Aug 5, 2014
By Barret Procyshyn, Pharmacist at the Dauphin Clinic Pharmacy
The mineral iron is found naturally in many foods and is added to many food products. Iron is an essential component of the blood, which is responsible for taking oxygen throughout the body. Aside from taking oxygen to muscles, iron is crucial for growth, development, normal body functioning and hormone production.
Dietary iron has two main forms. Heme iron is only found in meat, fish and poultry; while non-heme iron is present in both meat products and plant based products. The richest sources of heme iron in the diet include lean meat and seafood. Dietary sources of nonheme iron include nuts, beans, vegetables, and fortified grain products. In North America about half of dietary iron comes from bread, cereal, and other grain products. Many of the flours we use are fortified with iron.
Iron is a popular product in our pharmacy. We have people asking for it regularly and it also shows up on prescriptions from our physicians. This is because iron levels are a common level interpreted from blood tests to determine if you have deficiency anemia. Those at more risk of developing deficiency anemia include seniors with reduced food intake, vegetarians and young women with reduced food intake or unbalanced diets. Aside from treating deficiency anemia, iron is also indicated for restless leg syndrome and has shown some benefit in adolescent girls who have ADHD.
The choice of which iron supplement to take can be a little confusing, because there are so many variations and brands of iron available. When comparing absorption, there isnt very good information or hard evidence on which type of iron is best absorbed. Some brands of iron may boast better absorption than others, but be cautious of these claims. Vitamin C can have positive impact on iron absorption especially for ferrous gluconate, sulfate and citrate. When tolerated iron is always absorbed best on an empty stomach. Foods such as grains, rice and beans will reduce iron uptake. Coffee and red wine drinkers will also be disappointed to hear these beverages can also slow iron absorption.
Pharmacists also recommend separating iron from calcium supplements and dairy products as calcium will interfere with absorption of iron into the body. You can still use dairy products and calcium throughout the day; just need to separate the times they are taken.
Certain medications also impact how well your iron supplement is absorbed. Iron should always be separated from thyroid medication, antibiotics such as tetracycline and doxycycline as well as osteoporosis medications. Stomach medications used for acid reflux and heart burn work by decreasing stomach acid, so they can also limit iron absorption.
Patients with mild deficiency anemia will likely respond to an inexpensive iron such as ferrous gluconate. For more severe cases of anemia specialized formulations are usually recommended. Examples may include: Palafer and FeraMax which are more costly but may have a better effect on iron levels. Iron injections are also an option, but currently there are country wide shortages of iron injections.
The two important side effects of iron supplements are stomach upset and constipation. While studies done show all forms of iron have similar amount of stomach upset and constipation, we seem to have less complaints from ferrous gluconate. As mentioned iron is most effective when used on an empty stomach, however some cannot tolerate the gastric irritation and taking is with food is better than not taking it all. If constipation occurs, decreasing the dose is usually effective. Taking too much iron can commonly lead to gastric upset, constipation, nausea, abdominal pain, vomiting, and faintness. Make sure you speak to your physician or your pharmacist so you know the right amount of iron for you.