IRON - The SLY FOX & The Farmer

February 1999 Leslie N. Johnston, D.V.M. Most people do not know about Hemochromatosis or iron overload. For this paper, Hemochromatosis means iron overload or too much iron. We call Hemochromatosis a condition rather than a disease in that too much iron will cause all kinds of disease processes. Let me tell you up front that I am not anti iron, but I am anti too much iron. Iron is both a very necessary nutrient, but too much of it is very toxic. Too much iron can seriously affect your health and the health of the animals that you raise. The ocean needs just enough wind to make our ships glide gracefully across the surface and to make the surface choppy enough to oxygenate the water for our sea life; it does not need enough to make waves high enough to sink our ships or to wash our beaches away. Likewise, the animal body needs just enough iron to maintain it, and that is all. The sly and insidious ways that iron works to cause health problems in both humans and animals must be given more consideration from now on. I call iron the sly fox of medicine today; so slyly and insidiously causing too many of our health problems and this sly fox is not seen, looked for, or given any concern as it is desperately needed in both human and veterinary medicine today. I will take up the human aspect of Hemochromatosis first. There are about 10,000 farmers who have Hemochromatosis in our country based on a two million farmer population, and probably at least 70 percent of them do not know they have it.(1) It is not just the farmer himself, but his spouse, siblings, his business associates, his employees, and friends who have Hemochromatosis; and this amounts to many thousands of people having this miserable and deadly condition if it is not diagnosed early and properly treated by the simple donation of blood in most cases. I know of no other people who could suffer the devastation of Hemochromatosis as much as the farmers; for one reason, too much iron
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can involve their animals also. It can put you in a position that your wife is sick with it, and leave you with a crop in the field and several hungry kids in diapers to take care of or vice versa - as Kenny Rogers would say. Undiagnosed and untreated iron overload can insidiously break you as a farmer in so many ways just as badly as if you had multiple crop failures, floods, deaths or poor performance of your animals, droughts, tornadoes, and you name it. Undiagnosed, it can take all of your drive and strength that are needed to maintain a farm. Hemochromatosis, being diagnosed and properly treated, will lead to many years of the good life of farming oh, what a good life. The symptoms of Hemochromatosis usually start at about 30 to 40 years of age in men, and 40 to 50 years of age in women. This is not always the case. Bill Clinton's and Hillary's national health insurance program was to take care of us all from the womb to the tomb; Hemochromatosis can get you from within the womb to the tomb, and the time of the tomb, but not usually, can be at a ripe old age. These words, "And a certain woman, which had an issue of blood [Hemochromatosis] twelve years, And had suffered many things of many physicians, and had spent all that she had, and was nothing bettered, but rather grew worse," written 2,000 years ago, even with all of our new medical know how, still applies to too many Hemochromatosis patients today, usually from not being diagnosed as they should be. People are going back and forth to their doctor, or from one doctor to another, too many times, before a diagnosis is made. In many cases, the diagnosis is made much too late, and many times the diagnosis is not even made until after an early and miserable death. An early diagnosis and the simple and inexpensive treatment of donating blood will lead to a good and extended and normal life. The major health problems caused by iron overload are usually thought of as involving the heart, liver, pancreas and the joints. This is by far not all, for many tissues and functions of the body can be and usually are involved in the patient with too much iron. Too much iron can cause many heart problems; in particular, cardiac arrhythmia (flutters), cardiomyopathy, and most any kind of heart attack. Most any healthy person can have extra heartbeats, but when they come in bunches like bananas, they can be deadly. These extra beats make you
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feel like your heart is running like a four-cylinder engine with the timing chain broken, or that the wires are crossed from the distributor. The liver is greatly involved as well: too much iron producing enlargement of the liver, fatty degeneration, elevated liver enzymes, cirrhosis, poor liver function, and cancer of the liver. Cirrhosis of the liver caused by Hemochromatosis or any other cause, can lead to esophageal varices which can become suddenly deadly. Nearly any problem of the liver demand that the patient be tested for iron overload. People who have Hemochromatosis, and who are untreated, are 219 to 240 times more likely to develop hepatoma (cancer of liver cells) than the normal population. Many Hemochromatosis patients complain of pain in the upper right quadrant of the abdomen, and this pain is usually thought of as being associated with the liver, although pain in any portion of the abdomen can be associated with Hemochromatosis. The pain in your upper right abdomen associated sometimes with Hemochromatosis may make your doctor think of gall bladder problems and out comes your gall bladder, not exactly needing to be done. The pancreas involvement can be anything up to a deadly situation. There are three functional groups of cells in the pancreas, those that secret insulin, those that secrete digestive enzymes, and those cells lining the ducts of the gland leading to the intestine which produce bicarbonates that are so important in ph control of the gut contents. Patients suffering from partially or completely knocked out digestive enzyme cells and the bicarbonate producing cells often experience many kinds of digestive disturbances. Excess iron in these cells can cause anything from slight pancreatitis to death of the cells and even cancer of the pancreas. It would be easy to diagnose this patient as having irritable bowel syndrome (IBS) and finding iron overload would be the cause. The patient diagnosed as having IBS is told there is no cause for this. Iron overload of the body or just the pancreas can be a cause of IBS, and correcting the iron overload will help or "cure" the IBS in most cases. Iron overload of the pancreas will also enhance infection of this gland. Pancreatitis is serious business. Diabetes shows up in Hemochromatosis patients about four times more often than in the general population. This is the reason Hemochromatosis is sometimes called Bronze Diabetes. This diabetes also gets to be what is called a wild and uncontrollable type if not caught early and the iron levels of the patient brought down to normal. Glucose intolerance is often
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associated with Hemochromatosis patients. It is a must for diabetic or patients with pancreatitis to be tested for Hemochromatosis or too much iron. There is no doubt that most Hemochromatosis patients suffer from arthritis. This arthritis is sometimes referred to as atypical arthritis. It usually will start first in the hands (knuckles), then the hips, knees, feet, and can be all over the body. It can occur in the sternum, giving unusual chest pains leading to all kinds of false impressions and leading your doctors to test or check your chest - getting very expensive, and misleading your doctors to do many dangerous and unnecessary procedures. Nearly all arthritic and heart patients should be tested for Hemochromatosis. If your doctor tests you for rheumatoid arthritis, and the test is negative, make sure you are tested for Hemochromatosis. The arthritis of Hemochromatosis can make the doctor think that you have rheumatoid arthritis. These chest pains could lead your doctor to make a diagnosis of fibromyalgia, also called pleurodynia; this condition has no cause and will just stay with you in most cases if the doctor doesn't think to test your iron levels and treat your iron overload. Hemochromatosis has a cause, and that is iron overload. When diagnosed early, treatment leads to a normal life. If you have been diagnosed as having fibromyalgia, chronic fatigue syndrome, or irritable bowel syndrome, and your iron levels were not checked particularly for iron overload, then you need to either change doctors, or go back your physician and insist that this be done; the symptoms of all of these conditions and Hemochromatosis overlap too many times not to test these patients for Hemochromatosis.(2) (3) Infectious organisms just love people and animals with too much iron. Shell fish poisoning, caused by the mean bacterium Vibrio vulnificus, is the best example of this. Iron overloaded people getting this infection would be lucky to make it to the hospital, and even if they do live, permanent and severe damage may be done. Doctor Eugene Weinberg of the Indiana University usually lists more than 40 pathogens that their growth is enhanced by available iron.(4) (5) (6) In addition to iron enhancing infective organisms, iron overload is immune depressing to the body. Fatigue is very common with iron overload and can be, along with arthritis, the first presenting symptoms. Your doctor may prescribe iron to build you up which is the wrong thing to do without first checking your iron levels. Fatigue and farming do not go together; a farmer should all ways feel good so that he can enjoy the good life of farming to the fullest. Having
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Hemochromatosis should not rob him of this good life. Iron tests tell if you have an iron deficiency or iron overload! Hair loss may not be any big deal and would not result in major health problems, but may be a very good indication that the patient has Hemochromatosis, especially in more advanced cases. This hair loss is usually from those places where the sun don't shine: the axillary and pubic areas, and then body hair and eye brows. The pituitary gland has a dangerous affinity for iron which destroys a lot of the functions of this gland, and so all of the glands that the pituitary is interrelated with also suffer. These include the thyroid, parathyroid, gonads and adrenals. There can be direct deposits of iron in these glands that also cause damage. Loss of libido, impotence, and amenorrhea are common to Hemochromatosis patients in very many cases. Sounds strange that donating blood would extend your years of sexual activity, doesn't it? Amenorrhea, or early menopause can be caused by iron overload, and iron overload should always be considered as a cause; an early menopause is dangerous to the woman, for this will lead to iron build up earlier than normal. If a woman does have an early menopause, and is otherwise healthy, it may be good that she would become a frequent and regular blood donor. The results of iron overload in relation to the bowel is phenomenal. This begins with the secretion of lactoferrin by membranes of the eyes, nose, mouth, and all of the lining tissues through the bowel. Lactoferrin is an iron binding protein and it functions to bind or hold or sequester iron in a fashion that is protective or functional to the body. If there is not enough lactoferrin to do this, then iron is free and can cause all kinds of problems. Some of the bowel problems of Hemochromatosis patients tell us just how this iron bit works - it works just like the cowboy diarrhea - it runs in the genes, and literally it does - both ways. The Hemochromatosis patient is likely to complain of having severe and explosive diarrheas confusing the physician to diagnose IBS, and a few complain of constipation. I have always heard that ulcers are caused either by a bad job or a bad wife. A bad husband could have nothing to with causing them! Now we know that iron is involved in the ulcer process. Dr. Barry Marshall, MD, of Australia, has proven that Helicobactor pylori is the organism that infects the ulcer or causes the ulcers in the human. Iron is necessary for the
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growth and reproduction of this germ and if there is more iron in the medium of this organism, the growth of this germ is enhanced; in the same study that proved this, it was also proven that the growth of Entameba histolytica, Dientabeba fragilis, and Blastocystis hominis is enhanced by iron rich culture medium. It was concluded that these iron dependent pathogens will multiply excessively in an Fe-rich medium. Therefore, if iron is used loosely, it may enhance the multiplication of these organisms in the gut.(7) What is the germ, or what are the germs that are the infective organisms of stomach ulcers of hogs and horses, and other animals? Which comes first, the ulcer or the infection that is involved with the ulcer; and what part does too much iron play in the process? It is for sure that these organisms require iron to cause or infect these ulcers. Adding iron to human food or to animal feeds either by the manufacturer or owner of the animals is the wrong thing to do since it is known this will enhance infections of these ulcers - and also help to enhance systemic or other bowel infections. "Chemists compare the relative strength of chelation of metals by use of a value called the affinity constant. --- [iron binding sites on bacterial cells called] siderophores bind ferric iron much more strongly than any other metal."(8) This is where I call iron the top dog or it is at the head of the peck order of metals. It is easy to see with this that iron in excess could cause a detrimental imbalance of the other metals required in animal nutrition. In the case of lactase production, lactase producing bacteria are only a very small group of bacteria that do not use iron for their metabolic needs; they use manganese and cobalt, and iron in excess can cause a major disturbance in this digestive process.(9) From this it is easy to see how iron could out compete these two metals and cause serious problems of lactose digestion. Also, this could happen with the enhancement of pathogenic or unfriendly bacteria of the gut that would wipe out the very necessary friendly bacteria of the gut. It would be impossible for animals, and particularly the horse and ruminants, to function without the required friendly bacteria of the bowels. Too much iron, and not necessarily a deficiency of the other required metals, could be and is the culprit of so many of our health problems in animal and human medicine. For infection and neoplasia, the body must be able to sequester or withhold iron from both of these processes. If the body is unable to do this, then the cancer and infective cells find they have just the most required nutrient to propagate without restraint and can and do devastate the body. This is
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what Eugene Weingberg of the Indiana U. describes as the "iron withholding as a defense against infection and neoplasia". This can happen in the body tissues as well as in the gut. Adding iron to food or feeds would not help in these processes. Add iron to feed only when a true iron deficiency exist on an individual or herd basis.(5) Iron is involved with, or causes close to 100 percent of free radical production throughout the body and especially all the way through the gut. Free radicals are what cause or are involved in many of our disease processes. When you get to the colon, this is particularly the case - it reminds me of what goes on at a political convention developing into one big blow out. I can't say whether this would be a democratic or a republican convention. I have dealt with a lot of horsemen and most of them like to "build up their horses" and they will give them anything they can get their hands on to do so if they even think it will work including iron supplements, vitamins, the best feed they can buy and you name it. The problem is the so called "best feed" they can buy is not the best. It is feed that is loaded with or I would have to say the feed is adulterated with iron. One of these horse feeds was tested for total iron and was found to have an iron level of 103 ppm and this is a 700 percent increase over what a good homemade or a farm made ration made up of oats, wheat, corn, and soybeans would contain. Surely, a 700 percent increase over what nature would put in this ration should be enough to get the job done, that is to cause these horses to colic, develop infections, wallow, twist guts and even to die. The feed companies want to add "enough" iron to these rations, but they don't realize their "enough" is too much when it comes to iron. Any iron added to a ration is too much in most cases. Iron deficiency should be proven before any iron is given to any animal. It should not only be considered criminal to add iron to human or animal food, but it should be considered a heinous crime to add it to our food or feeds as is being done today. One research group working on these problems, told me the problems were seen when colts were brought in from the pasture, and put in stalls to finish out. It was mentioned these problems were probably caused by a lot of stress. At this time, these colts were put on these rations containing high iron. Not only high iron, but the added iron is ferrous iron, and this basically is changing the colt from a ferric world to a ferrous world. Ferrous iron is 5 to 10 times more absorbable or useful, that ferric iron. So, in effect, these
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colts are having precarious amounts of iron dumped on them that they just cannot tolerate. A study was made over a ten year period of 5000 ulcer biopsies, and iron was found in 450 of these biopsies. Iron build up in cells is detrimental as clearly seen by what happens to liver and pancreatic cells overloaded with iron.(10) Does this information tell us that iron in excess is connected with ulcer disease in at least a high percentage of cases? The iron problems are not just confined to the stomach, they continue through the bowel. In humans, infections, even infections causing SIDS, lactase deficiency, inflammatory bowel disease, Crohns disease, ulcerative colitis, cancer, and irritable bowel syndrome (IBS) are now found to be associated with iron overload in many cases.(11) In the case of equine infectious anemia, it is not the infection that kills the horse per se, it is the iron buildup in the body of the horse that does the damage. This iron loading anemia is and works like the iron problems in sickle cell anemia and thalassemia in humans. It is not only the horse, but nearly all animals are involved in this iron overload problem. Iron overload, more like iron toxicity as they call it, is now being diagnosed in cattle, especially dairy cattle. This comes from too much iron in their feed, forage and/or their water. It can cause silent heats, foot soreness, uterine infections, and rough hair coats. "Although iron is necessary in biological systems, it is a potent oxidant or pro-oxidant that can adversely affect cell function. We removed all the supplemental iron usually in the form of ferrous sulfate - from the trace mineral premix formulation. In some cases, the health of the cows improved. On the farms where the cows did not show any improvement, we found the dicalcium phosphate source contained over 1% (10,000 ppm) of iron, [and this is a bunch]. Switching to a more pure phosphorous source lowered the dietary iron intake. After switching, almost all incidents of silent heat, sore feet, and uterine infection disappeared. Hair coats became slicker." Iron in excess can and at times does oxidize some feed ingredients to give milk a rancid oxidized off-flavor(12). The use of calcium and phosphorous supplements should be looked at scrupulously. Hemochromatosis is found in the Saler breed of cattle and it follows along the lines of same genetic incidents as occurs in humans. These cattle would probably make a good role model for Hemochromatosis studies in humans.

When it comes to birds, we really do find that this iron bit is "really for the birds". The most interesting study I have found is that 23 ratites (ostrich and emu) were diagnosed on post mortem for iron toxicity in a recent 2 year span at the Oklahoma Animal Disease Diagnostic Laboratory.(13) This could be very devastating to the farmer in that these have been very expensive animals to invest in and to raise. I personally had 4 different ratite feeds tested for total iron content and they were found to be 85.50, 85.60, 95.90 and 111.00 ppm(14). This is more than 550 to 750 percent more than a good farm ration would contain in natural and healthy iron these high amounts should be "enough" - to make sick and to kill - pure ignorance and arrogance! Many other species of birds are subject to iron toxicity as well. We normally think hogs need a lot of iron and that it would not cause problems in these animals - wrong, it does in some cases. In the Sep-Oct issue of the "FDA Veterinarian", 1989, US Dept. Of Health and Human Services, there was a report of adverse drug reactions for iron dextran injections in pigs. The report says that 460 pigs were treated with iron dextran and that 234 reacted to the shots and 73 died(15). This had to be cases of ignorance and bad ethics for the misuse of iron - kill some, make others sick so money can be made treating the sick. Pigs are rather dirty creatures "at times" and harbor all kinds of pathogenic organisms that the misuse of iron will enhance to cause health problems. "Inappropriate diet, aberrant feeding patterns, and abrupt changes in feed [adulterating the feed with iron] easily disturb gastrointestinal function. Several factors contribute to ulcer development. A body of evidence {O'Brien Diseases of Swine 7th Edition} indicates that physical and chemical composition of feed is the most important factor causing ulcers in pigs."(16) "The most common request the toxicology laboratory receives is for metal analysis. Metal and metal-like elements the laboratory analyzes include potential toxicants such as lead, arsenic, chromium, and nutrients such as magnesium, as well as copper, selenium, zinc and iron [IRON], which may be nutrients or toxicants. --- Both iron deficiency and toxicosis occur in livestock, especially swine."(17) Strange isn't it that iron can cause ulcers in addition to the bad wife! Do you suppose the boar was married to a big fat sow who gave him his ulcers, or vice versa? The diagnosis of Hemochromatosis in humans is usually made on the basis of blood tests which include: Serum Iron, TIBC (Total Iron Binding Capacity) and or UIBC (Unbound Iron Binding Capacity), and Ferritin. The
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Serum Iron and TIBC should be included in all blood profiles, and if these are out of range, then the Ferritin should also be run at this same time. The problem is that nowadays, government medical insurance plans will not allow these tests to be included routinely in most blood workups, and most doctors would not include them at any rate - too bad. If the doctor routinely had these tests included in his patient's blood profiles, it would come under the heading of fraud and abuse as far as the government is concerned. Then, if these tests are indicative of Hemochromatosis, other tests like the MRI, trial phlebotomies, family history, and liver biopsy are indicated. DNA studies are very good and they are not that expensive; these DNA studies are better than 80 percent accurate and are non invasive as the liver biopsy is. Stay away from the liver biopsy if at all possible, for it is a dangerous procedure, and is not that necessary to diagnose Hemochromatosis. You may have to insist that your doctor test you for Hemochromatosis, because, still yet today, most doctors consider this to be a very rare condition. Many physicians never give it any thought, just treating you for one symptom after another for long periods of time until you become very sick, and then maybe and finally you get lucky and get diagnosed and the proper treatment. If you consider five out of a thousand to be rare for a disease condition, then Hemochromatosis is rare. (18)(19)(20) In animals, the diagnosis would probably be made on post mortem in most cases, and then examine tissues microscopically and chemically. Also, analysis of feed, feed ingredients, forage, and water for iron content should be done if iron toxicity is considered. It is now becoming a common practice to recycle animal feces and use it in animal feeds. Concentrating the iron in these feeds adulterated with such is just one of the bad effects of doing this.(21) This practice is absurd, obnoxious, preposterous, and most embarrassing to the good farmers of our land. Animal waste should be returned and plowed into the fields to grow lush crops, and then these crops fed back to our animals. What food and over-the-counter vitamin-mineral tablets one takes now days should be looked at scrupulously. If the cereal box or the vitaminmineral box says 100 percent of RDA (USRDA, daily value) for iron, this means that it contains 180 percent, repeat 180 percent, of the RDA for iron for most of the people eating such poisoned garbage. This should be considered a heinous crime to adulterate a food or medicine with such a

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toxic substance in such amounts. Iron supplementation in any fashion should be reconsidered. From this it is easy to see how iron could out compete the necessary metals and cause serious problems of lactose digestion. Also, this could happen with the enhancement of pathogenic or unfriendly bacteria of the gut that would wipe out the very necessary friendly bacteria of the gut. It would be impossible for animals, and particularly the horse and ruminants, to function without the required friendly bacteria of All men should start donating blood to their good health at about the age of 20 years of age about 2 to 4 times a year, and possibly some women also. Remember that the sly fox is out there and should be looked for. This paper is copyrighted but may be used for any reason to spread the word about Hemochromatosis and iron, proper credit given. Leslie N. Johnston, DVM 1. Witte, DL; Crosby, WH; Edwards, CQ; Fairbnks, VF; Mitros, FA. Hereditary Hemochromatosis (The Practice Parameter for Hereditary Hemochromatosis). Clinica Chimica Acta 245(1996) 139-200. 2. Johnston, Leslie N, DVM. Iron Overload = Hemochromatosis = Too much iron. 48 page booklet written and privately published by Dr. Leslie N. Johnston, DVM. 1993. 3. Berne, K. List of Symptoms of CFIDS. The Complete Guide to CFS (CFIDS). 1995. Pp57-60 4. Weinberg, ED, Patho-Ecologic Implications of Microbial Acquistion of Host Iron, Department of Biology and Program in Medical Sciences, Indiana University, Bloomington, Indiana, Reviews in Medical Microbiology 9: - July 98. 5. Weinberg, ED., Iron Withholding: A Defense Against Infection and Neoplasia, Physiological Reviews, Vol 64, No. 1, January 1984, 65-102.

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6. Barton, JC, McDonnell, SM, et al. Management of Hemochromatosis (Diagnosis and Management). Annals of Internal Medicine, 1 Dec 98. 129:932-939. 7. Cidon S, Zalman D, Darausha, Cahana Z, Rotman N, Able B, and Iancu TC. The Relationship Between Iron and Cultured Intestinal Pathogens. Pediatric Research Unit, Carmel Hospital and B Rappapoet Faculty of Medicine, Technion, and Hirsch Regional Microbiology Laboratory, Kupat Holim, Haifa, Israel. Taken from abstracts of the 4th International Conference on Hemochromatosis and Clinical Problems in Iron Metabolism. Jerusalem, Israel, April 27 - 30, 1993. 8. Emery, Thomas, PhD., Iron and Your Health: Facts and Fallacies,1991, CRC Press, Inc,. Boca Raton, Boston, Ann Arbor. 9. Weinberg, ED and Weinberg, GA. The role of iron in infection, Current Opinion in Infectious Diseases, 1995, 8:164-169. 10. Cidon S, Zalman D, Darausha, Cahana Z, Rotman N, Able B, And Iancu TC. The Relationship Between Iron and Cultured Intestinal Pathogens. Pediatric Research Unit, Carmel Hospital and B Rappapoet Faculty of Medicine, Technion, and Hirsch Regional Microbiology Laboratory, Kupat Holim, Haifa, Israel. Taken from abstracts of the 4th International Conference on Hemochromatosis and Clinical Problems in Iron Metabolism. Jerusalem, Israel, April 27 - 30, 1993. 11. Lisa, LIH-Brody, Md, Powell, SR, et al, Increased Oxidative Stress and Decreased Antioxidant Defenses in Mucosa of Inflammatory Bowel Disease, Digestive Diseases and Sciences, Vol. 41, No. 10 (October 1996), pp 2078-2086. 12. Pitzen, D. The Trouble With Iron. Feed Management. June 1993, and Feed International, Aug 1994. 13. Letter from Dr. W. C. Edwards, DVM, Of the Oklahoma Animal Disease Diagnostic Laboratory, Stillwater, Ok., 1997. 14. Case No. 97081006. Oklahoma Animal Disease Diagnostic Laboratory. Stillwater, Oklahoma.

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15. FDA Veterinarian. Washington: Dept. Of Health and Human Services, Sept-Oct., 1989. 16. Cooper, VL, DVM. Gastric Ulcers in Pigs: A Sore Spot. The newsletter of the College of Veterinary Medicine and Oklahoma Animal Disease Diagnostic Laboratory: "OSU Animal Health UPDATE." Vol 6 Issue 1, Jan 1999. 17. Bischoff, Karyn, DVM. Sample Submission For Metal Analysis. The newsletter of the College of Veterinary Medicine and Oklahoma Animal Disease Diagnostic Laboratory. "OSU Animal Health UPDATE". Vol 6 Issue 2, Jan 1999. 18. Yang, Q, McDonnell, SM, Khoury, MJ, Cono, J, Parrish, RG. Hemochromatosis-Associated Mortality in the United States from 1979 to 1992: An Analysis of Multiple-Cause Mortality Data. Annals of Internal Medicine. 1 Dec 1998. 129:946-953. 19. Powell, LW; George, DK; McDonald, SM, Knowdley, DV. Diagnosis of Hemochromatosis. Annals of Internal Medicine. 1 Dec 1998, 129:925932. 20. Looker, AC and Johnson, CL. Prevalence of Elevated Serum Transferrin Saturation in Adults in the United States. Annals of Internal Medicine. 1 Dec 1998. 129;940-945. 21. Taipan. Summer Forecast Issue. Taipan, 1217 St. Paul Street, Baltimore, MD 21202.

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