Your body needs iron to manufacture red blood cells, produce energy and fight infections. However, if you get too much iron, it is stored in your soft tissues, where it can trigger the generation of toxic free radicals. Excess iron accumulates in multiple sites – heart, pancreas, kidneys, nervous system and liver – so iron overload can cause symptoms referable to specific organs and tissues or to your body as a whole. Iron overload can result from genetic conditions that are fairly well defined, or it can stem from metabolic abnormalities that are not yet completely understood.
Hereditary hemochromatosis is a genetic disorder that affects 1 in 200 individuals of Northern European descent, with 1 in 10 being carriers of the gene. The effects of hemochromatosis are often not apparent until you reach middle age, when years of iron accumulation finally begin to damage your organs. Liver disease is the most common complication of hemochromatosis, but other tissues, as well as your nerves, are often involved. Both fatty liver and peripheral neuropathy have been identified in patients with hemochromatosis.
Dysmetabolic Iron Overload
Metabolic syndrome is a condition defined by the presence of any three of the following traits: high blood pressure, high triglycerides, abdominal obesity and insulin resistance. Metabolic syndrome is considered to be a “pre-diabetic” state, and fatty liver is generally accepted to be a liver manifestation of this disorder. According to an August 2008 review in “World Journal of Gastroenterology,” iron overload is a common finding in patients with metabolic syndrome and fatty liver disease, and this combination of findings is now called dysmetabolic iron overload. In some cases, dysmetabolic iron overload resembles hemochromatosis in its severity.
Severe iron overload frequently affects your pancreas and, if untreated, eventually leads to pancreatic failure and diabetes. In fact, “bronze diabetes” – excessive skin pigmentation and pancreatic failure – is a classic finding in untreated hemochromatosis. Diabetes caused by iron overload is associated with the same problems that are seen in other forms of diabetes, including peripheral neuropathy. In modern times, diabetes due to iron overload is uncommon, as pancreatic damage can be prevented by “donating” blood to bring your iron levels down.
Iron overload occurs in a variety of settings, and its severity ranges from very mild accumulation of iron in specific tissues, such as your liver, to widespread and marked deposition of excess iron in multiple sites in your body. Iron overload has been linked to fatty liver and peripheral neuropathy in certain disorders – hereditary hemochromatosis – but the spectrum of iron overload is so broad that fatty liver and neuropathy could also be seen in people with dysmetabolic iron overload. If you have fatty liver, iron overload and peripheral neuropathy, further evaluation is warranted to rule out hemochromatosis and to determine your best course of treatment.