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Haemochromatosis cannot be treated by diet.

You should have a healthy, nutritious diet. This will include foods with the small amount of iron that you continue to need.

Any excess iron absorbed by the body must be removed by venesection eventually. A 500 ml venesection removes 0.25 g of iron, which is roughly equivalent to two to six months’ worth of iron absorbed from your diet.

So eat what you like, as long as you participate in life-long monitoring of iron levels and you have enough venesections every year of your life to keep your iron stores at safe levels.

You may find that, if you are having frequent venesections because of the need to unload a lot of iron when you are first diagnosed, extra vitamin B12 and folate, either in your diet or taken as a supplement, can be very helpful.

Vitamins during frequent venesections

After a venesection, the body uses vitamin B12, folate, iron and protein to manufacture new red blood cells. During frequent venesections, vitamin B12 and folate supplements can be very helpful to boost the ability of the body to continually make new red blood cells.

The suggested daily doses of vitamin B12 taken as a tablet is usually about 5-10 micrograms, also written as 5mcg or 5μg. Any excess vitamin B12 ends up in the faeces.

The suggested daily dose for folate taken as a tablet is usually about 400-600 micrograms, also written as 400mcg or 400μg. Any excess folate ends up in the urine.

If you feel very tired during frequent venesections, there are three things that might need to be checked with a blood test:

1.     Haemoglobin – are you anaemic (too few red blood cells in the bloodstream)?

2.     Serum ferritin – are you actually iron deficient?

3.     Vitamin B12 and folate levels – are you vitamin B12 or folate deficient?

Vitamin B12

Vitamin B12 is a fat-soluble vitamin which can be stored in the liver for many years. It is also known as cyanocobalamin. Australian dietary recommendations for adults are 2.4 micrograms per day for good health.

Common dietary sources of vitamin B12 are animal products, including fish, meat, poultry, eggs, milk, and dairy products. Vitamin B12 is generally not present in plant foods, but there are fortified vegetarian foods such as some soy beverages, some vegetarian sausages and burgers, and some fortified breakfast cereals that can be a good source of vitamin B12 for vegetarians and vegans.

Mushrooms, tempeh, miso and sea vegetables are often claimed to be a source of vitamin B12. However, this is not accurate. They contain a compound with a similar structure to vitamin B12, but it doesn’t have the same effects in the body as true vitamin B12.

Table 1 - Vitamin B12 content of common food

What about vitamin B12 injections?

Vitamin B12 can be given as an injection to treat proven vitamin B12 deficiency. A blood test is needed to prove vitamin B12 deficiency. Injections must be prescribed by a doctor and then given by a doctor or a nurse.

Folate

Folate is a water-soluble vitamin, which can’t be stored by the body. It is also known as folic acid or sometimes as vitamin B9. Australian dietary recommendations for adults are 400 micrograms per day for good health.

Common dietary sources of folate are dark green leafy vegetables, citrus fruits and juices and beans and peas (legumes). Many foods now have added folate, including bread, cereal, flour, pasta and other grain products.


 Table 2 - Folate content in common food

Thanks to Dr Katie Goot MBBS BSc, Volunteer GP Liaison Officer, Haemochromatosis Australia for this information.

This article was first published in Iron Age News Edition 80, October 2012. the official newsletter of Haemochromatosis Australia.