Nutrition Hotline
By Suzanne Havala, MS, RD
QUESTION: My husband has an iron overload (hemochromatosis). We are treating the hemochromatosis with phlebotomy, but I am having trouble getting advice about foods. Dietitians have no knowledge of food and iron. Can you give me some direction?
Via e-mail
ANSWER: About one in every 200 - 500 people in the US has hemochromatosis, a condition in which the body stores excessive amounts of iron. This condition can be very serious and may increase the risk for heart disease and some forms of cancer, including liver, colon, and breast cancers. It can cause liver disease, diabetes, heart failure, thyroid disorders, sexual dysfunction, weakness, extreme fatigue, and joint pain and deformity.
The primary treatment for hemochromatosis is phlebotomy, which usually entails removing a pint of blood every week or two until iron stores return to normal levels. According to reports that were presented at a 1997 international conference sponsored by the Centers for Disease Control and Prevention, diet may help — but not replace — phlebotomy in preventing the complications of hemo-chromatosis. The reports add that people with hemochromatosis should avoid iron supplements, multivitamin and mineral supplements that contain iron, and vitamin C supplements of more than 500 milligrams per day. Alcohol should be used in moderation and raw shellfish avoided.
The guidelines also note that people with hemochromatosis should avoid red meats and organ meats, since they contain large amounts of iron that are readily absorbed by the body. Vitamin C also enhances the body's absorption of dietary iron, but it's not necessary to avoid fruits and vegetables that are high in vitamin C.
Another set of guidelines, published by the College of American Pathology in 1996, concludes that restriction of foods that are high in iron is actually unnecessary, since phlebotomy is so much more effective at removing excess iron from the blood.
The bottom line is that phlebotomy will continue to be the primary treatment for your husband's hemo-chromatosis. Aside from the dietary changes mentioned, additional dietary changes are likely to have relatively little additional impact on his condition.
Herbert, V. 1992. Everyone should be tested for iron disorders. J Am Diet Assoc 92: 1502-1509.
Thompson, HJ; Kennedy, K; Witt, M; Juzefyk, J. 1991. Effect of dietary iron deficiency or excess on the induction of mammary carcinogenesis by 1-methyl-1-nitrosourea. Carcinogenesis 12: 111-114.
Salonen, J; Nyyssonen, K; Korpela, H; et al. 1992. High stored iron levels are associated with excess risk of myocardial infarction in eastern Finnish men. Circulation 86: 803-11.
Knekt, P; Reunanen, A; Takkunen, H; Aroma, A; Heliovaara, M; Hakulinen, T. 1994. Body iron stores and risk of cancer. Int J Cancer 56: 379-382.
Nelson, RL. 1992. Dietary iron and colorectal cancer risk. Free Radical Biol Med; 13: 161-168.
Witte, DL; Crosby, WH; Edwards, CQ; Fairbanks, VF; Mitros, FA. 1996 Practice Parameters for Hereditary Hemochromatosis. (CAP, 1993) and Clin Chim Acta; 245: 139-200.
Barton, JC et al. 1998. Management of Hemochromatosis. Annals of Internal Medicine, 1 December, 129: 932-939.
