DR SCURR: When to Worry About Too Much Iron in Your Blood

I am fit and active but blood tests show my iron levels are high; 290ng/ml. My doctor is not concerned but I fear it will have a detrimental effect on my health. I am 80.

Carol Bryan, Chichester

Dr. Scurr responds: I understand your concern: Iron is an essential part of our body chemistry. It plays a central role in the molecule hemoglobin, the red oxygen-carrying pigment in red blood cells.

We measure the body’s iron stores by checking the levels of ferritin — an iron-carrying storage protein in the blood. A normal level is 24 to 336 ng/ml for men, 24 to 307 ng/ml for women.

Normally we only suspect a problem when ferritin levels rise above 300.

In that case, you may be referred for testing for hemochromatosis, a condition in which a mutation in a gene leads to excessive absorption of the mineral from iron-rich foods in our diet.

Over time, this genetic error leads to a toxic buildup of iron, eventually causing damage to important organs such as the liver and pancreas.

I suspect this is your concern.

Iron levels in the blood are checked by analyzing ferritin, an active-phase reactant that plays an important role in our immune response to perceived threats such as inflammation.

But if you did have hemochromatosis, your iron levels would be much higher at age 80 than they are now.

So it is very unlikely that you have this condition.

I do agree, however, that your ferritin levels are quite high. There are other possible reasons for this, the main one being inflammation in a part of the body. Ferritin is what we call an active phase reactant, meaning it’s a compound that plays an important role in our immune response to a perceived threat – iron, for example, is thought to help coordinate cell defenses against inflammation.

Therefore, your high reading can be seen as a marker of your immune system fighting something that is causing inflammation. These may be somewhat ‘housekeeping’ events, often occurring below our level of consciousness, and therefore nothing to worry about.

If you are in good health and reasonably active, as you say, then there is no need to panic. That explains why your GP is adopting a relaxed attitude.

I was prescribed the anticholinergic solifenacin for my overactive bladder, but when I heard about the link between this type of drug and dementia, I asked to be switched to darifenacin, which I had read works in a different way. My GP initially refused, saying they all carry the same risk. Who is right?

Geoff Dowdall, Essex

Dr. Scurr responds: Overactive bladder (OAB) is common, with about one in six adults suffering from it to a greater or lesser extent. Your question will therefore be of interest to many readers.

OAB is characterized by a sudden and frequent need to urinate and can cause incontinence.

The symptoms are thought to be due to overactivity of the detrusor muscles in the bladder wall. These muscles normally relax to allow the bladder to fill and contract when it is full.

Overactive bladder is common, affecting about one in six adults to some degree.

In OAB, however, the muscles behave irritably and unreliably, creating an urgent need to urinate even when the bladder is not full.

Anticholinergics block acetylcholine, the chemical messenger that tells the brain to contract muscles, and can be very effective in relieving OAB symptoms.

But acetylcholine is also involved in learning and memory, and long-term use of anticholinergics is associated with cognitive decline, so they are generally not prescribed to patients over 65.

For this older group, the non-cholinergic drugs mirabegron and vibegron are used. Research shows that these drugs are as good as anticholinergics in relieving symptoms.

In your longer letter you write that your GP prescribed you mirabegron, but that this had only a limited effect and that you therefore switched to darifenacin at your request.

But darifenacin is a different anticholinergic and so I tend to agree with your GP that the relative risk is the same. For that reason I strongly recommend that you reconsider mirabegron.

Patients generally start with 25mg per day, but this can be increased to as much as 100mg if needed. It may also be worth trying vibegron (75mg per day). This is something to discuss with your GP as a matter of urgency.

It’s also worth knowing that pelvic floor exercises (you can find out how to do these online) and lifestyle changes such as restricting fluid intake in the evening can increase the effects of medications.

Write to Dr Scurr at Good Health, Daily Mail, 9 Derry Street, London, W8 5HY or email drmartin@dailymail.co.uk — include your contact details. Dr Scurr cannot enter into personal correspondence. Responses should be taken in the context of general health and you should always consult your own GP with any health problems.