Iron Overload

Authored by Chris McDermott, APRN, practicing with autonomous authority in Florida

Introduction

While iron deficiency is widely recognized, iron overload is a less commonly discussed but equally important health concern. Iron is essential for life, but in excess, it becomes toxic, damaging organs and increasing chronic disease risk. Iron overload, most often caused by hereditary hemochromatosis, leads to progressive iron accumulation in vital organs including the liver, pancreas, heart, and brain.

At Intercoastal Health, we take a functional medicine practitioner approach to iron overload. This includes understanding genetic and environmental contributors, using targeted biomarker testing, and personalized strategies to prevent organ damage.

What is Iron Overload?

Iron overload refers to the accumulation of excess iron in the body beyond what is needed for physiological function. Unlike other minerals, the body lacks an excretion mechanism for iron, so when absorption exceeds demand, iron builds up in tissues.
Key Sources of Iron Overload:

• Hereditary Hemochromatosis (HH): A genetic condition most commonly caused by mutations in the HFE gene, leading to excessive intestinal iron absorption.
  
• Secondary Iron Overload: Results from frequent blood transfusions, chronic liver disease, or high supplemental/dietary iron intake.
  Excess iron creates oxidative stress, disrupts organ function, and causes cellular damage.
  
  

Symptoms of Iron Overload

Iron overload can be silent for years until damage occurs. As iron deposits accumulate, symptoms span multiple systems:

• Fatigue and weakness
  
• Joint pain, especially in the hands and feet
  
• Abdominal pain
  
• Bronzing or graying of the skin
  
• Diabetes mellitus (due to pancreatic damage)
  
• Liver disease, including elevated liver enzymes or cirrhosis
  
• Cardiac symptoms, such as arrhythmias or heart failure
  
• Cognitive decline or mood changes
  
• Decreased libido or hormonal imbalances
  
  

Without intervention, complications include heart failure, liver cancer, hypogonadism, and neurodegenerative disease.

Biomarker Evaluation and Diagnosis

At Intercoastal Health, we assess iron overload with a comprehensive biomarker panel:
Iron Panel

• Serum Iron
  
• Total Iron-Binding Capacity (TIBC)
  
• Transferrin Saturation – Key marker; >45% suggests overload
  
• Serum Ferritin – Elevated in overload but also with inflammation
  
  

Liver Function Tests

• AST , ALT , and Alk Phos
  
  

Genetic Testing

• HFE gene mutations (C282Y, H63D) confirm hereditary hemochromatosis
  
  

Imaging

• MRI with iron quantification for liver and heart iron burden
  
  

Liver Biopsy

• To assess fibrosis or cirrhosis if diagnosis is unclear
  
  

Functional Medicine Reference Ranges

Note: Ferritin is an acute-phase reactant and may be falsely elevated in inflammation—check CRP or ESR for context.

Contributing Factors

• Genetic Predisposition: Autosomal recessive inheritance, common in Northern European descent.
  
• Alcohol Use: Increases absorption and accelerates liver injury.
  
• Chronic Liver Disease: Exacerbates iron toxicity.
  
• High-Dose Iron Supplements or Fortified Foods
  
• Multiple Transfusions in conditions like thalassemia.
  
  

Clinical Implications of Untreated Iron Overload

• Liver: Cirrhosis, hepatocellular carcinoma
  
• Heart: Cardiomyopathy, arrhythmias, heart failure
  
• Endocrine: Hypothyroidism, hypogonadism, diabetes mellitus
  
• Musculoskeletal: Arthritis, osteoporosis
  
• Brain: Cognitive decline, Alzheimer’s risk
  
• Skin: Bronzing from iron deposition
  
  

Interfering Factors in Diagnosis

• Inflammation: Elevates ferritin (check CRP or ESR)
  
• Oral contraceptives or hormone therapy
  
• High-dose vitamin C: Increases absorption
  
• Recent blood donation: Temporarily lowers markers
  
• Liver conditions: Skew ferritin/transaminases
  
  

Medications That Influence Iron Levels

May Increase Absorption or Retention:

• Iron supplements
  
• Excessive vitamin C
  
• Some oral contraceptives
  
  

Treatment of Overload:

• Phlebotomy (gold standard for HH)
  
• Iron chelators (e.g., deferoxamine) for secondary overload
  
  

Functional Medicine Strategy for Managing Iron Overload

Phlebotomy

• Regular removal to reduce stores; frequency based on labs.
  

Nutritional Strategies

• Limit red and organ meats; avoid fortified foods.
  
• Reduce vitamin C with meals; increase polyphenol-rich foods (tea, coffee).
  
• Avoid alcohol.
  

Supplement Management

• Avoid iron supplements unless indicated; monitor multivitamins.
  

Address Comorbidities

• Manage glucose in diabetes; support liver detox with glutathione, milk thistle.
  
• Monitor cardiac function (echocardiogram/ECG) if symptomatic.
  

Genetic Counseling

• Screen first-degree relatives when HH is confirmed.
  
  

Monitoring and Follow-Up

Every 3–6 months: Serum ferritin, transferrin saturation, liver function tests, CRP, CBC.