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From: sbharris@ix.netcom.com(Steven B. Harris)
Subject: Re: Beef, iron, wine tonic
Date: 16 Apr 1997
Newsgroups: misc.health.alternative
In <19970416192900.PAA23067@ladder01.news.aol.com> lindar9874@aol.com
writes:
>Avoid the common problem of iron
>deficiency with our originial iron supplement
>formula. Helps simulate appetite and
>fight iron deficiency anemia.
>http://members.aol.com/lindar9874
>Linda Ringor
>lindar9874@aol.com
>Watkins Products
The problem of iron overload (often caused by the hemochromatosis
gene, one of the most common genetic "abnormalities" in humans) is just
as common as the problem of deficiency, and far more damaging.
Don't treat yourself with any iron tonic until you know your body's
iron status. That takes some blood tests, but they are worth the
money. Remember: your body has no way to dump excess iron you put
into it, the way it does for too much potassium or magnesium. So you
can harm yourself with iron by figuring that if a little is good, a lot
is better. Women of childbearing years, on average, need extra iron.
Everybody else, on average, doesn't. But to find out for sure, you
need to see your doctor.
Steve Harris, M.D.
From: sbharris@ix.netcom.com(Steven B. Harris)
Subject: Re: Beef, iron, wine tonic
Date: 17 Apr 1997
Newsgroups: misc.health.alternative
In <01bc4abf$bffa6b80$31cf2399@three> "Larey J. Kerling"
<L.Kerling@LJKSystems.com> writes:
>I saw an article in our local paper that said the most common form of
>poisoning in children was Iron supplement overdoses. So be sure you know
>what you are doing before you dose yourself or your kids with stuff like
>this.
To be fair, such overdoses in children are accidental, and have
nothing to do with deliberate supplementation by adults. Rather, it's
a toddler getting hold of mommy's ferrous sulfate pills, which look
sort of like M&Ms. This is big problem, because the group of women
who is MOST likely to BE iron deficient, are young, tired mothers with
one or more toddlers. Such women, when given iron pills, need to get
the Clorox lecture: "Think of this as Clorox. Keep it up on the HIGH
shelf WITH the Clorox." Perhaps also with a few graphic descriptions
of the way an acute iron pill overdoses cause the entire lining of
child's stomach to slough off, as a prelude to death from blood loss.
Steve Harris, M.D.
From: sbharris@ix.netcom.com(Steven B. Harris)
Subject: Re: iron supplements
Date: Mon, 13 Oct 1997
Newsgroups: sci.med.nutrition
In <3441F276.7901@netcom.ca> Tom Matthews <tmatth@netcom.ca> writes:
>Lutachris wrote:
>>
>> I was told two blood tests show me to be anemic. I was told my lab
>> result was "16" (thought that was normal...) and that another result
>> was 33.6 (would not tell me the units on this; said normal range is
>> 35-46....)/
>
>More important than the units (because we can guess that), is what these
>numbers are measuring and also are you male or female.
>
>I will guess that the "16" is hemoglobin in g/dl. If that is the case, it
>is excellent, in the upper part of the range for males (13 to 18) and
>right at the high boundary of normal for females (12 to 16).
>
>My guess is that the "33.6" is your hematocrit (red cell % of blood
>volume). In that case, it is low since the normal range for males is 41%
>to 52% and for females 37% to 48%
My guess also. But you can't have a hemoglobin of 16 with a
hematocrit of 33.6; you just cannot cram that much hemoglobin into that
small volume of cells. Won't go (it doesn't matter what size the cells
are-- there is a concentration limit). Generally hemoglobin is about a
third of hematocrit.
>On the other hand, the "16" could be your serum total iron level in
>mcg/dl which certainly would be low since the normal range is 25 to
>170, lower in the range for females than males.
I suppose. Or it could possibly be iron saturation, Fe/TIBC. Which
would put it in normal range.
>> ....lab said 325 mg which sounded crazy at first, but the
>>pharmacist said each tab would supply 105mg elemental iron
>Sounds like an awful lot of iron to me. The RDA for men is 10 mg, for
>women 18 mg. Make sure that you take several hundred mg (preferably, a
>couple of grams) of vitamin C daily with the iron pill.
Comment: this IS a lot of iron. Must be ferrous fumarate. A dose
of 100 mg elemental iron at once is guaranteed to cause nausea in just
about anybody. Even if enteric coated. In any case, it's not
something you want to give somebody you haven't made the diagnosis for
certain
>> ....I stopped taking multi-vitamins (which have about 20 mg) because of
>> the diarrhea...this new prescription pill is "enteric coated" and the
>> pharmacy instructions say "swallow whole, do not crush or break" and
>> the pharmacist said they do not come in any other dosage.
Poppycock. Maybe this brand doesn't, but there are iron pills in
just about every dosage you can think of. A major mistake with iron is
not starting with a low dose, and working your way up to higher ones
(the body gets used to taking iron, but you have to give it a chance).
Things like 100 mg elemental enteric iron tablets ought to be outlawed.
Or maybe I should say that doctors who START their patients on such
things, should be outlawed <g>.
>> These cause me some discomfort. Do I really need to take these?
No. But you might need to take some kind of iron supplement. We
can't tell without more information. Why is it that people posting in
newsgroups wanting medical advice don't include their age and sex? Do
you all think it's unimportant?
>> HMO which issued the prescription has no interest in discussing the
>> situation witrh me!
You get what you pay for in a free market.
Steve Harris, M.D.
From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med.nutrition,misc.health,alternative
Subject: Re: Iron and calcium
Date: 20 Apr 1998 11:09:58 GMT
Penina Freedenberg wrote:
>> Next question: Since I've been megdosing on iron (have to get my
blood levels up before June surgery) I haven't been getting enough
calcium, due to my understanding that calcium prevents iron absorption.
Well, I sorely need the calcium too, so I would like to know about how
long I have to wait between taking iron and eating calcium-rich foods
or taking calcium supplements. Could I eat dairy at breakfast,
approximately 6:45 or so, then a couple of hours later take my morning
iron? Is 2 hours enough or does it have to be more? Does it work the
same on the other end - if I took my iron first thing in the morning
and ate breakfast later, would the iron already be absorbed into my
bloodstream?<<
If you get your iron in the form of heme, you don't have to worry
about calcium. But that means you have to eat liver, liver pills, or
liquid calf liver extracts (I know you've been passing right by them at
the health food store). The "stomach substance" in you Chromagen is
just some snakeoil for B12 related stuff (this is a shotgun
supplement), but there is a product called "Ultimate Iron" by Enzymatic
Therapy (carried by a lot of high end health food stores) which has 250
mg of "liquid liver" per cap, plus some ferrous fumarate. You might
try that. The liquid liver has the iron in heme form, which is well
absorbed and not antagonized by calcium.
In any case, you should be taking iron salts with vitamin C and food
(your Chromogen), and calcium between meals, at night if you get up to
urinate, or when rising (wait an hour to eat). Then start with the
blood pudding!
Steve Harris, M.D.
From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: Take pills together?
Date: 27 May 1998 07:00:28 GMT
In <1998052705513800.BAA25698@ladder01.news.aol.com> dnchorley@aol.com
(DNChorley) writes:
>Given that so much food has iron in it I wounot think it would be
necessary to supplement your diet unless you have a demonstrated
anemia.<
There's fair evidence that many people with iron shortage get
symptoms from low iron BEFORE they get anemic. Probably something to
do with brain energy enzymes suffering from lack of heme.
I really recommend everybody had the appropriate lab tests run to
look at your iron stores. You can be in the 10% who stores too much
iron, or even the 1% who suffers damage there from. Or you can be in
the 5% that is iron deficient anemic. Your gender and age don't always
perfectly predict these things. Everybody really ought to go to a lab
and look. Otherwise, you really can't tell.
Steve Harris, M.D.
From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.life-extension,sci.cryonics,sci.med.nutrition,sci.med,
sci.med.cardiology,misc.health.alternative,allt.health.hemochomatosis,
alt.suppport.menopause,sci.med.pharmacy
Subject: Re: Cardivascular Dangers of Iron
Date: 7 Jun 1998 03:54:30 GMT
In <357922D9.57EA@netcom.ca> Tom Matthews <tmatth@netcom.ca> writes:
>Brian Manning Delaney wrote:
>
>> Tom Matthews wrote:
>>
>> > The American Journal of Epidemiology (1998;147:161-166)
>> > confirms the cardiovascular danger of iron.
>>
>> No, it confirms a _correlation_ between iron-intake and
>> cardiovascular disease, and merely _suggests_ that iron is
>> the culprit. The abstract indicates the researchers tried to
>> control for dietary factors, but one can't do that
>> perfectly. For example, the fat or protein in meat might be
>> the real cause of of the c-v disease, and meat has iron,
>> so.... Tom, have you read the actual article, as opposed to
>> the abstract? Can you tell us precisely how they tried to
>> control for meat-intake?
Brian, the conclusion that iron might not be good for arteries
comes not from a single article, or even a single class of articles.
An example is the strange fact that the risk for heart disease in women
goes up to measurable degree if they have a hysterectomy, even if the
ovaries are left intact. Now, if you can come up with a better and
more natural explanation for this fact than the one we're discussing,
I'd like to know it. I'll use it when arguing on the other side of
this question (no, my mind isn't made up, but it's beginning to look
bad for the Geritol set).
Steve Harris, M.D.
From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: misc.health.aids
Subject: Re: Question about HIV and Polio
Date: 29 Jul 1998 01:10:25 GMT
In <6pkstd$ev2@dfw-ixnews4.ix.netcom.com> gmc0@ix.netcom.com (George M.
Carter) writes:
>holzmr01@mcrcr6.med.nyu.edu (ROBERT S. HOLZMAN) wrote:
>
>>Please provide a reference for poppers or any other drug causing
>>susceptibility to toxoplasma encephalitis or disseminated M. avium infection
>>or PCP.
>
>I don't have a cite for either of these, but one study suggests that
>iron overload significantly increases the risk of TB (not too
>surprising). Generally, I think people should get iron-free multis if
>they're going to use vitamins.
>
> George M. Carter
Iron generally is candy for most bugs, which is why your body
sequesters it so viciously when you're infected (or inflamed, which
your bod assumes is the same). The "anemia of chronic disease" is just
the body doing this over a long period. There's iron, but the red
cells can't get it because the body has it all locked up.
I generally avoid giving ferrous (ionic) iron supplements to
anybody with an infection, since they just raise serum free iron
levels, and cause problems. I knock it into my interns heads that not
all problems need simultaneous treatement. You can almost always wait
until a person has been treated for the acute hospital infection before
you give ferrous sulfate. If they are REALLY anemic, you can give them
heme iron (liver, red meat), or even transfuse. Anything but what the
bugs like.
Steve Harris, M.D.
From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: low iron
Date: 28 Aug 1998 17:00:54 GMT
In <35ff510a.31205134@news.nas.com> DonM@BOGUS.ADDRESS.com (Don M.)
writes:
>Keep in mind that a low blood iron level isn't necessarily
>associated with anemia. When my wife had the low iron level, she
>was not anemic.
No, the low iron level happens FIRST. However, if you have one,
you're on your way to anemia. And it's definiately abnormal in a man.
The barium enema is indicated, especially in someone over 40. I would
do an upper endoscopy first, however, simply because they're easier.
And in a younger man < 40 (especially a smoker) are all that is needed,
very often-- since the cause of bleeding will be found.
Low iron for nutritional reasons in a man is a very rare thing to
find.
There is some evidence that low irons contribute to thinking
problems even before anemia starts. Brain enzymes need iron, too!
Steve Harris, M.D.
>
>Also, I believe that there are many possibilities other than
>celiac disease as possible reasons for a low blood iron level.
From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: Low iron -- is it really a problem?
Date: 14 Mar 1999 08:00:24 GMT
In <36f64ea9.15549597@netnews.worldnet.att.net>
Xiuh+tecuh+tli@World+net.Att.Net (Kolaga Xiuhtecuhtli) writes:
>My GP verified that I'm anemic. My astroentrologist says my GI
>tract is OK. I found an old (five years ago) blood analysis
>which says my iron was low back then too.
>
>Can a person have low iron for no good reason? I'm a man. Will
>taking the iron supplements prescribed (Chromagen) increase my
>risk of a heart attack?
>
>Thanks in advance
First you need to verify that you're anemic because of iron
deficiency this time, also. There are various tests for this, and the
gold standard is that you start making new red cells (which can also be
tested for) a week after you start the iron.
Iron deficiency in a man is pretty abnormal, and warrents a complete
GI workup. If your GI doc has been though you with endoscopy both
ways, recently, you probably have some vessel that bleeds
intermitantly. Which is okay, so long as not a tumor or ulcer.
There is no good evidence that iron supplementation to get your body
stores up to normal increases your chance of heart attack. Moreover,
iron deficiency doesn't just produce anemia-- mitochondria everywhere
in your body, including a lot in your brain, use iron also. There is a
large literature suggesting that low blood iron levels can have odd
mental effects, and cause symptoms from strange food cravings to
feeling cold to slowness of mentation. And this, even in the absense
of significant anemia. Iron deficiency is not a good thing to suffer
from all the time. Take your Chromogen. Get yourself checked every
few months. Get some guaiac cards and some peroxide, and learn to do
the stool blood test yourself. Your doc will show you how.
Steve Harris, M.D.
From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: Low iron -- is it really a problem?
Date: 15 Mar 1999 07:40:04 GMT
In <36ec42c0.7521966@nntp.ix.netcom.com> hhomler@ix.netcom.com (Howard
Homler) writes:
>If your iron is truly low, and you don't have thalessemia, then it is
>a good idea to correct the anemia.
Just to amply here-- where is meant is that if your iron is truely
low and your anemia is not due to thalassemia, it is a good idea to
correct the anemia. Even if you DO have thalassemia, if you have a low
iron level it's a good idea to correct it, as some of the symptoms of
iron deficiency, as discussed, are probably not due soley to anemia (as
seen by the fact that people who do have thalassemia, who may be just
as anemia, don't chew ice or get cold or have mental slowing).
If you do have beta-thalassmia minor (the common and benign one that
looks like iron deficiency), it can be suspected over iron deficiency
on your bloodwork, just because the cells will be smaller than they
usually are for the iron levels you will have, and have more hemoglobin
in them that iron-deficiency cells have, that are generally that small
(the hemoglobin concentration, MCHC, is normal, in other words). The
smear is nearly diagnostic to a hematologist, but on routine path lab
slide readouts, just comes out unusualy junky, with a lot of abnormal
cells noted. Iron won't correct the anemia in that case. If you
happen to be iron deficient also, however, then iron repletion can
alleviate some specific iron symptoms, and may bring up your blood
counts a bit. Finally, you have replete any simultaneous iron
deficiency to really diagnose beta-thal minor accurately, if you're
interested in a definitive answer. Iron deficiency screws up the
hemoglobin A2/A1 ratios used most often to make the diagnosis in beta
thal minor, so the two effects work against each other and the beta
thal A2 levels in iron deficiency people can come out normal when they
should be high. Though for all I know, the hematologists may have a
fancy genetic direct test for some of these things now. I've not been
to medline.
Steve Harris, M.D.
From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: Low iron is it really a problem?
Date: 24 Apr 1999 06:54:35 GMT
In <3720AD96.4D58D107@Mindspring.com> Jim <JDBarron@Mindspring.com>
writes:
>TRIAL iron supplementation is just plain bad medicine. Iron
>supplements can EXACERBATE many conditions in patients of ALL ages.
>Iron supplements should never be used unless a true iron deficiency has
>been established (and that means a FERRITIN test, among other things)
>***AND** the CAUSE of any true iron deficiency has been accurately
>identified.. Many conditions that can cause low iron levels are
>EXACERBATED by iron supplementation without also treating the underlying
>cause (especially chronic infections).
You're not going to accurately identify iron deficiency in a
chronically infected person with a ferritin test. Infection raises
ferritin levels. This is part of the iron withholding mechanism.
The anemia of chronic inflammation (including infection) is
thought to be a mild iron deficiency anemia, on the local level (in the
bone marrow), and due to the iron withholding mechanism working there,
too. So it's not surprising that iron deficiencies in a certain range
of iron saturation values cannot be differentiated as being due to iron
stores deficiency vs chronic inflammation, without directly doing a
bone marrow biopsy. A silly thing to do on the average anemiac child
or young pregant woman, even if the classic microcytosis and
anisocytosis are not there. Better to do a few tests to look for
chronic infection (temperature, sed rate, hand WBC differential, UA),
and give empiric iron if they are normal.
From: jrfox@no.spam.fastlane.net.no.spam (Jonathan R. Fox)
Newsgroups: sci.med
Subject: Re: Low iron is it really a problem?
Date: Thu, 06 May 1999 01:54:43 GMT
On Tue, 04 May 1999 16:14:09 -0400, Jim <JDBarron@Mindspring.com>
wrote:
>It took me about 2 minutes to narrow it down to one of seven articles.
>Unfortunately (probably because NZ is a SMALL country) there were no
>abstracts available and I may have to search between the two local
>medical libraries to get a copy (I cant afford the expense to download
>one. (Being a doctor you probably could do it for free, but what the
>heck.)
>
>I will post it when I get it. Some of us have relatively limited access
>to information and have to work harder to get it.
You don't have to post the abstract. Just the reference -- title,
journal, etc. I can go look up the article myself.
>> >Look, using STRAW DOGS in arguments is just plain nonsense, OK? I
>> >never suggested anything REMOTELY like that, nor did I imply it. I
>> >really don't understand by what twisted chain of "logic" you arrived
>> >at that, so since it doesn't have anything to do with me I won't
>> >address it.
>>
>> You didn't suggest anything REMOTELY like that? Read your own post,
>> quoted above. I will quote it again: "Iron supplements should never
>> be used unless a true iron deficiency has been established (and that
>> means a FERRITIN test, among other things) ***AND** the CAUSE of any
>> true iron deficiency has been accurately identified.."
>
>YOU are the one maintaining that you cannot accurately establish iron
>deficiency without an endoscopy and bone marrow test! I guess that may be
>true if you insist on an unnecessarily high degree of accuracy in YOUR
>interpretation of what I suggested (a degree of accuracy which you
>yourself consider absurd and then use THAT to show that YOUR
>interpretation of what I said is absurd. That's assuming what you are
>CLAIMING to prove. Circular logic, in case you never heard of the
>concept. There are other tests that are more accurate than assumption and
>less accurate that bone marrow biopsy plus endoscopy. But I'm sure you
>know that. So why did you assume that I was referring to them (unless if
>was so you could have a straw dog to knock down.)
Well, you said a true iron deficiency has to be established. You
didn't specify with what degree of accuracy, so I assumed by TRUE you
meant absolute accuracy, which means demonstration of absent iron
stores in the bone marrow. But if you agree then, that the finding of
a microcytic anemia in a breastfed infant which responds in 7-10 days
with a reticulocytosis after starting iron therapy is diagnostic of
iron deficiency anemia, then we will both agree that a bone marrow
biopsy is not needed to establish a true iron deficiency. The problem
is, you said iron therapy cannot be started until the iron deficiency
is diagnosed, so I presumed you would not allow a trial of iron
therapy as a form of diagnosis. Talk about circular logic!
>Gimme a break, already! If you want a REAL discussion, fine. But I'm not
>going to waste time fighting straw dogs. There's no end to that.
Then make up your mind as to whether or not you want TRUE iron
deficiency demonstrated before you can start iron on an infant or not.
>> Well, first, to establish a TRUE IRON DEFICIENCY requires a bone marrow
>> biopsy. After all, microcytic anemia with low iron levels and a low
>> ferritin level could simply be from congenital atransferrinemia,
>> with bone marrow iron overload, no? You have to biopsy the marrow to
>> be sure. Furthermore, you require that the CAUSE of iron deficiency
>> has to be accurately identified. This requires evaluation of the GI
>> tract as part of a complete work-up, even if stools test negative for
>> blood, which requires invasive studies.
>
>Look, I didn't SAY with "absolute" accuracy. The idea was that you need
>to be MORE accurate than ASSUMPTION. The question, as always, is what is
>reasonable under the circumstances and what I was arguing was that BLIND
>ASSUMPTION is clearly NOT reasonable. I said NOTHING about biopsy and
>endoscopy. That's a straw dog, it's NOT what I said, and I don't fight
>straw dogs.
No one said anything about assumption. A microcytic anemia with a
Meissner index suggestive of iron deficiency anemia rather than
thalassemia with a compatible clinical history is enough to diagnose
iron deficiency in an infant without doing a bone marrow biopsy or
even a ferritin test or other iron studies.
>> >If you will BOTHER to actually READ my post I was NOT talking about
>> >anemia in INFANTS (that section was only a brief aside!) I was talking
>> >about anemia IN GENERAL.
>>
>> You weren't?! Read your own post again! You said: "Iron supplements
>> can EXACERBATE many conditions in patients of ALL ages." So "ALL
>> ages" does not include infants?
>
>Learn to READ, OK? The "many" refers to "conditions in patients" not to
>"in all ages". The statement does NOT state that there are MANY
>conditions in EVERY age bracket. You and SH area both cut from the same
>mold - if you don't get the "upper hand" (as opposed to seek the truth)
>in an argument (as opposed to discussion) you both set up a straw dog (by
>attaching a twisted interpretation to something or using an outrageously
>inappropriate metaphor) and then proceed to spread straw everywhere.
>That proves absolutely nothing except that enlightenment is certainly not
>your goal.
Um, OK. Your statement still implies that there exists at least one
condition in all ages. And your entire posting was in response to my
post that your initial post does not apply to infants. I really don't
understand why you went on a big rant about infants in New Zealand
being harmed by iron, and about how there are conditions in "all
ages," specifically in response to my post about infants, and then
turn around and deny you were even talking about infants.
--
Jonathan R. Fox, M.D.
From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: Iron: removal effective for hepatitis, unneeded supplements
harmful
Date: 12 May 1999 07:44:07 GMT
In <37384B06.76BC53E5@Mindspring.com> Jim <JDBarron@Mindspring.com>
writes:
>(reposted as a new thread because of significant change in subject)
>
>A promising "new" treatment for hepatitis is one of the oldest in the
>books: "bloodletting"!
>
>Phlebotomy (the modern form of bloodletting - using a needle) is well
>known to be effective at treating iron overload and PCT. It has recently
>been discovered to be, at the least, a beneficial adjutant therapy for
>hepatitis. (Well iron overload patients have been TRYING to tell doctors
>for decades that many infections spontaneously resolved during phlebotomy
>therapy (even very long standing ones). I guess not that the obligatory
>decades have passed they are now willing to listen). (references &
>abstract below)
>
>The sharp drops in serum ferritin (far in excess of that which could be
>explained by the amounts of iron removed) which often occur during iron
>depletion are, IMHO (and that of others) due to the resolution of liver
>infections made possible by the decrease in the level of iron. I have
>seen no other hypothesis proposed for this common phenomenon.
It is known that hepatitis C infection is made worse by liver iron
overload, and perhaps better even with iron depletion from normal. But
the lilly-livered NIH has been reluctant to fund the necessary studies.
I actually wrote a letter on the matter to Scientific American a few
months ago, when they did a historical article about the yellow fever
epidemic in Philadelphia, and Dr. Benjamin Rush's 18th century
treatment, which was massive phlebotomy. Scientific American opined
that today we "know" that Rush's treatment could not have been helpful.
I wrote to say that we know no such thing. The yellow in "yellow
fever" is jaundice, and the disease is caused by a virus very closely
related to hepatitis C. Given those facts I wouldn't be too confident
that we know bleeding doesn't help acute yellow fever. Stranger things
in medicine have borne out. It's a hypothesis that remains to be
tested, and there is enough circumstantial evidence that it shouldn't
be laughed at until it is, and fails.
They didn't print the letter. Probably thought I was a kook. One
day somebody else will come up with the same idea and they'll try it.
But you heard it here first.
Steve Harris, M.D.
From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: Iron: removal effective for hepatitis, unneeded supplements
harmful
Date: 13 May 1999 07:55:15 GMT
In <7hbvue$12n$1@nnrp1.deja.com> tannert@my-dejanews.com writes:
>Since I have been saying iron is the link to ALL disease.. I may have
>beaten you to it? ;)
Well, maybe, but if so, only in the sense that a stopped clock is
still right twice a day. I know that there are a number of people who
think that iron is the root of all disease, and others that coeliac
disease is, and another group who think most of the world's ills are
caused by mercury fillings and another who figure we noadays most die
from Aspartame poisoning. These are nutty attitudes, all of them.
When the only tool you have is a hammer, every problem looks like a
nail. Beware the person who is convinced they have discovered THE
Simple Answer for a complex set of problems which most of the rest of
the world wrestles with, and on which some of the best minds ever known
have worked, and which is still generally thought to remain unsolved.
That person is bound to be a nut.
That being said, I think it is generally accepted in medicine that
iron is a bad thing in bacterial infections, although it is (to be
sure) generally ID people who most sensitive to the possible harm in
giving iron supplement to acutely infected people. Most of the
arguments are theoretical and from animal studies which it comes to
most kinds of infections, and I have been able to find no clinical
studies which suggest that iron supplements harm people with (say)
acute pneumonia. I cannot even find epidemiology, let alone case
controlled or prospective studies of the matter.
That leaves us in about the same place we are with treating fever in
infection. There are good *theoretical* reasons to avoid antipyrexics
when you can, but the hard evidence for humans is just not there. As
an attending I have to stop my interns and residents from automatically
giving iron to hospitalized anemic iron deficient patients with acute
infections, saying that waiting a few days to treat the anemia isn't
going to make an important difference, and might possibly do a great
deal of harm in somebody in whom a pneumonia or urosepsis can go
either way. But it's very empirical and unsatisfying to have to argue
the balance of a small theoretical chance of great harm against the
near certainty of helping the patient a little (repleting iron ASAP in
somebody who surely needs it). For a patient on the edge of needing a
transfusion, it becomes an even nastier problem, since if you can save
a patient a transfusion you may have done them a lot of good (who knows
what's still in the blood supply we can't test for?) Likewise, the
problem in a chronic-active hepatitis patient with cirrhosis who is
bleeding from varicies, is likely iron deficient, and may
have ascites and be a setup for infection also. Viral hepatitis
is presumably helped by iron unloading for yet other reasons-- iron is
not growth factor for viruses, but presumably causes extra damage to
the immune-damaged infected liver, via free radical mediated secondary
oxidative injury (Fenton reaction, etc).
> The NIH as of February has begun to fund studies of iron . Why
>don't you write up a proposal and PROVE what you believe? If one waits
>for someone else to do it .. it may never get done?
The NIH, which funds only 10-15% of grant proposals, gives grants
only for relatively sure-fire research, to people who have done that
kind of research before. I do not waste my time writing proposals
which don't have a snowball-in-hell's chance of being funded. I've got
my own research to work on.
Steve Harris
From: jrfox@no.spam.fastlane.net.no.spam (Jonathan R. Fox)
Newsgroups: sci.med
Subject: Re: Iron: removal effective for hepatitis, unneeded supplements
harmful
Date: Fri, 14 May 1999 06:23:12 GMT
On Thu, 13 May 1999 17:07:16 -0400, Jim <JDBarron@Mindspring.com>
wrote:
>With the skin infections: when you have an infection that will not heal for
>many weeks, regardless of what you do (topical antibiotics, etc.) or don't do
>and then it becomes inactive within a day or two after a phlebotomy and heals
>within a week and this happens over and over AND many other HH patients tell
>you the same thing AND you read detailed explanations in many articles about
>iron, infection and the IWDM, it may not be absolute proof, but it IS far more
>than a mere guess.
You're right -- it is more than a mere guess at that point. You have
established a temporal relationship. What you had was a skin
condition that resolved with phlebotomy. However, there is much, much
more to be demonstrated before you can conclude that you had a skin
*infection* that resolved from removal of iron in particular. Perhaps
the rash was atopic dermatitis (not an infection) that resolved after
phlebotomy because the bloodletting drained off your excess IgE, or it
resulted in an increase in interferons? I have no reason to believe
that either, but you see it could be presented as an equally valid
theory.
I think the saying recently quoted here that says when all you have is
a hammer, everything looks like a nail, is very pertinent here. Your
particular interest is iron metabolism and your particular medical
condition is iron overload. This does not mean the phenomenon you are
observing is necessarily related to either, however.
--
Jonathan R. Fox, M.D.
From: jrfox@no.spam.fastlane.net.no.spam (Jonathan R. Fox)
Newsgroups: sci.med
Subject: Re: Iron: removal effective for hepatitis, unneeded supplements
harmful
Date: Sat, 15 May 1999 04:40:06 GMT
On Fri, 14 May 1999 13:18:56 -0400, Jim <JDBarron@Mindspring.com>
wrote:
>Frankly, I think this "when all you have is a hammer, everything looks
>like a nail" thing is GROSSLY overused by physicians and prevents them
>from making what might be very beneficial observations. It really seems
>odd when you get in a patient support group and a large percentage of
>patients have been telling their doctors the SAME THING and all of them
>have disparaged their observations with some equivalent of the "hammer"
>thing. We start to wonder: Don't these guys know how to LISTEN? (we
>are NOT wanting you to accept it without question. Just to keep an open
>mind to the possibility.)
I just want to remind you that when you use your experiences from a
patient support group to show how often it seems important symptoms
are ignored, there is an extreme selection bias there. Certainly you
can find a gathering of people in a brain tumor group, for example,
who feel that their doctor seemed to ignore their headaches for some
time before the diagnosis of brain tumor was made. This does not
prove that all patients with headaches should get a CT scan, since the
vast majority of people with a headache do not in fact have a brain
tumor.
Doctors have to use their judgment. This means we have to try to
decide which symptoms are pertinent and which ones aren't. Sometimes
we are wrong, in both possible ways. Some people have a delay in
diagnosis of their brain tumors, and some get CT scans for headaches
when there is no tumor. Likewise, I'm sure you can find plenty of
people outside your support group who had the same symptoms but don't
have the disease.
Since most complaints are benign and self-limiting, it is usually best
to favor conservatism for the ones that lend favorably to this
approach, in my opinion, since all therapeutic and diagnostic
interventions have potential adverse effects. This will indeed result
in delay of diagnosis of many illnesses, and the ones whose diagnoses
have been delayed can gather in support groups and talk about it, for
sure, but remember the selection bias. Far more people turn out just
fine and are spared harmful diagnostic and/or therapeutic
intervention.
Take the celiac guy, for instance. This guy believes that ANY sort of
symptom pertaining to ANY organ system can be from celiac disease. If
he ran a clinic, everyone who came in his office would get antibodies
drawn, no matter what their complaint, and then some would undergo
endoscopy with biopsy. Never mind the cost -- endoscopy is risky.
Would he ever have a patient go to a celiac support group and complain
that he missed the diagnosis? Of course not. But would some of his
patients suffer complications of unnecessary procedures? Absolutely.
We have to try to find the right balance. I agree with your point
that physicians need to keep an open mind to the possibility of any
diagnosis. But we must be careful not to overdiagnose as well.
--
Jonathan R. Fox, M.D.
From: jrfox@no.spam.fastlane.net.no.spam (Jonathan R. Fox)
Newsgroups: sci.med
Subject: Re: Iron: removal effective for hepatitis, unneeded supplements
harmful
Date: Sat, 15 May 1999 04:44:56 GMT
On Fri, 14 May 1999 13:27:11 -0400, Jim <JDBarron@Mindspring.com>
wrote:
>"Jonathan R. Fox" wrote:
>
>> I remember the great Dr. Faith Fitzgerald once commenting on the
>> phrase "anemia of chronic disease." She said it's perhaps more
>> appropriate to say, "I'm too lazy to work up this anemia."
>
>I would certainly agree with that 100% if one used the phrase ACD and then
>STOPPED THERE. It would be essential to identify the disease and treat
>it. (As I have pointed out before, treating an anemia due to a disease
>with iron supplements without treating the disease is a VERY bad idea.)
>
>And, once the disease has been identified, one then would have to ALSO
>address the question of why this disease became chronic long enough to
>cause anemia (or perhaps was it the anemia that made the patient
>susceptible to the disease (iron deficiency also (as well as iron
>overload) hampers the immune system (iron is necessary for some of the
>killing action of macrophages, etc. etc.)
Lead poisoning in children give an interesting example. The usual
explanation for the anemia in lead toxicity is that lead intereferes
with hemoglobin synthesis. But one of our well-known hematologists
here says that it usually starts off as your garden-variety
iron-deficiency anemia, which leads to pica (eating inorganic
substances, a symptom of iron deficiency), particularly for paint
chips and such, which results in lead poisoning. The child then
presents with lead toxicity and anemia, and the iron deficiency is
thus not addressed, when it's what started the whole thing!
--
Jonathan R. Fox, M.D.
From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: Iron: removal effective for hepatitis, unneeded supplements
harmful
Date: 16 May 1999 20:05:20 GMT
In <7hjpsr$vqe$1@nnrp1.deja.com> tannert@my-dejanews.com writes:
>Yes I know who you're talking about and he makes a good superficial
>argument but iron has been linked to all diseases which are associated
>with IBS plus the number of studies which implicate free radicals and
>oxidation as a cause of most disease?
There are no studies which implicate free radicals and oxidation as
a cause of most disease. Get a grip. They are a part of the body's
reponse to damage, and also part of the body's healing process. But
since these have both good and bad effects (depending) it's hardly fair
to declare them to be part of the problem in most diseases, in any kind
of blanket way. Nature (evolution) gave you a certain free radical
level for a reason. Sometimes it's a dumb reason, and sometimes not.
No generalizations are possible, beyond the obvious one that the force
of selection declines with age, so your free radical tone in older
years is probably still that which is appropriate for someone younger.
If that causes a problem, you have a problem.
>Iron oxidizes causes free radicals/oxidation.. destroying
>'anti'-oxidants thereby leaving what MOST nutrition experts saying..
>"You cannot even consume enough food to get the antioxidants you
>need!".. ??
>Something is wrong in Denmark.
Yes, it's called age-specific genetic pleiotropy. Genes that are
good for young men running jumping and fighting, and women having
children, turn out not to be so good when they hit 50 or 60. However,
you should not blame iron for this. It's a much, much deeper problem,
and hemochromatosis is just the tip of the iceberg (or, perhaps, one
pale example of a general problem).
>It is simple 'logic' once one understands the mechanism which the body
>uses to control its' iron usage. It stores a 'set' amount of iron and
>simply absorbs less of a percentage of the iron we take in in our food.
>This food is vegetables/plants.. non-(blood)-heme bound iron.
Wrong. Vegetables have no blood, but every enzyme which uses oxygen
has a heme group. Plants have many such enzymes, and certainly contain
heme iron. Just not hemoGLOBIN iron. And yes, they have iron in
other forms. More of the iron in flesh is in heme form, but the
difference is quantitative, not qualitative. You can't say that plant
products have no heme in the same way you can say they have no
cholesterol (for example).
>Iron being so important to the body it is controlled by 'absorption'
>NOT excretion as is every other nutrient.
Semantic. You excrete iron all the time, as your intestinal cells
slough. The more you have in your body, the more iron you lose this
way (since the cells contain more). Excretion of iron IS a function of
body stores, so natural equilibrium IS maintained, unless intake
exceeds certain limits, and/or there is a genetic predispostition to
over absorption (as there is in perhaps person in 200, which translates
to 1 person in 100 in the population being iron overloaded). While
perhaps 3 people in 100 in the population have iron deficiency anemia.
>Therefore when we eat meat.. heme-bound iron, it being able to bypass
>the iron absorption process, even storing when the body is replete in its
>iron, builds iron stores higher than would *normally* be allowed. Simple
>logic.
You cannot "figure out" biology with "simple logic."
>The iron stores levels would/should be at what a vegetarian not even a
>vegan would be required because iron in cheese is not heme-(blood)iron.
>THEIR iron levels/stores at what WE have decided are ANEMIC are not
>anemic at all but what we have mistakenly understood to be anemic?
Anemia is not defined by iron stores. It is defined by how much
hemoglobin is in your blood.
> Simple logic. I agree anemia must be treated .. but
>once under control the iron stores must be reduced as long as the hgb
>remains above twelve and that number seems to be arbitrary.
It's based on curve norming, much like getting an A or an F in a
college class. It's as arbitrary (or not) as that is, at least.
There are mental changes associated statistically with low iron
levels (not necessarily low hemoglobin levels). Pica, mental slowness,
difficulty with attention, sensitivity to cold, all happen even in some
people who are not significantly anemic.
>Again .. since it has been SHOWN that heme-(blood)bound iron BYPASSES the
>bodies 'normal' process which would DISALLOW the ABSORPTION .. NOT
>excretion as is EVERY OTHER nutrient.
No, nothing of the kind has been shown. Iron is better absorbed as
heme, but once absorbed it contributes to body stores. Those stores
influence how fast iron is removed from intestinal cells which absorb
iron from food. If it isn't removed rapidly, it is lost as the cells
slough.
From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: Iron: removal effective for hepatitis, unneeded supplements
harmful
Date: 16 May 1999 22:53:12 GMT
In <373B45F1.E4FDF64D@Mindspring.com> Jim <JDBarron@Mindspring.com>
writes:
> Get off you pedestal, Steve. Try being a human being for
>awhile.
Hmmm. Are human beings whiney and paranoid?
> You might find out it's a lot better.
What, you mean people will treat me as well as they always treat
you? Thanks, but no thanks. I'm happy with my life. Most days, I
have fun.
>As much of a nut as someone who has to justify any criticism of medicine
>by branding the critic as a nut?
There are many justifiable criticisms of certain aspects of
medicine. There is no justifiable critisism of medicine per se, as an
entire institution. Or American medicine per se. People who think
that old, honored, tried and true institutions are rotten to the core
are generally nuts. Problems these things may have, but in basically
healthy society you don't get to an old, honored, tried and true
institution by being rotten to the core.
>> That being said, I think it is generally accepted in medicine that
>> iron is a bad thing in bacterial infections, although it is (to be
>> sure) generally ID people who most sensitive to the possible harm in
>> giving iron supplement to acutely infected people. Most of the
>> arguments are theoretical and from animal studies which it comes to
>> most kinds of infections, and I have been able to find no clinical
>> studies which suggest that iron supplements harm people with (say)
>> acute pneumonia.
>
>Try Yersinia entercolitica. Try campylobacter. Try entameoba
>histolytica (just a few from memory). Do a search on iron and
>infection. You'll get thousands of articles.
There are not very common infections. Your average hospitalized
patient has a wound/skin infection, urosepsis, or pneumonia.
>Would you consider MIDs and LD-50s 100,000 times lower significant?
>They're there.
And mean nothing without clinical correlation.
>> I cannot even find epidemiology, let alone case
>> controlled or prospective studies of the matter.
>
>There are some things you can't do, for very good ETHICAL reasons, Steve.
Epidemiology. Know the word? And one can do this in either
multiple regression or case control fashion.
Even prospective studies are doable. And since iron supplements are
given to infected hospitalizated anemic patients all the time, there is
hardly an ethical problem with randomizing people who would otherwise
get them, to get them immediately, or with a delay (as part of the
study). Such a study would approach people who had had orders written
in hospital, at the pharmacy level, and the attending asked if he or
she would agree to delay therapy or not, on the toss of a coin. No
ethicist could have a good argument against that, since withholding
iron is NOT standard of care, and all such people would be getting
iron anyway.
>Look up "anemia of chronic disease"
Thanks, I'm well aware of the term.
> You can have anemia due to iron
>deficiency caused by a chronic infection.
Some of this is probably a local marrow-erythroblast deficiency to
be sure, and not a systemic or strores deficiency, but it's not quite
the same pathology as classic iron deficiency. For one thing, it's
milder. Red cells are normally sized and have normal amounts of
hemoglobin. And although there is considerable overlap between the two
mechanisms in people with transferrin saturations between 5-15%, iron
deficiency (depletion of iron stores) very often shows transferrin
saturations lower than 5%, something rarely seen in the anemia
resulting from inflammation.
> In that case, IRON DEFICIENCY
>OR NOT, treating with iron supplements can be disastrous (without
>FIRST controlling the infection). This is not theoretical.
Cite your studies.
>The World Health Organization found that giving iron supplements to iron
>deficient victims of starvation during refeeding caused greatly increased
>death rates. This was because 1) they often had infections (that were
>kept in check by the lack of iron 2) iron deficiency hampers the immune
>system in some ways (macrophages need iron for killing power, etc.etc.)
>3) levels of iron transportation/sequestration proteins were low (due to
>low iron levels) so it didn't take too much iron to over saturate them
>(rendering the IWDM useless.
These are all nice theories. None have been proven. Starving
children in Africa who are dying of diarrheal diseases are not the same
as better-nourished hospitalized patients in the US who are
well-hydrated. One cannot extrapolate one to the other. Furthermore,
the studies even on malnourished children hardly show a clear danger of
giving iron. Here are two that do not. In a quick search I could not
find any that did. So you'll have to cite this WHO study.
Acta Paediatr Scand Suppl 1991;374:141-50
Interactions between infections, malnutrition and iron nutritional
status in Pakistani infants. A longitudinal study.
Javaid N, Haschke F, Pietschnig B, Schuster E, Huemer C, Shebaz A,
Ganesh P, Steffan I, Hurrel R, Secretin
MC
Allama Iqbal Medical College, Lahore, Pakistan.
The interactions between infections, malnutrition and poor iron
nutritional status in infants at weaning ages are poorly
defined. Therefore, four groups of infants from an area with a high
incidence of malnutrition (Lahore, Pakistan) were
enrolled in a prospective, randomized nutritional intervention study.
Between 122 and 365 days of age, the infants from
one community received either a milk cereal without iron fortification
(n = 29), a milk cereal fortified with ferrous fumarate
(7.5 mg/100 g; n = 30), or a milk cereal fortified with
ferric-pyrophosphate (7.5 mg/100 g; n = 27). Forty-four infants
from a neighbouring community did not receive a nutritional supplement
and served as the control group. Calculated mean
daily energy- and protein intake with the cereals was between 259-287
kcal, and 9.6-10.6 g at 12 months of age,
respectively. Mean daily iron intake with the fortified cereals was
between 4.1-5.1 mg at corresponding age. Nutritional
supplementation resulted in significantly lower incidence of
malnutrition and higher weight gain. Incidence of acute
diarrhoea was significantly (p less than 0.05) lower in the
supplemented groups. The infants fed the iron-fortified milk
cereals had significantly higher hemoglobin (mean 10.4 vs. 9.8 g.dl-1)
and serum ferritin (mean 13.3 vs. 8.5 ng.ml-1)
values than the infants fed the non-fortified milk cereals. However, no
differences in the incidence of infections were found
between the supplemented groups. It is concluded that poor nutritional
intake between 122 and 365 days of age
substantially contributed to the high incidence of diarrhoea and
malnutrition in Pakistani infants.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 1957618, UI: 92067468
Scand J Infect Dis 1995;27(4):385-9
Effect of supplementation with an iron-fortified milk on incidence of
diarrhea and respiratory infection in urban-resident infants.
Heresi G, Pizarro F, Olivares M, Cayazzo M, Hertrampf E, Walter T,
Murphy JR, Stekel A
Department of Pediatrics, University of Texas Medical School at Houston
77030, USA.
To address the hypothesis that increased infectious morbidity is
associated with iron supplementation, 783 randomly
selected infants were provided with a powdered full fat cow's milk
(non-fortified group) and 872 with a powdered
acidified full fat cow's milk fortified with 15 mg of iron as ferrous
sulfate (fortified group). All infants were followed from
birth to 15 months of age with a monthly home visit by a nurse who
recorded morbidity occurring during the previous 30
days. At 9 months of age, 15% of infants in each cohort were receiving
breast milk only; data for these infants were
segregated to make the third group. Episodes (mean +/- SD) of
diarrhea/infant/year were 1.06 +/- 1.29, 1.14 +/- 1.37,
and 0.82 +/- 1.04 for the fortified, non-fortified and breast-fed
groups, respectively; the fortified and non-fortified
bottle-fed groups had a very similar incidence of respiratory illness;
2.66 +/- 2.07 and 2.74 +/- 2.24 episodes/infant/year,
respectively. The incidence of respiratory illness for both bottle-fed
groups was significantly higher than that for the
breast-fed group (2.22 +/- 1.84 respiratory episodes/infant/year). We
conclude that for the infants the tested form of iron
fortified milk, which is sufficient to lower iron deficiency anemia,
does not result in an increased incidence of diarrhea or
respiratory illness.
Publication Types:
Clinical trial
Multicenter study
Randomized controlled trial
PMID: 8658075, UI: 96108306
Harris:
>> For a patient on the edge of needing a transfusion, it becomes an
>> even nastier problem, since if you can save a patient a transfusion you
>> may have done them a lot of good (who knows what's still in the blood
>> supply we can't test for?) Likewise, the problem in a chronic-active
>> hepatitis patient with cirrhosi who is bleeding from varicies, is
>> likely iron deficient, and may have ascites and be a setup for
>> infection also. Viral hepatititis is presumably helped by iron
>> unloading for yet other reasons-- iron is not growth factor for
>> viruses, but presumably causes extra damage to the immune-damaged
>> infected liver, via free radical mediated secondary oxidative injury
>> (Fenton reaction, etc).
Barron:
>Erythropoietin and folic acid plus supplemental oxygen. New RBCs
>are formed without any additional iron (in fact, this approach HELPS
>the IWDM
>by pulling iron OUT)
Comment:
Baloney. Erythopoetin plus folate obviously does not work
if you don't have iron anywhere. If you have it and it's sequestered
due to inflammation, EPO sometimes allows use of it, and sometimes not.
When it does, it's slow.
> (Oh God! heresy! Well try it on a patient who
>>could do without a transfusion but might be helped by it and who
>maybe has a compromised immune system make a transfusion more of a
>risk)
Comment:
Heresy, nothing. I've tried it, and it does not always work. My
patients are not young rheumatoid arthritics with a relative EPO
deficiency. They are geriatric and a very mixed set. Even those who
have iron don't always respond to EPO.
From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med,sci.med.nutrition
Subject: Re: Iron: removal effective for hepatitis, unneeded supplements
harmful
Date: 18 May 1999 09:35:30 GMT
In <373F63DF.98040E1B@Mindspring.com> Jim <JDBarron@Mindspring.com>
writes:
>Wrong. While INSIGNIFICANT amounts of iron are lost in skin, sweat, etc.
>they are far less than enough to maintain balance. And, although these
>losses may increase INSIGNIFICANTLY when iron is accumulating (due to
>excess uptake) these increases are far too little to balance any
>increase. They are, technically present but of no practical
>significance.
Iron losses increase by a factor 250% or so between total body iron
contents of 2.5 grams (about average) to 10 times that (typical for
iron storage disease). The regression equation is Loss (mg/day) = .9
(Iron stores in grams)^1/2 + 0.5. Thus, iron loss is proportional to
the square root of body iron stores. You can see this goes from around
2 mg a day in a normal person to around 5 mg a day in somebody who has
25 grams of iron from iron overload.
> ALL texts on the subject state that iron regulation is
>ENTIRELY by the down regulation of uptake when iron stores are
>sufficient.
Well, I guess that the text that comes immediately to hand at home
(Sixth Edition of Goodhart and Shils' Modern Nutrition in Health and
Disease, 1980) is from the Twilight Zone, then. As I read it (pg.
336-337) it says: "The body has a limited capacity to excrete iron....
However, the classical concept that no compensitory iron loss occurs
from the body of individuals with increased iron stores does not hold
up to scrutiny of the experimental evidence. A few estimates of iron
loss in individuals with increased iron burdens have been made and
show that the loss of iron exceeds that of normal persons." [By a
factor of 3 or more, as noted].
>I don't know where you got this idea you seem to have of iron
>establishing an equilibrium this way, but it is flat wrong. Any increase
>in excretion is always FAR less than any increase in uptake. Which means
>that NO decrease takes place. This does not allow for any equilibrium.
>
>Iron regulation is entirely by down regulation of uptake.
You can say this as much as you like and be wrong every time.
Uptake is downregulated according to body stores, via a relationship in
which body iron stores (minus about half the iron in the blood pool, or
1 gram in women) exponentially decrease absorbtion. That factor is
about e^-(0.2(S-1)) where S is stores in grams. For 6 grams it would
be e^-1 which is 0.63 = 63% of the absorption of a person with only 1
gram of iron stored. There is also a decreased absorption with
increasing dose (absorbed iron goes roughtly proportionally to the
2/3rds power of daily dose). All of this results in an essentially
static iron load for every reasonable iron dose in a normal person, so
that after 15 years of use of 240 mg a day, a woman isn't accumulating
iron any faster than after 15 years at 60 mg a day-- the only
difference is that her total body stores by then will be 7 grams
instead of 3 and a half. Goodhart and Shills note:
"As the fraction of iron absorbed decreases and the amount excreted
increases, an equilibrium is established at a level of body iron which
depends upon the dose given."
Now-- since you seem to know what all textbooks say, please quote
from an authoritative one you have at hand, which contradicts the
above. I showed you mine-- now you show me yours.
>There are very strong indications that the current levels of iron in
>the US population are far higher than is compatible with optimal
>health (much the same as our cholesterol levels are).
No, there are not.
>In ALL cases of anemia, good medical practice REQUIRES an accurate
>determination of the ultimate cause (within practical limits (and
>"presumption" does not qualify as a practical limit!))
You can presume to tell me what good medical practice requires
until you're blue in the face. It's just wind.
>(The WHO found that may starvation victims died during refeeding
>when iron supplements were used (in spite of the fact that they WERE
>truly iron deficient. Turns out that in some cases, the
>supplementation has to be done very carefully in order to not
>overwhelm the IWDM.)
Cite the study. At least two other investigations have looked for
such an effect and failed to find it. I have posted these.
>> There are mental changes associated statistically with low iron
>> levels (not necessarily low hemoglobin levels). Pica, mental
>>slowness, difficulty with attention, sensitivity to cold, all happen
>>even in some people who are not significantly anemia.
>
>Sounds oxymoronic to me. You are claiming significant effects but
>stating that the level of anemia is not significant!
That is correct. Iron does more in your body than simply carry
oxygen in your blood. There are numerous iron contraining enzymes
which carry out energy metabolism in many organs, including your brain.
> The only way I see out of that one is to acknowledge that other
>factors additional to anemia affect the symptoms and perhaps you
>should consider THOSE factors to be the "significant" ones rather than
>the borderline anemia (or, more accurately,
>the COMBINATION of the two (or more) to be what is significant.
Why says I don't? Depletion of body iron stores and constitutional
effects often precede significant anemia.
>In that situation you should not address merely the iron, but also the
>other factors.
Not at all.
>You are absolutely 100% dead WRONG here Steve. That would amount to
>DOWN REGULATION of iron uptake which contradicts every text on the
>subject.
Except the first one I pick up. But now you are going to quote from
the first one you pick up. Right?
>You are making guesses and your guesses are NOT accurate.
>JDBarron@Mindspring.com
No. That is what YOU are doing. I am reading. You are blowing
smoke.
From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med,sci.med.nutrition
Subject: Re: Iron: removal effective for hepatitis/link to ALL disease?
Date: 6 Jun 1999 21:36:34 GMT
In <7je963$1p1$1@nnrp1.deja.com> tannert@my-deja.com writes:
Quoting a conversation between myself and Barron:
Harris>>
>>Iron losses increase by a factor 250% or so between total body iron
>>contents of 2.5 grams (about average) to 10 times that (typical for
>>iron storage disease). The regression equation is Loss (mg/day) = .9
>>(Iron stores in grams)^1/2 + 0.5. Thus, iron loss is proportional to
>>the square root of body iron stores.You can see this goes from around
>> 2 mg/day in a normal person to around 5 mg a day in somebody who has
>> 25 grams of iron from iron overload.
Barron
>> > ALL texts on the subject state that iron regulation is
>> >ENTIRELY by the down regulation of uptake when iron stores are
>> >sufficient.
Harris>>
>>Well, I guess that the text that comes immediately to hand at home
>>(Sixth Edition of Goodhart and Shils' Modern Nutrition in Health and
>>Disease, 1980) is from the Twilight Zone, then. As I read it (pg.
>>336-337) it says: "The body has a limited capacity to excrete iron...
>>However, the classical concept that no compensitory iron loss occurs
>>from the body of individuals with increased iron stores does not hold
>>up to scrutiny of the experimental evidence. A few estimates of iron
>>loss in individuals with increased iron burdens have been made and
>>show that the loss of iron exceeds that of normal persons." [By a
>>factor of 3 or more, as noted].
>
>I don't know where you got this idea you seem to have of iron
> establishing an equilibrium this way, but it is flat wrong. Any
>increase in excretion is always FAR less than any increase in uptake.
>Which means that NO decrease takes place. This does not allow for any
>equilibrium.
>
>Iron regulation is entirely by down regulation of uptake.
Harris>>
>>You can say this as much as you like and be wrong every time. Uptake is
>>downregulated according to body stores, via a relationship in which body
>>iron stores (minus about half the iron in the blood pool, or 1 gram in
>>women) exponentially decrease absorbtion. That factor is about
>>e^-(0.2(S-1)) where S is stores in grams. For 6 grams it would be e^-1
>>which is 0.63 = 63% [sorry, that's .37 = 37%] that's more like of the
>>absorption of a person with only 1 gram of iron stored. There is also a
>>decreased absorption with increasing dose (absorbed iron goes roughtly
>>proportionally to the 2/3rds power of daily dose). All of this results
>>in an essentially static iron load for every reasonable iron dose in a
>>normal person, so that after 15 years of use of 240 mg a day, a woman
>>isn't accumulating iron any faster than after 15 years at 60 mg a day--
>>the only difference is that her total body stores by then will be 7
>>grams instead of 3 and a half. Goodhart and Shills note:
"As the fraction of iron absorbed decreases and the amount excreted
increases, an equilibrium is established at a level of body iron which
depends upon the dose given."
---------------------------------------------------
Tannert/Tom
>OK Doc.. hypothetically.. we believe iron is strictly controlled in
>the human body. It is THE most important nutrient in the body.
Comment: no, it's silly to imagine that there is a SINGLE most
important nutrient in a body. As well identify the single most
important component in a car engine.
>Since it is used in the
>most basic of requirements oxygen and blood it is the ONLY nutrient
>controlled by AbSORPTION not excretion.
No, you seem to be having some comprehension problems. There is
abundant evidence that iron is controlled partly by excretion also.
That means the more you both has in it, the faster you get get rid of
it. Not only absorption is affected.
> as is EVERY OTHER NUTRIENT. It has
>NOWAY of being excreted other than bleeding.
You can say it ten times and that will not make you correct.
Hemosiderinuria is one mechanism. There is evidence that levels of
iron in sloughed intestinal cells is not just a function of iron in the
gut, but also total iron body stores. Thus, when these cells are lost
without depleting them of iron, it counts as excretion. It's not just
a failure of absorption.
>Iron is kept in tightly sealed
>basketballs at less than 30% saturation. At this saturation the iron
>is unable to be access to form free radicals or to catalyze randomly.
>Once the iron in this basketball begins to become more full/more
>saturated the iron is known to be able to 'leak' out into surrounding
>areas and to 'interact' randomly. What 'could' the *possible* outcomes
>of this be? Oxidation/free radicals?
A great many more things in biology are possible than actually
happen. You do not base your belief in biology as to what is possible
and what seems aesthetic to you. Free radicals have important good
functions in the body, as well has bad ones.
> Since iron 'competes' with other minerals? Heavy metal toxicity is
>*known* to cause acidosis.
How much? Which metal? What circumstances? As a general
statement this is nonsense. Cite your reference.
> A recent study suggested that all newborns MUST be
>checked for acidosis or there WILL be long term medical maladies!
Cite the study.
> "And we'd better bone our boys up on it!" Iron from 'meat' is KNOWN
>to bypass the absorption mechanism
No, it merely uses another mechanism. One your body is carefully
designed to employ, in order to get more iron.
> Since iron again
>has been shown to be linked to virus/bacter/fungi? Yeast infections?
>Cysts/endometriosis? E-coli.. heartburn?
Who says? Cite your study? I think you are spouting urban myth.
Let's have one paper linking iron overload to say-- fungal infection.
Or endometriosis.
> You seem to know quite a bit about
>free radicals and their implications and therefore you can see that
>what Linus Pauling KNEW.. oxidation in the body is RAMPANT and RANDOM
>and NEEDS to be ATTACKED with extremely high doses of antioxidants????
Linus Pauling forgot that free radicals are important signal
molecules in the body. Block them all and you'd be dead in a day.
Recent trials of using hemoglobin complexed into larger molecules where
it wouldn't leak from kidneys, so that it could be used as a blood
substitute without red cells, had to be put on hold. You know why?
The hemoglobin leaked out of capillaries and absorbed your body's
natural signal molecule called nitric oxide. People's blood pressures
went throught the roof.
Your body's main defense against bacteria and fungi is to kill them
with free radicals like superoxide. Or nasty compounds like
peroxynitrite and hypohalous acids made from superoxide. Shut off this
mechanism with too many antioxidants and you get immune suppression.
Which might be fine if you have arthritis, but not if you're infected.
>He KNEW what just not WHY and BY.. what.?? THIS is WHY I way one CAN
>use logic in biology in THIS case..
It is exactly why we cannot. Linus Pauling had a very simplistic
idea of biology: free radicals bad, no free radicals good. And he was
wrong. Got it? His "logic" failed him. Nitric oxide, a free radical
your body produces, is what makes centers of your brain being used at
the moment get more oxygen and blood to work with. Superoxide is one
of the things that tells white cells where to go to find an infection.
It's the first step in using the oxygen you need to stay alive. Try
seeing free radicals (of which the oxygen you breathe is one) as
something more than the boogie man.
>we KNOW one should NOT have more than a 'set' amount of iron..
>*controlled* by the body and therefore we can say 'well what could the
>outcome be?'.. such as what would the outcome be of having varying
>numbers of 'shotgun pellets' in the body lodged in various organs but not
>being made of lead but.. iron?
The optimal amount of iron for body stores is unknown. It probably
depends on expectation, like the proper number of clothes to have in
your backpack while camping. Why not leave it at that?
Steve Harris, M.D.
From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.life-extension,sci.med
Subject: Re: Wacky Blood Test Results: update
Date: 14 Jun 1999 08:37:18 GMT
In <3764da74.165683603@news.earthlink.net> darrin99@iname.com (Darrin)
writes:
>
>On Fri, 04 Jun 1999 10:04:45 -0400, darrin99@iname.com (Darrin) wrote:
>
>
>>>Darrin wrote:
>>>>
>>>> hello,
>>>> I'm a "healthy" 33 y/o male, who just got back some wacky blood work.
>>>> Could someone tell me what these results mean, before I go back again
>>>> to the doctor? Are these numbers as bad as they look?
>>>>
>>>> WBC 7.7 (normal)
>>>> RBC 5.3 (normal)
>>>> Iron 14 (LO)
>>>> HGB 9.3 (LO)
>>>> HCT 31.5 (LO)
>>>> MCV 59.6 (LO)
>>>> MCH 17.6 (LO)
>>>> MCHC 29.6 (LO)
>>>> Platelet Count 501 (HI)
>
>Well, after a second blood test came back worse than the first, and
>almost showing that I need a transfusion, my doctor believes he's %99
>sure I have an ulcer. I have been having some stomach discomfort for a
>
>few months, but it was relatively minor, and I didn't think much of
>it. Anyway, I'm now taking Prevacid and heavy doses of iron. I go for
>an Upper GI tomorrow to confirm that it is an ulcer.
>Thanks to all that responded.
>
>Darrin's Vegas News and Links
>http://www.angelfire.com/nj/kitaro
It sure looks like you lost all your iron somewhere, though some
direct iron tests are necessary to be really sure. And there aren't
too many other possibilities than a GI bleed in a man. I hope your
doc tested your stool directly for blood. I hope you don't smoke. I
hope you're taking a good multivitamin. The GI tests are necessary for
a number of reasons. Go back, get them done, hang in there. And stay
away from aspirin completely for awhile. Not even ONE tablet. And
don't ever take iron on an empty stomach. I assume you've been told to
stop it a couple of days before your GI tests, at it stains everything.
From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.life-extension,sci.med
Subject: Re: Wacky Blood Test Results: update
Date: 14 Jun 1999 09:24:49 GMT
In <194FF6C38FF8B3AD.BD3B4A7DAC7EF1F3.C0B660F92BDD0CFD@lp.airnews.net>
jrfox@no.spam.fastlane.net.no.spam (Jonathan R. Fox) writes:
>On Sun, 13 Jun 1999 12:26:44 -0400, darrin99@iname.com (Darrin) wrote:
>
>>few months, but it was relatively minor, and I didn't think much of
>>it. Anyway, I'm now taking Prevacid and heavy doses of iron. I go for
>>an Upper GI tomorrow to confirm that it is an ulcer.
>>Thanks to all that responded.
>
>Woah. Can't "heavy doses of iron" worsen gastritis?
>
>--
>Jonathan R. Fox, M.D.
You bet. It's amazing how reflexively people get put on 300 mg of
FeSO4 tid, though. I've seen it happen to middle aged men who came
back from cardiac bypass with nasty green sputum bronchitis and an Hct
of 33. Surely most such men have plenty enough body iron stores (a
gram or so) to replace that quarter blood volume they lost (most men
have enough stored iron to easily replace a third of their blood). And
they surely don't need the iron pills giving them a better chance of
getting post op pneumonia from that bronchitis. And they REALLY don't
need it in that dose-- that's the max dose you give some JW who's dying
with a crit of 15. But it's a reflex. When I suggest they stop for a
week, or not take the stuff at all unless they fail to make up the Hct
in a month, they look horrified. Like they're going to die without the
dang iron.
A guy this anemic and microcytic, of course, probably has no more
iron stores left. He lost his blood chronically, and that's not the
same. But even he's not going to die of anemia while he waits a week
on heavy duty proton pump inhibitors for his upper GI (unless he's
melanotic, in which case he probably needs to be hospitalized, and
scoped pronto anyway). And waiting on the iron'll let them get a
better look at the mucosa, both above and certainly (if it comes to
that) in the colon.
It's a psych thing, of course. Doctors have a really hard time
withholding something they know the patient badly needs nutritionally.
Even if it's not a bad idea.
From: "Steve Harris" <SBHarris123@ix.netcom.com>
Newsgroups: sci.med.nutrition
Subject: Re: Brain cancer in my friend...getting chemo etc....any nutritional
suggestions?
Date: Mon, 23 Apr 2001 13:37:19 -0600
>
> I do agree that iron, like Calories, refined grains and sweets are
> things that are too easy to get in excess quantities in the western
> diet. Fortunately, iron is easy to chelate, I make a point of
> consuming tea with my red meats, as iron is about the only significant
> risk factor with meat that is still problematic.
You're not going to chelate iron in heme-- it's already chelated. And
absorbed better than any other kind of iron. So if you're taking those
chelators to deal with the iron in your meat, you're wasting your money.
Sorry. Suggest you donate blood as often as you can, instead.
From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: sci.med
Subject: Re: ferritin level
Date: Wed, 13 Feb 2002 17:27:50 -0700
Message-ID: <a4f0fl$sne$1@slb0.atl.mindspring.net>
"DMG" <quinn@snet.net> wrote in message
news:jZAa8.999$Aa4.383593487@newssvr10.news.prodigy.com...
> I have been taken iron supplements (2x a day) since Aug and my ferritin
> level (7) has not really gone up at all. All my other levels are now low
> normal. The Dr said he wouldn't think of me getting off iron until my
> ferritin level is at least 50 he would prefer 100, he is even thinking of
> doing IV iron if it hasn't budged in 3 more months. I understand that
> ferritin is a protein that carries iron, I guess what I forgot to ask was
> why it takes so long to get it to go back up.
COMMENT
It's a measure of your body stores, and it's slow to go up if your body
stores take a long time to go up. That's a matter of how well you absorb
iron. Ferritin is not a perfect index of your iron stores-- the gold
standard is a stain of your bone marrow.
There are some tricks you can use to increase iron absorption. You can go to
four times a day (with meals or snacks-- never empty stomach). That will do
better, even if your daily does is the same as now. You can also take 250 mg
of vitamin C (half a standard tablet) with every iron pill. Don't take
calcium supplements with iron.
Maybe the best thing is to get your iron in heme form, which is how it comes
in liver and red meat (and blood pudding if you're English). The mechanisms
for absorbing this form of iron are totally different, and much more
efficient than for the iron in iron pills. I know of nobody who makes
heme-iron pills (alas), but there are a few liver pills on the market. I'm
not sure I'd recommend them due to the raw beef prion problem, but there is
a liquid liver extract which is cooked and which you can cook further. And
of course, you can cook liver itself, if your cholesterol is up to it.
Finally, you can do things to evaluate your blood loss. Where are you losing
all that iron from? If you're a woman can you have fibroids treated? If
it's a GI problem can you have surgery? Where's the blood going?
Oh, BTW, I woudn't let them do IV iron on you. The risk is not worth the
benefit unless you have no gut and no choice.
SBH
From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: sci.med
Subject: Re: ferritin level
Date: Thu, 14 Feb 2002 18:34:39 -0700
Message-ID: <a4hopg$b6g$1@nntp9.atl.mindspring.net>
"DMG" <quinn@snet.net> wrote in message
news:wbWa8.1183$aL.431579286@newssvr10.news.prodigy.com...
> They think I am bleeding from my small intestine (I have had 2
> colonoscopies neg and entercylsis (sp) neg and upper endoscopy neg) they
> just can't find it and I am reluctant to have an angiogram.
See if your nuclear medicine department can come up with something. If
you're bleeding that badly a labeled RBC scan might show approximately where
it is.
> Why not IV iron maybe you could expand on that? And why is it so hard to
> get the iron into your marrow with supplements.
It's not getting it in the marrow that's hard, it's the absorption from your
gut. Try the liver stuff, for the reasons noted.
As for the IV stuff, I spoke out of turn, and (I find with a bit of digging)
that things have recently changed. For the last 25 years in the US iron by
IV has been rather nasty, with 25% side effects, and a life-threatening
reaction in 1 out of 500 people. We killed about 30 people that way in the
last 25 years, and the iron-dextran makers wouldn't even stand behind use of
the product in this way. So it was bootlegged on dialysis units. The advent
of EPO somewhat slowed up US acceptance of much safer European products, but
they have been approved in 1999 and another in late 2000. The 1999 product
is an iron-gluconate in sucrose stuff called Ferrlecit. You still get a
whopping dose of free iron that way, and probably the safer one is the one
just approved a bit more than a year ago, which is called Venofer (it's
iron hydroxide in sucrose, sometimes called simply iron-sucrose). This stuff
doesn't have as much soluble iron, so theoretically should not be such a
risk (bacteria like iron, and it also causes toxic free radicals, so it's
nice to keep it insoluble as much as you can till the liver gets it and
starts turning it into ferritin). Neither of the new products produce the
allergic reactions of iron dextran, which were probably due to the dextran
(a polymer of glucose which has its own problems).
So, I take it back. If the liver doesn't work, go for the Venofer.
SBH
From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: sci.med.nutrition
Subject: Re: just curious what kind of iron is better
Date: Wed, 8 May 2002 13:55:03 -0600
Message-ID: <abbvvd$1rp$1@slb7.atl.mindspring.net>
"Sir John" <Sir John@GetStev.com> wrote in message
news:1QcC8.12090$6T5.1121463@bgtnsc05-news.ops.worldnet.att.net...
> In regards to Runner's Anemia, anyone one can restore their iron levels by
> popping pills in about one week or less.
I'm afraid this isn't true. Body iron deficits for the anemic are a gram or
two, and it's very hard to absorb more than about 30 mg/day from pills (the
required 150 mg elemental iron a day will surely give you GI problems, at
least at first). Divide the first number by the second and you find that
typical oral iron repletion time, working as hard as you can, is around 1 or
2 MONTHS, not weeks. For most people, trying to do it with minimal GI
problems, it's considerably longer than that.
SBH
From: "Steve Harris" <SBHarris123@ix.netcom.com>
Newsgroups: sci.med.nutrition
Subject: Re: just curious what kind of iron is better
Date: Fri, 10 May 2002 03:17:26 -0600
Message-ID: <abg4ik$h1d$1@slb5.atl.mindspring.net>
"Gym Bob" <noney@spam.com> wrote in message
news:ylFC8.99530$KH4.524149900@radon.golden.net...
> 4 days?...bullshit!
> Hemoglobin levels take months to rise since the stores are in bone marrow.
Sigh. Not true, either, since you can mobilize them fast. You can raise Hb
levels as much as half a g/dL a day, ie from 11 to 11.5. This is about 1.5
points of hematocrit a day, or nearly 200 mL/day, which would require
absorbing 100 mg of iron a day (max is about 30, for which you need to take
150).
Take home message is that you can't really absorb iron from pills to make
blood as fast as the maximal rate that you can do it from your own stores.
I'm merely commenting that you can't do is replete the STORES at this rate,
which means also you can't replace lost blood this fast if you don't have
the stores, and are relying on pills.
From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: sci.med.nutrition
Subject: Re: just curious what kind of iron is better
Date: Fri, 10 May 2002 20:01:43 -0600
Message-ID: <abhu83$t03$1@slb7.atl.mindspring.net>
"Gym Bob" <noney@spam.com> wrote in message
news:1TXC8.107073$cI1.535003189@radon.golden.net...
> maybe iron levels but will they drop just as fast when not converted to
> usable forms?
There are two main forms of iron in the plasma (outside the red cells, in
which the iron is in in a third form--hemoglobin). One of the plasma iron
compounds is ferritin. The other is iron bound to transferrin. Tranferrin is
most of the "total iron-binding protein" (TIBC) content of your plasma. The
iron bound to transferrin (which helps make your plasma yellow) goes up
immediately if you take an iron pill-- half life is about 6 hours. It's what
is measured in Fe/TIBC on a lab test. It's why you should not take your iron
pill the day before you have this measured.
The other major measurement (ferritin) is an index of body stores of iron,
so long as you don't have an infection or some other inflammatory process
going on. It's not affected by single doses of iron at all.
We can't talk about iron unless we know which of these three kinds of blood
iron is being looked at.
SBH
From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: sci.med
Subject: Re: cold feet
Date: Mon, 12 May 2003 10:41:35 -0700
Message-ID: <b9omcc$dbs$1@slb6.atl.mindspring.net>
"DMG" <quinn@snet.net> wrote in message
news:I8Bva.5447$%F6.1280501808@newssvr10.news.prodigy.com...
>
> "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
wrote in message
> news:b9mh7v$irh$1@slb6.atl.mindspring.net...
> > Are you taking any new drugs? New sleeping pills?
> >
> No nothing new. I know Jeff said wear socks but wearing socks doesn't
> prevent it from happening and putting them on when it does happen
> doesn't end it. It just seems to come and go. The only thing I know
> that I do have is a low ferritin (5). But I take iron so all my other
> values are normal.
>
> Donna
Ah, but your stores are very low. Low iron storage levels
actually have been reported to cause complaints of cold
intolerance in some people, and these even preceed the
anemia, so that are probably a very early symptom, like the
pica. Perhaps when you get repleted up, your symptoms will
resolve a bit. Further than that, I don't have any
suggestions past the sensible ones about socks you've
already gotten.
From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med.nutrition,sci.med,misc.health.alternative,sci.med.pathology,
sci.med.laboratory
Subject: Re: Iron stores RISE progressively during ageing
Date: 26 Apr 2005 19:40:02 -0700
Message-ID: <1114569602.139739.149220@z14g2000cwz.googlegroups.com>
>Vegetarians have lower iron .. stores ..
>Stores ..
>Stores ..
>They do not have iron deficiency ..
>They do not have iron deficiency ..
============================
COMMENT:
In fact, many do. Very low iron stores are not a good thing, for they
correlate with difficulties in mentation, long before one becomes
anemic. The brain needs iron, too.
1: Ann Nutr Metab. 2004;48(2):103-8. Epub 2004 Feb 25.
Dietary iron intake and iron status of German female vegans: results of
the German vegan study.
Waldmann A, Koschizke JW, Leitzmann C, Hahn A.
Institute of Food Science, University of Hannover, Hannover, Germany.
BACKGROUND: As shown in previous studies vegetarians and especially
vegans are at risk for iron deficiency. Our study evaluated the iron
status of German female vegans. METHODS: In this cross-sectional study,
the dietary intakes of 75 vegan women were assessed by two 9-day food
frequency questionnaires. The iron status was analyzed on the basis of
blood parameters. RESULTS: Mean daily iron intake was higher than
recommended by the German Nutrition Society. Still 42% of the female
vegans < 50 years (young women, YW) had a daily iron intake of < 18
mg/day, which is the recommended allowance by the US Food and Nutrition
Board. The main dietary sources of iron were vegetables, fruits, cereals
and cereal products. Median serum ferritin concentrations were 14 ng/ml
for YW and 28 ng/ml for women > or = 50 years (old women, OW). In all,
40% (tri-index model (TIM) 20%) of the YW and 12% (TIM 12%) of the OW
were considered iron-deficient based on either serum ferritin levels of <
12 ng/ml or a TIM. Only 3 women had blood parameters which are defined as
iron deficiency anemia. Correlations between serum ferritin levels and
dietary factors were not found. CONCLUSION: Although the mean iron
intake was above the recommended level, 40% (TIM 20%) of the YW were
considered iron-deficient. It is suggested that especially YM on a vegan
diet should have their iron status monitored and should consider taking
iron supplements in case of a marginal status. Copyright 2004 S. Karger
AG, Basel
PMID: 14988640 [PubMed - indexed for MEDLINE]
2: Public Health Nutr. 2003 Aug;6(5):485-96.
Risk factors for low iron intake and poor iron status in a national
sample of British young people aged 4-18 years.
Thane CW, Bates CJ, Prentice A.
MRC Human Nutrition Research, Elsie Widdowson Laboratory, Fulbourn Road,
CB1 9NL, UK. christopher.thane@mrc-hnr.cam.ac.uk
OBJECTIVE: To examine the prevalence and dietary, sociodemographic and
lifestyle risk factors of low iron intake and poor iron status in British
young people. DESIGN: National Diet and Nutrition Survey of young people
aged 4-18 years. SETTING: Great Britain, 1997. SUBJECTS: In total, 1699
young people provided 7-day weighed dietary records, of which 11% were
excluded because the participant reported being unwell with eating habits
affected. Blood was obtained from 1193 participants, with iron status
indicated by haemoglobin, serum ferritin and transferrin saturation.
RESULTS: Iron intakes were generally adequate in most young people aged
4-18 years. However, low iron intakes (below the Lower Reference Nutrient
Intake) occurred in 44% of adolescent girls (11-18 years), being less
prevalent with high consumption of breakfast cereals. Low haemoglobin
concentration (<115 g l-1, 4-12 years; <120 or <130 g l-1, 13+ years for
girls and boys, respectively) was observed in 9% of children aged 4-6
years, pubertal boys (11-14 years) and older girls (15-18 years).
Adolescent girls who were non-Caucasians or vegetarians had significantly
poorer iron status than Caucasians or meat eaters, independent of other
risk factors. The three iron status indices were correlated significantly
with haem, but not non-haem, iron intake. CONCLUSIONS: Adolescent girls
showed the highest prevalence of low iron intake and poor iron status,
with the latter independently associated with non-Caucasian ethnicity and
vegetarianism. Risk of poor iron status may be reduced by consuming
(particularly lean red) meat or enhancers of non-haem iron absorption
(e.g. fruit or fruit juice) in vegetarians.
PMID: 12943565 [PubMed - indexed for MEDLINE]
3: Eur J Haematol. 2002 Nov-Dec;69(5-6):275-9.
The impact of vegetarianism on some haematological parameters.
Obeid R, Geisel J, Schorr H, Hubner U, Herrmann W.
Department of Clinical Chemistry, University Hospital of Saarland,
Homburg, Germany.
OBJECTIVE: Subjects adopting a vegetarian diet are liable to vitamin B12
and iron deficiencies. Co-existing vitamin B12 and iron deficiencies may
give an equivocal haematological picture, which may, in turn, delay
making an early diagnosis. The current work was undertaken to investigate
some haematological parameters in relation to vitamin B12 and iron status
in vegetarians. SUBJECTS AND METHODS: Twenty-nine vegans, 64 lacto- and
lacto-ovo-vegetarians, in addition to 20 occasional meat eaters, were
enrolled for this study. The total group included 49 males and 64
females aged [mean (SD) = 46(15) yr]. Complete blood count,
methylmalonic acid (MMA), homocysteine (HCY), ferritin, and transferrin
concentrations and percentage transferrin saturation were assayed, using
conventional methods. RESULTS: Vegans displayed the highest MMA and HCY
levels (median MMA = 708 nmol L(-1); HCY = 12.8 micromol L(-1)). A lower
lymphocyte count and a higher mean corpuscular volume (MCV) were found in
vegans compared with lacto- or lacto-ovo-vegetarians (median = 1.51 x
10(9) vs. 1.83 x 10(9) L(-1); 92 vs. 89 fL, respectively). Vitamin
B12-deficient subjects in the higher range of transferrin saturation
percentage had higher MCV than vitamin B12-deficient subjects in the
lower transferrin saturation range (mean MCV = 92 vs. 89 fL). A lower
platelet count was found in the highest quartile of MMA (mean = 211 x
10(9) L(-1)) and in the highest quartile of HCY (mean = 215 x 10(9)
L(-1)), compared with the other quartiles. Lower lymphocyte and platelet
counts and higher MCV were found in subjects with elevated MMA and HCY,
compared to those with normal metabolites. Factors that explained the
variations in MCV were red blood cell count, ferritin, transferrin
saturation, and methylmalonic acid levels. CONCLUSION: vitamin B12 and
iron status were compromised by a vegetarian diet. Variations in mean
corpuscular volume were determined by iron and vitamin B12 status. Lower
lymphocyte and platelet count were accompanied by metabolic evidence that
indicated vitamin B12 deficiency.
PMID: 12460231 [PubMed - indexed for MEDLINE]
4: Public Health Nutr. 2000 Dec;3(4):433-40.
Risk factors for poor iron status in British toddlers: further analysis
of data from the National Diet and Nutrition Survey of children aged
1.5-4.5 years.
Thane CW, Walmsley CM, Bates CJ, Prentice A, Cole TJ.
MRC Human Nutrition Research, Cambridge, UK. thane@mrc-hnr.cam.ac.uk
OBJECTIVE:: To examine risk factors for poor iron status in British
toddlers. DESIGN:: National Diet and Nutrition Survey (NDNS) of children
aged 1.5-4.5 years. SETTING:: Mainland Britain, 1992/93. SUBJECTS:: Of
the 1859 children whose parents or guardians were interviewed, a weighed
dietary intake was provided for 1675, and a blood sample obtained from
1003. RESULTS:: Mean haemoglobin (Hb) and ferritin levels were
significantly lower in younger (1.5-2.5 years) than in older (3.5-4.5
years) children, with boys having significantly lower ferritin levels
than girls. Poor iron status ferritin <10 microg l-1, or low values for
both indices) was associated with lower socioeconomic and employment
status. Iron status was directly associated with meat and fruit
consumption and inversely with that of milk and milk products, after
adjustment for age and gender. The latter association remained
significant after further adjustment for sociodemographic variables,
energy intake and body weight. Children consuming >400 g day-1 of milk
and cream were less likely to consume foods in other groups, with those
also consuming little meat, fish, fruit and nuts at greatest risk of poor
iron status. Few associations were observed between poor iron status and
individual nutrient intakes, and iron status was not associated with
either iron intake or with consumption of a vegetarian diet.
CONCLUSIONS:: Overdependence on milk, where it displaces iron-rich or
iron-enhancing foods, may put toddlers at increased risk of poor iron
status. However, this becomes non-significant when moderate-to-high
amounts of foods known to enhance iron status (e.g. meat and/or fruit)
are also consumed. Milk consumption in this age group should ideally be
part of a mixed and balanced diet including all food groups, and
particularly lean meat (or other iron-rich or fortified foods) and fruit.
This is particularly relevant for households of lower socioeconomic and
employment status.
PMID: 11135798 [PubMed - indexed for MEDLINE]
From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med.nutrition,sci.med.pharmacy
Subject: Re: calcium and iron
Date: 23 Jul 2005 11:42:40 -0700
Message-ID: <1122144160.541874.39240@g14g2000cwa.googlegroups.com>
Name wrote:
> "ken" <kphifer1934@yahoo.com> wrote in message
> > My primary care doctor has me on calcium/D bid becasue i am lactose
> > intolerant and can't drink milk....But I have iron deficiency anemia
> > and have a problem with low iron absorption - I take iron elixir twice
> > a day..my ferritin is very low (below 20 and my hemoglobin is in the
> > 12's...My hematologist is starting me on IV infusions of iron next
> > week.
> >
> > My question is this - is my taking calcium inhibiting my iron
> > absorption to a signifcant degree?
COMMENT:
You're not going to die or even get sick from a hemoglobin in the 12's
and a ferritin of 20. If I was in your condition I'd sure as hell be
eating fried liver before I'd let anybody shoot me up with iron
infusions. How much money does your hematologist make for that? Does he
do it in his little private chemo clinic and bill $300 for it? Howard,
now don't you start calling me cynical.
And if you're lactose intolerant, why don't you try lactose free milk?
Or take your calcium at lunch? Or stop it completely for a few weeks,
if you're wondering about its effect on iron.
Name:
> It all depends. While there is an antagonism between calcium
> and iron, extra Ca supplementation is not likely to be much of
> a problem if you do in fact need both, just like foods containing
> both minerals generally don't create a deficiency of either one.
>
> However if your doctor simply *assumes* that you need extra
> calcium, but in reality Ca levels are normal or on the high side,
> then an inhibiting effect of Ca on iron may well be taking place.
COMMENT:
What?? Nobody would (or should) assume *anything* about body calcium
status from calcium levels in the blood. The doctor won't, and you
shouldn't either. It's irrelevent.
> Red meat is generally considered the best dietary source of iron.
CORRECT. And if you don't absorb it will from iron elixers (which will
be iron salts) you still may get great absorption from liver, red meat,
and blood pudding. It's a separate iron absorption system.
SBH
From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med.nutrition,sci.med.pharmacy
Subject: Re: calcium and iron
Date: 23 Jul 2005 15:52:29 -0700
Message-ID: <1122159149.775019.150210@z14g2000cwz.googlegroups.com>
Enrico C wrote:
> Why *fried* liver? :)
Boiled or raw is just as good, insofar as iron goes. You like it like
that?
> What about ferrous sulphate (FeSO4) tablets, in case the original poster
> doesn't like liver?
They are not absorbed as well, and certainly would not be any better
absorbed than the liquid he's already taking. The iron in liver, meat,
and blood is heme-iron, and is especially well absorbed.
SBH
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