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

The Facts on Iron

In an old commercial now making the rounds on YouTube, a man trying to dance with his listless wife drags her around the floor like a rag doll, while a voice-over asks, "Tired because of iron-poor blood?" After taking Geritol, the wife dances into the room in a boa, and bends her husband backward into a kiss that’s reminiscent of Adrien Brody planting one on Halle Berry at the Oscars.

Over the years, the words Geritol and iron-poor blood have become American shorthand for middle-age fatigue. Many women, then, may be surprised to discover that iron depletion is far from being a given of life after 40. The landmark Nurses’ Health Study found that only about three percent of postmenopausal women are iron depleted — and those tend to be women who exercise more than average, take aspirin regularly, or have stopped menstruating relatively recently. In fact, the study found, more than three times as many postmenopausal women — almost 10 percent — have too much iron in their blood.

Consuming meat and alcohol often, taking iron supplements or birth control pills, and aging can all lead to increased iron stores in the body. Most at risk are the half-million women (mostly Caucasian) with hemochromatosis, a genetic tendency to absorb and hold on to large amounts of iron. Although the gene is present equally in men and women, most women don’t get symptoms until after they stop menstruating — a process that appears to protect against excess iron storage. Because hemochromatosis can lead to permanent damage to joints and certain organs, it’s important to detect and treat it early. That can be difficult, as some symptoms of too much iron are similar to those of anemia, or too little iron, and can also be mistaken for other conditions that hit women in menopause, such as osteoarthritis. In addition, many physicians think of hemochromatosis as a man’s disease because iron overload occurs more frequently in men.

Here’s how two women faced the iron issue in their own lives.

Too Much Iron

Paula Johnson, an avid sea kayaker, led an active life until her late 40s. Then her body started to betray her. By age 50, she felt as if she were 80. I’m too young to feel this old, she thought.

She downed three 12-ounce mugs of coffee every day to fight her fatigue, then came home from work and collapsed in front of the television. She experienced an irregular heartbeat. Fleeting pains in her knuckles worsened, and the pain in her wrists, shoulders, neck, and knees made just getting around her split-level home in Port Angeles, Washington, a challenge. Doctor after doctor found nothing physically wrong.

Finally, she laid out all her symptoms to a nurse practitioner, who ordered the right tests. They showed that Johnson was overloaded with iron. An average range of ferritin (a blood protein involved in iron storage) is 25 to 200 nanograms per milliliter; Johnson’s was 723. Genetic testing confirmed she had hemochromatosis.

An overload of iron keeps the organs and tissues of people with hemochromatosis from functioning properly, and the condition can eventually lead to diabetes, cirrhosis, and other life-threatening diseases.

Pumping Iron Out

When Johnson’s doctor asked how she thought they might treat this disease, she half-jokingly guessed, "By bloodletting?"

Bingo. It turns out that the most efficient way to reduce iron is to give blood — often. As the body replenishes iron-containing red blood cells, it borrows iron stored in the tissues. Repeating the process gradually reduces the iron level in the body.

Along with other treatments for problems brought on by high iron levels, Johnson’s therapy called for her to donate a pint of blood every week and reduce the iron in her diet. After four donations, her brain fog cleared and the pain in her hands eased enough that she could open jars and potato chip bags again. After giving eight pints, she no longer experienced the irregular heartbeat that had plagued her for six years. After 12 sessions, her level was so close to normal that her doctor said she could cut back on donating blood to once every couple of months, though her joint pain continues.

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