“Goldilocks was hungry. She tasted the porridge from the first bowl. ‘This porridge is too hot!’ she exclaimed. So, she tasted the porridge from the second bowl. ‘This porridge is too cold,’ she said. So, she tasted the last bowl of porridge. ‘Ahhh, this porridge is just right,’ she said happily and she ate it all up.”
The story of Goldilocks and the three bears fits the story of our relationship with the vital mineral, iron. We don’t want to have too little, but we actually don’t want to have too much either; we want to have just the right amount.
Iron is an essential element for blood production. About 70 percent of our body’s iron is found in red blood cells as part of hemoglobin, which carries oxygen to the body, and in muscle cells, as myoglobin, which accepts, stores, transports and releases oxygen. About 6 percent of body iron is part of certain proteins which are essential for respiration, energy metabolism, and nerve function. Iron also is needed for proper immune function.
Where do we get iron in our diet? A wide variety of foods contain iron. Red meat is a rich source of iron, and iron in animal products is absorbed better than iron from plant products. Nevertheless, foods such as spinach, fortified breakfast cereals and even dark chocolate have substantial amounts of iron. However, individuals vary a great deal in how well they absorb the food in their diet.
If iron consumption and absorption is chronically low, iron stores become depleted. In the typical American diet, iron depletion from poor dietary intake alone is uncommon. Most often, having low iron results from losing iron by blood loss. In women who are still menstruating, blood loss from their monthly cycle is the most common cause of iron deficiency. In non-menstruating women and in men, iron deficiency usually points to unrecognized persistent microscopic blood loss from the gastrointestinal (GI) tract. Thus, a colonoscopy and upper endoscopy are usually carried out to search for a GI source of blood loss such as a colon polyp or cancer, or a bleeding ulcer. There are numerous other causes of low iron, but the point is that, in addition to taking iron supplements, the reason for the iron deficiency must be thoroughly sought after.
What’s wrong with not having enough iron in our bodies? When iron is depleted over time, it begins to cause reduced red blood cell production and eventually results in a low red blood count, called iron deficiency anemia. Other symptoms such as fatigue, shortness of breath with exertion, restless legs, paleness, headache, racing heart, and a desire to chew on ice (oddly enough) can accompany the low iron state.
So, should everyone take an iron supplement just to play it safe? No, indeed; in a healthy non-menstruating adult an iron supplement can cause iron overload, which has its own toxicity. Likewise, children getting ahold of excessive amounts of iron-containing vitamins is a common cause of poisoning.
Besides taking too much iron in the form of supplements, there are also built-in genetic abnormalities which cause some adults to hold on to too much iron, even with a normal diet. The best known of these hereditary conditions is called hemochromatosis. It affects over 1 million Americans. Iron overload from these causes can damage the liver, pancreas, joints and heart, and can even be fatal if left untreated. Hemochromatosis is one of the few conditions that can benefit from an updated version of the old practice of blood-letting.
So, if you have symptoms that make you wonder if you have too little, or even too much, iron, get it checked out. Iron is vital, but like Goldilocks, we want the amount to be just right.
Andrew Smith, MD is board-certified in Family Medicine and practices at 1503 East Lamar Alexander Parkway, Maryville. He is contracted with some commercial insurance carriers and sees Direct Primary Care patients who do not have insurance, who belong to a cost sharing ministry, or who are on Medicare. He is accepting new patients. You may contact him at 982-0835