What are the key benefits of iron supplements. How much iron should you take daily. Can excessive iron intake be harmful. What are the common side effects of iron supplementation. How does iron impact overall health.

The Crucial Role of Iron in Human Health

Iron stands as a cornerstone mineral in maintaining optimal bodily functions. Its primary role revolves around oxygen transportation, a process vital for sustaining life. But how exactly does iron contribute to our overall well-being?

Iron is an integral component of hemoglobin, the protein in red blood cells responsible for carrying oxygen from the lungs to every cell in the body. Without sufficient iron, our bodies struggle to produce adequate hemoglobin, leading to a condition known as iron deficiency anemia. This condition can result in fatigue, weakness, and a host of other symptoms that significantly impact quality of life.

Beyond its oxygen-carrying capacity, iron plays a crucial role in various bodily functions:

• Energy production: Iron is essential for the proper functioning of enzymes involved in cellular energy production.
• Immune system support: Adequate iron levels are necessary for the proliferation and maturation of immune cells.
• Cognitive function: Iron is vital for brain development and maintaining cognitive abilities throughout life.
• Muscle metabolism: Iron is required for the proper functioning of myoglobin, a protein that provides oxygen to muscles.

Given its importance, ensuring adequate iron intake through diet or supplementation becomes paramount for maintaining overall health and well-being.

Understanding Iron Deficiency and Its Consequences

Iron deficiency is a global health concern affecting millions of people worldwide. But what exactly constitutes iron deficiency, and how does it impact our health?

Iron deficiency occurs when the body’s iron stores become depleted, leading to insufficient iron availability for various bodily functions. This depletion can result from inadequate dietary intake, increased iron requirements (such as during pregnancy or growth spurts), or excessive iron loss (due to conditions like heavy menstrual bleeding or gastrointestinal disorders).

The consequences of iron deficiency can be far-reaching and include:

1. Fatigue and weakness: As oxygen transport becomes compromised, energy levels plummet.
2. Impaired cognitive function: Iron deficiency can affect memory, attention span, and learning abilities.
3. Decreased immune function: The body’s ability to fight off infections may be compromised.
4. Reduced work capacity: Physical endurance and performance can significantly decline.
5. Complications during pregnancy: Iron deficiency in pregnant women can lead to preterm delivery and low birth weight babies.

Recognizing the signs of iron deficiency early on is crucial for preventing these complications. Common symptoms include persistent fatigue, pale skin, shortness of breath, and difficulty concentrating. If you suspect iron deficiency, consulting a healthcare provider for proper diagnosis and treatment is essential.

The Benefits of Iron Supplementation

Iron supplementation serves as a powerful tool in combating iron deficiency and its associated complications. But what specific benefits can one expect from taking iron supplements?

The primary benefit of iron supplementation is the prevention and treatment of iron deficiency anemia. By replenishing iron stores, supplements can help restore hemoglobin levels, leading to improved oxygen transport throughout the body. This, in turn, results in numerous health benefits:

• Increased energy levels and reduced fatigue
• Enhanced cognitive function and mental clarity
• Improved physical performance and endurance
• Strengthened immune system
• Better pregnancy outcomes for both mother and child

Iron supplements can be particularly beneficial for certain groups at higher risk of iron deficiency, including:

• Pregnant women
• Menstruating women with heavy periods
• Vegetarians and vegans
• Endurance athletes
• Individuals with certain gastrointestinal disorders

It’s important to note that iron supplementation should only be undertaken under the guidance of a healthcare provider, as excessive iron intake can lead to complications.

Optimal Dosage: How Much Iron Do You Need?

Determining the right dosage of iron is crucial for reaping its benefits while avoiding potential side effects. But how much iron should you be taking daily?

The recommended daily iron intake varies based on age, gender, and specific health conditions. Here’s a breakdown of the daily recommended intake of elemental iron:

• Infants (0-6 months): 0.27 mg
• Infants (7-12 months): 11 mg
• Children (1-3 years): 7 mg
• Children (4-8 years): 10 mg
• Boys (9-13 years): 8 mg
• Girls (9-13 years): 8 mg
• Boys (14-18 years): 11 mg
• Girls (14-18 years): 15 mg
• Men (19+ years): 8 mg
• Women (19-50 years): 18 mg
• Women (51+ years): 8 mg
• Pregnant women: 27 mg

It’s important to note that these recommendations are for dietary intake. If iron supplementation is necessary, the dosage may be higher and should be determined by a healthcare provider based on individual needs and iron deficiency severity.

When taking iron supplements, pay attention to the “elemental iron” content listed on the label. This represents the amount of iron your body can actually absorb. Different forms of iron supplements (such as ferrous sulfate, ferrous gluconate, or ferrous fumarate) contain varying amounts of elemental iron.

Maximizing Iron Absorption: Tips and Tricks

While taking iron supplements is important, ensuring optimal absorption is equally crucial. How can you maximize the absorption of iron from your supplements?

Several factors can influence iron absorption, and by understanding these, you can take steps to enhance the effectiveness of your iron supplementation:

1. Timing: Take iron supplements on an empty stomach, ideally 1-2 hours before or after meals. If this causes stomach discomfort, you can take them with a small amount of food.
2. Vitamin C: Consume vitamin C-rich foods or take a vitamin C supplement alongside your iron supplement. Vitamin C significantly enhances iron absorption.
3. Avoid certain foods and supplements: Calcium, dairy products, coffee, tea, and certain medications can interfere with iron absorption. Try to take iron supplements separately from these.
4. Choose the right form: Some forms of iron, such as ferrous sulfate, are more easily absorbed than others.
5. Spread out dosage: If you’re taking high doses, consider splitting them throughout the day to improve absorption and reduce side effects.

Remember, consistency is key when it comes to iron supplementation. Establishing a routine and sticking to it can help ensure you’re getting the most out of your supplements.

Foods That Enhance Iron Absorption

Incorporating certain foods into your diet can naturally boost iron absorption. These include:

• Citrus fruits (oranges, lemons, grapefruits)
• Berries (strawberries, blueberries)
• Bell peppers
• Broccoli
• Potatoes
• Tomatoes

By pairing these foods with iron-rich meals or taking them alongside your iron supplement, you can significantly improve iron absorption and overall effectiveness.

Potential Side Effects of Iron Supplementation

While iron supplements can be highly beneficial, they may also come with certain side effects. What are the most common side effects associated with iron supplementation?

Iron supplements can cause various gastrointestinal side effects, particularly when taken in high doses or on an empty stomach. These may include:

• Constipation
• Nausea
• Abdominal pain
• Vomiting
• Diarrhea
• Dark or black stools

In most cases, these side effects are mild and can be managed by adjusting the dosage, taking the supplement with food, or switching to a different form of iron. However, if side effects persist or become severe, it’s important to consult with a healthcare provider.

In rare cases, iron supplementation can lead to more serious complications:

1. Iron overload: Excessive iron intake can lead to iron toxicity, causing damage to the liver and other organs.
2. Interactions with medications: Iron can interfere with the absorption of certain medications, including antibiotics and thyroid hormones.
3. Zinc deficiency: High doses of iron can impair zinc absorption, potentially leading to zinc deficiency.

To minimize the risk of these complications, it’s crucial to take iron supplements only as directed by a healthcare provider and to inform them of any other medications or supplements you’re taking.

Special Considerations for Iron Supplementation

While iron supplementation can be beneficial for many, there are certain groups that require special consideration. Who should be particularly cautious about iron supplementation?

Several groups require careful monitoring when it comes to iron supplementation:

Pregnant Women

Pregnant women have increased iron needs due to the expansion of blood volume and the growing fetus. The recommended daily intake for pregnant women is 27 mg of iron. However, excessive iron intake during pregnancy can be harmful, so supplementation should always be guided by a healthcare provider.

Individuals with Hereditary Hemochromatosis

This genetic disorder causes the body to absorb too much iron from food. People with this condition should avoid iron supplements and limit iron-rich foods to prevent iron overload.

People with Certain Chronic Conditions

Individuals with conditions such as inflammatory bowel disease, celiac disease, or those who have undergone gastric bypass surgery may have impaired iron absorption. They may require special formulations or higher doses of iron supplements.

Vegetarians and Vegans

Plant-based diets are often lower in iron, and the iron from plant sources (non-heme iron) is less readily absorbed than iron from animal sources (heme iron). Vegetarians and vegans may need to pay extra attention to their iron intake and consider supplementation if necessary.

Endurance Athletes

Intense physical activity can increase iron loss through sweat and potentially damage red blood cells. Endurance athletes, particularly females, may have higher iron needs and should monitor their iron status closely.

In all these cases, consulting with a healthcare provider for personalized advice on iron supplementation is crucial to ensure safety and effectiveness.

Natural Sources of Iron: Boosting Your Dietary Intake

While supplements can be beneficial, obtaining iron from dietary sources is often preferable. What are some of the best natural sources of iron?

Iron from food sources comes in two forms: heme iron (from animal sources) and non-heme iron (from plant sources). Heme iron is more easily absorbed by the body. Here are some excellent dietary sources of iron:

Heme Iron Sources:

• Red meat (beef, lamb)
• Poultry (chicken, turkey)
• Fish (tuna, sardines)
• Organ meats (liver, kidney)

Non-Heme Iron Sources:

• Legumes (lentils, beans, chickpeas)
• Leafy green vegetables (spinach, kale)
• Fortified cereals and breads
• Nuts and seeds (pumpkin seeds, cashews)
• Dried fruits (raisins, apricots)
• Whole grains (quinoa, brown rice)

To enhance iron absorption from plant-based sources, consider pairing them with vitamin C-rich foods. For example, add bell peppers to a lentil dish or enjoy a spinach salad with strawberries.

By incorporating a variety of these iron-rich foods into your diet, you can help ensure adequate iron intake and potentially reduce the need for supplementation. However, for those with diagnosed iron deficiency or increased iron needs, a combination of dietary sources and supplements may be necessary.

Remember, while dietary sources are generally safe, it’s still possible to consume too much iron, especially from fortified foods. Always consult with a healthcare provider before making significant changes to your diet or starting any supplementation regimen.

Benefits, dosage and side effects

Iron is an important mineral that we all need to stay healthy.

One of its key jobs is to help our blood carry oxygen throughout the body. You can find iron in many different food sources, such as chicken, red meat, fortified cereals and beans. For those who don’t get enough iron through diet alone, an iron supplement may be recommended. It’s important to understand the benefits, dosages and side effects of iron supplements.

What are the benefits of iron
supplements?

The main benefit of taking iron supplements is to lower your chance of developing iron deficiency anemia, which can be diagnosed when people have very low levels of iron in the blood. If you think you might be at risk of developing iron deficiency anemia, talk with a healthcare provider before taking a supplement. They’ll be able to test your iron levels and help you assess your intake from food sources.

What is the correct dosage for iron
supplements?

The dose of iron supplementation will vary depending on age, gender and health factors. Your healthcare provider will give you directions on how much to take and for how long. The daily recommended intake of iron for age and gender is:

• Birth–6 months: 0.27 mg
• 7–12 months: 11 mg
• 1–3 years: 7 mg
• 4–8 years: 10 mg
• 9–13 years: 8 mg
• 14–18 years: 11 mg for men, 15 mg for women
• 19–50 years: 8 mg for men, 18 mg for women
• 51 years and older: 8 mg

The iron in our body is called elemental iron. The iron in supplements can come in different forms. Make sure to read the supplement label for “elemental iron” to see how much iron you’re taking with each dose.

Can you take too much iron?

Iron can be toxic at high doses. There is a Tolerable Upper Intake Level (UL) for iron, which is the amount that can be taken daily without causing severe health effects. The UL for iron in children under 14 is 40 mg. For those who are age 14 and older, it’s 45 mg.

What if I’m pregnant?

The recommended daily intake of iron for pregnant women between the ages of 14 and 50 years is 27 mg.  Pregnancy increases the number of red blood cells needed by the body, and these extra cells need the iron to carry oxygen to your baby.

How to take iron supplements

All iron supplements should be taken as directed by your healthcare provider. It’s generally recommended to take iron supplements on an empty stomach.

If you find this gives you an upset stomach, you can take your supplement with a little bit of food. Iron should be taken separately from antacids, caffeine, calcium supplements or foods containing calcium, such as milk, yogurt and cheese.

These supplements, foods and drinks may decrease the absorption of iron.

Vitamin C can help with iron absorption. So when taking an iron supplement, it may be a good idea to also take a vitamin C supplement or food or drinks that are high in the vitamin, like orange juice, sweet peppers and tomatoes.

Note that if you’re taking certain medications, they can be affected by iron supplements, just as some medications can have a negative effect on iron levels. It’s important to speak with a healthcare provider about your prescribed medications and any other supplements before you start taking iron.

What are the side effects of iron
supplements?

Iron supplements may cause side effects, including stomach discomfort, constipation, dark stool and nausea. An iron supplement of 25 mg elemental iron or more a day can also cause your body to absorb less zinc. Zinc is an important mineral for a number of roles, including immune system function and wound healing. Because iron can be toxic in large amounts, be sure to store iron supplements out of the reach of children.

Iron supplements may be beneficial for certain individuals who can’t get adequate iron from their diet. Speak with your healthcare provider for a full evaluation and recommendations before taking an iron supplement.

Published October 2021.

Sources:

1. https://ods.od.nih.gov/factsheets/Iron-HealthProfessional/
2. https://www. mayoclinic.org/diseases-conditions/iron-deficiency-anemia/symptoms-causes/syc-20355034
3. https://ods.od.nih.gov/factsheets/Iron-Consumer/
4. https://www.mayoclinic.org/drugs-supplements/iron-supplement-oral-route-parenteral-route/proper-use/drg-20070148
5. https://ods.od.nih.gov/factsheets/Zinc-HealthProfessional/

Overview, Uses, Side Effects, Precautions, Interactions, Dosing and Reviews

Overview

Iron is a mineral. Most of the iron in the body is found in red blood cells and muscle cells. Food sources include meat, fish, beans, spinach, and cereal.

Iron helps red blood cells carry oxygen from the lungs to cells all over the body. Iron also plays a role in many important functions in the body.

People commonly use iron for preventing and treating different types of anemia caused by low iron levels. It is also used for heart failure, memory and thinking skills, child development, fatigue, ADHD, and many other conditions, but there is no good scientific evidence to support most of these other uses.

Uses & Effectiveness ?

Effective for

• Low levels of red blood cells in people with a long-term illness (anemia of chronic disease). Taking iron by mouth or by IV along with other medications such as epoetin alfa can help build red blood cells and prevent or treat anemia in people with certain chronic diseases. IV products can only be given by a healthcare provider.
• Low levels of healthy red blood cells (anemia) due to iron deficiency. Taking iron by mouth or by IV is effective for treating and preventing anemia caused by too little iron in the body. IV products can only be given by a healthcare provider.
• Low iron levels during pregnancy. Taking iron by mouth during pregnancy reduces the risk of anemia caused by too little iron in the body.

Possibly Effective for

• Breath-holding attacks. Many children who have breath-holding attacks have low iron levels. Taking iron by mouth reduces the number of breath-holding attacks in children.
• Memory and thinking skills (cognitive function). Taking iron by mouth might help improve thinking, learning, and memory in children and adolescents with low iron levels.
• Heart failure. Up to 20% of people who have heart failure also have low iron levels. Giving iron by IV can improve heart failure symptoms. But taking iron by mouth doesn’t seem to help. IV products can only be given by a healthcare provider.
• A disorder that causes leg discomfort and an irresistible urge to move the legs (restless legs syndrome or RLS). Taking iron by mouth or by IV decreases symptoms of RLS such as leg discomfort and sleep problems. IV products can only be given by a healthcare provider.

Possibly Ineffective for

• Athletic performance. Taking iron by mouth doesn’t improve athletic performance.
• Child growth. Taking iron by mouth does not help a child grow faster.
• Preterm birth. Taking iron during pregnancy doesn’t seem to reduce the risk for preterm birth. It might actually increase the risk in areas where malaria is common.

There is interest in using iron for a number of other purposes, but there isn’t enough reliable information to say whether it might be helpful.

Side Effects

When taken by mouth: Iron is likely safe for most people when used in doses below the tolerable upper intake level (UL) of 45 mg elemental iron daily. It can cause side effects such as stomach upset, nausea, and vomiting. Taking iron supplements with food seems to reduce side effects. But food can also reduce how well the body absorbs iron. Doses above the UL should only be used while under medical supervision. Iron is likely unsafe when taken in excessive doses.

Special Precautions and Warnings

When taken by mouth: Iron is likely safe for most people when used in doses below the tolerable upper intake level (UL) of 45 mg elemental iron daily. It can cause side effects such as stomach upset, nausea, and vomiting. Taking iron supplements with food seems to reduce side effects. But food can also reduce how well the body absorbs iron. Doses above the UL should only be used while under medical supervision. Iron is likely unsafe when taken in excessive doses. Pregnancy and breast-feeding: Iron is likely safe to use while pregnant and breast-feeding in doses below the UL of 45 mg of elemental iron by mouth daily. But iron is likely unsafe when taken by mouth in high doses. If you do not have iron deficiency, don’t take more than 45 mg daily. Higher doses can cause stomach side effects such as nausea and vomiting and may even increase the risk for preterm birth.

Children: Iron is likely safe when taken by mouth in doses below the UL of 40 mg of elemental iron daily. But high doses of iron are likely unsafe for children. Iron is the most common cause of poisoning deaths in children. Doses as low as 60 mg/kg can be fatal.

Diabetes: High iron intake in the diet might increase the risk of heart disease in females with type 2 diabetes. If you have diabetes, discuss your iron intake with your healthcare provider.

Hemodialysis: Iron from supplements might not be absorbed well in people on hemodialysis.

Hemoglobin diseases: Taking iron might cause iron overload in people with these conditions. If you have a hemoglobin disease, do not take iron unless directed by your healthcare provider.

An inherited disorder that affects the formation of blood vessels (hereditary hemorrhagic telangiectasia or HHT): Taking iron might increase the risk of nosebleed in patients with HHT. Use with caution.

Premature infants: Giving iron to premature infants with low blood levels of vitamin E can cause serious problems. Low levels of vitamin E should be treated before giving iron. Talk with your healthcare provider before giving iron to a premature infant.

Physical training: Iron might not be absorbed as well in young females participating in physical training.

Interactions ?

Moderate Interaction

Be cautious with this combination

• Iron can decrease how much quinolone antibiotic the body absorbs from the stomach. Taking iron along with these antibiotics might decrease the effects of these antibiotics. To avoid this interaction, take iron 2 hours before or 2 hours after taking antibiotics.

• Iron might decrease how much tetracycline antibiotics the body can absorb from the stomach. Taking iron along with these antibiotics might decrease the effects of these antibiotics. To avoid this interaction, take iron 2 hours before or 4 hours after taking tetracyclines.

• Iron can decrease how much bisphosphonate the body absorbs from the stomach. Taking iron along with bisphosphonate can decrease the effects of bisphosphonate. To avoid this interaction, take bisphosphonate at least two hours before iron or later in the day.

• Iron might decrease how much levodopa the body absorbs. Taking iron along with levodopa might decrease the effects of levodopa. Do not take iron and levodopa at the same time.

• Levothyroxine is used for low thyroid function. Iron can decrease how much levothyroxine the body absorbs. Taking iron along with levothyroxine might decrease the effects of levothyroxine.

• Iron can decrease how much methyldopa the body absorbs. Taking iron along with methyldopa might decrease the effects of methyldopa. To prevent this interaction, take iron at least two hours before or after taking methyldopa.

• Iron might decrease how much mycophenolate mofetil the body absorbs. Taking iron along with mycophenolate mofetil might decrease the effects of mycophenolate mofetil. But it’s not clear if this is a big concern. Until more is known, take iron at least 4 hours before, or 2 hours after taking mycophenolate mofetil.

• Iron might decrease how much penicillamine the body absorbs. This might decrease the effects of penicillamine. To avoid this interaction, take iron 2 hours before or 2 hours after taking penicillamine.

• Dolutegravir is a drug used for HIV infection. Iron can reduce how much dolutegravir the body absorbs from the stomach. To avoid this interaction, take dolutegravir at least 2 hours before or 6 hours after taking iron.

• Taking iron along with integrase inhibitors might decrease blood levels of these drugs. This might decrease their effects. Talk to your healthcare provider if you are using integrase inhibitors and want to start taking iron.

Minor Interaction

Be watchful with this combination

• Iron is important for producing new blood cells. Chloramphenicol might decrease new blood cells. Taking chloramphenicol for a long time might decrease the effects of iron on new blood cells. But most people only take chloramphenicol for a short time so this interaction isn’t a big problem.

Dosing

Iron is found in many foods, including beef, liver, lamb, pork, ham, chicken, fish, spinach, and beans. The amount that should be consumed on a daily basis is called the recommended dietary allowance (RDA). For males 19 years and older and females 51 years and older, the RDA is 8 mg. For females 19-50 years of age, the RDA is 18 mg. While pregnant, the RDA is 27 mg. While breast-feeding, the RDA is 10 mg for those 14-18 years of age, and 9 mg for those 19-50 years of age. In children, the RDA depends on age. Don’t take more than 45 mg iron daily unless under the supervision of a healthcare provider. Speak with a healthcare provider to find out what type of product and dose might be best for a specific condition.

View References

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CONDITIONS OF USE AND IMPORTANT INFORMATION: This information is meant to supplement, not replace advice from your doctor or healthcare provider and is not meant to cover all possible uses, precautions, interactions or adverse effects. This information may not fit your specific health circumstances. Never delay or disregard seeking professional medical advice from your doctor or other qualified health care provider because of something you have read on WebMD. You should always speak with your doctor or health care professional before you start, stop, or change any prescribed part of your health care plan or treatment and to determine what course of therapy is right for you.

This copyrighted material is provided by Natural Medicines Comprehensive Database Consumer Version. Information from this source is evidence-based and objective, and without commercial influence. For professional medical information on natural medicines, see Natural Medicines Comprehensive Database Professional Version.
© Therapeutic Research Faculty 2020.

About iron deficiency: symptoms and remedies.

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Symptoms of iron deficiency

About iron deficiency

Prevention of iron deficiency

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Every 10th inhabitant of Russia

Currently, according to Rosstat data from 2019, in Russia, the frequency of iron deficiency is 1. 6 million people who have developed anemia associated with iron deficiency ¹ .

In the international classification of diseases ICD-10, iron deficiency is indicated as follows: E61.1 – Iron deficiency.

The role of iron

in the human body

Iron is an essential trace element that is part of more than 100 enzymes of the human body and takes part in respiration, blood formation, immunobiological processes and providing the body with energy.

So, for example, according to the results of a study of 40 patients with chronic heart failure and iron deficiency, it was shown that the use of iron preparations increased muscle activity, which means the activity of patients ⁶ .

Iron deficiency can not only lead to the development of iron deficiency anemia (decrease in blood hemoglobin levels due to iron deficiency in the body), but also complicate the course of chronic diseases.

Symptoms of iron deficiency

Initially, iron deficiency may be asymptomatic
.

It should be said that there are conditionally two types of iron in the body:

Which is actively and directly involved in the work of the body

Which is “in reserve”

In order to assess how much iron is enough in these reserves, it is necessary to evaluate the level of ferritin protein.

In addition, when this supply is depleted, deficiency symptoms may already appear:

Weakness

Headache

Restriction of physical activity

Fatigue

Irritability or may even develop depression

Retardation of the development of the nervous system (children)

Craving to “cool off” (pagophagia)

Restless legs syndrome ²

Thus, it is usually not possible to establish the presence of iron deficiency in the early stages by symptoms. Symptoms are a consequence of severe iron deficiency, that is, the disease – iron deficiency anemia (IDA).

It is important to say that in cases where a person does not notice the listed symptoms, the disease continues to progress, and as a result, a severe form of IDA appears.

Severe iron deficiency leads to cardiovascular complications and muscle dysfunction (myopathy) ¹¹ . The fact is that iron is extremely important to remove certain toxic substances from the body, which means that in people with a risk of cardiovascular diseases and older people, iron deficiency is an unfavorable risk of cardiovascular accidents ¹² .

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Causes of iron deficiency

Causes of iron deficiency (ID) can be divided into the following groups:

Malnutrition

Lack of iron from food may be associated with special diets, such as a vegetarian diet ¹⁴ .

There are also foods that contribute to the development of iron deficiency: coffee, tea, dairy products and supplements. These products are united by a high amount of calcium, which leads to a decrease in iron absorption ^20.21 .

Increased body requirements

High iron requirements are observed in children during the period of active growth and pregnant women ¹³ .

Athletes and those involved in challenging sports also have an increased need for iron. They are at higher risk of developing iron deficiency due to the greater loss of iron in the urine and sweat during exercise ^15.16 .

Decreased absorption

Iron absorption occurs in the small intestine. The presence of an insufficient amount of gastric hydrochloric acid inhibits the process of oxidation of one form of iron (Fe3+) to another form (Fe2+), which also affects the absorption of iron from food ¹⁷ . Moreover, long-term use of drugs that reduce stomach acid (such as proton pump inhibitors or histamine-2 receptor antagonists) increases the risk of developing IDA ¹³ .

After gastric surgery (bariatric surgery), patients are very sensitive to iron deficiency, as the total area of ​​the stomach decreases and the amount of gastric juice decreases ¹⁷ .

But not only surgical interventions affect the amount of iron in the body, but also infections of the gastrointestinal tract. For example, the bacterium Helicobacter pylori can lead to IDA due to decreased iron absorption and chronic blood loss in gastric ulcers ¹⁸ .

Chronic inflammation

It has been established that chronic diseases are characterized by a large formation of hepcidin. It is a protein that blocks iron transporters and reduces its absorption, and in some cases keeps iron in the depot, preventing the release of iron. As a result, in patients with chronic diseases, hemoglobin in blood tests may decrease ^13,22,23 .

Chronic blood loss

When identifying IDA, it is important to rule out occult blood loss or bleeding. It can occur without obvious manifestations inside the body. Therefore, it is recommended to consult an ENT doctor, a gynecologist, a urologist and a gastroenterologist. In some cases, you may need to consult other doctors ^13.24.25 .

About Iron Deficiency

Treatment of IDA is a complex, step-by-step process.

The cause of the initial loss of iron should be established along with treatment aimed at replenishing the deficiency of iron itself. Since the undiagnosed cause will continue to consume iron, and IDA may return in a short time ²⁶ .

The approach to treating iron deficiency depends on the cause and severity of the iron deficiency. For the treatment and replenishment of iron deficiency, tablet and injectable forms of iron preparations are used.

Iron tablets

Combining dietary intake with iron tablets (oral forms) is important to improve the effectiveness of treatment. Oral preparations differ in the amount and type of iron (Fe2+ or Fe3+), excipients and active ingredients in the tablet in addition to the iron itself, and the source of iron in the tablet.

The combination of iron (II) sulfate and ascorbic acid (vitamin C) is the most commonly prescribed oral drug due to:

• gradual release of iron ions, which ensures a uniform supply of iron in the body, and therefore reduces the risk of side effects
• highly bioavailable (final amount of substance that enters the body, released from the tablet in the intestines)
• improved intestinal absorption of the drug
• enhanced hemoglobin recovery

Tolerance of iron preparations

Adverse effects of oral iron preparations are mainly related to the gastrointestinal tract and include: nausea, dyspepsia, constipation or diarrhea, black stools, staining of tooth enamel, metallic taste in the mouth, burning behind the breastbone ²⁸ .

The manifestation of these undesirable effects when taking iron supplements is primarily due to the mechanism of action of the drugs and may also be related to the dosage of the drug used. Therefore, if such phenomena occur, it is necessary to consult a doctor for a possible correction of treatment.

How to help relieve the side effects of iron supplements:

Constipation and dark stools:

increase your water, fluid and fiber intake, include probiotics in your diet, in some cases your doctor may recommend taking laxatives.

Indigestion:

Stomach problems can be controlled by taking oral iron with meals instead of on an empty stomach and every other day, or reduce the dosage of the drug.

Stains on teeth:

it is recommended not to chew the tablet, but to swallow it whole with a glass of water. Liquid forms should be taken through a straw, dissolving in water or juice to avoid staining the enamel.

Metallic taste:

Drinking water or chewing gum can help eliminate the metallic taste.

Heartburn:

Taking iron supplements with food and avoiding them at bedtime may reduce heartburn.

Intravenous iron

Only when oral therapy fails for a long time, or iron recovery is needed in a short time (life-threatening conditions), should intravenous iron preparations be considered in a hospital under the supervision of a physician.

Side effects of intravenous iron

When a doctor prescribes an intravenous iron preparation, the presence of medical personnel is necessary, which carries out the manipulation itself, and also monitors the patient during the procedure. Serious side effects such as hypotonic and anaphylactic reactions, tachycardia and arrhythmias, dyspnea and bronchospasm may occur during infusion, although these are rare. ³⁰ Periodic taste disturbance, headache, dizziness, myalgia and fever may also occur during such treatment.

Intravenous iron preparations must be prescribed by a physician only!

Iron Deficiency Diet

It is important to understand that when iron is deficient in the body, diet is not the main way to replenish this trace element. This can be achieved by taking iron supplements with food.

Nutrition advice for iron deficiency

Which foods improve iron absorption

Substances that increase iron absorption are vitamin C or certain meat products, such as jelly. In addition, such traditional Russian dishes as sauerkraut, kvass, pickled cucumbers can also help restore iron levels better. The recommended iron intake is 14 mg per day ⁴² . For special categories of people, such as patients with chronic diseases, pregnant women and athletes, this figure may be higher.

Criteria for the effectiveness of treatment with iron preparations

To analyze the effectiveness of treatment, it is recommended to monitor the results of laboratory tests 6-8 weeks after the start of correction of iron levels.

Key efficacy criteria when taking iron supplements

³³ :

Increase in hemoglobin (Hb) concentration and hematocrit

Increase in hemoglobin (Hb) concentration by 10 g/l one month after the start of treatment and hematocrit by 3% relative to the initial values ​​
before treatment ³⁴

Clinical improvement in condition

Clinical improvement in condition after 1-1. 5 months from the start of treatment with iron preparations (improvement of the general condition of the patient, reduction of fatigue, weakness, dizziness)

Replenishment of iron in the depot

900 02 Replenishment iron in the depot after 3-6 months from the start of treatment (depending on the severity of anemia) is controlled by the normalization of the serum ferritin concentration (more than 30 mcg/l)

Depending on the results of the blood test, therapy will be continued or changed to achieve or maintain iron stores within the normal range.

Why iron supplementation may not be effective

³³

Possible causes are:

• the true cause of IDA has not been established
• Inappropriate dose of iron preparations selected
• the duration of treatment with IDA drugs has not been reached
• reduced absorption of iron preparations (presence of diseases)
• poor tolerance to iron preparation

Treatment of this type of IDA with oral iron preparations is ineffective, a partial response can be obtained with the use of parenteral iron preparations (eg, injections). The cause of IRIDA is a mutation in the TMPRSS6 gene. In this case, a geneticist and special laboratory diagnostics will help to identify such a condition.

Video

Treatment and prevention of iron deficiency anemia

Shikh Evgenia Valerievna

Director of the Institute of Vocational Education, Doctor of Medical Sciences, Professor, Head of the Department of Clinical Pharmacology and Propaedeutics of Internal Diseases, I.M. Sechenov of the Ministry of Health of Russia.

Prevention

iron deficiency

Primary prevention

Primary prevention of iron deficiency primarily consists of controlling the patient’s diet.

Pay attention to a number of foods rich in iron, such as meat, poultry, fish, plant products – legumes and green vegetables, spinach, fennel. Particular attention is paid to risk groups such as children, women, patients with chronic diseases (gastrointestinal tract, chronic heart failure, kidney disease, chronic blood loss, etc. ), adults who follow a vegetarian, vegan diet, blood donors: an additional intake is recommended prophylactic doses of iron preparations and clinical examination at least once a year ³³ .

Secondary prevention

Secondary prevention of iron deficiency is associated with early diagnosis of IDA. It includes preventive testing when visiting a doctor.

At the same time, specialists take into account the patient’s complaints, social status, risk factors for iron deficiency, medical history, clinical manifestations and changes in laboratory parameters ³³ .

For patients with persistently low ferritin levels, a doctor may recommend oral iron supplements. Only in selected cases with severe incompatibility with oral therapy, comorbidity (eg, depression), or repeated failure to respond to oral therapy, should intravenous iron be considered ³³ .

Long-term daily oral iron or intravenous iron with normal or high ferritin values ​​is not recommended and may even be harmful.

The main thing is not to self-medicate and seek advice from a specialist in time, as well as conscientiously follow all the recommendations!

Authors of the article

Shikh Evgenia Valerievna

Director of the Institute of Vocational Education, Doctor of Medical Sciences, Professor, Head of the Department of Clinical Pharmacology and Propaedeutics of Internal Diseases, First Moscow State Medical University named after I.M. Sechenov of the Ministry of Health of Russia.

Maria Aleksandrovna Balalaeva

Clinical pharmacologist, Candidate of Medical Sciences, Associate Professor of the Department of Clinical Pharmacology and Propaedeutics of Internal Diseases, PMSMU named after I.I. THEM. Sechenova, Head of the Centralized Department of Clinical Pharmacology, Federal State Budgetary Scientific Institution of the Republican Scientific Center of Surgery named after A.I. acad. B.V. Petrovsky.

Find out more about iron deficiency

#THE IRON

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How to get tested for ferritin?

Get a referral from your PCP

You can get a referral for a serum ferritin test from your PCP if you have symptoms and indications.

Take the test yourself

You can test your ferritin level yourself at clinics and laboratories in your city if such a service is available.

Where can I get tested?

Including you can take an analysis for the level of ferritin:

Go to website

Go to website

Go to website

The information contained on the site does not replace medical advice.

There are contraindications. Consult a

Specialist

Iron preparations for anemia – “Provincial pharmacies”

Anemia is a condition in which the level of hemoglobin in the blood decreases. Often, along with it, the number of blood cells, called erythrocytes, also decreases. Because of this, tissues are less supplied with oxygen and oxygen starvation occurs.

The condition is divided into several forms, but the most common of them is iron deficiency, in which there is a lack of iron in the body. We talk about the causes of the syndrome, what drugs are prescribed for anemia and how they differ.

What causes iron deficiency in the body

Iron deficiency anemia can occur for many reasons. For example, in women, anemia can be associated with severe blood loss – excessive menstruation, childbirth. Development is also affected by periods of pregnancy and lactation.

People who regularly donate blood as a donor, or patients with kidney failure who undergo a blood purification procedure, may experience anemia.

Iron deficiency can appear without regular blood loss. For example, such a condition is possible when following a plant-based diet or in children during growth. Intestinal diseases can also affect, since iron absorption mainly occurs in the duodenum and upper jejunum.

How iron deficiency symptoms appear

With anemia, a person feels tired and weak. He has shortness of breath after minor exertion, the skin becomes paler. Dizziness, brittle hair, loss of appetite, and dry skin are also possible.

Which drugs are prescribed for iron deficiency

To date, in pharmacies you can find many drugs that are prescribed for anemia. The main ones are iron preparations. They are divided into two groups: the divalent form of iron and the trivalent form.

The dosage of the drug for each patient is calculated individually, taking into account his age, weight and treatment plan. The duration of the course depends on the indicators of iron deficiency and varies from 1 to 3 months. On sale drugs are presented in the form of tablets, capsules, drops and syrups. The latter are well suited for the treatment of children.

If it is impossible to take an iron preparation inside, an intravenous injection is prescribed. This procedure is performed in a hospital setting.

Important: When choosing iron preparations, it is very important to correctly determine the dosage, since an excess of iron in the body can lead to serious complications: diabetes, cirrhosis of the liver. In addition, the presence of concomitant diseases in the patient and pregnancy also play an important role. Therefore, a specific medicine, daily dosage and number of doses should be prescribed by a doctor. Ferrous preparations

The bivalent form is iron sulfates, which are well absorbed in the stomach and have a convenient frequency of administration. The latter means that they contain a large dose, so it will be enough to take an iron preparation orally 1-2 times a day per day.

At the same time, this group of drugs has more pronounced side effects.

Ferric preparations

The trivalent form is different in that iron comes in combination with an amino acid, which helps it to be better absorbed. Side effects during the course of treatment are either absent or mild. At the same time, ferric iron preparations require a longer intake, as they need more time to be absorbed.

Complex preparations with additives

Iron preparations are the basis of deficiency therapy. But in addition to monopreparations, the basis of which is iron, vitamin complexes can also be used. They have ferric iron and additional vitamins and minerals.

Such funds can be effective in the prevention of anemia or in its initial stages, when iron is supplied less than normal, but there is no severe shortage yet.

Also, in the initial stages, along with iron, a specialist can prescribe drugs to improve absorption. These can be ascorbic acids, fructose, sorbitol, etc.

Iron side effects

Many iron supplements have side effects that vary in severity. So, the patient may experience:

• diarrhea;
• nausea;
• feeling of heaviness in the abdomen;
• metallic taste in the mouth;
• discoloration of feces.

If the side effects are too strong and are accompanied by abdominal pain, the patient should contact their doctor. The specialist may prescribe a different drug or reduce the dosage.

Which drugs are more effective

Preparations of ferrous and ferric iron are equally effective. However, due to mild side effects, ferric preparations may be more preferable in the treatment of children and patients who do not want to experience discomfort.

Experts also note that short courses of drugs at lower doses may be more effective than taking drugs with a large proportion of iron 2-3 times a day.

Iron recommendations

Maintain your daily iron requirement. Experts recommend 120 milligrams of iron per day for people with iron deficiency anemia and 60 milligrams for the prevention of the condition. These recommendations are relevant for adult patients, while for children this dosage is considered excessive.

For children under 3 years old, the dosage is determined at the rate of 3 mg / kg, children over three years old can be given no more than 60 milligrams, and adolescents no more than 120.

Other drugs may be taken to relieve side effects. For this, the doctor prescribes additional drugs depending on the patient’s condition.

If the stomach is irritated after taking iron supplements, experts also suggest taking them with meals. However, this partially reduces their effect, since they are most effective when taken on an empty stomach.

Why iron supplementation may not work

Iron supplements may not work in a few cases.

Incorrect diagnosis. The effectiveness of treatment depends not only on the replenishment of the norm of iron and hemoglobin, but also on the elimination of the root cause. If therapy does not work, then you may need to see your doctor again for re-diagnosis.

Undiagnosed pathologies. Because anemia has many causes, its source may not always be clear. For example, if a person has hidden blood loss from the gastrointestinal tract, which has not been diagnosed, then the therapy will not be effective.

Iron malabsorption. This can happen with intestinal pathologies, therefore, in such cases, for successful therapy, instead of oral drugs, the doctor prescribes parenteral iron preparations, which are administered intravenously.

Failure to follow recommendations. This is possible, for example, when a doctor has prescribed a remedy with a low iron content. Because of this, the drug has to be taken 5 or more times a day. This can be uncomfortable for the patient, so he fails to consistently adhere to the treatment regimen.

Another reason is the improvement in well-being, due to which the sick person ceases to systematically compensate for iron deficiency in the body. However, experts recommend taking the entire course of treatment in order to get a positive effect.

Is non-drug therapy effective for anemia

With a slight lack of iron, along with taking drugs, diet therapy is also prescribed. Patients are advised to include more meat, slaves and greens in the diet.

However, with a severe lack of iron and without taking medications, significant changes will not occur. Iron from products is absorbed to a lesser extent, so this will not be enough to normalize the condition.

Literature

1. Clinical guidelines “Iron deficiency anemia”. Developed by: National Society of Pediatric Hematologists, Oncologists // 2021
2. Dvoretsky L.I., Zaspa E.