What Your Doctor Doesn't Tell You About Iron Supplementation

Need Iron?

So you've been told by a doctor that you need iron. That's not surprising. About 1 in 4 people in the United States are low in iron at any given time. Usually, when it comes to iron supplementation, a doctor will either direct you to the supplements section in your grocery store or write you a prescription for $5 iron tablets. These are the tablets that most people dread. With iron supplementation comes the all too common complaints of stomach upset and constipation. But it doesn't have to be that way. Why? Because not all irons are created equal.

Which form?

Some doctors may not give you a specified amount of iron. Still others will prescribe the typical 325 mg of iron a day. But what does 325 mg mean? This 325 mg (milligrams) usually refers to the most common form of iron supplement - iron sulfate. Iron sulfate is a compound form of iron. Like many minerals, iron cannot be taken all by its lonesome (otherwise we could chew pieces of iron ore and be done with it). It must be consumed in the compound form, which the body then breaks down and gains access to the iron. I don't want to wander into the details of chemistry, but each different type of iron compound varies in the amount of iron it provides per milligram. Depending on the type of iron compound you are taking, the amount of milligrams you must take to achieve the same effect will vary greatly. If possible, ask your doctor about how much elemental iron you need to take rather than iron compound content. Elemental measurements are frequently used in Europe, and the amount of elemental iron does not change, no matter which compound you are taking. Many U.S. supplement companies only list the compound amount, though, so you may have to call the company and inquire how much elemental iron you are receiving per dose.

Iron sulfate, though popular and cheap, is not the most absorbable iron. It is not easily broken down in your digestive system, and so it usually absorbs at a rate of 5-7%. That means a lot of leftover, unabsorbed iron is left in your intestines to cause constipation.

Perhaps the most absorbable forms of iron to be found over-the-counter are iron gluconate and iron citrate. Both forms of iron are bonded with a naturally occurring acid that your body recognizes (gluconic acid and citric acid) and so they absorb at a much higher rate, about 23-25%. More iron absorbed means less iron left in your gut to block you up.

How To Take?

If possible, iron needs to be taken on an empty stomach, away from food. Many foods contain hidden sources of calcium, which hinders the absorption of iron. However, iron sometimes doesn't settle well in some people's stomachs, so if you absolutely need to eat, wait at least half an hour before doing so.

Liquid forms of iron (solutions, not suspensions) will be absorbed better than tablets. Stomach acid can usually only break down about 20% of a tablet. So if you can find a liquid form of iron, that is ideal. Some people may experience staining of the teeth when taking a liquid iron, so avoid this by tipping the dose to the back of the throat and by brushing your teeth immediately after taking the dose.

Your intestines can only absorb a certain amount of a nutrient at any given time. The same goes for iron. Split up your dose when you can and take it throughout the day. This will guarantee that more iron will be absorbed and less will be left to cause constipation.

Certain vitamins can be taken along with minerals to increase absorption. With iron, take in tandem with vitamin C and a vitamin B complex.  Some iron supplements contain these vitamins, but you may have to purchase them separate.

What to Avoid?

 The following items should be avoided when taking an iron supplement:

  • Calcium - as stated above, calcium will hinder absorption of iron. However, this doesn't mean that you should avoid eating any calcium at all! They should simply not be taken at the same time. So if you take your iron at least half an hour before food, you should be golden. If you have to take a supplement containing calcium, wait until after your meal to take it.
  • Coffee, Tea, and Wine - These three items contain tannins. Tannins are what cause that bitter aftertaste, but they also are pretty effective at blocking iron absorption. They can also leach iron out of your system, making anemia even harder to defeat. It's like taking one step forward and two steps back. So it's best to avoid these items until you are feeling stable again. (Note: when I say tea, I mean anything made with the tea plant, camellia sinensis. This is anything that contains black, green, white, or oolong tea. Herbal teas like chamomile and rooibos are fine.)

Good luck!

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