Contrary to popular belief, iron overload does not mean you have been watching too many Iron Man movies. Nor does it mean if you have iron overload, you will become Iron Man. It is a lot more sinister than that, I’m afraid.
Iron is a necessary element for healthy blood. It a crucial part of hemoglobin and carries oxygen to every cell in our bodies. When we don’t have enough iron, we can become anemic. This is called iron deficiency anemia and is very common, especially in women due to menstrual cycles. This is why many doctors automatically prescribe iron to anyone who is anemic. The question is, is everyone who is anemic iron deficient? The answer is a resounding NO.
This is what happens to those with G6PDD when they ingest a trigger or have some infections, like flu, hepatitis and others. The problem is that hemolytic anemia from G6PDD does not result in iron deficiency. The Iron Disorders Institute says:
“Iron overload can be inherited (genetic) or acquired by receiving numerous blood transfusions, getting iron shots or injections, or consuming high levels of supplemental iron. Some of the genetic disorders that result in iron overload include … enzyme deficiencies (pyruvate kinase; glucose-6-phosphate dehydrogenase)”
“G6PD: Iron overload is due to chronic hemolysis triggered by certain drugs, espeically anti-malarials or by foods, especially fava beans.”
Can’t our body just eliminate the excess iron? It does to a small degree, but it is a very slow process. This from Medscape:
“The human body has no active mechanism for the excretion of iron. Iron homeostasis thus relies on the amount that is absorbed from the small intestine. During normal physiology, the amount of iron absorbed (1-2 mg/d) is lost by sloughing of intestinal mucosa and skin, as well as small amounts in the urine and bile. The day-to-day iron requirements, as iron is needed by virtually all body cells and especially erythrocytes, are met by recycling between various compartments.”
Normally, iron is eliminated at the same rate it is absorbed (1 – 2 mg per day). Considering that one unit of blood that is transfused has an average of 250 mg of iron in it, it takes the body a long time to get rid of the excess. From my research of various iron supplements, they range from 18 mg to 325 mg of iron. Way more than is needed by our body for daily use. Remember that our body has no way to eliminate the excess iron, so it accumulates in our organs.
Consequences of Iron Overload
The Merck Manual states:
“Iron overload may result from hereditary hemochromatosis (a genetic disorder of iron metabolism) or from secondary hemochromatosis, which is an acquired form of the disease that is due to excess oral intake or absorption of iron, or to repeated blood transfusions. Morbidity is mainly due to iron accumulation in the endocrine organs (especially the pancreas, gonads, and pituitary), liver, and heart.”
The following chart illustrates the organs affected by iron overload.
As you can see, iron overload can be very serious and even fatal.
When I was young my mother warned me about taking iron because people in my family had died from it. Back then doctors didn’t know that people with G6PDD who were anemic did not need iron and in fact iron was harmful to them. Incredulously, even today many doctors are not aware of this fact and regularly prescribe iron to G6PDD patients without ordering an iron deficiency test.
Do not take iron supplements or have iron injections without insisting the doctor check for iron deficiency. Don’t take no for an answer. Many of the problems associated with G6PDD are caused by old fashioned ignorance and can be avoided with proper education. Since it is difficult to get doctors to understand that what they have been taught is incorrect, it is up to us to learn the truth and protect ourselves and our loved ones.
Ascorbic acid increases the absorption of iron in some cases up to ten times the absorption rate without it. A topic for another blog.
About the author: Dale Baker is the author of many articles about G6PD Deficiency, two books about G6PD Deficiency and the creator of the G6PD Deficiency website. He has been actively involved in researching G6PDD and helping people solve their G6PDD problems since 2006.