Care for a cup of tea? Vs A glass of orange juice? Both r good for Thalassemics!

O.K this is actually not an iron chelator and I couldn't find a better place to put this article

BUT!! studies shows that drinking tea after having a meal (Especially iron rich food like Spinach, meat and apples etc) reduces the absorption of iron from that food!

On the other hand, when you are taking an iron chelator, you should NOT take tea before your chealor, instead take fruit juice (esp. citrus fruits such as oranges etc) or Vitamin C pills, because it is totally opposite of tea as Vitamin C incaeases the absorption of iron stored in the organs to the blood stream and thus increasing the opportuinty for your chelator to work more efficiently.

So, if you're not using any chelating pills during your meals, don't drink orange juice, instead add a cup of tea to the menu! or vice versa if you do take chelating pills!

At the Dubai conference several times I heard that drinking tea with meals does decrease the amount of iron that will be absorbed by the gut. Studies have shown this to be true. The doctors speaking did agree that it works but they weren't really sure if there is any difference between the effects of green tea and black tea, but they did seem to feel that both do reduce iron absorption from food, and it was recommended as a standard practice for thals. I would think this may have an even higher special significance to non-transfusing thals who suffer from iron overload from iron absorbed by their gut.
Iron absorption by the gut is a serious problem in thals and there is some suspicion that this happens even in minor in some thals, but the effects of dietary iron are sometimes downplayed by transfusing thals, but thals do absorb far much more iron from their guts than non thals do, as the body tries to compensate for the anemia by absorbing iron. Over a period of time, iron absorption from the gut can cause or add to serious iron overload in many patients and dietary iron intake should be considered and kept to a minimum if possible.

Vitamin C has long been recommended to be taken at the same time as desferal, as it releases more of the body's iron into the blood where it can be removed by the desferal. The dose is usually limited to 100-250 mg/day, because higher doses of Vitamin C have been shown to release too much iron into the blood, sometimes resulting in clumping in the heart which can significantly reduce heart activity, and even possibily cause heart failure.

Iron absorption by the gut is a serious problem in thals and there is some suspicion that this happens even in minor in some thals, but the effects of dietary iron are sometimes downplayed by transfusing thals, but thals do absorb far much more iron from their guts than non thals do, as the body tries to compensate for the anemia by absorbing iron. Over a period of time, iron absorption from the gut can cause or add to serious iron overload in many patients and dietary iron intake should be considered and kept to a minimum if possible.

Andy, that's an interesting line of thought you open up there (emphasis mine).
I am one of the transfusing thals that have never given much thought to how much iron is absorbed through the gut, because in my view, it pales in comparison to the amount of iron that comes through each transfusion. But, if what you are saying is indeed true that thals absorb MORE iron than others through the gut, then that is cause for concern. Do you have any data sources that lead you to this conclusion?

Tea, on the other hand, is now well accepted as a "therapeutic" agent in India!! We are not a tea-drinking nation just for the heck of it  .  Besides, this property to apparently lower the absorption of iron, it is also very good at managing other "free radicals" in the system.

The first thing you might ask is why bother with tea to reduce the amount of iron absorbed by the gut if it's not a problem in thal major. It does seem to be related to the Hb level, and unfortunately, many thals do not reach or even approach normal Hb levels, resulting in increased absorption of iron in the gut. One of the goals of transfusion is to reduce the amount of iron that is absorbed in the gut.

From   Advice from the  Mumbai Thalassaemic Society Newsletter

*Drinking tea in any form, any number of times a day, before, during and after meals is a healthy life style for “Thal. Major” patients, due to it being extremely rich in anti-oxidants called “Flovonoids”. It contributes towards healthy cardio vascular functions and neutralizes cell-damaging free radicals. But the best is Tannin which helps remove iron digested from the natural foods in the gut.
    * Thalassaemics should avoid eating Red Meat (wether mutton, beef, pork, as well as dark meat of chiken, Sea food such as Sardines, Mussels, Cockales, as it is very rich source of iron.)

    * Pickles, Soya Souce, Vinegar & other fermented vegetables enhance iron absorption.

    * Milk intake, if possible, should be at least 3/4 litre a day, because it is rich source of calcuim, which helps prevent osteporosis.

    * Milk, cheese, Dahi helps decrease food iron absorption in our body.

In general, in regards to iron absorption in thal, from the website at

Thalassemia and increased gut absorption of iron

In any anemic state, there is increased gut absorption of iron. Even in non-transfused patients, iron overload is often noted in the more severe forms of thalassemia. Since thalassemia is not an iron deficiency problem, it is not be corrected by additional iron. In fact, in thalassemia over time, the body becomes iron overloaded, and iron is "stored" in the organs (liver, endocrine organs and heart), which can cause significant morbidity and mortality.

And from   Iron Overload in Thalassemia

Two factors contribute to iron overload in a thalassemic child:

a) Enhanced gastrointestinal absorption of iron.

b) Transfusional siderosis.

And interestingly, this is related to the ineffective production of red blood cells in the bone marrow...

From
Inappropriate absorption of iron

When anemia is accompanied by ineffective erythropoiesis, inappropriate absorption of iron from the gastrointestinal tract seems to be activated. Patients with anemias in which ineffective erythropoiesis does not play a role seem much less prone to hyperabsorb iron. Thus, it is patients with ineffective erythropoiesis who develop the largest iron burdens. Among the hereditary forms, the most common are the thalassemias...

One finding has shown a relationship between the the iron-regulating hormone, hepcidin being suppressed in thalassemia patients and iron overload.

From     Iron Overload

Inappropriate hepcidin expression in thalassemia may explain the increased iron absorption that even persists despite massive increases in total body iron load

The most severe danger of iron overload from the gut exists in non-transfusing intermedias, but there is some degree of excess iron absorption in the gut in all anemias.

Gee... All I knew about it was what I just said. I didn't know about all the scientific background behind that harmless little cup!

Thanks Captain Thal. Care!

Please also share your expertise on Vitamin C too. You acknowleged my statement that it increases the efficiency of Desferal! but what about the efficiency of other pills such as Exjade, Kelfer/Ferriprox etc.

I have never heard of any studies involving the combination of Vitamin C with any chelator other than desferal. .

This is from one of my favorite sites, the Northern Comprehensive Thalassemia Center, (Elliott Vichinsky, MD
Director).

The Vitamin C/Ferritin/Iron Connection

By increasing the pool of metabolically active iron in the cell, vitamin C increases the pool of iron available for chelation by Desferal. However, too much free iron can cause heart and other problems; thus moderate doses of vitamin taken shortly after starting Desferal infusions will provide optimal iron removal. People who are heavily iron overloaded should not ingest foods such as citrus and some vitamins in large quantities that would give them, for example, a gram (1000 mg) of ascorbic acid a day.

Howeve, this is straight from Cipla, manufacturers of kelfer.

Kelfer

The safety of concurrent use of deferiprone and Vitamin C has not been formally studied. Based on the reported adverse interaction that can occur between deferoxamine and Vitamin C, caution should be used when administering concurrent deferiprone and Vitamin C.

I think sticking to natural Vitamin C found in fruits and vegetables is probably the best source in this case, but it is advised that they be eaten separately from meals as Vitamin C increases iron absorption from foods.