Re: Decrease in running ability with increased hemoglobin>>" The subjects in this study were non-athletic healthy young men. The high
rate of abnormally low hemoglobin and ferritin values probably
indicates a
nutritional deficit in this population"
But I have been led to beleive this is impossible ? <<
What is impossible .. ?
A nutritional deficit .. ?
Which nutritional deficit .. ?
Iron .. ?
"non-athletic healthy young men"
**Men** who are .. iron deficient .. ?
Does that .. exist .. ?
Sooo .. it must mean .. the SAME .. as in Indian anemia or Brazilian
anemia .. both treated with vitamin C .. and cured ..
No lack of iron .. lack of vitamin C ..
"we instead suggest vitamin C tablets (500 mg) to be
given twice daily after every major meal. This will improve iron
status and correct anemia as shown in this study. In contrast to
iron
preparations ascorbic acid is well tolerated, quite palatable and
harmless. "
CORRECTION OF ANEMIA AND IRON DEFICIENCY IN VEGETARIANS BY
ADMINISTRATION OF
ASCORBIC ACID
DINESH C. SHARMA* AND RATI MATHUR
*Corresponding Author
Department of Biochemistry S M S Medical College, Jaipur - 302
004
(Received on December 8, 1994)
Abstract: Twenty-eight strict vegetarians were given 500 mg
ascorbic
acid twice daily after lunch and dinner for two months. Hemoglobin
and
certain iron status parameters were measured before and after the
treatment. Ascorbate treatment increased mean hemoglobin by 8%,
serum
iron by 17% and transferrin saturation by 23% and decreased total
iron
binding capacity by 7%. All these changes were statistically
significant. The rise in serum ferritin was 12%. The serum protein
or
copper level did not indicate their dietary deficiency, while
initial
serum ascorbate level were low which rose by 60% on therapy. It is
concluded that ascorbate supplementation is a better method of
improving hematologic and iron status than iron salt
administration.
Key words: ascorbic acid, iron deficiency, anemia, vegetarians,
hemoglobin, iron, ferritin
INTRODUCTION
Anemia is the second most common affliction in the world and iron
deficiency is the most common cause of it (1). The incidence of
iron
deficiency anemia is much greater in India than western countries,
despite the fact that daily iron intake of Indians is twice that
of
westerners (2, 3). This apparent paradox is attributed to
consumption
of predominantly cereal based diet, rich in phytate, oxalates,
phosphates, fiber and other inhibitors of iron absorption, by the
majority of Indians who practice vegetarianism on account of
religion
or poverty (4, 5). So we had found significantly lower serum iron
in
healthy vegetarians as compared to healthy non-vegetarians (6).
Similarly vegetarian parturient women had significantly lower
hemoglobin, serum iron and transferrin saturation in comparison to
their non-vegetarian counterparts (7). Recently in a closely
matched
study all the parameters (hemoglobin, serum iron, transferrin
saturation and ferritin) were significantly lower in vegetarian
women
and their newborns, respectively, despite having received
supplemental
iron (Ferrous sulphate=60 mg Fe) for about six months during
antenatal
period (5). The absence of expected response in hemoglobin
regeneration was perhaps due to the fact the vegetarian diet was
not
deficient in iron but some other nutrient. The dietary survey of
vegetarian mothers revealed that their diet was lacking in
ascorbic
acid as the consumption of fruits and citrus fruits was meagre
(5).
The present study was, therefore, undertaken to see the effect of
administration of ascorbic acid on hemoglobin and iron status of
strictly vegetarian people.
METHODS
The subjects of this study were taken from the staff of the
Department
of Biochemistry, medical and nursing students, neighbours etc. who
volunteered for the study and were vegetarians. All person were
known
to be healthy so that the drug compliance could be checked
frequently
and follow up was easy. They were selected on the basis of their
dietary habit (vegetarianism) rather than initial hemoglobin
level.
All the subjects were free from infection and inflammation which
are
known to affect serum iron, total iron binding capacity and
ferritin
values (3).
The study started with 36 persons but ended with 28; eight persons
discontinued vitamin tablets or were erratic in taking them. All
the
subjects were asked to take a 500 mg ascorbic acid tablet (Celin,
Glaxo) within half an hour after lunch and dinner regularly for
two
months. Then each person received 1 gm ascorbic acid daily and a
total
of 60 gm during the study. The dose was not large enough to cause
any
harmful effect. No one had complained of any side effect. The
subjects
were not allowed to take any hematinic during this study.
The blood was collected before and after the drug trial. The
following
estimations were performed on both the samples immediately after
the
collection - blood hemoglobin (Hb) (cyanmethemoglobin method),
serum
iron (8), total iron binding capacity (TIBC) (8), percent
saturation
(PS), (by calculation), serum ferritin (9), serum copper (10),
total
proteins (11) and ascorbic acid (12).
An oral questionnaire method was used to find out the details of
the
diet intake and dietary habits of all the subjects studied.
The results were statistically analyzed by the paired `t' test
(13).
The critical level of significance was 5 percent (probability,
0.05).
RESULTS
Out of 28 subjects of this study, 10 were male, 18 were female, and
28
had initial Hb level below the WHO normal range. Their age ranged
between 18-50 years. All were vegetarians and had regularly taken
vitamin C tablets. This is confirmed by a rise in ascorbic acid of
about 60% in two months time (Table I)
The pre- and post-treatment values are shown in Table I. There was
a
statistically significant rise in blood hemoglobin, highly
significant
rise in serum iron and a significant fall in total iron binding
capacity. The rise in transferrin saturation of plasma was highly
significant. Interestingly, the response to therapy was better in
those who were iron deficient/anemic. Serum ferritin level also
showed
a rise but statistically insignificant. It may be because (i) the
normal range of serum ferritin is very wide, (ii) increased iron
was
preferentially utilized for hemoglobin regeneration rather than
storage, and (iii) ferritin reflects storage iron which was not
expected to rise appreciably in such a short time.
TABLE I. : Hematalogic and iron status of vegetarians before and
after
ascorbate treatment
Parameter
Pre-treatment level
Post-treatment level
"t"
(paired)
"P"
Percent
rise
Hemoglobin (g/dl) 10.10 ± 01.80 10.90 ± 01.40 5.81 <0.001 07.90
Iron (µg/dl) 63.70 ± 13.70 74.50 ± 13.00 6.36 <0.001 16.90
Total Iron Binding Capacity (µg/dl) 325.30 ± 49.60 301.70 ±55.40
-3.62
<0.010 -07.20
Percent Saturation (%) 19.90 ± 05.40 24.40 ± 04.90 4.32 <0.001
22.60
Ferritin (ng/ml) 39.90 ± 39.30 44.70 ± 40.80 1.23 NS 12.00
Ascorbic Acid (mg/dl) 00.47 ± 00.10 00.75 ± 00.20 7.03 <0.001
59.50
Total Proteins (g/dl) 08.33 ± 00.47 06.42 ± 00.43 0.09 NS 01.40
Copper (µg/dl ) 80.90 ± 18.00 81.40 ± 19.30 0.53 NS 00.60
All values are Mean ± SD; NS-Indicates Not Significant
DISCUSSION
The improvement in iron status and correction of anemia in
vegetarians
by giving only ascorbic acid is a very important finding. Such
studies
were also conducted in the past but the results were not
conclusive
(14), because the studies were multifactorial (14).
The role of ascorbic acid in iron metabolism is manyfold. It
reduces
ferric iron to ferrous form which is then absorbed, lowers the pH
which is conducive to iron absorption, reverses the inhibitory
effect
of phytate, oxalate, phosphate etc., and also forms chelate with
iron
for absorption (15).
As dietary proteins and copper also affect iron absorption and
utilization, so in this study total serum proteins and serum
copper
were also estimated. Their levels were within normal range (16)
suggesting nutritional adequacy of these nutrients. On the other
hand
ascorbate level in serum was low or on the lower side of normal
(16)
indicating inadequate vitamin C nutrition. This confirms our
contention of Vitamin C nutritional inadequacy in vegetarian
population on account of meagre intake of fruits, especially
citrus
fruits (5). The intake of fruits by subjects of present study was
also
very bow, as revealed by diet survey during oral questionnaire.
The control of nutritional anemia is one of the national health
programme of Government of India (17) and pregnant women are
advised
to take ferrous sulphate tablets. As iron preparations did not
give
desired response in our previous study (5) and are not well
tolerated
by many persons we instead suggest vitamin C tablets (500 mg) to
be
given twice daily after every major meal. This will improve iron
status and correct anemia as shown in this study. In contrast to
iron
preparations ascorbic acid is well tolerated, quite palatable and
harmless. The risk of forming oxalate stones was reported with
only
megadoses of vitamin C (18), and even this was not confirmed in
experimental animals (19). In addition, the daily consumption of
vitamin C may confer following benefits (20) - prevent common cold
and
other viral infections, retard atherosclerosis, decrease risk of
cancer, slow down ageing and reduce toxicity of metals.
It is hoped that this study will stimulate further work in this
field
and that physicians will see the need for prescribing vitamin `C'
tablets instead of iron tablets for amelioration of anemia or iron
deficiency, especially because men and women need to absorb only
1.14
to 2.38 mg of iron per day (21) while the actual intake iron
vegetarian diet in this region is calculated to range from 22.0 to
37.0 mg per day (22).
ACKNOWLEDGEMENTS
This work was supported by a Research Grant from S.M.S. Medical
College, Jaipur for which we are thankful to the Principal, Dr. P.
L.
Nawalakha.
REFERENCES
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world. World Health Stat Q 1985;38:302-316.
2. Baker SJ, DeMeayer EM. Nutritional anemia: Its understanding
and
control with special reference to the work of the World Health
Organisation. Am J Clin Nutr 1979; 32:368-417.
3. Sharma DC, Mathur R, Singh PP. Iron metabolism: A review. Ind
J
Clin Biochem 1993;8:80-101.
4. Dwyer JT. Nutritional consequences of vegetarianism. Ann Rev
Nutr
1991;11:61-91.
5. Sharma DC, Kiran R, Ramnath, V, Khushlani K, Singh PP. Iron
deficiency and anemia in vegetarian mothers and their new-
borns.
Ind J Clin Biochem 1994;9:100-102.
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maternal and neonatal anemia at Udaipur during 2 decades in
relation to poverty, parity, prematurity and vegetarianism.
Asia-Oceania J Obstet Gynaec 1991;17: 13-17.
8. Tietz NW. Fundamentals of clinical chemistry. Philadelphia,
Saunders 1976:926-928.
9. Franco RS. Ferritin. In Pesce AJ, Kaplan LA, eds, Methods in
clinical chemistry. St. Louis Mosby 1987;1240-1242.
10. Zak B. Simple procedure for single sample determination of
serum
copper and iron. Clin Chim Acta 1958;34:328-334.
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1976:236-238.
12. Natelson S. Techniques of clinical chemistry. Springfield,
C.C.
Thomas 1971:162-165.
13. Mahajan B.K. Methods in biostatistics for medical students and
research workers. New Delhi, Jaypee Brothers 1991:146-151.
14. Hunt JE, Mullen LM, Lykken GI, Gallagher SK, Neilsen FH.
Ascorbic
acid: effect on ongoing iron absorption and status in iron
depleted young women. Am J Clin Nutr 1990;51:649-655.
15. Siegenberg D, Baynes RD, Bothwell TH, Macfarlane BJ,
LamParelli
RD, Car NG, Mac-Phail P, Schmidt U, Tal A, Mayet F. Ascorbic
acid
prevents the dose-dependent inhibitory effects of polyphenols
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phytates on nonheme iron absorption. Am J Clin Nutr
1991;53:537-541.
16. Behrman RE, Kliegman RM. Nelson text book of pediatrics.
Philadelphia, Saunders 1987:1536-1558.
17. Ministry of Health & Family Welfare. Policy on control of
nutritional anemia. New Delhi Ministry of Health & Family
Welfare,
Government of India 1991:1-8
18. Chalmers AH, Cowley DM, Brave JM. A possible etiological role
for
ascorbate in calculi formation. Clin Chem 1986;32:333-336.
19. Singh PP, Sharma DC, Rathore V, Surana SS. An investigation
into
the role of ascorbic acid in renal calculogenesis in albino
rats.
J Urol 1988;139:156-157.
20. Krupp MA, Chatton MJ, Tierney Jr LK. Current medical diagnosis
and
Treatment. Los Altos, Lange 1986;816&987.
21. FAO. Food and Nutrition Series No.23, Rome, F.A.O. 1988.
22. Soni BL, Sharma DC. Total and ionizable iron in common Indian
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From Indian Journal of Physiology and Pharmacology, October 1995,
Volume 39, Number 4, pp. 403-406
HTML Revised 16 January, 2000.
Corrections and formatting © 2000 AscorbateWeb
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