5

Ascorbic Acid:
An Enhancing Factor in Iron Absorption

ELAINE R. MONSEN
University of Washington, Division of Human Nutrition, Dietetics, and Foods and
Department of Medicine, Seattle, WA 98195
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Publication Date: November 1, 1982 | doi: 10.1021/bk-1982-0203.ch005

Ascorbic acid concomitantly consumed enhances non-

heme iron absorption 3-6 fold: a key factor in
the model estimating bioavailable dietary iron.
The 500 mgs iron store Reference Individual is
assumed to absorb 23% of ingested heme iron
(estimated at 40% of meat, fish or poultry iron)
and 3-8% of ingested nonheme iron (plant iron
plus remaining meat, fish, poultry iron). The
quantity of enhancing factors consumed at a spe-
cific meal, i.e. mgs ascorbic acid plus gms
cooked meat/fish/poultry, determines % absorption
of nonheme iron:

1. ΣEF < 75: % = 3 + 8.93 log n

-
2. ΣEF + ≥ 75: %= 8

HANES 2 (1976 - 80) reports low intake of iron

and ascorbic acid for large population segments,
especially females below poverty line, e.g. at
10th percentile 4 mg iron and 7 mg ascorbic
acid per day.

Prevention of iron deficiency in populations not sustaining

chronic blood loss is possible by judicious selection of diets
which enhance the bioavailability of dietary iron. The recent
decades have produced significant research on the availability
of iron asitisaffected by various dietary components, those
which enhance as well as those which inhibit iron absorption.
This has allowed for the first time the quantification of
dietary effects on a trace metal and the development of a model
whereby the quantity of bioavailable iron in a diet may be
estimated.
This paper will discuss four related areas: the major

0097-6156/82/0203-0085$06.00/0
© 1982 American Chemical Society

In Nutritional Bioavailability of Iron; Kies, Constance;

ACS Symposium Series; American Chemical Society: Washington, DC, 1982.
 86
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s e c t i o n w i l l be focused on the r o l e o f a s c o r b i c a c i d i n nonheme
i r o n absorption; the second s e c t i o n w i l l d i s c u s s b r i e f l y the
model f o r e s t i m a t i n g the q u a n t i t y o f a v a i l a b l e i r o n ; the t h i r d
s e c t i o n w i l l d e a l w i t h c u r r e n t estimates o f d i e t a r y i n t a k e o f
i r o n and a s c o r b i c a c i d i n the United S t a t e s ; and the l a s t
s e c t i o n w i l l d i s c u s s b r i e f l y the i n t e r r e l a t i o n s h i p s of a s c o r b i c
a c i d and i r o n i n abnormal s t a t e s of metabolism.

The r o l e of a s c o r b i c a c i d i n nonheme i r o n a b s o r p t i o n

Radioisotope techniques have allowed p r e c i s e measurement o f

dietary i r o n absorption. I n i t i a l s t u d i e s u t i l i z e d t e s t meals o f
i n d i v i d u a l food which had been i n t r i n s i c a l l y l a b e l e d with radio--
a c t i v e i r o n p r i o r to h a r v e s t i n g (1,2), U t i l i z a t i o n o f these
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s i n g l e food meals allowed a rank order to be e s t a b l i s h e d among

Publication Date: November 1, 1982 | doi: 10.1021/bk-1982-0203.ch005

the t e s t e d foods. Subjects could serve as t h e i r own c o n t r o l s

when an i d e n t i c a l r e f e r e n c e dose was given to each s u b j e c t .
T h i s reference dose of f e r r o u s s u l f a t e : a s c o r b i c a c i d was absorbed
at a higher r a t e i n i r o n d e f i c i e n t s u b j e c t s than i n i r o n r e p l e t e
s u b j e c t s ; a r a t i o o f the a b s o r p t i o n o f the t e s t meal to the
r e f e r e n c e dose allowed comparisons to be made between i n d i v i d u a l
s u b j e c t s . As these e a r l y s t u d i e s were l i m i t e d to study o f
s i n g l e food items an e f f o r t was made to extend the technique by
developing designs u t i l i z i n g e x t r i n s i c a l l y tagged t e s t meals
(3,4). U t i l i z a t i o n o f these techniques has given evidence that
d i e t a r y i r o n forms two separate pools i n the gut, one a p o o l o f
heme i r o n and the other a p o o l of nonheme i r o n . The predominate
source o f i r o n i n human d i e t s i s i n the form o f nonheme i r o n ( 5 ) ,
A s c o r b i c a c i d as an enhancing f a c t o r i n nonheme i r o n absorp-
t i o n has been f r e q u e n t l y observed, C a l l e n d e r , e t a l . , f e d i n t r i n -
s i c a l l y l a b e l e d hen eggs i n a b r e a k f a s t meal composed o f bread,
b u t t e r , jam, eggs, and t e a o r c o f f e e to 26 s u b j e c t s ; when an
a d d i t i o n o f 100 mis o f orange j u i c e was added t o t h i s meal
a b s o r p t i o n i n c r e a s e d to 280% o f the c o n t r o l meal (6), Cook,
e t a l . , provided a meal o f i n t r i n s i c a l l y l a b e l e d maize to sub^
j e c t s and observed that when 500 mgs o f a s c o r b i c a c i d was added
that a b s o r p t i o n o f both i n t r i n s i c and e x t r i n s i c a l l y l a b e l e d i r o n
was 6 times higher (3), Sayers, e t a l , , u t i l i z e d both i n t r i n -
s i c a l l y and e x t r i n s i c a l l y l a b e l e d maize, wheat and soybean,
p r o v i d i n g a d d i t i o n a l evidence o f the a p p l i c a b i l i t y o f the extrint-
s i c a l l y l a b e l e d model (_7), To the s u b j e c t s whom they gave maize
and 50 mgs o f a s c o r b i c a c i d , a b s o r p t i o n was i n c r e a s e d from 8,.8%
to 14.9%; to those subjects given maize p l u s 100 mg o f a s c o r b i c
a c i d a b s o r p t i o n was increased to 22,6%, The importance o f the
p r o c e s s i n g procedure was i n d i c a t e d i n that the t e s t meals to
which a s c o r b i c a c i d was added p r i o r to high temperature baking,
no enhancement o f i r o n a b s o r p t i o n was observed, suggesting that
the h i g h temperatures i n a c t i v a t e d the a s c o r b i c a c i d ,
Bjorn-Rasmussen gave meals o f maize p l u s 4.5 mgs o f i r o n ;
to these meals were added 0-200 mgs o f a s c o r b i c a c i d (8). I n -

In Nutritional Bioavailability of Iron; Kies, Constance;

ACS Symposium Series; American Chemical Society: Washington, DC, 1982.
 5. MONSEN Enhancement by Ascorbic Acid 87

cremental i n c r e a s e s i n i r o n a b s o r p t i o n were observed as a s c o r b i c

a c i d was i n c r e a s e d . I n another study, Cook and Monsen gave 63
male subjects 700 k i l o c a l o r i e meals composed o f s e m i s y n t h e t i c
i n g r e d i e n t s o f dextrimaltose, corn o i l and ovalbumin; to these
meals were added a s c o r b i c a c i d ranging from 0 to 1000 mgs (9)»
With each i n c r e a s e i n a s c o r b i c a c i d an i n c r e a s e i n i r o n absorp-
t i o n occurred. The r a t e o f a b s o r p t i o n appeared to be l o g a r i t h -
m i c a l l y r e l a t e d to the a s c o r b i c a c i d content. I t was f u r t h e r
shown i n t h i s experiment that a s c o r b i c a c i d must be present i n
the stomach a t the same time that the nonheme i r o n i s present,
Nonheme i r o n was absorbed a t a high r a t e from meals i n t o which
the a s c o r b i c a c i d was i n c o r p o r a t e d . However i f the a s c o r b i c
a c i d was given 4 o r 8 hours before the t e s t meal there was no
enhancing e f f e c t observed.
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S e v e r a l i n v e s t i g a t o r s have looked a t the e f f e c t o f mixtures

Publication Date: November 1, 1982 | doi: 10.1021/bk-1982-0203.ch005

of foods on nonheme i r o n a b s o r p t i o n , L a y r i s s e t e s t e d meals that

are reminiscent o f those w i t h i n v a r i o u s r e g i o n a l areas o f
Venezuela: nonheme i r o n was absorbed a t a higher r a t e from
meals that i n c l u d e d a s c o r b i c a c i d c o n t a i n i n g foods, the highest
r a t e r e s u l t i n g from meals c o n t a i n i n g 66 mgs o f ascorbate con-
t r i b u t e d by 150 gms o f papaya (10). H a l l b e r g , e t a l . , t e s t e d
37 subjects with a d i e t c o n s i s t i n g o f a mixture o f r i c e ,
cabbage, c o l l a r d s , s t r i n g beans, c h i l i paste, f i s h sauce and
coconut cream (11), When a f r u i t mixture c o n t a i n i n g banana,
papaya and oranges was added t o t h i s v e g e t a l mixture, a b s o r p t i o n
was reported to increase three f o l d . A s c o r b i c a c i d content was
c a l c u l a t e d from food t a b l e s as being 35 mgs. Further a d d i t i o n
of 80 gms o f l e a n beef to the v e g e t a l and f r u i t meal had an
a d d i t i v e e f f e c t and enhanced the a b s o r p t i o n o f the b a s a l d i e t
six-fold.
Rossander, e t a l , , t e s t e d the impact o f adding 150 mis o f
orange j u i c e t o a b r e a k f a s t c o n s i s t i n g o f bread, b u t t e r , mar-
malade, cheese and c o f f e e ; with the a d d i t i o n o f the orange
j u i c e , a b s o r p t i o n increased from 3,7% t o 8% (12), When the
b r e a k f a s t meal i n c l u d e d tea i n p l a c e o f c o f f e e , the enhancing
e f f e c t o f the orange j u i c e was l e s s pronounced, A recent study
compared v e g e t a r i a n meals (13), The f i r s t composed o f beans,
r i c e , cornbread and apples contained 7 mg a s c o r b i c a c i d ; non-
heme i r o n a b s o r p t i o n was 2.2%; the second meal, composed o f
c a u l i f l o w e r , red kidney beans, white bread, cottage cheese and
pineapple, contained 74 mg a s c o r b i c a c i d : from t h i s meal 16,9%
of the nonheme i r o n was absorbed.
Reviewing the s t u d i e s i n which nonheme i r o n a b s o r p t i o n has
been assessed a t v a r i o u s l e v e l s o f a s c o r b i c a c i d i n t e s t meals
composed o f e i t h e r s i n g l e food items o r food mixtures i t appears
t h a t , w i t h i n any i n d i v i d u a l study, a d d i t i o n a l increments o f
a s c o r b i c a c i d c o n s i s t e n t l y increased a b s o r p t i o n o f nonheme i r o n
(Table 1), Considering the wide d i f f e r e n c e s i n experimental
c o n d i t i o n s , the v a r i o u s s t u d i e s i n c o r p o r a t i n g 12.5 to 1000 mg
a s c o r b i c a c i d i n d i c a t e c l e a r l y the enhancing e f f e c t that
a s c o r b i c a c i d has on nonheme i r o n a b s o r p t i o n .

In Nutritional Bioavailability of Iron; Kies, Constance;

ACS Symposium Series; American Chemical Society: Washington, DC, 1982.
 88
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Table 1
The E f f e c t o f A s c o r b i c A c i d on Absorption
of Nonheme Iron i n Humans
Ascorbic Iron Absorption Ratio
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Publication Date: November 1, 1982 | doi: 10.1021/bk-1982-0203.ch005

Acid Test Meal + Ascorbic Acid Ref.

mg. - Ascorbic Acid
12.5 Maize 1.3 8
25 700 K c a l SS* 1.7 9
25 Maize 3.0 8
35 V e g e t a l meal + f r u i t s 2.7 11
50 Maize 1.7 7
50 700 K c a l SS 2.5 9
50 Maize 2.6 8
50 Bread, egg, + orange j u i c e 2,8 6
66 Maize + 150 g papaya 5.0 10
70 Bread, cheese, t e a + orange j u i c e 1.2 12
70 Bread, cheese, c o f f e e + orange j u i c e 2,2 12
74 600-700 K c a l v e g e t a r i a n 7,7 13
100 Maize 2,6 7
100 700 K c a l SS 4.1 9
100 Maize 4,6 8
200 Maize 6.1 8
250 700 K c a l SS 4,7 9
500 Maize 6.0 3
500 700 K c a l SS 6.2 9
1000 700 K c a l SS 9.6 9

*Semi-synthetic meal composed o f d e x t r i m a l t o s e ,

corn o i l and ovalbumin.

In Nutritional Bioavailability of Iron; Kies, Constance;

ACS Symposium Series; American Chemical Society: Washington, DC, 1982.
 89
5. MONSEN Enhancement by Ascorbic Acid
S e v e r a l d i e t a r y f a c t o r s have been i d e n t i f i e d which i n h i b i t
nonheme i r o n a b s o r p t i o n . Tea and tannates appear p a r t i c u l a r l y
i n h i b i t i n g (14). Rossander, e t a l . , reported only a s l i g h t i n -
crease i n a b s o r p t i o n when orange j u i c e was added to a t e a -
c o n t a i n i n g b r e a k f a s t meal (12). Other food a d d i t i v e s such as
EDTA may have an i n h i b i t i n g e f f e c t on nonheme i r o n a b s o r p t i o n i f
the EDTA i s i n h i g h molar concentrations r e l a t i v e to nonheme
i r o n (JL5).
A s c o r b i c a c i d has a l s o been shown to i n t e r a c t with t h e r a -
p e u t i c i r o n . Derman, e t a l . , have reported that a s c o r b i c a c i d
i n c r e a s e s a b s o r p t i o n of v a r i o u s i r o n f o r t i f i c a t i o n compounds i n
i n f a n t formulas i n c e r e a l s ; t h i s t h r e e - f o l d i n c r e a s e i n i r o n
a b s o r p t i o n induced by a s c o r b i c a c i d was observed i n multiparous
women (16). El-Hawary, e t a l . , s t u d i e d 97 i n f a n t s and young
c h i l d r e n and observed that a s c o r b i c a c i d increased a b s o r p t i o n
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Publication Date: November 1, 1982 | doi: 10.1021/bk-1982-0203.ch005

from a f o u r mg i r o n supplement as f e r r o u s s u l f a t e (17).

McPhail, e t a l . , have a l s o reported i n c r e a s e s i n a b s o r p t i o n of
i r o n from e i t h e r f e r r o u s s u l f a t e or iron:EDTA with i n c o r p o r a t i o n
of three to s i x molar concentrations of a s c o r b i c a c i d (18),
When these mixtures of a s c o r b i c a c i d and i r o n f o r t i f i c a t i o n com-
pounds were added to foods such as maize p o r r i d g e before the
foods were cooked a b s o r p t i o n was not enhanced.

E s t i m a t i n g b i o a v a i l a b l e i r o n i n the d i e t

Extensive research on the a b s o r p t i o n of i r o n from v a r i o u s

types of meals has allowed g u i d e l i n e s to be developed by which
the amount of d i e t a r y i r o n a v a i l a b l e f o r a b s o r p t i o n may be
estimated. I r o n i s the f i r s t t r a c e mineral to be thus t r e a t e d
and thus serves as a model f o r other n u t r i e n t s (19), The model
f o r e s t i m a t i n g b i o a v a i l a b l e i r o n i s based on the concept that
i r o n forms a) a p o o l of heme i r o n which i s r e a d i l y a v a i l a b l e
to humans and i s u n e f f e c t e d by other d i e t a r y components and b)
a p o o l of nonheme i r o n which i s of low b i o a v a i l a b i l i t y unless
enhancing f a c t o r s are present concommitantly (20).
Recognition i s made of the importance of the extent of an
i n d i v i d u a l ' s i r o n s t o r e s as i t w i l l i n f l u e n c e the amount of non-
heme i r o n and heme i r o n that would be absorbed. The conserva-
t i v e model suggests u t i l i z a t i o n of an i n d i v i d u a l with 500 mgs
of i r o n s t o r e s as the r e f e r e n c e i n d i v i d u a l f o r whom b i o a v a i l a b l e
i r o n may be c a l c u l a t e d . As the purpose of such a model i s to
compare one d i e t with another, i t i s immaterial what l e v e l of
i r o n s t o r e s an i n d i v i d u a l has i n that the comparison between
d i e t s w i l l not be a f f e c t e d . The c a l c u l a t e d values w i l l , of
course, be lower f o r the amount of t o t a l a v a i l a b l e i r o n with an
i n d i v i d u a l with moderate i r o n s t o r e s of 500 mgs than they would
be f o r an i n d i v i d u a l w i t h zero i r o n s t o r e s .
The enhancing f a c t o r s considered f o r the a b s o r p t i o n of non-
heme i r o n are a s c o r b i c a c i d and meat, f i s h and p o u l t r y . The

In Nutritional Bioavailability of Iron; Kies, Constance;

ACS Symposium Series; American Chemical Society: Washington, DC, 1982.
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e a r l i e r model c l a s s i f i e d meals as low, moderate o r h i g h a v a i l -
ability; t h i s produced a r t i f i c i a l s t a i r step increments. Thus,
the model has been f u r t h e r r e f i n e d t o show that the enhancing
f a c t o r s a r e a d d i t i v e i n t h e i r e f f e c t and smoothly i n c r e a s e
d i e t a r y nonheme i r o n a b s o r p t i o n i n a l o g a r i t h m i c f a s h i o n (21).
Thus the amount o f nonheme i r o n a v a i l a b l e f o r a b s o r p t i o n from
each meal o r snack can be estimated from the summation o f
enhancing f a c t o r s (milligrams o f a s c o r b i c a c i d p l u s grams o f
cooked m e a t / f i s h / p o u l t r y ) . Absorption o f nonheme i r o n f o r the
r e f e r e n c e i n d i v i d u a l with 500 mg i r o n s t o r e s i s assumed to
change from 3% f o r a meal w i t h no enhancing f a c t o r s to 8% from
a meal o f 75 enhancing f a c t o r s . The formulas f o r c a l c u l a t i n g
the r a t e o f a b s o r p t i o n o f nonheme i r o n f o r the r e f e r e n c e i n d i -
vidual are:
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For EF < 75: % b i o a v a i l a b i l i t y o f nonheme i r o n -

For EF ^ 75: % b i o a v a i l a b i l i t y o f nonheme i r o n • 8

Absorption o f heme i r o n i s estimated to be 23% f o r the

r e f e r e n c e i n d i v i d u a l . Heme i r o n may be estimated a t 40% o f the
i r o n i n meat, f i s h and p o u l t r y . Nonheme i r o n would be c a l c u -
l a t e d as the remaining 60% o f meat, f i s h and p o u l t r y i r o n p l u s
the i r o n i n vegetables, g r a i n and other foods. The a v a i l a b l e
nonheme i r o n and heme i r o n from each meal and snack can be
summed t o c a l c u l a t e the t o t a l day's a v a i l a b l e i r o n .

D i e t a r y i n t a k e o f i r o n and a s c o r b i c a c i d

P r e l i m i n a r y data (22) from the second Health and N u t r i t i o n

Examination Survey, 1976-1980 (HANES 2) i n d i c a t e s a mean i n t a k e
of i r o n f o r females a t 10.6 mgs per day (Table 2A)• T h i s l e v e l
i s 10% higher than HANES 1. A higher n u t r i e n t d e n s i t y e x h i b i t e d
by m i l l i g r a m s o f i r o n per thousand k i l o c a l o r i e s was seen i n each
age group, although the mean i n t a k e o f i r o n i s below the
Recommended D i e t a r y Allowances (19) f o r females during t h e i r
r e p r o d u c t i v e and menstruating years. The males a l s o show a
higher i r o n i n t a k e and higher n u t r i e n t d e n s i t y i n HANES 2 com-
pared to HANES 1 (Table 2B). A s c o r b i c a c i d i n t a k e (Tables 3A &
B) r e p o r t the mean i n t a k e o f a s c o r b i c a c i d to be above the
Recommended D i e t a r y Allowances i n a l l age groups.
Considering the i n t a k e data a t v a r i o u s p e r c e n t i l e l e v e l s ,
new i n t e r p r e t a t i o n s come forward. I n a l l cases the values a r e
skewed toward the upper i n t a k e l e v e l s , thus a l l s u b j e c t s a t the
50th p e r c e n t i l e r e p o r t consumption below the mean i n t a k e l e v e l .
For women a t the 25th p e r c e n t i l e the average i n t a k e was approx-
imately 7 mg o f i r o n per day and a t the 10th p e r c e n t i l e the i n -
take was down to only 5 mg p e r day. The males a t the 25th

In Nutritional Bioavailability of Iron; Kies, Constance;

ACS Symposium Series; American Chemical Society: Washington, DC, 1982.
 5. MONSEN Enhancement by Ascorbic Acid 91

Table 2A
IRON INTAKE (mg)
FEMALES
HANES 2, 1976-1980
A l l Income L e v e l s Income Below Poverty
Percentile: Mean 50th 25 th 10th 50th 25th 10th
6 mon-74 y r s 10.6 9.6 6.9 5.0 8.8 6.3 4.3
6-11 mon 12.9 9,4 4.8 3,4 7,8 3,5 2,3
1-2 y r s 8.5 7.0 5,1 3.6 7,1 5,0 3,4
3-5 9.5 8.5 6.4 4.6 9,0 6.4 4,4
6-8 10.8 10,1 7.8 5,9 9,8 7,6 5,5
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11.4 10.2 5,7

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9-11 7.5 5.8 9,6 6,9

12-14 10.8 9.9 6,8 5,3 8,5 6.5 4,7
15-17 9.9 9.4 6.3 4,4 9,8 6,8 5,0
18-24 10.6 9,7 6,8 4,6 8,8 6,1 3,8
25-34 10.9 9,7 7.0 4,9 10,3 6,4 4,5
35-44 11.2 10.0 7,5 5,3 8,6 6,0 4,2
45-54 10,4 9.5 7,3 5,5 8,4 6,0 4,5
55-64 10.7 9.4 7,0 5,2 7,8 5,5 4,0
64-74 10,2 9,0 6,6 5,1 8.0 6,0 4,3

Table 2B
IRON INTAKE (mg)
MALES
HANES 2, 1976-1980
A l l Income L e v e l s Income Below Poverty
Percentile: Mean 50th 25th 10th 50th 25th 10th
6 mon-74 y r s 15.5 13.8 9.7 7.0 12,2 8,2 5.7
6-11 mon 12.8 8.2 4.3 2.6 8.3 4.2 2.2
1-2 y r s 8.7 7.4 5.2 3.6 7.3 4.9 3.4
3-5 10.5 9.2 7.0 5.2 9.5 7.0 5.1
6-8 12.5 11.4 8.8 6.6 11.4 8.7 5.7
9-11 14.4 13.1 9.1 7,2 11.7 7,6 6,3
12-14 15.9 14.4 9.9 7.5 11,7 8,1 6,3
15-17 17.4 15.0 10.6 7,2 14.3 10,2 6,6
18-24 17.8 15.7 10.9 7.7 15,8 10.4 6.6
25-34 17.3 15.6 11.2 8.0 15.2 10,0 6.4
35-44 16.0 14.6 10.8 7.9 11.9 7.9 5,3
45-54 16.2 14.5 11.2 8.1 15.4 11,1 8.4
55-64 14.8 13.4 10.1 7.3 11,1 8,1 5,3
65-74 14.1 12.3 9.1 6.7 10.4 7,4 4,8

In Nutritional Bioavailability of Iron; Kies, Constance;

ACS Symposium Series; American Chemical Society: Washington, DC, 1982.
 92
NUTRT
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IABL
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ION

Table 3A
ASCORBIC ACID INTAKE (mg)
FEMALES
HANES 2, 1976-1982
A l l Income L e v e l s Income Below Poverty
Percentile: Mean 50th 25th 10th 50th 25th 10th
6 mon-74 y r s 93 63 27 11 44 19 7
6-11 mon. 72 51 31 13 51 34 21
1-2 y r s . 86 64 27 13 61 23 12
3-5 96 68 29 15 54 24 10
6-8 109 80 34 19 80 36 18
13
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9-11 94 59 32 17 43 19
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12-14 83 56 25 11 33 16 3
15-17 73 42 21 9 31 14 3
18-24 92 59 25 9 46 20 6
25-34 92 55 24 9 36 19 7
35-44 83 53 23 10 32 13 4
45-54 97 69 26 9 62 15 4
55-64 107 88 35 15 47 20 7
65-74 105 90 37 13 71 24 8

Table 3B
ASCORBIC ACID INTAKE (mg)
MALES
HANES 2, 1976-1980
A l l Income L e v e l s Income Below Poverty
Percentile: Mean 50th 25th 10th 50th 25 th 10th
6 mon-74 y r s 108 73 33 15 57 23 9
6-11 mon. 63 51 23 14 41 19 12
1-2 y r s . 90 64 28 13 46 20 9
3-5 104 76 34 16 72 33 12
6-8 105 68 34 19 52 26 15
9-11 119 88 41 20 76 37 15
12-14 123 72 32 15 51 22 12
15-17 112 69 33 16 55 23 10
18-24 129 76 35 14 72 36 12
25-34 108 66 31 13 48 18 5
35-44 96 66 28 15 46 17 3
45-54 102 76 34 13 80 24 7
55-64 103 82 34 15 52 23 6
65-74 100 79 33 11 45 11 3

In Nutritional Bioavailability of Iron; Kies, Constance;

ACS Symposium Series; American Chemical Society: Washington, DC, 1982.
 93
5. MONSEN Enhancement by Ascorbic Acid
p e r c e n t i l e s remain around 10 mg per day and a t the 10th per-
c e n t i l e are approximately 8 mg o f i r o n p e r day. Ascorbic acid
i n t a k e s a t the 25th p e r c e n t i l e f o r the females a r e under 30 mg
per day and a t the 10th p e r c e n t i l e they average o n l y 11 mg per
day. Males are s l i g h t l y higher, being 33 and 15 mg per day
r e s p e c t i v e l y a t the 25th and 10th p e r c e n t i l e .
I n d i v i d u a l s whose incomes are below poverty l i n e have even
lower intakes o f i r o n and o f a s c o r b i c a c i d . At these low i n -
come l e v e l s the females a t the 50th p e r c e n t i l e r e p o r t d a i l y i n -
takes o f only 9 mg o f i r o n ; t h i s drops to 6 mg a t the 25th
p e r c e n t i l e and to only 4 mg i r o n per day a t the 10th p e r c e n t i l e .
T h i s l e v e l o f intake i s only 22% o f the Recommended D i e t a r y
Allowance f o r the menstruating woman. The i n t a k e o f the males
whose income i s below poverty l i n e i s reduced to 6 mg o f i r o n
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per day a t the 10th p e r c e n t i l e . A s c o r b i c a c i d i s a l s o dramat-

Publication Date: November 1, 1982 | doi: 10.1021/bk-1982-0203.ch005

i c a l l y reduced i n intake f o r those i n d i v i d u a l s below the poverty

l i n e . At the 25th p e r c e n t i l e the females below poverty consume
on an average under 20 mg o f a s c o r b i c a c i d a day and a t the 10th
p e r c e n t i l e t h e i r average i n t a k e i s only 7 mg p e r day. The males
f a i r e d s l i g h t l y b e t t e r , being s l i g h t l y above 20 mg a t the 25th
p e r c e n t i l e and around 9 mg o f a s c o r b i c a c i d per day a t the 10th
p e r c e n t i l e . Groups a t and below the 25th p e r c e n t i l e , p a r t i c u -
l a r l y those below the poverty l i n e , are v u l n e r a b l e to d i e t a r y
i r o n d e f i c i e n c y due to low d i e t a r y i n t a k e o f i r o n ; p l u s i t i s
h i g h l y l i k e l y that these same people have low a s c o r b i c a c i d i n -
takes and thus the l i m i t e d amount o f d i e t a r y i r o n they consume
i s apt to be p o o r l y absorbed. Although on average the US i n t a k e
appears to be s u f f i c i e n t f o r a s c o r b i c a c i d and c e r t a i n l y f o r
i r o n i n the male, the i n t a k e o f these n u t r i e n t s appears to be
dangerously low f o r a s u b s t a n t i a l p o r t i o n o f the p o p u l a t i o n .
A study has r e c e n t l y been completed which i n d i r e c t l y i n -
d i c a t e s that high d i e t a r y q u a l i t y can provide the n u t r i e n t s
necessary f o r i r o n a b s o r p t i o n u t i l i z a t i o n . T h i s was a study
done i n a 176 high frequency blood donors who were able to
maintain hemoglobin l e v e l s considered adequate to donate blood
over an extended p e r i o d o f time (23). These blood superdonors
donated 17 u n i t s o f blood over a four year p e r i o d . Although
t h e i r i r o n s t o r e s were very low, these subjects were maintaining
hemoglobin and hematocrit l e v e l s above standard minimum l e v e l s .
These v o l u n t e e r s were queried as to t h e i r d i e t a r y i n t a k e s ; t h e i r
d i e t s were o f unusually h i g h q u a l i t y with regard to both a s c o r -
b i c a c i d intake and meat, f i s h and p o u l t r y .

A s c o r b i c a c i d : I r o n and r e l a t i o n s h i p s i n abnormal s t a t e o f me-

tabolism

A s c o r b i c a c i d and i r o n i n t e r r e l a t e i n a v a r i e t y o f c o n d i -
t i o n s where i r o n s t o r e s a r e e i t h e r g r e a t l y reduced o r drama-
t i c a l l y i n c r e a s e d . I n untreated i d o p a t h i c hemochromatosis
( B r i s s o t , e t a l . , 1978), white blood c e l l a s c o r b i c a c i d i s drama-

In Nutritional Bioavailability of Iron; Kies, Constance;

ACS Symposium Series; American Chemical Society: Washington, DC, 1982.
 94
NUTRT
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IAVAL
IABL
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ION
t i c a l l y reduced; i t i s assumed that t h i s decrease i n a s c o r b i c
a c i d s t a t u s r e s u l t s from i r o n overload (24). C h a t t e r j e a , et a l . ,
has reported that p l a t e l e t a s c o r b i c a c i d i s p a r t i c u l a r l y low i n
thalassemia, while i t i s higher than normal i n i r o n d e f i c i e n c y
anemia (25). G i v i n g i r o n s a l t s as the therapy f o r i r o n d e f i -
ciency anemia reduced the a s c o r b i c a c i d content i n both p l a t e -
l e t s and l e u c o c y t e s . Indeed reduced a s c o r b i c a c i d s t o r e s have
been shown to be b e n e f i c i a l to i n d i v i d u a l s with thalassemia
major when the thalassemia was t r e a t e d with blood t r a n s f u s i o n s
and i a t r o g e n i c i r o n overload produced; a s c o r b u t i c c o n d i t i o n
developed d e s p i t e adequate intake of v i t a m i n C with t h i s high
i r o n overload. The v i t a m i n C d e f i c i e n c y however appeared to
p r o t e c t the t i s s u e s from damage due to the i r o n overload. When
c h e l a t i o n therapy i s u t i l i z e d , a s c o r b i c a c i d s t a t u s needs to be
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monitored very c a r e f u l l y (26).

Publication Date: November 1, 1982 | doi: 10.1021/bk-1982-0203.ch005

Extensive research has been conducted i n guinea p i g s where-

by r e l a t i o n s h i p s between a s c o r b i c a c i d and i r o n were s t u d i e d .
A l t e r a t i o n s i n spleen and h e p a t i c i r o n l e v e l s of hemosiderin and
f e r r i t i n as w e l l as changes i n h e p a t i c microsomal cytochrome
P-450 have been observed with a s c o r b i c a c i d d e f i c i e n c y (27-29).

A s c o r b i c a c i d as panacea f o r i r o n d e f i c i e n c y
The importance of i r o n i n n u t r i t i o n a l s t a t u s has been r e c -
ognized f o r c e n t u r i e s . In an e f f o r t to d i s s o l v e i r o n and make
i t more a v a i l a b l e numerous t h e r a p i e s have been devised i n c l u d i n g
such r a r i t i e s as syrups of sherry i n which i r o n wire has been
soaked f o r 30 days, s l i c e s of apple i n t o which i r o n n a i l s have
been imbedded, and s o l u t i o n s of vinegar i n t o which i r o n f i l i n g s
have been placed weeks e a r l i e r . The i n t e r a c t i o n of a s c o r b i c
a c i d and i r o n has been recognized more r e c e n t l y (30). I t may be
that the most u s e f u l and r e a d i l y found therapy f o r i r o n d e f i -
ciency w i l l be d i e t a r y a s c o r b i c a c i d which has the c a p a b i l i t y of
i n c r e a s i n g the r a t e of nonheme i r o n absorption s e v e r a l f o l d .

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In Nutritional Bioavailability of Iron; Kies, Constance;

ACS Symposium Series; American Chemical Society: Washington, DC, 1982.