Cheerios 45% Iron daily value - ok or not ok?

[lalapple]

i like Cheerios, but discovered that they have 45% iron daily value.  should i avoid these?  
on tx: peg/ copeg


thanks

[meakea]

Good question.  I'll be watching this thread for answers.

Because I've heard that iron is bad for the liver when you have Hep C, I have been avoiding cereals with high iron values.  I love Cream of Wheat and Malto-Meal but, alas, they have even more iron than Cheerios so I don't eat them anymore.  

I'm hoping I'm wrong about this so I can eat them again.

[lalapple]

i stopped eating Cheerios bc of the iron thing. but tx makes me bleed like CRAZY on the monthly dot (i'm not on birth control bc i'm like 18yro) and made my hemoglob drop by 2.0 within a week.  so i thought maybe taking Centrum with iron and eating cereal with iron would be ok. been doing that for like 2-3 days until i read that anemia due to tx is hemolytic and has nothing to do with iron.  and iron should be avoided at all costs apparently according to like 90% of the posts i read here.

anyone want to share anything they know about iron would be greatly appreciated

or if not, just leave a comment on whether you would eat Cheerios or foods i guess enriched in iron that consistitues a large daily value % of iron intake... like 45% iron intake daily value for cereal.. etc.

thanks in advance to everyone and the best of luck to everyone

[Marcia2202]

I would say that iron fortified foods are the same as iron supplements.

So I would avoid them, unless your doctor had a specific reason for advising you to take iron supplements.

Marcia

[portann]

In addition to your tx blood tests, including hemoglobin that would indicate hemolytic anemia, I'd regularly test and monitor my iron levels for the anemia that can result from heavy periods. As I think you already pointed out, this is separate from the hemolytic anemia associated with treatment.

It's true that there's a widely held view here to not take dietary iron from supplements while on treatment but you are a special case, just as a vegan might be.

In the past, I felt much more confident in seeking out dietary sources of iron rather than supplements; however, if I were in your situation and on treatment, I simply couldn't look at iron-rich foods without their turning my stomach. So I'd have to make a call on that one.

One of my sons lived on Cheerios but he often acted anemic!!

[susan400]

Have you had your iron level or Ferritin level tested?  If it's not high and your body is still processing it okay, I wouldn't worry about it too much.  As long as you don't eat alot of other high iron foods in the rest of your diet.  Like for example, it would be kind of silly to stop eating Cheerios if you're eating steak and roast beef every other night..., I'd give up the red meat before worrying about the cheerios, if you get what I'm saying here.  I like my morning cereal, too; but I don't eat a lot of red meat either. My iron levels and ferritin levels aren't real high, so I feel like; it's one of the few things that I get to enjoy.  I don't get to drink; I gave up cigarettes; I don't use narcotics or illegal drugs; if I want to eat my Cheerios, I'm going to eat my Cheerios!  Which ones do you like?  I like the Honey Nut Cheerios myself.  As always, ask your doctor....

Susan400

[merryBe]

I think everyone on tx should get a complete iron profile before and during tx.

Heme iron is very absorbable (meat and eggs).
non-heme is not very absorbable except in the presense of heme in the same meal.

fortified cereals and pasta have iron filing added....and yes they absorb, but the blood is losing cells due to the chemo and generally has less ability to take it up...ergo it lays it down in tissue such as heart, brain and liver....where it does great harm.

The issue is not just how much ferritin you have but how much if floating around free with no blood cell to live in....which is why free Transferrin is an important number to also know and have tested.

The problem with iron, is it is not eliminated when in excess. All other minerals are self regulating, and if you get too much your body will recognise this and eliminate the excess. Not so with iron.  This mineral is so essential the body holds onto it tightly, even though sometimes to it's detrement.

So I respectfully disagree with Susan, even if you do eat an occassional steak or burger, which most will do, that doesn't mean you can't cut in other areas. For instance oatmeal is comforting, one can add a few raisens even and still have a 5 % iron breakfast rather than a 15(cherrios)-50%(Total) to daily requirement.
You can have dairy and many things fortified at a time when you need to keep your intake in check.

think of it this way: Say you start out with HGB at 15....and 4 months into tx you are at 10.  That means that you have lost 1/3 of your red blood cells, and ergo 1/3 of your ability to carry oxygen to the cells.  All that iron is now floating free with nothing to do. Normally it is in the blood, it takes up the oxygen molecule, and delivers it to the cell, then exchanges the Oxygen for a CO2 molecule and returns to the lungs.

As long as their are blood cells to carry the iron the iron is safe and doesn't oxidize anything but what it was intended to....the air be breathe. Once it has no purpose however,,,it starts oxydizing the cells whereever it get's stored. A lot of storage occurs in the liver, producing then too much oxygen, too many free radicals, and ergo hepatic cancer can result. This is the best reason for keeping a watch on your intake....bad enough to have HCV....we don't need to add liver cancer to the list as well. Amen.

If you shop brands you'll find that some forms of cherrios have half the iron of other brands, so this is an area where reading labels can really help us all.

mb

[merryBe]

sorry should have said, iron oxygenates the living cells via the air we breathe.

[susan400]

No problem for me, you're respectful disagreement that is.....

Susan400

[Rockerforlife]

Just dont go eating bags of nails and pooping crowbars...now thats eating too much iron.

[Marcia2202]

You are so naughty!!! Been missing you my BADSS bro'.

[Rockerforlife]

im so bad....when i was born after the doc slapped my ***...i dropped kicked him...nobody hits me and gets away with it

[Willy50]

I agree with both Merry and Susan; get an iron panel and then ask where you sit in regards to iron.

MANY heppers do indeed have too much iron but it is not true for everyone.  Why not find out what your specific needs are and go from there?  The panel is inexpensive and can be done when you get other tests.  DON"T forget that unless you ask for copies of the records and ask what they mean you have only done half the job.

Also.......IF you were planning on starting TX soon I'd want to have full stores (but not excess) before starting.  Some premenopausal women could indeed have low iron.  

I agree that diet will come into play afterwards.  I avoid iron enriched foods my iron is a smidge high).  I do simple oatmeal in the AM.  I'd also suggest measuring out what a "serving" of Cherios looks like.  It's not uncommon that a one could actually be doing 2 servings per day, thereby in effect doubling ones iron dose.

I'd see where scores lie and then plan your diet strategy from there.

best,
Willy

[Marcia2202]

If I'm not mistaken lalapple is also on procrit and on neupogen.

[lalapple]

yea close to getting procrit but definitely on neup

i should really ask my health care people for my iron panel

thanks all, everyone is too generous!  all the best!

[konyha]

Glad I found this thread! I remembered "Cheerios" in the subject heading!
It kind of explains the HUGE increase in all components of my Iron Panel.

All componenets in complete Iron Panels in Sep 2007 and another Dec 2007 were scavengly low and Thyroid Panel was a over normal on the Sep lab and normal on the Dec 2007 lab.

Around Aug 2007 I began losing hair.

By Dec 2007 I lost ALL body hair and 1/4 of my outer eyebrows. I about cried every time I took a shower because I was losing nassive amounts of hair,  I was convinced I was anaemic. My GI was not and said my symptoms were likely endocrine related.

The only thing I did differently between Dec 2007 and Aug 2008 was add evening Primrose oil (EPO) to my Omega Fat vitamins. According to Mary J. Shomon in her book "Living Well With Hypothyroidism," EPO helps curtail the hair loss related to Hypothyroidism. I switched to "NOW 3-6-9."

I can never know if the EPO is a factor (I kind of doubt it) - but my hair grew back rapidly and I have not had a problem since - and I am week 17.

Even though I increased Iron via supplements and in food, my preteatment Iron Panel (dated 22 Aug 2008: WEEK 1) were still below normal reference Intervals in all respects. I didn't care because my hair was thick and glossy, I was never tired anyway and my monthly cycle was always routine.

The only things different from Week 1 to week 11 were:
One abnormal monthly cycle (21 days)
Still ate tons of spinach (for iron and potassium)
Still ate A LOT of Cheerios
Quit taking supplents that contain iron
Increased RIBA from 800/day to 1400/day end of week 10.

Iron Panel Week 13:
IRON & TIBC
TIBC 271             (259 - 450)
UIBC  70             (150 - 340)   Low
  Iron, Serum  201 ( 35 - 155)   High
  Iron, Saturat   74 ( 15 -   55)   High
  Ferritin         295  ( 10 - 291)  High

I was stunned to see the high values given my consistent previously very low complete Iron panels.  (MCV and HCB dropped slightly due to RIBA increase)

In some way, Iron absorption must be different for some people after the start of the HCV Meds. I never read Iron threads on this forum because I believed Iron was not going to be a problem for me.

I'm not even sure of the implications of High iron. It will get pricey asking for the Iron Panel every time I have my labs done in the futute due to high Insurance deductible in 2008.

I eased up on the Cheerios and Spinach but I am still taking 1400 mg of RIBA rather than the weight based 1000 mg.....What else, if anything, to do?

[merryBe]

I don't think you need weekly or even monthy iron checks, unless you are feeling bad.

that's NORMALLY, normally your iron profile won't change that rapidly given SOME restraint on dietary intake.

HOWEVER, if you are taking 50% more Riba than your weight would indicate, then this could easily account for a spike in your iron, which would also be precipitated by a drop in both red and white counts. The higher the Riba intake, the greater the chance of getting into the dicey waters of low Hemoglobin, platelets etc.

Any particular reason your doctor decided to give you 1400 instead of SOC 1200 or weight based 1000?  I ask because part of the logic of SOC dosages has to do with not decimating the blood and allowing the tx to do more harm than good.
Also the logic included what risks are inherent to taking blood builders, which are signifigantly risky (not to mention expensive), but the risks of thrombosis, heart issues, cancer and much more exist with the use of Procrit, Neupo etc....
So why are you taking the higher dosing, if you don't mind me asking?

mb

[cathy77]

My iron levels were high, I dont eat much heavy iron content food except weetabix, but I understand that vitamin c can help store iron. I had a biopsy multi specimens took and no iron increase, hope this helps.
Cathy77

[scratchinghead]

my shirts I wear to work need more iron. . . .

[konyha]

Thanks

I increased the RIBA at week 10 and did two peg shots week 10 & 11 because 12 week lab were taken end of week 11 instead of end of week 12
Through this forum I discovered I had been under dosing 200 mg/week according to the weight based chart

If I did not get the 2 VL drop at week 12  Dr would not continue tx and I'd have had the extra meds on hand....I figured taking them was worth the risk - and it appeared to have worked given how slow I was progressing.

Week 9  VL = 4.538  (only 1.47 drop from baseline)
Week 12 VL = 3.984 (Just Barely made the 2 log drop)
Week 13 VL = 4.119 (VL INCREASED 0.135 Log despite the probably too high RIBA)

Week 18  = My next labs are 12/12/08 (Week 18)
Labs will be the usual CBC and VL
Plus a complete Thyroid Panel (TSH Low at 0.012) (T3 is low/T4 higher but normal)
No Iron Panel this time

Found info in product insert about overdose but not toxicity
Will adjust RIBA to the 1000 after the labs: I am curious about the result.

Have been searching the archives for threads related to VL fluctuation before I post the question on a new thread  :D

[cathy77]

I dont know if my post was stupid, if so put me right or get on to ironing your shirts for work.

Cathy77

[jankar]

Before treatment I add a lot of eggs and not much meat.  Since beginning treatment (now in week 10) I find I am better eating more red meat than I am used to.  By better, it means if I eat more red meat I feel less dizzy.  For me that is good.  Been testing it for 3 weeks now.  Until it changes I think I will stick to it - i. e. if I eat meat and start to feel dizzy again I know it isn't the meat.

I do not eat iron fortified food, never have.  Always lots of green vegetables.

I take 1200 riba daily, my last two hmg were consistent at 10.9, taken fortnightly at weeks 5 and 7 - waiting for the results of the next one taken at week 9. No idea what my thryoid is doing.

[jmjm530]

may be wrong here, but I don't see any problem with the Cheerios,iron enriched or not. the same thing with eating meat or the other foods mentioned that contain iron.

What is not recommended, or iron supplements or preparing your mails in iron cookware. If you check your typical iron supplements, you'll probably find that you would need a sink load of Cheerios to equal the amount of iron they contain. Could be wrong on that but easy enough for someone so motivated to do the math.

[lalapple]

great!  i'm getting an iron study soon!  hope it's iron def and not hemolytic anemia cause i don't want to be on procrit!

[Marcia2202]

I dont understand. Aren't foods like iron fortified cheerios enriched with iron supplement? Wouldn't it kind of be the same as crushing iron pills and putting them in the cheerios doe. I mean, aren't they are artificially fortified... yanno what I mean, right?

[jmjm530]

First, I'm far from a nutritional expert so I'll just tell you what I know, whether it's true or not hopefully people will research on their own LOL

First, the common wisdom among hepatologists is not to take supplemental iron. I've never really heard it defined more than that.

As to iron in so-called iron rich foods, like red meats for example, I've never heard hepatologists discourage those foods for people on treatment.

So that just leaves us with the category  of iron fortified foods like our example of Cheerios. Five minutes of research shows the average iron requirement for many adults is around 8 mg a day. A steak has 10 milligrams of iron. And a serving of Cheerios has 6 mg of iron.

Now does that mean that eating a bowl of Cheerios is the equivalent of eating three steaks in terms of iron? Is the iron absorbed as efficiently in a fortified cereal as with the steak? And in any event, are the levels of harmful?I 'm just asking questions now, don't really have the answers.

Another couple of minutes to research showed that iron supplements, at least for anemia are 60 mg a day and a random multivitamin with iron contains around 10 mg a day.

The other thing is that I've heard is that iron supplements can cause stomach upset, heartburn and constipation. I've never heard that about Cheerios or steak for that matter. Really not sure what that means but maybe there's a difference other than the milligrams why iron supplements are discouraged but not foods containing iron.

Of course we can ask the doctor's, however as a general rule great nutritionist's they're not. Still, an interesting question for Dr. Dietrich and maybe you want opposed it in the event he starts answering questions again and the expert forum LOL

So after thinking about this for a bit, I'm anything but certain, but maybe err on the side of safety and leave the Cheerios for the champions with better livers.

[Marcia2202]

I guess it probably does come down to mathematics. And what the source of iron is and how much. It is probably much more complicated, than we think. And it might depend on what kind of foods we eat, too.

(Btw, I was not referring to my own case of iron, whcih we have thoroughly discussed before)

I'm just really interested in the logic behind it. The difference between supplements and artificially fortified foods seems 0 to me. It's either supplements on their own eaten with foods or supplements someone has added to our food before we eat them. Both supplements.

It would be interesting to know about the assimilation of the different sources.

What are the proportions. Is 10mg of iron in a steak the same as eating 10mg of iron as supplement, if you don't eat the steak, of course.

Or what if you eat a steak and cheerios and spinach every day... combined with lots of vit C... Is one getting more iron out of that, than someone who does not eat those particular foods. etc, etc...

These are also just a whole bunch of questions in the air. My brain storming, yanno

[Marcia2202]

btw, dr d. answered 2 questions today

[lalapple]

i kind of stopped eating cheerios

[StormRider]

Marcia... FYI...Below is a copy and paste from a couple of questions Dr. Dieterich took awhile back regarding iron/ferritin.

"Ferritin of 1220 is likely due to the inflammation of HCV and interferon treatment. You need the iron in it to make red cells with the procrit. It has to be many time higher to worry about. I agree with your NP! DTD"

"Iron is a pro oxidant so in large quantities can harm the liver. Unless you have hemochromatosis then you really cant overload on just eating. Eat your spinach and limiting red meat is always a good idea! Good luck with the treatment! DTD"

[konyha]

¡¡¡Thanks StormRider!!!

Your post relating the link between ferritin and inflammation with HCV Meds addresses the question I had, namely what are the *implications* of elevated Iron - or the components in the Iton panel (e.g. ferritin).

It is common knowldge the USDA and/or like qualified bodies have established daily iron intake for the average child or adult.  Apparently, these standards may not apply to all folks on HCV medication.
  
As a hepper who suddenly developed very high serum values, I doubted the cause.was entirely related to iron fortified food or iron enriched supplements.

Once that aspect was ruled out, I was hoping one of the more experienced or resourceful members would post a related thread or link thar provides a physiological or metabolic explanation for the sudden increase.

K

[Marcia2202]

Thank you so much for posting it, I had actually already read it... :-) since I'm a big fan of Dr. D.

My ferritin level is far from that number and I do not eat red meat (am vegetarian). The questions I posted are not related to my case, am just curious about how it works.

Thank you again.

Marcia

[merryBe]

well I gave the laymens explaination above.

here's a more definitive one:

The mechanism of ribavirin-induced hemolytic anemia has not been clearly established. Lau et al. explain that ribavirin, following uptake into cells, is phosphorylated and converts to ribavirin triphosphates, which then must be dephosphorylated for elimination from cells.However, because red blood cells lack dephosphorylation enzymes, ribavirin accumulates in cells and destroys the cells, causing hemolytic anemia.

mb

[merryBe]

this link was a helpful primer for me, and also links to many studies.

what I remember, apart from iron overload being hardest on the heart, is that it causes a lot of constipation and other gastric disturbances.

iron already metabolized into a usable water soluable form by a plant or animal is very absorbable and easy on the body, ground up iron metal is not solulable, and while some will absorb, it is far more harmful to the body.  Of course I was a big Adele Davis fan, and she was a stickler for taking the best and purest forms of vitamins and knowing when a supplement was not helpful. (most in here won't remember her, but she had a huge following in the 50s and 60's. She took all her info from the vast pubmed and agricultural animal studies. Very few of her accessments have changes in all these years.
As a physical therapist I talked a lot to my clients about their nutrition. I can't tell you how many cured their anemia in 2 weeks without taking supplements, but doctors kept asking my people how they did it. Simple, dietary changes can increase or decrease iron without taking ground up metal.

http://ods.od.nih.gov/factsheets/iron.asp

[konyha]

The sudden increase in values of my Iron Panel seems to correlate with the excessive (and unnecessary) increase in daily Ribavarin dose (e.g.,, iron overload) = skip a dose along with dose adjustment. :c ..

As far as ribavirin-induced hemolytic anemia is concerned:

Ribavirin-induced hemolytic anemia cannot be treated by eating iron rich foods or taking iron supplements.
The components of the CBC used to diagnose Riba-induced anemia is the measure red blood cells and their oxygen capacity (hemoglobin and hematocrit).

http://www.hcvadvocate.org/hepatitis/factsheets_pdf/SEM_anemia.pdf

[jmjm530]

Maybe I misunderstood you, but it's bad advice to skip a dose of riba, or reduce riba, because of the referenced increase in iron values.
Staying on a full dose of riba is very important in terms of a successful treatment result. This is especially true, during the first 12 weeks of treatment, and/or before one becomes undetectable.

First of all, the iron values you referenced in your profile are not that high for someone treating. Second, your hemoglobin hardly moved down for the first eight weeks of treatment. That suggests the possibility you did not receive a high enough dose of riba, regardless of how many milligrams you took. This may be the reason why you had less than a two log drop at week eight, and barely a two log drop at week 12.

Because you were still detectible at week 12, hopefully your doctor has told you that you will need 72 weeks of treatment for a decent chance of being cured. And that assumes, you're not detectible at week 24. If you're still detectable at week 24, most doctors would tell you to stop, especially because you have so little liver damage.

Jim