Feeling worn out? You could have iron overload

Feeling a bit tired and worn out? Vague symptoms like these are common in iron deficiency and anaemia. But before you reach for the iron supplements or chow down on steak, these symptoms are common in another condition related to iron. This time the trouble is too much iron, not too little, because of the iron overload disorder called haemochromatosis.

What is haemochromatosis?

Haemochromatosis is the most common iron storage disease in Australia, the US and most European countries and occurs in about one person in 200. It is rare in people of Asian descent.

It is a recessive genetic condition, meaning you have to inherited two copies of the haemochromatosis gene (one from each parent). The defect is in the gene that regulates how much iron you absorb from food and supplements. This means that more iron gets into your system than you need to make red blood cells or to perform other functions. The excess iron ends up in your organs and can damage your heart, liver, pancreas, joint and glands that make hormones. If left untreated, you are at a higher risk of heart and liver disease, diabetes and arthritis.

Signs and symptoms

Symptoms commonly appear in men aged 40-60 years, but appear later in women due to blood loss from menstruation and childbirth.

The most common symptoms are fatigue and joint pain. More advanced symptoms include osteoarthritis, hormonal changes with loss of libido, skin that has a bronze or slate grey colour, heart problems, diabetes (including bronze diabetes) and liver diseases such as cirrhosis and liver cancer.

It seems confusing that absorbing more iron could lead to fatigue. Iron is needed to make red blood cells that carry oxygen around the body. However, too much iron is toxic. Excess iron gets deposited in your organs, and this then interferes with normal body functions, as well as the production of hormones that regulate your metabolism and sex drive. Not surprisingly, you don’t feel well.

Diagnosis and treatment

Your GP can order a simple blood test to check your iron status. This includes transferrin saturation and serum ferritin. If these suggest you could have an iron overload disorder then a gene test will confirm the diagnosis. Once diagnosed, close relatives would also need to be checked for the condition.

The good news is that treatment for haemochromatosis is straight forward and effective. The venipuncture process (similar to becoming a regular blood donor) removes excess iron from the body.

What do I need to avoid eating and drinking?

Avoiding eating meat, chicken and fish or becoming a vegetarian will help reduce the amount of iron you eat and can therefore potentially reduce what your body absorbs.

Other things to avoid are vitamin C supplements and juices high in, or supplemented with, vitamin C. Vitamin C converts the iron from legumes, eggs, nuts, seeds, grains and breakfast cereals into a form that is more easily absorbed, increasing your iron load.

There are many reasons why you could feel fatigued. If you have a lethargy that just won’t lift, see your GP for a check up.

Disclosure

Clare Collins is affiliated with the Priority Research Centre for Physical Activity and Nutrition, the University of Newcastle, NSW. She is an NHMRC Senior Research fellow. She has received a range of research grants including NHMRC, ARC, Hunter Medical Research Institute, Meat and Livestock Australia, Diabetes Australia, the Heart Foundation. She has consulted to SHINE Australia, Novo Nordisk, Quality Bakers and the Sax Institute. She is a spokesperson for the Dietitians Association of Australia on some specific nutrition issues, including Australia's Healthy Weight Week.