None of the content in this post should be considered medical advice or treatment for COVID-19, hemochromatosis, or for any illness or disease. If you feel sick, seek medical help. If you think you may have contracted COVID-19, visit the CDC's website for steps to take: https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/steps-when-sick.html.
Hey there!
You're on part 2 of my hemochromatosis and COVID-19 series. If you haven't read part one, go check it out here.
HEMOCHROMATOSIS AND INFECTION
You're in better shape if you have normal iron levels when your body fights off infection than if your levels are out of the healthy range.
Hemochromatosis heightens your iron levels in multiple ways, including:
- Ferritin levels
- Serum iron levels
- Transferrin saturation levels
Are your iron levels in these three categories under control?
High iron makes you an easy target for germs and weakens your immune system.
In science-speak, increased body stores of iron "may tip the immunoregulatory balance unfavorably to allow increased growth rates of...infectious organisms."
There are a variety of pathogens that you are more susceptible to than your friends and neighbors with normal iron levels, as there have been "numerous reports" of patients with hemochromatosis having inferior defenses when it comes to fighting off infections.
For example, people with excess iron are more vulnerable to:
- malaria
- tuberculosis
- listeriosis
- candida
- HIV
- hepatitis B & C
- e.coli
- vibrio vulnificus
- and other illnesses
And yes, all measures of iron matter - including serum, transferrin, and ferritin - when it comes to fending off illness.
That's because germs have adapted different ways of finding the iron within our bodies. Some get iron from our serum. Some get iron from our ferritin. Some get iron from our transferrin. And many pathogens "possess multiple iron acquisition systems" which is why you need to manage your iron levels, stat.
Why does high iron make us so defenseless against some of the germs out there?
If foreign invaders like viruses and bacteria find you as a host, they're able to easily access and control your iron - your iron fuels their growth.
According to Dr. Sharon Moalem (a doctor who also happens to have hemochromatosis):
With very few exceptions...almost all life on earth needs iron to survive. Parasites hunt us for our iron; cancer cells thrive on our iron. Finding, controlling, and using iron is the game of life. For bacteria, fungi, and protozoa, human blood and tissue are an iron gold mine.
HEMOCHROMATOSIS AND BACTERIAL INFECTIONS
Bacteria - like those that cause pneumonia, meningitis, and food poisoning - need iron or they'll die. Iron is a nutrient they simply can't live without. They've adapted ways to ingest iron from our bodies.
Some types of bacteria have evolved ways to steal iron directly from our cells' ferritin protein.
Some bacteria are able to snatch iron right out of our blood serum, and high serum iron levels "may promote replication and dissemination of bacterial pathogens that use iron as a growth factor."
Some extract it from hemoglobin.
Meaning what?
High iron levels can intensify bacterial infections, some of which are lethal.
The most famous example of the dangers of hemochromatosis combined with bad bacteria is Vibrio Vulnificus, a flesh-eating bacteria found most commonly in seafood and shellfish. It's a fatal illness with a 50% mortality rate in people with hemochromatosis.
HEMOCHROMATOSIS AND VIRAL INFECTIONS
You guessed it.
Viruses - like those that cause the flu, cold, and coronavirus - don't need iron for their individual survival, but they do depend on iron to replicate within their host.
Viruses hijack their host body's cells, and trick those cells to make more copies of the virus; in order to get more copies, viruses need to hijack cells that have enough iron.
One of the key takeaways is "...cells that are replete in iron make good homes for viruses."
Some types of viruses even "directly manipulate iron homeostasis." These viruses are able to CHANGE the way our bodies metabolize and distribute iron for their own advantage. They "manipulate" where iron lives and how it moves throughout the body. This may be hurtful especially to people with hemochromatosis, making those of us with hemochromatosis experience an escalated viral takeover of our bodies since we already have problems with our iron metabolism.
So when we're dealing with certain viral infections like HIV and hepatitis, the reality is...
"iron overload is associated with poor prognosis for the patient and enhanced progression of the disease."
HEMOCHROMATOSIS AND COVID-19
So what about the relationship between hemochromatosis and COVID-19?
There are two big things you should know:
- High ferritin levels lead to higher hospitalization rates in people with COVID-19.
- Liver enzymes are affected (in a bad way) by COVID-19.
This means there are two things you'll need to monitor to prepare for exposure to COVID-19 as a person with hemochromatosis:
- Watch your ferritin levels
- Watch your liver enzymes
WATCH YOUR FERRITIN LEVELS
Ferritin levels show you how much iron your body is storing away. Ferritin is a protein that binds to iron, and it's your body's way of "banking iron" to be used at a later date if you're ever running low.
A healthy and normal person banks a small amount of iron, but not too much. It's meant to be an emergency stash to get you through iron-poor times.
As someone with hemochromatosis, you tend to bank a lot more than necessary, and it's common for ferritin levels to get way out of control.
While this causes problems enough on its own (i.e. inflammation and organ damage), it's also a cause for concern when dealing with COVID-19.
Here's what the research is saying:
"The role of iron metabolism appears to be directly involved in COVID infection."
"Ferritin was associated with poor prognosis and could predict the worsening of COVID‐19 patients."
If you don't know your current ferritin levels, now would be a good time to get tested.
You can go to your doctor for an iron panel, or do an at-home kit like this one.
WHAT SHOULD I DO IF MY FERRITIN LEVELS ARE HIGH?
If your ferritin levels are high, the most common way to lower them is through phlebotomy (bloodletting). You can do this a few different ways:
DONATE BLOOD: If you live in a place where you're allowed to donate blood (pretty much everywhere except the USA), sign up for a blood donation! It's free and easy. Unfortunately, if you live in the USA, you're not allowed to donate blood if you've been diagnosed with hemochromatosis. Your next best option is to get a doctor's order.
GET A DOCTOR'S ORDER: If you live in the USA or elsewhere where donating blood isn't permitted, ask your doctor for a "therapeutic phlebotomy order." You can take the order with you to a local blood donation bank. This allows the blood donation bank to take a pint of your blood, exactly as if you were donating blood. The only difference is that your blood gets trashed since it's not eligible for donation. This service for hemochromatosis patients is typically available for a low fee (cheaper than a doctor's visit) from many blood donation banks.
PHLEBOTOMY AT YOUR DOCTOR'S OFFICE: While this is the most expensive option, if you need to go in for frequent phlebotomies to get your ferritin levels down quickly, this is sometimes your best bet. You may need to go into your doctor for weekly phlebotomies if your ferritin levels are especially high.
Don't get a phlebotomy if you're feeling sick or like you might be coming down with something. If you're showing symptoms of illness, call your doctor for the best way to proceed.
If getting a phlebotomy doesn't work for your situation, you may want to speak to your doctor about iron-chelation treatments and other methods that lower ferritin levels.
WATCH YOUR LIVER ENZYMES
COVID-19 can increase people's liver enzymes. This is a "red flag" for people with hemochromatosis because iron overload can also raise liver enzyme levels.
That's why many doctors test liver enzymes when they diagnose someone with hemochromatosis; higher liver enzyme levels can be a sign of inflammation and damage to your liver. In fact, hemochromatosis organizations and doctors around the world all agree that the liver is the most commonly harmed organ in a person with hemochromatosis.
One study of COVID-19 patients found that liver enzymes are a factor in predicting the gravity of the illness. Those experiencing a combination of elevated liver enzymes, elevated hemoglobin levels, and muscle aches were more likely to develop severe respiratory disease from the coronavirus.
Looking back, the SARS pandemic in 2003 was also caused by a coronavirus, and there are "striking similarities" between SARS and COVID-19. (86% similarity). Doctors know that SARS weakened liver function and caused hepatitis in some people, a disease where the liver gets extremely inflamed. Liver impairment has been reported in up to 60% of patients with SARS.
In fact, in a review of the SARS 2003 pandemic, hemochromatosis is mentioned because of the liver problems associated with SARS.
COVID-19 shares 50% genome similarity to another coronavirus - the Middle East respiratory syndrome coronavirus (MERS). Liver problems were also reported in some patients infected with MERS.
What does this mean for you?
If you have hemochromatosis and you know you have elevated liver enzymes or liver damage, then "there does seem to be some rationale for people with iron overload to take even further precautions with COVID-19," according to Dr. Eric Lewis.
Do you know your current liver enzyme levels?
Now's the time to check.
If you want to test your liver enzymes, you can ask your doctor or get yourself an at-home test kit.
WHAT SHOULD I DO IF MY LIVER ENZYMES ARE HIGH?
Here are some of the best-known methods to move abnormal liver enzyme levels into the healthy range.
- Get your iron levels in check
- Eat more antioxidants (coffee, tea, and lots of colorful plants!)
- Exercise and move your body
- Get to a healthy weight and lose belly fat
- Lower high cholesterol
- Eat more folic acid in your diet (spinach, black-eyed peas, avocado, asparagus, or try a supplement)
- Eat less meat and replace it with plant-based protein (beans, chickpeas, lentils, nuts, seeds, tofu, tempeh, and quinoa)
- Avoid alcohol, smoking, and toxins
WHAT WE STILL DON'T KNOW ABOUT HEMOCHROMATOSIS AND COVID-19
While we do know confidently that ferritin levels and liver enzymes are two overlapping issues for hemochromatosis and COVID-19, there are other factors that haven't been determined with such certainty.
The reality is that your hemochromatosis genes affect several processes in your body. These processes only impact your iron metabolism but also influence chemical and hormonal imbalances, tissue and organ abnormalities, and changes to the way the immune system works.
No one knows yet if these differences make you more vulnerable to COVID-19.
"An association between HH [hereditary hemochromatosis] and COVID-19 is not currently described in the literature. What does exist, however, is an evidence base for the detrimental impacts iron overload has on viral infections in general and the negative effects of HH on the immune system. We therefore postulate that the underlying metabolic and immune disturbances seen in HH should be considered a potential risk factor for the development of severe COVID-19."
GOLDILOCKS AND THE THREE BEARS
One thing to simply be aware of is that TOO LITTLE iron also leads to worse outcomes for COVID patients (this is true for many other illnesses as well).
When it comes to defending yourself against COVID-19 and all the other germs out there, you've got to find your iron sweet spot. Not too much, not too little, you need just the right amount. Like Goldilocks.
It is not uncommon for people with hemochromatosis to work so hard to get their iron levels low that they become anemic (that was me once!). A word of caution for my overzealous friends who are going to do anything and everything to get their iron levels as low possible. You know who you are - you're out getting phlebotomies for fun on the weekends and refusing the orange slice that comes with your lunch. Here's a gentle reminder that iron in moderation is good for us - we need iron to survive!
Iron is a mineral that must be maintained in BALANCE in order for our immune system to function properly.
WHY YOU MIGHT SURVIVE THE PLAGUE
So far in this post, you've learned that you may want to talk to your doctor about taking extra precautions against COVID-19 if you have high ferritin or high liver enzymes, and especially if you have other conditions that place you on the most susceptible list.
But...
Believe it or not, you've got one surprisingly positive attribute thanks to those hemochromatosis genes of yours.
A silver lining.
Your genes may have helped your ancestors survive the plague.
Don't get me wrong: Your genes undoubtedly have the potential to wreak havoc on your body and kill you slowly after decades of poisoning your body with excess iron.
But those same genes also provided your ancestors with a small, unexpected gift.
When everyone around them was dying throughout the several plague epidemics that swept across Europe and beyond, your ancestors were able to survive.
What does this have to do with COVID-19?
One of the main reasons people got so sick from the plague is the same reason people end up hospitalized for COVID-19. Cytokine storms.
Cytokine storms occur when cytokine molecules in your body send alarm signals to your immune cells to attack an infection. While this signal is beneficial on a quick, short-term basis, sometimes cytokine molecules don't ever turn off their cry for help, creating a storm of ambushing immune cells that don't stop fighting.
A cytokine storm is the immune system overreacting to the pathogen, and hurting the body instead.
People with hereditary hemochromatosis may be less likely to experience cytokine storms.
"It is an intriguing possibility that individuals with HFE deficiencies may have had a survival advantage during the European plague epidemics because they expressed reduced amounts of inflammatory cytokines," say researchers.
The very same genes that prevented our immune systems from unleashing cytokine storms during the 1300s could possibly do the same thing in the 2020s.
At this point, this is purely guesswork; there is absolutely no evidence demonstrating how people with hemochromatosis are unleashing cytokine storms in response to COVID-19. There currently isn't any research (that I know of) on the relationship between hereditary hemochromatosis and cytokine storms resulting from severe COVID-19. It's completely speculative, but it's very interesting to think about, don't you think?!
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