Digestive disorders and iron status?

[Kumar]

Hello,

Iron homeostatis is controlled by Intestinal Iron absorption depending on iron status in our body as iron can't be physiologically eliminated/excreted efficiently. Both diahharea or constipation, increased or decreased or appetite, increased or decreased food motility(nusea/vomating), increased or decreased gastric acid etc. look to be indicated in case of anemia and iron overlaoad and also as side effect of taking iron supplements. Iron is not osmolarlly active substance so can't draw water in intestines but its excess quantity can be harmful.

How both opposing conditions, as described above, can be possible?


Can such opposing conditions be related to iron status or iron need in
body?


Can such opposing conditions indicate, whether to take more iron in
diet/supplement or not?


Such aspect may also be related to other minerals and trace elements
whose homeostatis in body is controlled similar to iron.


Best wishes.

 

[CharonZ]

as iron can't be physiologically eliminated/excreted efficiently

That is not quite correct. While regulation of iron homeostasis is in fact mostly done by regulating the iron uptake systems, another important mechanism is the use of ferritins to sequester free iron. The symptons you describe are all secondary effects on iron anemia and/or overload. As such alone they are no good indicators of either condition. Yet, diagnosis is far easier than you imply. It is routinely done by testing the iron concentration in the blood.

Now to elaborate why the symptons are so varied:

iron overload
the easiest thing that can happen are that bacterial activities are stimulated. This can result in a number of negative effects on the gastrointestinal tract. A lot of free iron can, via the Fenton reaction, lead to oxidative stress resulting possibly resulting in sever tissue damage (e.g. as in hemachromatosis). And this in turn can lead to a variety of symptoms. Also it can enhance the chance or severity of infections (as bacteria now have easier access to iron and can proliferate easier). This again can lead to a number of disease-related symptoms.

iron anemia
Here the symptoms are also very varied as iron is needed in every cell. Not only for oxygen transport but also for a lot enzymatic reactions. As such any disruption can, as you might easily imagine lead to a variety of symptoms. These be for instance tiredness, dry skin, headache, dizzyness, tinnitus and so forth.

However many sudden impacts on the gastrointestinal tracts are the result of overload rather than anemia.

 

[Kumar]

Thanks for detailed reply.

Less common or rare—when taken by mouth only
Chest or throat pain, especially when swallowing; stools with signs of blood (red or black color)


Early symptoms of iron overdose
Diarrhea (may contain blood); fever ; nausea; stomach pain or cramping (sharp); vomiting, severe (may contain blood)


Symptoms of iron overdose may not occur for up to 60 minutes or more after the overdose was taken. By this time you should have had emergency room treatment. Do not delay going to emergency room while waiting for signs to appear.

Late symptoms of iron overdose
Bluish-colored lips, fingernails, and palms of hands; convulsions (seizures); drowsiness; pale, clammy skin; shallow and rapid breathing; unusual tiredness or weakness; weak and fast heartbeat


Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the dietary supplement. However, check with your health care professional if any of the following side effects continue or are bothersome:

More common
Constipation; diarrhea; leg cramps; nausea; vomiting http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202305.html

Above quote shows both constipation and diarrhea possible from taking iron supplements. Few says it is due to change in gut flora other shedding of iron in intestine.

It looks real iron need is bit complicated to understand...as it can be influenced by iron defficiency and infections/inflammations differently as in anemia of iron defficiency or of inflammation. As such it can be useful to understand, how intestinal absorption is regulated for true iron need.

About iron restriction, few indicates that low iron status may increase bacterial virluence to get needed iron...which can have adverse effects esp. in initial stages of infection or in latent period as indicated on following link.

Overwhelming evidence has accumulated over the past decade[2] that shows that iron-restricted conditions favoured the expression of a number of toxins and other potential virulence determinants:
http://www.ijmm.org/article.asp?iss...;issue=3;spage=163;epage=164;aulast=Sritharan

Probably, costipation or diahrrea may indicate something on taking iron supplement or body status of iron and its true need..

 

[CharonZ]

Few says it is due to change in gut flora other shedding of iron in intestine.

One has to look at microbiological papers. However, it is one of the "commonly known" stuff which is rarely looked into it in more detail and to which there are few papers as a result.

About iron restriction, few indicates that low iron status may increase bacterial virluence to get needed iron...which can have adverse effects esp. in initial stages of infection or in latent period as indicated on following link.

Just replying to this part. the influence on iron intake to bacterial virulence is quite complicated. First, bacteria need iron. And iron availability is usually restricted in their respective hosts. As such a high intake of iron actively influences bacterial growth. If during an infection iron is given to the patient, chances are high that the bacteria propagate faster. That is known. But the tricky part are virulence factors. In many bacteria virulence factors are regulated by the iron availability (more precisely by regulators like Fur [ferric uptake regulator] or DtxR [diphtheria toxin repressor]. This means that under iron restrictions the production of virulence factors (including siderophores but also toxins) is higher. It obviously largely depends on the kind of bacterial infections which is worse. In case of toxin producing bacteria (like tox carrying cornyebacteria) obviously low free iron can be a trigger to produce toxins.
But two other points that complicate matter:
Firstly, under physiological conditions the free iron in your body is always extremly low. Almost all iron that is taken up will be bound to a protein (to avoid toxicity). This meanst that if you have normal body iron, the free iron is usally low enough to trigger toxin production.
Secondly, bacterial infections themselves can result in iron anemia. If there is a heavy infection the bacteria can sequester iron more successfully than your body, resulting in an effective iron loss.
In fact, many Helicobacter pylori infections are believed to be associated with iron anemia.

 

[Kumar]

One has to look at microbiological papers. However, it is one of the "commonly known" stuff which is rarely looked into it in more detail and to which there are few papers as a result.

Which out of constipation or diahrrea can cause lesser or higher intestinal iron absorption?

This means that under iron restrictions the production of virulence factors (including siderophores but also toxins) is higher. It obviously largely depends on the kind of bacterial infections which is worse. In case of toxin producing bacteria (like tox carrying cornyebacteria) obviously low free iron can be a trigger to produce toxins.

Commonly more weightage is given on ironoverload whereas body's system tries to cause iron defficiency in case of chronic infections. But iron defficiency can also be important in case of getting harmful effects from bacteria(can't say about cancer cells, viruses etc.) I can't say, if body system also react similar to infection in non-infectious chronic inflammatory conditions?

In short, can it be thought that low iron makes bacterias more unstable(esp. in dormant/initial stages), normal iron stable and high iron levels enhance their multiplications and spread?

But two other points that complicate matter:
Firstly, under physiological conditions the free iron in your body is always extremly low. Almost all iron that is taken up will be bound to a protein (to avoid toxicity). This meanst that if you have normal body iron, the free iron is usally low enough to trigger toxin production.

Which out of hemoglobin, ferritin, iron in transfferin, iron in macrophases..is more related to supply of iron to bacterias more easily?

Secondly, bacterial infections themselves can result in iron anemia. If there is a heavy infection the bacteria can sequester iron more successfully than your body, resulting in an effective iron loss.
In fact, many Helicobacter pylori infections are believed to be associated with iron anemia.

I have one thought, do we also lose iron by elimination of dead bodies of bacterias?

Whether Helicobacter pylori causes loss or lesser absorption of iron resulting into anemia or these just take our iron in intestines?

 

[CharonZ]

Which out of constipation or diahrrea can cause lesser or higher intestinal iron absorption?

Low overdose often first result in constipation, also a black colour of stool. Long term overdose or extremely high overdoses can directly result in diarrhea. I assume it also depends on your gut flora.

In short, can it be thought that low iron makes bacterias more unstable(esp. in dormant/initial stages), normal iron stable and high iron levels enhance their multiplications and spread?

Essentially bacteria live in a low iron environment. They (esp. pathogens) are able to get the iron off their host, though. I do not assume that one could have such a strong anemia (or at least not for a considerable amount of time) that the iron would be more limiting to bacteria than it usually is.
High iron levels, if it results in excess free iron will very likely enhance bacterial growth.

Which out of hemoglobin, ferritin, iron in transfferin, iron in macrophases..is more related to supply of iron to bacterias more easily?

It depends where the bacteria live, of course, but the most common iron sources for bacteria are heme (out of hemoglobin), ferritin and transferrin. Probably in that order. Most animal (and plant) associated bacteria possess specialized transport systems to get iron from these sources.

I have one thought, do we also lose iron by elimination of dead bodies of bacterias?

I am not sure what you mean, by that. Do you mean wheter iron is set free again if bacteria lyse?

Whether Helicobacter pylori causes loss or lesser absorption of iron resulting into anemia or these just take our iron in intestines?

The bacterium is believed to compete for iron with the host.

 

[Kumar]

Low overdose often first result in constipation, also a black colour of stool. Long term overdose or extremely high overdoses can directly result in diarrhea. I assume it also depends on your gut flora.

I think black colour of stool can be due to unbsorbed iron and it should be common an both costipation and diahrrea. low/high overdose may indicate no toxicity or toxicity.

Can we conclude that after taking iron supplements, costipation indicated true need whereas diahrea no need/iron overload?

ally bacteria live in a low iron environment. They (esp. pathogens) are able to get the iron off their host, though. I do not assume that one could have such a strong anemia (or at least not for a considerable amount of time) that the iron would be more limiting to bacteria than it usually is.
High iron levels, if it results in excess free iron will very likely enhance bacterial growth.

On inflammation iron may be stored as ferritin which may make iron unavailable to bacterias. Different bacterias may takeiron from different source in body. As such, there can be specific defficiency to specific tissues.

I am not sure what you mean, by that. Do you mean wheter iron is set free again if bacteria lyse?

The bacterium is believed to compete for iron with the host.

What happens to bacteria's body aftertheir death? Whether it is eliminated from body or lysed and processed within body?

 

[Kumar]

What causes stool colour to look black on taking ion supplements? Is it colour of iron or of some intestinal secretions caused by taking supplemets?

Furthur, in view of following quote, what causes bleeding on taking iron's supplements overdose?

Iron is absorbed by villus enterocytes in the proximal duodenum. Efficient absorption requires an acidic environment, and antacids or other conditions that interfere with gastric acid secretion can interfere with iron absorption.

Ferric iron (Fe+++) in the duodenal lumen is reduced to its ferrous form through the action of a brush border ferrireductase. Iron is the cotransported with a proton into the enterocyte via the divalent metal transporter DMT-1. This transporter is not specific for iron, and also transports many divalent metal ions.

Once inside the enterocyte, iron follows one of two major pathways. Which path is taken depends on a complex programming of the cell based on both dietary and systemic iron loads:

Iron abundance states: iron within the enterocyte is trapped by incorporation into ferritin and hence, not transported into blood. When the enterocyte dies and is shed, this iron is lost.


Iron limiting states: iron is exported out of the enterocyte via a transporter (ferroportin) located in the basolateral membrane. It then binds to the iron-carrier transferrin for transport throughout the body.

http://www.vivo.colostate.edu/hbooks/pathphys/digestion/smallgut/absorb_minerals.html