Iron – a double-edged sword

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It’s not true that doctors don’t practice nutritional medicine: they do. Any doctor who has written a prescription for iron has, whether they like it or not, engaged in nutritional therapy. Iron is, in fact, by far the most commonly prescribed nutrient by members of the medical profession. It is ironic, therefore, that this is the very nutrient many nutritionists and nutritionally-oriented doctors tend to use with most caution in their patients. While iron undoubtedly has important roles in the body, including being an essential blood-building nutrient, too much can be a bad thing. Only last month, research from Japan suggested that taking more than the required amount of iron might increase the risk of heart disease. In extreme circumstances, iron can lead to other problems such as diabetes and liver damage too. So, how do we know if we need iron or not, and what’s the best way of ensuring a safe level in the diet?

Iron is perhaps best known for its role in treating anaemia. Iron is essential for the manufacture of a substance contained in the red blood cells called haemoglobin which transports oxygen around the body. Iron deficiency can lead to anaemia (a low level of haemoglobin) which often manifests as fatigue, reduced capacity for exercise and low mood. While anaemia is a relatively common cause of fatigue, it should be borne in mind that fatigue is not always caused by anaemia, and anaemia is not always caused by iron deficiency. To complicate things further, I have seen many patients who despite not being anaemic, are fatigued as a result of iron deficiency and go on to respond to iron supplementation. Other symptoms of iron deficiency include itching of the skin, ‘spooning’ (concavity) of the fingernails and, in women, diffuse thinning of the hair. While hair loss in women can have several causes, iron deficiency is one of the more common. Any woman complaining of thinning hair is best advised to have her iron levels checked with a blood test. Women who are pregnant or suffer from heavy periods are especially prone to iron deficiency. Other individuals at increased risk of this condition include vegetarians (their intake of iron is generally lower than that of meat-eaters), and those taking long term painkillers such as aspirin or non-steroidal anti-inflammatory drugs (these can induce bleeding in the gut).

While an individual’s symptoms can point to low iron as a problem, iron does need to be handled with some care. Iron is what is known as an ‘oxidising agent’, having quite the opposite effect of ‘antioxidant’ nutrients such as vitamins C and E which protect against disease. Research published last month from the Kurume Medical School in Japan suggested that high doses of iron induced changes which, at least theoretically, would increase the risk of heart disease. This study supports a previous finding of increased risk of heart disease in Finnish men with high levels of iron in their bodies. A small percentage of the population suffer from a condition known as haemochromatosis in which iron tends to accumulate in the body, depositing itself in various organs. More common in men than women, haemochromatosis can lead to problems with diabetes, cirrhosis of the liver, and heart rhythm abnormalities.

Probably the best way to assess determine iron levels in the body is with a blood test. The most commonly used test is known as the ‘serum iron’, which essentially measures the level of iron in the blood stream. However, it is far more useful to measure the level of something called ‘ferritin’, which gives a good indication of the overall level of iron in the body. If the ferritin level is low of on the low side of normal, it is very likely that someone will benefit increasing their iron intake.

Anyone with iron deficiency would do well to increase their consumption of iron rich foods such as red meat, oysters, fish, dried fruit and green leafy vegetables. Coffee and tea should be avoided, as these can substantially reduce the amount of iron absorbed from the diet. In addition, it usually helps to take iron in supplement form. Iron is available over”the-counter and also as a prescription medication. A typical recommended dose is 100 mg of iron per day, though this may need to be adjusted according to changes in the ferritin level. Quite often, iron supplementation can cause gastrointestinal symptoms, the most common of which is constipation. It is well known that vitamin C enhances the absorption of iron, thereby reducing the amount of iron that needs to be taken in the long term. The less iron is taken, the less risk there is of side effects such as constipation. 250 – 500 mg of vitamin C should be taken with each dose of iron.

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