"THE HEART OF THE MATTER"
a special program of the National Emergency Medicine Association (NEMA)

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Week: 597.7

GUEST: Dr. James Connor, Prof. Neuroscience & Anatomy, Penn State Hershey Medical Center

Topic: Iron & the elderly

Host/Producer: Steve Girard 

NEMA: Among the essential nutrients and minerals, iron is near the top of the list, and we've been taking iron supplements for many years. Today, our guest is Dr. James Connor of the Penn State Hershey Medical Center, who's co-written a study on whether iron should be supplemented without diagnosis of anemia or poor iron absorption. Dr. Connor, let's talk about the importance of iron in the diet... 

CONNOR: it's an absolute requirement. We need it for really basic functions of all aspects of metabolism, you can pretty much point to anywhere you want to a, a any type of enzyme reactions, oxygen - all of the oxidative metabolism that we use every time we're using oxygen...iron is involved in that process. We make a comment in our article that the Egyptian, Greek, Roman soldiers used to use the eating liver as a major iron source for their soldiers and that would help to speed up their recoveries when they were injured. So the requirement for iron is absolute in any type of the reactions in the body. 

NEMA: In the area of physical development...especially children...iron is very important.... 

CONNOR: If there's an iron deficiency in the diet, then there are both mental and motor problems that will persist throughout a child's life into adulthood. Even though the iron deficiency that had occurred around birth was rectified later on. And one of the things I didn't mention of course is blood. I mean hemoglobin has iron sitting in the middle of it and is obviously essential in a normal development.

NEMA: We need iron throughout our lives, but in what amounts? What are the requirements for normal adults? 

CONNOR: It changes a little bit with age and again it also changes, of course, in menstruating vs. non-menstruating women... but the current FDA's numbers are that males, adult males need about 10 mg per day and females during menstruating ages require about 15. That goes up to 30 a day if the woman's pregnant. And then once women are past menstruation, then it goes down to about 10 mg a day... back to the same levels that a are required for males. 

NEMA: Supplements and vitamins give us important body needs, and then the body finds a way to get rid of the excess...that's not the case with iron...correct? 

CONNOR: We don't get rid of it that easily, and that's the issue with.... you know if you're eating regular diets, you're getting enough iron. So if you start supplementing on top of that, then you start actually accumulating it. You lose a little in the bile, and you lose a little when you're sweating. But the predominant amount is what's lost through blood loss. And that's why with menstruation, and that's a maybe a benefit is the ability, at that point, to lose iron and be less susceptible to excessive iron accumulation. 

NEMA: Tell me a bit about your research as far as how iron, dietary iron and supplemental iron affects the elderly .  

CONNOR: We were specifically interested in looking at iron and brain function in the aged population. And a knowing as we said that there were clear iron deficiency problems associated with developmental issues...we wanted to look at iron in the aged and the adults brain...and particularly emphasizing some of the diseases. Parkinson's disease was a particularly good example of iron accumulating in a certain brain region. And the more we looked into it, the more we just sort of general comments in various neurological diseases, that there was iron accumulating in certain areas of the brain. And these certain areas of the brain happened to be iron rich areas under normal circumstances. So, what was happening was that these standard iron rich areas were accumulating even more iron in diseases...such as Parkinson's, Alzheimer's disease, Huntington's disease, multiple sclerosis. So, we weren't talking about rare disease here, we were talking about a fairly common group of neurological disorders. So what we set out to do was try to understand how iron is accumulating in the brain in a range of neurological disorders. And we began to look at iron accumulation issues in general in the aged population, and we found that the cardiovascular people were saying too much iron is a bad thing. And, of course the liver groups, with the iron overload disease hemachromatosis, were cautioning about too much iron in terms of liver function. And this, as we began to look, is in not only just the aged population, but in adult populations in general. It was becoming clear that too much iron is not a good thing, and that sort of prompted writing the article. Because we had groups of medical people and scientists referring to iron overload as being a problem in their own special areas. And so, we just sort of sat down and reviewed what everybody was saying - that too much iron in the diet, and particularly in elderly people, is a bad thing. 

NEMA: Now I understand the presence of iron and the need for iron, nutrition, brain function, and I just did couple of stories with a doctor at Penn's Alzheimer's Center a while back about brain plaques. But you know, they didn't mention the iron fields...  

CONNOR: Surrounding those plaques is a rich field of iron. And what we have been looking at, and actually had funding from the Alzheimer's association to do was look at the way that iron accumulation in the cells surrounding the plaque may be affecting the secretion of beta amyloid, the structure I'm sure that those guys did talk a lot about. The amyloid is the central core of those plaques. As we were looking at the Alzheimer's patients, what we saw were lots of those plaques, and a hallmark characteristic of many of those plaques is that there was a tremendous iron burden surrounding those plaques. 

NEMA: What is the link between iron status and cancer? 

CONNOR: Well there is... potentially a couple of things. One is the oxidative stress issue that you mentioned. Iron is when is can induce DNA damage and through out say of stress on the DNA itself. So there you have the potential for mutations there in the cell and, and generating oxidative stress. UV light, for example, perhaps interacting with iron in some cells can induce oxidative stress in the DNA and cause mutations that could lead to cancer. But the other thing is that once the cancer has started, all rapidly dividing cells have a very high requirement for iron. That's true if it's in a normal developmental situation, that's also try if it's a cancer. So in those individuals who have cancer, ongoing cancer, to iron supplement... you are feeding the cancer cells just as you are all of your other cells. But you may want to use some caution there, and obviously this would need to be discussed on an individual basis with one's physician. But one does need to bear in mind that the cancer cells, like all other cells, are requiring iron and given that the cancer cells are growing and dividing at a much more rapid rate then the normal cells... then they are going to certainly compete very effectively for the body iron stores and for any iron that you would supplement. You know people with cancer tend not to feel good, and they tend to take vitamins and supplements and again, one should be very cautious in taking iron supplements in that setting. 

NEMA: What were the solid recommendations that you made after your study? As a follow up on that...what has the response been? And there hasn't been any official government recommendation yet, right? 

CONNOR: It's a suggestion on our part... there are some other individuals as well who are beginning to petition the FDA to begin to look seriously at iron supplementation in foods. But our suggestion, which was taken at least locally here quite seriously by the George Leader family...who runs the Country Meadows assisted living retirement communities through out PA. I think there is about twenty of them now, and they are actively in the process of putting filters into their water system to keep iron out. And they used to provide their residents with multi-vitamin supplements, and now they are modifying that to a keep A's and C and E and calcium supplements available, but not the multi vitamins, which include an iron supplement. 

NEMA: Now well aside from the elderly population of course I am thinking about people who are you know, forties, fifties getting towards sixty or so and they are saying "well, I need more iron"... or maybe they just think they do because they see advertisements or there friends do it and all...  

CONNOR: The bottom line is if you're not diagnosed as having anemia or some problem with iron absorption, you don't need iron supplements. And a I think exactly what you said is that people tend to think, "well, I am getting older and therefore I need the following set of supplements". And that's just not the case, and certainly not the case as far as iron is concerned. It probably is the case as far as calcium is concerned , the data there quite good, but iron...unless there is a specific indication that there's a problem with iron absorption or iron levels in the blood... then you don't need to iron supplement. Just continue to exercise and continue to donate blood. I mean, the recommendations that I follow myself is eating as healthy a diet as I can. And I donate blood on a regular basis.  

NEMA: Dr. James Connor of Penn State university's Hershey Medical Center. His recommendation is, again, that you shouldn't supplement iron unless you've been diagnosed with anemia or poor iron absorption. Thanks Dr. Connor.  

SPOT: 15 years in the prevention of heart disease, stroke and trauma - The National Emergency Medicine Association. This show is just part of what NEMA does. We send out millions of pieces of prevention information to people around the country, give grants to organizations in research, public information and emergency services, and have been instrumental in the creation and expansion of the Chest Pain Emergency Room movement. To play a role, call 800-332-6362. 

NEMA: Thanks for joining us for today's program. If you have any comments or suggestions, contact this station. Or visit our home page at:www.nemahealth.org/ ...for a look at transcripts of this or past programs, or to find out more about the National Emergency Medicine Association. I'm Steve Girard at The Heart of the Matter.