Volume 12, Issue 29
You don't have to die of
heart failure – one simple mineral can reduce your risk by 500%
Congestive heart failure is an all too common problem. Although there are many conventional and alternative therapies that can help, patients with heart failure still have a significantly increased risk of dying. That's why this brand new study is so important. The authors have discovered that in patients with heart failure, one simple mineral can reduce the chance of dying by more than 500%.

The authors looked at 127 men and women with congestive heart failure. They were all stable. Their condition was such that even though their ejection fraction was less than 45%, they were not getting any worse. "Ejection fraction" refers to how much blood the heart is able to pump with each stroke. Healthy hearts have an ejection fraction over 60%. But, as the heart becomes weak from heart failure, the ejection fraction decreases. An ejection fraction of 45% is tolerable, but it will definitely limit the patient's ability to exert and get around.

The mineral the researchers were looking at was iron. Iron is a critical mineral. The cells cannot produce energy efficiently if there is not enough iron present. Additionally, many people, particularly women, are deficient in iron and don't know it because they haven't been tested for it. Since the heart is such a high energy organ, a deficiency of iron is very likely to cause problems, especially if the patient already has heart failure. And that's why this study is so important. When the researchers looked at the iron levels of these patients, they found out that 36% of them had an undiagnosed iron deficiency. But that's not all.

When the heart is failing, it produces a substance called brain natriuretic peptide or BNP for short. The higher the BNP levels are, the worse the heart failure is. And when the researchers looked at the BNP levels in the patients, they found out that the patients with iron deficiency were significantly more likely to have higher levels. And then the real cruncher.

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The researchers followed the patients for an average of 225 days to see how they fared. What they discovered was sobering. The patients with iron deficiency were more than five times more likely to have either died or had a heart attack in that time than those with healthy iron levels.

So if you have heart failure, make sure your doctor checks your iron levels. This can be done in several ways. First, you can just look at the level of iron in the blood. The problem here is that even when the blood iron level is normal, the actual level of iron in the tissues like the heart may be deficient. So it's not a standalone test. The best tests are the serum ferritin level and the transferrin saturation. These are both blood tests. Even though many labs report that a ferritin level as low as 20 μg/L is normal, don't believe it. A healthy level is always over 100 μg/L. And even if the ferritin level is high, if the transferrin saturation is less than 20%, you have an iron deficiency. So in order to really be sure that you don't have a deficiency of iron, all three of these tests need to be normal. And if you find out that you are low, the next thing to figure out is how you got that way.

The most common cause for iron deficiency is blood loss. Your doctor can check your urine and stool to make sure that you are not bleeding in such small amounts that you don't notice it. One cause for undiagnosed blood loss is aspirin and NSAID drugs, such as Advil and Aleve. They can cause microscopic bleeding that can go undiagnosed for years.

Another very common cause for iron deficiency is a vegetarian diet. Iron is in vegetables, but the iron in vegetables is very poorly absorbed compared to the iron in meats.

A third common cause for iron deficiency is poor absorption. This can happen from the use of drugs that deplete stomach acid. In order for iron to be absorbed, it has to come into contact with stomach acid. So if you are taking one of these drugs all the time, there is a fairly good chance that your iron levels are low. This is especially true in older folks who often already have low stomach acid levels and in people who don't eat enough animal protein.

Regarding treatment, just follow your doctor's advice. You will need to correct the cause of the low iron and also take an iron supplement to build your levels back to normal. If you have heart failure, this simple step could easily save your life.

Yours for better health,

Rangel I, Gonçalves A, de Sousa C, Leite S, et al. Iron deficiency status irrespective of anemia: a predictor of unfavorable outcome in chronic heart failure patients. Cardiology. 2014;128(4):320-6.

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