Iron in multivitamin side effects: Multivitamin with iron Uses, Side Effects & Warnings

04.08.202321.06.2023 by alexxlab

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Multivitamin with iron Uses, Side Effects & Warnings

Generic name: multivitamin with iron [ MUL-tee-VYE-ta-mins-with-EYE-ron ]
Brand names: Fero-Folic 500, Theragran Hematinic, Iberet-Folic-500, Dialyvite, TriHEMIC 600,
… show all 178 brands
Nephro-Vite with Fe, Allbee-C 800 with Iron, Livitrinsic-F, Foltrin, Intrinsitinic, Ferotrinsic, Contrin, Trinsicon, Iberet-500, Generet-500 with Folic Acid, Vi-Daylin with Iron, Dayalets Plus Iron, Nephron-FA, Sesame St. Vitamins Plus Iron, Fe-Tinic 150 Forte, Equi-Roca Plus, Equicyte Plus, Poly-Vi-Sol with Iron Drops, Vi-Daylin with Iron Chewable, Femiron Multi with Iron, Chewable-Vite with Iron, Garfield Vitamin with Iron, Vi-Daylin with Iron Drops, One Tab Daily with Iron, Bugs Bunny with Iron Chewable, Flintstones with Iron Chewable, Sunkist Child Chewable with Iron, Poly-Vi-Sol with Iron, Mult-Ferr Folic, Unicap with Iron, Icaps, Iberet, Stresstabs with Iron, Surbex-750 with Iron, Stress Formula with Iron, Geritol, SSS Tonic, Vi-Daylin ADC with Iron, Tri-Vi-Sol with Iron, Tab-A-Vite with Iron, Geri-Tabs, I-L-X, I-L-X and B12, Multibret Folic 500, IBC 500, Multiret Folic 500, Geravim, Chromatinic, Iromin G, Myferon 150 Forte, Pronemia, Vi-Stress with Iron, Fumatinic, Therems H, Tolfrinic, Fruity Chews with Iron, Feocyte, Vita-PMS, Vita-PMS Plus, Ferocon, Anemagen, Nu-Iron Plus, Anemagen FA, Ferragen, Conison, Poly Iron 150 Forte, Iberet Liquid, Iberet-500 Liquid, Hemocyte-F Elixir, Diatx Fe, Icar-C Plus, Senilezol, Ferrogels Forte, Promar, Fetrin, Feogen, Proferrin-Forte, FoliTab 500, FE C Tab Plus, Icar-C Plus SR, Ferbee, Uni-Daily Plus Iron, Multifol, Irofol, Uni Kar Plus C SR, Repliva 21/7, Niferex Gold, Tricon, Hematogen, Hematogen FA, Hematogen Forte, Iferex 150 Forte, Vita Drops with Iron, Niferex-150 Forte, Chromagen, Chromagen FA, Chromagen Forte, Ferrex 150 Forte, MyKidz Iron, Martinic, Apetimar with Iron, Vimar with Iron, Multi-Delyn with Iron, Maxaron Forte, Ferralet 90, Multigen, Multigen Plus, Anemagen Forte, Ferrex 150 Forte Plus, Good Sense Children’s Vitamins with Iron, PruVate 21/7, Ferraplus, Multigen Folic, Integra Plus, Integra F, Integra, Vitagen Advance, Rexavite 150 Forte, Vitagen Forte, Trimagen, Trimagen Forte, Triferex 150 Forte, Se-Vate, Ferotrin, FerroVite, Ferroflex-150 Forte, FerroVite FA, FerroVite Forte, Ferrex 28, Trimagen FA, TL Icon, Suplevit, Folivan-F, Folivan-Plus, Taron Forte, Gentle Iron, BiferaRx, Lydia Pinkham, Trigels F, CorviteFE, Irospan 24/6, NovaFerrum, TL-Fol 500, Daily-Vite with Iron, Iron-150, EnLyte, Poly-Vita Drops with Iron, Hemetab, Iron 100 Plus, Niron Komplete, FeRiva, Abatron AF, FeRivaFA, Fusion Plus, FeRiva 21/7, Niva-Plus, MaxFE Drops, Focalgin DSS, Geriaton, Thrivite 19, Fusion Sprinkles with Probiotic, Nufera, Celebrate Iron + C, Active FE, UpSpring Baby Iron, TL-HEM 150, Baby Iron+Immunity, Feonyx, Actiron, Flintstones Complete, Cerovite Junior, Centrum Jr, Centrum Kids

Dosage forms: oral capsule (Multiple Vitamins with Iron, Minerals and Docusate; Vitamin B Complex with C and Iron; Vitamin B Complex with C, Folic Acid and Iron; Vitamin B Complex with C, Folic Acid, Iron and Probiotics; Vitamin B Complex with Folic Acid, Iron, and Essential Fatty Acids; Vitamin B Complex with Iron and Intrinsic Factor; Vitamin B12 with C, Folic Acid and Iron; Vitamin B12 with Folic Acid and Iron),
. .. show all 7 dosage forms
oral capsule, extended release (Vitamin B Complex with C, Folic Acid and Iron), oral liquid (Multiple Vitamins with Iron; Pediatric Multiple Vitamins with Iron; Vitamin A, D and C with Iron; Vitamin B Complex with Iron; Vitamin B12 with Iron and Zinc), oral powder for reconstitution (Vitamin C with Folic Acid and Iron), oral tablet (Multiple Vitamins with Folic Acid and Iron; Multiple Vitamins with Iron; Multiple Vitamins with Iron, Minerals and Docusate; Vitamin B Complex with C and Iron; Vitamin B Complex with C, Folic Acid and Iron; Vitamin B Complex with C, Folic Acid, Iron and Docusate; Vitamin B Complex with Iron; Vitamin B12 with C, Folic Acid and Iron; Vitamin B12 with C, Iron and Intrinsic Factor; Vitamin B12 with Folic Acid and Iron), oral tablet, chewable (Multiple Vitamins with Iron; Vitamin C with Iron), oral tablet, extended release (Vitamin C with Folic Acid and Iron)

Drug classes: Iron products, Vitamin and mineral combinations

Medically reviewed by Drugs. com on Jan 16, 2023. Written by Cerner Multum.

What is multivitamins with iron?

Multivitamins are a combination of many different vitamins that are normally found in foods and other natural sources.

Iron is normally found in foods like red meat. In the body, iron becomes a part of your hemoglobin (HEEM o glo bin) and myoglobin (MY o glo bin). Hemoglobin carries oxygen through your blood to tissues and organs. Myoglobin helps your muscle cells store oxygen.

Multivitamins with iron are used to provide vitamins and iron that are not taken in through the diet. They are also used to treat iron or vitamin deficiencies caused by illness, pregnancy, poor nutrition, digestive disorders, and many other conditions.

Multivitamin and iron may also be used for purposes not listed in this medication guide.

Warnings

Never take more than the recommended dose of a multivitamin. Avoid taking any other multivitamin product within 2 hours before or after you take multivitamins with iron.

Seek emergency medical attention if you think you have used too much of multivitamin with iron. An overdose of vitamins A, D, E, or K can cause serious or life-threatening side effects. Iron and other minerals contained in a multivitamin can also cause serious overdose symptoms if you take too much.

Before taking this medicine

Iron and certain vitamins can cause serious or life-threatening side effects if taken in large doses. Do not take more of this medicine than directed on the label or prescribed by your doctor.

Ask a doctor or pharmacist if it is safe for you to take a multivitamins with iron if you have other medical conditions.

Do not use this medicine without a doctor’s advice if you are pregnant. Some vitamins and minerals can harm an unborn baby if taken in large doses. You may need to use a prenatal vitamin specially formulated for pregnant women.

Your dose needs may also be different while you are nursing. Do not use this medicine without a doctor’s advice if you are breast-feeding a baby.

How should I take multivitamins with iron?

Use multivitamin with iron as directed on the label, or as your doctor has prescribed. Do not use the medicine in larger amounts or for longer than recommended.

Never take more than the recommended dose of multivitamins with iron. Avoid taking any other multivitamin product within 2 hours before or after you take multivitamins with iron. Taking similar vitamin products together at the same time can result in a vitamin overdose or serious side effects.

Many multivitamin products also contain minerals such as calcium, magnesium, potassium, and zinc. Minerals (especially taken in large doses) can cause side effects such as tooth staining, increased urination, stomach bleeding, uneven heart rate, confusion, and muscle weakness or limp feeling. Read the label of any multivitamin product you take to make sure you are aware of what it contains.

You may take the medicine with food if it upsets your stomach.

The chewable tablet must be chewed or allowed to dissolve in the mouth before swallowing.

Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one.

Liquid or powder multivitamin may sometimes be mixed with water, fruit juice, or infant formula (but not milk or other dairy products). Follow the mixing directions on the medicine label.

Do not crush, chew, break, or open an extended-release capsule or tablet. Swallow it whole.

It is important to take multivitamins with iron regularly to get the most benefit.

Store in the original container at room temperature away from moisture and heat. Do not allow the liquid to freeze.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of vitamins A, D, E, or K can cause serious or life-threatening side effects. Iron and other minerals contained in a multivitamin can also cause serious overdose symptoms.

Overdose symptoms may include severe stomach pain, vomiting, bloody diarrhea, coughing up blood, constipation, loss of appetite, hair loss, peeling skin, warmth or tingly feeling, changes in menstrual periods, weight loss, severe headache, muscle or joint pain, severe back pain, blood in your urine or stools, black and tarry stools, pale skin, easy bruising or bleeding, weakness, shallow breathing, weak and rapid pulse, pale skin, blue lips, and seizure (convulsions).

What should I avoid while taking multivitamins with iron?

Avoid taking any other multivitamin product within 2 hours before or after you take multivitamins with iron. Taking similar vitamin products together at the same time can result in a vitamin overdose or serious side effects.

Avoid taking an antibiotic medicine within 2 hours before or after you take multivitamins with iron. This is especially important if you are taking an antibiotic such as ciprofloxacin, levofloxacin norfloxacin, doxycycline, minocycline, tetracycline, and others.

Certain foods can also make it harder for your body to absorb iron. Avoid taking this multivitamin within 1 hour before or 2 hours after eating fish, meat, liver, and whole grain or “fortified” breads or cereals.

Do not take multivitamin with iron with milk, other dairy products, calcium supplements, or antacids that contain calcium. Calcium may make it harder for your body to absorb certain ingredients of the multivitamin.

Multivitamins with iron side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

When taken as directed, multivitamins are not expected to cause serious side effects.

Call your doctor if you have:

Common side effects of multivitamin with iron may include:

constipation, diarrhea;
nausea, vomiting, heartburn;
stomach pain, upset stomach;
black or dark-colored stools or urine;
temporary staining of the teeth;
headache; or
unusual or unpleasant taste in your mouth.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Multivitamin with iron dosing information

Usual Adult Dose for Anemia:

Tablets or capsules:
1 tablet orally once daily or as indicated by individual product directions.

Oral liquid:
5 to 15 mL orally once daily or as indicated by individual product directions.

Usual Pediatric Dose for Anemia:

Tablets:
1 tablet orally once daily or as indicated by the individual product directions.

Drops:
0.5 to 1 mL orally once daily or as indicated by the individual product directions.

Oral liquid (100 mg elemental iron):
>= 12 yrs:
5 to 10 mL orally once daily or as indicated by the individual product directions.

What other drugs will affect multivitamins with iron?

Other drugs may interact with multivitamins with iron, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

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Drug class: iron products
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Patient resources

Patient Information
Cyanocobalamin/Folic Acid/Iron
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Iron, Folic Acid, Vitamin C, and Vitamin B3
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Other brands

Integra, Integra Plus, Fusion Plus, Flintstones Complete, … +25 more

Related treatment guides

Anemia
Vitamin/Mineral Supplementation and Deficiency

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

Daily Multivitamin With Iron Oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing

Warnings:

Accidental overdose of iron-containing products is a leading cause of fatal poisoning in children younger than 6 years. Keep this product out of reach of children. If overdose does occur, get medical help right away or call a poison control center.

Warnings:

Uses

This medication is a multivitamin and iron product used to treat or prevent vitamin deficiency due to poor diet, certain illnesses, or during pregnancy. Vitamins and iron are important building blocks of the body and help keep you in good health.

How to use Daily MULTIVITAMIN-IRON

Take this medication by mouth, usually once daily or as directed. Follow all directions on the product package, or take as directed by your doctor. Do not take more than the recommended dosage. If you have any questions, ask your doctor or pharmacist.

This medication is best taken on an empty stomach 1 hour before or 2 hours after meals. Take with a full glass of water (8 ounces or 240 milliliters) unless your doctor directs you otherwise. If stomach upset occurs, you may take this medication with food. Avoid taking antacids, dairy products, tea, or coffee within 2 hours before or after this medication because they may decrease its effectiveness. Do not lie down for at least 10 minutes after taking the tablets or capsules. Consult your doctor or pharmacist for details for your particular brand.

If you are taking the delayed-release form or extended-release capsules, swallow them whole. Do not crush or chew delayed-release or extended-release products. Doing so can release all of the drug at once, increasing the risk of side effects and decreasing absorption. Also, do not split extended-release tablets unless they have a score line and your doctor or pharmacist tells you to do so. Swallow the whole or split tablet without crushing or chewing.

Take this medication regularly in order to get the most benefit from it. To help you remember, take it at the same time each day.

Side Effects

Constipation, diarrhea, or upset stomach may occur. These effects are usually temporary and may disappear as your body adjusts to this medication. If any of these effects last or get worse, contact your doctor or pharmacist promptly.

Iron may cause your stools to turn black, an effect that is not harmful.

If your doctor has prescribed this medication, remember that your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US – Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada – Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Precautions

Before taking this product, tell your doctor or pharmacist if you are allergic to any of its ingredients; or if you have any other allergies. This product may contain inactive ingredients (such as soy found in some brands), which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before taking this medication, tell your doctor or pharmacist your medical history, especially of: iron overload disorder (such as hemochromatosis, hemosiderosis), use/abuse of alcohol, liver problems, stomach/intestinal problems (such as ulcer, colitis).

If your brand of multivitamin also contains folic acid, be sure to tell your doctor or pharmacist if you have vitamin B12 deficiency (pernicious anemia) before taking it. Folic acid may affect certain laboratory tests for vitamin B12 deficiency without treating this anemia. Untreated vitamin B12 deficiency may result in serious nerve problems (such as peripheral neuropathy). Consult your doctor or pharmacist for details.

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

Tell your doctor if you are pregnant before using this medication.

This medication passes into breast milk. Consult your doctor before breast-feeding.

Interactions

Overdose

If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: stomach pain, nausea, vomiting, diarrhea.

If your doctor has prescribed this medication, do not share it with others.

Keep all medical and lab appointments.

Some brands may also contain ingredients such as docusate. Ask your doctor or pharmacist if you have questions about the ingredients in your brand.

This product is not a substitute for a proper diet. Remember that it is best to get your vitamins and minerals from healthy foods. Maintain a well-balanced diet and follow any dietary guidelines as directed by your doctor.

If you are taking this product on a prescribed schedule and miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

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Selected from data included with permission and copyrighted by First Databank, Inc. This copyrighted material has been downloaded from a licensed data provider and is not for distribution, except as may be authorized by the applicable terms of use.

CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.

Interaction of iron and calcium | Shikh E.

The quality of multivitamins is determined by the balance of the composition and the efficiency of assimilation of biologically active components from them. All vitamins and most essential minerals play an important role in biochemical processes by interacting with other biologically active substances. They also interact with each other: during storage, in the process of release from the dosage form, during absorption (compete for carriers), on metabolic pathways in the body (show synergism or antagonism).

Numerous studies have shown that calcium significantly reduces the absorption of iron in the gastrointestinal tract.
To prevent antagonistic interactions of calcium and iron allows the separate intake of calcium-containing foods (milk, green vegetables) and iron-rich foods (meat, liver). And when choosing vitamin and mineral preparations, preference should be given to those in which calcium and iron are separated.
Mineral deficiency and methods of its correction. According to the Research Institute of Nutrition, a deficiency of vitamins and minerals was detected in more than 50% of the surveyed population. The reason for this is not only that the standard adult diet contains only about 70% of the required amount of micronutrients (54% iron, 40% vitamin C, 65% vitamin B1), but also a number of environmental and geochemical factors that worsen the situation. So, environmental pollution and bad habits (increased consumption of antioxidants), as well as some geochemical features (low iodine content in water) lead to the development of deficiency. Current scientific evidence strongly suggests the possible negative effects of vitamin and mineral deficiencies. Under the current conditions, the regular intake of complex vitamin and mineral preparations becomes the only way to prevent and treat polyhypovitaminosis and polyhypomicroelementosis.
There are a large number of preparations on the market that contain an almost complete set of essential micronutrients. But sometimes it is difficult to choose a particular drug, since they have a similar composition (10-15 vitamins and vitamin-like substances, 5-15 minerals) and do not differ in the form of release. Moreover, substances (vitamins, metal salts) for the production of vitamin-mineral complexes are purchased from the same suppliers.
All vitamins and most essential minerals enter the body in microdoses, but play an important role in biochemical processes, showing their pharmacological activity, interacting with other biologically active substances.
Especially often a competitive type of interaction takes place for minerals, since they are used in the form of chemically related derivatives and use common mechanisms of transport into the internal environment.
Absorption of calcium and iron in the body
Brief information on the physiological role and absorption of calcium and iron is presented in Table 1.
Calcium is the most abundant mineral in the human body. It plays an important role in both intra- and extracellular processes: in the contractile function of the heart and skeletal muscles, nerve conduction, regulation of enzyme activity, and the action of many hormones. It is a cofactor for the activation of a number of enzyme complexes in complex multi-stage processes of blood coagulation. Essential for bone growth and formation. Therefore, the need for calcium in children and pregnant women is especially great.
The body of an adult male contains approximately 1200 g of calcium. 99% of this amount is concentrated in bones and teeth, the rest of calcium is distributed in intracellular and extracellular fluids. With food, a person consumes about 1 g of calcium daily. In the acidic environment of the stomach, calcium salts dissociate, 20-40% of the macronutrient is absorbed. The main site of absorption is the duodenum and jejunum, but some of this element is absorbed in the ileum and large intestine. The availability of calcium for absorption depends on many dietary factors, including the presence of phosphates, fatty acids, and phytates, which bind calcium and make it unavailable for absorption. Absorption in the intestine is carried out by active transport against an electrochemical gradient, as well as by passive diffusion (when the calcium content in food and, consequently, its concentration in the intestinal lumen increases excessively). Reabsorbed calcium is transported across the cell membrane by the vitamin D-dependent calcium-binding protein calbindin. Vitamin D promotes the synthesis of calbindin in the body, and hence the absorption of calcium. That is why calcium preparations usually also contain vitamin D. Most often, calcium salts such as carbonate, gluconate, citrate, and phosphate are used in the production of food supplements and vitamin-mineral complexes [2, 3].
Iron is one of the most studied and researched trace elements. Iron deficiency is the most common nutritional deficiency in the world, affecting mainly children in the active phase of growth and women of childbearing age.
Iron requirements are determined by age, sex and physiological status. The increased iron requirements of infants and pregnant women are due to the need to support growth and the formation of new tissues. Iron requirements in non-pregnant women are largely determined by blood loss during menstruation.
A healthy man’s body contains an average of 3. 8 g of iron, while a woman’s body contains 2.3 g. There are practically no iron stores in the female body. Iron in the human body is distributed between an active pool and an inactive one – a depot. The active pool contains an average of about 2100-2500 mg of iron in hemoglobin, 200-300 mg in myoglobin, 150 mg in tissue enzymes, and a transported fraction of 3 mg.
Iron is a component of hemoglobin in red blood cells, which carry oxygen from the lungs to tissues, and myoglobin in muscle tissue, which stores oxygen necessary for muscle work. Iron has several special properties that distinguish it from most other nutrients. Only a small part of the total amount of iron in food is absorbed (out of 10-20 mg daily with food, no more than 10% is absorbed). From the intestinal mucosa, iron is transported into the blood using active transport mechanisms of cells. This process is carried out only with the normal structure of mucosal cells, which is supported by folic acid [4]. Transport through the cells of the intestinal mucosa is carried out both by simple diffusion and with the participation of a special carrier protein (mucin-b3-integrin, DMT1). These proteins are most intensively synthesized in anemia, which ensures better absorption of iron. The protein transfers iron only once, the next iron molecules carry new carrier protein molecules. It takes 4–6 hours for their synthesis, therefore, more frequent intake of iron preparations does not increase its absorption, but increases the amount of unabsorbed iron in the intestine and the risk of side effects [5].
Iron in dietary sources exists in two forms: heme (HJ) and non-heme iron (NJ). Heme iron is present in hemoglobin and myoglobin in meat (especially in the liver) and fish. The average rate of absorption of heme iron from meat is about 25%. However, most dietary iron is present in non-heme form. Non-heme iron is present mainly in foods of vegetable and dairy origin and makes up over 85% of the iron received by the body with food. The absorption of non-heme iron is much lower than that of heme, and depends on the total iron content in the body of a particular person: more non-heme iron is absorbed in people whose iron content is reduced, less in people whose body is saturated with iron. The absorption of NJ is strongly influenced by its solubility in the upper part of the small intestine. In turn, this solubility depends on how food in general affects the solubility of iron [6]. Activators and inhibitors present in food often play a decisive role in the amount of absorbed iron [6,4].
The amount of iron absorbed in food depends on the ratio between inhibitors and promoters. Since the interaction occurs in the gastrointestinal tract, the inhibitory or accelerating effect of food components on iron absorption is strongest when these components are consumed in one meal. One of the most powerful stimulants of iron absorption is vitamin C, found in fresh vegetables and fruits. Fermented foods (such as sauerkraut) also speed up the absorption of non-heme iron. In the presence of acid, complexes with iron are formed, which prevent the formation of poorly absorbed iron phytate. In addition, some types of milling and cooking reduce the phytate content of staple plant foods and thereby help increase the absorption of non-heme iron.
The strongest inhibitors of iron absorption are calcium, phytates and polyphenols. Phytates are a storage form of phosphates and minerals found in cereal grains, vegetables, seeds, and nuts. They actively inhibit the absorption of iron, while acting in a direct dose-dependent manner.
Phenolic compounds exist in almost all plants and are part of their defense system against insects and animals. Several phenolic compounds bind iron and thus prevent its absorption. Such compounds are found in tea, coffee, and cocoa, as well as many vegetables and several herbs and spices.
Tea has been found to reduce iron absorption from food by 62% compared to water. The inhibitory effect of tea is caused by the polyphenol tannin contained in it.
Iron stores are mainly regulated by changes in absorption. Damage to the intestinal mucosa can lead to a syndrome of insufficiency of absorption, including iron. This can be especially pronounced in gluten-sensitive celiac disease, which, if left untreated, is often accompanied by iron deficiency anemia. A common cause of iron deficiency due to malabsorption is also gastrectomy and resection of the stomach, chronic inflammatory bowel disease. During systemic infections, there is an acute decrease in iron absorption, accompanied by the transfer of iron from the circulation to the liver. It is the body’s natural defense mechanism during times of infection to reduce the growth of harmful bacteria that require iron to thrive.
Normally, the ratio of iron intake with food and its losses is such that even a very small decrease in intake or an increase in losses can lead to iron deficiency. With significant chronic blood loss (regardless of its cause), the amount of iron lost always exceeds that which enters the body from food. As a result, iron depletion and deficiency are inevitable. The causes of iron deficiency anemia can also be intravascular hemolysis, ankylostomidosis, bloodletting due to erythremia, hemodialysis [4].
Not only pathological conditions lead to the development of iron deficiency anemia. Quite often, the cause of iron deficiency is physiological conditions – rapid growth (especially in infants and adolescents), donation, hypermenorrhea, pregnancy. It is in these cases that the preventive intake of rationally formulated vitamin and mineral complexes can play a decisive role in maintaining health.
Experimental data
on the mutual influence of calcium and iron
Clinical studies have shown that the combined intake of calcium and iron leads to a decrease in iron absorption. The data of various authors indicate that this effect depends on the form of release of calcium preparations, and on the amount of calcium consumed, and on the general composition of the food. Thus, one of the inhibitors of iron absorption is calcium phosphate [7,8].
During the experiment, 34 people received physiological amounts of calcium salts and phosphoric acid in the form of single preparations or as a mixture [7]. While in the first case it was not possible to reliably detect changes in the absorption of non-heme iron, in the second case it turned out that the absorption of iron decreased by 20%. According to other data, it is recommended to separate the intake of dairy products and iron-containing foods in time, since the absorption of iron in this case decreases by 50-60% [9]. This is especially important for groups of people with a physiologically increased need for iron – children and women of childbearing age.
A group of 12 physically healthy women received preparations containing either calcium with iron or only iron in an amount that was two times less than in the first preparation [10]. Studies of the iron content in the blood showed that its absorption from both drugs was almost the same. The authors believe that this effect is associated with the absence of calcium in the second preparation.
Previously, it was also shown that 12% of the mineral was assimilated from a monopreparation containing 65 mg of iron, while only 3-5% was assimilated from a polymineral complex [11]. A decrease in the content of calcium carbonate and magnesium oxide in the preparation led to an increase in iron absorption up to 7%. Similar data were obtained in experiments where the observation group included pregnant women who took nutritional supplements with different calcium content [12].
Using the method of double labeled isotopes, the absorption of iron from cow and human milk was compared [13]. It turned out that only 19.5 ± 17.3% of iron is absorbed from cow’s milk, while for human milk this figure is 48.0 ± 25.5%. Since the calcium content in human milk is several times lower than in cow’s milk, the authors suggested that this is the reason for such a significant difference. Indeed, when calcium chloride was added to human milk in such an amount that its content became comparable to the calcium content in cow’s milk, the absorption of iron from it fell almost by half.
To prevent the mutual influence of calcium and iron allows taking drugs separately in time [16]. Eating milk and cheese for breakfast (about 340 mg calcium) did not affect iron absorption from a hamburger eaten 2-4 hours later. This effect was observed for a group of 21 people using the method of double radioisotopes. Thus, the authors recommend separating the intake of calcium and calcium-containing foods from iron-rich foods (meat, fish, usually consumed at lunch). Similar conclusions are given in other works [14, 15].
The reasons for the decrease in iron absorption by calcium are not fully understood. Various authors express different hypotheses on this score. Thus, based on the data on the inhibition of iron absorption by calcium phosphate, the authors suggest that the formation of a triple insoluble complex between iron, calcium, and phosphate anion is possible [7].
US scientists tried to solve the problem of calcium and iron interaction by creating a two-layer tablet. The core of such a tablet consists of iron, the outer layer is made of calcium. The tablet shell is soluble in the stomach, so calcium absorption occurs in the first two hours after ingestion. Iron is released and absorbed over the next 6 hours, with the tablet core dissolving in two hours. Such an invention really makes it possible to separate calcium and iron according to the time and place of absorption (in the upper and lower gastrointestinal tract). But it must be borne in mind that the average time for food to pass through the stomach is 1 hour, and through the small intestine – 4 hours. Then the food enters the large intestine, in which the absorption of vitamins and minerals no longer occurs. Since the core will dissolve within two hours after the shell dissolves, iron from such a tablet will have only two hours to be absorbed.
Thus, there is no doubt the need to take into account the inhibitory effect of calcium on the absorption of iron, both in the joint consumption of products containing calcium and iron, and in the choice of vitamin-mineral complexes, giving preference to those in which these minerals are in different tablets.

Literature
1. N.A. Korovin. Vitamin-mineral deficiency // RMJ, 2003. 11 No. 25.
2. Gusev N.B. Intracellular Ca-binding proteins. Part 1. Classification and structure // Soros educational journal. 1998.5, 10-16.
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Dietary supplements and liver.

Healthy and Harmful Food Supplements for the Liver

Food and herbal supplements are becoming more and more popular. According to studies, they are taken by approximately 50% of the adult population of developed countries. Most nutritional supplements are in the form of vitamins and minerals, as well as muscle building and weight loss supplements, but herbal supplements are also very popular. However, many people are not well aware of the active ingredients of dietary supplements, side effects and drug interactions. In our article, we collected data on healthy and harmful dietary supplements based on scientific research.

Why are dietary supplements so popular?

In medical practice, one often encounters diagnoses that do not require treatment, and it is only necessary to monitor its course in dynamics. In such cases, representatives of alternative medicine can easily convince a person to “do not hesitate” and drink drugs that will help cure the disease and prevent its progression. However, it is extremely rare that they inform the patient about the harm and side effects of the recommended dietary supplement / nutritional supplement.

Often people prescribe these remedies to themselves after reading forums, Instagram blogs and watching some Youtube channels. Recently, the idea that taking a dietary supplement can replace the positive health effects of proper diet and physical activity has become extremely attractive.

In addition, drugs with proven efficacy have a long list of possible side effects from taking them, and little is known about the side effects of dietary supplements. Therefore, patients can make a seemingly obvious, but in fact the wrong choice in favor of unreasonable intake of dietary supplements instead of the drug prescribed by the doctor.

Health risks associated with taking dietary supplements

Contamination with heavy metals, bacteria and fungal infections

nutritional supplements, because their pills contained large amounts of lead. Bacterial and fungal (potentially dangerous mold fungi) contamination (contamination) is also not uncommon. In a 2009 study138 out of 138 formulations studied, bacterial contamination of food additives was found.

In addition, hundreds of weight loss, sexual dysfunction, and muscle building products contain substandard or harmful substances.

Cancer-related risks

Taking more than the recommended dosage of vitamin A precursor beta-carotene, such as in immune system stimulants, has been found to increase the risk of lung cancer and heart disease by 20%. In a study of 35,533 participants, supplementation with vitamin E in the form of tocopherols was shown to significantly increase the risk of developing prostate cancer in healthy men (17% higher in the study group than in the placebo group, while the dosage of vitamin E was 400 IU per day).

Risks of interaction with the main therapy, for example, chronic diseases

Patients of the older age group tend to remain silent about the multivitamin complexes and / or biologically active supplements, herbal preparations they take, as a result of which there is a risk of side effects, aggravation of the clinical picture of the underlying disease .

Incorrect positioning

Supplements are sold to children as sweetened lozenges or candies. This practice is unhealthy and carries an inappropriate educational message in the field of nutrition.

Quality problems

Food supplement quality problems have long been a commonplace in the industry. For example, a study of multivitamin and mineral supplements showed significant differences between the amounts of various ingredients listed on the labels and the amounts contained in the supplements themselves.

Are there any proven liver supplements?

There are a number of herbal medicines and herbal supplements that are being offered as natural treatments for liver disease, but it is worth noting that only a small proportion of these have been included in clinical trials.

The first group includes nutritional supplements based on milk thistle seeds , which contain the flavonoid silymarin in their composition. Taking into account that milk thistle seeds can have different content of silymarin depending on the place of growth, only nutritional supplements standardized by its composition are used in medical practice.

Clinical studies of silymarin preparations were carried out with intravenous administration of its preparations, as well as when taken in tablet form. The use of this drug in chronic hepatitis C has been studied, but after the advent of direct-acting antiviral drugs, silymarin preparations have lost their relevance in this case. In non-alcoholic fatty liver disease (non-alcoholic fatty liver disease), the effectiveness of taking the drug in tablet form was noted only in combination with other hepatoprotectors.

Studies have also been conducted on the use of silymarin preparations for the prevention and treatment of drug-induced hepatitis when taking anti-tuberculosis drugs, showing its effectiveness as a prophylactic agent.

Based on research data, taking preparations containing milk thistle seed extract for liver diseases can be recommended in some cases only on prescription and in a standardized form.

The second group is represented by preparations containing extracts from the root licorice (glycyrrhizic acid) . The use of preparations containing glycyrrhizic acid has shown its effectiveness in various liver lesions and has been confirmed by a number of clinical studies in the treatment of hepatitis of various origins. Preparations based on glycyrrhizin are not recommended for independent use and are used only as directed by a doctor, as they have a number of contraindications.

The third group is food supplements based on artichoke or other medicinal herbs that have choleretic properties and improve the outflow of bile. The use of these nutritional supplements has not been shown to be effective in liver diseases, they are recommended only for diseases of the biliary system.

Although these are over-the-counter products, artichoke supplements require consultation with a gastroenterologist before use, as certain gastrointestinal conditions, such as gallstones, can aggravate the condition. In addition, the use of some medicinal herbs, which are recommended as cholagogues in various sources, can cause liver damage. Therefore, the intake of choleretic food supplements and medicinal herbs must be agreed with the attending physician.

Herbs and food additives harmful to the liver

Toxic liver damage is a specific type of inflammation and/or changes in the structure of the liver, often leading to liver cell death, caused by drugs, herbs and food additives, which are often recognized late because their negative impact on the liver is considered minimal or absent, and there are no specific blood tests before the stage of exclusion of other causes.

Due to interdrug interactions, including those between dietary supplements, the risk of adverse reactions during treatment increases significantly, and the rate of development of drug-induced hepatitis varies from several days to several months.

The FDA (Food and Drug Administration) estimates that there are about 50,000 adverse events each year that can be associated with the intake of dietary supplements, and these are only cases that were reported, and how many more are unreported adverse events phenomena is a big question. Adverse reactions can vary from a slight increase in biochemical parameters to severe, life-threatening conditions, such as liver failure requiring a liver transplant.

Despite the established belief that natural remedies do not harm the liver, dietary supplements and medicinal herbs can be even more dangerous for the liver than chemically synthesized drugs. This is due to the lack of clinical trials of their safety, the unknown composition of the active substances and the presence of hazardous impurities due to insufficient purification. For example, in Asia, especially in China, where herbal treatments are more common, liver damage associated with herbal use predominates over drug-induced liver damage.

Many nutritional supplements are positioned as natural remedies that are safe and cannot harm health, but this is not always true, since among natural remedies there are enough of those that are poisonous, for example, plants – belladonna, celandine and many others or snake venom.

Before appearing in medical practice, drugs go through a long path of clinical trials, during which all the side effects that occur are recorded. On the contrary, nutritional supplements are not a medicine, it is written on their packaging, clinical studies are not conducted for most of them, and one can only guess about the effect of dietary supplements on the body.

More than 100 natural food supplements have been described to date with hepatotoxic effects. The most famous among them are Herbalife, dietary supplements for weight loss and muscle building, supplements containing linoleic acid, aloe vera, green tea, kava kava, noni juice. More than 6,000 types of medicinal plants contain substances that can be harmful to the liver. Hepatotoxic effects have been reported with comfrey, ephedra, senna, dubrovnik, celandine, valerian, turmeric, pennyroyal, kava kava, black cohosh, heliotrope, ragwort, crotalaria, and other medicinal herbs, as well as some traditional Chinese medicine and Ayurveda.

Herbal remedies and dietary supplements can cause a wide range of liver damage from mild asymptomatic elevations in liver enzymes to acute or chronic hepatitis, cirrhosis of the liver, acute or chronic inflammation of the bile ducts (cholangitis), and vascular lesions of the liver. In addition, the use of anabolic steroids in bodybuilding can lead to a wide variety of liver damage, from acute hepatitis to liver tumors, both benign and malignant.

The most harmful food additives for the liver

Bodybuilding supplements.
Weight loss supplements. For example, aegelin, an alkaloid from the aegle jujube fruit, has been used for many years for gastrointestinal problems and for weight loss. However, studies show that this substance can cause serious liver damage, including the need for an emergency liver transplant.
Green tea extracts from Camellia sinensis are often used for weight loss. It has been proven that the substance can cause liver damage due to the production of free radicals. The negative effects of taking usually develop 3 months after the start of use and stop immediately after stopping its use. Approximately 10% of cases of liver damage are fatal. As a result, weight loss products containing green tea extract have been banned in some countries.
Energy drinks for frequent or high consumption and herbal complex supplements that increase energy levels.

Even vitamin and dietary supplements can harm the liver. An excess of iron or vitamin A that occurs while taking prophylactic drugs can lead to significant damage to it. Therefore, iron supplements should not be taken unless a deficiency has been diagnosed, and vitamin A should never exceed 5,000 units per day.

When taking dietary supplements and medicinal herbs, we recommend that you follow the same precautions as when taking medication and do not take them without consulting a doctor. During long-term use of drugs or dietary supplements, it is necessary to monitor the biochemical parameters of the liver at least once every three months. When taking dietary supplements and medicinal products at the same time, drug interactions may occur, so inform your doctor about any food supplements and medicinal herbs you are taking.

Doctors “Expert Gastroenterology Center” before prescribing a course of treatment that includes drugs with high hepatotoxicity, it is recommended to check the health of the liver. This is especially true for people who are obese and regularly drink alcohol or patients who are constantly taking medications for a chronic disease. You can check the health of the liver using the comprehensive HepatoCheck-up program, which includes all the necessary examinations and an appointment with a hepatologist.

References

Stephanie M Woo, William D Davis, Soorya Aggarwal, Joseph W Clinton, Sara Kiparizoska, and James H Lewis
Herbal and dietary supplement induced liver injury: Highlights from the recent literature.
World J Hepatol. 2021 Sep 27; 13(9): 1019–1041.