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IRON NEWS: June 2017
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Solutions for Iron-Out-of-Balance and Joint pain

Chronic fatigue and joint pain top the list of complaints by individuals whose iron levels are abnormal. Fatigue is the number one complaint by people who are iron deficient or by people with iron overload; joint pain is usually more prominent in those with iron overload.  A complete iron panel is needed to determine the type of iron disorder a person has: iron deficiency with or without anemia, iron overload, anemia of inflammatory response, or iron avidity. The therapies are dramatically different for these types of iron disorders. For this report, we will concentrate on joint pain for people with hereditary hemochromatosis (iron overload); these individuals are generally ones who have undergone years of iron reduction with phlebotomy and have become iron avid and suffering from severe joint pain.  
 
When symptoms of joint pain are persistent in spite of endeavors to reach healthy iron levels, quite likely irreversible iron-related damage has taken place in the synovial joint.

Iron triggers free radical activity; behaving normally this activity works as a vital component of metabolism. When excessive, free radical activity causes oxidative stress which plays a major role in cell death and chronic disease such as arthritis. 
 
Humans have multiple systems and ways to counter oxidation; we normally derive antioxidants from foods and can keep free-radicals in check. When they are not, inflammation and the pain it brings are the consequences. Inflammation can be caused by things other than free-radical excess. Infection, disease, injury, allergies, and surgery are among some of the causes of an inflammatory response.
 
Regardless of the reason, inflammation is generally included as a leading cause of pain and in the presence of high iron and inflammation, oxidative stress on the joints is increased significantly furthering the damage to these already painful joints. Anti-inflammatory remedies have generally include NSAIDS (non-steroidal anti-inflammatory drugs) but some people cannot take these medications and turn to alternative or complementary solutions to address inflammation and reduce the pain that accompanies it.
 
The potential of anti-inflammatories has been widely studied in animals but not specifically in the hemochromatosis patient.  Dr. Ralph Schumacher, University of Pennsylvania reports in his conclusion: that tart cherry juice provided symptom relief for patients with mild to moderate knee osteoarthritis, but this effect was not significantly greater than placebo. Tart cherry juice lowered hsCRP levels (marker for inflammation) and this effect was associated with improved WOMAC scores (ability to move and walk.)

According to arthropathy expert  Joanne M. Jordan, MD, MPH,   University of North Carolina's Thurston Arthritis Research Center “Given the lack of studies of [supplemental antioxidants}  in hemochromatosis arthropathy, we cannot say for certain if these over-the-counter products will work. The issue is most likely due to bio-availability. However, curcumin (turmeric) remains an interesting compound to study for these indications, with some properties that might target specific pathways important in different types of arthritis.” 

It is generally best to get antioxidants from food sources such as coffee, tea, walnuts, fresh fruits and vegetables such as spinach (yes, spinach is okay for people with hemochromatosis!), natural sources of vitamin C (Yes, non-supplemental sources of vitamin C such as fresh but low sugar sources, example: berries)  are okay for people with hemochromatosis) The list of over-the-counter supplemental anti-oxidants  is quite long but those of particular interest include: phytic acid (inositol-6-phosphate), curcumin (turmeric,)  white willow bark, green tea, pycnogenol, Boswellia, cat’s claw, capsaicin, quercetin, bromelain, resveratrol, flax seed oil, fish oil, ginger, alpha lipoic acid, and zinc. Any one or combination of these substances may result in pain reduction but there are side effects that must be considered before launching into taking these items. Too much zinc, for example, can result in a copper imbalance and anemia.
 
Food or supplement forms of antioxidants vary in bioavailabitity; also taken in supplemental form, an antioxidant can become a pro-oxidant and kick up the cycle of free radical activity. Alpha Lipoic Acid (ALA) for example was found to alter iron metabolism in such a way as to act as a pro-oxidant. For instance, the compound has been observed to dislodge iron from ferritin retention and to increase lipid peroxidation by ferrous ions. Nevertheless, in other systems, ALA has lowered the risk of iron-induced oxidative damage. Vitamin E, a powerful antioxidant was found to function similarly.
 
Every food contains some level of antioxidant: nuts, grains, oils, fruits, vegetables, chocolate, coffee, and tea. How do we determine which choices are best? Coffee and tea, for example, are high in antioxidants, but too much of these beverages can damage the liver because of the high tannin content.  Plums are very high in antioxidants but not highly bioavailable to the body.  Wild blueberries while both high in antioxidants and high in bioavailability must be consumed in large amounts—at least a half-cup to earn the distinction of the super antioxidant. An apple a day…still has merit since a good old-fashioned red-skinned apple joins the ranks of potent oxygen-radical-busting foods on the United States Department of Agriculture (USDA) list of foods with the greatest antioxidant capacity.

Solutions for Iron-Out-of-Balance™ and the symptoms that accompany this state must combine therapeutic strategies to bring iron levels into a healthy balance. For those with excess iron, reduction can be achieved with blood donation or phlebotomy or iron chelation in limited cases. For those with too little iron, replenishment is more complex and can include oral supplementation, whole blood or iron infusions. And for those who are iron avid or dealing with anemia of inflammatory response iron reduction or replenishment might be postponed until your healthcare provider can find and correct the reason for these two iron disorders.   

Dr. Leo Zacharski comments: “People with iron overload need to take precautions for iron excess: supplements should be totally avoided and red meat ingested once per week or less (Framingham study, Fleming). I strongly believe that much can be achieved by dietary restriction of iron supplementation and consumption of red meat, but this is very challenging because of wide-spread food supplementation. This practice can give you your “total daily requirement” in one bowl of cereal which can cause iron accumulation over time, and may account for the rise in ferritin of about 3-5 ng/mL per year in males between the late teens and early 30’s, and during the menopausal transition in women. People need guidelines on how to read cereal side panels. This supplemental iron is too much for people with iron overload and too little for people with iron deficiency - that is presumably undiagnosed assuming the CDC, Institute of Medicine and FDA know how much iron any given individual “requires”, which they do not. Some people can markedly reduce phlebotomy requirements by simply paying close attention to dietary intake.” 
 
Meanwhile, know your iron levels! Ask your healthcare provider for a complete iron panel: fasting serum iron, total iron-binding capacity, serum ferritin and hemoglobin. GGT is another test we suggest getting because the results are helpful in determining your ability to manage oxidation. Elevated GGT is a strong indication that disease is underway and needs to be corrected.  

Upcoming issue:

July: Genetics and inheritance patterns.

Links and Helpful Reading:

 
http://www.ars.usda.gov/is/pr/2007/070612.htm
 
Halvorsen BL, Carlsen MH, Phillips KM, Bøhn SK, Holte K, Jacobs DR Jr, Blomhoff R. “Content Of Redox-Active Compounds (i.e., antioxidants) in Foods Consumed In The United States” American Journal of Clinical Nutrition (2006) 84:95-135
For a complete bibliography contact publications@irondisorders.org
 
World J Gastrointest Pathophysiol. 2017 May 15;8(2):67-76. doi: 10.4291/wjgp.v8.i2.67. Combination curcumin and vitamin E treatment attenuates diet-induced steatosis in Hfe-/- mice.
Heritage M, Jaskowski L, Bridle K, Campbell C, Briskey D, Britton L, Fletcher L, Vitetta L, Subramaniam VN, Crawford D.
 
 
Osteoarthritis Cartilage. 2013 Aug;21(8):1035-41. doi: 10.1016/j.joca.2013.05.009. Epub 2013 May 31. Randomized double-blind crossover study of the efficacy of a tart cherry juice blend in treatment of osteoarthritis (OA) of the knee.
Schumacher HR, Pullman-Mooar S, Gupta SR, Dinnella JE, Kim R, McHugh MP.
 
Integrative Medicine (Encinitas). 2015 Feb; 14(1): 48–49.
PMCID: PMC4566454
Tart Cherry Juice as a Treatment for Peripheral Neuropathy
Cindy Alberts Carson, MD, FACP, ABIHM
 
Bardou-Jacquet E, Lainé F, Guggenbuhl P, Morcet J, Jézéquel C, Guyader D, Moirand R, Deugnier Y. Worse Outcomes of Patients With HFE Hemochromatosis With Persistent Increases in Transferrin Saturation During Maintenance Therapy. Clinical Gastroenterology and Hepatology. 2017 Jan 19. pii: S1542-3565(17)30056-3. doi: 10.1016/j.cgh.2016.12.039.
 
International Journal of Biomedical Science. 2008 Jun; 4(2): 89–96.
PMCID: PMC3614697 Free Radicals, Antioxidants in Disease and Health
Lien Ai Pham-Huy, Hua He, and Chuong Pham-Huy

THREE IMPORTANT VIEWS ON IRON

  1. WORK: Hemoglobin
  2. MOVE: TS%
  3. STORED: Ferritin
Easy Diet TIPS: If you need iron, avoid coffee, tea, and dairy; if you don't need iron, include coffee, tea, and dairy.

CONTROL IRON LEVELS with diet; know foods that enhance or impair iron absorption. Visit this link for more information.

THE BASICS ON IRON LEVELS


Optimum Iron Levels for Adults:
Hemoglobin: 12.5 g/dL
Serum ferritin: 50-150 ng/mL
TS*: 25%-35%

*TS%: transferrin-iron saturation percentage (fasting serum iron divided by total iron binding capacity, aka TIBC, multiplied by 100%).

REDUCE HIGH IRON LEVELS with blood donation or therapeutic phlebotomy.

KNOW YOUR IRON LEVELS!


FeGGT Life Pro™:
A life-saving set of tests for those who pay out of pocket, have a high deductible, or who just want to know these important health details. Please click BELOW for more information or the image below to order tests.

When Life Sucks Foundation helps veterans with hemochromatosis who are struggling with sleep or traumatic stress. If you would like to connect with WLS, contact Timothy Wiles at twiles@whenlifesucks.org.
Copyright © 2017 Iron Disorders Institute - The Hemochromatosis Foundation, All rights reserved.
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