Introduction

There has been much debate about the role of excessive alcohol ingestion in the development of iron overload and hemochromatosis. Some have suggested that hemochromatosis is the end-point of alcoholism; others suggest that excessive alcohol ingestion and hemochromatosis are unrelated. Recent observations helped resolve these controversies. First, the hepatic iron index is a reliable diagnostic tool for differentiating hemochromatosis from alcoholic liver disease. Second, alcohol ingestion can cause perturbations of several non-invasive iron status measurements used to screen for hemochromatosis. Third, and most importantly, the genetic basis of many cases of hemochromatosis has been established. This was initially accomplished by means of elegant and pioneering linkage studies that revealed that the hemochromatosis allele resides on chromosome 6 in proximity to the HLA-A locus. The recent description of the putative hemochromatosis gene and the production of animal gene knockout models should lend greater specificity to the molecular and biochemical characterization of the disorder. Further, African iron overload is a condition in which alcohol excess has been incriminated as an etiologic agent in the development of iron overload although there is a possible genetic component of this disorder also. This chapter delineates the effects of alcohol on iron measurements performed as screening tests for hemochromatosis, reviews the interactions between the use of excess alcohol and the pathogenesis of hemochromatosis, and explores the possible role of alcohol in the development of African iron overload.