The Trouble with Iron: Iron Deficiency vs. Iron Overload

How much iron do you really need? And what are the dangers of too much or too little?

By Susan Ince

This past September, nine months after her diagnosis, Johnson returned to her beloved kayak, spending six days paddling and camping in British Columbia.

"To be able to go out with a group and spend those days on the water, being self-sufficient and feeling well enough to enjoy the adventure, was incredible," she reports.

Iron Deficient

When Carolyn Winslow, 47, describes what she experienced in 2006, you would swear you were talking with Paula Johnson.

"I didn’t have enough energy for someone my age. I tried taking yoga and Pilates classes, and they wore me out — all these people older than me would just walk out afterward, while I had to sit down and rest," says Winslow, a computer instructor from Mooresville, South Carolina.

Soon even daily activities were too taxing: walking up stairs, drying her hair, taking a shower. Like Johnson, she was feeling foggy mentally.

Unlike Johnson, Winslow was familiar with hemochromatosis — her brother had had it before he died of liver cancer, 10 years before. But tests revealed her to be seriously iron deficient: Her ferritin level was only 3 nanograms per milliliter.

Pumping Iron In

Iron-deficiency anemia is usually treated with a diet change and supplements, but Winslow’s specialist decided on a more aggressive approach: intravenous infusions, which would deliver iron faster and without the gastrointestinal side effects many suffer from while taking supplements.

Getting the level back up is important: As women age, they’re more likely to become frail and have cognitive problems if they’re iron deficient. And changes during perimenopause, such as heavier periods, can lead to a loss of iron. "I’ve heard more and more women say they lose a lot of blood during perimenopause," says Laura Murray-Kolb, PhD, of the Johns Hopkins Bloomberg School of Public Health. "A couple of women who had difficulties concentrating and remembering showed vast improvement once they started taking iron supplements."

Even anemic women need a checkup before turning to iron supplements. Some women whose test results show too little iron in the blood may actually have plenty of stored iron in other tissues, though their systems are trying to cut off the supply so it doesn’t nourish diseased cells or germs in the blood. "It’s a defense your body has so you won’t feed these invaders," says Cheryl Garrison, executive director of the Iron Disorders Institute. That mechanism makes it vital for a woman who is told she has anemia to dig deeper and be checked for stored iron before taking iron pills, she adds.

Should All Women Get Iron Tests?

"No one recommends that people without symptoms be tested," says Heidi Blanck, MS, PhD, of the Centers for Disease Control and Prevention. "But if you have the symptoms of iron deficiency or overload — and plenty of people do — ask your doctor to test you."

Iron and Heart Disease

There’s an ongoing medical debate about whether excess iron contributes to heart disease. Estrogen is usually credited with protecting women against heart disease prior to menopause. But about 25 years ago, researchers in the Framingham Heart Study noticed that the heart disease rate for women who had undergone hysterectomies — whether or not they still had their estrogen-producing ovaries — was identical to that of women who had gone through natural menopause.

That piqued experts’ curiosity, and today, some think it may actually be menstrual flow that protects the heart, by keeping iron levels down. One such expert is Jerome L. Sullivan, MD, PhD, of the University of Central Florida College of Medicine. He offers the following points as further support for the theory.

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