Iron Overload (Hemochromatosis)

Iron overload, medically known as hemochromatosis, is an inherited metabolic disease in which the body absorbs too much iron from food. Normally, the body recycles iron from old red blood cells and absorbs new iron when its reserves are low. In hemochromotosis, this natural control goes awry, and the body both recycles its own iron and extracts more from food. Eventually, deposits of iron in many of the body's organs and tissues become dangerously high, resulting in possible diabetes and damage to the heart, liver, pancreas, joints, and testicles. Congestive heart failure is a leading cause of death among people with hemochromatosis.

Symptoms rarely appear before age 20 and are observed most commonly between ages 40 and 60. Manifestations include chronic fatigue, aching joints, gastrointestinal pains, jaundice, an enlarged liver, and cardiac arrhythmias. Many people also develop abnormally ruddy skin, especially on the face.

About one person in 10 carries the responsible gene, but to develop the disease, a person must inherit it from both parents, who may themselves be asymptomatic carriers. Hereditary, or primary, hemochromatosis is far more common than previously thought, affecting more than 1 million Americans. Men outnumber women five to tenfold; this is attributed to the fact that women lose iron periodically through menstruation or pregnancy.

Diagnostic Studies and Procedures

Too much iron in the blood can be verified through blood tests and a liver biopsy, which will reveal the excessive iron deposits. A liver specimen is obtained by means of a thin, hollow aspiration needle.

Unfortunately, the disease often goes undiagnosed until it causes widespread damage, because early symptoms are easily mistaken for those of rheumatoid arthritis, hepatitis, or heart disease, and doctors often order extensive tests for these other diseases. With increasing awareness of hemochromatosis, however, a number of diagnostic laboratories have added a screening test for high iron levels to their list of routine blood studies. Patients who are experiencing symptoms of mysterious origin, or are visiting a doctor for a routine checkup, should request this blood test.

Medical Treatments

The only effective treatment is bloodletting, or phlebotomy. In times past, this procedure was widely practiced to treat a variety of ailments, often with disastrous results. With the advent of more effective treatments, bloodletting was deemed a form of quackery, so today, many patients with iron overload are skeptical when their doctors prescribe it. But removing a pint of blood once or twice a week for several weeks usually brings iron levels down to normal. More severe cases may require removal of larger amounts over two or three years. (The blood can be donated to a blood bank if the patient has no blood-borne diseases.) Bloodletting is then repeated from time to time whenever it's necessary.

In most cases, bloodletting therapy can reverse some heart damage, reduce the size of the liver and spleen, and return liver function to normal. Drugs may be prescribed, depending upon manifestations of the iron overload. For example, deferoxamine (Desferal) is prescribed to remove excessive iron in patients with severe heart disease.

Alternative Therapies

Nutrition therapy is an important adjunct to medical care. People who are genetically predisposed to conserve iron should consult with a clinical dietitian or qualified nutritionist, who will design a diet that incorporates substitutes for high-iron foods, especially red meat, liver, egg yolks, and cereals fortified with iron. Persons with iron overload should also avoid vitamin C supplements, which increase the body's iron metabolism.

Self-Treatment

Read all food labels carefully, and avoid products, especially cereals and breads, that are fortified with iron. If you are taking a daily multiple vitamin, make sure it does not contain iron. Check with your doctor to ascertain that other supplements are safe.

Other Causes of Iron Overload

Frequent blood transfusions, liver disease, or prolonged and excessive intake of iron supplements can result in iron overload without the inherited gene.