron supply, can carry oxygen from the lungs to every cell in our bodies. Because iron is chemically reactive, nature packages it within a large molecule, hemoglobin. This ingenious molecule keeps iron from reacting chemically with cell membranes at random, a process that would cause cell death. Instead, iron is tucked safely within the large hemoglobin complex, providing electrons that permit hemoglobin to trade oxygen for hydrogen in the more active and therefore acidic tissues. Thus iron and hemoglobin serve to carry oxygen to the tissues and bring carbon dioxide as carbonic acid back to the lungs, in the process undergoing a color change from the bright red of the arteries to the dark blue of the veins.

©2007 Richard A. Kunin, M.D.