What's the "dragon's" (HCV) worst nightmare?
EVERYTHING you NEED to know about HEP C and IRON OVERLOAD.
EXCESS IRON CAN
DAMAGE THE LIVER, HOW CAN I LIMIT MY IRON UPTAKE?
It is overwhelming clear that excess iron (also known as "iron overload")
is one thing Hep C patients need to be aware of and avoid diligently.
Iron is needed by the virus to survive. Excess stores of iron in the
blood and in the liver can cause progression of the disease and further
damage to liver cells, which in turn could lead to fibrosis. We DO NOT
want excess iron.
So the question has come up, what can Hep C patients do to minimize
uptake of iron? Another question is, since vitamin C can enhance iron
absorption, should it be avoided as a supplement.
Let's talk about vitamin C, which is considered by many to have
very important antioxidant properties as well as anti-viral properties
(two things Hep C patients need). Given all the wonderful things about
this vitamin, many would conclude: the more the better. However, since
it has been shown that vitamin C can increase levels of iron, in some
cases, this gives us a dilemma.
SUGGESTIONS REGARDING VITAMIN C FOR EFFECT ON IRON LOAD
In reading about this subject from many different sources I have
come across a number of suggestions.
DO NOT TAKE VITAMIN C WITH MEALS Some sources say that vitamin
C enhances iron only when taken at the same time. In other words,
just to avoid taking vitamin C with a meal, when the dietary iron
I think it is safe to assume that it is good advise not to take
supplemental vitamin C with a meal. If you take it, take it several
hours after the meal.
TAKE CALCIUM WITH MEALS TO BLOCK IRON ABSORPTION:Soluble
fibers such as psyllium seed husks (Metamucil), guar gum, and the
pectins also help to block iron.
Many of the people in my E-groups take calcium to block iron absorption.
Here is what an abstract from Life Extension Foundation's website
"Practical way of lowering iron is to interfere with its absorption
from food. The American Journal of Clinical Nutrition (1998; 68:3-4)
stated that if 300 mg of calcium were taken with a meal, the amount
of iron absorbed would be reduced by 40%. That's a simple and inexpensive
way to reduce iron in the blood. In order to obtain 300 mg of calcium,
it is necessary to take a calcium supplement that supplies 300 mg
of elemental calcium. The best way of doing this is to take one to
two 1000-mg capsules of calcium citrate with every meal that contains
iron. Each 1000-mg calcium citrate capsule provides 220 mg of elemental
calcium. Another calcium supplement called Bone Assure would provide
333 mg of elemental calcium (and other important minerals) per 2-capsule
dose. According to the published studies, the maximum amount of calcium
that will inhibit iron absorption is 300 mg with each meal. Amounts
of calcium greater than 300 mg do not cause any additional interference
with iron absorption. It is important to note that some people become
tolerant to calcium-induced iron-absorption blockage after several
months, so if calcium provides a sudden reduction in serum iron levels,
make sure it continues to work by having regular blood tests. Soluble
fibers such as psyllium seed husks (Metamucil), guar gum, and the
pectins also help to block iron (and other mineral) absorption."
TAKE A MAGNESIUM SUPPLEMENT (200 mgs elemental magnesium)
HOW TO REDUCE YOUR IRON LEVELS
GREEN TEA POLYPHENOLS 300-900 mg/day - available in "green
tea" and also as a nutritional supplement.
Life Extension Foundation website (lef.org) provides this information
about tannins in tea:
"A recent study in the U.K. journal Gut, indicates that drinking
black tea rich in tannin with meals can reduce iron absorption. The
control group drank water with meals; the study group drank tea with
meals. Intestinal iron absorption was measured by studying serum iron
binding capacity and serum ferritin. Results showed a significant
reduction in the study group as opposed to the control group. The
goal then is to use the drinking of black tea to reduce phlebotomy
frequency in the management of patients with hemochromatosis."
"A potent iron-chelating agent is green tea extract. Green tea is
an antioxidant that helps to remove excess iron from the liver. Hemochromatosis
patients should take 4 to 10 green tea extract capsules with at least
250 mg of active polyphenols per capsule."
VITAMIN B 6 - Considered by some sources to be a good supplement
to block iron absorption, especially when vitamin C is present.
MILK THISTLE - silymarin is considered to have increased iron chelation.
IP6 (aka PHYTIC ACID) IP6 binds to iron (also known as phytic acid)
IP-6 reduces the number of free radicals by binding with iron, states
Dr. Shamsuddin. Hydrogen peroxide is another by-product of energy
production in the cells. If there is iron in the vicinity, hydrogen
peroxide will react with it and form hydroxyl free radicals. IP-6
locks up excess iron, thus preventing this harmful reaction from taking
Phytic Acid - Phytic acid found in bran helps is an antioxidant
and mineral chelator (binding agent). It removes only excess minerals--not
those bound to proteins. Like EDTA (the agent used in chelation therapy
to remove heavy metals from the body), phytic acid is used as a food
preservative and is available as a supplement. If you are anemic,
taking phytic acid will make you feel weaker. If you have too much
iron, the supplement will make you feel stronger.Go
to Phytic Acid
Another important component in soybeans is called phytic acid. This
acts as an antioxidant and protects against damage from harmful free
radicals. By binding to iron, phytic acid reduces the amount of oxidation
caused by iron in the body, thereby reducing the number of free radicals.
Researchers suggest this is how soybeans help lower the incidence
of colon cancer and protect against other inflammatory bowel diseases.
LACTOFERRIN MAY BIND AND TRANSPORT EXCESS IRON IN THE BODY Inhibits
Bacterial Growth?The name lactoferrin itself suggests its biological
activity. It refers to this protein?s ability to bind and transport
iron in the body (ferrum is the Latin root for iron). Lactoferrin?s
ability to lock up iron is probably the reason it?s capable of killing
or inhibiting infectious bacteria, viruses, and parasites. These organisms
need iron to proliferate, but lactoferrin, by absorbing excess iron
in the body, deprives them of this necessary nutrient. Studies indicate
that lactoferrin may be able to bind to and damage the cell membranes
of some bacteria, an anti-bacterial effect independent of its iron-binding
TIPS FOR KEEPING IRON TO A MINIMUM
1. Avoid alcohol
2. Avoid breakfast cereals high in iron
3. Avoid red meat
4. Avoid cooking in cast iron cookware
5. Avoid raw shellfish
6. Avoid taking vitamin C with meals (or drinking citrus juice at
SOME THERAPIES USED TO COMBAT IRON OVERLOAD
PHLEBOTOMY This is an iron reduction therapy involving "blood-letting".
CHELATION THERAPY I found some information on this "controversial"
therapy at the Alternative Medicine.com website: Go to alternativemedicine.com
and enter "chelation therapy" as a search word. CHELATION
"Chelation refers to the ability of a chemical compound to grab
on to a mineral. Chelation therapy is used to remove toxic minerals
(such as lead) and metabolic wastes from the body. It also increases
blood flow and removes arterial plaque. Basically, chelation removes
charged minerals, but in doing so, it also may help your body's enzymes
to function better, thus directly leading to the elimination of toxic
"In chelation, the patient recieves a series of EDTA infusions,
plus vitamin C, magnesium, and other ingredients, given in the doctor's
office. Usually 2 infusions per week are given, lasting 3 hours each.
Most patients get at least 20 to 30 infusions, each costing between
$90-$125 per infusion. Unfortunately, because mainstream medicine
does not accept this approach for treating heart and blood vessel
disease, Medicare and most other insurance plans do not reimburse
for this therapy."
"Although most conventional physicians believe no medical literature
exists to support the use of EDTA chelation therapy for heart disease,
this is not true. At least 40 clinical studies have been published
and 38 show positive results. Meanwhile, you should know that hundreds
of physicians in the U.S. and other countries believe chelation therapy
is the best available treatment for these conditions."
"With regard to safety, the American College for Advancement in
Medicine (ACAM), which conducts workshops for doctors on chelation
therapy, estimates that at least 500,000 patients have received this
therapy without a single death attributable to EDTA, when the ACAM
protocol is followed. This makes it one of the safest therapies of
COLONICS Coffee retention enemas (retained for about 15 minutes)
are reported to have a powerful impact and can also eliminate excess
iron. Some people use chamomile instead. I read about this in Matthew
Dolan's book The
Hepatitis C Handbook.
WHO IS AT RISK FOR IRON OVERLOAD?
It is my conclusion from what I have read that Hep C patients in
general have a tendency more so than "normal" healthy individuals
to store iron. However, amongst Hep C patients, males have more of
a tendency to store iron than females (due to menestuation in females).
A quote from The
Hep C Handbook by Matthew Dolan, "males have been observed to
suffer from more severe liver disease and faster progression... higher
levels of iron are linked to disease progression." It is also known
that patients with a history of drinking tend to have higher levels
of iron deposition in the liver cells.
Patients with beta-thalassemia major and sickle cell anemia who
suffer from iron overload due to regular blood transfusions or excessive
destruction of red blood cells need specialized medical treatment
with iron chelators and should also control their intake of iron.
It is advised that vitamin C be generally avoided by people with these
conditions due to the fact that vitamin C facilitates the uptake of
A mild to moderate iron excess is found in patients with liver diseases
apparently unrelated to genetic hemochromatosis. Iron appears to affect
the natural history of hepatitis C virus-related chronic liver diseases,
alcoholic liver disease and nonalcoholic steatohepatitis by leading
to a more severe fibrosis and thus aiding the evolution to cirrhosis.
A higher frequency of mutations of the HFE gene, the gene responsible
for hereditary hemochromatosis, is found in patients with liver diseases
and increased liver iron than in normal patients. Patients with excess
iron are potentially at a higher risk of developing hepatocellular
carcinoma. Iron depletion therapy could interfere with fibrosis development
and possibly reduce the risk of liver cancer occurrence.
VITAMIN C CAN INCREASE IRON UPTAKE, HEP C PATIENTS SHOULD AVOID
Vitamin C may have a dark side. Vitamin C increases iron uptake
and hypothetically this could lead to iron accumulation in those with
an inherited tendency to store iron. That is, unless the Iron is water-soluble.
(See Iron in the Mineral Section). Iron and vitamin C spontaneously
form free radicals (pro-oxidant effect). Excessive vitamin C supplementation
together with excessive iron storage may be detrimental. However,
under usual physiologic conditions, the amount of free iron would
likely be very small; it would be stored in the iron binding protein
FERRITIN. With injury or inflammation some iron could be released
and could react with hydrogen peroxide to produce damaging free radicals.
In susceptible people large amounts of vitamin C could promote the
appearance of oxalate in the urine, thus increasing the risk of kidney
stones. Supplementing with magnesium and extra vitamin B6 can diminish
this risk. To
see internet resource on this topic
see a list of side effects of excessive vitamin C supplements
I sent an email to Dr. Reichen regarding this topic and he wrote
me back with this answer:
"The value of high dose vitamin C has never been proven but some
people - even Nobel prize winners - firmly believed in it. I have
some patients who swear on it - all I can say it does not affect their
viral load. Vitamin C clearly enhances uptake of iron in all people;
my guess is that it does this more in patients heterozygote for HFE
(the hemochromatosis gene) since they cannot fully control their iron
uptake. Thus, in a patient with already high iron loads I would definitively
recommend *against* high dose vitamin C supplementation. If the patient
were to insist I would advise him/her to have phlebotomies - this
has clearly been shown to improve liver histology. In in vitro systems
(liver mitochondria) vitamin C at usual concentrations (even those
you attain with high dose vitamin C) vitamin C is a pro-oxidant. Only
at very high concentrations (not attainable by supplementation) will
it become an antioxidant."
vitamin C: a risk for persons with high iron stores?
Source: Int J Vitam Nutr Res 1999 Mar;69(2):67-82 Author: Gerster
H Institution: Vitamin Research Department, F. Hoffmann-La Roche Ltd,
Abstract: The contribution of vitamin C (ascorbic acid) to the prevention
of iron deficiency anemia by promoting the absorption of dietary non-heme
iron-especially in persons with low iron stores--is well established.
But the question has been raised whether high-dose intakes of vitamin
C might unduly enhance the absorption of dietary iron in persons with
high iron stores or in patients with iron overload, possibly increasing
the potential risk of iron toxicity. Extensive studies have shown
that overall the uptake and storage of iron in humans is efficiently
controlled by a network of regulatory mechanisms. Even high vitamin
C intakes do not cause iron imbalance in healthy persons and probably
in persons who are heterozygous for hemochromatosis. The uptake, renal
tubular reabsorption and storage of vitamin C itself are also strictly
limited after high-dose intake so that no excessive plasma and tissue
concentrations of vitamin C are produced. The effect of high-dose
vitamin C on iron absorption in patients with iron overload due to
homozygous hemochromatosis has not been studied. Of special importance
is the early identification of hemochromatosis patients, which is
assisted by the newly developed PCR test for hereditary hemochromatosis.
Specific treatment consists of regular phlebotomy and possibly iron-chelating
therapy. These patients should moreover avoid any possibility of facilitated
absorption of iron and need to limit their intake of iron. Patients
with beta-thalassemia major and sickle cell anemia who suffer from
iron overload due to regular blood transfusions or excessive destruction
of red blood cells need specialized medical treatment with iron chelators
and should also control their intake of iron. The serum of patients
with pathological iron overload can contain non-transferrin-bound
iron inducing lipid peroxidation with subsequent consumption of antioxidants
such as vitamin E and vitamin C. The role of iron in coronary heart
disease and cancer is controversial. Early suggestions that moderately
elevated iron stores are associated with an increased risk of CHD
have not been confirmed by later studies. In vitro, ascorbic acid
can act as a prooxidant in the presence of transition metals such
as iron or copper, but in the living organism its major functions
are as an antioxidant. High intakes of vitamin C have thus not been
found to increase oxidative damage in humans.
Accordingly, the risk of CHD or cancer is not elevated. On the contrary,
most studies have shown that diets rich in vitamin C are inversely
related to the incidence of these diseases.
CONCLUSION: I decided to write this article, which is just a "gathering"
of information made possible by a lot of other people, not the least
of which is the E-group I belong to Hep
C Web Warriors I would like to acknowledge all the helpful individuals
who helped gather the information on the internet. The reason for
writing the article is because this is a common question that I get
asked from visitors to my website healthyhepper.com
HERE IS A SUMMARY OF WHAT WE LEARNED:
DO NOT take vitamin C with meals
DO take calcium with meals
DO drink green tea with meals
AVOID cooking in iron skillets
AVOID red meat
AVOID cereals with high-iron
AVOID raw shellfish
DO eat and drink soy products
DO NOT take a multi-vitamin that has iron
Green Tea Polyphenols
I hope this report has been helpful. If you have any questions about
Hep C and nurtitional supplementation please send some feedback through
my website. Anna Rockenbaugh, healthyhepper.com
DISCLAIMER: None of the information included in this report, in
my publications, or on my website is intended to diagnose, treat or
cure any medical condition. This is educational information only and
does not replace the treatment from a qualified medical professional.
Please see medical advise for your condition.