Dietary Recommendation
Patients with HH should try to abstain from alcohol especially if advanced fibrosis is present. They should also minimize vitamin C use and supplements containing iron tablets. Vitamin C can lead to increased intestinal iron absorption and release of iron stores. Concomitant risk factors for liver disease should be evaluated for and managed as needed. Thus, patients with metabolic syndrome should be advised to lose weight with appropriate diet and exercise. Non-citrus fruits may be beneficial. Similarly, proton pump inhibitors such as omeprazole also can be helpful as they decrease the acidity of duodenal contents, thus decreasing absorption of iron. There is increased absorption of dietary iron, especially heme iron in HH patients, which is associated with higher SF concentration in some patients. Food fortified with inorganic iron may worsen the iron overload severity in HH patients. Although, it is not clear whether use of supplemental iron may cause clinical symptoms in undiagnosed HH patients, their use is prohibited as reports of iron overload with their intake has been described in literature. Similarly, there have been reports of Vibrio vulnificus infection with raw shellfish or uncooked oyster ingestion and HH patients should be educated about it. Iron homeostasis is also related to other metals such as copper. An Austrian study showed that copper deficiency was associated with increased SF and hepatic iron levels, possibly due to copper involvement in the enzymes involved in iron transport such as copper containing ferroxidases.