I heard the word "Hemochromatosis" (in South Africa it would be “Haemochromatosis”) for the first time on May 1st, 1975, at the old Johannesburg General Hospital, and knew, at last, what had ailed my husband for nearly eight years. It was a momentous occasion, but unfortunately neither he nor I could remember that word once we got home. It was not in any dictionary, medical or otherwise (I know that because our family doctor presently also found that to be the case) and we were soon to discover that Tom had been especially blessed by being referred to someone who just happened to be an authority on the disorder, and was, furthermore, one of the world's few such experts. Little did I realize then that I would never again be allowed an opportunity to forget that word. Hemochromatosis would take over my life, and even now, as my friend Elaine Murray has written, although I say that I have "let go of Hemochromatosis," it will not let go of me. After so many years, the phone still rings, and desperate people still call or write. The tail still wags the dog.
Iron in Our Food
If I were to be awarded ten bucks for every conference I have attended on the subject of “Iron in Food,” or even given five for each of the protests I have lodged over the years, against “misleading labelling of iron-containing food products,” I could probably buy myself a new car. No matter how eloquently I would try to make the point that there were salt-free products for those who were obliged to limit their intake, and what a blessing sugar-free commodities were to diabetics, I would either be dismissed as a crackpot or shouted down by manufacturers’ reps and others who had a vested interest. Was I not aware of the fact that people were starving in Africa? That iron was added to avoid anaemia around the world? My arguments that I was not talking about Africa and that, in any case, one size did not fit all, fell on deaf ears. It did little good to explain that there were many people, already so overloaded with iron that they could suffer cruelly and even die because of it, who also had to be taken into consideration.
Those were the days before the Internet, long before the existence of Google and other Search engines, and the myriads of references now readily available.
Symptoms and Iron Supplements
Even today, while conceding that iron deficiency still exists in many areas of the population, there is still some concern about the type of advertising which has led the public to the belief that iron supplements are a “cure-all” for everything from senility to impotence. There is the alarming prospect of people relying upon self-diagnosis and self-prescription of iron without their having been warned of some of the possible consequences of its use. Such symptoms as fatigue, lethargy, dizziness and loss of memory could as much be signs of iron overload as of iron deficiency. Prompted by commercials depicting the glow of youth and the physical well-being promised by the media, many desperate people will resort to vitamins and for some of them — as already stated — iron supplements could prove fatal! It should therefore be of some concern that few salespeople in health food stores are competent to decide who needs iron and who does not.
Before I go any further I must make it clear that my concern is not about foods naturally high in iron. I am talking about "added" iron, the fortification of food, for whatever reason. Non-heme iron, found in plants like the iconic iron source, spinach, is tougher for the body to extract and use; estimates are that only 10 to 15% of the iron can be absorbed, while "heme-iron," or iron bound to the plate-like heme structure found in hemoglobin is readily absorbed by the body, and it this form of supplementation that bothers me.
“Reduced Iron” — A Rose by Another Name, But With the Same Thorns
Unfortunately, in this day and age, it is virtually impossible to maintain an iron-free diet, and trying to do so would be extremely stressful. “There’s iron in nearly everything I buy at the grocery store!” one woman complains. She’s not mistaken. Olives are blackened with ferrous gluconate in what is virtually rusty water, and red or orange tablets are coloured with iron oxide. Every cereal contains iron. All wheat products are routinely fortified and, to make matters worse, many manufacturers add extra iron — which sells the product to more people. Only frantic folk, faced with the dilemma of avoiding iron could sympathize with the woman who, overjoyed at finding cookies that were evidently safe for her husband to eat because they were “iron reduced,” had to discover that what the label did, in fact, state was that the product contained “reduced iron.” She was feeding him iron in a form which is more readily assimilated!
Can There Actually Be Metal in Some Foods?
Sure! In cereals. I use as a good example the interesting question posed by the Fun Lab at the California Science Centre, under the headings “Do It Yourself” and “Nutrition/Iron.” It reads as follows: “What's found in the ground and something that you put in your mouth? If you guessed metal, you're right!” An explanation follows. “Many vegetables, meats, and cereals contain iron, which helps to build blood cells and helps your cells to carry oxygen throughout your body.” Directions for the experiment are then provided and labelled as “Activity 3: Metal in Your Mouth.” They read as follows: “In order to participate, the following items are necessary: A box of Total cereal, a dinner plate, a Zip-lock bag, water, and a strong magnet (such as a neodymium magnet).”
If the instructions are carefully followed, the amateur scientist who is rewarded by the discovery of iron particles adhering to the magnet will undoubtedly find this exciting, but to people predisposed to developing hemochromatosis — the most common genetic disease of all — it is scary. For them the possible intake of too much iron, and enhanced absorption of it, is life threatening. Consider the fact they have to be bled on a regular basis just to try and maintain at a safe level the amount of iron already stored in their bodies.
The Suggestion That There is No One Who Will Not Benefit from Supplementation is Irresponsible
There appears to be a tremendous lack of responsibility on the part of sports writers and other individuals who promote iron as the key to performance, health and beauty, without modifying their statements. The very expression to “pump iron” suggests a connection between the mineral and strength, and an article which appeared in a travel magazine some time ago, under this seemingly innocuous heading, went as far as to suggest that there is no one who will not benefit from supplementation. An earlier story which had featured an interview with a doctor of sports medicine at a prominent university brought a spate of protest from hemochromatotics.
The doctor was quoted as saying that that an iron supplement was the only realistic treatment for a condition characterized by “a definite lack of performance, frequent injury and fatigue,” and because that was not all he had said, while being specific in his statements, those who voiced concern did so on the grounds that, since there was already a temptation among some sportsmen to resort to steroids, there was a grave risk attached to the suggestion that the intake of iron would magically change an under-performing athlete into an Olympic star. Surprisingly, when I later telephoned the doctor in question, he was in complete agreement. He would never dream, was his assurance, of prescribing iron for anyone without preliminary tests! One can only hope that he really meant what he was saying for, as William H. Crosby, M.D. had written years earlier, “The diagnosis of Hemochromatosis is easy. It requires the demonstration of increased amounts of iron.” (Arch Intern Med — Vol 146, June 1986).
I personally found it reassuring when, in more than one centre, medical societies passed resolutions to have government agencies consider making it mandatory for over-the-counter iron pills and dietary iron supplements to carry a warning label; one stating that chronic daily use of extra iron is a hazard to individuals with HH.
Absorbing Iron from Every Conceivable Source
As before said, and despite talk of “carriers,” one does not “catch” it, and although it may sound like it, it is not a blood disease. Hemochromatosis, which is caused by an overload of iron in the body, is primarily an hereditary condition, an “inborn error of metabolism.”
Some people find it easier to understand the analogy of a fridge with a faulty thermostat — one that keeps on freezing even when everything inside it is frozen. Normally the absorption and excretion are controlled by the body, but hemochromatotics lack that ability and consequently keep absorbing iron from every conceivable source. Although this is not technically correct, I like to think of the HH “fault” as a “ferrostat!”
The disorder only becomes a disease when sufficient iron has been accumulated to cause the complications. It is thus the only inherited disorder of which all the complications are preventable and the only one which is treatable, with the right intervention.
Could Your Cereal Be Giving You Too Much of a Good Thing?
A study investigating the iron contained in breakfast cereals found that some cereals contain more than indicated on the label. Yet many adults would get more than what's listed anyway, because their average portions are twice the standard serving size listed on package labels.
Research by the Food and Drug Administration (FDA), which was published in the Journal of the American College of Nutrition, found that, among 29 different cereals tested, the actual iron content ranged from 80 percent to almost double the listed amount. Whether levels in those cereals are consistently this high would require further research. The recommended daily level of iron intake is based on the iron content of foods, but it is important to remember that some sources are better absorbed than others, which is why many of us get our iron from fortified cereals — to which the mineral has been added in the form of “reduced iron.” In other words, iron in the pure metallic form.
Tea and Orange Juice
There is ample evidence that absorption of iron from individual food items is profoundly affected by the composition of the meal as a whole. For example, egg iron is very poorly absorbed, but the percentage of absorption is greatly increased by drinking orange juice with it. (Disler, P.B.; Lynch, S.R.; Charlton, R.W.; Torrance, J.D.; Bothwell, T.H.; Walker, R.B.; and Mayet, F.: The Effect of Tea on Iron Absorption: Gut. l975, 16, 193–200
(xii) Callender, S.T.; Marney, S.R.; Warner, G. T.: Eggs and Iron Absorption: Brit J of Haem, 19: 657–665, l970) HH patients are thus advised to take their orange juice between meals, as Vitamin C, even in low doses, increases the absorption of iron from food.
The interest in tea was aroused during a study of the absorption of iron from cornmeal porridge served with sugar containing ferrous sulphate and ascorbic acid. When tea was drunk with the meal, the absorption seemed lower than was expected. My husband was a more than willing guinea pig in this experiment.
One of the greatest moments in my life came when I was invited to attend the first World Health Organization conference on the “Prevention and Control and of Hemochromatosis” in 1991, and was able to report that Canada had not only followed the example of South Africa in making possible the acceptance of blood from well-screened people in the prophylactic and maintenance stages of HH — so that blood from phlebotomies (blood-lettings) would not be wasted — but also that Consumer and Corporate affairs Canada had been persuaded to take the necessary steps to change misleading “reduced iron” labels on food packages.