Title 39 - Trade and Commerce
http://www.scstatehouse.net/code/t39c027.htm
CHAPTER 27.
FLOUR AND BREAD
SECTION 39-27-10. Enrichment of certain flour.
It shall be unlawful for any person, except as hereinafter provided, to
manufacture, mix, compound or sell for human consumption in this State
any white flour or self-rising flour made from wheat which does not
contain the vitamins and other ingredients contained in the following
provisions:
(1) White flour shall contain in each pound not less than one and
sixty-six one-hundredths milligrams and not more than two and five
tenths milligrams of vitamin B-1 (thiamine), not less than six
milligrams and not more than twenty-four milligrams of nicotinic acid
(also recognized under the name of niacin) or nicotinic acid amide
(also known under the name of niacin amide) and not less than six
milligrams and not more than twenty-four milligrams of iron (Fe);
(2) If other vitamins or minerals are added to bread or flour, they
shall be added only in accordance with the regulations of the
Department of Health, Education and Welfare;
(3) These ingredients and amounts are in accordance with the definition
of enriched flour as promulgated by the Federal Security Agency
(Federal Register, May 27, 1941 pp. 2574 to 2582, and December 3, 1941
pp. 6175 and 6176, postponing the effective date of riboflavin as a
required ingredient in enriched flour) and the State Department of
Agriculture shall change or add to the specifications for ingredients
and the amounts thereof as necessary to conform to changes in the
Federal definition of enriched flour; and
(4) Iron shall be added only in forms which are harmless and
assimilable.
<My Comment>
THE HELL WITH THE FORM, WHAT ABOUT THE QUANTITY!
</My Comment>
http://www.ironoverload.org/hippocrates.html
Hippocrates Magazine
November/December 1995
Page 28
"The Shocking Truth About Iron"
A Million Americans have a potentially fatal disease--iron overload. So
why are we still focused on deficiency?
by Steven Finch
The oft-repeated first law of modern medical diagnosis is that when you
hear hoofbeats, think horses not zebras. So in 1951, when 19-year old
Roberta Crawford complained of constant fatigue and lingering flu
symptoms, her doctor took one look at her pale skin and thin frame and
heard the clipperty-clop of iron deficiency anemia. He sent her off
with a prescription for a new iron supplement called Trinsicon. "At
first it seemed to help," Crawford recalls, "but then I'd get clobbered
by the flu again, only worse." She started with a single capsule each
day, but when her doctors noted that the Trinsicon wasn't curbing her
anemia, they bolstered the dose. by the time Crawford was up to five
pills a day, she'd become disabled from sheer exhaustion. "I knew I
didn't want the iron," she says, "but when I asked one doctor if I
could give it up, he said, 'No. It's crucial for your life. You have to
keep taking it forever.'"
Crawford took iron for her "deficiency" for the next 27 years. Then in
1978, Crawford's swollen liver led her gastroenterologist to make a
lifesaving diagnosis. To the GI, a distended liver, coupled with her
symptoms of fatigue and flu, sounded a lot like cancer. He ordered a
biopsy. The liver sample came back clean, except that it was brimming
with iron. He then ordered a series of blood tests, including one to
determine her levels of the iron-binding protein, ferritin. Healthy
adults have up to 160 grams in a deciliter of blood. A measure of 300
grams can indicate advanced iron overload. Roberta Crawford's ferritin
approached 7,000. "You have an interesting, rare disease," her doctor
told her. "Hemochromatosis".
The GI was right about the diagnosis, but he was off the mark about its
frequency. A hereditary disease in which the intestine absorbs excess
iron, hemochromatosis is, in fact, the most common and one of the most
misunderstood--and most underdiagnosed--genetic disorders in the
country. The hemochromatosis gene is 30 times more prevalent than the
gene for Duchenne muscular dystrophy and occurs far more frequently
than the genes for either Down syndrome, cerebral palsy, or cystic
fibrosis. All told, more than a million Americans (about one out of
every 250) suffer from hemochromatosis. And that's not counting the
gene in the Americans (fully 23 million) who are carriers of the genes
for the disease.
Normally, healthy people absorb about 10 percent of the iron in the
foods they eat. Carriers, who have only one of the two hemochromatosis
genes, can absorb half-again that much, while Crawford and others with
full-blown hemochromatosis can soak in up to 20 percent or more. Since
the body has no natural way of excreting iron (other than through a
woman's menses and the minuscule amounts everyone sloughs off in dead
skin), any extra iron that's absorbed is relentlessly dumped into
tissues and vital organs, especially the heart, liver, and pancreas.
The good news is that, if hemochromatosis is discovered early,
phlebotomies, or bloodletting, will entirely prevent illness associated
with the disease. But left unchecked, excess iron can turn the skin a
coppery, bronze, or grayish color and clog vital internal organs to
such an extent that initial, vague ailments such as stomach pain and
fatigue can develop into arthritis, diabetes, cancer, heart disease,
cirrhosis of the liver, and a host of other ills.
Unfortunately, iron overload is left unchecked all too often. Surveys
of hemochromatosis patients conducted in 1985 and 1988 by the Iron
Overload Diseases Association found that the average patient had to
wait more than five years before being properly diagnosed. Most of
those surveyed had consulted multiple doctors; 25 percent of them also
had a type of anemia unrelated to iron status and, like Crawford, were
actually first prescribed iron before anyone successfully diagnosed
their hemochromatosis.
Given iron overload's prevalence and seriousness, why the long delay?
For one thing, say a group of health experts who are trying to raise
physicians' awareness, symptoms, such as fatigue and pain in the
joints, are fairly nonspecific. For another, our decades-old
preoccupation with iron deficiency anemia has too often led medical
schools--and therefore the medical profession--to focus attention on
the benefits of iron at the expense of its dangers.
Even today, says Kenneth Bridges, an assistant professor of medicine at
Harvard who has spent the last 15 years researching iron's effects on
the body, most doctors aren't taught enough. "A lot of medical schools
still only skim over iron deficiency and don't even touch on
hemochromatosis except to say that it's a rare iron disease that
yellows the skin," he says. As a result, despite more than a million
people at serious risk, hemochromatosis remains an invisible problem.
Lack of physician awareness, Bridges says, extends even to his own
clinical affiliation, Harvard's prestigious Brigham and Women's
Hospital in Boston.
Iron is, of course, essential to life. Skimp on iron and the result is
anemia, a condition that decreases hemoglobin in the blood, which in
turn, cheats the body of enough oxygen for proper growth and
functioning. Sic percent of Americans--almost exclusively infants,
adolescents, and women in their childbearing years--need additional
iron.
It's known, for example, that while adequate iron is vital to healthy
pregnancies, about 20 percent of women of child-bearing age are iron
deficient. Numerous studies have confirmed that low iron stores in
children can impair physical and mental development. That's an alarming
fact when you consider that, according to a 1994 Johns Hopkins study,
at least 15 percent of all adolescent girls have some form of iron
deficiency.
But as a group, Americans are in much more danger from overloading on
iron than from getting too little. For one thing, although iron
deficiency is the most common reason for anemia, it's far from being
the only one. Anemias are caused by everything from vitamin
deficiencies to defects in the hemoglobin itself or in the bone
marrow's production of red blood cells. That distinction isn't always
clearly understood. Like Crawford (whose anemia turned out to stem from
insufficient vitamin B-12), many anemic patients are prescribed iron as
a matter of course, sometimes with drastic consequences.
William Crosby, a former director of hematology at the Chapman Cancer
Center in Joplin, Missouri, calls iron deficiency anemia a "nothing
problem"--a statement that puts him at odds with many in the medical
community.
"What I mean is that although a lot of women have iron deficiency
anemia and are worn down and fatigued by it, their deficiency doesn't
kill them, " says the 30-year military veteran, who introduced
hematology as a specialty to the Army Medical Corps. "Iron overload is
lethal."
Hematologist Victor Herbert, a professor of medicine at Mount Sinai and
Bronx Veteran's Affairs Medical Centers in New York City, and one of
the world's foremost experts on nutrition, echoes Crosby's concern.
Except for high-risk groups like children and premenopausal women, it's
pretty tough for other Americans to come up iron deficient, he says.
Not only is iron abundant in unprocessed meat and vegetables, but since
the early 1940's the FDA has required that virtually all four products
be iron- enriched. so while in the rest of the world more than a
billion people are iron-deficient, in this country you can't trip over
a Twinkie without getting metal shavings on your sneakers. In fact,
Americans who need extra iron are outnumbered nearly 20 to one by those
who don't. Nevertheless, tens of millions of Americans regularly
supplement their diets with multivitamins, minerals, or other iron
products because they believe it will keep them healthier.
Worse, doctors frequently prescribe iron without fully diagnosing the
cause of a patient's anemia or ruling out iron overload. "It happens
all the time," says Herbert. "And that's just plain dangerous. No one
should take a supplement without having their iron status checked."
Most hemochromatosis carriers, for example, will live full, healthy
lives despite absorbing twice as much iron as the average person. "But
give carriers a bunch of multivitamins or a string of iron supplements
like Geritol," says Herbert, "and you're going to throw them into iron
overload too." The bottom line, he adds, is that people who take iron
are twice as likely to be hurt by a supplement as they are to be helped
by it.
What's needed, Herbert and his colleagues maintain, is a sharp increase
in doctors' awareness of how serious a problem hemochromatosis is as
well as universal screening for patients' iron status. The old
definition for hemochromatosis won't do anymore, says David Witte, a
University of Iowa pathologist who's written new guidelines on
hemochromatosis due out sometime in early 1996. (See additional
information attached to this article on how to order a copy of these
guidelines).
"We have to move beyond thinking about this disease as a liver malady
in old men," Witte says. "For one thing, the condition affects as many
women as men. Women just have an early advantage, which they lose after
menopause." For another, he adds, we're doing patients an inexcusable
disservice by refusing to recognize hemochromatosis as a chronic,
genetic disorder that makes people absorb excess iron. Using this new
definition, he says, the challenge becomes to find these people and
treat them before their excess iron causes complications.
"If you don't look for hemochromatosis until a patient displays
clinical symptoms or until a liver biopsy turns up full of iron,"
Bridges says, "too much damage has already been done."
Screening would go a long way in reducing such damage, Witte and other
experts insist. "People are getting bounced around from doctor to
doctor, suffering from fatigue or headaches, and no one thinks to check
for iron overload," Witte says. "A few patients are still being sent to
psychiatrists, because their doctors pass them off as hypochondriacs."
Roberta Crawford remembers when doctors told her she was crazy. Now 63
and quite sane, Crawford's only concessions to iron overload are
phlebotomies once or twice a year and regular yoga and swimming to ease
her nagging arthritis. But she's come to realize how lucky she is to
have survived her condition relatively unscathed. Since starting the
Iron Overload Diseases Association in 1981, Crawford has met or talked
to the families of hundreds of seemingly healthy people--many who'd
never taken an iron supplement--who became permanently disabled or died
in their thirties or forties, a few even younger. Crawford and her
association have been trying to educate both doctors and the public
alike about the need to know their iron status. A second goal is to
convince public health officials that it's worth the cost to screen
seemingly healthy patients for a hidden disease.
Managed care giant Kaiser Permanente may already be convinced. At
Kaiser San Diego, home of the country's single largest preventive
medicine program, doctors in its department of preventive medicine are
testing the iron status of every patient they see (until they reach
30,000). So far, of the approximately 8,000 patients they've tested,
about one out of every 250 has had hemochromatosis. Most have been
treated. That's fine for a relatively few southern California patients,
says Bridges, but until screening becomes universal, it's up to
individual practitioners to decide. "Look at it this way," he says.
"There just aren't many diseases out there that a million Americans
have. And while there's nothing you and I can do about advanced colon
cancer or diabetic end stage renal disease, we can save a whole lot of
people from hemochromatosis.
Appendix
Iron Overload Diseases Association, Inc. (IOD)
433 Westwind Drive
North Palm Beach FL 33408-5123 561-840-8512 fax
561-842-9881
"Practice Parameter for Hereditary Hemochromatosis," David L. Witte et
al., in press, College of American Pathologists, Northfield, Illinois.
"Diagnosis and Treatment of Iron Disorders," Victor Herbert et al.,
Hospital Practice Symposium Supplement, Vol. 26, Supplement 3, 1991.
The Iron Elephant: What You Should Know About the Dangers of Excess
Body Iron, Roberta Crawford, Glyndon, Maryland: Vida Publishing, Inc.
1992.
tick ... tick ... tick ... by Roberta Crawford (a novel)
"Spellbinding, moving mystery," says Clive Cussler, best selling
novelist.
National Heart Lung and Blood Institute Information Center, Bethesda,
Maryland.
-------------------------------------------------------------------------------------------------------------
FERROUS FABLES: EIGHT MYTHS ABOUT IRON
Anyone whose family had a television probably grew up watching
Popeye-the pipe-smoking, pip-squeak of a sailor who could transform his
sagging biceps into twin turbines with a few gulps of iron-rich
spinach. Well, Popeye lied. Extra iron, whether from spinach or
supplements, doesn't make us any stronger, smarter, faster, or more
attractive. Here are some other common ironclad misconceptions.
Iron supplements are not good medicine. Almost certainly not for most
men--who have no natural way of getting rid of excess iron--and not for
women.
An anemic woman is not always iron deficient. She could be, but iron
deficiency is only one from a long list of underlying problems that can
trigger anemia, including vitamin deficiencies, defective hemoglobin,
and even iron overload.
An enlarged liver means your patient drinks too much? Not necessarily.
Sure, some patients will flat out lie about how much alcohol they
drink. But if you don't know why Mr. Jones' liver is enlarged; and he
insists he's a teetotaler, screen for iron.
Women can also get too much iron. The genes for hemochromatosis are
equally distributed between genders. Tthey are not at lesser risk,
women with hemochromatosis, even those in their childbearing years, can
easily absorb more iron than is healthy.
You can't cure hemochromatosis by eating less iron. It's impossible to
avoid iron in the American diet. Iron resides in every living plant and
animal cell, and virtually all commercials flours are iron-enriched.
Switching to a multivitamin without iron will help. Only marginally.
Most multivitamins contain small amounts of elemental iron. More
important, vitamin C enhances the body's ability to absorb iron.
<My Comment>
RIGHT, AND GET LOTS OF VITAMIN C.
</My Comment>
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