Iron

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Ferritin and Iron

What is Ferritin?

Ferritin is an intracellular (inside the cell) protein, in the shape of a hollow sphere. Ferritin stores iron by allowing entry of iron as ferric hydroxide phosphate complexes, and when the body needs iron, releases it as required.
Ferritin is produced by almost every living organism, from bacteria to plants, animals and humans.
In humans, ferritin is a buffer against iron deficiency and iron overload, and is found in most tissues as a cytosolic protein, which means it is inside the cytoplasm, the fluid inside each cell between the outer shell wall and the nucleus (The nucleus contains our DNA).
However, small amounts of ferritin are secreted into the serum (blood) where it works as a carrier of iron.
Plasma ferritin (in the blood) is also an indirect marker of the total amount of iron stored in the body. Serum ferritin levels are used to determine iron deficiency (anaemia) or iron overload.
Ferritin keeps iron in a soluble, non-toxic form. Free ferritin (not combined with iron) is called apoferritin.
Iron is the central atom of haemoglobin, which gives blood it’s red colour. 75% of the body’s iron is stored in haemoglobin, 10 to 20% in the protein ferritin, and the rest in the protein transferrin (the iron transport protein). Small amounts are found in myoglobin, cytochromes, as unbound serum iron and in body tissues.
Excess iron is usually stored in the Liver, Spleen and Bone Marrow, but also in the Pancreas, Joints, Skin, Pituitary, Adrenals, Thyroid, Heart and other organs.
The haemoglobin molecule is a very large molecule, almost identical to the Chlorophyll molecule in plants. Chlorophyll has a central atom of Magnesium, giving grass the green colour. Haemoglobin has Iron as the central atom, giving blood the red colour.
Chlorophyll is commonly best known for “cleansing of the blood”. Best sources are green leafy vegetables and wheatgrass.

Why do we need Iron?

If we have too little iron, we cannot make enough red blood cells, reducing our ability to carry oxygen to all parts of the body.
If we have too much iron, it can damage organs and contribute to cancer, heart disease, the entire cardiovascular system, especially the endothelial cells (the inside lining of all blood vessels), the kidneys and the liver.
Red blood cells are made in the bone marrow, and have a lifespan of around 4 months, when they die (the process called Necrosis).
The body makes around 200 billion new red blood cells every day, along with around 10 billion white cells and about 400 billion platelets every day, and around the same amount die every day.
Dead red blood cells are then broken down by Macrophages (special white blood cells) in the spleen. Some are disposed of in the digestive tract (which makes our poo brown) and parts of other cells are re-used. Haemoglobin is further broken down to salvage the iron, and excess iron is then stored in the liver.
Too much iron in the liver can cause Cirrhosis (Scar tissue replacing healthy cells).
We can have too much iron in some cases because the body does not know how to get rid of excess iron, it only knows how absorb it and to store it (using the transferrin protein).


Healthy red blood cells.

As red blood cells approach death, or are infected with a parasite or bacteria, or have a genetic defect, or are cancerous, the shape, size, smoothness and colour may be different.

How is Iron absorbed?

Iron in food is processed in the high-acid stomach, where it is changed into a form that allows it to be absorbed.
Absorption takes place mainly in the duodenum (part of the small intestine) and also to a lesser extent near the end of the small intestinal tract.
After absorption, iron is transported by the transferrin protein. A healthy body has the ability to absorb more iron when it is required, and absorb less when it is not required.

Haemoglobin, Hemoglobin or Hbg

Haemoglobin is a protein contained in red blood cells.
The job of haemoglobin is to carry oxygen from the lungs to all of the tissue in the body, then return carbon dioxide back to the lungs.
Haemoglobin is composed of four globulin chains (protein molecules) which are connected together, and in adults, haemoglobin contains two alpha-globulin chains and two beta-globulin chains.
In foetuses and infants, haemoglobin contains two alpha chains and two gamma chains, and during growth to an adult, gamma chains are slowly removed, replaced by beta chains to form adult haemoglobin.
Every globulin chain contains the heme molecule as the central structure, and iron is embedded in the heme molecule, essential for the transport of oxygen and carbon dioxide.
Haemoglobin is also essential to help maintain the shape of every red blood cells, which resemble a donut with a dished centre rather than a hole. Any abnormal shape can cause poor flow through blood vessels.

Anaemia, Anemia

Anaemia is a condition where we do not have enough haemoglobin, which is usually, but not always, related to iron deficiency. It can be related to blood loss, from donating blood, from heavy menstrual bleeding, internal bleeding, blood loss from an injury, or insufficient iron in the diet (such as vegans or vegetarians).
IDA (Iron Deficiency Anaemia)
In most cases of anaemia, a blood test will reveal low haemoglobin and low ferritin, a result of iron deficiency, and the doctor will normally recommend iron supplementation or dietary changes or both.
ACD (Anaemia of Chronic Disease)
The body has a safety mechanism against harmful invaders such as cancer or bacteria. When sensing an invader, the body will move all iron it can from red blood cells back to ferritin, because all invaders need iron to thrive, and so does cancer. The body will leave just enough iron in haemoglobin for the cells to survive, but not enough to feed the invader.
We must NEVER take extra iron in cases of Chronic Disease, as we are only feeding the invader and doing more harm to our body.
ACD can be diagnosed by blood tests where we have low haemoglobin, but high ferritin. A C-Reactive Protein test (indicator of inflammation) is advised as well as ferritin if ACD is suspected.
When the disease clears up, the body will automatically return iron levels to normal.
Many doctors do not order ferritin tests when iron is low, resulting in the patient taking iron supplements which can cause damage or even death, so an accurate diagnosis of IDA or ACD is essential.
In some cases, IDA and ACD can occur at the same time, making diagnosis more difficult. One traditional test is Bone Marrow Aspiration with Iron Staining, but the Serum Transferrin Receptor test can help differentiate between IDA and ACD.
The Serum Transferrin Receptor test is significantly less affected by inflammation than the Serum Ferritin test. Results can be high in IDA and usually low in ACD, and the ratio of Serum Transferrin Receptor to the logarithim of Serum Ferritin Concentration is more helpful to distinguish ACD from IDA than is either individual test.
Kidney Damage
If the patient has any kidney damage (sometimes as a result of high iron) then it is possible to have high iron in the body tissues, while regular iron and ferritin tests results are normal or even low. In these cases, a specialist should supervise all testing.

Blood Tests

Normally, the doctor will organise a “Ferritin Study”.
This includes the following tests:

  • Serum Iron – how much iron is circulating in the blood, but this varies considerably and does not always mean a lot without also looking at the TIBC test below.
  • Serum Transferrin – or TIBC (Total Iron Binding Capacity) or Transferrin Saturation. Iron is bound to transferrin (which is produced by the liver), and TIBC is a direct measure of transferrin. Iron overload is indicated with levels over 55% for males and 50% for females. Fasting is preferred for accuracy. Note that inflammation causes reduced transferrin levels
  • Serum Ferritin – Indicates body iron stores. Typical lab results: Normal range 15 to 350 ug/L for men (some labs say up to 500ug/L), 15 – 300 ug/L for women, and varies depending on the lab and the method used, however LeanMachine says that these upper limits are way too high, and that anything over 80 ug/L indicates a possible iron overload condition, and anything below 20 ug/L indicates a possible iron deficiency. A healthy range is 20 to 80 ug/L, and the desirable range is 40 to 60 ug/L, but note that levels over 80 ug/L may be also be caused by liver disease, inflammation or cancer
  • Soluble Transferrin Receptors – Transferrin receptors present on cell surfaces are responsible for internalization of transferrin resulting in intracellular release or iron. With low iron stores, expression of transferrin receptors increases, so the level of soluble transferrin receptors inversely reflects iron stores, and is unaffected by any inflammation, however high soluble transferrin receptors may also mean haemolysis (premature red cell death)
  • A complete blood examination is also required to check Haemoglobin and other factors related to red blood cells, also liver and kidney function. Typical haemoglobin blood results 130g/L to 170g/L for adult males, 120g/L to 150g/L for adult females. For more info on these tests, see my article Blood Tests – How to read the results
  • Further tests may include a Liver Biopsy, SQUID (Superconducting Quantum Interference Device), or MRI (Magnetic Resonance Imaging), but these are generally not required except for extreme cases

Note that these are Australian tests. In the USA, the results are in ng/ml (nanograms per millilitre), which is exactly the same as ug/L (micrograms per litre), with upper and lower numbers both divided by 1000, giving the same numerical result.

Types of dietary Iron

There are two main types of dietary iron, heme iron found in meat and other animal products, and non-heme iron found in plant products.
Generally, heme iron is better absorbed than non-heme iron, leaving vegans more at risk for iron insufficiency, however heme iron is also more dangerous for the body in high levels.
A healthy body self-regulates iron levels, by absorbing more iron when we need it, and absorbing less iron when we do not need it, but sometimes this regulation is upset or overloaded.

Factors affecting ferritin/iron levels

Menopausal women often (but not always) have low iron, especially if periods are heavy, while post-menopausal women usually have normal iron.
Pregnancy increases iron requirements, as the body needs to make around 30% more blood to support the developing foetus, requiring 30% more iron. The body will use the body’s stored iron, but if stored iron is insufficient, anaemia will occur. All pregnant women should get their iron and haemoglobin tests done at each trimester, especially if diet or other factors place them at risk.
Blood donors will often have low iron. Red Cross blood donation centres always test haemoglobin levels, and if too low (or even too high), that person cannot donate blood.
For an adult male, the normal range is 125g/L to 185g/L
For an adult woman, the normal range is 115g/L to 165g/L.
For donations of whole blood for males, the acceptable range is 120 to 165g/L for women, and 130 to 185g/L for men.
For donations of plasma and platelets, the acceptable range is 115 to 165g/L for women, and 125 to 185g/L for men.
If below 130 (male) or 120 (female), that person should build up their iron reserves and seek medical advice.
Bleeding in the GI (Gastro-Intestinal) tract can cause low iron, as in any other form of blood loss.
Bleeding because of haemorrhoids or anal fissures, or bleeding from cancer or inflammation in the small intestine, colon or stomach will cause low iron. If stools are dark, or blood in urine, or any unexplained abdomen pain, see your doctor.
Various foods and vitamins can increase or decrease iron absorption – see below.
Foods high in iron are also generally high in Vitamin B12, and both are required for correct ferritin/iron metabolism and healthy Red Blood Cells.
Vegetarians and vegans in particular are susceptible to low iron and B12, as both come mainly from animal products.
As we age, we tend to have reduced stomach acid, resulting in less B12 absorption, and to a lesser extent, reduced absorption of all other minerals, vitamins and other nutrients.
If we take supplemental iron, the body will absorb less iron from the diet.
If we have a low-iron diet, the body responds by absorbing more iron from anything available in food.

Genetics

Sickle cell disease, thalassemia and haemochromatosis can all be inherited, and genetic testing for these and other genes affecting ferritin/iron is available.

Sickle Cell Anaemia

An inherited condition, mainly descendants of African people. A problem with the haemoglobin beta gene causes some red blood cells to become sickle-shaped, especially in hot, dry and intense exercise conditions.
25% of the population in West Africa have the sicklemia trait, also high in South and Central Americans, especially in Panama. Sometimes appears in Mediterranean countries like Italy, Greece, and Spain. Malaria may be a factor, as Indians, Middle Easterners (e.g. Arabs and Iranians), Native Americans, North Africans, and Turks have small but significant cases.
People with Sickle Cell Anemia actually have an advantage in some countries, as they are able to survive better if infected with Malaria. The “sickleing” of the red blood cells is promoted when the Malaria parasite enters, and the body’s own immune system is then able to identify and destroy the cell, along with the malaria parasite.

Thalassemia

An inherited condition, originating in Mediterranean countries, causing weakening and destruction of red blood cells by mutant genes, affecting haemoglobin production. Similar to Sickle-Cell Anaemia.

Haemochromatosis (inherited iron overload disorder)

There is a genetic test for Haemochromatosis.
The test gives results for mutations C282Y and/or H63D of the HFE gene:

  • Mutation not found (No Haemochromatosis)
  • Heterozygous (which means one faulty gene) – Generally no or mild symptoms, bu bay be a “carrier” for children
  • Homozygous (which means two faulty genes)

Children of a Mother and Father who are both carriers of one faulty gene have:

  • 50% risk of inheriting one mutated HFE gene (and becoming a carrier)
  • 25% risk of inheriting both mutated HFE genes (and at risk of excess iron absorption and symptoms of haemochromatosis)
  • 25% risk of inheriting two normal genes, and will not be a carrier

Around 1 in 188 Australians have the HFE genotype C282Y mutation, the most dangerous kind, although 1 in 8 people are carriers for this gene. There are many primary (inherited) types, including:

  • Type 1 – Classical haemochromatosis – Gene Mutation – HFE Genes C282Y and H63D, often with variations. C282Y is more serious.
  • Type 2A – Juvenile haemochromatosis – HJV (Haemojuvelin), also known as RGMc and HFE2 Genes
  • Type 2B – Hepcidin antimicrobial peptide (HAMP) or HFE2B Gene
  • Type 3 – Gene Mutation – Transferrin receptor-2 (TFR2 or HFE3 Genes)
  • Type 4 – African Iron Overload – Ferroportin (SLC11A3/SLC40A1 Genes)
  • Neonatal haemochromatosis – unknown cause
  • Acaeruloplasminaemia (very rare) – Caeruloplasmin
  • Congenital atransferrinaemia (very rare) – Transferrin
  • GRACILE syndrome (very rare) – BCS1L Gene

Also secondary types, which are not inherited, but acquired, especially if the patient has received many repeated blood transfusions.

  • Severe chronic haemolysis – either intravascular haemolysis or ineffective erythropoiesis (haemolysis within the bone marrow)
  • Excess iron from the diet
  • Excess iron from supplements. Any supplements must be kept away from children. This is a common cause of childhood poisoning

Conditions may involve mutant genes inherited from both parents, so patients may have widely differing symptoms.
1 in 700 people with haemochromatosis have no mutation in the HFE gene. This is called Non-HFE haemochromatosis, due to mutations in other genes.

Symptoms of Low Ferritin/Iron

  • Brittle Nails and/or spoon-shaped fingernails
  • Intolerance to Cold
  • Craving or Eating Non-Foods – dirt, hair, coins, etc (Pica)
  • Irritibility, Loss of Concentration, Dizziness
  • Pale appearance, especially membranes – inside of mouth and eyelids
  • Headache
  • Increased infections
  • RLS (Restless Leg Syndrome)
  • Shortness of Breath
  • Weakness
  • Fatigue
  • Loss of Appetite
  • Mouth Ulcers
  • Dry Mouth and/or Sore Tongue
  • Tachycardia (faster than normal heartbeat
  • Arrhythmia (irregular heart beat)
  • Dizziness
  • Drowsiness
  • Loss of Consciousness (Syncope)
  • Enlarged spleen
  • Vitamin B12 deficiency
  • Vitamin D3 deficiency

Symptoms – High Ferritin/Iron

  • Chronic fatigue, tiredness, weakness
  • Low levels of L-Glutathione
  • Low levels of antioxidants
  • Joint pain or aches
  • Abdominal pain
  • Diabetes mellitus (Type 2)
  • Arrhythmia (irregular heart beat)
  • Congestive heart failure
  • Heart attack
  • Changes in skin colour to bronze, ashen-grey or green
  • Period is irregular or stops (women)
  • Low Libido
  • Osteoporosis
  • Osteoarthritis
  • Hair loss
  • Enlarged liver or spleen
  • Impotence (men)
  • Infertility
  • Hypogonadism
  • Hypothyroidism
  • Depression
  • Mood swings
  • Low adrenal function
  • Neurodegenerative disease
  • High blood glucose
  • High liver enzymes – ALT, AST, GGT
  • High serum iron and serum ferritin
  • Higher risk of cancer
  • Weight Loss

How Much Iron do we Need?

Depends on who we are.
For post-menopausal women and healthy men, 8mg daily.
For menopausal women or blood donors, 18mg daily to replace iron in lost blood.
For pregnant women, 27mg daily for rapid growth and development.
Many breakfast cereals give all of menopausal women’s iron requirement, two-thirds the amount required for pregnancy, but double the amount for men and post-menopausal women, not counting intake from other meals.
Typically, there is a total of 3 to 4 grams of iron in the body. A normal diet should give most people enough iron, but vgans and vegetarians and blood donors will oten be lacking. People consuming large quantities of meat, especially liver meats, can reach iron overload withour knowing.

To INCREASE Ferritin/Iron

  • Some breakfast cereals are fortified with extra iron
  • Red meat – beef, lamb, kangaroo and organ meats, especially liver are rich in iron
  • Low alcohol consumption (one drink daily with food) is fine, but overdoing it will cause liver damage
  • Vitamin C (orange juice, fruit, supplements) will increase absorption of iron from food, up to 6 times greater absorption
  • Avoid donating blood too often, or not at all if haemoglobin is less than 130 (men) or 120 (women)
  • Build testosterone, by diet and exercise and/or supplementation to help build new red blood cells
  • If vitamin B-12 and/or Folate is low, supplement or change diet

Iron Overload

This is a dangerous condition, and if iron overload is suspected, a ferritin study is required. See above under “Blood Tests”.

To DECREASE Ferritin/Iron

Blood donation (therapeutic venesection) is usually the best method, and helps save lives of others.
If ineligible for Red Cross donations, private organisations can do this. Usually a ferritin reading of several hundred can be brought down to the normal range after half a dozen or so blood donations.
The only down side is that donations must be spread out over many months to allow the body to build new blood.
Next best option is using IP6 (Inositol Hexaphosphate) which can chelate excess iron from the body.
IP6 can help when the body cannot excrete excess ferritin/iron on it’s own, which can often happen. The body has limited capacity to remove iron, as it tries to always recycle iron.
Also the best alternative when blood donation is impossible, impracticable or ruled out for religious reasons.
IP6 has the added benefit of improving immunity.

More serious cases of iron overload can be treated with:
Deferoxamine (Desferal®) – administered via a needle from a pump attached to the body for 8 to 10 hours a day.
Deferasirox (Exjade®) – a tablet dissolved in a glass of water or juice, taken once a day.
Both methods can have undesirable side-effects, including hearing and vision loss, nausea, diarrhea, rash, kidney or liver injury, so LeanMachine recommends first using blood donation, IP6 and diet measures first.

  • Donate Blood at the Red Cross. Reduces old blood recycling, leading to reduced iron stores which are used up in making new blood. May take several sessions over several months
  • Take IP6 (Inositol Hexaphosphate)
  • Eat cabbage every day (cooked, not raw). No scientific studies have been carried out with cabbage, but plenty of anecdotal evidence suggest it works, possibly by filling up on cabbage, the patient may not feel like red meat…
  • Avoid red meat, and especially liver and other organ meats
  • Drink green tea, black tea, oolong tea or coffee, and/or take a Green Tea Extract. The tannins in tea reduce iron absorption
  • Take Vitamin EVitamin B-6Curcumin
  • Avoid taking too much Vitamin C, as this can increase iron absorption
  • Do not cook in iron pots or pans, even if you have low iron, as metallic iron is bad for the body, regardless of the Ferritin status
  • Avoid alcohol, especially wine with steak
  • Never take iron supplements. If you take a multivitamin, or a “women’s health” or “men’s health” supplement, ensure it has no iron
  • Never drink well water or bore water unless it has been tested free from iron (and other harmful metals)
  • Take Astaxanthin – an extremely powerful antioxidant, 550 times better than Vitamin E. Will not chelate iron, but will help repair the damage

The Low-Iron Diet

Green Tea, black tea, oolong tea and coffee all contain tannins which inhibit iron absorption, so drinking these with a meal can help lower ferritin and iron levels.
Drinking milk with a meal also helps reduce iron absorption because of the calcium in milk that competes with iron for absorption.
Eat an egg every day, as eggs contain a compound that impairs absorption of iron. Avoid red meats, chicken and fish are better choices, much lower in iron than red meat. Better still, go vegetarian or vegan.
Calcium supplements can reduce iron absorption, but can also cause increased plaque in arteries, especially the Calcium Carbonate (ground limestone) used in cheap supplements, so should be avoided.
Breakfast cereals with whole grains contain some iron, but many are fortified with extra iron and should be avoided. Try an apple for breakfast instead and help keep the doctor away.
LeanMachine online supplements

Disclaimer

LeanMachine is a health researchere, not a doctor, and everyone should consult with their own health professional before taking any product to ensure there is no conflict with existing prescription medication.
LeanMachine has been researching nutrition and health since 2010 and has completed many relevant studies including:
Open2Study, Australia – Food, Nutrition and Your Health
RMIT University, Australia – Foundations of Psychology
Swinburne University of Technology, Australia – Chemistry – Building Blocks of the World
University of Washington, USA – Energy, Diet and Weight
Johns Hopkins Bloomberg School of Public Health, USA – Health Issues for Aging Populations
Johns Hopkins Bloomberg School of Public Health, USA – International Nutrition
Johns Hopkins Bloomberg School of Public Health, USA – Methods in Biostatistics I
Johns Hopkins Bloomberg School of Public Health, USA – Methods in Biostatistics II
Johns Hopkins Bloomberg School of Public Health, USA – Principles of Human Nutrition
TUFTS University, USA – Nutrition and Medicine
TUFTS University, USA – Lipids/Cardiovascular Disease I and Lipids/Cardiovascular Disease II
Technical Learning College, USA – Western Herbology, Identification, Formulas
Bath University, England – Inside Cancer
WebMD Education – The Link Between Stroke and Atrial Fibrillation
WebMD Education – High Potassium: Causes and Reasons to Treat
Leiden University Medical Center, Netherlands – Anatomy of the Abdomen and Pelvis
MIT (Massachusetts Institute of Technology) – A Clinical Approach to the Human Brain
LeanMachine has now examined thousands of studies, journals and reports related to health and nutrition and this research is ongoing.

Updated 13th January 2020, Copyright © 1999-2020 Brenton Wight and BJ & HJ Wight trading as Lean Machine abn 55293601285

Flesh eating bacteria attacks those with excess iron

Analysis by Dr. Joseph Mercola Fact Checked – July 30, 2019
Reproduced from original article:
https://articles.mercola.com/sites/articles/archive/2019/07/30/necrotizing-fasciitis.aspx

Story at-a-glance

  • Flesh-eating disease (necrotizing fasciitis) can be caused by several different organisms. In cases where the infection is contracted through contact with seawater, the culprit is typically Vibrio vulnificus, a particularly dangerous Vibrio species that occurs naturally in warm seawater
  • Having liver disease increases your risk of V. vulnificus infection by 800% and your risk of death from it is 200 times higher than those with healthy livers
  • Having diabetes, HIV, thalassemia or cancer also raises your risk of Vibrio infection, as does taking antacids
  • Iron overload may be a key factor in life-threatening Vibrio infections. High iron provides prime growth conditions for V. vulnificus, and minihepcidin, an iron-lowering drug, has been shown to cure the infection by inhibiting the bacteria’s growth
  • Vibrio bacteria have a high affinity for attachment to human skin. In one study, all participants had Vibrio bacteria on their skin after swimming in seawater

The very idea of flesh-eating bacteria is horrifying and the real-world effects can indeed be devastating, necessitating the removal of large portions of flesh or amputation of limbs. Its effects can also be lethal.

July 15, 2019, WGN9 News reported the case of a woman being infected with flesh-eating bacteria after a quick swim at Norfolk’s Ocean View beach in Virginia the week before.1

She started feeling ill the very next day, and noticed symptoms of infection in her leg. It spread rapidly, and within a couple of days, she could no longer walk. Treating doctors suspect the bacterium made its way into her body via a small cut. She’s currently recovering from leg surgery. Another Florida woman who contracted the infection is also on the path to recovery.2

Two other recent cases did not end as well. A man crabbing at Magnolia Beach in Texas, and another who went for a swim in the Gulf, contracted infections that led to their deaths.3

“Health officials urge swimmers to avoid swallowing water and taking a dip after a heavy rainfall. Don’t swim if you are ill or have a weakened immune system and swim away from fishing piers, pipes, drains and water flowing from storm drains onto a beach Once you get out of the water, health officials say you should shower with soap,” WGN9 reports.4

What WGN9 does not cover is evidence suggesting flesh-eating bacteria are ubiquitous in the ocean and on human skin after swimming in saltwater, and that the difference between those who come into contact with the bacteria and remain unaffected and those in whom the bacterium unleashes a dangerous infection is strongly related to their iron levels.

Another sad note is that this woman may have undergone needless surgery as this infection, and similar diabetic leg infections, are relatively easily treated in a hyperbaric oxygen chamber.5,6

These types of infections typically require higher pressures with a hard-shell chamber7 and 100% pure oxygen with greater than two atmospheres of pressure — a treatment approved8 by the FDA for necrotizing infections, certain other wounds and gangrene. A soft-shell chamber would not likely be an effective treatment.

Necrotizing fasciitis

Flesh-eating disease (necrotizing fasciitis) can be caused by several different organisms, although group A Streptococcus are responsible for a majority of cases. Group A Strep is also responsible for strep throat, rheumatic fever and scarlet fever.9

Death is typically related to sepsis and subsequent organ failure. Due to its rapid spread, it’s important to seek medical attention as quickly as possible. According to the U.S. Centers for Disease Control and Prevention, early symptoms of necrotizing fasciitis include:10

  • Redness and/or swelling that rapidly spreads
  • Severe pain in the area and beyond (pain is typically described as worse than would be expected by the look of the wound)
  • Fever

In particular, be on the lookout for skin discoloration such as black spots, ulcers or blisters on the skin, and/or oozing pus. Dizziness, fatigue, nausea and diarrhea are symptoms associated with heightened infection.

According to the CDC’s active bacterial core surveillance system, which tracks necrotizing fasciitis cases caused by group A Strep, the U.S. has averaged between 700 and 1,200 such cases per year since 2010.11

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Flesh-eating Vibrio infections are also common

Now, in cases where the flesh-eating disease is contracted through contact with seawater, the culprit is typically the bacterium Vibrio vulnificus, a particularly dangerous Vibrio species that occurs naturally in warm seawater.12 For this reason, it’s not a good idea to go swimming if you have open cuts, sores or fresh tattoos.13

According to the U.S. National Oceanic and Atmospheric Administration,14 the Vibrios species prefer salty water above 59 degrees Fahrenheit (15 degrees Celcius). In fact, 93% of the time, the water temperature and salinity can correctly identify V. vulnificus hotspots. Iron- and nitrogen-rich dust settling in seawater has also been shown to fuel the bacteria’s growth.15

According to the CDC, Vibrio infection (by all species) causes 80,000 illnesses and kills 100 people in the U.S. each year.16 Aside from seawater exposure, raw or undercooked seafood are other common routes of exposure.

Liver disease increases risk of V. vulnificus infection

Importantly, having liver disease dramatically increases your risk of V. vulnificus infection. CDC findings reveal people with liver disease are a whopping 80 times more likely to contract V. vulnificus infection from raw oysters than those without liver problems, and 200 times more likely to die from it.17

Having diabetes, HIV, thalassemia (an inherited blood disorder that I actually have, which is associated with both anemia18 and iron overload19) or cancer also raises your risk of Vibrio infection, as does taking antacids.20 These risk factors are worth considering when swimming in the ocean as well.

Preliminary, as-yet unpublished research presented at the 2019 annual meeting of the American Society for Microbiology and reported by Medicine Net21 revealed all participants had the Vibrio genus of bacteria on their skin after swimming in the ocean and then air drying.

Vibrio was also found to have “specific affinity for attachment to human skin,” Medicine Net reports,22 as the presence of Vibrio on the swimmers’ skin was tenfold greater than in water samples.

Iron overload increases your vulnerability to V. vulnificus

I’ve mentioned iron a couple of times already, and iron may actually be a key factor in these life-threatening Vibrio infections. Not only does iron-rich water dramatically boost the growth of V. vulnificus, having excess iron in your blood may also predispose you to flesh-eating disease when exposed to the bacteria.23

In 2015, the University of California, Los Angeles (UCLA) published an article on this important finding, noting that:24

“People with a weakened immune system, chronic liver disease or iron overload disease are most at risk for severe illness. Vibrio vulnificus infections in high-risk individuals are fatal 50 percent of the time. Now, researchers at UCLA have figured out why those with iron overload disease are so vulnerable.

People with the common genetic iron overload disease called hereditary hemochromatosis have a deficiency of the iron-regulating hormone hepcidin and thus develop excess iron in their blood and tissue, providing prime growth conditions for Vibrio vulnificus.

The study25 also found that minihepcidin, a medicinal form of the hormone hepcidin that lowers iron levels in blood, could cure the infection by restricting bacterial growth … [R]esearchers compared the fatality of Vibrio vulnificus infection in healthy mice with mice that lacked hepcidin, modeling human hereditary hemochromatosis.

The results showed that the infection was much more lethal in hepcidin-deficient mice because they could not decrease iron levels in the blood in response to infection, a process mediated by hepcidin in healthy mice. 

Giving minihepcidin to susceptible hepcidin-deficient mice to lower the amount of iron in the blood prevented infection if the hormone was given before the Vibrio vulnificus was introduced. Additionally, mice given minihepcidin three hours after the bacterium was introduced were cured of any infection.”

The links between iron levels and liver health

Hemochromatosis, a hereditary disorder that causes your body to accumulate damaging levels of iron, affects 1 in 300 to 500 Caucasians.26 However, you don’t have to have a genetic disorder to have high iron.

In fact, most all adult men and non-menstruating women have damaging levels of iron, as the primary way to lower your iron level is through blood loss. Even women with hemochromatosis are relatively protected in their youth thanks to regular blood loss through menses.27 The primary therapy for hemochromatosis, and the easiest way to normalize your iron level if it’s high, is by regularly donating blood.28

Your liver is the primary organ responsible for regulating your iron level. Provided your liver is healthy, your ferritin level is likely to be healthy as well. As explained in a 2013 paper:29

“Iron is an essential nutrient that is tightly regulated. A principal function of the liver is the regulation of iron homeostasis. The liver senses changes in systemic iron requirements and can regulate iron concentrations in a robust and rapid manner.

The last 10 years have led to the discovery of several regulatory mechanisms in the liver which control the production of iron regulatory genes, storage capacity, and iron mobilization. Dysregulation of these functions leads to an imbalance of iron, which is the primary causes of iron-related disorders …

During conditions of excess iron, the liver increases iron storage and protects other tissues, namely the heart and pancreas from iron-induced cellular damage.

However, a chronic increase in liver iron stores results in excess reactive oxygen species production and liver injury. Excess liver iron is one of the major mechanisms leading to increased steatohepatitis, fibrosis, cirrhosis, and hepatocellular carcinoma.”

Crucial nutrients for liver health

Two nutrients crucial for liver health and function are methionine — a sulfur containing amino acid30 — and choline. Research31 shows a methionine and choline deficient diet causes rapid onset and progression of the clinical pathologies associated with nonalcoholic fatty liver disease (NAFLD) in rodents, and other researchers have suggested choline may be an essential nutrient for patients with liver cirrhosis.32

Researchers have also shown that iron overload triggers inflammation and necrosis of the liver in animals with methionine/choline‐deficiency induced NAFLD.33

According to Chris Masterjohn, who has a Ph.D. in nutritional science, choline deficiency actually appears to be a far more significant trigger of NAFLD than excess fructose and, in his view, the rise in NAFLD is largely the result of shunning liver and egg yolks. Masterjohn explains:34

“We now know that choline is necessary to produce a phospholipid called phosphatidylcholine (PC) … a critical component of the very low density lipoprotein particle, which we need to make in order to export fats from our livers.

The amino acid methionine can act as a precursor to choline and can also be used to convert a different phospholipid called phosphatidylethanolamine directly into PC. Thus, the combined deficiency of choline and methionine will severely impair our abilities to package up the fats in our livers and to send them out into the bloodstream.”

Best sources of choline and methionine

A single egg can contain anywhere from 113 milligrams35 (mg) to 147 mg36 of choline, or about 25% of your daily requirement, making it one of the best choline sources in the American diet.37 Only grass fed beef liver beats it, with 430 mg of choline per 100-gram serving.38 As noted in the Fatty Liver Diet Guide:39

“Eggs rank very high on the list of foods that are high in either lecithin, which converts to choline, or in choline itself. Note that this is the egg yolks only, not egg whites, which only have traces of this micronutrient.

Choline is essential in the production of phosphatidylcholine, a fat molecule called a phospholipid. But wait! Isn’t all fat bad? No — especially if it is essential to overall health and in particular, liver health. Simply put — if you don’t have enough choline, your liver can’t move out fat. It instead begins to collect within your liver, creating fatty liver.”

This is one of the reasons I eat about six eggs a day — typically raw in my two smoothies. This gives me about 900 mg of dietary phosphatidyl choline. Other healthy choline sources include:40

  • Wild-caught Alaskan salmon41
  • Krill oil — One 2011 study42 found 69 choline-containing phospholipids in krill oil, including 60 phosphatidylcholine substances, which helps protect against liver disease (including hepatitis and cirrhosis in alcoholics), reduce digestive tract inflammation and lessen symptoms associated with ulcerative colitis and irritable bowel syndrome
  • Organic pastured chicken
  • Vegetables such as broccoli, cauliflower and asparagus
  • Shiitake mushrooms

As for methionine, this amino acid is found in animal protein such as fish, poultry, pork and beef. High amounts are also found in Swiss cheese and provolone.43 When it comes to beef, eating “nose-to-tail,” opposed to steak exclusively, is the best way to optimize your methionine intake, as this will provide you with a healthy methionine to glycine ratio.

How to minimize your risk of flesh-eating disease

To try to tie this all together, here’s a quick summary of the key points and take-home messages presented in this article:

Chronic liver disease raises your risk of V. vulnificus infection. Optimizing your methionine and choline intake will help prevent liver disease, thus lowering your susceptibility to flesh-eating disease as well. Pastured eggs are the best source of choline, while animal protein of all types will provide varying amounts of methionine.44

Addressing insulin resistance — which may affect as many as 8 in 10 Americans45,46 — is another important strategy to protect your liver health and avoid fatty liver disease.47

Having a healthy liver is key for iron homeostasis in your body.

Excess iron — which affects most men and menopausal women — significantly raises your risk of flesh-eating disease when exposed to V. vulnificus, either from eating raw/undercooked seafood or swimming in seawater with an open cut or scrape, allowing the bacteria entry into your body.

Normalizing your iron may thus be an important way of preventing this life-threatening infection. To do that, simply donate blood a few times a year. If your ferritin level is over 200 ng/ml, a more aggressive phlebotomy schedule is recommended.

Ideally, your serum ferritin should be somewhere between 20 and 80 ng/ml. As a general rule, somewhere between 40 and 60 ng/ml is the sweet spot for adult men and non-menstruating women.

V. vulnificus is ubiquitous in seawater, and risk of infection rises along with water temperatures, as warm water spurs growth, and the bacteria adheres well to skin. To limit your risk, avoid swimming if you have open cuts or scrapes on your body, and avoid taking water into your mouth.

Sources and References