Nothing causes stress more than the unknown.  We should all be working with our doctors to rule out hidden dangers to our health, especially ones that are easily treated.

Iron Horse or Iron Surplus? Too little blood iron can cause fatigue, but too much can also be harmful!

iron surplus

In a previous post, we discussed the common problem of iron deficiency, as determined by a low level of ferritin.  As we test for the “silent signals” during a regular physical exam, we are also looking for problems of iron surplus.  While some of us are a bit stressed by needles, this is another example of the merits of looking beneath the surface for health clues.

To begin, we check the blood for its levels of ferritin, a protein found in the liver, spleen, muscles, and marrow of our bodies.   Shaped like a hollow sphere, it stores iron inside, which can be released if needed, as in the case of blood loss from heavy periods or from colon polyps.  In the case of too much iron in the body, the ferritin will absorb the excess.

If ferritin is found to be high on screening, (levels should be 80-300 mcg/L, and are considered serious if over 1,000 mcg/L) a repeat test should be ordered, to include the serum iron, saturation levels, and Total Iron Binding Capacity.   Also tests for viral hepatitis and other inflammatory conditions should be considered.  Remember that these tests can be influenced by recent food intake, so are best done fasting.   Usually the only way to make this diagnosis is through early routine testing, as most cases of excess iron (hemochromatosis) start with no symptoms until age 40 or 50 in men.  Women have an advantage of 15 years later onset of symptoms, due to their iron loss in menstruation.  The consequences of high iron levels are alarming.  Deposits in the pancreas can result in Diabetes; in the testicles and pituitary gland: impotence.   In the liver, excessive iron can cause cirrhosis and even an increased risk of cancer.  The heart responds to iron deposits in its muscle by going into irregular rhythms or even heart failure.

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If your doctor finds you have high levels of ferritin, further tests can be arranged, which may include genetic testing, and liver tests including scans or even needle-biopsies. 

In treating this condition,  we first make sure the patient is not taking iron supplements, which are sold without prescription, and sometimes included in multiple-vitamin pills. Secondly, we suggest reducing the intake of iron rich foods, such as red meats.  But the definitive treatment is to draw blood, usually at the rate of one unit (which contains 250 mg of iron) every one or two weeks, depending on the levels.  Tests of ferritin and transferrin saturation are checked every couple of months.  Until tests return to normal, vitamin C supplements should be avoided due to problems with heart rhythms, and alcohol should be avoided.

The good news is that early detection of iron overload works wonders.  Simply by drawing blood, the dangers can be avoided, and no other drug therapies are needed.

In all, another good reason to see your doctor regularly.  We all hate surprises!

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