Let's talk Iron
and iron overload.
Occasionally we get questions about iron or see discussions on line about iron. In this post we’ll focus on the topic of iron overload.
What is the function of iron in the body?
Most body iron is in
- hemoglobin, the oxygen carrying component of red blood cells, and
- ferritin, the protein that binds to iron and acts as a store of iron in the blood and in cells.
Iron is essential to carry oxygen for use by the body and also is involved in muscle contraction. Low iron levels results in low hemoglobin levels and a condition known as iron deficiency anemia. The main symptom of iron deficiency is fatigue. Vitamin mineral supplements often contain iron as one means of preventing low iron.
What is iron overload?
Iron overload, also known as hemochromatosis, is an accumulation of iron in the body to abnormal levels.
In iron overload, there is so much iron that there is more than can be held in the blood in hemoglobin and ferritin. The excess iron is deposited in other cells and body organs.
Is it hemochromatosis Common?
No, it isn't very common, although incidence varies somewhat by location and ancestry. In general, lack of iron is a greater public health problem than iron overload - that's why flour has been enriched with iron for many years.
What causes iron overload?
The two principal causes of iron overload are hereditary hemochromatosis, a genetic error of iron absorption, and repeated blood transfusions.
Less common causes include certain severe chronic anemias such as thallasemia, congenital atransferrinemia, congenital aceruloplasminemia, and shunt hemochromatosis (a shunt or connection between portal and systemic venous systems that occurs spontaneously or from surgery to relieve bleeding in the esophagus).
What happens in hereditary hemochromatosis?
Hereditary hemochromatosis is a disturbance in normal iron absorption.
Humans lose about one milligram of iron per day through sweat and shedding of skin, hair and intestinal cells. Women who are menstruating or breast-feeding lose another milligram per day. We absorb enough iron from food or supplements to replace the lost iron but not more because the absorption mechanism controls the amount of iron based on blood levels of iron – iron absorption goes up when blood levels are low and goes down when blood levels are high.
But in hereditary hemochromatosis, an inherited genetic mutation interferes with production of a protein called HFE that regulates iron absorption. This effectively takes the ‘brakes’ off, allowing iron absorption even when blood levels are high. Over a number of years as iron accumulates, it begins to deposit in body cells. As iron deposits increase, they may cause darkening of the skin, cirrhosis (scarring) of the liver, reduced insulin production and diabetes, heart problems and impotence. Because this can process can take years, the problem may not be detected until a person is in their 20's.
How common is the hereditary hemochromatosis genetic mutation that causes iron overload?
The gene mutations associated with hereditary hemochromatosis are relatively common in non-Hispanic Caucasians in the US (about 9%) and less for other races, but the mutations are autosomal recessive. That means an individual needs to inherit the gene from both father and mother for disease to result. That reduces the percentage of people with both genes considerably, to an estimated 0.5%.
Even a person with both genes may not develop iron overload – penetrance is the technical term for the rate of a disease occurring in people with genes associated with that disease., For hereditary chromatosis, penetrance is <50%, and possibly as little as 1% of people with the mutation developing laboratory or other signs of overload. A retrospective analysis of blood samples taken from over 4000 subjects in a study conducted by the CDC (Center for Disease Control) reported elevated iron stores in 0.3% of non-Hispanic Caucasians, 0.06% of non-Hispanic African-Americans and 0.03% of Mexican-Americans.
Of course, an individual’s likelihood of inheriting the gene mutation is greater if anyone in their family is known to have been diagnosed with iron overload. It is also true that, while the large majority of iron overload cases occur in people with the 3 known gene mutations, some cases occur in people who do not have one of the known mutations. This may indicate there are other unrecognized mutations or other factors that affect iron absorption.
Can a person be tested for hereditary hemochromatosis gene mutations?
It’s possible to take a DNA sample and determine whether a person has the mutations that could lead to iron overload. However, because not everyone with the mutations goes on to develop symptoms, it makes more sense to do blood testing for iron overload. The blood tests are serum ferritin, serum iron, TIBC (total iron-binding capacity) and serum transferrin saturation.
Can people who do not have hereditary hemochromatosis develop iron overload from eating iron-enriched foods or taking supplements?
Generally, no, although it may be possible. The body tightly controls iron absorption, so as iron levels rise, less ingested iron is absorbed. People who do not have hereditary hemochromatosis or one of the rare anemias are very unlikely to develop iron overload from food or supplements.
For people with normal iron absorption, calculations show that even taking 240 mg per day of iron for many years would not result in iron levels found in people with hereditary hemochromatosis. There is some debate as to whether liver disease can cause iron overload.
Who should take iron supplements?
People who have conditions that increase iron loss or reduce absorption may develop iron-deficiency anemia, which can be corrected with additional iron. Some medical conditions that can increase iron loss are
- Heavy, long, or frequent menstrual periods
- Cancer in the esophagus, stomach, or colon
- Esophageal varices
- Prolonged use of aspirin, ibuprofen or arthritis medicines
- Peptic ulcer disease
- Ulcerative colitis
Conditions that can reduce absorption of iron from diet are
- Crohn's disease
- Celiac disease
- Gastric bypass (weight-loss) surgery
- Heavy use of antacids that contain calcium
Why do FORVIA Tablets and Chewables contain iron?
FORVIA products were designed for people with malabsorbing conditions, like Crohn’s disease, ulcerative colitis, celiac disease or prior weight-loss surgery. These conditions can put people at risk for iron deficiency anemia and other nutritional deficiencies. Iron-deficiency anemia is one cause of fatigue. FORVIA was designed to provide the vitamins and minerals, including iron, that are most often deficient in malabsorbing conditions.
FORVIA Tablets and Chewables are high potency and are intended for use under medical supervision. As always, it’s best to discuss any non-prescription medications or supplements with your doctor or dietician.
New technological advances have made it possible to inventory and define the kinds of bacteria inhabiting our gastrointestinal tracts. Medical researchers have long realized that the bacteria in our digestive tracts likely affect our health, including gastrointestinal diseases, but have not been able to learn much about exactly what those bacteria are. The new techniques are allowing researchers to investigate factors that affect the bacterial population.
Recently I had the chance to meet with Dr. Robert Baldassano of the Children's Hospital of Philadelphia. Dr. Bob, as some of his patients and their families call him, is a gastroenterologist with particular interest in Inflammatory Bowel Disease. He is an active researcher and has a number of publications to his credit. Dr. Baldassano participated in a study published last year that looked at how diet affects intestinal bacterial populations. We talked about his research - here's a part of that discussion:
Director, Center for Pediatric Inflammatory Bowel Disease
Colman Family Chair in Pediatric Inflammatory Bowel Disease, CHOP
Professor of Pediatrics, Perelman School of Medicine at the University of Pennsylvania
Q: Dr. Baldassano, I know you’ve published research on something called the “intestinal microbiome” – could you please describe what the intestinal microbiome is for our readers?
A: The population of bacteria that each of us harbors in and on our bodies is known as the human microbiome. The intestinal microbiome is the name for the population of bacteria in the gastrointestinal tract. Up until very recently we had only limited knowledge of the identity and range of those bacteria because of the difficulty in keeping samples of those bacteria alive long enough to study and identify. So, we had relatively little information on the number, kind and variety of bacteria inhabiting the human gut, or whether there were differences between people or within the same person over time. Because of changes in technology, it’s now possible to study the biome not only in the intestinal tract but other areas of the body as well. The Human Microbiome Project1 was established in 2007 by the National Institutes to coordinate research into the biome.
Q: What technological changes have made it possible to better study the biome?
A: Two things – first, the advent of rapid gene sequencing and second, the brilliant work of a University of Colorado scientist named Rob Knight2. Dr. Knight developed computer algorithms that for the first time permitted efficient low cost identification of bacteria and classification of those bacteria by their degree of relationship to each other. Dr. Knight’s innovation allows us to examine the range and makeup of the biome for the first time, and it’s staggering.....
When Venus aligns the Sun
If you haven't heard, there's an unusual and exciting event happening in the sky above you this Tuesday, June 5, 2012. It won't happen again until 2117!
It's the Transit of Venus, when the Earth, Venus and the Sun align and it's possible to watch Venus cross over the orb of the Sun. Here in Philadelphia the Transit begins about 6:05 p.m., a very civilized hour as astronomical observing times go. The Transit occurs at different times of day depending on your location, so if you'd like to see it, check your local times.
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What does the Transit of Venus look like? It will appear as a black dot crossing the Sun.
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How long does it last? The Transit is 6-7 hours but may not be visible the whole time where you are.
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What is the best way to watch? Looking directly at the Sun is not safe unless the light is filtered through dark lens or through a pinhole. Here's a YouTube video on how to modify binoculars to watch the Transit by Derek Pitts, chief astronomer at the Franklin Institute.
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Why was the Transit important to scientists? The Transit of 1769 provided the chance to calculate the distance of the Earth to the Sun by using geometry. Taking observations of the Transit from widely separated points on Earth of known distance apart was key to the calculation. Accurate measurement of the distance to the Sun meant being able to use that to measure distance to other planets and the size of the solar system.
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Who was involved in the world-wide observations? The quick answer is several hundred. Expeditions were sent by many countries like England, France, Sweden and Russia to locations from Siberia to Hudson's Bay to Tahiti and India. All the leading scientific organizations and names were involved.
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Were Americans involved? Yes, the East Coast of the US was a good location for observation of the 1769 Transit. It was the first chance for Americans to participate in a world-wide scientific event and show the Old World what the New World scientists could do. FORVIA's home town of Philadelphia represented the American colonies in this world-wide scientific effort, including people like Benjamin Franklin and David Rittenhouse, who later became the first director of the US Mint.
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Is observing transits still important in exploring the skies? Yes! But now we have better techniques than sending people to Siberia with a telescope. The Kepler satellite in Earth orbit scans distant stars to watch for transits across the face of those stars. If a transit is detected it indicates that a star has planets in orbit around it and stars with planets have been detected by the Kepler satellite.
Hope you get the chance to watch!
Yesterday I got a note from Charlie, an acquaintance from our Church. He wanted to let me know he was 'retiring' from organizing the ushers each Sunday. Charlie is a fixture at St T's. I first became aware of him as the kindly man who always had root beer candies in his pocket to calm restless children during services. Over the years I got to know a little more about Charlie - I got to know he ran the usher program and I got to know he had a slight limp and I got to know he never complained about his leg or any other ailment.
And one other thing I got to know about him was, he sometimes wore a small metal pin in his lapel - a Purple Heart award ribbon. You see, Charlie is a Korean War vet and was wounded there.
This Memorial Day I thought about Charlie and the veterans I know and served with. Then I thought about the ones who didn't come home. Our flags were put out as usual on Memorial Day, the big one hanging from the garage and smaller ones at the mailbox and along the drive. But surveying the sight of those American flags, I paused longer than usual to reflect on Memorial Day's meaning, then quietly saluted those like Charlie who've shed their blood, especially those who gave their lives, for our freedom.
Thank you, Charlie, for reminding me what's important about Memorial Day.
Sincerely,
Timothy R. Russell
LTC, USAR (Retired)
Inovera Bioscience employees volunteered and Team FORVIA walked at last Saturday's CCFA Take Steps fund-raiser for Crohn's and colitis. Manager Suz Rostron took a lot of pics of the fun. The weather couldn't have been better, all the kids and adults were having a great time and the many teams walking raised a lot of $$ for IBD (Crohn's disease and colitis) research. Hot dogs, cotton candy, Philly soft pretzels - hey, doesn't get any better than that! Check out these pics (more from the day can be seen here )
Take Steps and Team Challenge are fun ways to help. Check with your local CCFA chapter for events in your area if you'd like to participate.
The internet is a great way to get information on any subject and there are lots of sites with information on IBD (Inflammatory Bowel Disease) - sites from e-medicine to WebMD and Wikipedia and of course the FORVIA website (http://www.inovera.com/forvia/). That's helpful in getting background information but nothing beats the opportunity to meet experts and ask questions. Patient Education Days have the latest information presented by specialists plus the chance to ask questions and meet other people sharing the same interest. IBD Patient Education Days are sponsored by local Crohn's and Colitis Foundation Association Chapters and are often held in area hospitals once or twice a year. These are typically on a weekend morning and address topics like current treatments for Crohn's disease and ulcerative colitis, pregnancy and fertility issues, and dealing with chronic illness as an adolescent or adult. Besides presentations from physician experts, there are information tables for product and support organizations, as shown here where Chris from Inovera talks to Brenda Greene of the Delaware Valley CCFA Chapter about an upcoming Take Steps benefit walk in Philadelphia (see below for more on Take Steps!). Information on Patient Education Days is available on-line at the CCFA web site for chapters around the country (http://www.ccfa.org/chapters/services?LMI=8.4).
INOVERA attended two area Patient Education Days recently at Nemours/Alfred I. DuPont Children's Hospital in Wilmington and Thomas Jefferon University Hospital in Philadelphia. Interacting with people seeking information on IBD and on FORVIA products was great, talking about our product and answering questions about how FORVIA products might be helpful in addressing their nutritional needs. It was nice, too, to connect with a number of existing customers who were gracious enough to introduce themselves and let us know their experience with FORVIA.
We learned a good deal from them, too, and took note of their questions. Look for us to address some of those questions in a future blog post and a downloadable white paper on our site.
PS - Going to Take Steps in the Philadelphia area May 19th? Stop by the Take Steps walk registration booth that afternoon and say hello - Inovera employees will be working the booth on the Benjamin Franklin Parkway at the Art Museum!
A research study published October 12th in the Journal of the American Medical Association compared four groups of men taking daily doses of either selenium, Vitamin E, both or placebo (sugar pill) over several years. The group taking only Vitamin E had a statistically significant increase in incidence of prostate cancer compared to the placebo group, but not the groups taking selenium alone or both selenium and Vitamin E. The authors concluded "Dietary supplementation with vitamin E (statistically) significantly increased the risk of prostate cancer among healthy men."
News reports often hit the basics but leave out important information. If you take FORVIA Tablets and Chewables, here's some important information about the study and FORVIA:
- FORVIA Tablets and Chewables contain both selenium and Vitamin E and the study group that took both selenium and Vitamin E did not show a significant increase in incidence of prostate cancer .
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The dose of Vitamin E in the study was more than 2 1/2 times that in FORVIA Tablets and Chewables - 400 IU (International Units) in the study compared to 150 IU of Vitamin E in FORVIA.
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The study was limited to healthy men over 50 without conditions such as Inflammatory Bowel Disease or surgery that affect absorption of Vitamin E, while FORVIA products are intended for people with these conditions. People with malabsorption can have difficulty absorbing the fat-soluble vitamins A, D, E and K and are at risk of vitamin deficiency. Vitamin E deficiency can affect vision and cause ataxia (motor disruption such as tremor) and other problems.
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If you have concerns, consult your personal physician - he/she is in the best position to judge your individual medical situation.
For a summary of the study, click
http://jama.ama-assn.org/content/306/14/1549.
For more information on FORVIA products, go to www.forvia.com
Answer: Recommended amount of daily Vitamin D is up.
Most people know adequate Vitamin D levels are key to calcium absorption in the body for strong bones. The Recommended Daily Allowance (RDA) has been 5 micrograms of cholecalciferol (equal to 200 International Units of Vitamin D) for years. Recently, though, the Institute of Medicine of the National Academies of Science recommended a higher RDA for Vitamin D. The new RDA for most age groups is 600 International Units.
The old RDA was conservative (it's a good thing to be conservative about what to put in your body!) and also based on the expectation that most people would get Vitamin D from sun exposure (humans convert sunlight to vitamin D in skin). More people working indoors and using sunscreens outdoors (another good thing!) means less 'solar power' while research has indicated higher levels of Vitamin D are safe and helpful.
FORVIA Tablets and Chewables provide 800 IU of Vitamin D per day and Forbones calcium diphosphate supplement with Vitamin D provides 400 mg of non-carbonate calcium and 75 IU of Vitamin D per tablet.
