DIETARY CONSIDERATIONS, including Vitamin C, smoking, alcohol use, etc.

The fortification of our food should be of special concern to those with HH.  Some products [at least in the U.S.A.] give us 100% of the RDA  for iron in ONE serving size!  Cereals are probably the worst & how many of us only eat the recommended serving size of 3/4 cup?  Check your labels!  Know the iron content in your food! Write to the manufacturer!.  Let's stop this practice of medicating 100% of the population with iron just so they can reach those who may be TRULY iron deficient & who really need it. Doesn't it make more sense to simply medicate the 10-15% who really need the extra iron instead of slowly poisoning the 10-15% who have HH???

Click on the title to read more on these topics.

• Advanced Medical Nutrition Multiple Vitamin/Mineral supplements New Warnings About Too Much Iron (Basic Preventive and Added Protection III) have been available with or without iron since 1984. Be sure to select the correct formula for your individual needs.

• Annals of Internal Medicine SUPPLEMENT DIAGNOSIS AND MANAGEMENT 
  Diagnosis of Hemochromatosis, Annals of Internal Medicine, 1 December 1998. 129:925-931. Lawrie W. Powell, MD; D. Keith George, MD; Sharon M. McDonnell, MD; and Kris V. Kowdley, MD
  

• Are You Getting Enough Iron, or Perhaps, Too Much? 
  By Eve Shatto Walton, R.D., L.D.N. [List of foods high in iron]

• Blood Bank lists iron rich foods so that you can become a better blood donor!  If you have HH, these are foods that you will want to AVOID!! 

• Blood Donating, Iron, Tannins and Tea 
  Nutriquest.  Why does drinking tea cause me to have a low level of iron?

• Chronic iron overload and toxicity: clinical chemistry perspective. Clin Lab Sci 2001 Summer; This toxicity involves many organs leading to a variety of serious diseases such as liver disease, heart disease, diabetes mellitus, hormonal abnormalities, dysfunctional immune system, etc. The tissue damage associated with iron overload is believed to result primarily from free radical reactions mediated by iron.

• Clinical trial on the effect of regular tea drinking on iron accumulation in genetic haemochromatosis GUT 1998;43:699-704 ( November ) ResultsA significant reduction in iron absorption was observed when the test meal was accompanied by drinks of tea instead of water. In the tea drinking group, the increase in storage iron was reduced by about one third compared with that of the control group.  Conclusions:  Regular tea drinking with meals reduces the frequency of phlebotomies required in the management of patients with haemochromatosis.

• Contact the food manufacturers!!  Canadian/U.S. Manufacturer Contact List   Let them know about the IRON  in their products which is so poisonous to our families!  According to their website, "they assume that for every contact, approximately 200 other people feel the same way but didn't write or phone. So your contact carries clout!" Write them, and please let me know what they say if you do! 
   

• Desferrioxamine and vitamin E protect against iron and MPTP-induced neurodegeneration in mice.
   J Neural Transm 1997  Our data suggested that: (1) iron may induce neuronal damage and thus excessive iron in the brain may contribute to the neuronal loss in PD; (2) iron chelators and antioxidants may serve as potential therapeutic agents in retarding the progression of neurodegeneration.

• Diagnosis and management of hemochromatosis
  by Dr. Anthony Tavill, Director of the Maurice and Sadie Friedman Center For Digestive Diseases and Liver Disorders, Mathile and Morton J. Stone Professor of Digestive Diseases and Liver Disorders at the Mt. Sinai Medical Center, Professor of Medicine and Nutrition at Case Wetern Reserve University. [Excellent & thorough article of diagnosis & treatment.  This is a pdf file]  Recommends no more than 200mg of Vit C daily & none during initial phlebotomies when phlebbing frequently.
   

• Dietary Iron Supplements - Use or not to use? Nutrition Today James R. Connor John L. Beard 05-06-1997 There is little reason to support a general need for iron supplementation in the diet at any age. Perhaps this article and review of supplementation pros and cons should conclude with a new interpretation of an old saying: "It is better to wear out than to rust out;" don't expose your system to more iron than it needs.

• Dietary Iron: Trends in the Iron Content of Foods, Use of Supplemental Iron, & the Framework for Regulation of Iron in the Diet.  Although this chapter deals with supplemental iron from an iron deficient standpoint, it is  still helpful to the HH patient by learning what foods to avoid & how our foods are adulterated with iron from so many places.  Infant formula, baby foods & cereals are especially a concern for those with HH risks in their families.

• Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc (2001)

• Effect of hemochromatosis genotype and lifestyle factors on iron and red cell indices in a community population Clin Chem 2001 Feb; There was a significant increase in ferritin concentrations in both genders with increasing frequency of red meat consumption above a baseline of 1-2 times per week and alcohol intakes >10 g/day.

• Excess Iron Throws Out Welcome Mat to Bacteria  Heart, liver, intestines may suffer from over-fortified diet 11/2/2001 News By Serena Gordon HealthScoutNews Reporter (HealthScoutNews) -- Too much iron in the diet could be making people more susceptible to intestinal infections, claims a new study.  And that puts into question whether U.S. food makers need to fortify foods with iron, says one of the nutritionists who conducted the research.
   

• Fortified Cereals - - Too Much of a Good Thing? 
  By REUTERS July 11, 2001 Eating two bowls of cereal can be equivalent to taking two vitamins, a spokesperson from the US Food and Drug Administration (FDA) told Reuters Health. ``You can easily take in several times the daily value just from cereal alone,'' she said.
   

• FYI–Iron Q&A with Craig Petersen/Registered Dietitian: "Too much can be a problem though and there's probably a tendency in this country to over supplement iron and we probably need to take a little closer look at who we're giving iron to and why we're giving it to them." Craig does not recommend iron supplements unless your iron intake is grossly inadequate in iron and even then, he reminds you to do it only with a doctor's supervision.

• Genetic Health-What Is Hemochromatosis?
  By Amanda Ewart Toland, PhD  Reviewed by Chris Friedrich, MD, PhD Last updated September 1, 2000
   

• Get out the magnets! Total Cereal is the Breakfast of Champions. It also supplies us with 100% of our daily requirement of iron. Try this experiment & when you pull the magnet out, you will see lots of little iron shavings attached to it. 

• The Guide to Vitamins courtesy of: Herbshop.com
  
   

• Haemochromatosis and Diabetes– By Paul Steel--  Paul Steel is a diabetes educator with Manningham Community Health   Service in Victoria. He has both a personal and professional interest in haemochromatosis, the most common genetic disorder in Australia, occurring in about one in 300 people.

•  

• Hemochromatosis at Tummyhealth.com 
  Screening, Diagnosis, Treatment discussed on this website hosted by Dr. Cory Vergilio who practices Gastroenterology and Hepatology in Somerville, New Jersey and South Plainfield, N.J
   

• Hemochromatosis, Cooley Dickinson Hospital   Editor: George R Bowers MD CDH Oncology  January 2000 Volume 4: No. 1.   Hemochromatosis is a common, genetically transmitted disease. The diagnosis of hemochromatosis is sometimes difficult and frequently missed. This issue will review the pathogenesis, diagnosis and treatment of this fascinating disease. Ms. Kathy Fleming will review the management of a most troubling complication of therapy---lymphedema. 

• Hemochromatosis  Gale Encyclopedia of Medicine The symptoms of hemochromatosis include fatigue, weight loss, weakness, shortness of breath, heart palpitations, chronic abdominal pain, and impaired sexual performance. The patient may also show symptoms commonly connected with heart failure, diabetes or cirrhosis of the liver. Changes in the pigment of the skin may appear, such as grayness in certain areas, or a tanned or yellow (jaundice) appearance.

• Hemochromatosis:  Life Extension Foundation website.  Disease, Prevention & Treatment 3rd editon.  Dietary & Vitamin recommendations listed here including calcium for blocking of iron absorption.

• Hereditary Hemochromatosis--A Risk Factor for Cardiovascular Disease   The HH mutation is a human genetic model of disturbed iron metabolism, which facilitates research to the mechanism of HH and iron involved in cardiovascular disease. We expect that in the near future, the mechanism of disturbed iron metabolism leading to cardiovascular disease in human will be better understood.

• Hereditary Hemochromatosis 
  CME Activity, Release Date: 2/28/2000 Expiration Date: 2/28/2002 From the February 2000 Issue of Physician Assistant  Objectives: After reading the article, the reader should be able to:
  1. describe the pathophysiology of hereditary hemochromatosis;
  2. recognize the clinical symptoms and signs of hereditary hemochromatosis;
  3. outline screening and evaluation testing; and
  4. provide accurate diagnosis, management, and treatment.
   

• Hereditary Hemochromatosis FamilyPractice.com  Robert B. Hash, MD, Department of Family Medicine, Mercer University School of Medicine, Macon, Ga. [J Am Board Fam Pract Dec. 2000] Considering the prevalence of the disease, it is important for physicians to consider it in the differential diagnosis when patients complain of the common signs and symptoms. For most patients hereditary hemochromatosis can be successfully treated in the physician's office. Early diagnosis and treatment, before signs of iron toxicity, if possible, can result in improved quality and quantity of life for many patients.

• Iron absorption in the thalassemia syndromes and its inhibition by tea. 
  N Engl J Med. 1979 Jan 4 Tea produced a 41 to 95 per cent inhibition of iron absorption. Since patients with thalassemia intermedia may absorb a large percentage of dietary iron, inhibitors of iron absorption, such as tea, may be useful in their management.
  

• Iron and colorectal cancer risk: human studies  Nutr Rev 2001 May Because iron is broadly supplemented in the American diet, the benefits of iron supplementation need to be measured against the long-term risks of increased iron exposure, one of which may be increased risk of colorectal cancer.

• Iron Bioavailability in Humans from Breakfasts Enriched with Iron Bis-Glycine Chelate, Phytates and Polyphenols  Journal of Nutrition. 2000;130:2195-2199.)  The American Society for Nutritional Sciences  This article describes iron absorption from the perspective of those who are treating iron deficiency but much can still be learned for those with IO  from what they describe.
   
• Iron deficiency and overload in relation to nutrition  Nutritional iron intake in the Netherlands. IJzertekort en ijzerstapeling met betrekking tot voeding Spanjersberg MQI ; Jansen EHJM 34 p in English, 2000 Iron supplementation or fortification in functional foods should be avoided and discouraged until the risks of iron overload have been more clearly determined, since in the general population iron overload is associated with increased risk of several chronic diseases as well.
   

• Iron excretion in iron-overloaded rats following the change from an iron-loaded to an iron-deficient diet. 
   J Gastroenterol Hepatol 2000 Jun  The similarity in the degree of fall in transferrin-bound iron levels with a change in diet suggests that iron excretion involves the uptake and excretion of transferrin bound-iron, possibly by goblet cells

• IRON FREE Multivitamins & minerals for adults & children.  www.health-pages.com   "There is NO iron. Most Americans are doing themselves a disservice by choosing a multi that contains iron. Most people do not need iron, and iron is highly reactive, interacting with many other ingredients in a multi."
   

• Iron is Hot:  An Update on the Pathophysiology of Hemochromatosis: Blood Journal Sept. 15, 1998  Genetic iron overload disorders are prevalent yet poorly understood. [A pdf file.]
   

• Iron Loading and Disease Surveillance 
  Eugene D. Weinberg   Indiana University, Bloomington, Indiana   Emerging Infectious Diseases Journal, National Center for Infectious Diseases, Centers for Disease Control and Prevention. Excessive iron in specific tissues and cells (iron loading) promotes development of infection, neoplasia, cardiomyopathy, arthropathy, and various endocrine and possibly neurodegenerative disorders.
   

• Iron Poisoning  California Poison Control System Iron is important for good nutrition because it is used in blood and muscle tissue. However, it is also very poisonous if too much is taken.

• Management of hemochromatosis. Hemochromatosis Management Working Group.
  Ann Intern Med. 1998 Dec 1  Barton JC, McDonnell SM, Adams PC, Brissot P, Powell LW, Edwards CQ, Cook JD, Kowdley KV.  The complications of iron overload in hemochromatosis can be avoided by early diagnosis and appropriate management.

• Marlboros and Iron Don't Mix Study finds lower levels of iron may help smokers fight heart disease
  By Meredith Guinness HealthScout Reporter FRIDAY, Oct. 27, 2000 (HealthScout)-- Japanese researchers have just linked extremely high levels of iron to a greater risk of heart disease, but experts say the real news is their finding that low iron levels might help protect smokers from cardiovascular disease.
   
• New Warnings About Too Much Iron Advanced Medical Nutrition, Inc NOTE: AMNI's Multiple Vitamin/Mineral supplements (Basic Preventive and Added Protection III) have been available with or without iron since 1984. Be sure to select the correct formula for your individual needs.
   
• Nutrient overload at breakfast News You Can Use at US News.com  7/30/01 Your breakfast cereal may be giving you too much of a good thing.

• Patterns of food iron absorption in iron-deficient white and indian subjects and in venesected haemochromatotic patients.  Br J Haematol. 1976 Jul  The results of this study suggest that mal-absorption of non-haem iron from a meal containing bread, presumably due to a defect at the luminal level, may be an important factor in the pathogenesis of iron deficiency in some subjects.

• POST cereals.
  Many of the cereals made by Post only have 10% iron which is why we mostly choose this brand of cereal.  Write to Post & other cereal companies & demand that they reduce the iron content in their cereals so that our families can enjoy a bigger variety!  Or better yet, that they stop this practice completely!

• Pro-oxidants and Singlet Oxygen: 
  HealthWorld Online,   Interview With Dr. Lester Packer, Interviewed By Richard A. Passwater Ph.D.

• Protect Yourself: Only Eat Fish That's Been Thoroughly Cooked  Important Health Information For People With Diabetes Mellitus   DEPARTMENT OF HEALTH AND HUMAN SERVICES   PUBLIC HEALTH SERVICE  U.S. FOOD AND DRUG ADMINISTRATION  This brochure is to inform people with diabetes mellitus of the hazards they face if they eat raw molluscan shellfish-- oysters, mussels, clams, and whole scallops.
   

• PULLING IRON OUT OF THE FIRE by Shelly Morrow.  This article appeared in the Sept/Oct 2000 issue of Arthritis Today, published by the Arthritis Foundation, Inc.,
   

• Safety aspects of iron in food. 
  Ann Nutr Metab 2001;  There is no regulated iron excretion in overload. Excess of pharmaceutical iron may cause toxicity and therapeutic doses may cause gastrointestinal side effects.
   

• "The Elusive Hemochromatosis Gene and Other Reports on Iron Metabolism"
   by Bruce R. Bacon,    M.D., Director, Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine/Page 2 & Page 13  American Liver Foundation Progress Newsletter-Special Double Issue Vol. 17, No. 2/Fall 1995-Winter 1996 
   

• Too Much Iron Intake From Fortified Cereals? By Charnicia E. Huggins 7-12-01 Rense.com
   

• Too Much of a Good Thing   by Bill Sardi  From The June 2000 Issue of Nutrition Science News For those at risk for iron overload, it may be wise to avoid iron in multivitamins and shun fortified foods that provide more than 25 percent of the recommended daily intake for iron. No doctor should prescribe iron tablets for patients who complain of fatigue without blood tests and a thorough health history.

• Whole Foods Market, The worlds largest retailer of natural & organic foods.

ALCOHOL

Alcohol should be avoided in anyone with HH or liver disease.

• Alcoholism in hereditary hemochromatosis revisited: prevalence and clinical consequences among homozygous siblings. Hepatology. 1996 Apr  Hemochromatosis patients with heavy alcohol consumption had a higher prevalence of cirrhosis than hemochromatosis patients without heavy alcohol consumption. Long-term survival was significantly reduced in patients with heavy alcohol consumption.

• C282Y and H63D mutations of HFE gene in patients with advanced alcoholic liver disease. 
  Rev Esp Enferm Dig 2001 Mar  Our results suggest that H63D mutation of the HFE gene, but not the C282Y mutation, is associated to the risk of developing advanced liver alcoholic disease.
  

• Diagnosis and management of hemochromatosis
  by Dr. Anthony Tavill, Director of the Maurice and Sadie Friedman Center For Digestive Diseases and Liver Disorders, Mathile and Morton J. Stone Professor of Digestive Diseases and Liver Disorders at the Mt. Sinai Medical Center, Professor of Medicine and Nutrition at Case Wetern Reserve University. [Excellent & thorough article of diagnosis & treatment.  This is a pdf file] 
  

• Dr. Rose's Peripheral Brain--HEMOCHROMATOSIS Must abstain completely from alcohol
  

• Effect of hemochromatosis genotype and lifestyle factors on iron and red cell indices in a community population Clin Chem 2001 Feb; There was a significant increase in ferritin concentrations in both genders with increasing frequency of red meat consumption above a baseline of 1-2 times per week and alcohol intakes >10 g/day.
  

• FINAL DIAGNOSES: 
  A case of Hereditary Hemochromatosis with dilated cardiomyopathy, micronodular cirrhosis, history of chronic alcoholism from Department of Pathology, University of Pittsburgh School of Medicine.

• HCV AND C282Y: A SINISTER SYNERGISM? 
  SELECTED SUMMARY  GASTROENTEROLOGY 1999  The authors conclude that despite only modest increases in iron stores, individuals who are heterozygous for the C282Y mutation develop more fibrosis than homozygous normals with hepatitis C. They speculate that this subgroup of patients may benefit from therapeutic phlebotomy.  The current study supports the hypothesis that even minimal amounts of iron can cause or promote liver injury in the presence of other hepatotoxic conditions, such as alcohol abuse, chronic viral hepatitis, nonalcoholic steatohepatitis, and chronic hepatic porphyria.
  

• Hemochromatosis: A Common, Rarely Diagnosed Disease
  By Vincent J. Felitti, MD, FACP  Commentary by David Baer, MD, FACP.  Hemochromatosis is the most common, life-threatening genetic disorder in North America, yet most physicians have never personally diagnosed a case: all see an unrecognized case in their offices every two weeks.
  

• Hemochromatosis, Cooley Dickinson Hospital   Editor: George R Bowers MD CDH Oncology  January 2000 Volume 4: No. 1.   Hemochromatosis is a common, genetically transmitted disease. The diagnosis of hemochromatosis is sometimes difficult and frequently missed. This issue will review the pathogenesis, diagnosis and treatment of this fascinating disease. Ms. Kathy Fleming will review the management of a most troubling complication of therapy---lymphedema. 
  

• Hemochromatosis: Gastrointestinal Health Hemochromatosis, the most common genetic disease in the United States, results in iron overload and, if left untreated, severe organ damage. 
  

• Hemochromatosis: genetics helps to define a multifactorial disease  
  Clin Genet, 54(1):1-9 1998 Jul University of Washington, Seattle 98105 wburke@u.washington.edu  Early detection is desirable, because periodic phlebotomy provides effective treatment for iron overload and may prevent complications of the disorder.

• Hemochromatosis:  Genetics, Pathophysiology, Diagnosis and Treatment, "Introduction to Hemochromatosis"  Part I,  by Barton & Edwards.  Except from their book, [a pdf file] This is a large & excellent book covering all areas of hemochromatosis.  Published in 2000, $215.00 [**According to Barton & Edwards, "alcohol can increase the absorption of iron & lower the threshold for hepatic injury in hemochromatosis, alcoholism is common among case series of hemochromatosis patients"]
  

• Hereditary Hemochromatosis 
  CME Activity, Release Date: 2/28/2000 Expiration Date: 2/28/2002 From the February 2000 Issue of Physician Assistant  Objectives: After reading the article, the reader should be able to:
  1. describe the pathophysiology of hereditary hemochromatosis;
  2. recognize the clinical symptoms and signs of hereditary hemochromatosis;
  3. outline screening and evaluation testing; and
  4. provide accurate diagnosis, management, and treatment.
  

• Hereditary Hemochromatosis--A Risk Factor for Cardiovascular Disease The HH mutation is a human genetic model of disturbed iron metabolism, which facilitates research to the mechanism of HH and iron involved in cardiovascular disease. We expect that in the near future, the mechanism of disturbed iron metabolism leading to cardiovascular disease in human will be better understood.
  

• Hereditary hemochromatosis: Preventing chronic effects of this underdiagnosed disorder
  Sharon M. McDonnell, MD, MPH; David Witte, MD, PhD VOL 102 / NO 6 / DECEMBER 1997 / POSTGRADUATE MEDICINE.  In this article, Drs McDonnell and Witte discuss the diagnosis and management of this underrecognized problem as well as the various issues involved in screening. An illustrative case of hemochromatosis is also included.
  

• Interrelationships of alcohol and iron in liver disease with particular reference to the iron-binding proteins, ferritin and transferrin   Linda M Fletcher; June W Halliday; Lawrie W Powell   Journal of Gastroenterology and Hepatology 14 (3), 202-214 It is known that the regular consumption of alcohol is responsible for the disruption of normal iron metabolism in humans, resulting in the excess deposition of iron in the liver in approximately one-third of alcoholic subjects.  It is known that the regular consumption of alcohol is responsible for the disruption of normal iron metabolism in humans, resulting in the excess deposition of iron in the liver in approximately one-third of alcoholic subjects.
  

• Iron Loading and Disease Surveillance
  Eugene D. Weinberg   Indiana University, Bloomington, Indiana   Emerging Infectious Diseases Journal, National Center for Infectious Diseases, Centers for Disease Control and Prevention. Excessive iron in specific tissues and cells (iron loading) promotes development of infection, neoplasia, cardiomyopathy, arthropathy, and various endocrine and possibly neurodegenerative disorders.
  

• Iron is Hot:  An Update on the Pathophysiology of Hemochromatosis: Blood Journal Sept. 15, 1998  Genetic iron overload disorders are prevalent yet poorly understood. [A pdf file.]

• Iron: 'Too Much Is A Problem'
  by Joseph B. Verrengia [News Science Writer]  High levels of iron, already considered to be a major risk factor in heart attacks, are being implicated in the progression of AIDS, Lou Gehrig's disease and cancer.   "Iron will be the cholesterol of the 1990s," McCord predicts, ". . .most people don't know their iron status."
  

• Non-transferrin-bound iron in alcohol abusers Alcohol Clin Exp Res 2001 Oct Non-transferrin-bound iron could have a role in initiating or promoting alcohol-induced liver damage.
  

• Overview on Iron Overload and Hemochromatosis CDC website, National Center for Chronic Disease Prevention and Health Promotion.  Early detection of hemochromatosis is essential because the disease’s potentially serious complications can be prevented by early therapy.
  

• Primary liver cancer in genetic hemochromatosis: a clinical, pathological, and pathogenetic study of 54 cases Gastroenterology 1993 Jan

• THE ADVERSE EFFECTS OF ZINC DEFICIENCY  
  A review from the literature by Tuula E. Tuormaa for FORESIGHT, the Association for the Promotion of Preconceptual Care  [first published in: Journal of Orthomolecular Medicine, 10 (3 & 4): 149-164, (1995)

• The haemochromatosis gene: a co-factor for chronic liver diseases?
  J Gastroenterol Hepatol. 1999 Aug George DK, Powell LW, Losowsky MS  Iron loading of mild to moderate degree due to heterozygosity or homozygosity for the haemochromatosis genetic mutations acts as a significant hepatotoxin aggravating hepatic damage from other causes of liver disease.

   

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SMOKING

Hereditary Hemochromatosis--A Risk Factor for Cardiovascular Disease
The HH mutation is a human genetic model of disturbed iron metabolism, which facilitates research to the mechanism of HH and iron involved in cardiovascular disease. We expect that in the near future, the mechanism of disturbed iron metabolism leading to cardiovascular disease in human will be better understood.

Click on this link to read about HH. Discussion of a liver biopsy is also here: 

Back to the "Munnsters" main Hemochromatosis page