Ferrous sulfate and vitamin c
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The Role of Ferrous Sulfate and Vitamin C in Iron Supplementation
Introduction to Iron Deficiency Anemia (IDA) and Supplementation
Iron deficiency anemia (IDA) is a prevalent condition that affects various populations, including pregnant women, children, and patients with chronic diseases. Oral iron supplementation is a common treatment for IDA, but its efficacy can be influenced by several factors, including the presence of vitamin C.
Ferrous Sulfate and Vitamin C: Mechanism of Action
Vitamin C is known to enhance the absorption of iron by converting ferric iron (Fe³⁺) to its more absorbable ferrous form (Fe²⁺) in the gastrointestinal tract. This conversion increases the solubility of iron, facilitating its uptake in the intestines 17.
Efficacy of Ferrous Sulfate Plus Vitamin C in Pregnant Rats
A study on pregnant rats demonstrated that the combination of ferrous sulfate and vitamin C significantly decreased blood glucose levels and increased blood hemoglobin levels compared to ferrous sulfate alone. This suggests that vitamin C enhances the efficacy of iron supplementation in improving hemoglobin levels while also managing glucose levels .
Comparative Studies in Children with IDA
In children with IDA, both ferrous sulfate and a combination of ferrous fumarate, zinc, and vitamin C were effective in increasing hemoglobin and iron levels. However, the addition of vitamin C did not significantly enhance hematologic recovery compared to ferrous sulfate alone, indicating that while vitamin C aids in iron absorption, its impact on overall hematologic outcomes may be limited in this population .
Impact on Chronic Kidney Disease (CKD) Patients
For patients with chronic kidney disease (CKD), a formulation combining ferric sodium EDTA with vitamin C, folic acid, and other micronutrients showed superior efficacy in improving iron parameters and reducing systemic inflammation compared to ferrous sulfate alone. This highlights the potential benefits of vitamin C in enhancing iron absorption and reducing inflammation in specific patient groups .
Oxidative Damage and Safety Concerns
While vitamin C can enhance iron absorption, there are concerns about oxidative damage. A study on healthy volunteers found that co-supplementation with iron and vitamin C increased oxidative DNA damage in individuals with initially high plasma vitamin C levels. This oxidative stress returned to normal levels after 12 weeks, suggesting a transient risk that warrants consideration, especially in well-nourished individuals .
Histopathological Effects on Liver and Brain
In a histopathological study on rats, ferrous sulfate combined with vitamin C caused significant liver damage compared to heme iron. However, no significant changes were observed in the brain tissues. This indicates that while vitamin C enhances iron absorption, it may also exacerbate iron-induced liver toxicity .
Systematic Review and Meta-Analysis Findings
A systematic review and meta-analysis concluded that adding vitamin C to iron supplementation results in a statistically significant but clinically modest increase in serum hemoglobin and ferritin levels. The review also noted a lower incidence of gastrointestinal upset with the combination therapy, suggesting some benefits in terms of tolerability .
Conclusion
The combination of ferrous sulfate and vitamin C can enhance iron absorption and improve hemoglobin levels, particularly in populations with increased iron needs, such as pregnant women and CKD patients. However, the benefits must be weighed against potential risks, including oxidative damage and liver toxicity. Further research is needed to fully understand the clinical relevance of these findings and to optimize iron supplementation strategies.
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