Iron – best in moderation

diet2_(Masahiro_Ihara)

You can eat fruit and vegetables to your heart’s content.

I like to promote a varied and balanced diet – all in moderation. But no, I get criticised for recommending and not defining a balanced diet. I think it’s self evident, a bit of everything without overindulging in any particular food or food group, possibly with fruit and vegetables a free for all exception.

But food “nazis” want to air their opinions. They used to say that you should seriously reduce your fat intake, particularly saturated fat. Then they changed their tune and gave the all clear to fat, but instead banned carbohydrates in general and plain sugar in particular.

Extreme ketogenic diet

According to the latest fad you should try to get your metabolism into a ketogenic state by removing almost all carbohydrates from your diet. That way you force the body to burn its own fat and produce ketones that the brain can use for its energy needs. You will easily lose weight, mainly through water loss, and feel energised, they say.

Inspired by the US president who in early 2018 used the “shit” word I will indulge in some profanity and say “bullshit”. While a ketogenic diet may be an appropriate short-term solution under strict supervision for some, and will result in weight loss, it could lead to serious health complications over time. In the long run, a keto diet will do more harm than good for a majority of the population, especially if they have any underlying kidney or liver issues.

Ketogenic diets practically eliminate an essential food group from your diet, which means you are not going to be getting all of your daily nutritional needs from this diet. This diet is also very low in fibre, which can cause your digestive system to slow down. You will be forced to take mineral supplements or vitamins to hit your daily needs that you will not be getting from a ketogenic diet.

The essential iron

red blood cells

Our red blood cells need iron to function.

That’s a long winded introduction to get us to iron and the important balance of iron intake. Iron is an essential component of life. It is responsible for transporting oxygen in red blood cells, for activation of enzymes involved in DNA production and for energy production in the cell. Iron deficiency impairs oxygen transfer throughout the body, cell division and energy production yet, excess “free” iron that is not bound to any protein may trigger oxidative stress that can be toxic to the organism.

So it is not the case of the more the better. Both iron deficiency or overload may lead to damaging effects by mediating inflammatory diseases, cancer and neurodegenerative diseases, such as Alzheimer’s and Parkinson’s disease. And remember that all bugs, including the disease causing pathogens, love iron. Acquiring iron is crucial for the development of any pathogen.  Too much iron through food or supplements encourage pathogen growth.

Complex mechanisms have evolved that illustrate the longstanding battle between pathogens and humans for iron access. Ferritin is one of the central factors regulating cellular iron content and protecting the organism from iron toxicity.

We learn more about iron balance all the time. A recent study looked at the distribution of the ferritin protein within cells and the mechanisms underlying its secretion from the cell. They found iron rich extracellular ferritin strongly implying that ferritin is not merely a vessel for secure and available storage of iron within the cell, but also a key player in tissue and systemic iron distribution.

Always more to learn

Even if we learn more about our complex metabolism all the time, there is still a lot of uncertainty remaining. So the safe bet is still to eat a balanced diet all in moderation, be it iron intake or any other nutrient.

And by all means reduce any excessive sugar intake as long as you maintain your fibre consumption.

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Iron – friend or foe?

red blood cells

Iron is necessary for the red blood cell supply.

Well the answer to the question is both, but that might be a surprise to you since iron has a clearly positive reputation among the general public. Iron is a mineral and a friend in that it plays a key role in the making of red blood cells. Too little iron may lead to anaemia, a low level of red blood cells. Anaemia can cause fatigue and other symptoms. Too little iron can also have disastrous effects on memory, growth, and overall physical health. It is often said that the more iron, the better. But that is actually not true since excess iron can be a foe. Let me explain in more detail.

Too much iron

Large amounts of ingested iron can cause excessive levels of iron in the blood.  There is also the issue of haemochromatosis, a genetic disorder where affected people absorb too much iron from a perfectly normal diet. Excess iron is stored in the body. Over time this leads to iron overload.

The problem is that although we have mechanisms in place for regulating iron absorption, men of any age and post-menopausal women have no mechanisms that can get rid of excess iron, except by giving blood. That reminds me of medieval blood letting as a primitive “cure” for most diseases. There might actually be some benefits to such treatments.

Iron toxicity

Campylobacter

Bugs just love excess iron.

Iron toxicity occurs when there is free iron in the cell, which happens when iron levels exceed the capacity of transferrin to bind the iron. Damage to the cells of the gastrointestinal tract can also prevent them from regulating iron absorption leading to further increases in blood levels.

High blood levels of free ferrous iron react with peroxides to produce free radicals, which are highly reactive and can damage DNA, proteins, lipids, and other cellular components. Observational studies have tracked such changes to the development of  type 2 diabetes, heart disease, insulin resistance, inflammation, Alzheimer’s disease, hypertension, fatty liver, hypothyroidism, and arthritis. A daunting list of diseases connected to excess body stores of iron.

There is also the issue of the purported connection between red meat consumption and the development of colorectal cancer. One of the theories supporting this connection blame the high iron content of red meat.

Complicating things further, this is heaven for disease-causing bacteria. Like all living beings, bacteria need iron to survive and multiply. Excess iron promotes their growth and capacity to make you sick.

So what to do?

Let’s first look at iron intake. You can certainly get enough iron from food. Iron absorption is best (15-18%) from foods that contain haem iron. Red meat, seafood and poultry are the best sources of haem iron. Iron absorption from foods that contain non-haem iron is much lower (<5%). Non-haem iron is predominantly found in plant foods such as cereals, vegetables, legumes and nuts.

In case of a deficient diet it is also possible to use iron supplements to improve iron status. Iron supplements are often used to treat anaemia caused by pregnancy, heavy menstrual periods, kidney disease and chemotherapy. Iron supplements are commonly recommended for infants and toddlers, teenage girls, and women who are pregnant or of childbearing age to help prevent anaemia.

But if you actually need less iron?

coffee3

A cup of coffee after dinner can reduce iron absorption.

Phytonutrients like polyphenols, flavanols and other plant-derived antioxidant compounds inhibit iron absorption. They can be found in apples, onions, grapes, many other plant foods, and in most colourful spices and herbs.

Even low levels of phytates have a strong inhibitory effect on iron absorption. Phytates can be found in walnuts, almonds, sesame, dried beans, lentils, peas, cereals and wholegrain.

A cup of coffee after dinner is particularly good at inhibiting iron absorption with instant coffee the most effective. Tea might even be better. Tannins in coffee and tea bind the iron and prohibit absorption.

But there is more help at hand in a piece of cheese after dinner. The calcium it contains is a potent inhibitor of iron absorption. More than that, calcium reduces any carcinogenic interactions between haem iron and colonic cells.

If you’re going to drink alcohol, make it red wine and lean toward lower-alcohol wines. Its polyphenols inhibit iron absorption, while straight ethanol enhances iron absorption.

And if that is not enough you might try some ancient blood letting or in simple terms become a blood donor.