Vitamin C enhances Chelation

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

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.

That's fantastic. So I should take adequate amount of Vit. C now?

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

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.

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 ?

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.

Hi Andy,

So can I take Vitamin C (preferably orange juice) it with Exjade?

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.

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.

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.

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

Ascorbic acid (vitamin C)
75 to 90 mg/day
If on chelation, 100 to 250 mg/day
recommended.

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.

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

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