What is the relationship between Vitamin C and iron-deficiency anemia?

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Last updated: May 5, 2025 • View editorial policy

From the Guidelines

Vitamin C is essential for increasing iron absorption and reducing the risk of iron deficiency anemia, and its intake should be increased, especially when consuming iron-rich plant-based foods. According to a recent study published in The Lancet Planetary Health 1, combining vitamin C with iron-rich plant-based foods can significantly enhance iron bioavailability. The study highlights that vitamin C is a powerful enhancer of non-haeme iron absorption, which is found in plant foods.

Key points to consider:

  • Vitamin C can increase iron absorption by converting dietary iron from the ferric to the ferrous form, making it more readily absorbed by the intestines.
  • A systematic review and meta-analysis concluded that increasing vitamin C intake is a practical approach to lowering the risk of iron deficiency and minimizing the occurrence of iron-deficiency anemia 1.
  • Iron-rich plant-based foods, such as pulses and grains, should be consumed in combination with sources of vitamin C to maximize iron absorption.
  • Common vitamin C-rich foods include citrus fruits, strawberries, bell peppers, and broccoli, which can be incorporated into meals containing iron sources for maximum benefit.

It is crucial to note that while vitamin C can help with iron absorption, it alone cannot treat anemia caused by other factors like B12 deficiency or chronic diseases. Proper diagnosis is essential before self-treating, as different types of anemia require different treatments.

From the Research

Vitamin C and Anemia

  • Vitamin C is known to enhance iron absorption and is often prescribed with iron for anemia patients 2, 3, 4, 5.
  • A systematic review and meta-analysis of experimental studies found that the treatment efficacy of oral vitamin C or ascorbate given as co-intervention with iron compared to providing only iron among participants with anemia was not statistically significant 2.
  • The study found that the pooled estimate for standardized mean difference of hemoglobin and Serum Ferritin for intervention-type ferrous ascorbate and oral iron and vitamin C were not statistically significant 2.
  • Another study found that high-dose vitamin C intakes do not cause iron imbalance in healthy persons and probably in persons who are heterozygous for hemochromatosis 3.
  • Vitamin C has been shown to have a dual action in iron supplement therapeutics for iron deficiency anemia, preventing liver damage induced by iron overload 4.
  • A randomized clinical trial found that oral iron supplements alone were equivalent to oral iron supplements plus vitamin C in improving hemoglobin recovery and iron absorption in patients with iron deficiency anemia 5.
  • The trial suggested that on-demand vitamin C supplements are not essential to take along with oral iron supplements for patients with iron deficiency anemia 5.

Mechanism of Action

  • Vitamin C aids in increasing absorbable ferrous iron in iron deficiency anemia by acting as a reducing agent 4.
  • Vitamin C also acts as an antioxidant, preventing liver damage caused by iron excess and targeting the mitochondria to prevent mitochondrial swelling and ROS burst 4.
  • The antioxidant effects of vitamin C may help to prevent oxidative damage and reduce the risk of diseases such as coronary heart disease and cancer 3.

Clinical Implications

  • The use of vitamin C with iron supplements may not be essential for patients with iron deficiency anemia 5.
  • However, vitamin C may still have a role in preventing liver damage induced by iron overload in patients with iron deficiency anemia 4.
  • Further studies are needed to fully understand the treatment efficacy of oral vitamin C or ascorbate given as co-intervention with iron for anemia 2.

References

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.