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Medical Forum / General / General / June 2006Dietary iron overload has a high mortality
S Afr Med J. 1999 Sep;89(9):966-72. Related Articles, Links Measurements of iron status and survival in African iron overload. MacPhail AP, Mandishona EM, Bloom PD, Paterson AC, Rouault TA, Gordeuk VR. Department of Medicine, University of the Witwatersrand, Johannesburg. INTRODUCTION: Dietary iron overload is common in southern Africa and there is a misconception that the condition is benign. Early descriptions of the condition relied on autopsy studies, and the use of indirect measurements of iron status to diagnose this form of iron overload has not been clarified. METHODS: The study involved 22 black subjects found to have iron overload on liver biopsy. Fourteen subjects presented to hospital with liver disease and were found to have iron overload on percutaneous liver biopsy. Eight subjects, drawn from a family study, underwent liver biopsy because of elevated serum ferritin concentrations suggestive of iron overload. Indirect measurements of iron status (transferrin saturation, serum ferritin) were performed on all subjects. Histological iron grade and hepatic iron concentration were used as direct measures of iron status. RESULTS: There were no significant differences in either direct or indirect measurements of iron status between the two groups. In 75% of these subjects the hepatic iron concentration was greater than 350 micrograms/g dry weight, an extreme elevation associated with a high risk of fibrosis and cirrhosis. Serum ferritin was elevated in all subjects and the transferrin saturation was greater than 60% in 93% of the subjects. Hepatomegaly was present in 20 of the 22 cases and there was only a moderate derangement in liver enzymes except for a tenfold increase in the median gamma-glutamyl transpeptidase concentration. There was a strong correlation between serum ferritin and hepatic iron concentrations (r = 0.71, P = 0.006). After a median follow-up of 19 months, 6 (26%) of the subjects had died. The risk of mortality correlated significantly with both the hepatic iron concentration and the serum ferritin concentration. CONCLUSIONS: Indirect measurements of iron status (serum ferritin concentration and transferrin saturation) are useful in the diagnosis of African dietary iron overload. When dietary iron overload becomes symptomatic it has a high mortality. Measures to prevent and treat this condition are needed. PMID: 10554633 [PubMed - indexed for MEDLINE] -------------------------------------------------------------------------------- Who loves ya. Tom Jesus Was A Vegetarian! http://jesuswasavegetarian.7h.com Man Is A Herbivore! http://tinyurl.com/a3cc3 DEAD PEOPLE WALKING http://tinyurl.com/zk9fk > S Afr Med J. 1999 Sep;89(9):966-72. Related Articles, Links > [quoted text clipped - 38 lines] > > PMID: 10554633 [PubMed - indexed for MEDLINE] There is a lot this study doesn't tell us, however. When it says, for instance, that "when dietary iron overload becomes symptomatic it has a high mortality...," we are not told what the diets of these individuals were, their proportions of carbohydrate intake to protein, their medical histories, or what medications they may have been taking. There is no mention of DNA testing, either, so we don't know what genetic factors may have predisposed them to this. Once again, no study proves that vegetarianism is right for everyone, just that iron is a tricky mineral. If the message is to eat less meat, that's certainly good advice for most westerners. > -------------------------------------------------------------------------------- > [quoted text clipped - 9 lines] > DEAD PEOPLE WALKING > http://tinyurl.com/zk9fk > Once again, no > study proves that vegetarianism is right for everyone, just that iron > is a tricky mineral. Yes it .. does .. though .. > If the message is to eat less meat, that's > certainly good advice for most westerners. The article .. seems .. to SPECIFICALLY show a DIRECT result OF increased iron by DIETARY means. The iron from MEAT has been SHOWN to be the ONLY type of iron which is UNCONTROLLED in its' .. absorption. And since the increased iron is KNOWN to increase incidence of .. mortality .. then one can conclude .. "a food substance ingested by man leads to increased mortality. This food substance appears to be meat. Due to its' KNOWN absorption properties." Therefore .. the 'argument/debate' .. OF .. 'whether man IS a herbivore or not .. HAS to begin WITH .. "meat is known to cause increased mortality in humans" .. therefore beginning with the argument OF .. "a food which kills human beings is a NORMAL food for that human being" .. Which in my way of thinking .. is .. "look at me .. I .. am .. stupid .. " But .. hey .. Who loves ya. Tom Jesus Was A Vegetarian! http://jesuswasavegetarian.7h.com Man Is A Herbivore! http://tinyurl.com/a3cc3 DEAD PEOPLE WALKING http://tinyurl.com/zk9fk > > Once again, no > > study proves that vegetarianism is right for everyone, just that iron [quoted text clipped - 7 lines] > The article .. seems .. to SPECIFICALLY show a DIRECT result OF > increased iron by DIETARY means. Here is something relevant to that particular population, from http://www.irondisorders.org/Disorders/Siderosis.asp. African iron overload (AIO) (previously known as African siderosis) is a condition observed in sub-Saharan Africans. It is characterized by the accumulation of large amounts of iron in the reticuloendothelial cells of the liver, spleen and bone marrow as well as in hepatocytes. While the distribution of iron differs from that seen in classical type 1 haemochromatosisas, organ dysfunction and high levels of body iron of similar magnitude may be found in AIO. AIO was thought to be solely due to the consumption of a traditional beer contaminated with iron. The beer has a high lactic acid content which is thought to be the reason why iron is leached out of the iron containers in which it is brewed. The iron concentrations can be as high as 80 to 100 mg per litre and, as the alcohol content is low (1 to 3%), consumption of several litres per day is possible. Recent work has suggested that a genetic defect in iron regulation, together with high dietary iron consumption may be responsible for AIO. A defect in the iron transporter ferroportin, responsible for iron release from the gut and reticuloendothelial cells, is thought to be a possible cause. A mutation in the ferroportin 1 gene has been found to be common in populations of West and Southern African origin and is associated with a tendency to higher serum ferritin levels. Other mutations of this gene are associated with iron overload with a similar tissue distribution to that seen in AIO. "Risk Groups: Anyone of African descent. Iron overload is a common condition in Africa where the prevalence of excessive body iron sufficient to cause liver damage affects as many as 10% of the population in some areas." Thus, eating meat would not be the causative factor for AIO in this population. > The iron from MEAT has been SHOWN to be the ONLY type of iron which is > UNCONTROLLED in its' .. absorption. The fact it's utilized more efficiently at the cell level doesn't mean it's "uncontrolled." The fact it is over-consumed in western society also doesn't mean everyone is genetically adapted to being complete herbivores. A number of our ancestors consumed meat, and we have to have genes expressing for it. Some sources say we lose about 1mg of iron per day in our hair and nails. That would imply a very small need for this mineral. I would suggest the USDA RDI for iron is about x4.5 times too high for meat eaters, and about x1.8 times too high for vegetarians (based on 10% and 25% iron absorption rates and an RDI of 18mg.) Even this can vary by individual, of course. > And since the increased iron is KNOWN to increase incidence of .. > mortality .. then one can conclude .. "a food substance ingested by man > leads to increased mortality. This food substance appears to be meat. > Due to its' KNOWN absorption properties." We have far more studies linking iron deficiency to disease than iron overload. Both are problems in various demographics, for obviously different reasons. > Therefore .. the 'argument/debate' .. OF .. 'whether man IS a herbivore > or not .. HAS to begin WITH .. "meat is known to cause increased > mortality in humans" .. therefore beginning with the argument OF .. "a > food which kills human beings is a NORMAL food for that human being" .. It's true that vegetarians have fewer heart attacks than their meat-eating counterparts. Unfortunately, we have very few studies relating this to specific levels of meat intake, whereas reduced cancer and heart disease risk are related to higher levels of fruit intake. >From a genetic standpoint, what is optimal for one is not optimal for another. Adulteration of animals foods is also a factor in health outcomes. Use of chemicals, steroids, and unnatural feeding practices in farmed animals affects EFA levels, effecting the health of the animals and humans who eat them. > Which in my way of thinking .. is .. "look at me .. I .. am .. stupid > .. " [quoted text clipped - 12 lines] > DEAD PEOPLE WALKING > http://tinyurl.com/zk9fk > "Risk Groups: Anyone of African descent. Iron overload is a common > condition in Africa where the prevalence of excessive body iron [quoted text clipped - 3 lines] > Thus, eating meat would not be the causative factor for AIO in this > population. Your right ... it wouldn't .. IF .. the hypothesis of .. genetic .. is correct .. but .. since it HASN'T been .. proven .. but the absorption of MEAT iron / heme iron .. HAS .. 'tends to accumulate in the body" .. then the dietary iron excess STILL holds .. > > The iron from MEAT has been SHOWN to be the ONLY type of iron which is > > UNCONTROLLED in its' .. absorption. > > The fact it's utilized more efficiently at the cell level doesn't mean > it's "uncontrolled." Absorption .. past the gut .. is uncontrolled .. THAT is the 'point' of 'no return' .. The body controls the amount of iron it has in its' .. stores .. and just keeps this level / pool topped up and downregulates the absorption of iron at the GUT .. level. The body has no method to eliminate iron from the body once it is absorbed. >The fact it is over-consumed in western society The first bite of meat you have at one year old causes you to absorb MUCH more iron than you would have the day before .. then the next day you absorb again and as long as you continue to eat meat you will have abnormal levels of iron in the body and these levels will continue to rise. > also doesn't mean everyone is genetically adapted to being complete > herbivores. If a substance .. "tends to accumulate " .. in a 'closed' system that substance will eventually completely fill the system. And if that substance is KNOWN to cause disease then one cannot argue that substance is natural for that animal. > We have far more studies linking iron deficiency to disease than iron > overload. An iron deficiency that has been recently shown to NOT .. exist .. in fact .. BECAUSE the anemia they THOUGHT was iron deficiency is in FACT .. not .. but IS ... in fact the body withholding iron from the invaders/pathogens. >Both are problems in various demographics, for obviously > different reasons. Iron deficiency doesn't exist. > >From a genetic standpoint, what is optimal for one is not optimal for > another. Foods for body type .. ? Your argument now BEING .. there are those who will die / become ill if they do not eat meat. > > Which in my way of thinking .. is .. "look at me .. I .. am .. stupid > > .. " [quoted text clipped - 12 lines] > > DEAD PEOPLE WALKING > > http://tinyurl.com/zk9fk "The iron from MEAT has been SHOWN to be the ONLY type of iron which is > > UNCONTROLLED in its' .. absorption." No, it can and is controlled, end of iron causes all disease because people eat meat notion. > > "Risk Groups: Anyone of African descent. Iron overload is a common > > condition in Africa where the prevalence of excessive body iron [quoted text clipped - 8 lines] > of MEAT iron / heme iron .. HAS .. 'tends to accumulate in the body" .. > then the dietary iron excess STILL holds .. Genetic-based iron overload has been proven, that's why those of African descent are more susceptible. > > > The iron from MEAT has been SHOWN to be the ONLY type of iron which is > > > UNCONTROLLED in its' .. absorption. [quoted text clipped - 4 lines] > Absorption .. past the gut .. is uncontrolled .. THAT is the 'point' of > 'no return' .. Haem iron isn't 100% absorbed, however. Through intestinal inhibitition of one or more iron transporters, hepcidin regulates haem and non-haem iron alike. And just like non-haem iron, its absorption varies by individual, falling between 20-30%. It's true you can overwhelm the body's natural regulatory mechanisms, but that's just as true for zinc, calcium, and selenium. > The body controls the amount of iron it has in its' .. stores .. and > just keeps this level / pool topped up and downregulates the absorption > of iron at the GUT .. level. > > The body has no method to eliminate iron from the body once it is > absorbed. Actually, we lose about 1mg iron through normal processes each day. http://www.ibms.org/index.cfm?method=science.haematology&subpage=haematology_iro n_deficiency_anaemia > >The fact it is over-consumed in western society > [quoted text clipped - 3 lines] > abnormal levels of iron in the body and these levels will continue to > rise. My personal view is that red meat should not be consumed more than 3 times a week. > > also doesn't mean everyone is genetically adapted to being complete > > herbivores. > > If a substance .. "tends to accumulate " .. in a 'closed' system that > substance will eventually completely fill the system. It's not really a closed system, it's just very input sensitive. We don't actually know the point at which excess iron becomes problematic, either. And too little iron is just as harmful as too much. > And if that substance is KNOWN to cause disease then one cannot argue > that substance is natural for that animal. That argument can be applied to drugs, but not nutrients. Too much of any nutrient creates imbalance by synergizing or antagonizing other nutrients and potentially causing disease. Despite that negative potential, all nutrients are natural and required. What you are questioning is whether haem iron is a nutrient, and I respect your view that it isn't. I just don't agree with it. > > We have far more studies linking iron deficiency to disease than iron > > overload. [quoted text clipped - 3 lines] > .. not .. but IS ... in fact the body withholding iron from the > invaders/pathogens. ?? > >Both are problems in various demographics, for obviously > > different reasons. > > Iron deficiency doesn't exist. Deficiencies in every nutrient exists somewhere, in someone. The reasons for such deficiencies vary widely. > > >From a genetic standpoint, what is optimal for one is not optimal for > > another. > > Foods for body type .. ? I think you mean blood type (ie., Peter Adamo). I would just say it's genetic based. > Your argument now BEING .. there are those who will die / become ill if > they do not eat meat. No, since iron is available in plant foods. B12 is the bigger problem. > > > Which in my way of thinking .. is .. "look at me .. I .. am .. stupid > > > .. " [quoted text clipped - 12 lines] > > > DEAD PEOPLE WALKING > > > http://tinyurl.com/zk9fk PeterB wrote:> > Genetic-based iron overload has been proven, that's why those of > African descent are more susceptible. Hinted / suggested .. but NOT .. 'proven' .. Iron overload in Sub-Saharan Africa: to what extent is it a public health problem? Authors: Walker A.R.P.*; Segal I.1 Source: British Journal of Nutrition, Volume 81, Number 6, 1999, pp. 427-434(8) Publisher: CABI Publishing Abstract: Excessive deposition of Fe in the organs and tissues of Sub-Saharan Africans was first described in South Africa in 1929. Fe overload, or siderosis, was initially attributed to infections and to metallic poisoning (Cu, Sn, Zn), and then to malnutrition. In 1953 it was hypothesized that it was due primarily to excessive Fe intake derived from foods and drinks prepared in Fe vessels. Recently, in 1992 it was advanced that a gene distinct from any HLA-linked locus may also play a role. As to sequelae, in early research on series of hospital patients, the condition was linked to scurvy, osteoporosis, diabetes, cirrhosis, and latterly, to hepatocellular cancer and tuberculosis. Accordingly, many have concluded that Fe overload is responsible for considerable morbidity and mortality, that adventitious Fe intake should be reduced, and that phlebotomy be recommended for those severely affected. However, there are numerous limitations in the evidence. There are also problems in interpretation, since levels of Fe in the serum are affected additionally by a variety of factors: infection, inflammation, certain cancers and alcohol intake. These considerations complicate attempts to assess to what extent the associations described denote causation, and whether Fe overload has significant ramifications for ill in the general African population. While the adverse sequelae of overload may be less of significance than many believe, the precise pathogenicity of the phenomenon will remain uncertain until further investigations, including prospective studies, are undertaken. Keywords: Iron overload; Africa; Cirrhosis; Hepatocellular carcinoma Language: English Document Type: Research article Affiliations: 1: Gastroenterology Unit, Department of Medicine, Baragwanath Hospital and the University of the Witwatersrand, Johannesburg 2000, South Africa > My personal view is that red meat should not be consumed more than 3 > times a week. Sooo .. in effect you are .. limiting your iron overload .. BUT .. not .. eliminating it. . > > If a substance .. "tends to accumulate " .. in a 'closed' system that > > substance will eventually completely fill the system. > > It's not really a closed system, it's just very input sensitive. We > don't actually know the point at which excess iron becomes problematic, either. I believe the last study found 25% saturation of transferrin is the 'point' at which the body begins to DOWNREGULATE the active absorption .. process .. >And too little iron is just as harmful as too much. Which has never been proven .. because .. ? .. there simply haven't BEEN enough people who are .. iron deficient .. to PROVE .. anything. Why .. ? because 'they' have JUST .. admitted to NOT .. 'being able' to .. JUDGE whether one is iron deficient or NOT .. Because what they THOUGHT was iron deficiency .. is NOT .. iron deficiency .. <<snip>> This finding suggests that the contribution of iron deficiency to pregnancy associated anemia in this region is *low*. <<snip>> > > > We have far more studies linking iron deficiency to disease than iron > > > overload. [quoted text clipped - 5 lines] > > ?? They have recently tested for SPECIFIC .. 'iron deficiency' .. and FOUND .. contrary to what they have ALWAYS believed .. that the apparent iron deficiency they 'thought' existed .. doesn't .. exist .. The apparent iron deficiency was NOT iron deficiency at all .. but is UNUTILIZED .. iron .. <<snip>> This finding suggests that the contribution of iron deficiency to pregnancy associated anemia in this region is *low*. <<snip>> Blood Cells Mol Dis. 2006 Jun 2; [Epub ahead of print] Links Thalassemia and hemoglobinopathies rather than iron deficiency are major causes of pregnancy-related anemia in northeast Thailand. Sanchaisuriya K, Fucharoen S, Ratanasiri T, Sanchaisuriya P, Fucharoen G, Dietz E, Schelp FP. The Graduate School of Khon Kaen University, Khon Kaen, Thailand; Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand 40002. A cross-sectional prevalence study of anemia was undertaken on 412 pregnant women in northeast Thailand during January 2003 to May 2004. With standardized diagnostic protocols and the CDC criteria of anemia [hemoglobin (Hb) <11 g/dl at </=12 weeks of gestation and Hb <10.5 g/dl at </=20 weeks of gestation], 71 (17.2%) subjects were anemic. Of these, 42 (59.2%) subjects had thalassemia, 5 (7.0%) had iron deficiency, 18 (25.4%) had combined thalassemia and iron deficiency and 6 (8.5%) had no thalassemia nor iron deficiency. Adjusted logistic regression analyses indicated that various thalassemia genotypes were significantly related to anemia, while homozygous Hb E had the highest risk with an odds ratio (OR) of 44.8 (95% CI 12.6-159.7). In comparison, iron deficiency demonstrated a much lower risk with OR of 3.1 (95% CI 1.4-6.8). This finding suggests that the contribution of iron deficiency to pregnancy associated anemia in this region is low. PMID: 16750922 [PubMed - as supplied by publisher] -------------------------------------------------------------------------------- > Deficiencies in every nutrient exists somewhere, in someone. The > reasons for such deficiencies vary widely. *Impossible* to deplete seven months worth of iron without .. dying .. > > > > Who loves ya. > > > > Tom [quoted text clipped - 7 lines] > > > > DEAD PEOPLE WALKING > > > > http://tinyurl.com/zk9fk >PeterB wrote:> >> Genetic-based iron overload has been proven, that's why those of >> African descent are more susceptible. > >Hinted / suggested .. but NOT .. 'proven' .. Then none of your arguments are worth anything because NONE of them have been "proven." Just that there is a greater or lesser amount of evidence. Iron deficiency can exist. Iron overload can exist. Individual responses vary widely because humans are not all the same. So using terms like "proven" in this context are a little silly. There is an art to medicine, an art to living. Data and observation may help to enhance the practice of either. But they may also obstruct and confuse if initial premises are inaccurate. George M. Carter > Then none of your arguments are worth anything because NONE of them > have been "proven." The study PROVES iron overload DUE TO .. diet .. They 'say' .. genetics .. 'may' be involved .. Dietary is .. PROVEN .. Unless you can figure somehow ELSE the iron got into their .. system .. ? I will bet a real smart guy like you can .. figure .. it .. out .. "absorb it through the soles of their feet because they have no shoes" .. There you can use that one .. that came right from the mouth of some of .. your .. cohorts .. the 'artsy' type of medical practitioner .. Who loves ya. Tom Jesus Was A Vegetarian! http://jesuswasavegetarian.7h.com Man Is A Herbivore! http://tinyurl.com/a3cc3 DEAD PEOPLE WALKING http://tinyurl.com/zk9fk >> Then none of your arguments are worth anything because NONE of them >> have been "proven." > >The study PROVES iron overload DUE TO .. diet .. Nope. Just provides strong evidence in some populations for a risk of dietary iron overload. George M. Carter > >PeterB wrote:> > >> Genetic-based iron overload has been proven, that's why those of [quoted text clipped - 6 lines] > > Just that there is a greater or lesser amount of evidence. I've often made that argument to our resident pharma bloggers, who repeatedly call for "proof." The fact they have none of their own is telling. Of course, Tom isn't one of them, but his allegiance to vegan ideology leads him to think that way. The irony, of course, is that he isn't far from the truth in terms of dietary science, just in terms of nutritional science. > Iron deficiency can exist. Iron overload can exist. Individual > responses vary widely because humans are not all the same. [quoted text clipped - 4 lines] > may help to enhance the practice of either. But they may also obstruct > and confuse if initial premises are inaccurate. Be careful, George. The truth gets you into trouble around here. ;) > George M. Carter >Be careful, George. The truth gets you into trouble around here. ;) I've spent most of my adult life in this kind of trouble. Keeps me poor too. In the US, if you want to speak the truth or do work to reveal the truth, you will be punished. Eh. I sleep well. George M. Carter > >Be careful, George. The truth gets you into trouble around here. ;) > [quoted text clipped - 6 lines] > > George M. Carter I hear ya' If in some parts of the population of sub sahara africa iron levels are high it is not for having eaten meat. The diet for most of sub sahara africa is very close to vegitarian with very high intake of grains and tubers etc. and little meat eaten in very small amounts or only on special occasions. We must then ask what is the cause of this. At the same time that area is also one with low iron in many people to the point of it being a health problem. >> S Afr Med J. 1999 Sep;89(9):966-72. Related Articles, Links >> >> Measurements of iron status and survival in African iron overload. >There is a lot this study doesn't tell us, however. Actually, this isn't the study but just the abstract. What would be great would be to review the entire paper where some of the important questions you raise may be answered. Whether the source is beer and/or meat, encouraging dietary changes is always a challenge. How to empower people to recognize they have choices and to make them consciously, with awareness of risks, is one general approach. George M. Carter Old news, iron overload can have health risks. The question is what is overload. An interesting question is what percentage of the iron in their bodies was plant derived and added to the increased risk level? |
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