What To Do About Iron

Too much or too little iron. Either one can get you into big trouble. In this country, health-conscious people may take too much iron rather than not enough. The link between "that tired feeling" and iron-deficiency anemia is well-known. Older adults especially may self-medicate themselves with over-the-counter iron supplements.

Iron supplements at several times the RDA levels of 10 mg for men and 18 mg for women may be dangerous for those who absorb iron too easily. Ordinarily, the human body severely restricts iron absorption from the intestinal tract to ten percent or less. Heme iron in meat is more readily absorbed than plant iron. Iron receptors in the cells lining the intestinal wall shut down when the cell has enough iron. But some people with a genetic susceptibility to iron overload are less able to regulate iron absorption. Chronic iron overload or hemochromatosis can seriously damage the liver, pancreas, heart and other endocrine organs even leading to death.

Acute iron poisoning can threaten life. Children who swallow an adult's iron pills can become acutely ill. The lethal dose of ferrous sulfate for a 2-year-old child is about 3 grams. Keep all iron medications out of a child's reach.

On the other hand, anemias are the most common and widespread nutritional problem in both developed and developing countries with iron deficiency responsible for the vast majority of anemias. On a global basis, an estimated 2,150,000,000 persons are anemic or iron deficient. Women and children are most often affected. Elderly are less so. If anemia does occur, the person or health care provider should find out the underlying cause.

Some of the consequences of anemia are pale skin, fatigue, difficult or labored breathing, heart palpitations, and reduced work capacity . Other physical signs include "spooning of the nails" and greater susceptibility to infections as well as sensitivity to cold, tingling sensations in hands and feet, and an inflamed, red tongue. Anemia during pregnancy can increase risk for infant death, prematurity and low birthweight. Even if the woman or child is not anemic but just low in iron, the iron deficiency can lead to reduced work capacity and fatigue in women and adolescents and apathy, short attention spans, and retarded mental and physical development in children. Deficiency can also lower resistance to infections and reduce appetite.

In older adults, anemia is a sign of unusual blood loss, a symptom of a chronic infection or a malignancy, or subtle nutritional deficiencies such as folate, protein, iron or ascorbic acid. Although there is some dispute about what constitutes anemia in an elderly person, the health care provider should search for the underlying cause when the hemoglobin level falls to less than 13 g/dl in males or less than 11.5 g/dl in females. Perhaps for those in their 90's, 11 g/dl may be acceptable in healthy elderly.

So if you often feel tired, reach for the phone to call your doctor rather than the bottle of iron pills. Don't be talked into iron pills by the chiropractor or the salesperson in the health food store. Either iron deficiency or overload should be treated seriously and the proper diagnosis made. Then follow treatment instructions carefully.

Sources: Andreoli, T. E., et al. 1993, Cecil, Essentials of Medicine, 3rd ed. W. B. Saunders, Philadelphia. 451-452:, National Research Council, 1989, Recommended Dietary Allowances, 10th ed., Food and Nutrition Board, National Research Council, National Academy Press, Washington, D.C. pp. 195-205.; Nutrition & the M.D., University of California, San Diego. 8 (6): 1-3, June 1982 and 21 (5): 1-5, May 1995.; Stephenson, L. S., Possible new developments in community control of iron-deficiency anemia, Nutrition Reviews, USDA Human Nutrition Research Center on Aging, Tufts University, Boston, 53 (2): 23-30, February 1995.

Mary Clarke, Ph.D.
Extension Specialist, Nutrition Education

5/95 File: NUTRITION/NORMAL/General

K-State Research and Extension is a short name for the Kansas State University Agricultural Experiment Station and Cooperative Extension Service, a program designed to generate and distribute useful knowledge for the well-being of Kansans. Supported by county, state, federal and private funds, the program has county Extension offices, experiment fields, area Extension offices and regional research centers statewide. Its headquarters is on the K-State campus, Manhattan.