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Iron deficiency

Iron deficiency is the most common nutritional disorder in the developed world. Iron deficiency and anaemia caused by iron deficiency is still common in girls in adolescence and in pregnant women. Children under two years of age are at risk of iron deficiency because of their rapid growth, small reserves of iron and its low content in the milk.

People at puberty (especially the girls because the menstrual cycle) may also have an iron deficiency disorder, then women during menstruation, pregnancy and lactation. Iron deficiency can also occur in older people because of reduction of hydrochloric acid in the stomach, which convert iron to available form (from ferrous to ferric form). During some medical operations, and injuries where there is a large loss of blood anaemia can occur. Some stomach and internal organs diseases may also cause anaemia because they reduce the absorption of iron. Some medicines can cause occasional hemorrhages in the stomach and can cause anaemia. Since there are many reasons that can lead to the loss of large amounts of iron from body and cause anaemia, it is always recommended to determine the cause of anaemia prior to the application of appropriate therapy.

Symptoms of iron deficiency include anaemia, fatigue, heart palpitations, shortness of breath, decreased concentration, dizziness, disturbed sleep, severe menstrual pain and bleeding, cracked lips, inflammation of the eye, mouth ulcers and hair loss.

Low iron levels in blood plasma can cause itchy skin especially in the elderly. The nails become soft, brittle and white.

If iron deficiency occurs in pregnancy the newborn child can become easily infected, miscarriage and premature birth. Iron deficiency can cause low weight in newborns and an increased risk of anaemia of child. The drastic impact may lead to the death of a child at birth.

Iron deficiency is associated with increased mortality of older persons because low iron levels increase the risk of heart disease.

Anaemia is the final stage of iron deficiency. Before anaemia affect the red blood cells it affects enzymes in their structure that contain iron. Immune function is also reduced. Symptoms include small, pale red blood cells, high fatigue, poor concentration, shortness of breath and dizziness. Symptoms of anaemia can occur gradually and sometimes are not easily recognizable.

Determination of haemoglobin and haematocrit levels do not always indicate an early stage anaemia. The most reliable tests for anaemia are determination of serum ferritin and total iron binding capacity test. Iron level can vary from day to day, so the average value over the performed tests, the most reliable indicator of anaemia.

Iron deficiency anaemia is the most common nutritional disorder in children. It can lead to slow growth of children and weaker development of mental abilities.

If mother has enough iron in the body newborns may receive additional amounts of iron through breast milk or infant formula. Breast milk has small amount of iron, but it has a lot of lactose (milk carbon hydrate) and vitamin C that increase the absorption of iron.

The people with iron deficiency will have the immune system significantly weakened. Infections and herpes are far more common in people who eat a food with a low iron content or where the iron is in the form of Fe(III) which is poor absorbed. Certain cells involved in the immune response which include the iron generates oxidative reactions that allow cells to destroy bacteria and other pathogens. If iron levels are low, then these cells do not function properly.

In athletes strenuous exercise leads to iron deficiency. This is due to the increased production of hemoglobin, which occurs when starting the training. Symptoms of iron deficiency in athletes cause fatigue, rapid heart rate, shortness of breath and an increased amount of lactic acid (which is manifested by inflammation of the muscles). Iron deficiency occurs due to increased metabolic demands for iron, increased synthesis of red blood cells and an increased loss of iron through sweating. After the adjustment and adaptation of organism anaemia is reduced if the diet is adequate. Iron intake in athletes must be carefully dosed.

Iron deficiency is also associated with Plummer–Vinson syndrome it creates a cone-like network on the surface of the esophagus, which leads to difficulty in swallowing food and water. This disease, which was common in some countries, was eradicated when the food was enriched with iron.

Iron deficiency can also causes difficulty in physical and mental strain, lowers immunity, causes anaemia, muscle pain, headache, and hair loss.

Overdose 

Large amounts of iron in the body can cause damage to the intestinal tract, vomiting, diarrhoea, liver damage, abdominal and joint pain, weight loss, fatigue, thirst and hunger, cancer, heart disorders, arthritis, osteoporosis, diabetes, a variety of psychiatric disorders, cirrhosis of the liver, excessive skin pigmentation, body weakness. People with high levels of iron in the body need urgent medical attention.

The liver is particularly sensitive to the excessive amount of iron in the body since it is the main place where the iron stores.

Quantities of more than 3.0 gm of iron in children can lead to death.

Constipation is also one of the common side effects of large amounts of iron in the body, but diarrhea can also occur. The side effects can be reduced if the iron is consumed in smaller portions (as a supplement, for example).

High levels of iron (more than 200 micrograms per liter of blood ferritin), leads to an increased risk of cardiovascular disease. This occurs because of oxidative damage to the heart and blood vessels and increased oxidation of LDL cholesterol.

Some studies have shown that iron can inhibit the development of tumors, while others show that iron can affect the development of tumors. Iron may increase the risk of cancer disease as it affects the formation of free radicals. Some studies have shown a relationship between high iron levels with throat cancer and gastrointestinal cancer, but it is not yet fully proven.

The enzyme cyclo-oxygenase is holoenzyme that catalyzes the oxygenation and cyclization of fatty acid giving prostaglandin endoperoxide G₂. This enzyme contains haeme, which acts as a center for the creation of catalyzing oxygen cofactors. Little is known about the effects of metabolic imbalances in the synthesis of iron prostanoid molecules. It is known that rheumatoid synovial membrane contains a high concentration of iron and those prostanoid molecules are mediators of inflammatory processes. In those cases is therefore suggested that are used iron chelates that bind iron located in the enzyme cyclo-oxygenase and thus deactivate it.

An inherited disorder in the regulation of mucosa iron absorption leads to iron overload syndrome called hemochromatosis. In this disease, which affects several organ systems, it is absorbed from the gastrointestinal tract about 2 to 3 mgs of iron daily, and not as it is normally about 1 mg. For 20-30 years in body will accumulate about 20-30 gm of iron, that is much more than the normal 3-4 gm. The accumulated iron is stored in the haemosiderin placed in the liver, pancreas, skin, heart and joints and it can produce free radicals, which cause great damage to the body. This disease can occur also as a result of chronic alcoholism. Treatment of haemochromatosis includes a diet rich in bread, cereals, fruit and vegetables and sometimes phlebotomy. The amount of meat and alcohol is limited. Intake of foods rich in vitamin C is not recommended. Tea and coffee are also recommended because they reduce iron absorption.

Iron in medicine

The most important use of iron for the treatment of anemia. Since the anemia involves low levels of iron in the blood and that is the main component of hemoglobin (the protein that carries oxygen in the body). It has been shown that iron is best absorbed by the body if it is organically bonded (e.g. malate, fumarate, gluconate, etc.).

References

Bothwell T.H., 1979, “Iron metabolism in man,” London, Blackwell Scientific Publications.

Brock J.H., et al., 1994, “Iron metabolism in health and disease,” London, W.B. Saunders Company Ltd.

Dallman P.R., 1986, “Biochemical basis for the manifestations of iron deficiency,” Ann. Rev. Nutr.; 6: 13-40. [Web Reference]

Hallberg L., 1982, “Iron absorption and iron deficiency,” Hum Nutr: Clin. Nutr.; 36:259-278.

Institute of Medicine (US) Panel on Micronutrients. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington (DC): National Academies Press (US); 2001. 9, Iron. [Web Reference]

Kühn L.C., 1996, “Control of cellular iron transport and storage at the molecular level,” In: Hallberg LA, et al., eds. Iron nutrition in health and disease. p. 17-29. London, John Libbey & Company.

Malhotra V.K., 1998, “Biochemistry for Students. 10^th Ed,” Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India. [Web Reference]

Mascotti D.P., Rup D. and Thach R.E., 1995, “Regulation of iron metabolism: Translational effects medicated by iron, haeme and cytokines,” Ann. Rev. Nutr.; 15: 239-61. [Web Reference]

Soetan K.O., Olaiya C. O. and Oyewole O.E., 2010, “The importance of mineral elements for humans, domestic animals and plants-A review,” African Journal of Food Science; 4(5): 200-222. [Web Reference]

von Drygalski A. and Adamson J.W., 2012, “Iron metabolism in man,” Journal of Parenteral and Enteral Nutrition; 37(5): 599-606. [Web Reference]

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