Thalassemia Patients and Friends

Discussion Forums => Iron Chelation Corner => Topic started by: ironjustice on June 22, 2012, 04:30:30 PM

Title: Vitamin C enhances Chelation
Post by: ironjustice on June 22, 2012, 04:30:30 PM
Exp Hematol. 2012 Jun 16. [Epub ahead of print]
Ascorbate status modulates reticuloendothelial iron stores and response to deferasirox iron chelation in ascorbate deficient rats.
Brewer C, Otto-Duessel M, Lykkesfeldt J, Nick H, Wood J.
SourceDivision of Pediatric Cardiology, Children's Hospital Los Angeles.

Abstract
Iron chelation is essential to patients on chronic blood transfusions to prevent toxicity from iron overload and remove excess iron. Deferasirox (DFX) is the most commonly used iron chelator in the United States; however, some patients are relatively refractory to DFX therapy. We postulated that vitamin C supplementation would improve the availability of transfusional iron to DFX treatment by promoting iron's redox cycling, increasing its soluble ferrous form and promoting its release from reticuloendothelial cells. Osteogenic dystrophy rats (N=54) were given iron dextran injections for 10 weeks. Cardiac and liver iron levels were measured after iron loading (N=18), 12 weeks of sham chelation (N=18), and 12 weeks of DFX chelation (N=18) at 75 mg/kg/day. Ascorbate supplementation of 150 ppm, 900 ppm, and 2250 ppm was used in the chow to mimic a broad range of ascorbate status; plasma ascorbate levels were 5.4±1.9, 8.2±1.4, 23.6±9.8 uM, respectively (p<0.0001). The most severe ascorbate deficiency produced reticuloenthelial retention, lowering total hepatic iron by 29% at the end of iron loading (p<0.05) and limiting iron redistribution from cardiac and hepatic macrophages during 12 weeks of sham chelation. Most importantly, ascorbate supplementation at 2250 ppm improved DFX efficiency, allowing DFX to remove 21% more hepatic iron than ascorbate supplementation with 900 ppm or 150 ppm (p<0.05). We conclude that vitamin C status modulates the release of iron from the reticuloendothelial system and correlates positively with DFX chelation efficiency. Our findings suggest that ascorbate status should be probed in patients with unsatisfactory response to DFX.

Copyright © 2012 ISEH - Society for Hematology and Stem Cells. Published by Elsevier Inc. All rights reserved.

PMID:22713799
Title: Re: Vitamin C enhances Chelation
Post by: Andy Battaglia on June 22, 2012, 04:51:19 PM
Thanks for posting this. Vitamin C has gotten a bad rap concerning thals and it needs to be re-examined. With this info, we can now confidently recommend that C be taken with Exjade.
Title: Re: Vitamin C enhances Chelation
Post by: Pratik on June 22, 2012, 06:42:39 PM
That's fantastic. So I should take adequate amount of Vit. C now?
Title: Re: Vitamin C enhances Chelation
Post by: Dharmesh on June 24, 2012, 11:08:34 AM
Hi Andy,
I want to share my personal experience.
Since Last Ten days i am taking Asunra with Orange Juice Natural(Mosumbi). Till then from 2008 i was taking the Desirox and Asunra with plain water.
What the difference i see is that the color of faeces is dark black which was not prior to taking Asunra with Orange Juice.
So I think Vit C is very helpful
Dharmesh
Title: Re: Vitamin C enhances Chelation
Post by: Andy Battaglia on June 24, 2012, 03:40:46 PM
Yes, vitamin C makes more iron available for chelation. However, with high iron loads, the dose of C has to be limited. The maximum per day is 250 mg.
Title: Re: Vitamin C enhances Chelation
Post by: ironjustice on June 25, 2012, 12:04:09 AM
Andy , you say 250 mg per day but the article says , ppm ? The article is specific that it HAS to be the highest amount of the three amounts used , 2250 ppm . I cannot calculate enough to see if your 250 mg is the same ? You have any ideas whether the 250 mg jibes with the 2250 ppm ?
Title: Re: Vitamin C enhances Chelation
Post by: Andy Battaglia on June 25, 2012, 01:36:23 AM
The maximum suggested dose for transfusing thals is 250 mg. Most doctors will only recommend 100-200 mg and only when taking desferal. This is based on a study that showed that doses of 800 mg freed so much iron into the blood that it caused a reduction in heart function because so much iron reached the heart. I wish that more study had been done because all thals should not be lumped together. Thals with very low iron loads would be in much less danger, if at all. The ppm is based on the weight of the individual. I cannot extrapolate what this means in terms of this study. My point about 250 mg daily is to try to get thals to take this essential nutrient safely, as it has great use beyond chelation in the body.
Title: Re: Vitamin C enhances Chelation
Post by: Pratik on June 26, 2012, 06:24:06 AM
Hi Andy,

So can I take Vitamin C (preferably orange juice) it with Exjade?
Title: Re: Vitamin C enhances Chelation
Post by: Andy Battaglia on June 26, 2012, 01:36:40 PM
I would suggest trying to get most of your vitamin C from diet. Don't overdue it, but I feel that having citrus is beneficial in many ways and may also boost your chelation effort a bit.
Title: Re: Vitamin C enhances Chelation
Post by: Pratik on June 27, 2012, 07:18:09 PM
Hi Andy, just started it and no I only take around half small glass (plus water added) in morning and another half in evening considering split dosage in mind.

Would you think Lemon would also work as it's also a citrus element (and I believe it has higher Vit. C than orange) ?

-Pratik.
Title: Re: Vitamin C enhances Chelation
Post by: Waleed on July 22, 2012, 08:54:21 PM
Desferal document says to start Vit-C supplementation not before one month regular chelation therapy. I am in doubt to wait for 2 weeks or just start supplementation now since i have high iron overload.
Title: Re: Vitamin C enhances Chelation
Post by: Andy Battaglia on July 23, 2012, 04:29:43 AM
You can take smaller amounts all the time. It is advised to be on desferal for one month before increasing the dose. If your ferritin is high, the desferal will most likely find plenty of iron to chelate without added C. Is it possible for you to also use Kelfer or Ferriprox in combination with the desferal?

From the Standards of Care
Quote
Ascorbic acid (vitamin C)
75 to 90 mg/day
If on chelation, 100 to 250 mg/day
recommended.

Title: Re: Vitamin C enhances Chelation
Post by: Waleed on July 24, 2012, 03:00:03 PM
I am on 24/7 subcutaneous pump 2gram desferal for 24 hours plus 7 tablets 500mg Kelfer. Just thinking to add Vit C to add effects.
Title: Re: Vitamin C enhances Chelation
Post by: Dharmesh on October 08, 2012, 09:35:53 AM
See the Extracts of the Defrijet (Deferasirox/DFX) Literature

'' The concomitant administration of deferasirox and Vitamin C has not been formally studied. Doses of vitamin C up to 200 mg were allowed in clinical studies WITHOUT NEGATIVE CONSEQUENCES.''

So we can take 200 mg Vitamin C easily without any worry with DFX
Title: Re: Vitamin C enhances Chelation
Post by: Lokkhi maa on May 31, 2015, 07:34:18 AM
Dear all,

My 20 months old baby still not start chelaton therapy by Exjade or Asunra. Her ferritin is 459. I was read this forum that Lemon water taking  before 1 or 2 hrs of lunch is helpful for those whose are getting chelaton. What will I do? May I give lemon juice  or vitamin C to my baby how much?

Best Regards
Title: Re: Vitamin C enhances Chelation
Post by: Andy Battaglia on May 31, 2015, 10:12:49 PM
Your baby isn't chelating, so adding lemon juice will not help lower iron. However, your baby needs some vitamin C, so lemon juice if good. Don't take it with meals, though. It will cause more iron to be absorbed from foods if high vitamin C foods are taken with them, so always take citrus between meals to avoid added iron absorption.
Title: Re: Vitamin C enhances Chelation
Post by: Nomad on August 25, 2015, 12:24:53 AM
Andy, I got pure vit. C in powder. Do you think I can put it right in the glass of water with the exjade? I do take 1000mg exjade in the afternoon and about 120mg vit C. In the morning and evening I take 2500mg ferriprox.
Title: Re: Vitamin C enhances Chelation
Post by: Andy Battaglia on August 25, 2015, 03:28:53 PM
You could mix small amounts in with the same water. I take it dry. 3 grams on the tongue and water to wash it down. Whatever works for you.
Title: Re: Vitamin C enhances Chelation
Post by: Nomad on August 25, 2015, 07:03:28 PM
3 grams!? Oh I forgot you're not a Thalassaemic :wink
Andy what do you think about α-lipoic acid to scavenge iron from the liver? Since they are using it for other heavy metals too?
Title: Re: Vitamin C enhances Chelation
Post by: Andy Battaglia on August 26, 2015, 12:10:36 AM
Alpha lipoic acid is a good antioxidant and it increases the formation of glutathione, which is a powerful antioxidant. It's properties include free radical scavenging, metal chelation and regeneration of other antioxidants, so it does have value in thalassemia.
Title: Re: Vitamin C enhances Chelation
Post by: Nomad on August 26, 2015, 12:18:24 AM
Good.  Then I will continue taking it. I take it every morning on empty stomach 900mg and the urine stinks like a sulfurous smell. Maybe a sign of detox?
Title: Re: Vitamin C enhances Chelation
Post by: Andy Battaglia on August 26, 2015, 01:39:43 AM
ALA contains sulfur, hence the odor.