Transcript Diet and Haemochromatosis - The Haemochromatosis Society

Diet and Haemochromatosis
On behalf of
The Haemochromatosis Society
Presentation by Cristina Testa BSc Hons RD
Specialist Oncology/Stroke Dietitian at Northampton General Hospital
As part of Northamptonshire Healthcare NHS Foundation Trust
Introduction
Learning about you: –
Haemochromatosis
oInherited genetic disorder, 3 different HEF types- Homozygosity (a genetic defect on both chromosomes
(C282Y/C282Y), Hetrozygosity (a genetic defect on any chromosomes (H63D/wt)
Background to iron absorption in the body
oHepcidin – Hormone key role in iron absorption – controls Ferroportin regulates iron into blood stream
oNormal iron absorption – when serum ferritin value is high – Ferritin is good reflection of body iron stores
in the blood- higher hepcidin value and the lower the absorption of iron
oHaemochromatosis- When defect in HFE protein gene lower production of Hepcidin feedback system less
effective and more iron is transported from blood cells into blood stream.
oStandard treatment – Venesection or phlebotomy – removal of blood from body to lower iron levels.
Outline and Aim
o Can diet improve management of haemochromatosis?
o How can dietary manipulation help?
oIron in food – types
oFoods that can affect iron absorption
oTake home messages for diet at home
AIM:
To give a rounded balanced view on current dietary advice based on current knowledge and
resources for haemochromatosis.
Image made by Cristina Testa
Iron in food
2 different types of iron:
oHaem iron –
found in meat- beef, poultry, fish – 30-70% iron content, and 15-35% is absorbed
oNon Haem iron –
found in plant e.g. green leafy vegetables –spinach, and non cellular animal sources e.g. milk
and milk products, 100% of iron content in plant foods , 2-20% often <10% absorbed.
Iron in food – Meat
oHaem iron found in animal sources most commonly meat- increases overall iron status by increasing
serum ferritin (iron in blood)
o All meat contains iron some higher than other haem content – rule of thumb redder meat more
haem containing
o Still need meat and fish as provide B12 vitamin
o Have 3-4 days meat free- meat substitutes such as eggs tofu quinoa
o Fish have 2 x a week
oAvoid organ meat –this is non haem iron however very rich and well absorbed 100g would give entire
daily intake iron for men and women >50
o Avoid raw seafood- particularly shellfish and any cooked fish that has been sprinkled or had fresh
seawater added after cooking – bacteria Vibrio Vulnificus as this can cause rapid and life threatening
infection
Iron in food – Vegetables
oNon haem iron present in foods such as green leafy vegetables eg spinach, beans.
oVegetables contribute 7% of iron intake
oImportant to have vegetables of different colours due to antioxidants.
oAlso spinach contains oxlate is an inhibitor of absorption
Iron in food – Fortified, Supplemental
and other
Fortified foods
oIron is added to some foods e..g white flour and breakfast cereals
oA Study in Sweden showed stopping of fortification was associated with less iron absorption,
resulting in fewer phlebotomies per year.
oA study in the United Kingdom suggested that little or nothing of the added iron would be
absorbed.
oTo avoid these foods if able, not much is known regarding absorption of the iron in these foods.
oDark chocolate contains iron, therefore choose milk chocolate but again keep in moderation
alongside healthy eating advice.
Iron in Supplements
oIron supplements e.g. ferrous sulphate, ferroglobin (vitabiotics).
oIron in multivitamin and mineral supplements – often with Vitamin C.
oStudy found 20% of supplemented iron absorbed and stored.
oAdvice: to avoid unless other wise advised by Haematologist or GP.
Foods that affect iron absorption
Enhancers
o Meat enhances iron absorption due to a ‘meat factor’ which can help absorption of both haem
and non haem iron
o Organic acids e.g. ascorbic – found in orange juice (vitamin C)
o Alcohol –enhances absorption of iron and may also cause liver damage if too much taken (Red
wine in moderation can be of benefit as contains tannins which can inhibit absorption)
Foods that affect iron absorption
Inhibitors
o Tea – black and herbal tea eg green tea bind non haem iron
o Coffee – contain poly phenols
o Shell of nuts, seeds, legumes and grain- due to phyates – inhibit non haem iron absorption – full
extent not known
o Calcium- inhibits haem and non haem absorption – found in milk and dairy sources. However weak
effect if taken between meals and no studies or effects shown on haemochromatosis patients
A healthy balanced diet and lifestyle
Eat well guide formally plate published FSA 2016 – for everyone
o Base meal on starchy carbohydrate e.g. potatoes, rice, pasta – choose wholegrain due to fibre
content
o Try to eat plenty fruit veg - a day
o Eat more fish, alternative sources of protein;
o Beans, pulses
o Cut down in saturated fat and sugar, salt
o Eat less chocolate, crisps sweets
o Get active and be healthy weight – BMI 20-25kg/m2
As shown those with BMI > 30 obese
have higher blood iron levels
Take home messages
Consider changes in diet:
o2-3 free meat days/ week and have meat substitute and fish x 2 week if possible.
oAvoid iron supplements or if taking multivitamin ensure iron is not contained within and if
contains vitamin C avoid taking with meals.
oAvoid/ limit keep alcohol intake within moderation
oAvoid organ meat eg liver
oEnjoy balanced diet of all other food groups on eat well guide.
oKeep healthy weight
oDo not restrict diet to unrealistic expectations – it is still likely that venesection/phlebotomy will
be needed
NB: Manipulating diet - iron absorbed 2-3mg from meat VS venesection can remove 250mg iron.
oPost venesection however best to drink plenty of fluids eg water, milk, tea and be aware of high
iron foods and limit intake as iron absorption may be higher post venesection due to less iron in
blood.
References
Dietary advice in HFE-hemochromatosis, by GM van Doorn - 2012
BDA (British Dietetic Association) Eating Guidelines for Hemochromatosis, 2015
http://www.pennutrition.com/viewhandout.aspx?Portal=V7Ge&id=JMfsXwE=&PreviewHandout=bA=
=
The Haemochromatosis Society http://haemochromatosis.org.uk/
Iron disorders Institute, 2006
Hemochromatosis Australia
Thank you for listening...Any questions?
Image made by Cristina Testa