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Encore (A Special Report): Upfront
Iron Overload
By Carol Gentry

03/19/2001
The Wall Street Journal
R4
(Copyright (c) 2001, Dow Jones & Company, Inc.)

Feeling tired and achy? Don't shrug it off as age or stress. Above all, don't start taking iron. That could make it worse.

Medical researchers are learning that many adults have a genetic mutation that causes their bodies to absorb too much iron. The substance silently builds up in organs and joints until midlife, when the damage begins to reveal itself.

The disease, hereditary hemochromatosis, afflicts more than one million Americans, making it the most common genetic disease in North America. It can be detected with an inexpensive blood test, and the damage is preventable, yet most cases are never properly diagnosed.

"Many diseases attributed to old age are actually symptoms of hemochromatosis," says Sandra Thomas of Daytona Beach, Fla., president of the American Hemochromatosis Society, a support group. "People in their golden years could have a better qualify of life if they were diagnosed and treated."

Even though hereditary hemochromatosis is common, most doctors never diagnose a single case because they aren't looking for it, says Vincent J. Felitti, director of the Department of Preventive Medicine for the Kaiser Permanente health plan in San Diego. Since Kaiser-San Diego began screening adults for iron overload three years ago, it has found 500 cases; Dr. Felitti expects to find an additional 1,400 or so among the 500,000 Kaiser Permanente patients in San Diego.

"The fact is, every practitioner in the country sees a case every two or three weeks, only they're not recognized because they come in disguised as something else, or symptoms haven't developed yet" Dr. Felitti says.

Patients come in complaining of chronic fatigue, stomachaches, joint pain, heart palpitations, impotence or depression. After the usual medical workups lead nowhere, puzzled doctors often send the patient home with a prescription for Viagra or Prozac. But the iron, undetected, keeps building up in the organs and joints, leading to arthritis, diabetes, heart arrhythmias, cirrhosis of the liver and certain cancers.

The irony is that both testing and treatment for iron overload are simple. A "transferrin saturation" test that shows whether excess iron is being absorbed adds only a few dollars to the cost of a routine blood test, Dr. Felitti says. A genetic test that identifies 85% of hereditary hemochromatosis patients is available, and though it isn't necessary for diagnosis or treatment, it's useful in helping relatives learn they have the disease before they develop symptoms.

Treatment is simple: regular blood draws. When serious iron overload cases are first caught, experts say, the patient may need to give up one or two units of blood a week. Once the iron level drops to normal, blood is drawn about once every three months.

Hemochromatosis can be the result of environmental factors -- it often occurs in Africa from cooking in iron pots -- but the hereditary form of the disease is more common in Europe and the U.S., with a prevalence of about four cases per 1,000. Fully 12% of the population are carriers of one, but not both copies, of the defective gene necessary to develop the disease.

The disease isn't caused by eating iron-rich foods, but by over-absorbing the iron in a normal diet. Iron overload occurs because the defective gene interferes with the normal function of the intestinal lining and allows too much iron to pass through to the bloodstream, where it is carried to certain organs that are sensitive to it, especially the liver. The iron causes inflammation, which damages the organs.

Many patients go for years thinking their symptoms are due to stress. Harry Kieffer of Cordele, Ga., got that medical assessment when he saw his doctor due to fatigue, joint pain, irregular heartbeat and migraines. It was easy to believe; as production manager for a new building-products plant, he was working 60 to 80 hours a week. "During this whole time, we took stress-formula vitamins with iron," says Mr. Kieffer's wife, Chris. "We thought we were being good to ourselves, but were compounding the problem."

The American Academy of Pathology in 1996 called for doctors and hospitals to run iron-status tests on all new patients, but there has been little movement in that direction. Officials at the Centers for Disease Control and Prevention say there must be better safeguards in place to prevent discrimination by insurance companies before widespread screening can begin. But they say anyone who shows symptoms, or has a relative with the disease, should ask for a test.

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Ms. Gentry is a writer in Atlanta. She can be reached at Encore@wsj.com





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