The Role of Iron Overload in Metabolic Disease | Chris Kresser
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Iron Behaving Badly: The Role of Iron Overload in Metabolic Disease

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apolactoferrin iron overload
As previously presented at the 2012 Ancestral Symposium.

At 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.

  1. 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.

    • 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.

      Jules

  2. 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 http://dbkgroup.org/publications

  3. 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..

  4. 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.

  5. 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”.

  6. Chris,

    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.

  7. 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.

  8. Chris,
    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?

  9. 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.

    • I cannot bring the presentation up on my computer. If you happen to come accross it, I would very much appreciate knowing where you found it. I too have genetic hemochromotosis on the high end

  10. Chris,

    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?

    Thanks!

    • Maria,

      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.

      • John,

        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.

  11. 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.

  12. 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?

  13. 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!

  14. 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

    • 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.

  15. 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.

    • “Women are especially prone to low iron levels or low iron storage.”

      SOooooo not true! Look at the full iron panel.

      • As Sunny says – look at the full iron panel!
        I have been put on iron pills (100 mg/day) on and off for whole of my life – only because of low hemoglubin levels. The last period of supplementing (by the diabetes doctor) was a 8 years long period – and not ever the hemoglubin levels got good- bearly above the lowest “normal range”.
        When, at last, at least Ferritin was checked- it was 361.
        During the past year I have requested the whole iron panel and my Hemoglobin have always been just above the lowest range in the same time when Ferritin has been 250-300 and serum iron between 10-22 (referenge range beeing 9-32), saturation between 17-28% and TIBC the same: 53-58 (ref. range 40-80). I have also gotton Hepcidin level that showed: 3,2. Hepcidin beeing the iron regulator hormone.
        So, if the doctors only take Hemoglobin- it tells us NOTHING! Low hemoglobin actually could demonstrate high iron levels in tissues!
        But – there are also B vitamines – they too affect body iron!!
        If the body is deficient on B12 and you start supplement on B’s- your blood irons will go down. I was pussled by my iron levels dropping so fast but then I found out that it is normal to happen after supplementing with B12 after being deficient on it.

  16. 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.

  17. 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?
    Thanks
    Dutch

    • 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.