When to Supplement Iron (and what kind) (and how much)
| Iron is one of the most consumed supplements in the world, an everyday ritual for countless adults and children. It can also be confusing, frustrating, and even potentially dangerous. Why Should People Take Iron? People should supplement iron to prevent or treat an iron deficiency. There isn’t any other reason to take it. Nobody should take extra iron to get extra healthy. It doesn’t work like that. Why Should People Take Iron? People should supplement iron to prevent or treat an iron deficiency. There isn’t any other reason to take it. Nobody should take extra iron to get extra healthy. It doesn’t work like that. Who Tends to be Deficient? First, bear in mind the best way to tell if you’re deficient is a blood test. Iron-deficiency anemia is commonly and easily tested for. Having said that, populations that are more likely to be deficient include people with bleeding disorders, or recent blood less; and women during the childbearing years. (One of the biggest differences between men’s and women’s multis is usually iron. Also, one of the biggest differences between “regular” women’s multis, and “over-45” women’s multis). Vegetarians are also at higher risk of deficiency, although it’s still possible possible to get enough iron even on a vegetarian diet. (It’s vitamin B12 that vegetarians really need to watch…) People on acid-blocking drugs may have a harder time getting iron from food. People with inflammatory bowel disease may have a harder time absorbing it. How Much Should I Take? The short answer is: enough to correct the deficiency1. Follow-up blood tests really are the best way to see if you’re hitting the mark. Having said that, there are some rules of thumb. And having said that, those rules of thumb depend on the kind of iron you take… Different Kinds of Iron There are two kinds of iron in the Physician’s Desk Reference (PDR): ferrous sulfate, and ferrous gluconate. Long story short: ferrous sulfate absorbs poorly and often constipates people. I really see no reason to use ferrous sulfate, except habit. And that’s not a very good reason! A standard dose is 325 mg of ferrous sulfate, which yields 65 mg of elemental iron. Meanwhile, ferrous gluconate absorbs better, and is less likely to constipate. A standard dose is again 325 mg of the compound, here yielding just under 40 mg of elemental iron. It’s hard to make definitive statements, but it’s ballpark-accurate to say that 40 mg of iron as ferrous gluconate will provide roughly as much iron bioavailability as 65 mg of iron as ferrous sulfate. Now, if we only went as far as the two forms in the PDR, we’d have a clear winner. However, there are other forms of iron that outshine both of them. In particular, we’ve had great success with ferrous glycinate here at Debra’s. It absorbs great, and only very rarely interferes with digestion. A daily dose of around the Daily Value of 18 mg is usually sufficient to maintain healthy iron levels. Some people will of course need to take a bit more. There are other forms of iron as well. Generic chelates are pretty good. There are also iron supplements made from food. I like the idea of these, but can’t really say how good they are. With one exception: iron from beef liver. There’s been some fascinating research where anemic rats (or was it mice?) were supplemented with elemental iron, or liver concentrates yielding the same amount of iron. The liver provided vast benefits to their stamina, well above and beyond the straight iron supplements. What Helps Iron Absorb? Vitamin C can help… but it’s really only a major issue with ferrous sulfate; better, organic forms of iron don’t really need it. Meanwhile, you don’t want to be deficient in vitamin B12 (which contributes to anemia from another angle). Some people who have a really hard time raising their iron may find that adding a chlorophyll supplement can make a difference. What About Iron from Food? Of course you can get iron from food. Animal foods are the easiest sources, and contain well-absorbing heme iron. Liver and oysters are quite high. (Clams, much less so). Duck is up there. Muscle meats from beef, lamb, and goat; and small fish are all good sources. Larger fish, eggs, and poultry are decent. Plant foods also contain iron. Lentils and chick peas, pumpkin seeds and sesame are all good sources. A tablespoon of blackstrap molasses has around 5 mg. Stone fruits will give you some. Spinach and beets are famously overrated… Meanwhile, my South Indian friends will be pleased to know curry leaves are through the roof. What About Too Much Iron? This is a real concern. Acute iron toxicity usually may occur when someone takes the whole bottle, or when a child gets into their parents’ chewables. This does happen, and it’s the reason iron-containing supplements always come with child-proof caps. Longer-term, having more iron than we need may promote oxidation, and has been linked with increased risks for liver and lung cancer, as well as cardiovascular disease. Although there’s some evidence that this risk is only for non-heme (vegetarian) iron. To reiterate, the goal with iron is to prevent and treat deficiency – not to seek out megadoses. |