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Haemochromatosis.

To the Editor: The mainstay of treatment for patients with clinical haemochromatois is largely phlebotomy and much less attention is paid to the role of dietary iron restriction, although patients are usually advised not to eat too much red meat. We believe that dietary iron restriction has an important role to play in conjunction with regular phlebotomies, as illustrated in the following case.

A 44-year-old man with Homozygous Haemochromatosis (C282Y mutation) had abnormal liver function tests and arthritis on original presentation. He had marked hyperferritinaemia with a serum ferritin of 202 [micro]g/L and 78% saturation. He embarked on a program of regular venesections but despite normalisation of his ferritin he later required two arthroplasties for his arthritis. In an effort to decrease the frequency of his phlebotomies, especially in view of the persistent elevation of his ferritin saturation, he was placed on a special diet which over a 12-month period resulted in a 50% reduction in the rate of his venesections and a 17% reduction in the percentage saturation, compared to a previous 12-month period when the patient was not on a diet.

The diet comprised trying to keep iron intake from all sources to 5 to 6 mg per day. In addition, vitamin C was restricted to no more than 30 to 50 mg and was to be consumed two hours before or after a meal containing significant iron. A vitamin C supplement or food source such as orange juice was recommended before bed.

The client was given a comprehensive diet sheet outlining the iron and vitamin C content of all relevant foods plus a chart of foods low in both iron and vitamin C.

The low iron categories were given as Best choices 0-1 mg per serve, Moderate choices 1.1-1.9 mg per serve and Poor choices less than 2 mg per serve. The vitamin C categories were Best choices 0-5 mg per serve, Moderate choices 5.1-10 mg per serve and Poor choices less than 10 mg per serve. A meal plan was also supplied. Any supplements or enriched foods containing added iron and vitamin C were avoided.

* The client was also encouraged to:

* Consume tea with meals

* Have more dairy foods

* Take a zinc supplement to compete with iron absorption and to ensure adequate zinc levels as iron and zinc are found in most of the same foods.

* Drink red wine in an effort to further reduce absorption.

* Lean towards a vegetarian diet as animal protein enhances absorption.

* Avoid fermented products that enhance absorption.

* Eat more bran containing phytates and more rhubarb containing oxalates.

* Drink coffee containing phenols.

With such a restriction along with phlebotomies, it was possible that the client could have been compromised in zinc, vitamin B 12, vitamin C and folate. Regular blood tests were carried out and additional supplements prescribed as necessary.

After the additional learning curve the client adjusted well to this dietary regime.

Dr Ram Tampi

Haematologist

Peggy Stacy APD DAA

Perth Diet Clinic

Western Australia
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Title Annotation:Letters to the Editor
Author:Stacy, Peggy
Publication:Nutrition & Dietetics: The Journal of the Dietitians Association of Australia
Article Type:Letter to the Editor
Date:Jun 1, 2004
Words:499
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