#082 3 Easy Ways You Can Optimize Dietary Iron and Cardiac Blood Flow
Dr. John Day
Dr. Day is a cardiologist specializing in heart rhythm abnormalities at St. Mark’s Hospital in Salt Lake City, Utah. He graduated from Johns Hopkins Medical School and completed his residency and fellowships in cardiology and cardiac electrophysiology at Stanford University. He is the former president of the Heart Rhythm Society and the Utah chapter of the American College of Cardiology.
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3 Easy Ways You Can Optimize Dietary Iron and Cardiac Blood Flow
Conventional wisdom would have us believe that when it comes to iron in the diet, more is better. New research suggests that eating too many iron rich foods may damage the heart. In this article, I will teach you three easy ways to optimize dietary iron and cardiac blood flow.
Should Jennifer take the iron supplements her doctor prescribed?
Jennifer was borderline anemic. In other words, her hematocrit and hemoglobin blood tests were in the low normal range. Marci also had heavy menstrual bleeding each month.
While she wasn’t too concerned, her doctor recommended eating plenty of red meat and even prescribed iron supplements. Marci, though, was worried about this treatment plan given her strong family history of heart disease.
Why are women protected against heart disease prior to menopause?
For years, cardiologists, like me, have wondered why women don’t seem to get heart attacks prior to menopause. We used to think it was the estrogen that protected women until more recent studies showed that supplemental estrogen may actually increase the risk of a heart attack or stroke.
Could the answer as to why women get heart disease 10 years later than men simply be because their iron levels are much lower? It could be that these regular monthly periods may actually be a blessing for women by allowing them to get rid of extra iron through this monthly blood loss.
To support this theory, studies show that women that have irregular or just occasional periods have a much higher risk of a heart attack. In men, regular blood donors have an 88% lower risk of a heart attack!
Were physicians from the Dark Ages actually onto something with their practice of blood letting? It appears from these, and other studies, that those who regularly lose blood (and iron) from monthly periods or blood donating seem to be protected against heart disease.
Why Do We Need Iron?
If people who regularly lose blood (and iron) are protected against heart attacks, why do we worry so much about getting enough iron in our diet?
It turns out that we need oxygen to survive. Our red blood cells carry all the oxygen we need to the rest of our body. If we don’t have enough iron then we won’t make enough red blood cells and we will become anemic, like Marci.
Like with most things in life, there seems to be a “sweet spot.” Iron is no exception. Too much iron and we are at risk of a heart attack from iron overload. Not enough iron and we become anemic which also puts us at risk of a heart attack.
Who is at risk for iron deficiency?
The main groups of people at risk for iron deficiency in the U.S. are menstruating women and young children. Approximately 10% of women and 15% of young children in the U.S. suffer from iron deficiency. People with ongoing bleeding issues are also at risk for iron deficiency. In these people, they must focus on foods high in iron to avoid becoming anemic.
The Number One Group of People at Risk for Too Much Iron
At the opposite end of the spectrum is a genetic condition called hemochromatosis which affects up to 5% of the population. Because of this genetic abnormality, these people hold onto iron and are at high risk of heart attacks, diabetes, and other conditions.
Studies show that even people without hemochromatosis, but still carry one copy of the gene, have a heart attack risk twice that of everyone else. Also, just taking in too much iron may cause heart attacks regardless of whether they have hemochromatosis or not.
Which foods are highest in iron?
Would it surprise you that red meat is one of the highest sources of iron in the diet? Other forms of meat are also high in iron.
With our meat heavy diets in the U.S., our risk of iron deficiency anemia is much lower than most of the world. For us, it usually is not the lack of iron but rather too much iron that may be the problem.
Iron in food comes in two different forms. One is heme iron which is the type of iron found in animal meat. Heme iron is easily absorbed by the body.
The other form of iron, non-heme iron, is the type of iron found in plant-based foods. Non-heme iron is not absorbed as well from the gut.
Plant-based foods high in iron include some vegetables, like spinach, as well as legumes, nuts, and seeds. Interestingly, vitamin C can help you to absorb more iron whereas foods high in calcium tend to block iron absorption.
3 Reasons Why Iron May Be Dangerous for the Heart
Researchers are still not sure why studies have consistently shown that people who eat a lot of red and processed meats seem to be at increased risk for heart attacks. Processed meats include deli meats, hot dogs, pepperoni, sausage, etc.
In the past it was felt that it was the cholesterol and saturated fats in red and processed meats which caused the increased risk of heart attacks. Now, as newer research has shown that dietary cholesterol and saturated fats are not as much of a problem for most people, researchers are looking for other explanations as to why red and processed meat eaters are more likely to have heart attacks.
1. The Iron Overload State
One possible theory is due to an iron overload state. Studies have consistently shown that iron overload is associated with heart attacks.
2. Heme vs. Non-Heme Iron
A second theory may be that it is the type of iron that matters. For example, high levels of heme iron, which is the type of iron found in red meat, is consistently associated with heart attacks in studies. However, non-heme iron, or the form of iron found from plant-based sources, may prevent heart disease.
3. Iron May Damage Endothelial Cells
A third theory is that iron is directly toxic to the inner layer of our arteries. This theory is supported by a recent Japanese study which showed that by injecting iron intravenously into young healthy men you could cause their arteries to constrict. In addition, the oxidative stress, or “rusting” which comes from excessive iron may cause plaque build up within the arteries.
Can too much iron cause Alzheimer’s Disease?
Iron overload is not just dangerous to the heart but is also dangerous to the brain. For example, iron overload states lead to iron accumulation in the brain which damages the hippocampus. The hippocampus is the part of the brain responsible for our memories.
Indeed, iron overload has now been implicated as a cause of Alzheimer’s Disease. Based on these studies, some researchers now recommend decreasing red and processed meats to protect against Alzheimer’s Disease.
What should Jennifer do?
In Jennifer’s case, her borderline anemia or low hematocrit/hemoglobin wasn’t any cause for concern. Given her strong family history of heart disease, she focussed her efforts on optimizing her iron stores from non-heme iron.
To achieve this goal, she made sure to eat legumes like lentils or beans, spinach, and sesame seeds every day. As lentils, beans, spinach, and sesame seeds are very high in non-heme iron, things quickly changed. After a couple of months of eating this way, her borderline anemia resolved and she had more energy than ever.
How to Optimize Dietary Iron and Cardiac Blood Flow
Iron overload is an increasingly recognized cause of heart attacks and dementia. To protect yourself from the risks of iron overload, let me suggest the following:
1. Get Your Iron and Blood Levels Tested
Your doctor can order some simple blood tests to check your iron levels and to see if you are anemic or not. If your levels are low, boost your intake of lentils, beans, spinach, and sesame seeds. Even if your iron levels are normal, eating more non heme iron sources like lentils, beans, spinach, or sesame seeds is very safe unless you have hemochromatosis.
However, if your iron levels are high, or your have hemochromatosis, you may want to consider reducing meat intake. Based on this information, you can then adjust your diet to optimize dietary iron and cardiac blood flow.
2. Minimize Heme Iron
If you are not menstruating or regularly donating blood, you may want to consider minimizing heme iron by limiting red and processed meats. If your iron levels are too high, or you suffer from hemochromatosis, then you will definitely want to limit all meat intake.
Studies have not yet been done to see if the carnivores among us, or those who love meat with every meal, can be protected by donating blood to lower their iron levels. Work with you doctor to determine what the right amount of meat is right for you to optimize dietary iron.
3. Donate Blood
If you are healthy enough to donate blood then you may want to consider becoming a blood donor. As mentioned, studies show that blood donation decreases the risk of a heart attack by 88%. While blood donation will definitely decrease your iron levels, other possible benefits of blood donation include lowering your blood viscosity and the benefits that come from volunteering.
Blood viscosity is a function of how well blood flows. The more red blood cells you have the more blood tends to clump together which impedes blood flow. Blood donors lower their blood viscosity by donating their red blood cells. Studies have shown that a lower blood viscosity is associated with a lower risk of a heart attack.
There is also the possibility that much of the benefit of blood donation is from the volunteer effect. Unfortunately, only 27% of Americans give of themselves as volunteers. Those that do volunteer experience great benefits. For example, a recent meta-analysis of 40 studies showed that volunteers, who gave at least 15 minutes of their time each week, lived 22% longer and were much happier.
If you are interested in experiencing the tremendous health benefits that come from becoming a blood donor, please speak with your physician to make sure it is safe for you. Also, if you have any iron issues be sure to also work with your physician to optimize dietary iron.
Disclaimer Policy: This website is intended to give general information and does not provide medical advice. This website does not create a doctor-patient relationship between you and Dr. John Day. If you have a medical problem, immediately contact your healthcare provider. Information on this website is not intended to diagnose or treat any condition. Dr. John Day is not responsible for any losses, damages or claims that may result from your medical decisions.
Very interesting article that might help to explain what’s going on with me. I have had gout (untreated) for about 12 years and elevated ferritin around 400, but also had lab results that indicated anemia. Unfortunately, when we started treating the gout to lower high uric acid, I also was prescribed iron supplements for about a year and ferritin went above 1200. I say unfortunately because we later discovered I had iron overload “instead” of anemia due to blood loss or hemochromatosis, and the iron sups didn’t help any. We’ve stopped the iron sups about 6 mos ago and the dizziness/heart palps during exercise have simmered down quite a bit. Are the affects reversible on their own with time, now that gout is being treated and not taking iron?
Sorry to hear about this. Fortunately, studies show that if iron overload states can be reversed before permanent heart failure occurs then you can generally avoid long term cardiac effects.
Here is a reference if you want to read more: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2947953/
Hello Dr. Day
This was a very interesting article. I have heard some of the information before, particularly about the women and the monthly loss of blood and those who donate blood.
As I was thinking about the article while reading I was also thinking about my sister. She is still young and in the menstruating group of women, but she has also had a heart valve replaced. She is on blood thinning medication. At one of her appointments she was told she is so tired because she was anemic. I watch her try to balance out the iron issue along with the blood thinning issue.
For people with similar issues what food or diet suggestions do you think work best. Watching her I have noticed that daily stresses interrupt the way her body utilizes the nutrients. Exercise also affects the outcome.
As an encourager what words of hope do you have for those who are frustrated with the ups and downs of balancing their lives to keep the iron and blood levels in check.
Thanks for your input for them 🙂
I’m glad you found this article useful. Thanks for your comments.
Your sister is definitely in a challenging situation with warfarin and a heart valve. For her it sounds like the challenge is to get enough iron. Anemia can certainly cause significant fatigue.
You also bring up a good point. People who are under significant stressors may not be as able to absorb all of their nutrients from the gut.
For people like your sister, she needs to live as healthy as possible and work very closely with her physician to overcome her anemia challenges. As I don’t give any medical advice online, please continue to work with your doctor.
Hope this helps!
Thank you for the article.
What about iron deficiency anemia for men around 60 years of age?
Do the lower risks of heart disease outweigh the symptoms of iron deficiency anemia?
Is there harm in lower iron levels other than the symptoms?
Thank you so much for your interesting question! I am not aware of any data that suggests that iron deficiency anemia is protective against heart disease. For a man to have this condition suggests either a diet extremely low in iron or absorption problems (I’m guessing it many be the later). Please continue to work with your physician on correcting the iron deficiency anemia. As I don’t give any medical advice online, please continue to work with your doctor.
Hope this helps!