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From the Townsend Letter
August/September 2006


Letter to the Editor
Common Causes of an Iron Imbalance

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The fortification of processed foods helps to prevent iron deficiency, but may cause an iron imbalance (either iron overload or iron deficiency) in certain people.1-4 In developed countries, iron fortification of white flour began in the 1930s. All cereals (including white rice and cornmeal), pasta, and bread have been "enriched" with added iron. The standards for iron fortification differ among countries and have changed over time. For example, enrichment of these foods is mandatory at the state level for almost two-thirds of the United States, and yet fortification has been abolished in Finland and Denmark because of fears of iron overload.1

Are these fears justified? Recently, when twenty-nine breakfast cereals were analyzed for iron content in the US, the levels of iron per serving were found to be substantially higher than the declared labeled values. The amount of cereal consumed in a serving by seventy-two adults was about twice the labeled serving size. Therefore, in a single serving of ready-to-eat cereal, adults are often consuming more than double the recommended Reference Daily Intake (or Daily Value) for iron, which is 18 mg.2 All these fortified products can cause iron overload in people with a high iron intake and a sufficiently acid stomach.3,4 Symptoms of excess iron can occur with a daily intake of over 75 mg of added iron, as long as there is a healthy production of stomach acid.4,5 Researchers have found that the stomach's pH must be less than 2.0 to extract iron from a fortified product and dissolve it.4

On the other hand, people with even a slightly lower production of stomach acid could become iron-deficient on a diet that is heavy in these "enriched" products or in grains, legumes, seeds, and vegetables, because non-heme iron is much more difficult to absorb than the heme iron in rneat.4 A diet that contains mainly vegetarian foods could also result in iron deficiency if that diet was rich in fiber and therefore rich in phytates and phosphates. These nutrients reduce the absorption of iron.3 Eggs are often listed among the foods that are good sources of iron. However, the content of a nutrient in a food is not as important as the nutrient's digestibility. Egg yolks inhibit iron absorption, and egg whites contain the iron-binding compound ovotransferrin.6,7 Aside from low stomach acid and a highly fibrous diet, or a diet consisting mainly of eggs, common causes of iron deficiency include the following:

  • Blood loss, e.g., from menstruation, chronic inflammation, surgery, aspirin or anti-inflammatory drug usage, hemorrhoids, an ulcer or tumor, diverticulosis, infestation by specific parasites or fungi, ulcerative colitis, Crohn's disease, or from regularly donating blood.3,6
  • Malabsorption, e.g., caused by a copper deficiency; a gastrointestinal infection or damage; a consumption of laxatives, antacids, or acid stoppers; food allergies; celiac disease; liver/gallbladder disease; digitalis treatment; or radiation therapy.3,8
  • Poor dietary intake of iron, which often applies to infants but also affects the elderly. A diet of tea and toast or milk and crackers is likely to cause iron deficiency.3 Polyphenols in tea inhibit iron absorption. Bovine milk contains a negligible amount of iron.9 Furthermore, the absorption of iron is reduced by calcium-rich foods.10 Meat, citrus fruits, and vitamin C (found with iron in, for example, dark-green leafy vegetables) improve the absorption of iron.1,11
  • Physical or emotional duress, strenuous exercise, and heavy perspiration. Chronic physical and emotional stress have been shown to cause a greater loss of iron (44%) than of any other trace mineral tested.12
  • Pregnancy, lactation, and periods of rapid growth in infancy and adolescence.3,10 An adequate supply of iron is essential for the regulation of cell growth. However, infections and tumors also require iron to grow.3, 13 Therefore, if you feel that you are deficient in iron, before increasing your intake, you would be well advised to have a nutritionally oriented doctor's assessment of your digestion, your need for iron, and the cause of the deficiency.3,4 Adult men and women past menopause rarely need extra iron.14 Excess amounts of iron can lead to toxicity and even death.10

The following are some common causes of iron overload:

  • Increased iron uptake accompanied by increased iron absorption, as seen in heavy drinkers of alcohol or red wine, or found in patients after a prolonged intake of foods fortified with iron, iron supplements, iron tonics, or acidic foods cooked in iron cookware.3 The consumption of traditional beers that have been brewed and fermented in iron-clad pots has been linked with high serum ferritin iron concentrations in sub-Saharan populations.15 However, only some of the consumers of this beer (which contains as much as 82.0 mg/I) develop iron overload.15,16 Scientists have discovered that a variable mutation in the gene ferroportin (hemochromatosis type 4) is the actual reason for the absorption of excess iron in certain people of African descent.16 Liver disease can also cause increased storage of iron.3
  • Hereditary hemochroinatosis is a common genetic iron overload disorder.3 Iron accumulates initially in the organs, then throughout the body.3,17 At least two white American males in every 500 suffer from it.10 More men than women are afflicted.3 Genetic studies point to the disorder's Celtic origin during a time of dietary iron deficiency about 2000 years ago when this mutant gene was actually an advantage.16 The large majority of cases have various mutations in the HFE gene; several other mutations that cause the disease have also been identified.16,18
  • Focal hemosiderosis occurs mainly in the lungs and kidneys and is secondary to another disease process that causes episodes of pulmonary hemorrhage (as in pulmonary aspergillosis) or extensive intravascular hemolysis (as in autoimmune diseases such as rheumatoid arthritis).3,18,19
  • Sideroblastic anemias can be inherited or acquired. Iron accumulates first in the bone marrow. Hereditary sideroblastic anemia, affecting mostly men, may respond to vitamin B6 therapy. Patients requiring either regular blood transfusions or chloramphenicol treatment or taking anti-tubercular, antimicrobial, or anti-Parkinsonian drugs that inhibit B6 metabolism develop iron overload, as do patients with chronic infections or malignancies.3
  • Porphyria (a sideroblastic condition) occurs when one or more of the eight enzymatic reactions in heme synthesis are blocked, resulting in the overproduction of porphyrin compounds and their precursors. Any of these sideroblastic conditions results in the ineffective production and maturation of red blood cells, because the mitochondria cannot utilize the iron trapped intracellularly.3 HFE hemochromatosis gene mutations have been linked with porphyria cutanea tarda and have been found in patients with acute inherited variegate porphyria.20
  • The inhibition of enzymatic reactions in the heme biosynthetic pathway can also cause a mitochondrial buildup of iron.3 This enzymatic pathway is inhibited by metals such as excess iron (or lead that damages at least six of the enzymes in the pathway) and by omega 6 fatty acids and many chemicals.21,22 The dental metals that accumulate in our mouths (and then bodies), the man-made chemicals, fats, and added iron that are prevalent in our food, beauty, and personal care products (and therefore in our tissues) are the most insidious causes of anemia.21,23 Either too much or too little intracellular iron leads to heme deficiency, anemia, and oxygen-deprived tissues.4,24

Adequate iron and oxygen are vital for one's immunity.3,25 The iron-rich soils of East and Central Africa have been associated with the development of Kaposi's sarcoma in HIV-1 positive cancer patients.15 Conventional responses to cancer such as chemotherapy, radiation, and testosterone blockade can cause or worsen an anemia.3,9 Cancer patients with anemia have been shown to have a 65% increase in mortality. The risk of death from either a stroke or heart attack sharply increases with the severity of an anemia. Extremely anemic heart-attack patients have been found to be 78% more likely to die within 30 days and moderately anemic patients 52%. The elderly develop anemia more frequently than any other blood disorder.9 Iron deficiency and iron overload are treatable conditions, especially when they are diagnosed and treated early on.9,10 The good news is that the majority of anemic patients have been successfully treated simply by correcting their production of stomach acid.4

Judy Kitchen
3637 Serra Road
Malibu, CA 90265


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Action to Take to Make Yourself Heart Attack Proof. Atlanta, GA: Second Opinion Publishing, Inc., 2002.
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BMC Infect Dis. 2003;3: 21.
16. Pietrangelo A. Hereditary hemochromatosis: A new look at an old disease.
N Engl J Med. 2004;350:2383-97.
17. McLaren GD, Muir WA, Kellermeyer RW. Iron overload disorders: natural history, pathogenesis, diagnosis, and therapy.
Crit Rev Clin Lab Sci. 1983;19(3):205-66.
18. Beers MH., Berkow R. Hematology and oncology. Chapter 128. In:
The Merck Manual of Diagnosis and Therapy. Seventeenth Edition. New York: Merck & Co.,2005.
19. Reichenberger F, Habicht JM, Gratvvohl A, Tamm M, Diagnosis and treatment of invasive pulmonary aspergillosis in neutropenie patients.
Eur Respir J. 2001; I 9:743-755.
20. de Vilhiers, J, Nico P, Hillermann, R, Loubser L, Kotze, MJ. Spectrum of
mutations in the HFE gene implicated in haemochromatosis and porphyria. In:
Human Molecular Genetics. Cambridge: Oxford University Press, 1999:1517-1522.
21 . Marks GS., Exposure to toxic agents: The heme biosynthetic pathway and hemoproteins as indicator.
CRC Critical Reviews in Toxicology. 1985; 15 (2).
22. Hanson JW., Dailey HA. Purification and characterization of chicken erytlirocyte ferrochelatase. Biochemistry Journal. 1984; 222:695-700.
23. Nick GL. Inflammation and detoxification.
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24. Atamna H, Killilea DW, Killilea AN, Ames BN. Heme deficiency may be a factor in the mitochondrial and neuronal decay of aging.
PNAS. 2002; 99(23): 14807-14812.
25. Kitchen, J. Why nutritional therapies fail in patients who need them the most.
Townsend Letter. April 2004; 249.
26. Potter BJ, Wang F. Molecular regulation of iron homeostasis and resistance to infection in alcoholics.
Frontiers in Bioscience 7. May 1, 2002;1396-1409.


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