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

Simone Buerkli, Laura Salvioni, Natalie Koller, Christophe Zeder, Maria José Teles, Graça Porto, Jana Helena Habermann, Irina Léa Dubach, Florence Vallelian, Beat M Frey, Diego Moretti, Jeannine Baumgartner, Michael B Zimmermann, Simone Buerkli, Laura Salvioni, Natalie Koller, Christophe Zeder, Maria José Teles, Graça Porto, Jana Helena Habermann, Irina Léa Dubach, Florence Vallelian, Beat M Frey, Diego Moretti, Jeannine Baumgartner, Michael B Zimmermann

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).

Keywords: Hereditary hemochromatosis; Iron absorption; Polyphenols; Reducing dietary iron absorption; Supplement.

Conflict of interest statement

The authors have no relevant financial or non-financial interests to disclose.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Study participant flow
Fig. 2
Fig. 2
Percentage of precipitated iron after in vitro digestion in a 20 µg Fe/g solution with the PPS and other food powders at different doses of 1 g, 2 g and 3 g. Shown are means ± SD. Significant differences between doses within a PP source are indicated with * (one-way ANOVA with Bonferroni corrections, p < 0.05)
Fig. 3
Fig. 3
Correlation of percentage precipitated iron with measured PP content (mg) as gallic acid equivalent (GAE). Spearman’s rho = 0.629, p < 0.001 (1-tailed)
Fig. 4
Fig. 4
A FIA from test meals and B test drinks consumed either with the PPS (Meal-PPS & Drink-PPS) or with the placebo supplement (Meal-Placebo & Drink-Placebo). Shown are individual datapoints and the geometric mean with the 95% CI, p = 0.026, and 0.002, respectively, paired samples T test

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