DRHOOK- Red-blooded: Iron overload a flat-out problem

the handsome doctor John Hong

When I was a kid, I used to read everything from Spider-Man to X-Men, but Iron Man was never one of my favorite comic book heroes. Who would have imagined in years to come that all these superheroes' stories would become blockbuster movies? I guess it's like Bonnie Tyler's hit song, "I Need a Hero."

However, did I love the Rodney Downey Jr. movie of Iron Man? Why, yes! He might not be the Man of Steel, but iron is a good thing— especially for red blood cells.

But is it possible to have too much iron?

Hemochromatosis (HC) is a genetic disorder that causes too much iron absorption from the gut. In most cases of HC, the HFE gene goes haywire, and iron absorption is unregulated like Wall Street executives who want to buy an extra mansion– and yacht– and island. 

Though HC is an autosomal recessive trait (meaning two copies of the abnormal gene must be present for the disease or trait to develop), still, having just one defective gene (heterozygote) is enough to cause some iron overload. Ten percent of white Americans and Europeans have one defective HC gene. (I even have a relative with this– and she's as white as Wonder Bread.) For people with both defective genes, about 0.5 percent have the full-blown version of HC. 

So what's the big deal with too much iron? The big problem is it can cause damage to the liver as well as to the pancreas, heart, and pituitary gland.

The liver is hardest hit. Elevated liver enzymes are usually found in lab studies. The liver becomes fatty, and in time cirrhosis and/or liver cancer can develop. Compounding factors like alcohol use can accelerate liver disease, in particular for heterozygotes (one bad gene), who tend not to get complications like homozygotes (two).

Too much iron in the body usually gives a person a "savage tan," so if someone looks bronze like an Olympic medal, it could be a sign of HC.

Feeling tired, weak, run down? While many folks today seem to feel that way, excessive iron can be a biological reason for a lack of umph. 

Diabetes occurs in about half of people with HC. Low thyroid function from HC can cause fatigue and weight gain. Low libido and erectile dysfunction are another down side of HC because testosterone levels can drop from an ailing pituitary gland. Interestingly, the index and middle fingers often feel arthritic in people with HC. 

Congestive heart failure from a weakened heart riddled with iron can cause shortness of breath, leg swelling, and death. A slow or erratic pulse can be detected on EKG as well as physical examination.

Yes, many women are told to take iron because they lose it in menstrual bleeding. So often women don't show signs of HC until years after menopause, unlike men who tend to start to have liver problems at an earlier age (in their 40s).

How do you get the lead– er, iron– out? Blood-letting is kind of medieval, but the concept is the same. Blood is drawn out of the vein (like in donating blood) until the iron loads come down– and the sooner the better, because the more the iron deposits in the organs, the more likely the damage is irreversible.

Blood tests to check iron panels are used to screen for HC. The genetic test is also a blood test. Liver biopsies might be done to check the extent of liver damage from HC. 

I wonder if Iron Man is as tough on the inside as he is on the outside. I'm glad he, as a former irresponsible playboy turned moral superhero, has time to iron things out.


Dr. Hook cracks a joke or two, but he's a renowned physician with an interesting website, drjohnhong.com. Email him with your questions.