Iron deficiency is one of the most common nutrient deficiencies in the world.
An estimated 20% of the entire world’s population has iron deficiency and iron deficiency anemia. Iron deficiency occurs so commonly because of poor dietary intake, poor absorption or blood loss or a combination of these factors. Iron deficiency and iron deficiency anemia presents with a whole host of symptoms that include fatigue and lethargy.
Iron supplementation can improve iron levels in individuals low in iron, most of the time. However, there are patients who still have low iron levels. They often don’t respond to basic iron supplementation.
Vitamin C enhances iron absorption. Vitamin C, in the form of one glass of orange juice added to a meal, enhances absorption of heme iron by 2.5 times.
Other acids found in different foods may help to increase iron absorption, including acids found in fruit juices and fermented foods like pickles, sauerkraut and yogurt. Low stomach acid, or hypochlorhydria, is known to be associated with poor iron absorption.
Phytates in food can inhibit iron absorption of up to 50%. Phytates are found in high fibre foods like wheat, bran and other whole such as grains, beans and legumes.
Polyphenols in foods and beverages like coffee and tea can also inhibit iron absorption by 50% to 90%, as can calcium, in both foods and as supplements. Calcium has been shown to inhibit the absorption of both heme and non-heme iron. A 300 milligrams dose of elemental calcium has been shown to impair iron absorption while smaller doses have not.
Alcohol has also been shown to increase iron absorption, especially heme iron as has garlic, the latter by more than 50%.
Different proteins can enhance or diminish iron absorption. Animal-sourced protein from red meat, fish and poultry can increase it as can whey protein may increase iron absorption slightly. Egg protein and soy protein can decrease iron absorption.
If you have an iron deficiency or iron deficiency anemia, as determined by lab tests, and dietary requirements are not met, iron supplementation can be recommended. The RDA, or recommended dietary allowance, of iron for adults between the ages of 19 to 50 years old is eight milligrams daily for men, 18 milligrams daily for women, 27 milligrams daily for pregnant women and nine milligrams per day for lactation. Other specific doses can be found online.
Choose an iron supplement based on the results of a patient’s lab test, type or iron, the elemental dose, dietary requirements, digestive capacity, price point, the clinician’s experience and generally what is in the patient’s best interest.
Start by taking iron supplements on an empty stomach and not with food. Take it at least 30 minutes to one hour before a meal, or two hours after a meal. Do not take it with other supplements or medication unless suggested by the clinician.
Take iron supplement once per day, or if taking more than one dose and the patient gets nausea or an upset stomach, then take twice per day. Take it consistently for two to three months before retesting iron levels in a lab test that includes CBC, ferritin and iron.
Take vitamin C with iron supplement in a general ratio of 10:1—that is 10 milligrams of vitamin C to every one milligram of elemental iron. (If the elemental iron dose is 10 milligrams, then take with at least 100 milligrams of vitamin C.)
If a patient complains of nausea, constipation, or other digestive disturbance, they should take the iron supplement with food. If there is no change in iron levels after several months decide on a different iron supplement or different strategy.
Also, if there is no change in iron levels, consider taking iron every second day instead of every day. Some studies show that regimen can be effective for some patients who are resistant to everyday dosing.
A dose between 25 to 50 milligrams of elemental iron per day seems to be adequate for most people who are iron deficient. Some people require a dose of 100 milligrams per day or more of elemental iron. Higher doses can be recommended for those who do not respond to the lower dose. Be mindful that a higher daily dose of iron can have negative feedback on iron absorption mechanism. High iron can trigger the opposite effect and decreasing iron absorption.
If iron levels are still depressed after six months of supplementation or longer, and you have not improved subjectively, a re-evaluation of the treatment strategy is on order. Remember some people’s lab values may not improve no matter what is done.
In that case, a referral for further evaluation may be in order, and sometimes iron shots or intravenous iron may be suggested if nothing else helps.
The information provided in this article does not, and is not intended to, constitute medical advice. All information and content are for general information purposes only.
This article is written by or on behalf of an outsourced columnist and does not necessarily reflect the views of Castanet.