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The Iron Elephant - What you should know about the dangers of excess body iron (Vida Publishing Inc.) - is a book written by journalist Roberta Crawford which was first brought to my attention via sott.net's discussion board. As it happens, one of the members was suffering from extreme fatigue and joint problems related to an autoimmune condition that was not responding to either vitamin C or dietary measures. In fact, she was getting progressively worse. A blood test analysis revealed high ferritin levels which indicated high iron stores. Furthermore, there was a history of hemochromatosis within the family. This prompted much research and learning which was posted on our Forum thread Hemochromatosis and Autoimmune Conditions.

Slowly but surely, the picture of iron overload toxicity began to emerge and the final pieces of the puzzle fell into place. Several people who were having trouble recovering their health on a diet that was basically bulletproof were found to have iron overload.

The healing diet which is a gluten and dairy free ketogenic diet with moderate intake of protein and plenty of animal fats does not work as it should be as long as there is excess iron in the body.

Iron overload may affect any organ in the body and may include symptoms such as fatigue, depression, arthritis, irregular heart beat, high blood sugar and/or diabetes, shortness of breath, swelling of the abdomen and legs, jaundice, loss of sexual drive, premature menopause, loss of body hair, shriveling of the testicles, hypothyroidism, and redness of the palms of the hands. A suntan that does not fade in winter may or may not be present.

The excess iron oxidizes in your body and can literally rust your organs leading to diseases such as cancer, thrombosis, cirrhosis, arthritis and so forth.

The Iron Elephant describes the bitter journey of many people who suffered needlessly from iron's toxicity effects. It is a warning for the rest of us who might be unaware of silent iron overload. Let's have a closer look to the key concepts and warnings.

Iron 101

Only about 10% of the iron in food is available for absorption. Once you absorb iron, it has no exit from the body except by blood loss. Iron is not excreted. Once allowed into the body, it takes up stubborn residence.

The red blood cell is born in the bone marrow and lives for about one 120 days. When the red cell breaks down, it releases iron, to be recycled into new cells. Only about 1 mg a day is lost in finger nails, dead skin cells and other detritus, and this is the loss that needs to be made up from food.

Many people are unknowingly storing too much iron every day because of an iron metabolism imbalance. They are unable to keep from absorbing unneeded iron. Iron is so abundant and ubiquitous that you just can't simply formulate an iron-free diet.

Celtic curse

As many as 32 million Americans (one in eight people of Northern European ancestry) may be carriers of genetic hemochromatosis, also known as iron overload disease or iron storage disease. Hereditary hemochromatosis (HH) has been dubbed the "Celtic Curse" and it is the most common genetic disease in the USA. Researchers believe that HH originated at least 40,000 years ago in the area we now know as Ireland with a single ancestor whose genes mutated to over-absorb iron from what was then a very poor iron diet and famine conditions. Nowadays, descendants of these ancestors absorb too much iron until it reaches toxic levels.

Geoffrey Block, MD, an hepatologist, states,
"the appearance of the HFE gene mutation [for HH] occurred somewhere from 40,000-60,000 years ago. Human DNA goes back to somewhere between 120,000-200,000 years ago. The ethnogenetic source for the C282Y (HFE) mutation arose in the Celtic 'empire'. Most people think that Celtic means Ireland, however, the Celts of 40-60,000 years ago covered Ireland to just west of Moscow, north to the upper reaches of Scandinavia, south into Spain and Portugal, and south east across the Italian peninsula and north of Greece and Turkey/Iraq."
But any ethnic group can also have the mutations even though it is more infrequent (i.e. Asian or Jewish). In fact, the single gene carrier estimate for the abnormality runs to 650 million people world-wide, more than half a billion people. Needless to say, that a heck of a lot of people. The tragic thing is that even today in 2013, many people are having a hard time getting their doctors to order iron testing, let alone interpret them correctly once they are done. Excess iron has no way to leave the body but by bleeding. When the body is storing excess iron, then it must be unloaded in order to avoid injury. It is already too late when the damage is done. When iron is the underlying factor, no amount of testing, no method of treatment will do a person any lasting good unless the iron is removed. Excessive iron may be the cause of arthritis, hypothyroidism, diabetes, cirrhosis, cardiomyopathy, chronic fatigue and much more.

Each person's unique metabolism will result in varying degrees of damage due to iron overload.

Untreated iron overload can give you cancer

Excess iron storage in the liver is carcinogenic for primary liver cancer. If cirrhosis had not developed due to iron burden, and treatment is adequate, liver cancer rarely develops. Early detection is essential.

Among the most important concepts reported in The Iron Elephant was the one where it was speculated that, contrary to all accepted belief, in Hodgkin's disease or leprosy, the white blood cells (leucocytes) are not diminished, but are simply trapped in areas other than where they belong and that iron proved to be the trapping agent.

Iron depresses the immune system. Tumors require iron for survival. Due to a tumor's iron sequestration phenomenon, when there is a finding of iron deficiency, one must search for cancer. Iron might be sequestered by the tumor itself and therefore not available for blood formation.

Dry weight of iron in breast cancers are threefold greater than that of normal breast tissue. Nearly 90% of those with metastasizing breast cancer have elevated serum ferritin - marker of iron storage.

In both infection and malignancy iron is shifted to storage tissues. The severity of cancer is related to displacement of iron. Levels of iron go back to normal if a person recovers. This is why it is very important to screen for iron markers. If they are low, it is essential to investigate for cancer or infection.

Inhalation can be another form of iron entry into the body, raising the risk of cancer. Workers in iron mines develop bronchial cancer five to ten times the rate of the general population. Lung cancer can be nearly 8 times higher than expected in patients with hemochromatosis. Other cancers recorded are pancreas, stomach, rectum, gallbladder, bladder, prostate, colon and brain among others.

People with iron overload provide a favorable environment for cancer growth.

Untreated iron overload can give you arthritis

Sore or stiff fingers with affection of the index and middle finger is typical of iron overload. However it can vary depending on overuse and straining. Do test for iron load if it hurts when someone shakes your hand and the pain lingers. Other joints that may get affected include knees, hips, jaw, shoulder. The most frequently affected are the hands and wrists and weight-bearing joints such as knees. Joint pain is not always present.

Dupuytren's contracture - which is a proliferative connective tissue disorder which involves the palmar fascia of the hand - is sometimes seen. In severe cases, the hand takes the form of a claw. When something similar happens in other parts of the body - cheek, stomach, arm - it is called panniculitis. The tissues seem to fasten to the underlying connective tissue leaving an impression, like a dimple.

Along with arthritis, there might be acute synovitis with subsequent inflammation of the tendons. But the most common feature of iron overload is chondrocalcinosis also known as pseudo-gout.

Arthritis is one of the most difficult symptoms to improve. Furthermore, iron promotes the growth of microorganisms, which can further contribute to the inflammation associated with arthritis.

Untreated iron overload can give you heart disease

Traces of iron greatly increase rhythm irregularities following heart attacks. Furthermore, chelating iron greatly decreases rhythm irregularities following heart attacks. Even iron levels long regarded as within range, may have deleterious effects in the heart. As we will see, within range may already be too toxic. Normal iron load levels have been set too high and should be redefined in view of iron's toxicity.

Abnormalities such as atrial ectopic heart beats, atrial fibrillation, incomplete right bundle branch (long regarded as a normal variation in the electrocardiogram), low voltage and enlarged heart is seen more often in those with iron overload. Heart failure incidence increases in iron storage diseases.

Supplementing with Vitamin C might be dangerous. Vitamin C binds with iron and moves it around where it might end in the heart muscle. Vitamin C taken with iron increases absorption of the iron.

Iron in the heart is a poison related with arrhythmias and heart damage.

Untreated iron overload can give you cirrhosis

The primary target organ for iron is usually the liver, which becomes overloaded and damaged. The liver can either become enlarged or atrophied. Liver enzymes that never get normalized is indicative of iron overload.

Whenever cirrhosis is suspected, iron should be checked. Cirrhosis is a consequence of chronic liver disease where replacement of liver tissue by fibrosis, scar tissue and regenerative nodules leads to loss of liver function. Liver dysfunction leads to all kinds of problems including mental confusion. When you have a sluggish liver, you have more problems in metabolizing even healthy foods such as protein and fat.

Untreated iron overload can give you diabetes

Diabetes that is difficult to manage and/or that appears at an earlier age than expected is indicative or iron overload. Severity depends upon the amount of iron load and whether diabetes is discovered early or late in the course of iron accumulation. Improvement might be expected if iron is unloaded promptly.

Blood sugar levels are very difficult to regulate when the underlying cause of pancreas damage is excess iron.

Untreated iron overload can impair your immune system

The body has mechanisms to withhold iron from invading microorganisms, but when there is iron overload, this ability is seriously impaired. Everyone with depressed immune function should check their iron load levels. People are much more susceptible to infections at times of high iron elevation. Low iron body stores reduce mortality due to certain infectious diseases.

One thing that is easily forgotten is that many anemias are in themselves iron loading anemias. For instance, thalassemia and sideroblastic anemia among others. The worst thing in this case is to reach out for iron supplementation. That will do nothing to correct the underlying problems and will only worsen things. Patients with rheumatoid arthritis may have anemia as a body mechanism to withhold the iron in order to defend the body against arthritis.

The only anemia that improves after iron supplementation is iron deficiency anemia, and you can't diagnose it based on hemoglobin levels alone. Iron stores must be checked.

Untreated iron overload can make you very tired

Hypothyroidism can be a complication of iron overload and people with chronic fatigue syndrome should be screened for iron load levels.

It is ironic that excess iron may be the underlying cause of pallor, weight loss and fatigue. In fact, up to 25% of those diagnosed with hemochromatosis might be anemic.

Laboratory screening

Ferritin is an ubiquitous intracellular protein that stores iron and releases it in a controlled fashion. The amount of ferritin stored reflects the amount of iron stored.

There is a specific iron-binding protein called transferrin which holds and controls iron transit. Transferrin binds to iron and delivers it to wherever it is needed.

The concentration of iron per se in blood plasma is about one hundred micrograms per one deciliter. Serum iron (SI) normal values goes from 50 to 160 depending on the lab. Serum iron above 150 must be followed up with transferrin saturation and ferritin levels.

The blood plasma contains enough transferrin to combine with about 300 micrograms of iron per deciliter. This is called Total Iron Binding Capacity (TIBC). When the concentration of iron is one hundred micrograms, the transferrin is about one-third saturation.

You obtain the percentage of transferrin saturation by dividing serum iron by TIBC and multiplying by 100 percent. It's the proportion of these two numbers that is significant. You're looking for a normal range of 25-35%.

If you have elevated transferrin iron saturation percentage greater than 45% with an accompanying elevated serum ferritin, iron overload is present and bloodletting/phlebotomy should be commenced. Blood-work should be done in fasting and after drinking enough water for hydration.

Iron levels fluctuate from day to day and from hour to hour. When transferring saturation persists over 45% and ferritin is above 150, then you have iron overload.

It is important to keep in mind that people who might be gene carriers or relatives of someone diagnosed with hemochromatosis, may test "normal" and later proved to have a considerable iron load at a later examination. There is a variable rate of iron accumulation within families.

In the absence of symptoms and with blood tests that show normal levels, the relatives nevertheless can sometimes be diagnosed after persistent checking. Liver tests had confirmed a diagnosis, even after blood tests were normal.

The doctors on the Board of Directors of The American Hemochromatosis Society state that transferrin saturation percentage greater than 40% and serum ferritin greater than 150ng/mL could indicate clinical iron overload/iron storage in the body and treatment with phlebotomy (bloodletting) should be considered regardless of DNA test results.

Some researchers suggest that ferritin should fall between 20-80 ng/ml, with an ideal range being 40-60 ng/ml. If you are above those levels, but less than 150, consider donating at the blood bank. You can only benefit and at the same time, your blood will potentially go to someone who needs it more.

As for the person who inspired all this research, here is a recent report:
[Our] daughter with the serious problems who has been prescribed regular phlebotomies has made enormous improvements over the past few weeks. She decants about a pint every two weeks. Obviously, if someone was really HIGH they would need to get it down as quickly as possible, but this schedule seems to work after she did two in rapid succession.It really is amazing to see how her energy/mood has improved and her inflammation has quieted down with just getting rid of some blood.
Those who can't donate blood and/or are having problems getting a phlebotomy prescription, opt for decanting iron through oral EDTA chelation and/or activated charcoal. Here is an interesting testimonial about the later one:
Just an update for the data pool - After giving two pints of blood and drinking activated charcoal on average of every few days for the past 2 months (some days I'd drink it some days I would not), my Ferritin level dropped to 55 from 197, so I think the activated charcoal really played a part since giving a pint of blood should only drop it about 50 points from what I understand, so if the drop were just from the pints of blood, the reading should have been around 97. Of course there could be other factors at play of which I am unaware. Serum iron level dropped to 70, though that doesn't tell us much.

Unfortunately, this doctor I had didn't do either of the binding capacity tests so I have no idea of the saturation, logically, it should have improved (I think). So, I'm going to continue to give blood as often as the red cross allows me to and I think that should manage it. All my other blood tests were normal and she did an abdominal ultrasound to make sure I didn't have liver enlargement or anything and that all looked normal as well. I did have one liver hemangioma, a benign mass but she said that's no big deal.

So, if anyone can't do EDTA or doesn't want to do EDTA, activated charcoal certainly appears to be an alternative.
For more information on this topic visit the Iron Disorders Institute and read The Iron Elephant - What you should know about the dangers of excess body iron.