Thursday, September 23, 2010

2.12c Iron a nutrient and a cause of disease

Physician's Notebooks 2 - - See Homepage
Continues Chapter on Minerals
2.12C: Iron Fe Update 26 July 2020
The symbol for Iron is Fe from Latin ferrum. Its deficiency sign is a small-cell (microcytic), pale (hypochromic) red blood cell anemia. The opposite is a toxic syndrome from eating too much iron including iron pills or tonics, with the iron's plating out in liver causing cirrhosis. Excess iron deposition in key brain cell is implicated in Alzheimer's, Parkinson's and other degenerative brain diseases.
The Fe is the central atom of the heme molecule that with globin forms the hemoglobin used by the body for oxygen transport to vital organs.
Iron Intake and Source: natural fruit juices have iron – important to consider because the juice drinker often has huge intake over years and also because fruit has high vitamin C, making Fe more absorbed by intestines. Dry wine has 0.4 mg iron per goblet. City tap water, depending on location, may have up to 5 mg iron per liter; much of this iron is not absorbed. But if you boil water for tea, coffee and soup in iron pot or kettle, the iron gets into the water, which is not good because it is source of lifetime low-level toxicity. In plant, green vegetable and legume is a modest iron source; a big serving of lentil gives 3.3 mg iron. Dairy is not a good source. Red meat is a high-iron source. If you like chicken, crunching the long bone and eating marrow is source of iron and other blood-forming nutrient. (Be careful not to crack a tooth or aspirate a piece of bone into your windpipe) In USA, foods are enriched with iron.
The elderly, indigent, dieting person who eats an unhealthy diet is at risk of becoming iron deficient. Also menstruating and pregnant women.
   Pregnancy: if one is planning pregnancy, one should eat more food iron and make it more bio-available by use of same-time vitamin C, in order to build up iron reserve before becoming pregnant so that one is not left iron deficient
Absorption: Since healthy non-menstruating person loses little or no iron, the iron balance is determined by regulation of the amount of iron absorbed from food and drink. Important food iron in meat is hemoglobin (organic heme iron). Heme iron is more easily and efficiently absorbed than inorganic iron (from beverage and fruit & veg), much of which is lost in feces.
Alkali antacid taken regularly can lead to iron deficiency because it forms insoluble iron salt. Tea and coffee reduce inorganic iron absorption by about 50%.
Abnormal bleeding causes iron loss that will need replacing by additional intake. If one-time hemorrhage or blood donation, then several days of red meat may suffice; low-grade bleed may be treated by iron injection or pill supplement but also the bleeding source should be determined and stopped.
Test to Determine Iron Nutritional Status: CBC (complete blood count). Red blood cell low level indices (MCV<90 MCH<30, microcytic/hypochromic anemia) are best measure of iron deficiency: With low values, the serum Fe blood test should be done. It is good test of iron: large reserve is best before pregnancy, surgery or blood donation. Otherwise a low-normal iron is best because of long-term toxicity of even small excess of iron in key brain cells as factor favoring Alzheimer's or Parkinson's disease so serum iron of 65 to 85 is preferable to 100 to 120 microgram/dl, though both normal.
Iron Supplement: Be sure before taking iron pill that your Doctor tests whether your anemia is iron deficiency. Some microcytic/hypochromic anemia looks like iron deficiency but has other causes (Mediterranean, or Cooley's anemia is most frequent). In that case, iron pills do not help, but lead to iron toxicity. The pills are ferrous sulfate or gluconate, taken one tab with meal 3 times a day and using vitamin C at same time. Iron pill may turn stool black, but, even if taking iron, such a case should be investigated for bleeding from stomach or intestine. Iron causes constipation, which should not be treated by eating bran because bran decreases iron absorption. Iron tablets can irritate the stomach lining and cause upper GI bleeding in persons already prone to it with ulcer or gastritis. (Iron may be given by injection) The other bad point about iron supplements even with blood loss anemia is that too many iron pills at a time often cause abnormally high serum iron levels. When you take or receive iron supplement for anemia, the serum iron blood test should be checked before starting the iron and then once a month.
Injectable iron may be given as intramuscular (IM) shots or in IV infusion daily over several days based on calculation of total deficient iron need. It is used much on patients in renal dialysis. There is a small incidence of hypersensitivity to injected iron so the IV route may be best because patient can be observed better and infusion stopped compared to IM injection iron. 
     End of Section on Iron in Nutrition. Chapter Continues. Click 2.12d Magnesium/Phosphorus/Selenium/Zinc

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