1. Iron Metabolism Mike Clark, M.D.

2. Normal Iron Values Serum iron 52 – 169 micrograms per deciliter Total Iron Binding Capacity 246 – 455 micrograms per deciliter

3. Roles of Iron 1.Serves as cofactor in oxidation-reduction reactions 2.Forms part of the Electron Transport Chain 3.Found in hemoglobin and myoglobin 4.A proper iron metabolism protects against bacterial infection. If bacteria are to survive, then they must get iron from the environment. Disease-causing bacteria do this in many ways, including releasing iron-binding molecules called siderophores and then reabsorbing them to recover iron, or scavenging iron from hemoglobin and transferrin. The harder they have to work to get iron, the greater a metabolic price they must pay. That means that iron-deprived bacteria reproduce more slowly. People with increased amounts of iron, like people with hemochromatosis, are more susceptible to bacterial infection.

4. Note: Iron can also be potentially toxic. Its ability to donate and accept electrons means that if iron is free within the cell, it can catalyze the conversion of hydrogen peroxide into free radicals. Free radicals can cause damage to a wide variety of cellular structures, and ultimately kill the cell.

5. Body Iron Stores Most well-nourished people in industrialized countries have 3-4 grams of iron in their bodies. Of this, about 2.5 g is contained in the hemoglobin needed to carry oxygen through the blood. Another 400 mg is devoted to cellular proteins that use iron for important cellular processes like storing oxygen (myoglobin), or performing energy-producing redox reactions (cytochromes). 3-4 mg circulates through the plasma, bound to transferrin.

6. Surplus iron is stored in tissues as ferritin. The cells containing the most ferritin are in the liver, but also in the bone marrow and spleen. When iron content becomes extremely high – the liver uses another protein to store iron forming hemosiderin

7. Acquiring Iron External – Diet Internal - Recycling

8. Dietary Iron Most U.S. diets provide 6 – 7 mg. of iron for every 1,000 Kcal consumed Recommended for men is 8 mg. per day Recommended for women during childbearing years is 18 mg. per day (however women generally only receive 12 – 13 mg per day – not enough until after menopause)

9. Iron Absorption Special proteins assist the body to absorb iron Mucosal ferritin received iron from the GI tract Some iron is stored in the epithelial cells of the GI tract as mucosal ferritin – this stays until the cell dies and is sluffed off – occurring every 3 days However some is transferred to mucosal transferrin then to blood transferrin Blood transferrin delivers iron to cells that have receptors for transferrin – which are primarily liver cells, bone marrow cells and spleen cells – however all cells need some iron

10. Sources of Iron Heme iron – found in meats – the best absorbed form Non-heme iron found in plants Approximately only 10% of iron comes in from heme iron – but 25% of it is absorbed Only approximately 10% of non-heme iron is absorbed Vitamin C appears to help non-heme iron absorption Phytate, fiber in soy products, whole grains, nuts, oxalates in spinach; the calcium and phosphorous in milk; EDTA ins food additives; and the tannic acid in tea, coffee, nuts and some fruits and vegetables can interfere with iron absorption

11. Recycling of Iron This occurs primarily when red blood cells are broken down

12. Reasons for Iron Deficiency Iron is an important topic in prenatal care because women can sometimes become iron-deficient from the increased iron demands of pregnancy. Functional or actual iron deficiency can result from a variety of causes Increased demand for iron, which the diet cannot accommodate. Increased loss of iron (usually through loss of blood). Nutritional deficiency. This can be resultant of a lack of dietary iron or consumption of foods that inhibit iron absorption. Individuals following a strict vegan diet are at increased risk for this type of deficiency. Inability to absorb iron because of damage to the intestinal lining. Examples of causes of this kind of damage include surgery involving the duodenum, or diseases like Crohn’s Disease or Celiac Sprue which severely reduce the surface area available for absorption. Inflammation leading to hepcidin-induced restriction on iron release from enterocytes

13. Iron Overload The body is able to substantially reduce the amount of iron it absorbs across the mucosa. It does not seem to be able to entirely shut down the iron transport process. Also, in situations where excess iron damages the intestinal lining itself (for instance, when children eat a large quantity of iron tablets produced for adult consumption), even more iron can enter the bloodstream and cause a potentially deadly syndrome of iron intoxification. Large amounts of free iron in the circulation will cause damage to critical cells in the liver, the heart and other metabolically active organs. Iron toxicity results when the amount of circulating iron exceeds the amount of transferrin available to bind it, but the body is able to vigorously regulate its iron uptake. Thus, iron toxicity from ingestion is usually the result of extraordinary circumstances like iron tablet overdose rather than variations in diet. Iron toxicity is usually the result of more chronic iron overload syndromes associated with genetic diseases, repeated transfusions or other causes. Classic examples of genetic iron overload includes Hereditary Hemochromatosis (HH) and the more severe disease Juvenile Hemochromatosis.