Iron from the diet and iron supplements

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Iron from the diet and iron supplements

Healthylife Pharmacy5 April 2022|4 min read

Iron is an important micro mineral needed for the transport of oxygen throughout the body. It also plays a role in other body functions such as energy production, DNA synthesis and cell proliferation. Although iron is available from the diet, for some people dietary supply is not attainable, iron absorption is restricted or iron needs or iron loss may be greater than supply. In these cases, supplementing with iron may be necessary – which brings us to whole gambit of iron supplements to choose from.

Improving dietary iron intake and uptake and choosing the right supplement can improve iron levels and replete storage iron.

Iron-deficiency anaemia occurs when there is insufficient iron to produce haemoglobin – the part of the blood cell which transports oxygen through the body (and also gives blood its colour).

Symptoms of iron deficiency 

  • Fatigue (which can be extreme)
  • Dizziness, feeling light-headed or headache
  • Increased heart rate or palpitations, chest pain
  • Shortness of breath
  • Cold extremities (fingers and toes)
  • Brittle nails, inflamed tongue 
  • Eye conjunctiva, lips, gums and skin may appear pale

Iron anaemia can exacerbate some diseases. Angina, cause nervous system disorders such as restless-leg syndrome cognitive function can be influenced by lack of iron. 

Confirming iron-deficiency

Many disorders, lifestyle, and dietary factors can result in iron deficiency and some diseases have symptoms which resemble  iron deficiency, thus a correct diagnosis by a medical practitioner is important. Supplementing with iron when iron is not needed can result in serious health complications. For example, in the gut, excess iron can increase pathogenic bacteria. Symptoms of iron over-load or haemochromotosis include fatigue, which may be mistaken as a symptom of anaemia - without a confirming diagnosis.  

An iron study

An iron study, performed through a sample of blood, is used to confirm iron deficiency or anaemia. An iron study includes serum iron levels, ferritin, total iron-binding capacity, transferrin and transferrin saturation. The doctor will then do further research if needed to identify the cause of results.  

Iron deficiency can be characterised as:

An absolute iron deficiency – this is when iron stores are insufficient.  

Functioning iron deficiency when the production of red blood cells is greater than supply of iron.

Sequestration - when there is adequate iron but it is unavailable - as can happen in autoimmune disease, infection, inflammation and malignancy. In this situation iron supplementation can have potentially harmful consequences and it is why it is important to investigate.

Common causes of iron-deficiency 

The Diet

Iron is usually supplied to the body through the diet. Iron deficiency can occur when there is insufficient iron intake from food, avoidance of dietary sources (don't like the food) or due to special diets such as vegan and vegetarian if non-meat sources have not met needs. 

Blood loss

Because blood contains iron any blood loss can also result in a loss of iron. This is not always a health problem unless the blood loss is large or chronic.

Heavy menstruation for females can result in anaemia; or the chronic blood loss with gastrointestinal bleeding. Causes of gastrointestinal bleeding include peptic ulcer, hiatal hernia, colon polyp or colorectal cancer. The regular use of some pain relievers (such as aspirin) can cause irritation to the gastrointestinal tract and result in bleeding).

Absorption issues

The process of absorption of iron from foods can be restricted by some disorders - such as coeliac disease, irritable bowel disease, or from surgical removal of part of small intestine.

Who is at risk of iron deficiency?

Infants, children and adolescents. Iron is required at times of rapid growth and development and deficiency can occur in children who are fussy eaters and fail to consume enough iron-rich foods.

Premature babies and those with low birth-weight may be at greater risk if intake from breast milk or formula is low.

Pregnancy - iron is needed for the growth and development of the foetus, and the increased volume of blood needed by the mother.

Vegans and vegetarians may be at risk due to their dietary choices.

Blood donors who frequently give blood may temporarily become iron deficient.

Preventing iron-anaemia and improving iron absorption

The diet

The diet can be one of the easiest places to go to help increase iron intake. Iron-rich foods such as red meat, pork and poultry offer the best form of iron for absorption whilst other sources such as eggs, beans, leafy green vegetables and dried fruits (sultanas and apricots) need to be eaten in higher amounts. Some processed food have iron added, such as breads and cereals (check labels). Combining foods with vitamin C helps absorption – for example, a steak dinner with steamed broccoli  or chicken with a tomato and leafy green salad followed by strawberry and kiwi fruit desert, combined with a glass of orange juice.

Supplementing

After establishing iron deficiency, a medical practitioner will generally advise to supplement with iron combined with increasing iron-rich foods in the diet.

Which iron supplement?

Some common supplemental forms of iron and examples include:

  • Ferrous sulfate (FGF, Fefol, Ferro-gradumet, Ferrograd C)
  • Ferrous fumarate (Ferro-F tab, Ferro-tab, Ferro liquid)

These forms of iron need to be taken on an empty stomach to avoid combining with phosphates, tannins and phytates which can bind to iron and prevent adequate absorption. Iron also requires an acid environment (as found in the stomach), antacid medication can reduce acid levels and require iron supplements to be taken either 2 hours before or 4 hours after antacid medication. These forms are often associated with symptoms of gastrointestinal distress – such as constipation, nausea and changes to taste.

  • Iron polymaltose (Maltofer)

Polymaltose can be taken with food, has less interactions with medication, only absorbs if needed and has fewer gastrointestinal side-effects.

  • Iron diglycinate Iron amino acid chelate (Meta Fe® Ethical nutrients mega iron)
  • Ferrous bisglycinate Iron amino acid chelate (Ferrochel™ Herbs of Gold organic Iron Max).
  • Iron (II)glycinate (Blackmores Bio iron advanced)
  • Iron Amino Acid Chelate (Fab Iron + Vitamin B Complex)
  • Ferrous gluconate dihydrate (Floradix Floravital Liquid Iron Plus)
  • Iron (Fe2+) (Spatone contains a naturally occurring, iron-rich water from the mountains of Snowdonia, Wales).

These iron supplements are easily absorbed and gentle on the stomach. They are not suitable for iron deficiency, but can be used to help maintenance of iron levels and prevent dietary iron deficiency.

Vitamin C, B12 and Folic acid

Vitamin C (ascorbic acid) facilitates iron absorption and is often combined in supplements with iron. Supplements may also contain folic acid or/and B12 - needed for red blood cell development. 

In some cases, an iron infusion may be necessary to increase iron levels quickly to a healthy level or when iron supplementation is not sufficient. 

A doctor or pharmacist can advice the best supplement to support iron needs in the body. 

References

  1. https://www.mayoclinic.org/diseases-conditions/iron-deficiency-anemia/symptoms-causes/syc-20355034
  2. https://www.cdc.gov/nutrition/micronutrient-malnutrition/micronutrients/index.html
  3. https://accessmedicine.mhmedical.com/content.aspx?bookid=2969&sectionid=250454109#:~:text=The%20ocular%20conjunctiva%20can%20be,hinder%20red%20blood%20cell%20productio
  4. Iron Binding Capacity https://www.nps.org.au/australian-prescriber/articles/correcting-iron-deficiency-1#introduction
  5. Transferrin Saturation - an overview | ScienceDirect Topics
  6. Iron Binding Capacity Iron Binding Capacity - StatPearls - NCBI Bookshelf (nih.gov)
  7. Efficacy and safety of oral iron (III) polymaltose complex versus ferrous sulfate in pregnant women with iron-deficiency anemia: a multicenter, randomized, controlled study https://www.tandfonline.com/doi/full/10.3109/14767058.2011.599080
  8. Interaction of vitamin C and iron: https://pubmed.ncbi.nlm.nih.gov/6940487/#:~:text=Ascorbic%20acid%20facilitates%20iron%20absorption,combat%20nutritional%20iron%20deficiency%20anemia.