October
1995
READERS DIGEST
Following article is by Suzanne Chazin as published in the October
1995 issue of Readers' Digest. I have heard from many patients
whose lives were saved by reading this article.
Sandra
Thomas, President, American Hemochromatosis
Society (AHS)
-----------------------------------
Is
Iron Making You Sick?
Iron
builds strong, healthy bodies - that's one
of the first nutritional axioms Americans
learn. Television ads used to urge people
to perk up their "tired" blood
with a liquid iron supplement. Breakfast
cereals are routinely fortified with 25 to
100 percent of the FDA's recommended daily
intake of iron. The mineral is also added
to multivitamins, breads and pastas.
All
this iron is supposed to prevent anemia,
a condition in which the blood is unable
to carry the required amount of oxygen. And
it has helped: only two to six percent of
Americans - mostly children and women - ever
develop the condition.
Until
recently, most experts believed you couldn't
get too much iron. But new studies reveal
a chilling possibility: a high-iron diet
may increase a person's risk of heart disease.
Although inconclusive, the studies suggest
that iron may be more dangerous than people
realize.
Harmful
Stores?
The
human body needs iron to make red blood cells,
the body's transport system for oxygen. Without
iron, new cells couldn't be produced, and
organs, starved for oxygen, would no longer
function properly. Those who fail to ingest
adequate amounts feel sluggish and may succumb
to illness more easily.
Once
iron is absorbed, however, almost none of
it is eliminated except through blood loss:
menstruation, child-birth, trauma or blood
donation. The iron not needed for producing
new blood cells is stored inside a protein
called ferritin. Those stores, which rise
gradually with age, were considered benign
until 1979.
Then
along came medical student Jerome Sullivan,
now a pathologist at the Veterans Affairs
Medical Center in Charleston, S.C. Beginning
his medical residency, Sullivan often examined
the arteries and hearts of people who had
died of coronary disease. A question gnawed
at him: Why were these patients almost always
men? Why did young women, even those with
high cholesterol levels, rarely have heart
attacks?
Experts
insisted that estrogen protected women from
heart disease. Poring over medical texts,
Sullivan noticed a curious finding: women
who had undergone hysterectomies had an increased
risk of heart disease - even when their estrogen-producing
ovaries were left intact. Estrogen didn't
seem to protect them, but their uteruses
had.
There
is only one function for the uterus other
than carrying a child: menstruation. Could
the loss of iron-rich blood protect premenopausal
women from heart disease?
Startling
Connection.
Sullivan
charted the rates of iron stores in men and
women. The average age menstruating female
had an excess iron level of only ten to 40
micrograms of ferritin per liter of blood
- a negligible amount. By the time she was
in her 60s, however, that level often tripled.
Men started accumulating iron once they stopped
growing. By the time the average male was
45, he had as much iron in his blood as the
average woman had at 70.
Next,
Sullivan analyzed the heart-attack death
rate for men and women. At age 45, men had
about four times more fatal heart attacks
than women. He compared this graph to one
charting stored iron levels and noticed that
at age 45 men also had four times the iron
level of women. By age 70, however, as women's
iron stores climbed after menopause, women
were equally likely to have heart attacks.
Sullivan
then found that the typical menstruating
female loses about 700 mg. of ferritin iron
a year. A person donating a pint of blood
twice a year sheds about the same amount.
If losing blood protects menstruating women
from heart disease, then donating it regularly,
he reasoned, might do the same for men and
older women.
Sullivan
published his findings in the British journal
The Lancet in June 1981, but the medical
community expressed no interest. His theory
ran counter to decades of research suggesting
heart disease was linked to hypertension,
obesity, high cholesterol, smoking, inactivity,
age and gender.
Another
major problem with Sullivan's theory, critics
said, was that the kind of iron absorbed
is heme iron or meat iron. Wasn't Sullivan's
theory just an argument for cutting down
on the real culprits - saturated fat and
cholesterol? "I don't think there's
any harm in lowering a person's iron stores," maintains
Dr. Meir Stampfer, an epidemiologist and
leading researcher on heart disease at Harvard
University's School of Public Health and
a critic of the iron theory. "But I
do think it's a distraction from the main
causes of heart disease, including high cholesterol."
Still,
Sullivan felt he was on to something. Despite
the advances in cholesterol-lowering drugs,
no studies at that time could demonstrate
that the drugs prolonged life. (Two major
studies of heart-disease patients have since
found that treating cholesterol with medication
prolongs life, but these studies don't address
the issue of preventing heart disease.) Something
else, Sullivan reasoned, was helping to fuel
heart disease.
Sticky
Situation.
In
1990, University of Minnesota cardiologist
John Murray, studying nomadic African cattle
herders, noted that none of the men over
age 50 had heart disease, even though their
diet was mainly whole milk, high in saturated
fat and cholesterol. Obviously, the cattle
herders exercised more than the average sedentary
U.S. male, but that alone couldn't explain
why cholesterol wasn't killing them.
Murray
knew whole milk was low in iron. Drawing
on Sullivan's contention that saturated fat
and cholesterol appear to be benign without
iron's oxidizing effects, he measured the "stickiness" of
cholesterol in the men's blood before and
after iron supplementation. His findings:
in 60 days after supplementation began, the
increased levels of iron in the body tended
to result in more oxidized LDL cholesterol
(the "bad" cholesterol).
Other
studies have linked this oxidized cholesterol
with artery-clogging plaque. Broad-based
evidence of iron's role in heart disease
- and its effect on cholesterol - didn't
arrive until 1992 from scientists in Finland,
where meat consumption and heart-attack rates
are among the world's highest. Epidemiologist
Jukka Salonen and colleagues at the University
of Kuopio studied 1900 Finnish men, ages
42 to 60, for five ears. They measured the
men's iron stores and compiled questionnaires
on their dietary habits.
Over
the course of the study, 83 men had heart
attacks. The men with higher levels of stored
iron were more than twice as likely to have
heart attacks as those with lower levels.
For men with both high levels of iron and
LDL cholesterol, the risk of heart attack
quadrupled. Salonen assessed all the risk
factors and found high iron levels exceeded
high cholesterol, high blood pressure and
diabetes as a risk factor for heart attacks.
Several
animal studies have suggested that high iron
levels may destroy the heart in other ways.
Research by Joe McCord, a biochemistry professor
at the University of Colorado, found that
iron stores may contribute to heart damage
after a heart attack by helping to unleash
free radicals, unstable particles that destroy
healthy tissue.
While
critics maintain saturated fat and cholesterol
are the villains, these studies show that
iron's interaction with cholesterol may play
a role in the development of heart disease.
The higher the iron stores, the more oxidation
of cholesterol occurs. Unfortunately, no
significant studies have been conducted to
test what would happen to oxidation levels
of cholesterol if iron stores were regularly
depleted.
Although
scientists continue to study the extent of
iron's dangers, they agree no evidence exists
that iron stores have any benefit, particularly
to men and postmenopausal women. "Adult
men in this country shouldn't be worrying
about putting more non-meat iron in their
diets," says Dr. Walter Willett, a leading
Harvard University epidemiologist who has
reviewed the data on iron and heart disease.
Ironclad
Findings.
Indeed,
anyone who thinks excess iron is beneficial
need only look at how dangerous it can be:
34 children have died in the last five years
after accidentally ingesting iron supplements.
One hundred and sixty others were made severely
ill. Iron is also lethal to people who have
hemochromatosis, an inherited disorder affecting
about 1.25 million Americans that causes
the body to store excessive iron. One in
eight Americans is a carrier, yet because
symptoms are so vague and the damage is so
similar to that of other diseases of middle
age, such as diabetes, heart disease, cirrhosis
and cancer, many doctors fail to recognize
hemochromatosis until its effects are irreversible.
William
Sartor was a physically active 42-year-old
power-line repairman in Taylorsville, Miss.,
when he first complained of fatigue. When
his blood sugar tested high, his doctor told
him he was diabetic. Sartor quit smoking
and went on a diet. Two years later, he complained
of joint pain. This time, another doctor
diagnosed arthritis and gave him cortisone
pills. After a battery of blood test, Sartor
learned his liver enzymes were elevated and
was told to stop drinking. Sartor said he
didn't drink.
Over
the next six years, Sartor saw six doctors
for complaints ranging from indigestion to
difficulty swallowing food. He was put on
ulcer medication and vitamin supplements
with iron to relieve fatigue, but blood tests
always showed high liver enzymes. He grew
weaker and developed heart disease. In October
1992, Sartor died of congestive heart failure.
An
autopsy uncovered huge iron deposits in his
pancreas and heart, as well a cirrhosis of
the liver (caused by iron deposits). Since
Sartor's death, his eldest son has also tested
positive for hemochromatosis and is undergoing
frequent blood-letting (phlebotomy) to remove
iron.
Sartor's
doctors were not alone in failing to diagnose
his condition. In a 1990 regional study of
167 cardiac patients whose iron stores were
measured in the hemochromatosis range (500
or higher), only 11 of 167 patients' doctors
- 6.6 percent - had considered the connection
between hemochromatosis and their patients'
heart disease.
Protect
Yourself.
Even
if you're not among the million or so Americans
prone to iron overload, you may want to consider
some precautions:
