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Iron in Men

Why men store this nutrient in their bodies and the harm that it does

Copyright © 1996 by Alex Vasquez

This article appeared in the January 1997 issue of M.E.N. Magazine

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Notice: The educational information contained in this article is meant to provide the reader with information that he may choose to discuss with his physician. Although the information contained in this article has been thoroughly researched and is thought to be accurate, it may not be appropriate for and applicable to all persons. Therefore, before anyone chooses to act upon any of the information contained herein, the individual's primary-care physician should be consulted. This information is not intended to represent nor can it replace individualized care from a qualified health care professional.



From medieval European legends of "Iron John" to American cartoons of Popeye, to the notion of getting stronger by "pumping iron," iron has always been associated with strength and vitality. However, recent research suggests that iron should be more properly associated with the nation's top two killer diseases: cancer and heart disease.

While iron is a necessary nutrient, it is needed only in small amounts. When too much iron is absorbed from the diet, it can cause a wide variety of health problems. High levels of iron are associated with an increased risk for cancer, heart disease, and other illnesses such as endocrine problems, arthritis, diabetes, and liver disease.1

Men absorb iron from the food that they eat, and once this iron is in the body it has essentially no way to get out. Women also absorb iron, however they are generally-though not completely- protected from excess iron accumulation through regular iron loss by way of menstrual blood (they lose this benefit after menopause).2 Because of the health risks associated with high levels of body iron, all men should consider having their iron levels tested.3 If the test results indicate that iron levels are too high, specific treatments and lifestyle modifications may be used to lower body iron stores to more healthy levels.

Excess Iron and Cancer

Iron acts as a cancer-promoting agent by two separate yet synergistic mechanisms: 1) by producing "free radicals," and 2) by feeding cancer cells. Iron increases the production of free radicals, and-in fact-the production of free radicals is largely proportionate to the level of iron.4 This means that the more iron there is in the body, the more free radicals will be produced and thus the greater the risk of disease, in this case, cancer. Free radicals are oxygen-containing molecules which damage (oxidize) the DNA of cells. Since DNA controls the activities of the cell, once the DNA is damaged, the cell becomes "out of control." Essentially, all cancer cells are out of control. These cancer cells then replicate and grow rapidly and eventually infiltrate and damage the body's organs. Additionally, cancer cells consume many nutrients and thereby starve the host. One of the nutrients cancer cells need most is iron. In fact, researchers now think that iron may be a "rate-limiting" nutrient for cancer cell growth.5 This means that the more iron that is available, the more the cancer cells will divide and flourish, and the better chance they have of killing the host. Recent research has shown that people with high levels of iron have an increased risk for cancer.5, 6

Excess Iron and Heart Attacks

The free radicals which are produced by iron can promote the development of heart disease. Free radicals can damage (oxidize) cholesterol in the blood. When cholesterol has been oxidized, it is much more likely to "get stuck" in the arteries and blood vessels in the body and especially in the arteries that deliver nutrients and oxygen to the heart. When too much of this cholesterol becomes stuck in the arteries, it makes the inside of the artery smaller, and less blood can get to the heart muscle. Eventually, the blood flow may become so reduced that the heart cannot receive enough oxygen and nutrients, and some of the "starved" heart tissue may die-this is called a heart attack. Heart attacks are one of the leading killers of people in this country and are a very common cause of death in men. Men who have high levels of iron are at an increased risk for heart attack.7

All men should have their iron levels tested.

The only practical way to determine how much iron a person has in his body is to use blood tests called "serum ferritin" and "transferrin saturation." These tests can provide a fairly accurate estimate of the amount of iron in the body. However, either one of these tests could be normal even if a person has severe excess iron accumulation, so it is very important that both tests be performed. Also, no food should be eaten for 8-12 hours before having the test performed; this will help to ensure accurate test results. If you have these tests performed, your doctor should be able to help you understand your test results and to give you specific advice for your particular situation. These tests must be performed if unhealthy iron levels are to be detected. Given that iron accumulation disorders are very common in men, all men should have their iron levels tested.3 Indeed, everyone-men and women-should be screened for iron disorders.8

"If excess iron is such an important health issue for men, then why hasn't my doctor already told me about it and why hasn't my doctor already performed these tests on me? When should I have these tests done?"

The negative effects of excess iron have only been recognized within the past few years. No doctor can stay informed of every important advance in clinical information. Thousands of important articles are published every day. And although many articles on excess iron have been published recently, perhaps your doctor hasn't yet read the ones on iron overload. If you visit your doctor to have your iron status tested, you might want to take this article so that your doctor will have an opportunity to learn about the adverse effects of excess iron.

Misinformation about iron has been widely publicized for several decades. For years, we were so convinced that iron deficiency was the problem that we never thought to consider that iron overload-too much iron-might cause even more serious health problems. It is true that iron deficiency is a problem for some people, especially some pregnant women 9 and young children.10 However, adults generally do not need to eat a high-iron diet (i.e., lots of beef, liver, pork) and do not need to take iron supplements unless they have been advised to do so by a doctor for the specific treatment of iron deficiency.11

You might consider having these tests done when you have your next annual physical examination. Although excess iron is certainly an important health issue for men, you probably don't need to rush to your doctor's office right away. But, based on the present research which shows that excess iron may be hazardous to your health, if you haven't already been tested for excess iron, you may want to have your iron levels tested within the upcoming year.

Early testing and treatment for iron overload saves money and lives by preventing serious disease, 12 and doctors and public health organizations may eventually begin screening everyone for excess iron.13 But until routine screening becomes more widely implemented, you'll have to look out for yourself and become your own health advocate if you want to have these tests performed.

"How much iron is too much?"

Research by several experts on iron metabolism has suggested that iron levels which correlate with a serum ferritin value greater than 100 and a transferrin saturation value greater than 35% may be a predisposing factor for the development for cancer, heart attack, and other diseases.2, 5, 6, 14, 15

Although not all persons with excess iron develop disease, and not all persons with disease have excess iron, researchers are continually finding an association between the amount of iron in the body and the risk for disease. Since excess body iron, especially in men, can do little good and yet can do great harm, all men who want to reduce their risk of cancer and heart disease should consider reducing their levels of iron.

Reducing body iron levels with blood donation and a low-iron diet.

When laboratory tests indicate a high level of body iron, the next step toward better health is a regular program of iron removal. "Blood donation" is the only practical and effective method for the removal of excess iron.2, 6, 14, 16, 17 The rate of iron removal (i.e., the frequency of blood donation) is determined by the severity of the iron overload, and persons with severe iron overload need to receive frequent and comprehensive treatment.18 However, for men with moderate excess iron accumulation, periodic blood donation may help to reduce body iron stores to a more healthy level.2, 6, 14, 16, 17 Most healthy people can donate blood several times per year.

In addition to regularly donating blood, you may also reduce your risk of cancer and heart disease by decreasing your intake of iron from the foods that you eat. Several foods contain high amounts of iron. You may want to avoid vitamin and mineral supplements which contain iron, iron-fortified foods such as some breakfast cereals, and especially avoid beef, liver, and pork. Just about all foods contain some iron, but those with high amounts of iron (e.g., 18 milligrams of iron per serving-common in many cereals and vitamin-mineral supplements) might be best avoided.

Decreasing consumption of these foods is a good way to reduce iron intake, yet blood donation is the only effective way to remove iron that is already in the body. How fortunate that blood donation may help save the life of both the donor and the receiver.

Conclusion and Summary

Although iron accumulation can affect both men and women, men more often suffer from the harmful effects of excess iron. Iron accumulation increases the risk for cancer, heart attack, and several other diseases. For men, sources of iron such as beef, liver, pork, iron-fortified foods and iron-fortified vitamin-mineral supplements can be avoided. Everyone-men and women-should be tested for iron disorders.8 The only way to measure body iron levels is by visiting a physician and having blood tests performed. If the serum ferritin value is greater than 100 or the transferrin saturation value greater than 35%, then periodic blood donation should be considered as a way to remove excess iron and lower body iron levels. Persons with severe iron overload may need to receive more frequent and comprehensive treatment.

Selected References

1. Niederau C, Fischer R, Purschel A, Stremmel W, Haussinger D, Strohmeyer G. Long-term survival in patients with hereditary hemochromatosis. Gastroenterology 1996; 110: 1107-19

2. Sullivan JL. Iron and the sex difference in heart disease risk. Lancet 1981;1:1293-4

3. Baer DM, Simons JL, Staples RL, Runmore GJ, Morton CJ. Hemochromatosis screening in asymptomatic ambulatory men 30 years of age and older. Am J Med 1995; 98: 464-8

4. Herbert V, Shaw S, Jayatilleke E, Stopler-Kasdan T. Most free-radical injury is iron-related: it is promoted by iron, hemin, holoferritin and vitamin C, and inhibited by desferoxamine and apoferritin. Stem Cells 1994; 12: 289-303

5. Stevens RG, Jones DY, Micozzi MS, Taylor PR. Body iron stores and the risk of cancer. N Engl J Med 1988; 319: 1047-52

6. Stevens RG, Graubard BI, Micozzi MS, Neriishi K, Blumberg SB. Moderate elevation of body iron level and increased risk of cancer occurrence and death. Int J Cancer 1994; 56: 364-9

7. Salonen JT, Nyyssonen K, Korpela H, Tuomilehto J, Seppanen R, Salonen R. High stored iron levels are associated with excess risk of myocardial infarction in eastern Finnish men. Circulation 1992; 86: 803-11

8. Herbert V. Everyone should be tested for iron disorders. J Am Diet Assoc 1992; 92: 1502-9

9. Allen LH. Iron-deficiency anemia increases risk of preterm delivery. Nutr Rev 1993; 51: 49-52

10. Walter T. Impact of iron deficiency on cognition in infancy and childhood. Eur J Clin Nutr 1993; 47: 307-16

11. Vasquez A. High body iron stores: causes, effects, diagnosis, and treatment. Nutritional Perspectives 1994; 17: 13, 15-7, 19, 21, 28

12. Balan V, Baldus W, Fairbanks V, Michels V, Burritt M, Klee G. Screening for hemochromatosis: a cost-effectiveness study based on 12,258 patients. Gastroenterology 1994; 107: 453-9

13. Adams PC, Gregor JC, Kertesz AE, Valberg LS. Screening blood donors for hereditary hemochromatosis: decision analysis model based on a 30-year database. Gastroenterology 1995; 109: 177-88

14. Lauffer, RB. Iron and Your Heart. New York: St. Martin's Press, 1991

15. Herbert V. Viewpoint: Does mega-C do more good than harm, or more harm than good? Nutrition Today 1993; 28: 28-32

16. Conrad ME. Excess iron and catastrophic illness. Am J Hematol 1993; 43: 234-6

17. Sullivan JL. Blood donation may be good for the donor. Iron, heart disease, and donor recruitment. Vox Sang 1991; 61: 161-4

18. Crosby WH. Hemochromatosis: current concepts and management. Hosp Pract 1987; 22:173-92

About the author: Alex Vasquez holds degrees of Bachelor of Science in Human Biology and Doctor of Chiropractic and is presently a full-time student at Bastyr University, where he is pursuing his second doctorate in primary healthcare. His health-related articles have appeared in such journals and magazines as Nutritional Perspectives, MENTOR, Townsend Letter for Doctors and Patients, and most recently the American College of Rheumatology's journal Arthritis & Rheumatism. Dr. Vasquez has been a member of the review staffs of Journal of Naturopathic Medicine and Journal of Men's Studies, and is Health Editor for M.E.N. Magazine.

For additional information: For the reader interested in additional information, I recommend the book by Harvard Medical School professor Randall Lauffer, PhD, entitled Iron and Your Heart (New York: St. Martin's Press, 1991). Special note to physicians: Care must be used when interpreting serum ferritin and transferrin saturation as false elevations may be due to nonfasting specimens, infection, inflammation, cancer, or recent alcohol overconsumption. False positive results are more common than false negative results, though both do occur. If you would like to receive a comprehensive and referenced 8-page information packet regarding the diagnosis and management of iron overload disorders, please send $5 and a double-stamped, self-addressed envelope to:

Dr. Alex Vasquez
PO Box 19602
Seattle, WA 98109

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