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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 is consumed.

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 reads:

"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

SUPPLEMENTS:

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 place.

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

SOY PRODUCTS

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 ability. LACTOFERRIN

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 meals)

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 THERAPY

"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 wastes."

"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 modern medicine."

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 iron.

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 IRON

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

To see a list of side effects of excessive vitamin C supplements

DR. REICHEN

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."

High-dose 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, Basel, Switzerland.

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 alcohol

AVOID raw shellfish

DO eat and drink soy products

DO NOT take a multi-vitamin that has iron

SUGGESTED SUPPLEMENTS

IP6

Vitamin B6

Magnesium

Calcium

Green Tea Polyphenols

Milk Thistle

Lactoferrin

Phytic Acid

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.