I talk a lot about nutrient deficiency, particularly considering the types of health challenges I see come into my clinic. However, iron overload is an increasing problem we are less likely to talk about. Though there are many who are deficient in iron, subsections of the population run the risk of having too much iron in their bloodstream.
It’s not well known that iron overload is an underlying factor in metabolic syndrome, and a risk factor for other chronic diseases such as cardiovascular disease, diabetes and, potentially, cancer. As levels of iron increase in the body we see a subsequent increase in blood glucose, insulin resistance and inflammatory markers associated with cancer.
Iron is an essential co-factor for haemoglobin — the protein that binds oxygen in the lungs and takes it to where it is required. The oxygen is taken up by the mitochondria, our body’s own powerhouse of energy, and therefore iron is important for normal mitochondrial function and producing energy for cells.
When iron isn’t tightly bound to a protein in the body and it is hanging around in the bloodstream, it can create a lot of oxidative stress, and can end up in the cells, creating cell and mitochondrial damage.
Unlike other nutrients (such as vitamin C) which we excrete readily, certain nutrients build up and iron is one of them. While the body is good at regulating required levels of nutrients, some people are more likely to be able to store iron due to mutations in various genes.
From an evolutionary perspective, this ability to store iron was likely useful when out hunting or fighting and at risk of bleeding frequently. It would have provided a storage buffer, as iron is required to make more blood cells. It is a gene that would have given us an evolutionary advantage in the past but is now causing health complications.
You can test this mutation through your doctor easily enough with a test for the HFE (C282Y) gene. A mutation in the HFE gene can predispose to hemochromatosis, a condition of iron overload — and people of Caucasian descent, males in particular, are more at risk.
Two copies of this gene are required for true hemochromatosis. This can lead to end organ damage, causing organ failure (pancreatic failure, leading to diabetes) or cardiac myopathy, causing heart failure. Liver cirrhosis can also occur if iron is deposited in the liver. It can go anywhere: thyroid, adrenals, joints (it can be related to joint inflammation and arthritis).
One in 10 people have one mutation, which doesn’t mean you will end up with iron overload leading to organ failure, but it can have implications for lethargy, joint pain and weakness as these are milder symptoms.
People live with this on a day-to-day basis, which could definitely affect how they feel. To establish true iron overload (high ferritin), you should see a haematologist to determine whether it is hemochromatosis and what your next steps will be.
Giving blood is an easy way to reduce ferritin and can also reduce blood pressure and other markers of metabolic disease, including fatty liver disease. It’s been shown that people with the mutation who give blood will improve insulin sensitivity, reduce overall risk of mortality, reduce HbA1c (a measure of blood sugar control), improve lipids (LDL to HDL ratio) and can improve liver function also.
Iron can be measured in several ways through the blood, which you’re likely familiar with (using ferritin, serum iron and a full iron panel). It’s difficult to know what’s going on with looking at a single marker, and often better to get more than one.
Those who do have an iron overload should:
- Avoid iron supplements and ensure micronutrient supplements do not contain iron.
- Avoid taking vitamin C supplements with meals.
- Eat plenty of fibre and vegetables with meals. These can inhibit the absorption of iron, particularly as many vegetables contain oxalates (an iron inhibitor).
- Avoid overeating red meat, mussels or offal, all of which are rich in iron.
- Drink coffee and tea around meals if you don’t suffer from digestive issues.
- Drink alcohol in moderation, and avoid completely if you have liver damage.