CEREAL KILLER?

You could be consuming far too much iron

NEXT time you are in a supermarket, take a closer look at the bread you
buy or your cereal packet – you might be surprised to see how many of
these staples are fortified with iron. In fact, cereal products make up a
whopping 45 per cent of our average daily iron intake.

“Too much iron from supplements can cause our organs literally to
rust”

That may seem like a good thing, if it wards off iron deficiency and
anaemia. But evidence is emerging that decades of fortifying food with
iron and regularly popping supplements could be leading people to ingest
more iron than they need.

While the effects of this overload are still up for debate, some scientists
believe that it could be damaging our health – and the prevalence of
diseases like diabetes and heart disease could be a symptom of this excess.
What’s more, too much iron seems to be a source of cancer-causing free
radicals.

“Iron overload degrades the chemical structure of DNA, predisposing us

to everything from heart disease and stroke to diabetes and obesity,” says
Leo Zacharski at Dartmouth-Hitchcock Medical Center in Lebanon, New
Hampshire. “It’s a far stronger risk factor than smoking for all sorts of
clinical disorders.”

The primary use of iron in the body is in haemoglobin proteins, the part
of red blood cells which carry oxygen to tissues. If you don’t have enough
iron in your body, because there’s not enough in your diet or you can’t
absorb enough from your food, you might have shortness of breath,
fatigue, and cognitive and immune problems.

The most severe form of iron deficiency, anaemia, affects 2 billion people
worldwide, especially those in developing countries. It is also common
among pregnant women.

The issue came to the fore in Europe and the US during the second world
war when rationing left large swathes of the population malnourished.
The response of governments was to increase the iron content in staples
like flour and cereals, to make sure people got enough in their diets. The
policy was widely extended to infant formula, and since the 1970s,
pregnant women in the US have also been prescribed iron supplements.
Today, many of us buy these over the counter. Forty per cent of Americans
take supplements which contain iron, often unaware that many of these
contain more than twice the amount of iron recommended for an entire
day.

At that time, though, not everyone was convinced of the benefits of

boosting the amount of iron in the diet.

Iron deficiency anaemia is now rare in the West, but might we be getting
too much of a good thing? More than 30 years ago, Jerome Sullivan, then
a researcher at the University of South Florida in Tampa, was puzzled by
the fact that women don’t tend to suffer from heart attacks until after the
menopause, during their late 40s or early 50s, whereas rates in men rise
during their 30s.

He wondered whether the menstrual loss of iron in pre-menopausal

women had any a protective effect. Sullivan published this “iron
hypothesis” in 1981 in The Lancet.

The idea was backed up by research at the time showing that populations
with lower levels of iron in their blood and cells had low rates of heart
disease. But these signs were largely ignored against a backdrop of
decades of iron fortification.
Bad behaviour

Today, concerns are growing that population- wide fortification policies

have been overzealous , supporting what some physicians argued at the
time. “In the US it was not the medical doctors who pressed for
supplementation, but nutritionists,” says Andrew Ghio, a medical officer
at the US Environmental Protection Agency in Washington DC. “The
physicians suggested using iron in a select group of patients who are iron
deficient and that there was no need to provide iron on a population-
wide basis.”

They might have been on to something. Support has been trickling in for
Sullivan’s hypothesis that too much iron could be bad for the heart. At
the time, he suggested that an excess of iron could cause the walls of
arteries to narrow and harden, a condition known as atherosclerosis.

That idea was put to the test when Hidehiro Matsuoka, at the Kurume
University School of Medicine in Japan, injected 10 healthy men with high
levels of iron and used ultrasound to monitor changes in their blood
vessels. The injections caused the vessels to constrict, leading Matsuoka
to believe that iron excess could be the first step in a cascade of events
leading to atherosclerosis. Other work has found high levels of iron in the
blood and arteries of people with diseases of the heart, including
atherosclerosis and angina. This doesn’tprovethatironisthecause,butdoes
hint at a connection.

And heart health is just the start. One of today’s main proponents of the
iron hypothesis is Douglas Kell at the University of Manchester, UK. He
reviewed more than 2000 scientific papers examining iron and disease
and concluded that iron overload contributes to a host of today’s most
common illnesses.

Why might this be? It could be because even though iron is essential to
life, it is also toxic. To make it less harmful, most of the iron we absorb
from food gets bound to proteins, mostly those involved in the transport
of oxygen, such as haemoglobin. Excess iron gets stored in a protein called
ferritin, which is especially abundant in the liver, spleen and bone
marrow.

Kell suggests that the problems arise when this system goes wrong. As
long as the iron remains locked up with these proteins, there’s no
problem, but if it is released then iron begins to behave very badly indeed.
This “free iron” is dangerous because it reacts with the everyday products
of cell metabolism to produce highly reactive molecules known as free
radicals. These can wreak havoc in the body, damaging parts of the cell
they come into contact with, including DNA.

Some of the strongest evidence for the damaging effects of free iron comes
from people with a genetic disorder called haemochromatosis. They
absorb too much iron from their food, because the condition disrupts the
signalling of a hormone called hepcidin. The hormone usually stops
9887=the gut absorbing excess iron and makes sure that when immune
cells known as macrophages digest old red blood cells, the iron stays
locked inside the macrophages and out of harm’s way. In people with
haemochromatosis, macrophages and cells that line the gut dump iron
into the circulation. And between 30 and 60 per cent of them develop
type 2 diabetes.

The increased risk doesn’t seem to be unique to this group. The most
compelling indication comes from a study of nearly 10,000 US adults,
which found that high levels of the iron-storing protein ferritin in the
blood – a common test for iron levels – were associated with a nearly
fivefold hike in the chances of men getting diabetes, and a 3.6-fold
increase for women.

So if systems are in place to keep iron safely bound up, what’s the risk
to most people? Many of the diseases that Kell’s review found to be
affected by iron overload, which include cancer as well as type 2 diabetes
and heart disease, are increasingly being linked to inflammation. Kell and
the other supporters of the iron hypotheses believe this is no coincidence.

Inflammation is the normal immune response when the body comes under
attack from foreign invaders, but it is also caused by the everyday wear
and tear that comes with ageing. And it seems to affect how our bodies
handle iron.

In the short term, in`lammation can cause iron to be even more tightly
locked away. This is probably an evolutionary adaptation, designed to
stop bacterial invaders, which need iron to survive.