Doctor's Responses Archive

Viewer Question:

My family has had a long history with the iron overload disease of hemochromatosis. Though I do not have the disease myself, I most likely am a carrier for the gene.

Recently, my husband and I moved into a house that has well water. We recently found out that the red sludge that we found in the back of our toilet tank was caused from excess iron in the water. We were told that the water contains about 30% iron.

My question is what are the health risks associated with drinking, bathing, cooking, etc. in this water, knowing that my family has a problem already with iron overload. Secondly, my husband and I are expecting our first child. What precautions should we take to make sure that our unborn child does not get sick from all of this iron?

Doctor's Response:

Iron overload usually is caused by the disease, hemochromatosis. It is a genetic disease caused by a change (mutation) in a gene that is important in limiting the absorption of iron from the intestine. If an individual is homozygous for a mutated gene, that is, mutated genes are found on both chromosomes that contain the gene, iron absorption from the intestine is abnormally increased. As a result, iron accumulates in organs within the body. Therefore, in this situation, liver, heart, and pancreatic damage from the iron is highly likely, though not invariable. If an individual is heterozygous for a mutated gene, that is, only one of the chromosomes contains a mutated gene and the other chromosome contains a normal gene, there may be an increase in absorption of iron. However, the increase in absorption is less, and there is no clear evidence that organs are damaged.

All individuals with family members with hemochromatosis should have their genes analyzed since the mutant genes can be identified in most patients who have them. This is recommended primarily to uncover individuals who are homozygous and, therefore, would benefit by treatment before damage occurs. Genetic testing also identifies individuals who are heterozygous (carriers). You suggest that you are a carrier, but genetic testing is the only way to definitively determine your status--normal, heterozygous, or homozygous.

If you undergo genetic testing, it also may tell you something about your child. If you have no mutated genes, your child should have no problem with the iron-containing water. That's because your child would have normal genes that would assure that the intestine does not absorb excessive iron. (It's unlikely that your child would get a mutated gene from your husband unless your husband's family has a history of hemochromatosis or diseases that might be associated with hemochromatosis, e.g., unexplained liver disease.)

If you have one gene that is mutated, your child has a 50% chance of getting that gene. In this case, testing your child would determine whether or not he or she got the mutated gene and is a carrier. Testing your child would be important also because he or she might get one mutated gene from you and, though unlikely, a second one from your husband. In this far-fetched situation, your child would have a high likelihood of developing hemochromatosis.

If an individual has two normal genes, he can drink water with high levels of iron. If he is heterozygous for a hemochromatosis mutation, he probably should drink bottled water rather than water containing high levels of iron, even though this may be unnecessary. Of course, if he is homozygous for a hemochromatosis mutation, he should drink bottled water rather than watercontaining high levels of iron. Moreover, he should be evaluated by a physician to determine if he requires therapy to remove iron from his body and if there already has been damage to his organs.

Thank you for your question.

Jay W. Marks, M.D.
Last Editorial Review: 7/7/2004




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