Controversy
There are many controversial topics in the diagnosis and treatment of Hereditary Hemochromatosis.
Women
When you look at the charts under Doctors which define the path to diagnosis of GH, premenopausal women can actually be diagnosed with a lower serum ferritin than either men or postmenopausal women. However it is generally believed among doctors that young women are protected from Hereditary Hemochromatosis by childbirth and regular menstrual cycles. To me this is more sexism than science. A young, Caucasian woman with red hair who has never been pregnant and has irregular, light menses presenting to a doctor with 'phantom' stomach pain, fatigue and mood swings should absolutely have her iron levels tested (Serum Ferritin and Transferritin). She should not be in the same 'bucket' as a woman who has had multiple pregnancies. Yet she may go straight down the path of misdiagnosis and be prescribed medications that she should never have been exposed to and which may do her harm.
To this should be added that if a woman chooses to use oral contraceptives not only may her iron loss through her cycle be diminished, but she may also have increased iron absorption. This is why many women taking oral contraceptives are told not to take vitamins containing extra iron.
As we are understanding that many of the symptoms of GH are related directly to low hepcidin production rather than to the high iron levels there is nothing about being a women that changes how much hepcidin her liver can produce when her HFE gene has the right variants.
Finally, there is also research showing that low Body Mass Index (BMI) results in lower hepcidin production. As does excessive exercise. Media and current social pressures lead women to believe that unless they have a low BMI they are not as attractive as they should be. At the same time they are attempting to meet these social pressures they are further increasing their iron stores.
For these reasons I argue that women who have undiscovered SNPs on their HFE gene they can be starting to overload at least as early as men.
To this should be added that if a woman chooses to use oral contraceptives not only may her iron loss through her cycle be diminished, but she may also have increased iron absorption. This is why many women taking oral contraceptives are told not to take vitamins containing extra iron.
As we are understanding that many of the symptoms of GH are related directly to low hepcidin production rather than to the high iron levels there is nothing about being a women that changes how much hepcidin her liver can produce when her HFE gene has the right variants.
Finally, there is also research showing that low Body Mass Index (BMI) results in lower hepcidin production. As does excessive exercise. Media and current social pressures lead women to believe that unless they have a low BMI they are not as attractive as they should be. At the same time they are attempting to meet these social pressures they are further increasing their iron stores.
For these reasons I argue that women who have undiscovered SNPs on their HFE gene they can be starting to overload at least as early as men.
Vitamin C
In pill form, vitamin C (which is both an antioxidant and a pro-oxidant) can do damage in the presence of iron overload. It can alter iron stores by kicking out an oxygen molecule which turns them into nasty free radicals. These can then become even nastier if they hook up with some hydrogen peroxide. Once this happens they will attack whatever is closest and damage cells. Iron is stored in the heart or liver predominately, so in theory, someone with significant iron overload could cause themselves to have a heart attack by taking vitamin C supplements.
People with an HFE variation can have a 50% to 300% increase in iron absorption and vitamin C in pill OR dietary form will further increase iron absorption On the other side, excess iron causes damage to the body that vitamin C can repair and at the same time excess iron decreases vitamin C absorption. The CDC says that people with hereditary hemochromatosis should limit vitamin C supplements to less that 500 mg/day. Aggressive experts say to eliminate it entirely.
Really, there is just not enough research to sway one from taking vitamin C pills. Vitamin C has many good effects including the ability to repair DNA, so even if C damages us it also repairs us. Maybe it leaves us a bit better off?
One thing does seem certain, if you chose to take extra Vitamin C get it from food! Papayas, strawberries, bell peppers and broccoli all pack a nutritional punch and it will be hard to find a doctor who tells you not to eat them!
People with an HFE variation can have a 50% to 300% increase in iron absorption and vitamin C in pill OR dietary form will further increase iron absorption On the other side, excess iron causes damage to the body that vitamin C can repair and at the same time excess iron decreases vitamin C absorption. The CDC says that people with hereditary hemochromatosis should limit vitamin C supplements to less that 500 mg/day. Aggressive experts say to eliminate it entirely.
Really, there is just not enough research to sway one from taking vitamin C pills. Vitamin C has many good effects including the ability to repair DNA, so even if C damages us it also repairs us. Maybe it leaves us a bit better off?
One thing does seem certain, if you chose to take extra Vitamin C get it from food! Papayas, strawberries, bell peppers and broccoli all pack a nutritional punch and it will be hard to find a doctor who tells you not to eat them!
Milk Thistle
Milk Thistle is an herb that has some likelihood of generally improving liver function. Since hepcidin is produced by the liver and iron overload generally damages the liver, it makes sense to add milk thistle to one's diet as long as it does no harm.
But does it do harm? A case study was published regarding one woman with GH who had abnormally high liver labs (AST and ALT). She was taking milk thistle daily, but she was also taking Tylenol and drinking soda everyday. Her doctor had her stop all three and her labs rapidly returned to normal. This was then published along with the recommendation that people with GH avoid milk thistle. The problem with this is obvious. Tylenol is processed by the liver and is known to elevate AST and ALT results. Diet sodas also have this effect, although we do not know what type of soda she was drinking. Therefore, the removal of milk thistle from her diet could have had nothing to do with her labs returning to normal. I have not yet found any other indications that milk thistle may be dangerous to those with GH. Every reference that I have found ultimately has been founded on this one case study.
I have chosen to incorporate milk thistle as part of my diet.
But does it do harm? A case study was published regarding one woman with GH who had abnormally high liver labs (AST and ALT). She was taking milk thistle daily, but she was also taking Tylenol and drinking soda everyday. Her doctor had her stop all three and her labs rapidly returned to normal. This was then published along with the recommendation that people with GH avoid milk thistle. The problem with this is obvious. Tylenol is processed by the liver and is known to elevate AST and ALT results. Diet sodas also have this effect, although we do not know what type of soda she was drinking. Therefore, the removal of milk thistle from her diet could have had nothing to do with her labs returning to normal. I have not yet found any other indications that milk thistle may be dangerous to those with GH. Every reference that I have found ultimately has been founded on this one case study.
I have chosen to incorporate milk thistle as part of my diet.
Is this An old white guy disease?
I already discussed the 'guy' part of this above under Women. The current emphasis on the C282Y SNP is why so many think this is a disease which only affects the Northern Europeans. The variations of the HFE gene are not proving to be quite that simple.
The C282Y SNP has moved into most of Northern Europe after initially appearing in the Western Danube valley at or before 500 BC. This SNP can be traced through migrations, famines, plagues, conquests and Viking voyages. This population is definitely significantly impacted by Genetic Hemochromatosis, but they are not alone.
Current research is showing many occurrences of Iron Overload in places like India, Southern Greece and Brazil. These are people with two copies of the H63D SNP which is far more common than C282Y in the global population. In current genetic testing for Genetic Hemochromatosis having 2 H63D SNPs will return a Negative result! There are many theories being tested as to why these populations are experiencing iron overload, but the answers are yet to be found.
As far as the 'old' part, this was true once but only because by the time doctors were able to make a diagnosis people were in the later stages of organ damage from Iron Overload. In this modern era there is no age too young for someone to exhibit symptoms of low hepcidin production and the symptoms of high iron are happening younger and younger due in part to iron being more bioavailable now than in any other time in the history of our world.
The C282Y SNP has moved into most of Northern Europe after initially appearing in the Western Danube valley at or before 500 BC. This SNP can be traced through migrations, famines, plagues, conquests and Viking voyages. This population is definitely significantly impacted by Genetic Hemochromatosis, but they are not alone.
Current research is showing many occurrences of Iron Overload in places like India, Southern Greece and Brazil. These are people with two copies of the H63D SNP which is far more common than C282Y in the global population. In current genetic testing for Genetic Hemochromatosis having 2 H63D SNPs will return a Negative result! There are many theories being tested as to why these populations are experiencing iron overload, but the answers are yet to be found.
As far as the 'old' part, this was true once but only because by the time doctors were able to make a diagnosis people were in the later stages of organ damage from Iron Overload. In this modern era there is no age too young for someone to exhibit symptoms of low hepcidin production and the symptoms of high iron are happening younger and younger due in part to iron being more bioavailable now than in any other time in the history of our world.
Iron fortified everything
Iron deficiency is the most common medical issue in the world affecting almost exclusively women of childbearing age. In an attempt to combat this issue most of the world enforces 'enriching' grains and dairy with the goal of providing around 25% of the Recommended Daily Allowance (RDA) of iron in each serving. The first thing to note is that the RDA on labels is for women of childbearing age. This is about double the recommendation for everyone else other than teenage girls who are about about the same.
There are many studies coming out showing that this iron fortification has not prevented iron deficiency as anticipated and several countries are considering removing the requirement for this and other reasons.
For those of us with variations of the HFE gene, avoiding iron fortified foods is crucial.
There are many studies coming out showing that this iron fortification has not prevented iron deficiency as anticipated and several countries are considering removing the requirement for this and other reasons.
For those of us with variations of the HFE gene, avoiding iron fortified foods is crucial.