The effect of a natural polyphenol supplement on iron absorption in adults with hereditary hemochromatosis

Abstract

Objectives We developed a natural polyphenol supplement that strongly chelates iron in vitro and assessed its effect on non-heme iron absorption in patients with hereditary hemochromatosis (HH). Methods We performed in vitro iron digestion experiments to determine iron precipitation by 12 polyphenol-rich dietary sources, and formulated a polyphenol supplement (PPS) containing black tea powder, cocoa powder and grape juice extract. In a multi-center, single-blind, placebo-controlled cross-over study, we assessed the effect of the PPS on iron absorption from an extrinsically labelled test meal and test drink in patients (n = 14) with HH homozygous for the p.C282Y variant in the HFE gene. We measured fractional iron absorption (FIA) as stable iron isotope incorporation into erythrocytes. Results Black tea powder, cocoa powder and grape juice extract most effectively precipitated iron in vitro. A PPS mixture of these three extracts precipitated ~ 80% of iron when 2 g was added to a 500 g iron solution containing 20 µg Fe/g. In the iron absorption study, the PPS reduced FIA by ~ 40%: FIA from the meal consumed with the PPS was lower (3.01% (1.60, 5.64)) than with placebo (5.21% (3.92, 6.92)) (p = 0.026)), and FIA from the test drink with the PPS was lower (10.3% (7.29 14.6)) than with placebo (16.9% (12.8 22.2)) (p = 0.002). Conclusion Our results indicate that when taken with meals, this natural PPS can decrease dietary iron absorption, and might thereby reduce body iron accumulation and the frequency of phlebotomy in patients with HH. Trial registry: clinicaltrials.gov (registration date: 9.6.2019, NCT03990181).

Food‐borne polyphenols: A biocompatible anchor recuperating iron homeostasis

“…In addition, polyphenols could also reverse organ damage caused by (Buerkli et al, 2022); in this way, more attention is in need to understand the inhibiting iron absorption effects of polyphenols.…”

“…(2020) compared the alleviation effects of procyanidins on dietary iron absorption in patients and mice, and they found that the procyanidin supplementation showed unremarkable protections on either type I HH or dysmetabolic iron overload syndrome in murine models, which was quite inconsistent with the results in human. Buerkli et al., 2022 formulated a polyphenol supplement (PPS) containing black tea powder, cocoa powder, and grape juice extract and performed iron digestion experiments to assess its effect on nonheme iron absorption in patients with HH. Results indicated that natural PPS could decrease dietary iron absorption when taken with meals, and thereby reducing body iron accumulation and the frequency of phlebotomy in patients with HH (Buerkli et al., 2022); in this way, more attention is in need to understand the inhibiting iron absorption effects of polyphenols.…”

“…Polyphenols are often considered as an adjunct in the treatment of hereditary hemochromatosis (HH) by inhibiting iron absorption (Milman, 2020). Tea drinking with meals partly reduced the excessive iron storage and lessened the frequency of phlebotomies in patients with hemochromatosis (Buerkli et al., 2022). The protective effects of baicalin and quercetin on iron overload mice varied in different tissues.…”

“…Buerkli et al., 2022 formulated a polyphenol supplement (PPS) containing black tea powder, cocoa powder, and grape juice extract and performed iron digestion experiments to assess its effect on nonheme iron absorption in patients with HH. Results indicated that natural PPS could decrease dietary iron absorption when taken with meals, and thereby reducing body iron accumulation and the frequency of phlebotomy in patients with HH (Buerkli et al., 2022); in this way, more attention is in need to understand the inhibiting iron absorption effects of polyphenols.…”

Proposed dietary recommendations for iron overload: a guide for physician practice

“…Treatment with interval phlebotomy is most effective for reducing iron burden [1]. Dietary modification is not emphasized due to the lack of large clinical trials since HH is a rare condition but limiting iron intake is promising and can lead to a reduced phlebotomy requirement up to 1.5 liters per year [4,5,6 ▪ ]. This article aims to provide dietary guidelines for HH patients stemming from physiological concepts of iron absorption, animal studies, and limited patient studies…”