IRON-OUT-OF-BALANCE IN MEN

Iron out-of Balance in Men

Iron overload or hemochromatosis is more prominent in adult males; less than 2% of the male population at risk for iron-deficiency with or without anemia. Males tend to eat a more bio-available form of iron contained in red meat and they do not lose blood in the volumes that females do through menstruation or childbirth. Dysmetabolic iron overload syndrome (DIOS), Iron Avidity, and Anemia of Inflammatory Response are also conditions of iron imbalance seen in adult males.

Excerpt from Iron Disorders Institute Guide to Anemia (Cumberland House An Imprint of Sourcebooks) Chapter Eight: Anemia in Adult Males

According to the U.S. Centers for Disease Control and Prevention, “Most men 20 to 50 years of age meet the recommended dietary allowance for iron through diet. Of the male adults studied who had iron-deficiency anemia, 62 percent had clinical evidence of internal blood loss that was determined to be caused by ulcers and tumors in the gastrointestinal tract. In another major study called the NHANES I, conducted during 1971–75, about two-thirds of anemia cases among men were attributable to chronic disease or inflammatory conditions.”

Blood loss

Ulcers, colon polyps, bleeding hemorrhoids, liver disease, bleeding esophageal varices, tumors, cancer, celiac sprue, crohns or ulcerative colitis, chronic use of aspirin and aspirin-containing drugs, alcohol abuse, bacterial infection, overbleeding during treatment for hemochromatosis, and blood diseases are all possible sources of blood loss.

Bleeding disorders, such as hemophilia or acute blood loss as a result of trauma or surgery can occur in males and result in anemia. However, it is chronic blood loss or severe problems of absorption that takes place somewhere along the digestive tract that is the most common reason for iron-deficiency anemia in males.

When males, especially those between the ages of eighteen and sixty, are diagnosed as iron deficient with or without anemia, one of the first areas a physician will investigate, given the patient’s family history of disease, is blood loss from the digestive tract.

Esophageal bleeding can be caused by inflammation, varices, tears in the lining of the esophagus, and from cancer. Esophagitis, or the inflammation of the esophagus, occurs when stomach acid is repeatedly pushed up into the esophagus. Constant irritation causes the tissues in the lower part of the esophagus to become inflamed, a condition known as Barrett’s esophagus. If not corrected these inflamed tissues can bleed and in 5 to 10 percent of cases with Barrett’s, cancer of the esophagus will develop.

Enlarged veins called varices can also cause blood loss from the esophagus. When engorged, these veins can rupture and bleed massively. Cirrhosis of the liver is the most common cause of esophageal varices. Cirrhosis is often seen in chronic alcoholics, patients with viral infections, or in persons with undetected and advanced hemochromatosis—iron overload disease. When iron overload disease is diagnosed in a person who has cirrhosis, the risk of liver cancer increases 200-fold.

Another cause of esophageal bleeding is from a condition called Mallory-Weiss syndrome. In Mallory-Weiss, the lining of the esophagus is torn, usually from repeated vomiting or uncontrolled and chronic coughing. Males who are heavy smokers or who have lung problems and who experience prolonged bouts of extreme coughing are most at risk for this syndrome.

The stomach is a frequent site of bleeding. Infections with Helicobacter pylori (H. pylori); alcohol abuse; and repeated consumption of aspirin, aspirin-containing medicines, and NSAIDS, particularly those used for arthritis, can cause stomach ulcers or inflammation (gastritis). Acute or chronic ulcers may enlarge and erode through a blood vessel, causing bleeding.

In the lower digestive tract, the large intestine and rectum are frequent sites of bleeding. Hemorrhoids are the most common cause of visible blood in the feces, especially blood that appears bright red. Hemorrhoids are enlarged veins in the anal area that can rupture and produce bright red blood, which can show up in the toilet or on toilet paper. If red blood is seen, however, it is essential to exclude other causes of bleeding since the anal area may also be the site of cuts (fissures), inflammation, or cancer.

Benign growths or polyps of the colon are very common and are thought to be forerunners of cancer. These growths can cause either bright red blood or occult bleeding. Colorectal cancer is the third most frequent of all cancers in the United States and often causes occult bleeding at some time, but not necessarily visible bleeding.

Different intestinal infections, such as salmonella, Campylobacter, E. coli, and Shigella (dysentary), which are bacteria, and G. lambdia, a protozoan parasite responsible for giardiasis, can cause inflammation of the colon and bloody diarrhea. These infections are acquired from consuming water or foods contaminated with these pathogens. Swimming in lake waters, drinking water in some foreign countries, and eating in restaurants that have poor sanitary standards are ways people can become infected with these germs.

Diverticular disease can also have anemia as a consequence. Weaknesses in the colon wall allow pouches called divertica to form. These pouches can remain without consequence, or get filled with fecal matter and become inflamed (diverticulosis) or infected (diverticulitis). Diverticular disease occurs closer to the fourth or fifth decade of life. When onset is prior to the age of fifty, the incidence is three times more common in males than in females. When the onset is age seventy or older, the reverse is true and incidence is three times more common in females. Symptoms range from mild cramping to pain in the lower left quadrant of the abdomen. Diarrhea, nausea, vomiting, and blood in the stool can accompany diverticulitis, where bloating and constipation are more common in diverticulosis. Blood may or may not be visible in the stool of patients with diverticulosis but there can be minute traces of occult blood (not visible to the naked eye) upon medical examination.

Aspirin consumption and blood loss

Healthy adult males who are meat eaters will not likely become iron deficient due to aspirin ingestion; they may, in fact be helped by it.

Many physicians recommend that patients take one 88-grain aspirin per day as a preventive measure against heart disease. The benefit may be due to the loss of blood and therefore the loss of iron that can build up undetected in organs such as the heart.

However, long-term use of aspirin, NSAIDs (non-steroidal anti-inflammatory drugs), or blood thinning medications can result in iron deficiency and anemia due to the chronic loss of blood. These males could lose a half-cup or more of blood per month, which is comparable to the blood loss of some menstruating females.

Alcohol abuse

Abusers of alcohol and some heavy drinkers have increased liver disease, frequent infections, and internal bleeding due to too few platelets. Abuse is defined as drinking in excess of one pint or more of 80- to 90-proof distilled spirits per day. Inflamed livers (hepatomegaly), commonly seen in heavy drinkers, cannot function normally. These livers are unable to produce clotting factors, leading to an increased risk of bleeding, and anemia is the consequence. Other causes of anemia in abusers of alcohol are folic acid and B6 (pyridoxine) deficiency. Persons with deficiencies in these nutrients can have large red blood cells, a condition called macrocytic anemia. Eighty percent of males who abuse alcohol have macrocytic anemia.

One uncommonly known cause of iron deficiency is overbleeding with therapeutic phlebotomy. Bloodletting, also called phlebotomy, is the therapy used for people with hemochromatosis, a leading cause of iron overload.