The U.S. Food and Nutrition Board has set the new tolerable upper limit (UL) for dietary iron at 45 mg/day primarily on the basis of the adverse side effects (e.g., gastrointestinal pain and constipation) of iron supplements.1 However, these adverse gastrointestinal (GI) effects are unlikely to occur if this amount of dietary iron is exceeded provided it comes from iron fortified foods or foods rich in iron (liver, beef, clams and beans). While this upper limit is fine to avoid GI distress, most older individuals should not consume more than 10 mg per day.
Data from the NHANES III indicated that about 9% of toddlers and adolescents are iron deficient. And about 11% of women of childbearing age were also found to be iron deficient. This makes iron deficiency the most common nutritional deficiency in the US.2 Clearly, those individuals in these high-risk groups should be encouraged to consume iron-rich or fortified foods. By contrast, adult men and postmenopausal women are at low risk of iron deficiency.
In 1981, Sullivan was the first to propose that excessive iron stores may promote atherosclerosis and heart disease and could explain the much of the higher risk of cardiovascular disease in men relative to premenopausal women.3 More recently, two large, prospective epidemiological studies that were carefully controlled for confounding variables found increased iron stores correlated with a greater risk of cardiovascular disease in both men and women.4, 5 There is also growing evidence that excess iron stores can adversely affect glucose metabolism and may be particularly dangerous for those with insulin resistance and diabetes.6 Excess iron stores can also damage the liver and promote liver cancer.
Bottom Line: The new UL for iron is clearly too high for people with diabetes, dyslipidemia, atherosclerosis and/or liver disease. Men and older women should be discouraged from taking supplemental iron or using iron-fortified foods unless they can be shown to have low iron stores. This is particularly true for those with diabetes and those at high risk for CVD. If low iron stores are confirmed, iron supplements should be limited to 45 mg of iron because of adverse GI problems.
1. Dietary reference intakes. Washington, D.C.: National Academy Press, 2001:9-1-78
2. JAMA 1997;277:973-6
3. Lancet 1981;1:1293-4
4. Am J Clin Nutr 1999;69:1231-6
5. Circulation 1998;97:1461-6
6. Diabetes 2002;51:2348-54
Judy’s passion for cooking began with helping her grandmother make raisin oatmeal for breakfast. From there she earned her first food service job at 15, was accepted to the world-famous Culinary Institute of America at 18 (where she graduated second in her class), and went on to the Fachschule Richemont in Switzerland where she focused on pastry arts and baking. After a decade in food service for Hyatt Hotels, Judy launched Food and Health Communications to focus on flavor and health. She graduated with Summa Cum Laude distinction from Johnson and Wales University with a BS in Culinary Art, holds a master’s degree in Food Business from the Culinary Institute of America, 2 art certificates from UC Berkeley Extension, and runs a food photography studio where her love is creating fun recipes.
Judy received The Culinary Institute of America’s Pro Chef II certification, the American Culinary Federation Bronze Medal, Gold Medal, and ACF Chef of the Year. Her enthusiasm for eating nutritiously and deliciously leads her to constantly innovate and use the latest in nutritional science and Dietary Guidelines to guide her creativity, from putting new twists on fajitas to adapting Italian brownies to include ingredients like toasted nuts and cooked honey. Judy’s publishing company, Food and Health Communications, is dedicated to her vision that everyone can make food that tastes as good as it is for you.