I’m fit and active, but blood tests show my iron levels are high; 290ng/ml. My doctor is not concerned but I fear they’ll have a detrimental effect on my health. I’m 80.
Carol Bryan, Chichester
Dr Scurr replies: I understand your concern — iron is a vital component of our body chemistry; it’s central to the molecule of haemoglobin, the red oxygen-carrying pigment in red blood cells.
We measure the body’s iron stores by checking levels of ferritin — an iron-carrying storage protein in the blood. A normal level is 24 to 336ng/ml for men, 24 to 307ng/ml for women.
Usually, we only suspect there might be a problem when ferritin levels climb above 300.
At that point you might be referred for testing for haemochromatosis, a disorder where a mutation in a gene leads to excess absorption of the mineral from iron-rich foods in our diet.
Over time, this genetic fault leads to toxic levels of iron accumulating, eventually causing damage to vital organs such as the liver and pancreas.
I suspect this is your worry.
Iron levels in the blood are checked by anaylsing ferritin, an active-phase reactant which has an important role in our immune response to perceived threats such as inflammation
But if you did have haemochromatosis, by the age of 80 your iron levels would be far higher than they are.
So it is most unlikely that you have this condition.
However I agree that your ferritin level is quite high. There are other potential reasons for this, the main one is inflammation in some part of the body. Ferritin is what we call an active-phase reactant, meaning it’s a compound that has an important role in our immune response to a perceived threat – it’s thought iron helps coordinate cell defences against inflammation, for instance.
Therefore your high reading can be seen as a marker of your immune system fighting something that causes inflammation. This could be some ‘housekeeping’ events, which often take place below our level of awareness, and therefore nothing to worry about.
If you are in good health and reasonably active, as you say, then there is no cause for alarm here – which explains why your GP is taking a relaxed line.
I was prescribed the anti-cholinergic drug solifenacin for my overactive bladder but on hearing about links between this type of drug and dementia, I asked to switch to darifenacin which I’d read works in a different way. My GP initially refused and said they all carry the same risk. Who is right?
Geoff Dowdall, Essex
Dr Scurr replies: Overactive bladder (OAB) is very common – it affects around one in six adults to some degree, and so your question will be of interest to many readers.
OAB is characterised by a sudden and frequent need to urinate and can cause incontinence.
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.
An overactive bladder is very common, affecting around one in six adults to some degree
But in OAB, the muscles behave in an irritable and unreliable manner, creating an urgent need to urinate, even when the bladder is not full.
Anti-cholinergic drugs block acetylcholine, the chemical messenger that tells the brain to contract the muscles and can be very effective at easing OAB symptoms.
But acetylcholine is also involved in learning and memory and long-term use of anti-cholinergics drugs is associated with cognitive decline. This is why they are not typically prescribed to patients over the age of 65.
For this older group, the non-cholinergic drugs mirabegron and vibegron are preferred and studies show these are just as good at easing symptoms as anti-cholinergics.
In your longer letter, you say your GP prescribed mirabegron, but it was of limited benefit and so — on your request — you were switched to darifenacin.
But darifenacin is another anti-cholinergic and so I am inclined to agree with your GP that the relative risk is the same. For that reason, I strongly suggest you think again about mirabegron.
Patients generally start on 25mg a day, but this can be increased to as much as 100mg, if necessary. It could also be worth trying vibegron (75mg a day). This is something to discuss with your GP with some urgency.
It’s also worth noting that pelvic floor exercises (you can find out how to do these online) and lifestyle changes, such as reducing fluid intake in the evening, can also bolster the effects of any medication.
Write to Dr Scurr at Good Health, Daily Mail, 9 Derry Street, London, W8 5HY or email drmartin@dailymail.co.uk — include your contact details. Dr Scurr cannot enter into personal correspondence. Replies should be taken in a general context and always consult your own GP with any health concerns.
