Bonnie and Clyde: Vitamin C and iron are partners in crime in iron deficiency anaemia and its potential role in the elderly

is an obligate nutrient for life, due to its key roles in myriad cellular processes. This vital transition metal is also an essential component of haemoglobin in red blood cells [3, 4], of which 200 billion new red cells are produced every day [5, 6]. It is well known that vitamin C (ascorbate) is crucial for collagen formation and the prevention of scurvy [2]. However, an underappreciated fact is that ascorbate, in addition to its well established role in dietary iron absorption, is also vital for maximal uptake of iron from the serum-iron transport protein, transferrin [1, 2] (Figure 1). Indeed, in light of these new findings, the role of combination therapy employing both iron and ascorbate requires critical reappraisal for the treating iron-deficiency anaemia. The following epidemiological observations are pertinent to this discussion: (1) while ascorbate deficiency is thought to be rare in Western countries, it is surprising that 7.1% of US adults and up to 40% of elderly UK individuals (≥65 years) were ascorbate-deficient [7-9]; (2) low ascorbate is common in critical care patients[10], including Australian dialysis patients [11]; (3) ascorbate deficiency remains a critical problem in the third world, and also in indigenous populations, e.g., Australian Aborigines [12]; and (4) by age 80 years, up to 10% of Australians are anaemic, and this contributes to significantly increased risk of disability, morbidity and death [13]. Thus, optimising combinations of iron and ascorbate could be vital. Anaemia in the elderly is of high clinical relevance, as several studies have linked it to an increase in overall morbidity, Alzheimer's disease [14], decreased " quality of life " scores, and increased rates of hospital admissions and mortality [15]. In considering the causes of anaemia in the elderly, it is worth noting that chronic inflammation is common in elderly individuals, which increases circulating hepcidin levels, leading to a suppression of circulating iron that is available for erythropoiesis [16]. Other significant contributory factors to anaemia in the elderly are a poor diet, which may be deficient in iron, folate and/or ascorbate, and may potentiate or promote iron deficiency and iron deficiency anaemia (IDA) [16]. As Lopez and colleagues [17] recently reported, anaemia affects approximately one third of the global population, namely 2.1 billion people, with IDA accounting for at least half of these cases [17]. In fact, IDA represents a health problem of global proportion, with the burden of disease falling on young …