Q: At 58, with heart disease in my family, I have taken a multivitamin and mineral supplement with iron for many years. A friend recently told me that men shouldn’t take supplemental iron. Is that true? 

A: Iron is an essential nutrient. It’s needed to make hemoglobin, the oxygen-carrying red pigment of blood. It also plays important roles in energy production and in supporting the health of the immune, reproductive, and central nervous systems.

As important as this mineral is, however, getting too much of it in supplement form can be dangerous. The reason for this is simple: the body is efficient at storing iron, but it doesn’t do a good job of eliminating stored iron except through bleeding. That’s why men and postmenopausal women are generally advised not to take an iron supplement except under a doctor’s orders.

Did You Know?

Dried apricots are a rich food source of iron, with 3.5 mg per cup.

Understanding Iron Levels

Most people know that too little iron can lead to iron-deficiency anemia, which is most likely to develop in menstruating and pregnant women, vegans, people who take medications that cause internal bleeding, or people who have digestive disorders that interfere with iron absorption. But the opposite problem—iron overload, usually due to too much supplemental iron—is drawing more attention these days.

Research suggests that building up large stores of iron in the body over the years can increase the production of free radicals, damage internal organs, and may increase the risk of diabetes, heart attack, and cancer, particularly in older people. In examining more than 1,000 white Americans ages 67–96 who participated in the Framingham Heart Study, researchers found that only about 3 percent had an iron deficiency, but 13 percent had iron levels considered too high. The authors of the study concluded that the likely liability in iron nutrition in elderly white Americans eating a Western diet is iron overload, not iron deficiency.

Iron overload can be inherited—as in hemochromatosis, the genetic iron overload disorder—or it can be acquired by receiving numerous blood transfusions, getting iron injections, or consuming high levels of supplemental iron. According to the nonprofit Iron Disorders Institute, too much iron can lead to chronic fatigue, joint pain, abdominal pain, liver disease, diabetes, and heart attack.

Data from the large Framingham study suggests that the low risk of heart disease among premenopausal woman may be partially attributable to menstruation and the monthly loss of iron that goes with it. After menopause, when menstruation stops, women begin to catch up to men in heart disease risk, suggesting that higher iron stores may be a factor.

Some studies also link high iron levels with diabetes. For example, among 32,000 women followed for 10 years in the Nurses’ Health Study, those with the highest levels of stored iron were nearly three times as likely to have diabetes as those with the lowest levels. Other studies have shown that when people with high levels of stored iron donate blood regularly, their insulin sensitivity and risk of diabetes decrease.

Iron Intake Recommendations

So, what should you do to get just the right amount of this important mineral? The best idea is to play it safe. Try these tips:

• Focus on whole-food sources of iron, including beef, turkey, liver, dried fruit, broccoli, peas, and sunflower seeds.
• Watch your intake of fortified foods. Some fortified breakfast cereals contain 100 percent of the Daily Value for iron.
• Avoid cooking in cast-iron skillets because iron filings can get into food.
• Unless they’ve been diagnosed with a deficiency, most men and postmenopausal women should take an iron-free multi (see below).
• If you’re a postmenopausal woman or a man concerned about the possibility of iron overload, many doctors advise donating blood.

To determine your iron status, ask your doctor for a complete panel of tests, including CBC, serum iron, serum ferritin, iron serum transferrin saturation, total iron-binding capacity (TIBC), and percentage of saturation.