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Getting the Most From Iron

May 11, 2021

Many healthcare providers recommend taking an iron supplement if you’re low on this essential mineral. But unless you are diagnosed with anemia – the most severe stage of iron deficiency – you may not get much direction, or even a recommended dose from your doctor.

Often people are not even sure if they should supplement, unless they are anemic, because they have heard that too much iron is dangerous. The results of living with a deficiency can be devastating – symptoms of suboptimal iron can impact your thinking and energy, which in turn can impact your whole life!

A recent study, “Iron deficiency without anemia – a clinical challenge” stated: “One should always consider iron deficiency (without anemia) as the cause of persisting, unexplained unspecific, often severe, symptoms”. This is not news to the millions of people worldwide who suffer from iron deficiency – the world’s most common deficiency.

Anyone dealing with iron deficiency knows how debilitating it can be. Reversing it shouldn’t have to be difficult. But how can you be sure what plan to follow? And what do you need to do to be sure you get the most from your supplement?

These questions and more, answered right here!

Q:   IF I AM NOT ANEMIC, AM I DEFICIENT?

A:   Officially, ferritin levels under 30 mcg/L indicate iron deficiency.

Q:   WHAT ARE SOME SYMPTOMS OF LOW IRON STORES?

A: Commonly people with ferritin levels under 30 mcg/L can experience fatigue, brain fog, muscle and joint pains, weight gain, headache, palpitations and arrhythmias, even sleep disturbances, difficulty swallowing, cold feet, dry or falling hair, and restless legs.

Q: WHAT TEST SHOULD I GET TO KNOW IF I AM DEFICIENT OR ANEMIC?

A: The National Institute of Health’s Iron factsheet for health professionals states:

“Serum ferritin concentration, a measure of the body’s iron stores, is currently the most efficient and cost-effective test for diagnosing iron deficiency. Because serum ferritin decreases during the first stage of iron depletion, it can identify low iron status before the onset of Iron Deficiency Anemia. A serum ferritin concentration lower than 30 mcg/L suggests iron deficiency, and a value lower than 10 mcg/L suggests Iron Deficiency Anemia.”

Q: I AM FAITHFUL TO MY WHOLE FOODS, PLANT-BASED LIFESTYLE BUT AM ALWAYS FIGHTING A DEFICIENCY. WHAT IS BEST FOR ME?

A: It is safe to take a supplement to cover your daily iron needs. Unfortunately, most forms of iron have their absorption severely impacted by the phytates in grains like whole wheat, oxalates in plant foods (often the same ones people use as iron sources, like spinach, beet tops, nuts and seeds), and even just by fiber! For vegetarians, eggs are another potential problem as the whites can bind to iron. Ferritin+ is the only iron supplement that is plant-based (made using organic peas!) and yet is NOT affected at all by these dietary anti-nutrients.

Q: I LOVE TEA, RED WINE AND COFFEE, WHAT DO I NEED TO KNOW?

A: The tannins in these drinks could be impacting your iron absorption. Taking iron supplements with tea is extremely inefficient. Treat these drinks like medication and do not mix with iron.

Q: I AM AN ATHLETE, IS IT TRUE THAT THAT COULD BE WHY I AM LOW IN IRON? WHAT CAN I DO?

A:   Athletes are at greater risk of low iron because of a higher red blood cell turnover, impact, foot strike hemolysis, hepcidin bursts, and other factors. This means you need to be iron-wise. Take or eat iron early in the day, when hepcidin is lower, and time iron supplements or iron-rich meals away from exercise, when they will be best absorbed – not right before or after exercise. You may also have exercise-related gut microbleeds. If so, choose an iron without risk of gut irritation – such as Ferritin+.

Q: I HAVE HEARD THAT IRON OVERLOAD IS A SERIOUS CONCERN, WHAT SHOULD I KNOW?

A: Iron is a goldilocks mineral, and it is dangerous to be too low or to be too high. Some people are prone to being low, and some prone to being high, but if you are not sure which you are more like, or if you are very concerned, try Ferritin+. Form matters, and Ferritin+ does not pose a risk of overload due to its unique, protein-bound form.

Q: MY CHILD IS LOW IN IRON, WHAT DO I NEED TO KNOW?

A: If your child’s main beverage is milk, and they consume it with meals, the calcium may be impacting the absorption of iron from the meals or any iron supplements taken at the same time. Avoid large amounts of calcium with iron.

Q: I AM DEFICIENT BUT I WAS NOT GIVEN A DOSE BY A HEALTHCARE PRACTITONER. HELP!

A: In this case, just take an over-the counter iron product that provides 100% of the Daily Recommended Intake and take as directed on the label. Flora has a few to choose from, in a variety of forms, they are the two-tone red and pink boxes that can be found here: CA/US.

Q: DO I NEED TO TAKE EXTRA VITAMIN C OR NOT?

A:   There are some forms of iron, like ferric supplements, or the iron in the spinach that you eat, that need vitamin C to be used. People taking vitamin C often get their iron levels up faster, as the acidity of vitamin C might help with iron assimilation. So, do use some lemon on your salads! But you DO NOT need vitamin C to use the forms of iron in Flora products, they are already in the form the body can utilize without additional vitamin C.

Q: I HAVE CROHN’S/IBS/CELIAC/DIVERTICULITIS/COLITIS – AND AM ALWAYS LOW IN IRON. AN IRON LIQUID IS THE ONLY THING THAT WORKED FOR ME. IS THIS THE BEST THING FOR ME?

A: The form of iron and the dose are the most important factors to reduce the potential of inflaming the digestive tract. Ferrous gluconate is a gentle form that is soluble in liquids, and is a good option, especially at lower doses, but if you have been asked to take larger amounts to correct anemia, you should look for plant-sourced ferritin, as this causes zero inflammation even at larger doses.

Q: I HAVE HAD A BOWEL RESECTION, A GASTRIC SLEEVE, A GASTRIC BYPASS, OR SIMILAR. WHAT PRODUCT WILL HELP ME WITH MY EXTREME IRON DEFICIENCY?

A: Like the question above, liquid ferrous gluconate can be a good option for you, and a liquid will maximize coverage of surface area quickly, optimizing absorption for those without a lot of intestinal surface area. However, if you are low in every kind of mineral, and you are supplementing with lot of products, including lots of iron, you may prefer Ferritin+, as it is unique in that it can be taken alongside other mineral products without having them reduce its absorption at all, and taking multiple doses at one time also cause no irritation.

Q: I AM SEVERELY ANEMIC AND MY DOCTOR PRESCRIBED 300 MG OF FERROUS SULFATE DAILY, BUT I HATE TAKING THAT BECAUSE I FEEL SO SICK (DIGESTIVE UPSET, ETC.). WHAT CAN I USE INSTEAD, AND HOW MUCH DO I TAKE?

A: If you had bloodwork and a prescription, stick to the amount your doctor prescribes. To recover from anemia and get the same amount that your doctor is suggesting, while avoiding digestive upset and constipation, it would be three Ferritin+ capsules daily.

Q:   I HAVE HYPOTHYROIDISM. WHAT CAN I USE?

A:   Hypothyroidism is linked to lower iron levels, and often slow bowel transit time or digestive issues. Ferritin+ is gentlest on the digestive tract, does not need refrigeration (in case you have hypothyroid brain fog, and forget it there!), and it is easy if you take a thyroid medication since you can take it with anything, even other iron.

Q: MY DOCTOR ASKED ME TO TAKE ANOTHER IRON PRODUCT AND I DON’T WANT TO STOP TAKING IT, BUT MY IRON AND FERRITIN NUMBERS ARE NOT IMPROVING. CAN I TRY TAKING FERRITIN+ AS WELL?

A: First, rule out thalassemia, since that can be a missed reason for this problem. But if that is not the problem, yes, take both. Studies indicate that ferritin is absorbed even in the presence of iron supplements or iron from meat. Unlike other plant-based iron, consuming other sources of iron will not impact absorption of this supplement. Ferritin iron is absorbed by different pathways and mechanisms than iron salts and heme iron, is not affected or reduced by anti-nutrients, and you can take it alongside any other iron product.

Q: HOW CAN I IMPROVE MY DIETARY IRON UPTAKE?

A: Make sure you pair leafy greens with vitamin C and carotene-rich food such as tomato, peppers, cauliflower, or citrus. If you are not sure, look for red and yellow and orange, they are carotene-rich. Berries, unfortunately, are like cocoa and tea – they have polyphenols that can block iron uptake. Two hours before and after eating an iron-rich meal, avoid coffee, tea, fiber supplements or super high fiber foods like chia puddings, eggs, chocolate, calcium supplements or even too much dairy. If you eat non-sentient beings, try clams and mussels. If you eat meat, favor dark meats, game like duck or venison and organ meats above the lower-iron light meats. A little bit of sugar or alcohol can improve iron uptake, but no one should increase their intake of these items as a means of raising iron.

References:

  1. Taylor CL, Brannon PM. Introduction to workshop on iron screening and supplementation in iron-replete pregnant women and young children. Am J Clin Nutr. 2017 Dec;106(Suppl 6):1547S-54S. [PubMed abstract]
  2. Lynch S, Pfeiffer CM, Georgieff MK, Brittenham G, Fairweather-Tait S, Hurrell RF, et al. Biomarkers of Nutrition for Development (BOND)-Iron Review. J Nutr. 2018 Jun 1;148(suppl 1):1001S-67S. [PubMed abstract]
  3. DeLoughery TG. Microcytic anemia. N Engl J Med. 2014 Oct 2;371(14):1324-31. [PubMed abstract]
  4. DeLoughery TG. Iron deficiency anemia. Med Clin North Am. 2017 Mar;101(2):319-32. doi: 10.1016/j.mcna.2016.09.004. [PubMed abstract]
  5. Short MW, Domagalski JE. Iron deficiency anemia: evaluation and management. Am Fam Physician. 2013 Jan 15;87(2):98-104. [PubMed abstract]
  6. Gibson RS. Assessment of Iron Status. In: Principles of Nutritional Assessment. 2nd ed. New York: Oxford University Press; 2005:443-76.
  7. Camaschella C. Iron-deficiency anemia. N Engl J Med. 2015 May 7;372(19):1832-43. [PubMed abstract]
  8. https://irondisorders.org/diet/
About the Author: Dana Remedios
Holistic Nutritionist Dana Green Remedios, RHN, RNCP has a passion for helping others break through their blocks to greater health, wealth, and happiness, working with transformational mind-body tools. The Vancouver-based educator and coach answers your questions in English, French, and Spanish as a Specialist working in the Product Information Department at Flora, and is a regular contributor to the FloraHealthy blog.

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