Latest research finds lactoferrin as effective as iron treatment for low hemoglobin

13 Feb 2024 --- Cyprus-based researchers conclude that bovine lactoferrin is an effective intervention for patients with low hemoglobin (Hb) concentration after reviewing clinical trials that compare the ingredient with iron. Although iron supplementation is currently the most common treatment for low Hb blood levels, its adverse side effects lead to poor patient adherence.

An insufficient level of red blood cells to support the body’s metabolic needs can lead to anemia — low Hb concentration — contributing significantly to global morbidity and mortality figures. According to the review, oral iron supplementation “usually causes unwanted gastrointestinal side effects in patients in 70% of cases.”

Meanwhile, lactoferrin — a globular glycoprotein found in milk and other mammalian secretions — has shown promising results in patients with low Hb profiles without similar side effects. The ingredient can bind essential minerals, enhance gut barrier formation and regulate the gut environment. 

In a recent episode of Nutrition Insight’s NutriPod, Dr. Vanessa Castagna, the director of clinical and scientific affairs at TurtleTree, tells us that the ingredient is an iron-binding protein. 

“It helps modulate the gut environment and boosts gut health, but it can also get through into blood circulation and helps regulate iron distribution from your diet into where it needs to go in the body. It appropriately regulates iron levels in all kinds of states, whether you’re doing an athletic performance, studying for an exam or sick.” 

TurtleTree produces precision fermentation-derived lactoferrin that closely matches bovine lactoferrin’s structure, function and bioavailability. 

Lactoferrin vs. iron 
The systematic review and meta-analysis, published in BMC Nutrition, included data from 19 randomized clinical trials that examined bovine lactoferrin’s protective or potential effect on participants with a Hb value of less than 11.5 g/dL. 

At doses of 100–250 mg daily, the review supports oral lactoferrin’s effectiveness compared to conventional iron preparations in patients with low Hb levels. Patients’ Hb concentration levels underwent a moderate to significant change after either iron or lactoferrin treatment. 

The review concludes: “Most studies report that lactoferrin showed a statistically significant increase in Hb concentration levels, compared to those in the iron group.”

Dr. Castagna adds: “If you look at clinical studies over the last two to three decades, you’ll see that about 90% look at lactoferrin in regulating iron and its impact on things such as iron-induced anemia. Lactoferrin has also been shown over and over to be safe and effective in pregnancy-induced anemia.” 

“Inside the body, lactoferrin has a role in the iron regulation process, including working with hepatocytes or liver cells and the acute phase response of immune cells found in the liver when you have an initial injury or assault from foreign cells. It can help dampen that overreacted response to promote the efficient regulation of iron in the body.”

The review authors conclude that lactoferrin is a safer option than iron with high compliance evidence and can serve as an alternative treatment for patients experiencing adverse side effects from iron intake. 

Moreover, they suggest that lactoferrin’s ability to reduce proinflammatory cytokines is crucial in regulating and restoring Hb levels. “Reducing inflammation could potentially serve as the first step toward normalizing Hb concentration levels in patients with low Hb and inflammation-related conditions.” 

At the same time, the research team highlights that further studies need to focus on improving the methodological quality of studies to help ensure the validity of the results. The researchers add that it is essential to examine whether different types of lactoferrin preparations affect Hb concentration differently. 

The review notes that oral iron supplementation, typically used in low Hb treatment, causes side effects in 70% of cases.Additional health benefits  
Dr. Castagna underscores that lactoferrin has many health benefits in the gut. 

“It can interact directly with the gut microbes to help modulate the gut microbial community, boost the beneficial ones and help reduce the potential pathogens in the gut. It can change the environment of the gut by regulating iron, and it is also good at binding other minerals, such as copper and manganese, which are important for the diet, and can help absorb these different minerals.” 

In addition, she highlights that it can bind directly to gut cells to fortify the barrier in the gut and prevent leaky gut syndrome. 

“Outside of the gut, lactoferrin can modulate the immune system, binding directly to different immune cells, including the master regulators of the immune response — neutrophils and macrophages — these are pivotal for recognizing foreign cells and alerting the immune system to respond appropriately.” 

“It can also bind directly to the activators in the immune system, the T cells, and can help skew it away from aberrant allergic responses, to keep it in line to respond appropriately to whatever the onslaught is in the body.” 

While the review focused on bovine lactoferrin, TurtleTree produces precision fermentation-derived lactoferrin to address a lactoferrin shortage on the market. 

Dr. Castagna previously told us that the company’s LF+ is a direct alternative to cow’s milk-derived lactoferrin. TurtleTree has obtained access to the US market with the ingredient by achieving self-affirmed Generally Recognized as Safe status. 

The company notes that producing lactoferrin with microbes ensures a consistent supply with minimal variations, while bovine lactoferrin can vary in bioactivity and efficacy.

By Jolanda van Hal, with additional reporting by Milana Nikolova