I am fit and active, but blood tests show that my iron levels are high: 290 ng/ml. My doctor is not worried, but I fear that they may have a detrimental effect on my health. I am 80 years old.
Carol Bryan, Chichester
Dr. Scurr responds: I understand your concern: Iron is a vital component of our body chemistry; it is essential for the hemoglobin molecule, the red pigment that carries oxygen in red blood cells.
We measure the body’s iron stores by checking the levels of ferritin, a storage protein that transports iron in the blood. A normal level is 24 to 336 ng/ml for men and 24 to 307 ng/ml for women.
Typically, we only suspect there may be a problem when ferritin levels exceed 300.
At that point, you may be referred to a doctor to be tested for hemochromatosis, a disorder in which a mutation in a gene causes excessive absorption of the mineral from iron-rich foods in our diet.
Over time, this genetic defect causes toxic levels of iron to build up, eventually causing damage to vital organs such as the liver and pancreas.
I suspect this is your concern.
Iron levels in the blood are monitored by testing for ferritin, an active phase reactant that plays an important role in our immune response to perceived threats such as inflammation.
But if you had hemochromatosis, at age 80 your iron levels would be much higher than they are.
Therefore, it is very unlikely that you have this condition.
However, I do agree that your ferritin level is quite high. There are other possible reasons for this, the main one being inflammation somewhere in the body. Ferritin is what we call an active phase reactant, meaning it is a compound that plays an important role in our immune response to a perceived threat – iron is thought to help coordinate cellular defenses against inflammation, for example.
Therefore, your high reading can be considered an indicator that your immune system is fighting something that causes inflammation. It could be some “internal cleansing” event, which often occurs below our level of awareness and is therefore not a cause for concern.
If you are in good health and reasonably active, as you say, then there is no cause for alarm, which explains why your GP is taking a relaxed line.
I was prescribed the anticholinergic solifenacin for my overactive bladder, but after learning there were links between this type of drug and dementia, I asked to be switched to darifenacin, which I had read works differently. My GP initially refused, saying they all carry the same risk. Who is right?
Geoff Dowdall, Essex
Dr. Scurr responds: Overactive bladder (OAB) is very common – it affects about one in six adults to some degree – so your question will be of interest to many readers.
VAH is characterized by a sudden and frequent need to urinate and may cause incontinence.
The symptoms are thought to be due to overactivity of the detrusor muscles in the bladder wall. These muscles normally relax to allow the bladder to fill and contract when it is full.
Overactive bladder is very common, affecting about one in six adults to some degree.
But in VAH, the muscles behave in an irritable and unreliable way, creating an urgent need to urinate, even when the bladder is not full.
Anticholinergic medications block acetylcholine, the chemical messenger that tells the brain to contract muscles, and can be very effective in relieving the symptoms of overactive bladder.
However, acetylcholine is also involved in learning and memory, and long-term use of anticholinergic drugs is associated with cognitive decline. For this reason, they are not usually prescribed to patients over 65 years of age.
For this older group, the noncholinergic medications mirabegron and vibegron are preferred and studies show that they are as good at relieving symptoms as anticholinergics.
In your longer letter, you say that your GP prescribed mirabegron, but that the benefit was limited and so, at your request, you were switched to darifenacin.
But darifenacin is another anticholinergic, so I am inclined to agree with your GP that the relative risk is the same. For that reason, I strongly recommend that you reconsider mirabegron.
Patients usually start with 25mg a day, but the dose can be increased to 100mg if necessary. It might also be worth trying vibegron (75mg a day). This is something you should discuss with your GP with some urgency.
It’s also worth noting that pelvic floor exercises (you can find out how to do them online) and lifestyle changes, such as reducing fluid intake at night, can also boost the effects of any medication.
Please write to Dr Scurr at Good Health, Daily Mail, 9 Derry Street, London, W8 5HY or email drmartin@dailymail.co.uk; please include your contact details. Dr Scurr is unable to enter into personal correspondence. Responses should be interpreted in a general context and always consult your GP if you have any concerns about your health.
