A Mayo Clinic Hepatologist on Iron Overload and His Go-To Liver-Healthy Snack

Iron is essential for making red blood cells, but for people with hereditary hemochromatosis, the body absorbs and stores far more than it needs. Over years, that extra iron can quietly build up in the organs, often without causing noticeable symptoms until damage has already begun. The good news is that hemochromatosis can be detected with simple blood tests, and when it’s caught early, treatment can prevent most complications.

The Educated Patient spoke with William C. Palmer, M.D., professor of medicine and consultant in the Division of Gastroenterology and Hepatology at the Mayo Clinic, about what happens in the body with hemochromatosis, which warning signs deserve attention, why family members should consider testing and how therapeutic phlebotomy helps patients live full, active lives.

Alongside regular monitoring and treatment, everyday habits like eating well are part of caring for your liver. That’s why Palmer also selected a favorite from the American Liver Foundation’s 30-Day Liver Healthy Meal Plan: baked apple chips. Made with just two apples and a sprinkle of cinnamon, the chips bake low and slow until crisp, making for an easy, satisfying snack you can prep ahead. Find the full recipe after the interview.

Baked Apple Chips

Ingredients:

• 2 large apples
• 1 teaspoon ground cinnamon (or other flavoring you enjoy)

Directions:

1. Preheat your oven to 225°F. Line baking sheet with parchment paper.
2. Wash and dry the apples well, then slice the apples into thin rounds. Remove seeds as needed.
3. Arrange the slices in a single layer on the baking sheet.
4. Lightly sprinkle cinnamon over the apple slices.
5. Bake for 45 minutes to 1 hour, then flip each slice. Continue baking for another 25-45 minutes, or until the apples are dry and crisp.
6. Remove from oven and allow to fully cool before enjoying!

What exactly is hemochromatosis, and what's happening in the body when someone has it?

William C. Palmer, M.D.: Hemochromatosis is an inherited genetic disorder that causes the body to absorb and store too much iron. Normally, the body tightly controls how much iron is absorbed, but people with hemochromatosis have a genetic mutation that disrupts that regulation process. Over time, the excess iron builds up in organs such as the liver, heart, pancreas, joints and hormone-producing glands. At first, this extra iron may not cause any symptoms, but if iron continues to accumulate for years, it can damage organs and lead to serious health problems. The good news is that when hemochromatosis is found early, treatment can prevent most of these complications.

Fatigue and joint pain are easy to write off as just getting older or being busy. What are the more telling warning signs that point specifically to hemochromatosis, and why does it so often go undiagnosed for years?

WP: One of the challenges with hemochromatosis is that the earliest symptoms are often common and nonspecific. Patients might experience fatigue, joint pain or a general sense of not feeling well, and these symptoms are easy to attribute to aging, stress or other common issues. As iron accumulates, patients can develop diabetes, abnormal liver labs, decreased sex drive, heart rhythm problems or bronzing skin. However, many individuals have no symptoms at all until significant iron overload has already occurred. The condition often goes undiagnosed for decades because symptoms develop slowly over many years, and many people do not know they have a family history of the disease. In many cases, it is first discovered when routine blood work shows elevated iron levels or abnormal liver tests.

If a close family member has hemochromatosis, what does that mean for your own risk, and is it worth getting tested even if you feel completely fine?

WP: Yes. If a parent, sibling or child has hereditary hemochromatosis, it is worth discussing testing with your health care provider, even if you feel completely fine. Close family members of affected persons have an increased chance of carrying the same gene changes that can lead to iron overload. Many people who ultimately develop hemochromatosis feel perfectly well when elevated iron levels are first detected. Simple blood tests can measure iron levels, and genetic testing can determine whether a person carries the most common gene variants associated with the condition. Identifying hemochromatosis before symptoms develop is one of the best ways to prevent long-term organ damage.

Excess iron doesn't just sit quietly in the body. What kind of damage can it cause to organs like the liver, heart or pancreas if it goes untreated long enough?

WP: Iron is essential for red blood production, but too much iron becomes toxic. When excess iron accumulates in tissues for years, it can lead to permanent organ damage. The liver is one of the most commonly affected organs. Untreated iron overload can cause scarring of the liver, known as cirrhosis, and significantly increase the risk of liver cancer. In the pancreas, iron can interfere with insulin production and contribute to diabetes. In the heart, it can cause irregular heart rhythms or weaken the heart muscle, leading to heart failure. Iron can also affect the joints, causing arthritis, and damage hormone-producing glands, leading to problems such as low testosterone or infertility. These complications are much less likely to occur when excess iron is identified and treated early.

The main treatment for hemochromatosis is essentially bloodletting, therapeutic phlebotomy. How does something that sounds so old-fashioned work, and can patients expect to live a normal life once it's under control?

WP: Therapeutic phlebotomy may sound old-fashioned, but it remains the most effective treatment for hemochromatosis. The process is very similar to donating blood. During treatment, a unit of blood is removed, which also removes a significant amount of iron because most of the body's iron is contained within red blood cells. To replace those cells, the body uses stored iron, gradually lowering excess iron levels. Many patients initially need more frequent phlebotomies, sometimes every week or two, until their iron levels return to a healthy range. After that, most only require occasional maintenance treatments a few times yearly. The outlook for people with hemochromatosis is excellent when the condition is diagnosed and treated before serious organ damage develops. Many patients can expect a normal life expectancy and can live full, active lives with ongoing monitoring and maintenance therapy.