Iron Behaving Badly: The Role of Iron Overload in Metabolic Disease

Screen Shot 2013-07-14 at 9.46.00 PMAt the Ancestral Health Symposium last year, I presented a talk entitled “Iron Behaving Badly: The Role of Iron Overload in Metabolic Disease” about the pathophysiology of iron-related metabolic disease, and propose a clinical framework for diagnosing and treating it.

We’ve known for almost a hundred years that aggressive iron storage disorders like hereditary hemochromatosis (HH) are associated with increased morbidity and mortality. Yet recent research suggests that even mild iron accumulation (at ferritin levels still well within the laboratory reference range) can cause significant metabolic problems, including insulin deficiency, insulin resistance and hepatic dysfunction. Studies have shown that the frequency of diabetes is increased in HH, that elevated ferritin levels are associated with increased incidence of diabetes, and that reducing iron stores reverses or improves the metabolic abnormalities associated with excess iron.

The talk is now available on Vimeo, so I’ve posted it here so that my readers can access the talk easily. I hope you enjoy it, and I’d love to hear your thoughts and opinions on the topic in the comments below.

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    • Chris Kresser says

      It’s possible. You didn’t mention whether your client is male or female. 305 in a female is much more significant than 305 in a male. But in either case, donating blood is a safe and easy way to bring it down and see if there is a link.

  1. Penny Lee says

    very good information. I am starting my journey with hemochromatosis. After 9 phlebotomies am at low level and starting a every 2 to 3 month program .

  2. Jay M says

    Even as a vegan (mostly fruits and veggies) and no supplementation (expect B12 & D) my hemoglobin stays above the minimum (12.5) while donating blood every 2 months. I now regret having consumed Total Cereal (100% iron) for many years.

  3. says

    Than you Chris for the iron overload presentation as I am now learning that my husband who has had type 2 diab. for 15 years and kept it stable with diet and supplements, now seems to have excess iron come suddenly in the lab work not too bad, but his Ferritin was 88 in the spring doctor visit, and this number had never been over 27 for years. When I saw this, I knew something was different because his hba1c and fbs were elevated too beyond anything before. Over the summer I researched a lot and found the HH factor a high risk for Irish descent families and he as that going back far. He was on iron pills for 8 years because our hematologist was treating him for severe anemia when he first got type 2. The hematologist studied him 3 years and said it must be genetic but HH never came up, this was in 1999-2003. So mid summer I took the iron supplements away! Then we had 2 months of normal readings. Then they elevated again when we tried chia seed which I found is high in iron, so we quit that. Than I found the inulin in our stevia packets were from chickory root, also high in iron and actually activated an iron transporter gene?????So we quit that brand of stevia. His readings are still mildly elevated and we are going to the blood bank next week. Adding to all of this I say we went gluten free with the Wheatbelly book in 2011, so we have been off gluten and sugar as much as we could, but got stricter with it Jan. 2014. The elevated Ferritin and diabetes higher number showed up in end of March in lab work. I am grateful that I got the paperwork to see the numbers myself as our doctor never said anything, but I felt right away the Ferritin of 88 just wasn’t good. I really think that going gluten free allowed him to absorb those iron pills a lot more plus what he was eating, like beefsteak, so I am grateful because I might never have gotten on this research path that lead me to where I am and the Web has been our salvation, providing information that I really needed. Thanks to you Chris! From Mary and Bill in Chattanooga.

  4. Mark McCoskey says

    With straight phlebotomies of 450 ml a week my ferritin dropped 300+ points. With the same phlebotomies plus 500 mg of IP6 I dropped 1000+ points twice. One month I went up 150 points. I’m guessing that was because the blood level got low enough that the organs began to stuff off iron. My ferritin is currently at 3,256.

  5. John says

    Great source of information. I wish I could present it to the panel of doctors that is reviewing my appeal for Exjade. I know it is a medicine that wouldn’t fall under homeopathic medicine, but I’m desperate. I’ve been maintenancing my hemoch. with phlebots., for 15 years – good ferritin – but my iron saturation has remained above 90% all of that time. My doctor said it didn’t matter if iron didn’t have the ferritin to work with so I sat on it. I finally asked him so many times that he sought to pacify me with an MRI of my liver. “Damage indicadive of hemochromatosis” came back. Long story short, I can’t get the iron down even if I phlebotomize 500ml ever two weeks for months. I’m drained (literally) and exasperated. Last week I read about IP-6 as an inhibitor, today I heard about lactoferrin as a cheletor (?). Can anyone tell me if these things will do the job? Now that I’ve seen this presentation, I know what I’m in for if they don’t do the job. My insurance will only prescribe it for something having to do with transfusions. The Exjade I’m trying to get approved for costs $11K/month so my chances of getting it are slim. It

  6. Shawna says

    I have really enjoyed reading more about this. I was recently diagnosed with HHC and I have 2 copies of the C282Y mutation. My ferritin levels at the time they were considering admitting me to the hospital were over 2,300. At the same time my HGB was only 9.1… As it turns out, I now have stage 4 liver disease. The joint pain is horrible and my sleep patterns are very disrupted. Nose bleeds are common for me as well and the phlebotomies leave me VERY tired. Chronic fatigue is probably the most upsetting to me. I have a wonderful hematologist at the Cancer Care Center in San Antonio, Texas and a large transplant team at the Texas Transplant Institute. I work for an Internest and I also have a GI doctor in San Antonio that is great. There is not a plethora of information easily available but if you are continuing to research, I would highly recommend the CDC website and the Iron Disorders Institute at . Also, I read The IDI Guide to Hemochromatosis, 2nd ed and have found many stories from people who have dealt with this. If you are on facebook, there are also a couple of “Closed Groups” for people affected by these diseases and talking to them has been a great support system for me! Good luck everybody!

  7. Dan says

    Doing trend testing on my iron parameters caught a life threatening disease in me. If you do trend testing and are supplementing with iron, I recommend a non-fasting iron panel after 30 days then 5 day fasting of iron supplementation and C panel. If Ferritin decreases materially and Transferrin increases, this most likely indicates you body still needs more supplementation of iron as it was assuming the iron would keep coming in at the supplementation rate. TIBC and UBIC will be medium to high as well. I am posting this since there seems to be not much of how-to out there.

  8. Mark McCoskey says

    Great to find your presentation, Chris.

    I found out this year that I have genetic hemochromatosis (homozygote, C282Y, chromosome 6) after entering into emergency with congestive heart failure. I’m a 54 year old male who had not been to the doctor in years (decades). My Ferritin level upon entry was 26,205. Today I’m around 5,200. I have 2 phlebotomies per week of 250 ml.

    I discovered your presentation when I Googled hemochromotosis & Paleo. You were #1.

    I enjoyed everyones posts which are giving me some leads in which to explore further. Thanks!

    • says

      ifinally found a doctor,who found i have high iron.their measure units only go to 1650,so they dont really know how high my iron really is. giving blood weekly but still no change.

  9. Jay Beard says

    HI Mary it is not likely that platelets donation would lower Ferritin levels with any significance, as Ferritin is part of the iron stores in red blood cells, JTB

  10. Jay Beard says

    Can Regular Double red donation be a cause of very low Ferritin, my iron was good 12.9 this past time before donation. I went on to have my blood tests and found my Ferritin to excessively low at 6. Suggestions anyone, JTB

    • Jay Beard says

      Correction on the 12.9 that is hemoglobin not iron, but my Ferritin is at 6, and I have ruled out internal bleeding, and other internal anomalies. I am beginning to think there might need to be safeguards regarding checking ferritin levels in regular blood donors, as this might become an issue, as the blood banks are starting to be more aggressive about getting donors to donate double red (ALYX Donors). I am still looking for information regarding this topic please… JTB

  11. Beth says

    Just a bit of interesting data, I had some blood tests done for an entirely differetn reason but it showed up that my serum iron and transferrin saturation were high, so my doctor requested genetic tests and it turned out I have one copy of the C282Y gene (not too surprising, I’m Irish and about 20% of Irish people have one copy!).
    Normally with just one copy you would only be a carrier, it can cause a slight elevation in iron levels but not usually anything much to worry about and wouldn’t normally be treated.
    It was a bit of a puzzle as to why my iron was significantly high. I had noticed that on some of my blood tests my lymphocyte count was a bit low, I asked was there some correlation with the iron and was assured there wasn’t but I thought I’d check it out myself and found some studies that showed there is a correlation and that people with one copy of the gene but also have a low lymphocyte count have much higher iron accumulation than those with a normal lymphocyte count and that the low lymphocytes may be a marker for another genetic mutation that together with teh one copy of the haemochormatosis gene will cause iron overload.
    I brought one of the studies to the consultant I saw and he was quite sensible, he explained that there’s a lot we don’t yet know about iron overload and that although having one copy didn’t usually cause a problem, in my case my iron was pretty high and although my ferritin was in the normal range it should be kept an eye on and he prescribed a blood test every 6 months from here on out.
    He also said that it might explain a whole family that he was treating who all only had one copy of the gene yet all had quite severe iron overload and said he may test their lymphocyte levels to see!

  12. says

    I’m so thrilled that I found your blog Chris. I’m a holistic nutritionist and this is exactly the information I needed to help a client this week. Keep up the excellent work, you are one of my trusted experts.

  13. Michaela says

    I have the gene mutation for hemochromatosis that I inherited from my mother. I was diagnosed at 24 years old with a ferritin level of around 432. I am now 25 and 4 months pregnant. My hematologist and OB both suggested I find prenatals without iron in them. Luckily I did. I only take half the dosage I’m supposed to since I know supplements are bad for my liver.

    Before I was pregnant I had two phlebotomies, but I don’t know what my levels got to. (My doctor never told me.) Since I’m pregnant now she has put me on monitoring status and decided to not take any of my blood. She expects that the baby will suck up my excess iron.

    Although I do feel guilty for possibly passing on the mutation, I am doing fine in my pregnancy. I don’t eat meat everyday, and I’ve been sticking with soymilk and beans for my protein. I also don’t feel anemic. I avoid alcohol (obviously), cast iron skillets, and Tylenol. Next month I’m due to see my hematologist so I’ll see how I’m doing.

    I’d also like to mention that my mother had two successful pregnancies with her hemochromatosis. She didn’t take prenatals with me or my sister. She also wasn’t diagnosed until she was 38, long after we were born. My sister is a carrier for the gene, whereas I have the full-blown disease.

    • Meghan says

      Hi, I am 8 weeks pregnant and have HH and the same question. Can you email me and tell me the outcome of your pregnancy and what your docs advised? smegmurf at gmail dot com. Thank you!

      • Tamara says


        I felt better when I was pregnant, I took some prenatal vitamins during 4 pregnancies and have 4 healthy kids non HH. I guess I was the lucky one in our family. My brother and sister were negative. My ferritin was over 3000 and after 7 years of phlebotomist my ferritin is at 44. Good luck god bless ;)

  14. Francesca says

    Hi Chris,

    My issue is unique:

    My ferritin was tested as 20, and after 3 months of iron supplementation, my iron saturation got to an above-normal range of 58% and ferritin at 26. I’m not too sure what low ferritin and high iron saturation level means. Could you explain this? I stopped the iron supplementation after seeing the high saturation, and am now at 48% saturation and 27 ferritin. What actions should I be taking to ameliorate my low ferritin?


  15. Susie says

    Thanks so much for this Chris, not a lot of information out there on this serious issue!
    One thing that I can’t figure out is what does the issue of hemochromatosis mean DURING a pregnancy. I understand we need a good dose of iron to create the 40% boost in blood volume that occurs during gestation, so part of me thinks that this moderate elevation will take care of itself during the pregnancy and sort of act like internal blood donation and bring iron levels down to a healthy normal during pregnancy. The other part of me worries that having naturally high iron/ferritin levels will result in a bigger build up of iron as blood supply grows and will lead to gestational diabetes and oxidative stress on the pregnancy. What are your thoughts on this issue? Generally blood donation during pregnancy is not recommended, but in this situation is regular donation advised? What protocol do you recommend to someone trying to get pregnant or already pregnant with this issue? Thanks much for your time! Appreciate all that you do.

    • Jules says

      I too have this same enquiry regarding pregnancy and iron overload. I have the C282Y homozygous gene and prior to my pregnancy I never had to have a phlebotomy. I would get tested every 3-6 months and it was always generally within normal range for someone with heamochromatosis.

      I am 38 years old and knew issues would likely arise after menopause but did not expect what I am now experiencing.

      Since having my child 4 months ago I have started to experience significant fatigue and terrible arthritic symptoms throughout my entire body, particularly my hands and feet. It turns out that my saturation levels are high and so I have to start doing regular phlebotomys to reduce my levels. My doctor is starting me on once a month for perhaps 3 months and then possibly a regular red cross arrangement.

      The only significant change in my life is pregnancy so am I right to assume that pregnancy can affect a person’s iron overload to this extent given menstruation doesn’t occur for approx 9 months or possibly more if breastfeeding?

      Thanks so much for this presentation as well. It is frustrating to have a condition where there is little information considering it can have a significant impact on one’s well being long term and how to best manage it.


  16. says

    Was interested to come upon this when googling the title of my paper: Kell DB: Iron behaving badly: inappropriate iron chelation as a major contributor to the aetiology of vascular and other progressive inflammatory and degenerative diseases. BMC Med Genom 2009; 2:2. It and others may be downloaded for free from

  17. Iveta says

    Thank you Chris,

    Another great article!
    I have been on paleo diet for two months now (feeling great, lost 10% of body weight). I have H63D gene, so better get iron test done in a few weeks time. I wonder if there will be any change..

  18. says

    Thanks very much Chris,
    This is an excellent presentation of a major health problem that’s been continually neglected by a medical community sworn to pharmaceutical cures. We also thank you on behalf of Dr. Weinberg and all of us at Iron Disorders Institute.

  19. marian says

    This was an excellent presentation on iron. That’s why I was doubly disappointed and offended to see you using the Torah scroll, the most sacred text in Judaism as a joke or worse. I would really like to know why you would do such an anti-judaism thing. Imagine using the crucifixion or a koran as an illustration to the joke, “Iron behaving badly”.

  20. John says


    Excellent presentation. I watched it at least 3 times (I’ve been slightly obsessed with the iron issue, if you can’t tell). Like I said in another comment, I lowered my ferritin levels from 440 to about 120 in about seven months both through blood donation and use of IP6. IP6 seemed to work in my case, as my ferritin lowered quicker than would be expected from blood donation alone, but I guess this could be due to the blocking of iron absorption, and not actual chelation (or possibly some other factor I missed). I would be interested to see the studies that showed lactoferrin was an effective chelator. I could find plenty of people on the internet singing the praises of IP6 (all anecdotal), but nothing, anecdotal or clinical, on the use of lactoferrin.

  21. says

    This is a very informative article, Chris! I just researched about this rare disease and I find it interesting. The study that anyone can get this disease is more interesting.

  22. kerry says

    Is there any other way of getting iron out of the blood, they won’t let me donate blood d/t heart defect and when I’m in the hosp dr’s usually tell me I’m anemic and give me more iron. I’m almost done with menopause at age 54. I’ve had numerous blood tests, do they always test for ferritin level?

  23. Katharine Foote says

    I have the C282Y gene. Diagnosed ten years ago by a hematologist. My ferritin was over 1000 but After 50 phlebotomies, I finally got my ferritin down to 10. My doctor retired and since then no doctor I have seen knows anything about hemachomatosis. I get a phlebotomy once in a while when my ferritin climbs again and I try to keep it under 50.
    Does the fact that I have hemachomatosis and have phlebotomies have any thing to do with my aching and inability to sleep?
    Your site is by far the most helpful information I have found, and I am deeply grateful.
    I would like a hard copy of the video to keep and refer to.

  24. Maria says


    Thanks so much for this information. Just found out recently that my husband has one mutation of the HFE H63D gene. His total Serum Ferritin was over 300, high normal. When he went to give blood, he was told his hemoglobin is low (14)… which puzzled us. What would be some of the causes of High Serum Ferritin and low hemoglobin?


    • John says


      The accepted range for hemoglobin for adult males goes from 14-18. So, while your husband’s is in the lower level of that range, it’s still within the “normal” range. The minimum hemoglobin to donate blood (at least in California) is 12.5. So this “low” level sounds like the opinion of the nurse at the blood donation center, maybe in comparison to other levels he or she has seen. When I’ve given blood, hemoglobin is the only iron related number they’ve ever checked.

      There are conditions that can create low hemoglobin (anemia) in the face of high iron levels. Low levels of B vitamins such as B12, B6 and folate are probably the most common. It can also be present in more serious conditions where the body has problems making hemoglobin, but this is mostly due to multiple blood transfusions, at least the way I understand it.

      • Maria says


        Thanks so much for the response and great info… interesting about the B vitamins, very possible. I also heard that it may be caused by a low thyroid, so we’re getting that checked out.

  25. Maureen Hodge says

    Finally I have the answers as I was told ‘not to worry about it’ when tests showed I have 1& 1/2 genes. My ferritin levels were 2,000 post surgery & 10 units of blood via transfusions. Then a second brother died from Hemochromatosis & I wondered. Again doctors said no worries, no treatment. I finally demanded phlebotomy 3 mthly & my ferritin is now considered ‘normal’ at 200. Can’t win in Australian rural areas. No doctors know a thing about this disorder. Now I have morbidity, lung issues, high cholesterol so doc offers statins. From your video clip I see that 200 is still a problem & thyroid symptoms are probably the blood condition also. All bloods for liver & thyroid are ‘normal’. Many people like me will die unless we find our own answers. I am sorry the clip does not come in hard copy for non US citizens & it is a brilliant coverage of a mostly ignored condition in Australia. Thank you very much.

  26. Flory says

    Hi Chris,
    I have high levels of Iron (with supplementation), but very little Ferritin (3 – 4). Binding capacity is really high too. Doctors are scratching their heads. I’ve been grain free for over 3 years. Any suggestions?

  27. Suze says

    As a raw vegan, my ferritin dropped to 4. But so did my happy neurotransmitters, and I landed myself in deep trouble with depression. Back to beef, and now within 2 years I am Type II diabetic. My daughter has PCOS. I am a living example of what Chris defined! Thank you for an excellent presentation and for providing me with a starting place. As a woman now in menopause, I no longer have the automatic reset button of menstruation. My blood sugar problems began at menopause. Wish me luck!

  28. Marilyn says

    Hi Chris,

    Loved your presentation. I am 63 and have had a ferritin level of 400 or better for several years that I know of. I have every symptom you mentioned. Its getting worse and worse. Some days I can barely function. I live in Tucson Arizona and cannot find a doctor that seems to know anything about high ferritin. Do you know of any doctors here you could direct me to? Should I simply try to donate blood?
    I would greatly appreciate any help you can give me
    Thanks Marilyn

    • John says

      Hi Marilyn,

      I had a similar ferritin to yours back in December (it was 440), and as soon as I found that out, I started donating blood immediately. I got it down to about 120 with Blood Donation and some IP6 supplementation (I want to get it under 80). I personally didn’t look for a doctor, but I did monitor my iron levels and researched the issue. I wasn’t really experiencing any symptoms, except maybe fatigue. Anthony Colpo shared how he lowered his iron on his blog, which I kinda mimiced myself. You could look up his protocol if you decide to “Do it yourself,” or you could take it to a doctor and ask about theraputic phlebotomy. “Exposing the Hidden Dangers of Iron” by E.D. Weinberg is also a great resource. You can donate blood at a local hospital or the Red Cross without going to your doctor first. You may even want to call a blood donation center and see if they know any doctors that prescibe phlebotomies and are aware of the iron overload issue.

  29. Kj says

    One thing to make sure of here is that too- little iron and/or too-low ferritin levels can also be dangerous. Women are especially prone to low iron levels or low iron storage. This is even more true for menstruating women. It is rare for a woman to have too much iron. Ways to increase iron include: eating more (grass-fed, antibiotic and hormone-free) red meats and organ meats, dark green, leafy vegetables, and some nuts and seeds; cooking with a cast iron pan; or taking a low-dose, high-quality iron supplement. Taking Vitamin C with your meals can enhance iron absorption. Heme iron, which comes from animal proteins, is more effectively absorbed by the body than non-heme iron, which is found in plant foods. Your doctor can order iron tests as well as ferritin levels. These are simple blood tests.
    Men or woman who have too high levels of iron can donate blood to lower their levels.

  30. Eric says

    I just started donating my blood at a hospital that takes blood from patients with iron Overload. They can take two units of red blood cells at a time because they give back your plasma while you are donating. Iron is bound to the red blood cells, so you can lower your iron levels by removing red blood cells. The previous hospital I was going to was throwing by blood in the trash as part if my weekly treatment. I’m glad I found a hospital that is willing to take my blood.

  31. Dutch says

    Hey Chris,
    I’ve been giving blood regularly for some time now. I am always asked if i want to give whole blood or plasma or just red blood cells. Is there a better method of giving blood for Iron overload than just Whole blood?

    • John says

      According to the book “The Hidden Dangers of Iron,” Double Red Cell Apherisis takes out twice as much iron as whole blood donation. It basically takes out twice the red blood cells, and returns plasma and other fluids to your body. Double Red Cell donation does take longer (like donating plasma), as they are returning fluids to your body. Blood Donation centers won’t even offer it to you unless your hemoglobin is high (I think about 16.0 g/dl), and I believe you have to wait 16 weeks instead of 8. Unless, of course, you have a doctor’s prescription for a phlebotomy or Apherisis.

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