A New Perspective on Iron Deficiency: Roberta Crawford, NIH Workshop: Iron Overload

A New Perspective on Iron Deficiency

Presentation Given by Roberta Crawford in June 2001 at NIH Workshop in Bethesda, MD

A prevailing myth says that iron deficiency is the world's greatest nutritional problem.

Let's define anemia: a deficiency of red cells or hemoglobin, or red cells that die too young or are discolored or possess an abnormal shape, or red cells that lack adequate iron.

Now defining iron deficiency -- so-called "normal" iron levels vary from lab to lab. Most "normal" levels are set too high. Saturation: 12 to 40-45% is reasonable at the present time. Ferritin: 5 to probably 50. As our years of study have shown, we have had to lower these levels several times to be safe.

Think about it. If "normal" levels are set artificially high, and your levels fall below that "normal," you are "iron deficient."

So how much iron does the human body really need? Iron is not excreted. The iron you absorb stays and accumulates in storage except that you can lose one milligram a day through hair, finger nails, skin cells and other detritus. That is the amount needed every day to replace the loss. One milligram. (Women in reproductive years, one and a half milligram). The RDAs or RDIs recommended by the Food and Nutrition Board is out of date and incorrect. The other way to lose iron, of course, is by blood loss.

The normal levels of iron need to be lowered.

Hemoglobin is not iron! Unfortunately physicians prescribe iron to anemic people who test with low hemoglobin. Yes, the patients are anemic, but the iron is collecting in storage instead of going into hemoglobin. These people are iron-loaded. They need iron removed despite the anemia. The anemia should be treated with B vitamins, especially B12, B6 and folic acid. Many patients with anemia are dying of iron overload, and some are hastened to their death by their physicians who give iron. Blood banks seem to believe that hemoglobin and iron are the same. They have prepared lists of high iron foods to give out to donors with low hemoglobin. They invariably tell these people: "Your iron is low." Dangerous misinformation.

Physicians like to diagnose or rule out a disease called hemochromatosis. That causes confusion and many problems. There is no consensus. Doctors hesitate to treat without a diagnosis. Too bad that word was ever invented. Each patient is different with different symptoms and different iron levels.

First: treatment does no harm whether there is excess iron or not. A cutoff is set on hematocrit to prevent severe anemia, and when the patient tests under that cutoff, blood is not taken that day. Giving blood is beneficial.

Second: even a small amount of excess iron can damage heart and brain and other storage sites in the body and lead to heart attack or stroke. It is foolish to wait until iron levels confirm "hemochromatosis."

There is exaggerated concern when hemoglobin falls temporarily, following surgery, for example. Blood transfusions are over-used. A study shows that surgery patients who do not receive transfusions survive better than those who do. [NEJM Feb 1999 340:409-17]

Before taking iron you must test saturation and ferritin. (Ferritin indicates storage iron, which is not essential to maintain life). If both saturation and ferritin are extremely low, you must discover why. Low iron is a signal that iron is being used by cancer cells or is feeding bacteria, or usually it means there is chronic daily blood loss. The bleeding could be from an ulcer or tumor, etc. The source must be found.

Iron is in just about everything. If you are not absorbing the one daily milligram, you are truly on a starvation diet, and low iron is the least of your worries.

Let's look at iron with 21st Century eyes and be aware of excess iron's toxic ability to harm.

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