How to counteract too much iron?

In this brief guide, we will answer the question, “How to counteract too much iron?”. We will further elaborate on the symptoms, causes and risk factors of too much iron. 

How to counteract too much iron? 

If your blood and urine tests have reported high levels of iron, and you are searching for ways to counteract it, do not worry, here we have shared a list of approaches to counteract too much iron in the body. The below-mentioned approaches might help you:

  • Reduction in the intake of iron-rich foods, for instance, red meat
  • Limited consumption of vitamin C with foods that have high levels of iron.
  • A regular donation of blood
  • Limited use of iron cookware
  • Chelation therapy
  • Phlebotomy 
  • Whole bowel irrigation 

Iron toxicity 

Iron is an essential element in a plethora of cellular processes where one-electron transfer reactions are required. However, iron is an intrinsic producer of reactive oxygen species, and increased levels of iron promote neurotoxicity because of hydroxyl radical formation, which results in glutathione consumption, protein aggregation, lipid peroxidation and nucleic acid modification. Neurons from brain areas sensitive to degeneration accumulate iron with age and thus are subjected to an ever increasing oxidative stress with the accompanying cellular damage (1).

An average healthy person who consumes iron solely through the diet does not need to be worried that much. But a person who takes high doses of iron supplements for extended periods, or has taken a single overdose may experience symptoms of too much iron in the body.

Single doses at the lowest possible level i.e., 10-20 milligram/kilogram can result in few symptoms of too much iron. Medical treatment is required at doses more than 40 milligram/kilogram, and any concentration higher than 60 milligram/kilogram can be fatal.

Different ways to counteract too much iron

Dietary changes

The iron that is naturally in the diet, is indicated as ‘native iron’. There are two distinct forms: heme and non-heme iron. Heme iron is only found in poultry, fish and meat, and their derivatives. Non-heme iron is widely present in animal and vegetable foods. In the study of iron absorption it is important to separate these two forms. The bioavailability of the two forms is different which is attributable to a different route of uptake; heme iron is absorbed 15-35% and non-heme -iron is absorbed 5-15%. Therefore, it is advisable to restrict heme iron sources in the diet, such as red meat. Iron fortified food also should be avoided, as well as some types of beer, which contain a great amount of iron (2).

Dietary changes to decrease the consumption of iron can help to relieve many of the symptoms caused by too much in the body. For this purpose, you may need to:

  • Avoid taking supplements containing iron
  • Avoid taking supplements containing vitamin C, as it boosts iron absorption. Vitamin C can make iron (from other foods) better available for absorption and stimulates the release of iron from the cells where it is stored (2).
  • Decrease the consumption of iron-rich foods and iron-fortified foods
  • Avoid consuming raw fish and shellfish
  • Limit alcohol consumption, as it can lead to liver problems 

Phlebotomy

Phlebotomy, or venesection, is a routine procedure to vacate blood rich in iron from the body. Phlebotomy is a procedure that involves drawing blood from the patient, just like blood donation. Its purpose as a treatment is to rid the body of excess iron storage. One therapeutic phlebotomy will remove 250 mg of iron at once (2).

Typically, this will have to be done every week until iron concentration returns to usual. Whenever iron concentration rises again, the individual will need to get the treatment again.

Removing the excess iron by phlebotomy is proposed as the predominant therapy and attention to the prevention of increased iron levels is subject to caution, based on the ‘burden’ that dieting entails (2). 

The amount of blood the doctor takes, and the frequency of the treatment, relies on:

  • the patient’s age and gender
  • the patient’s general health
  • the severity of the iron excess

Doctors may remove 1pt of blood one or two times every week in the earlier stages of treatment. Afterwards, they may draw blood every two to four months. Changes in nutrition can perhaps reduce the number of required phlebotomies (2).

Phlebotomy can not invert cirrhosis, but it can relieve signs, for instance, nausea, abdominal discomfort, and tiredness. It may also help with heart health and joint pain.

Chelation

Iron chelation treatment is characterized by taking oral or injected drugs to remove too much iron from the body. Medicines can comprise a drug that attaches to the extra iron before it is eliminated from the body.

In practice, chelation therapy is often used to remove excess stored iron and to reverse related complications. Generally, chelation therapy is done with deferoxamine, which is a hexadentate chelator binding iron at a 1:1 molar ratio, thus preventing its participation in toxic reactions. Data indicate that deferoxamine is effective at lowering serum ferritin levels and hepatic iron and in preventing endocrine complications. Long-term therapy with deferoxamine is also associated with a reduction in cardiac complications and improved survival (3).

Though doctors do not generally recommend chelation therapy as a first-line treatment for too much iron, it may be appropriate for a few individuals.

Whole bowel irrigation

Whole bowel irrigation is a procedure that rapidly excretes out too much iron from the stomach and intestine. The patients will have to either drink a specific solution or take it by a tube through the nose into the stomach. X-rays can be helpful in detecting and tracking iron pills as they pass through the system. Whole-bowel irrigation with polyethylene glycol solution may clear the GI tract of iron pills before absorption and should be administered at 250 to 500 mL/h in children and 1.5 to 2 L/h in adults via nasogastric tube (4).

Symptoms of too much iron

Ingestion of less than 20 mg/kg of elemental iron is non-toxic. Ingestion of 20 mg/kg to 60 mg/kg results in moderate symptoms. Ingestion of more than 60 mg/kg can result in severe toxicity and lead to severe morbidity and mortality. The amount of elemental iron ingested is different depending on the formulations of iron salts. The most common iron formulations are 325 mg ferrous sulfate tablets, which contains 20% (or 65 mg) of elemental iron per tablet; 300 mg ferrous gluconate tablets, which contain 12% (or 36 mg) of elemental iron per tablet; and 100 mg ferrous fumarate tablets, which contain 33% (or 33 mg) of elemental iron per tablet (4).

When a person consumes too much iron, he may not experience side effects for up to an hour, but one should not hold back in getting medical advice. 

Early symptoms of too much iron include (4): 

  • Stomach ache
  • Diarrhea
  • Fever
  • Nausea and/or vomiting

Subsequently, you could experience: 

  • Seizures
  • Bluish lips
  • Deep breathing 

Iron toxicity typically generates symptoms within 6 hours after consuming too much iron and can be severely harmful to the gut. 

With time, iron can get accumulated in the body organs, and cause severe damage to the liver or brain, which can be lethal. Other organs that can be affected include:

  • Airways and lungs
  • Stomach and intestines
  • Cardiovascular system 
  • Blood
  • Skin
  • Nervous system

If the condition progresses, the major symptoms include:

  • Weakness
  • Loss of weight 
  • Tiredness or exhaustion
  • Abdominal cramps
  • Elevated blood sugar levels
  • A loss of libido, or decreased sex drive
  • Hyperpigmentation, or the skin becoming brown 
  • In males, a decrease in the size of the testicles
  • in females, decreased or missing menses

Over time, the following health conditions may occur:

  • Liver disorder- cirrhosis (permanent scarring) of the liver
  • Arthritis
  • Enlargement of the liver
  • Hypothyroidism
  • Diabetes
  • Cardiovascular disease
  • Infection of the pancreas

To avoid any complications, it is best to get medical attention at the earliest. 

Conclusion 

In this brief guide, we have provided an answer to the question, “How to counteract too much iron?”. We have further elaborated on the symptoms, causes and risk factors of too much iron. 

References 

  1. Núñez, M.T., Urrutia, P., Mena, N. et al. Iron toxicity in neurodegeneration. Biometals, 2012, 25, 761–776.
  2. van Doorn, G. M., and I. M. G. Gosselink. Dietary advice in HFE-hemochromatosis. No. 285. Wageningen UR Science Shop, 2012.
  3. Poggiali, Erika, et al. An update on iron chelation therapy. Blood Transf, 2012, 10, 411.
  4. Yuen HW, Becker W. Iron Toxicity. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022.
  5. Yen, Andrew W., Tonya L. Fancher, and Christopher L. Bowlus. Revisiting hereditary hemochromatosis: current concepts and progress. Am j med, 2006, 119, 391-399.