Watch Your Iron Levels for Optimal Heart Health

03/29/2021 | 5 min. read

Dr. Stephen Sinatra

Dr. Stephen Sinatra

Iron is an essential mineral that is required for the production of hemoglobin, the protein in red blood cells that binds to oxygen and transports it to cells throughout your body. 

If your iron level is too low, your body cannot make enough hemoglobin. Oxygen delivery to your cells declines, and your health suffers. Too much iron, on the other hand, is also an issue because excesses build up in your organs and tissues and can cause serious damage. 

Cardiovascular disease is among the many problems associated with both iron deficiency and iron overload. Let’s look at why it is important to stay on top of your iron level and what you can do to keep it in the optimal range.

Low Iron & Heart Disease

When your iron level is low, hemoglobin production and your body’s ability to make healthy red blood cells declines. This condition is called iron deficiency anemia, and it is most common during pregnancy and in conditions involving blood loss, such as heavy menstrual periods or gastrointestinal bleeding. 

Signs and symptoms of iron deficiency anemia include weakness, cold hands and feet, pale skin, and pica (cravings for ice, dirt, and other unusual things). The primary symptom, however, is fatigue. Oxygen is a key player in the production of ATP (energy) in the mitochondria of your cells. When the oxygen-carrying capacity of your red blood cells is reduced, your mitochondria cannot make enough ATP to meet energy needs. 

This oxygen and energy deficit also affects the cardiovascular system. Because the heart has to work harder and pump more blood to make up for less-than-optimal amounts of oxygen on the red blood cells, low iron can cause an increased heart rate. Iron deficiency can also cause heart palpitations, shortness of breath, or lightheadedness. In severe cases, the extra workload can lead to enlargement of the heart and heart failure. More than half of patients with heart failure have iron deficiency anemia, although anemia can be a consequence rather than a cause of heart failure.

What about other cardiovascular problems, such as low iron and heart attacks? There is no clear evidence that iron deficiency causes them, but people who have anemia do tend to have worse outcomes after a heart attack. I have also been asked if low iron can cause high blood pressure. Actually, the links between low iron and low blood pressure are much stronger. 

How Elevated Iron Levels Affect Heart Health

The flip side of iron deficiency is iron overload, or hemochromatosis. Most people have a built-in regulator of iron absorption. Once levels are sufficient, your body puts the brakes on further absorption, so your iron level remains steady. 

Individuals with hemochromatosis, however, lack the ability to regulate iron levels. So, absorption goes unchecked and iron is deposited in organs and tissues throughout the body, including the heart. 

Surplus iron ramps up inflammation, oxidative stress, and tissue damage. Buildup in the heart can lead to arrhythmias (abnormal rhythms), cardiomyopathy, and in advanced cases, heart failure. Plus, by weakening the heart’s ability to pump blood, excess iron can cause circulation problems throughout the body. 

Hemochromatosis is usually due to an inherited defect of iron metabolism, which can result in extremely high iron levels. Yet, less severe iron overload is also problematic. Studies show that men who eat a lot of red meat have a greater risk of coronary artery disease, and one proposed reason is red meat’s high iron content.

Lower iron levels—due to blood/iron loss in monthly menstrual periods—helps explain why younger women’s risk of heart attack is lower than men’s. After menopause, however, iron levels in women steadily rise, along with their risk of heart disease. 

Do You Have Healthy Iron Levels?

To find out if your iron level is in the healthy range, ask your doctor to perform a special iron test called serum ferritin. Ferritin is a protein that stores iron in your body, and testing can determine both iron deficiency and iron overload. 

Ideally, you want your level to be:

  • Women: Less than 80 mg/L
  • Men: Less than 90 mg/L 
  • Levels below 12 mg/L are indicative of iron deficiency  

Ferritin testing is important because the usual blood tests—hemoglobin and hematocrit—can detect iron-deficiency anemia but not hemochromatosis. If hemochromatosis is diagnosed and treated at a young age, patients can live a long and healthy life. Unfortunately, this condition has no symptoms early on, so it often goes undiagnosed until middle age, after serious organ damage has already occurred.  

If your ferritin level is exceptionally high, further testing will be ordered to rule out hemochromatosis. This will likely include genetic testing. About 10% of Americans, most of them of Northern European ancestry, carry a gene for hereditary hemochromatosis. However, the condition itself isn’t nearly that common because it only develops when both parents pass on the gene. 

Treating Highs & Lows

The good news is that iron deficiency and overload can be treated. If your iron level is modestly low or high, you may be able to normalize it within a few months by making appropriate diet changes. If not, other treatments are available.

  • Diet: Red meat is particularly high in heme iron, which is the most bioavailable type. Beans, tofu, potatoes, dried fruit, and fortified cereals and other grain products are reasonably good sources, although they contain non-heme iron, which is not as well absorbed. If your iron level is low, eat more of these foods; avoid them if it is high. Note that vitamin C-rich foods and supplements increase iron absorption. Cooking in cast iron skillets can also leech iron into food. 
  • Phlebotomy (bloodletting): Regular phlebotomy is the treatment of choice for hemochromatosis. Frequency of treatments depends on your initial iron stores but usually tapers over time as iron load decreases. Even if you have normal or modestly elevated ferritin, donating blood is a good idea. Research shows that healthy people who donate blood one to three times a year have a lower risk of heart attack. As an added bonus, your blood donation will make a difference in the lives of others.
  • Supplements: Iron supplements may be needed for individuals with anemia. For optimal absorption, take on an empty stomach or with orange juice. Do not take iron supplements unless recommended by your doctor. This is especially true for men and postmenopausal women, who are more likely to have elevated iron rather than iron deficiency. Many multivitamins include iron, so read labels carefully.
Dr. Stephen Sinatra

Meet Dr. Stephen Sinatra

Dr. Stephen Sinatra is a highly respected and sought-after cardiologist and nutritionist with more than 30 years of clinical practice, research, and study. His integrative approach to heart health focuses on reducing inflammation in the body and maximizing the heart's ability to produce and use energy.

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