Discussion Forums > Diet, Nutrition and Supplements
Multivitamins for thal major children
Andy Battaglia:
Umair,
I have posed this question to Apo Pharma, makers of Ferriprox, and was told they don't know if it's been tested. Cipla also hasn't tested C with L1. It may seem in theory that C would help add more iron to be chelated but without trials, it is only speculation, so we can't make any statement to that effect.
I think many people are missing the point. Vitamin C is not just something that is to be taken with desferal to remove more iron. Vitamin C is an essential nutrient and most thals are deficient. Thals should not take high doses of C but they should get what is safe. This has nothing to do with chelation. It is all about maintaining optimal health.
Sharmin:
Thanks Andy,
In recent months I finally began understanding and appreciating the importance for thals of taking supplements to support the cardiopulmonary system. A major problem in thals is hypertension and heart failure - this results from iron overload as well as issues with the arteries - so we need to prevent both! Vitamin C plays a very important role in protecting the blood vessels, and keeping them flexible that is why vitamin C deficiency in thals can cause trouble. Thals, despite having low hg can have high blood volume, so the blood vessels need to be able to compensate for the changes in blood volume in thals. Vitamin C, L-carnitine, L-argenine, watermelon - can all help keep your blood vessels healthy. Vitamin C also plays an important role in immunity, bone health and many other functions.
The role that vitamin C can play in chelation is a seperate matter. With desferal this is a little more clear - as vitamin C causes organs to release iron into the plasma - desferal mops up this iron from the plasma and excretes it. This mechanism helps desferal chelation because desferal itself is not able to enter cells and tissue to remove iron - so when vitamin C expels the iron desferal has more iron to remove.
With L1 and exjade - we know that these chelators are good at removing iron from tissue - so the need for vitamin C for this particular purpose MAY NOT be the same. The other thing is that we don't know if L1 and exjade are as efficient at removing iron from plasma - therefore, in theory if you take a large dose of vitamin C with L1 or exjade - it may not be mopped up quickly as it would be by the desferal.
Regardless, we need to find a way for thals to get the vitamin C that they desperately need - I am wondering whether it is better to take it in small doses between meals throughout the day for patients who do not use desferal - and 250mg 1/2 after chelation for those who do use desferal. I will try to get more information during our next visit to Oakland, as little A's desferal may be decreased to 2 or 3 days a week - and I want to ensure that he gets enough vitamin C even when he is using only exjade.
Andy, am I understanding this correctly?
Sharmin
Andy Battaglia:
Vitamin C is best taken multiple times each day because it washes through the body so quickly. Small doses at least twice daily would be best and until we can learn more about what this study showed, I think it is prudent to continue to take vitamin C and citrus fruits between meals. I think that even small doses can do a lot for the health of thals, so it is important to think of C as necessary and not just for those taking desferal.
Manal:
--- Quote ---If the thinking that iron intake is increased by vitamin C intake is based on a model and not the result of studies, one may conclude that the model is wrong,
--- End quote ---
Andy, what do you mean by a model and how it differs from a study??
manal
Andy Battaglia:
Manal,
A model is basically a given set of conditions and the results that would be expected from that set of conditions. A study as cited here, involves studying actual human subjects and observing what is happening in the real world. In this case, what was seen was NOT what was expected and in fact resulted in the suggestion that eating non-citrus fruits may actually cause a reduction in serum ferritin levels. I would guess that the beneficial value of eating fruits is a factor here and is having some positive effect on serum ferritin. This may tun out to be a no-brainer and the obvious is the answer. People who eat a lot of fruit generally have a better diet and would most likely be in better health than those whose diets are not healthy. Being thalassemic doesn't change these facts, and thals can expect to benefit from a good diet just like anyone else.
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