Iron

Iron deficiency is the most common nutrient deficiency worldwide. The groups at highest risk are infants under 2 years of age, teenage girls, pregnant women, and the elderly. Studies have found evidence of iron deficiency in 30 to 50 percent of the people in these groups. For example, some degree of iron deficiency occurs in 35 to 58 percent of young, healthy women. During pregnancy, the number is even higher.¹

Iron deficiency is the most common cause of anemia. However, anemia is the last stage of iron deficiency. It is characterized by red blood cells that are small and pale. This condition is treated with supplemental iron, usually in combination with Vitamins A, C, E, and copper.

Iron is essential to periods of growth, such as infancy, adolescence, pregnancy, and lactation. During these times, the amount of iron obtained through the diet may not be enough. In addition to an inadequate dietary supply of iron, deficiency may result from absorption problems, chronic diarrhea, antacid use, and blood loss (such as menstruation). While deficiency can result from excessive menstrual bleeding, it is also a common cause of heavy menstruation. Deficiency is associated with anemia, learning problems, depressed immunity, and a loss of energy. Even mild iron deficiency was shown in 1979 to lessen physical capacity and work productivity. Studies in 1990 and 1994 found the endurance capacity increases three times in rats supplemented with iron, further strengthening the link between metabolism and iron.²

Iron is found in functional forms, such as hemoglobin and enzymes, and in transport and storage forms such as transferrin, ferrin, and hemosiderin. It is needed to transport oxygen from the lungs to body tissue and to bring carbon dioxide from body tissues to the lungs. It interacts with enzymes regulating the production of energy, metabolism, and DNA synthesis. This mineral also serves to reduce the reactivity of some oxygen compounds by forming catalase.

Functional iron exists in the form of heme proteins. Heme iron binds to hemoglobin in the blood and myoglobin in the muscles. Iron that is involved in storage and transport functions is of the nonheme variety. Both heme and nonheme iron are absorbed by the body differently. While a greater percentage of nonheme iron is available through the diet, heme iron is more easily absorbed. Heme iron is found in meat sources, poultry, and fish. Plant and dairy foods contain nonheme iron. Absorption of this form of the nutrient is affected by various components in food. Vitamin C and various compounds in meats, for instance, enhance the absorption of nonheme iron, while phytic acid, coffee, and calcium phosphate hinder the body’s ability to use the mineral. In addition to the amount and the bioavailability of the iron in food sources, absorption of the mineral is also dependent upon individual levels of storage iron. When body reserves of the mineral are low, it is absorbed more efficiently.

Elevated body stores of iron or excessive intake is implicated in the development of cancer. Some studies on human populations suggest that excessive iron intake and/or abnormally high serum iron levels are associated with the initiation and promotion stages of cancer. Excess body stores of iron in men have been associated with an increased risk of cancer. Dietary intake in these men did not correlate to the amount of iron stored in their bodies, indicating abnormal iron metabolism. This could mean that cancer risk is linked to how the body metabolizes and stores that iron, not with iron intake per se. The link between elevated iron levels and cancer remains inconclusive to date.³

Some studies have found that excess stored iron is associated with heart disease. A 1992 study conducted on Finnish male meat eaters raised concern about the safety of iron in regards to heart attacks. However, there were other factors in this study that could have played into an increased risk of heart disease. This study looked at men eating large quantities of meat. High meat consumption has long been associated with an increased risk of heart attack, increased LDL cholesterol, and increased iron stores.⁴ Other lines of research have found no association between iron intake and heart disease.

About one in every 200-400 people is affected by hemochromatosis, a genetic condition in which the body absorbs and stores excessive amounts of iron. Hemochromatosis is dangerous because it can result in organ damage. The symptoms of this condition are individual and are easily treated by blood transfusions. In persons who do not suffer from this disease, the risk of obtaining excessive amounts of iron from oral intake is quite rare.⁵

1 Krause MV and Mahan KL, Food, Nutrition and Diet Therapy, 7th Edition. WB Sanders, Philadelphia, PA, 1984, 128-131.

2 Willis W, Gohil K, Brooks G, et al: Iron deficiency: Improved exercise performance within 15 hours of iron treatment in rats. J Nutr 1990; 120:909-916. Hunt J, Zito C, Erjavec J, et al: Severe or marginal iron deficiency affects spontaneous physical activity in rats. Am J Clin N 1994; 59:413-418.

3 Stevens R, Graubard B, Micozzi M, et al: Moderate elevation of body iron level and increased risk of cancer occurrence and death. Int J Canc 1994;56:364-369.

4 Salonen J, Nyyssonen K, Korpela H, et al: High stored iron levels are associated with excess risk of myocardial infarction in eastern Finnish men. Circulation 1992; 86:803-811.

5 Yip R and Dallman P, Iron, in Ziegler EE and Filer LJ, Present Knowledge in Nutrition, 288.

• Bread, enriched
• Cashews
• Caviar
• Cheese, cheddar
• Egg yolk
• Garbanzo beans (chickpeas)
• Lentils
• Molasses, black-strap
• Mussels
• Pistachios
• Pumpkin seeds
• Seaweed
• Walnuts
• Wheat germ
• Whole-grain products

NOTE: Plant sources and dairy products contain nonheme iron. The hemoglobin and myoglobin in meats, poultry, and fish provide heme iron. While nonheme iron makes up over 85% of the iron in our diet, heme iron is more easily absorbed.

Available as:

• Injectable forms are administered by doctor or nurse.
• Also comes as ferrous fumarate, ferrous gluconate, ferrous sulfate, iron dextran, iron bisglycinate, and iron-polysaccharide.¹

1 From Griffith HW, Vitamins, Minerals, and Supplements.

PROVEN BENEFITS:

• Prevents and treats iron-deficiency anemia due to dietary iron deficiency or other causes. Iron bisglycinate is particularly useful for people who develop severe gastrointestinal symptoms when they take iron orally.
• Stimulates bone marrow production of hemoglobin, the red blood cell pigment that carries oxygen to body cells.
• Forms part of several enzymes and proteins in the body.
• Replace iron lost during menstruation.

What this mineral does:

• Iron is an essential component of hemoglobin, myoglobin and a co-factor of several essential enzymes. Of the total iron in the body, 60 to 70% is stored in hemoglobin (the red part of red blood cells).
• The heme compound myoglobin is an iron-protein complex in muscles. This complex helps muscles get extra energy when they work hard.¹

1 From Griffith HW, Vitamins, Minerals, and Supplements.

UNPROVED SPECULATED BENEFITS:

• Controls alcoholism.
• Helps alleviate menstrual discomfort.
• Stimulates immunity.
• Boosts physical performance.
• Prevents learning disorders in children.¹

1. From Griffith HW, Vitamins, Minerals, and Supplements.

• Many women of child-bearing a.ge are mildly iron deficient even when they get all their nutritional requirements.
• Anyone with inadequate caloric or dietary intake or increased nutritional requirements.
• Older people (over 55 years).
• Pregnant or breast-feeding women.
• Women with heavy menstrual flow, long menstrual periods or short menstrual cycles.
• Those who abuse alcohol or other drugs.
• People with a chronic wasting illness, excess stress for long periods or those who have recently undergone surgery.
• Athletes and workers who participate in vigorous physical activities.
• Those with a portion of the gastrointestinal tract surgically removed.
• Patients with recent severe burns or injuries.
• Anyone who has lost blood recently, such as from heavy menstrual periods or from an accident.
• Vegetarians.
• Infants from 2 to 24 months.

Miscellaneous information:

• Iron-deficiency anemia in older men is usually considered to be due to slow loss of blood from a malignancy in the gastrointestinal tract until proved otherwise.
• Iron content of foods, especially acidic foods, can be dramatically increased by preparation in iron cookware.
• May require 3 weeks of treatment before you receive maximum benefit.
• Works best with vitamin C (ascorbic acid).
• Iron dextran contains 50mg elemental iron per milliliter. It is a special form of iron designed to be used as an injection deep into muscle, usually in the buttocks.
• Ferrous fumarate is 33% elemental iron.
• Ferrous gluconate is 11.6% elemental iron.
• Ferrous sulfate is 20% elemental iron.
• Also comes in iron-polysaccharide and iron bisglycinate forms.¹

• Listlessness
• Heart palpitations upon exertion
• Fatigue
• Irritability
• Paleness of skin
• Cracking of lips and tongue
• Difficulty swallowing
• General feeling of poor health¹

UNPROVED SPECULATED SYMPTOMS

May contribute to baldness.¹

1. From Griffith HW, Vitamins, Minerals, and Supplements

LAB TESTS TO DETECT DEFICIENCY

• Red blood cell count
• Microscopic exam of red blood cells
• Serum iron
• Hemoglobin determinations¹

Optimal Levels

• 10-30 mg.

Minimum Dosage

Recommended Dietary Allowance (RDA):

Estimate of adequate daily intake by the Food and Nutrition Board of the National Research Council, 1989.

Don't take if you:

• Are allergic to any iron supplement.
• Have acute hepatitis.
• Have hemosiderosis or hemochromatosis (conditions involving excess iron in body).
• Have hemolytic anemia.
• Have had repeated blood transfusions.

Consult your doctor if you have:

• Plans to become pregnant while taking medication.
• Had stomach surgery.
• Had peptic-ulcer disease, enteritis, colitis.
• Had pancreatitis or hepatitis.
• Alcoholism.
• Kidney disease.
• Rheumatoid arthritis.
• Intestinal disease.

Pregnancy:

• Pregnancy increases need. Check with doctor. During first 3 months of pregnancy, take ONLY if doctor prescribes it.
• Don't take megadoses.

Breast feeding:

• Supplements probably not needed if you are healthy and eat a balanced diet.
• Baby may need supplementation. Ask your doctor.
• Don't take megadoses.

Effect on lab tests:

• Effect on lab tests:
• May cause abnormal results in serum bilirubin, serum calcium, serum iron, special radioactive studies of bones using technetium (Tc 99m-labeled agents), stool studies for blood.

Storage:

• Store in cool, dry place away from direct light, but don't freeze.
• Store safely out of reach of children. Iron tablets look like candy, and children love them.
• Don't store in bathroom medicine cabinet. Heat and moisture may change action of mineral.

Others:

• Iron can accumulate to harmful levels (hemosiderosis) in patients with chronic kidney failure, Hodgkin’s disease, rheumatoid arthritis.
• Intramuscular iron can leave unsightly black deposits in skin that mimic tattoo marks.
• Accidental overdoses in children may result in death.¹

OVERDOSE/TOXICITY

Signs and symptoms:

EARLY SIGNS: Diarrhea with blood, severe nausea, abdominal pain, vomiting with blood.

LATE SIGNS: Weakness, collapse, pallor, blue lips, blue hands, blue fingernails, shallow breathing, convulsions, coma, weak, rapid heartbeat.

What to do:

• For symptoms of overdosage: Discontinue mineral, and consult doctor. Also see ADVERSE REACTIONS OR SIDE EFFECTS.
• For accidental overdosage (such as child taking entire bottle): Call emergency services, the telephone operator or your nearest Poison Control Center.¹

ADVERSE REACTIONS OR SIDE EFFECTS

INTERACTION WITH OTHER SUBSTANCES

• Alcohol increases iron utilization. May cause organ damage. Avoid or use in moderation.
• Milk decreases iron absorption.
• Tea decreases iron absorption.
• Coffee decreases iron absorption.¹

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