COVID-19 and Iron Deficiency: Avoidable Risk Factor?
Increased Zinc Excretion In Patients With Pernicious Anemia: Avoidable COVID-19 Risk Factor?
Abstract:
Iron deficiency is a risk factor for severity of Coronavirus. People with pernicious anemia who eat folic acid, a synthetic form of B9, excrete more zinc in their fecal waste. Knowing this, and separating out this demographic could make it easier to decide the correct dose of zinc, which has been found to be beneficial for patients with coronavirus, but the exact dosing of which has not yet been concluded. Alternatively, people with iron deficiency could have folic acid containing foods removed from their diet and be replaced with whole grain products if it is found safe to do so, at which point there zinc requirement should come more similar to the average patient.
-
Discussion:
A cluster of pneumonia was reported in Wuhan, Hubei China for the first time in December of 2019[1]. A corona virus was identified as the pathogen - SARS Cov 2 - and the disease it caused was designated Covid 19. The disease emerged in China and has spread rapidly throughout the world.
A meta-analysis of clinical, laboratory and imaging features of Covid 19 described fever, cough and myalgia as the most common clinical features. Regarding the laboratory findings, lymphopenia was the most common, in almost one quarter of the patients (23.8%)[2].
Zinc has been found to have benefit for many people with Coronavirus. The risk to reward ratio is in favor of Zn supplementation in COVID-19, although research is still at infancy stage with regard to the optimal dose of Zn supplementation as a therapeutic treatment as well as a preventative measure for viral infections including SARS-CoV-2.[3]
Various factors affect human zinc absorption.[4]
Iron deficiency seems to be a risk factor for severity of Coronavirus.[5]
Folic acid, a synthetic form of B9.[6], is provided in fortified grain products such as bread, noodles, rice, and breakfast cereal.[6,7]
There are studies showing that people who have an iron deficiency such as pernicious anemia excrete more zinc in the fecal waste than non-anemic individuals after consuming folic acid.[8,9,10]
People with pernicious anemia who are given folic acid in fortified bread or other grain products in the hospital, with the doctors being unaware that their patients are being given a nutritional supplement thereby, will have a different requirement of zinc than people who do not have pernicious anemia, and who are thus not having a higher amount of their zinc exit in their fecal waste.
That might be one reason research is described as still at infancy stage with regard to the optimal dose of Zn supplementation as a therapeutic treatment as well as a preventative measure for viral infections including SARS-CoV-2.[3]
It would be logical to conclude there for that people with pernicious anemia and possibly other iron deficiencies should avoid folic acid and therefore have food with folic acid no longer given to them for the duration of their coronavirus infection.
It should be confirmed that, as long as they are receiving a healthy diet in the hospital otherwise, there is no particular risk factor involved in giving them whole grain instead of grain products which are enriched with folic acid.
Alternatively, people with pernicious anemia could require a higher dose of zinc if they are being given folic acid in the food in the hospital. Separating this demographic in this way could take one factor out of the difficulty of coming up with the best dose of zinc for the individual patient.
-
Conclusion:
Doctors are liable to be unaware that patients are being given folic acid in refined grain products which are being fed to them in the hospital. People with pernicious anemia may require a higher dose of zinc if they are being fed folic acid, which may explain why it has been difficult choose the correct dose of zinc for individual, because they are not including pernicious anemia as a demographic for a higher zinc requirement, something which could be reduced by no longer giving the patients folic acid by giving them whole grain bread instead if it is safe to do so.
-----
Author Contributions:
D.B. performed literature research, wrote this article, and did all the editing.
Corresponding email address: acctdmail@aol.com
This is a pre-publication version of this manuscript.
---
Funding:
There has been no funding.
Conflict of interest statement:
The author declares no conflict of interest.
---
Deborah Barges is an independent researcher, initially studying one of the causes of fibromyalgia, having isolated it by experience and accident, and the zinc-copper-iron homeostases as a result.
---
Citations:
1. Zhu N., Zhang D., Wang W., Li X., Yang B., Song J., Zhao X., Huang B., Shi W., Lu R., Niu P., Zhan F., Ma X., Wang D., Xu W., Wu G., Gao G.F., Tan W., China Novel Coronavirus Investigating and Research Team 2019 a novel coronavirus from patients with pneumonia in China, 2019. N. Engl. J. Med. 2020 Feb 20;382(8):727-733. doi: 10.1056/NEJMoa2001017. (Epub 2020 Jan 24)
https://www.nejm.org/doi/full/10.1056/nejmoa2001017
2. Rodriguez-Morales AJ, Cardona-Ospina JA, Gutiérrez-Ocampo E, Villamizar-Peña R, Holguin-Rivera Y, Escalera-Antezana JP, Alvarado-Arnez LE, Bonilla-Aldana DK, Franco-Paredes C, Henao-Martinez AF, Paniz-Mondolfi A, Lagos-Grisales GJ, Ramírez-Vallejo E, Suárez JA, Zambrano LI, Villamil-Gómez WE, Balbin-Ramon GJ, Rabaan AA, Harapan H, Dhama K, Nishiura H, Kataoka H, Ahmad T, Sah R; Latin American Network of Coronavirus Disease 2019-COVID-19 Research (LANCOVID-19). Electronic address: https://www.lancovid.org. Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis. Travel Med Infect Dis. 2020 Mar-Apr;34:101623. doi: 10.1016/j.tmaid.2020.101623. Epub 2020 Mar 13. PMID: 32179124; PMCID: PMC7102608.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7102608/
3. Amit Pal, Rosanna Squitti, Mario Picozza, Anil Pawar, Mauro Rongioletti, Atanu Kumar Dutta, Sibasish Sahoo, Kalyan Goswami, Praveen Sharma, and Rajendra Prasad; Zinc and COVID-19: Basis of Current Clinical Trials. Biol Trace Elem Res. 2020 Oct 22 : 1–11.
doi: 10.1007/s12011-020-02437-9 [Epub ahead of print]
PMCID: PMC7580816
PMID: 33094446
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7580816/
4. Maria Maares, Hajo Haase; A Guide to Human Zinc Absorption: General Overview and Recent Advances of In Vitro Intestinal Models. Nutrients. 2020 Mar; 12(3): 762.
Published online 2020 Mar 13. doi: 10.3390/nu12030762
PMCID: PMC7146416
PMID: 32183116
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7146416/
5. Faghih Dinevari, M., Somi, M.H., Sadeghi Majd, E. et al. Anemia predicts poor outcomes of COVID-19 in hospitalized patients: a prospective study in Iran. BMC Infect Dis 21, 170 (2021). https://doi.org/10.1186/s12879-021-05868-4
https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-021-05868-4
6. Field MS, Stover PJ. Safety of folic acid. Ann N Y Acad Sci. 2018 Feb;1414(1):59-71. doi: 10.1111/nyas.13499. Epub 2017 Nov 20. PMID: 29155442; PMCID: PMC5849489. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5849489/
7. Marion Dietrich, Coralie J.P. Brown & Gladys Block (2005) The Effect of Folate Fortification of Cereal-Grain Products on Blood Folate Status, Dietary Folate Intake, and Dietary Folate Sources among Adult Non-Supplement Users in the United States, Journal of the American College of Nutrition, 24:4, 266-274, doi:10.1080/07315724.2005.10719474
https://www.tandfonline.com/doi/full/10.1080/07315724.2005.10719474
8. Milne DB, Canfield WK, Mahalko JR, Sandstead HH. Effect of oral folic acid supplements on zinc, copper, and iron absorption and excretion. Am J Clin Nutr. 1984 Apr;39(4):535-9. doi: 10.1093/ajcn/39.4.535. PMID: 6711464.
https://academic.oup.com/ajcn/article-lookup/doi/10.1093/ajcn/39.4.535
9. Simmer K, Iles CA, James C, Thompson RP. Are iron-folate supplements harmful? Am J Clin Nutr. 1987 Jan;45(1):122-5. doi: 10.1093/ajcn/45.1.122. PMID: 3799496
https://academic.oup.com/ajcn/article-abstract/45/1/122/4694916
10. Butterworth CE Jr, Tamura T. Folic acid safety and toxicity: a brief review. Am J Clin Nutr. 1989 Aug;50(2):353-8. doi: 10.1093/ajcn/50.2.353. PMID: 2667316.
https://pubmed.ncbi.nlm.nih.gov/2667316/
---
Pre-publication version
©Deborah Barges Apr 2019 - Apr 2021. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/)
Abstract:
Iron deficiency is a risk factor for severity of Coronavirus. People with pernicious anemia who eat folic acid, a synthetic form of B9, excrete more zinc in their fecal waste. Knowing this, and separating out this demographic could make it easier to decide the correct dose of zinc, which has been found to be beneficial for patients with coronavirus, but the exact dosing of which has not yet been concluded. Alternatively, people with iron deficiency could have folic acid containing foods removed from their diet and be replaced with whole grain products if it is found safe to do so, at which point there zinc requirement should come more similar to the average patient.
-
Discussion:
A cluster of pneumonia was reported in Wuhan, Hubei China for the first time in December of 2019[1]. A corona virus was identified as the pathogen - SARS Cov 2 - and the disease it caused was designated Covid 19. The disease emerged in China and has spread rapidly throughout the world.
A meta-analysis of clinical, laboratory and imaging features of Covid 19 described fever, cough and myalgia as the most common clinical features. Regarding the laboratory findings, lymphopenia was the most common, in almost one quarter of the patients (23.8%)[2].
Zinc has been found to have benefit for many people with Coronavirus. The risk to reward ratio is in favor of Zn supplementation in COVID-19, although research is still at infancy stage with regard to the optimal dose of Zn supplementation as a therapeutic treatment as well as a preventative measure for viral infections including SARS-CoV-2.[3]
Various factors affect human zinc absorption.[4]
Iron deficiency seems to be a risk factor for severity of Coronavirus.[5]
Folic acid, a synthetic form of B9.[6], is provided in fortified grain products such as bread, noodles, rice, and breakfast cereal.[6,7]
There are studies showing that people who have an iron deficiency such as pernicious anemia excrete more zinc in the fecal waste than non-anemic individuals after consuming folic acid.[8,9,10]
People with pernicious anemia who are given folic acid in fortified bread or other grain products in the hospital, with the doctors being unaware that their patients are being given a nutritional supplement thereby, will have a different requirement of zinc than people who do not have pernicious anemia, and who are thus not having a higher amount of their zinc exit in their fecal waste.
That might be one reason research is described as still at infancy stage with regard to the optimal dose of Zn supplementation as a therapeutic treatment as well as a preventative measure for viral infections including SARS-CoV-2.[3]
It would be logical to conclude there for that people with pernicious anemia and possibly other iron deficiencies should avoid folic acid and therefore have food with folic acid no longer given to them for the duration of their coronavirus infection.
It should be confirmed that, as long as they are receiving a healthy diet in the hospital otherwise, there is no particular risk factor involved in giving them whole grain instead of grain products which are enriched with folic acid.
Alternatively, people with pernicious anemia could require a higher dose of zinc if they are being given folic acid in the food in the hospital. Separating this demographic in this way could take one factor out of the difficulty of coming up with the best dose of zinc for the individual patient.
-
Conclusion:
Doctors are liable to be unaware that patients are being given folic acid in refined grain products which are being fed to them in the hospital. People with pernicious anemia may require a higher dose of zinc if they are being fed folic acid, which may explain why it has been difficult choose the correct dose of zinc for individual, because they are not including pernicious anemia as a demographic for a higher zinc requirement, something which could be reduced by no longer giving the patients folic acid by giving them whole grain bread instead if it is safe to do so.
-----
Author Contributions:
D.B. performed literature research, wrote this article, and did all the editing.
Corresponding email address: acctdmail@aol.com
This is a pre-publication version of this manuscript.
---
Funding:
There has been no funding.
Conflict of interest statement:
The author declares no conflict of interest.
---
Deborah Barges is an independent researcher, initially studying one of the causes of fibromyalgia, having isolated it by experience and accident, and the zinc-copper-iron homeostases as a result.
---
Citations:
1. Zhu N., Zhang D., Wang W., Li X., Yang B., Song J., Zhao X., Huang B., Shi W., Lu R., Niu P., Zhan F., Ma X., Wang D., Xu W., Wu G., Gao G.F., Tan W., China Novel Coronavirus Investigating and Research Team 2019 a novel coronavirus from patients with pneumonia in China, 2019. N. Engl. J. Med. 2020 Feb 20;382(8):727-733. doi: 10.1056/NEJMoa2001017. (Epub 2020 Jan 24)
https://www.nejm.org/doi/full/10.1056/nejmoa2001017
2. Rodriguez-Morales AJ, Cardona-Ospina JA, Gutiérrez-Ocampo E, Villamizar-Peña R, Holguin-Rivera Y, Escalera-Antezana JP, Alvarado-Arnez LE, Bonilla-Aldana DK, Franco-Paredes C, Henao-Martinez AF, Paniz-Mondolfi A, Lagos-Grisales GJ, Ramírez-Vallejo E, Suárez JA, Zambrano LI, Villamil-Gómez WE, Balbin-Ramon GJ, Rabaan AA, Harapan H, Dhama K, Nishiura H, Kataoka H, Ahmad T, Sah R; Latin American Network of Coronavirus Disease 2019-COVID-19 Research (LANCOVID-19). Electronic address: https://www.lancovid.org. Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis. Travel Med Infect Dis. 2020 Mar-Apr;34:101623. doi: 10.1016/j.tmaid.2020.101623. Epub 2020 Mar 13. PMID: 32179124; PMCID: PMC7102608.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7102608/
3. Amit Pal, Rosanna Squitti, Mario Picozza, Anil Pawar, Mauro Rongioletti, Atanu Kumar Dutta, Sibasish Sahoo, Kalyan Goswami, Praveen Sharma, and Rajendra Prasad; Zinc and COVID-19: Basis of Current Clinical Trials. Biol Trace Elem Res. 2020 Oct 22 : 1–11.
doi: 10.1007/s12011-020-02437-9 [Epub ahead of print]
PMCID: PMC7580816
PMID: 33094446
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7580816/
4. Maria Maares, Hajo Haase; A Guide to Human Zinc Absorption: General Overview and Recent Advances of In Vitro Intestinal Models. Nutrients. 2020 Mar; 12(3): 762.
Published online 2020 Mar 13. doi: 10.3390/nu12030762
PMCID: PMC7146416
PMID: 32183116
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7146416/
5. Faghih Dinevari, M., Somi, M.H., Sadeghi Majd, E. et al. Anemia predicts poor outcomes of COVID-19 in hospitalized patients: a prospective study in Iran. BMC Infect Dis 21, 170 (2021). https://doi.org/10.1186/s12879-021-05868-4
https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-021-05868-4
6. Field MS, Stover PJ. Safety of folic acid. Ann N Y Acad Sci. 2018 Feb;1414(1):59-71. doi: 10.1111/nyas.13499. Epub 2017 Nov 20. PMID: 29155442; PMCID: PMC5849489. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5849489/
7. Marion Dietrich, Coralie J.P. Brown & Gladys Block (2005) The Effect of Folate Fortification of Cereal-Grain Products on Blood Folate Status, Dietary Folate Intake, and Dietary Folate Sources among Adult Non-Supplement Users in the United States, Journal of the American College of Nutrition, 24:4, 266-274, doi:10.1080/07315724.2005.10719474
https://www.tandfonline.com/doi/full/10.1080/07315724.2005.10719474
8. Milne DB, Canfield WK, Mahalko JR, Sandstead HH. Effect of oral folic acid supplements on zinc, copper, and iron absorption and excretion. Am J Clin Nutr. 1984 Apr;39(4):535-9. doi: 10.1093/ajcn/39.4.535. PMID: 6711464.
https://academic.oup.com/ajcn/article-lookup/doi/10.1093/ajcn/39.4.535
9. Simmer K, Iles CA, James C, Thompson RP. Are iron-folate supplements harmful? Am J Clin Nutr. 1987 Jan;45(1):122-5. doi: 10.1093/ajcn/45.1.122. PMID: 3799496
https://academic.oup.com/ajcn/article-abstract/45/1/122/4694916
10. Butterworth CE Jr, Tamura T. Folic acid safety and toxicity: a brief review. Am J Clin Nutr. 1989 Aug;50(2):353-8. doi: 10.1093/ajcn/50.2.353. PMID: 2667316.
https://pubmed.ncbi.nlm.nih.gov/2667316/
---
Pre-publication version
©Deborah Barges Apr 2019 - Apr 2021. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/)
