It's one of those things particular to the male condition. It's one of those things that quietly affects legions of bodybuilders. It can be detrimental and even damaging – particularly for those who have high androgen levels. Yet it's often omitted during discussions among certain nutrition "experts" that tend to focus on the plights of women. I'm talking about iron overload.

From the name of the condition, you'd think it's pretty cool. I mean, that's the name of the game, isn't it? Big iron rules, right? Well, we'll see that axioms which hold true in the gym sometimes misguide us at the dinner table. Although more is indeed better (within reason) regarding calories and protein for many of us, too much iron in our beloved meats and supplements could literally leave us toxic. After participating in discussions here on T-mag, seeing it clinically and experiencing a bit of it myself, I feel it's time to burst the bubble: excess iron – in all its forms – isn't pretty.

You wouldn't think this by listening to most educational sources. I mean, we're taught from the time we're kids that iron is an essential nutrient that will help us grow strong and "enrich our blood." Heck, even Nutrition Facts labels list iron (along with calcium) as one of the mandated minerals. But highlighting a nutrient because it's important for (sometimes anemic) women doesn't mean the average guy should think he needs it too.

Potential Problems

So what's the problem? Well for starters, iron has been linked to cardiovascular disease, in part due to its pro-oxidative nature.(2) That's right; it has properties which make it the antithesis of beneficial antioxidants that we hear so much about (4). One might think of it as "anti-vitamin E."

Such oxidation could "harden" the plaques lining one's arteries (lipid peroxidation) and increase the atherogenic effects of high-cholesterol diets.(2) And as a component of hemoglobin, iron is related to another heart-unfriendly characteristic of some high-Testosterone men: polycythemia. This condition of excess red cells increases the viscosity of the blood leading to greater cardiac workload, potential hypertension, increased risk of stroke and, despite homeostatic adjustments, poorer blood flow to tissues.(9, 20, 24, 25)

Of course, as longstanding treatments for anemia, Testosterone, nandrolone and other anabolics really kick up hemoglobin and hematocrit levels. T is a fundamental reason why men have higher hematocrits than women so you can imagine what pharmacological doses can do. Now, admittedly, the epidemiological (population based) evidence is spotty regarding iron and heart disease (2), but the underlying physiology makes enough sense to look pretty scary.

As many of us are aware, oxidative damage goes beyond hardened arteries. Excess iron in tissues is also linked to DNA damage and cancer development,(4, 22) as well as diabetes (11) and elevated transaminase levels like ALT and AST (3, 7, 12) – although this has been questioned.(21)

I've had bodybuilders ask me many times why they can't get their ALT and AST levels down, even after taking a week off from training and avoiding other, ahem, "liver stressors." Could bodily iron concentrations be yet another reason why men get more damaged than women after intense exercise?

It may be the case that simply enjoying iron-rich, plentiful meat year-round – combined with high Testosterone levels and certain genes – will leave us pushing up daisies along with the carnivores of the past.

Look what aggressive behavior and bloody meat got the T-Rex!

A Widespread Issue

Let's start with a quote. "Iron stores in excess of normal eventually occur in most men and some women."(1) Ugh. Whereas women rid themselves of a fair amount of iron-rich blood monthly and generally consume less meat, we meat-swilling men have no good way of disposing of the stuff. Iron just hangs around in our systems, accumulating with time.

And the fact that (terrestrial) animal flesh contains heme iron – which is particularly bioavailable – doesn't help. At a whopping 30% or so bioavailability (depending upon bodily iron stores) (18), a big steak equates to bushels of plant material. We might call it the predicament of the predatory instinct, because veggies offer us as little as 2%.(18) And let's not even get into the "meat-fish-poultry" factor that further enhances iron bioavailability in animal foods.(18) Hence we're victims of our very carnivorous nature. (And sadly I, for one, enjoy meat in a big, bloody way.)

So how do we know that men accumulate iron in their circulation as they age? Although there is some debate whether transferrin saturation or serum ferritin (both iron-related proteins) is the best marker of iron status (23), it's clear that we gain progressively more iron from age 12 to 32 or so.(6) As an example, a teenage male may have a serum ferritin of 23 ug/L whereas a thirty-something man will be closer to 125 ug/L.(6) If iron overload does indeed predispose us to several diseases (10) or tissue damage, then this is disconcerting.

And things get worse. In an effort to combat oxidative damage, whether from muscle-damaging workouts or excess iron (or both), many bodybuilders take vitamin C. The ironic thing is that ascorbic acid actually enhances iron absorption (10), potentially leading to more iron overload – and among other things, greater oxidation. Double ugh! (Actually, vitamin E would be a much better choice.) For high-iron guys insistent upon their vitamin C intake, it appears best to take it as far away from iron-containing meals as possible to avoid problems.

In severe cases (much less common), iron overload can also result in iron storage abnormalities like hemosiderosis and hemochromatosis. The former is over-stuffed cell storage of hemosiderin, the (you guessed it) long-term iron storage protein. The latter is a chronic disease that is literally characterized by a dark or reddish coloring due to iron saturation of tissues. Liver damage (hepatomegaly and cirrhosis) and diabetes mellitus result.

Of course we're talking extreme examples here but the lesser, chronic effects of iron accumulation are also real. Hepatic damage, diabetes and a chest-clenching M.I. [myocardial infarction] are not on my "to do" list – not now and not twenty years from now.

Dietary Fixes

There is hope. One corrective approach for men who are cognizant of their high iron levels – or are concerned over where they're heading – is to include plenty of low-iron and iron-free foods instead of obsessing over meats. (God, it pains me to say this.) Luckily, several are great for bodybuilding. Milk and eggs can be very valuable as they not only provide superior protein quality and contain no iron, but these foods actually block iron absorption (17, 19).

Although some authorities site literature that meat-containing diets are superior to lacto-ovo-vegetarian ones for muscle gain (5), recent data seem to refute this notion, at least in part.(13) High fiber foods also help reduce iron absorption due to compounds like phytates (10), as do coffee and tea, due to phytochemicals like tannins. Green tea in particular – at a dose of ten cups per day – has been shown to drop serum ferritin concentrations and tends to reduce ALT and AST enzyme levels as well.(15)

If a man were to limit iron intake to no more than about 30 mg per day as has been suggested (10, 22), there are a couple more beneficial moves he can make. Aside from avoiding iron and stainless steel-lined cookware, one dietary maneuver is to go for the tuna and even artificial crab meat – both low-iron alternatives to terrestrial meat.

Another smart move is to avoid iron in dietary supplements. This should be a no-brainer. If you're a man, you need supplemental iron about as much as you need a bad case of "gyno." I noticed early-on that Biotest leaves iron out of its supplements, so kudos to them. Even your daily multivitamin/ multi-mineral should be the iron-free type like Centrum Silver (marketed toward older folks).

Breakfast cereals too, need attention as some are pretty heavily iron fortified. Be careful. Go for ones that provide less than 15% of your daily value and contain plenty of fiber. You're probably starting to see now that with a little dietary prudence, you can affect your iron status. Bodybuilders are not doomed to a ferric death. Remember, iron content information, in part thanks to the higher anemia risk of women, is ever present on food labels. Whereas they can readily seek it out, we men can avoid it if need be.

Special note: androgen users who are polycythemic (hematocrits over 54%) should not get too aggressive in eliminating dietary iron. The resulting smaller red blood cells would still be numerous and would actually increase blood viscosity worse than larger iron-replete ones.(14, 16) That is, although polycythemia is associated with an excess of iron-rich hemoglobin, it's a distinct condition from other types of iron excess. It's not like one can decrease his hemoglobin and hematocrit levels rapidly just by avoiding dietary iron. Phlebotomy (and androgen withdrawal) is called for.

Phlebotomy

Of course, the best acute way for a man to rid himself of some iron is to give blood. There are numerous personal benefits, as we "give the gift of life." A 500 cc donation can draw-off 250 mg of iron (7) and significantly drop one's hematocrit. It's prudent for anyone who's self-administering androgens (either O.T.C. or otherwise) to get their "crits" checked regularly.

With iron overload/polycythemia being such common genetic abnormalities, some authorities are recommending broad scale screening of young men anyway.(8) For persons with high hematocrit (47-53%), a drop to the low 40s can increase cerebral blood flow 50 %.(24) And you thought ginkgo was great.

Regarding serum ferritin, a healthful goal achievable by phlebotomy every few months is 50-100 ug/L. (1, 7). Oh, and regular donation of one unit of blood per year can halve the iron stores of men (2), might reduce heart disease risk (2) and may even bring down those ALT and AST levels (12). See? Being charitable really does pay dividends. Besides, think of the old lady who gets your prohormone-laden, nutrient-rich blood donation. She'll be doing "flag poles" off her I.V. stand!

So to summarize our little excursion into iron overload, let's just say that there's potential for physiological problems in the bodybuilding lifestyle of some men. We're not all doomed to a meatless existence... nor are we going to seize-up if we take prohormones, have high T-levels, or eschew tea. But with the nutritional concerns of men sometimes underemphasized, it's worth pointing a finger at iron as being more than the warm and fuzzy buddy he's often portrayed to be.

Ultimately, if you're a man who enjoys his red meat, thrives on heavy weights and revels in his androgenic nature, remember that – at least when it comes to supplements – it's best to keep the iron on the bar.

References

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2. Ascherio, A., et al. Blood donations and risk of coronary heart disease in men. Circ 2001 103(1): 52-57.
3. Brissot, P., et al. Clinical aspects of hemochromatosis. Transfus Sci 2000, 23(3): 193-200.
4. Britton, R., et al. Iron toxicity and chelation therapy. Int J Hematol 2002, 76(3): 219-228.
5. Campbell, et al. Effects of an omnivorous diet compared with a lactoovovegetarian diet on resistance-training-induced changes in body composition and skeletal muscle in older men. Am J Clin Nutr 1999, 70:1032-1039.
6. Custer, E., et al. Population norms for serum ferritin. J Lab Clin Med 1995, 126(1): 88-94.
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16. Milligan, D., et al. The influence of iron-deficient indices on whole blood viscosity in polycythemia. Br J Haematol 1982, 50(3): 467-471.
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19. Monsen, E. and Cook, J. Food iron absorption in human subjects. IV. The effects of calcium and phosphate salts on the absorption of nonheme iron. Am J Clin Nutr 1976, 29(10): 1142-1148.
20. Namazi, M. Minor thalassemia as a protective factor against cerebrovascular accidents. Med Hypotheses 2002 Sep;59(3):361-362.
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22. Schumann, K. Safety aspects of iron ion food. Ann Nutr Metab. 2001 45(3): 91-101.
23. Taylor, P., et al. Relationships among iron absorption, percent saturation of plasma transferrin and serum ferritin concentration in humans. J Nutr 1988, 118(9): 1110-1115.
24. Thomas, D., et al. effect of hematocrit on cerebral blood flow in man. Lancet 1977, 5(2): 941-943.
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