Dietary Advice

Everyone, including people affected by haemochromatosis, should aim to eat a healthy, balanced diet. People with genetic haemochromatosis might be concerned about the amount of iron in their food. However, genetic haemochromatosis cannot be treated through diet. A restricted diet is not recommended for people affected by haemochromatosis. Iron is an essential part of a balanced diet. This is true even for people with haemochromatosis. Please note: one venesection will remove approximately 250mg iron and in one portion of meat contains 3-4mg of iron.

It is important to remember that having haemochromatosis does not mean that iron rich foods should be avoided altogether as iron is required for important body functions. In addition, foods containing iron will also contain other nutrients that are essential for good health.

Iron is essential for:

1. The formation of haemoglobin – a protein in red blood cells that carries oxygen around the body.
2. The production of myoglobin – a protein in muscle tissue, used for storage of oxygen.
3. Regulating normal energy metabolism.
4. DNA synthesis and repair.
5. Supporting the immune system.
6. Brain development.
7. Internal temperature regulation.

This diagram shows how iron absorbed in the duodenum, transported to muscle, liver, and bone marrow. Haemoglobin is the protein in red blood cells that transports oxygen, and macrophages are cells that recycle red blood cells and the iron they contain. This normal cycle of iron in the human body is finely balanced and is important for our wellbeing.

The human body finds haem iron much easier to absorb than non-haem iron. Because of this, choosing foods from non-haem iron sources and fewer from haem iron sources, can help to reduce the overall amount of iron absorbed each day. However, it is important to note that patients with haemochromatosis can still suffer from iron-deficiency if there is not enough in the diet.

Some foods contain inhibitors (such as tannins, oxalates, phytates), which can reduce the amount of iron absorbed from meals, particularly non-haem iron. These inhibitors work by either binding to the iron to stop it from being absorbed, or by competing with iron for absorption. Eating foods which limit iron absorption (inhibitors) with each meal can help to reduce the rate in which the body absorbs iron from food.

Table 2: Inhibitors of iron absorption

Inhibitor	Dietary source
Tannins	Tea, coffee
Oxalates	Spinach, kale, rhubarb, strawberries, beetroot, parsley, almonds
Polyphenols	Chocolate, walnuts, cocoa, almonds, peppermint, berries, tea, coffee, olives, spinach, broccoli, onions, apples
Phytates	Sesame seeds, lentils, whole grain cereals, wholegrains, wholemeal bread, nuts, soy
Calcium	Milk, yoghurt, cheese, leafy greens
Soy protein	Tempeh, tofu, soy milk, soybeans, edamame beans

 

Some foods and supplements can increase the rate of iron absorption from food. These are known as enhancers such as Vitamin C (ascorbic acid). Advise patients to avoid taking vitamin C supplements and avoid drinking glasses of orange juice with meals. It is still safe to eat fresh fruit and vegetables daily. Alcohol is also an enhancer and in patients who may have liver damage secondary to haemochromatosis are advised to reduce their alcohol intake or abstain altogether.

 

Learning points

• Haem iron is much easier for the body to absorb than non-haem iron
• Actively encourage patients with GH to drink tea or coffee with every meal and avoid drinking orange juice to reduce iron absorption
• Reassure your patient that a venesection will remove more iron than they can absorb
• It is important to explain to patients why they should limit their intake of alcohol, as alcohol is an enhancer and if consumed in greater amounts than the recommended weekly units, can further damage the liver. This is particularly important if the liver is already damaged by haemochromatososis.

Next steps

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