Iron supplements for deficiency, treatment of anemia and supplementation with iron rich foods, benefit and side effects
September 29 2016 by
Ray Sahelian, M.D.


Your body needs dietary iron to produce hemoglobin, which allows healthy red blood cells to carry oxygen to the body's tissues. A shortage of healthy red blood cells causes a condition called anemia, and lack of dietary iron is a prime cause. The element iron is needed for production of hemoglobin, and oxygenation of red blood cells. This page will discuss iron deficiency anemia and iron rich food sources. The amount of iron within the cell is carefully regulated in order to provide an adequate level of the micronutrient while preventing its accumulation to toxic levels. Iron excess, either due to excess iron supplement use or accumulation in the body, is believed to generate oxidative stress, due to high concentration of oxygen radical intermediates. The amount of iron needed is higher in women of childbearing age.


Benefit of Iron mineral
This mineral is required in numerous essential proteins, such as the heme-containing proteins, electron transport chain and microsomal electron transport proteins, and iron-sulfur proteins and enzymes such as ribonucleotide reductase, prolyl hydroxylase phenylalanine hydroxylase, tyrosine hydroxylase and aconitase. The essentiality of iron resides in its capacity to participate in one-electron exchange reactions. However, the same property that makes iron essential also generates free radicals that can be seriously deleterious to cells.


The amount of iron within the cell is carefully regulated in order to provide an adequate level of the micronutrient while preventing its accumulation to toxic levels. Iron excess is believed to generate oxidative stress


Absorption from different forms and preparations, liquid, pill
Scien Pharm. 2013. Comparison study of oral iron preparations using a human intestinal model. The standard treatment involves supplementation with solid or liquid iron supplement preparations, usually based on a ferrous salt such as ferrous sulphate, ferrous fumarate, or ferrous gluconate. In the present study, we compared iron uptake and absorption from various solid and liquid iron supplement preparations currently available in the United Kingdom using the well-characterised human epithelial adenocarcinoma cell line Caco-2. Intracellular ferritin protein formation by the Caco-2 cell was considered an indicator of cellular iron uptake and absorption. We investigated the effects of formulation ingredients at a defined pH on iron uptake and absorption, and designed a novel two-stage dissolution-absorption protocol that mimicked physiological conditions. Our experiments revealed wide variations in the rate of dissolution between the various solid iron preparations. Conventional-release ferrous iron tablets dissolved rapidly (48 ± 4 mins to 64 ± 4 mins), whereas modified-released tablets and capsules took significantly longer to undergo complete dissolution (274 ± 8 to 256 ± 8 mins). Among the solid iron preparations, ferrous sulphate conventional-release tablets demonstrated the highest iron absorption, whereas modified-release ferrous preparations demonstrated uniformly low iron absorption, as compared to the control


Recommendations for Iron Intake:
According to USDA recommendations, the allowances of dietary iron intake are as follows:

Iron allowance for Males and females
Younger than 6 months: 6 mg
6 months to 1 year: 10 mg
1 to10 years: 10 mg

11 to 18 years: 12 mg
19 and older: 10 mg

11 to 50: 15 mg
51 and older: 10 mg
Pregnant: 30 mg
Lactating: 15 mg

Any male or postmenopausal female with iron deficiency anemia should be evaluated by a health care provider to rule out whether the problem may be due to a more serious gastrointestinal cause such as ulcers, polyps, or tumors.


Is there any reason why a male should not take iron, say in a multi-vitamin supplement at an RDA recommended level?  Or is it best for males to avoid iron supplementation altogether? 
   Since men do not lose iron like women do during periods, there is no need to supplement with this mineral unless blood studies show iron deficiency anemia. High doses could act as a pro-oxidant and be harmful in those whose bodies have the tendency to store it such as in a condition called hemochromatosis which affects a small minority of the population.

Source of Iron- food rich in this mineral
Foods high in iron include ground beef, fish, spinach, lentils, eggs, baked potato with skin, sunflower seeds, brewer's yeast, and cashews. In more detail, meat, including liver, lean beef, and pork loin; seafood like oysters, clams, shrimp, tuna, and sardines; fruits, including raisins, figs, dried apricots, and prunes; vegetables like spinach, greens, broccoli, lima beans, and avocado; and beans, peas, and lentils. Iron rich foods should be consumed daily by those who have iron deficiency anemia. Some foods high in iron may not be healthy to eat daily, such as beef, but many vegetables and beans and some fruits have a good amount of this mineral. If you are vegetarian or vegan, consider taking a product that includes several vitamins and minerals, including iron, that may be deficient in the vegetarian diet.


Iron and Diabetes
Too much heme iron -- the form of the mineral found in meat -- may contribute to diabetes through long-term damage to body cells. Harvard researchers found that among 85,000 women followed for 20 years, the risk of developing type 2 diabetes climbed in tandem with heme iron consumption. Women who ate the most heme iron had a 28 percent higher risk than those with the lowest intakes, even with factors like body weight, exercise and overall diet considered. Iron from plant foods and supplements, which is not as readily absorbed as heme iron, was unrelated to diabetes risk. Though it's not fully clear why too much iron might contribute to type 2 diabetes, the mineral is involved in many body processes that generate reactive oxygen species.


Iron deficiency anemia
This condition is a decrease in the number of red blood cells caused by a lack of sufficient iron. It is the most common form of anemia. Iron is an essential component of hemoglobin, the oxygen-carrying protein in blood. Iron is normally obtained in the diet and by the recycling of iron from old red blood cells. Babies are born with about 500 mg of iron in their bodies. By the time they reach adulthood they need to have accumulated about 5000 mg. Children need to absorb an average of 1mg per day of iron to keep up with the needs of their growing bodies. Since children only absorb about 10% of the iron they eat, most children need to ingest 8-10mg of iron per day. An iron deficient diet is a common cause of iron deficiency. Drinking too much cow's milk is a classic cause of iron deficiency in young children, because cow’s milk does not contain iron and inhibits absorption of iron. Iron deficiency may also result from blood loss in stool from a problem in the intestines. A common time for iron deficiency is between 9 and 24 months of age. All babies should have a screening test for iron deficiency at this age. The adolescent growth spurt is another high-risk period.

     Iron deficiency is one of  the most common nutritional deficiencies in Western countries, and the world as a whole. Iron deficiency causes anemia, but this is not the total picture. Many reproductive age women and teenage girls has biochemical iron deficiency, but less than a quarter of these women are anemic. Anemia only occurs towards the end of a process of falling iron stores, which in some cases may have been in progress for many years. When Iron deficiency anemia occurs, that means there is little iron left in the bone marrow. Hemoglobin production falls to the point where hemoglobin concentration is below the reference range.


The U.S. National Institutes of Health says these people are at increased risk of iron deficiency:
Pregnant women.
Preterm or low birth-weight babies.
Teen girls.
Women of childbearing age, and those with heavy menstruation.
People in renal failure who require dialysis.
People who do not properly absorb iron from foods or supplements.


Iron supplement and IQ
Children whose mothers take iron supplements while pregnant don't have higher IQs than those whose mothers didn't take iron pills. Animal studies have shown that iron deficiency in pregnancy -- usually more severe than the anemia that may strike pregnant women -- can cause brain damage in offspring. Doctors in many industrialized nations routinely advise pregnant women to take iron supplements, but the evidence for their benefits is not clear. However, there is no strong evidence at this time that pregnant women should take iron supplements. American Journal of Clinical Nutrition, May 2006.


Heme and Non Heme Iron
Iron is an essential trace element in human nutrition and its deficiency is a world nutritional problem. Due to the high prevalence of anemia in developing and industrialized countries, it is necessary to maintain a suitable iron intake through diet in order to achieve an appropriate status of this element in the body. Regarding to the two forms of iron present in foods, heme iron has greater availability than non-heme iron. Beside this, non-heme iron availability is conditioned by several dietary factors, such as classic factors (meat, ascorbic acid, fibre, phytic acid, polyphenols) and new factors (caseinophosphopeptides and fructo-oligosaccharides with prebiotic characteristics).


Iron deficiency as cause of chronic cough in some women
Tests on women with chronic cough and iron deficiency showed that a simple iron supplement often cleared up the cough.  Dr. Caterina Bucca of the University of Turin in Italy believes cough is much more frequent in women and iron deficiency is very frequent in women due to pregnancy and menses. Dr. Caterina Bucca evaluated 16 women with chronic cough who were found to have normal lung function. All had iron deficiencies. And they all had signs of swelling in the back of the mouth and red, inflamed mucous membranes. Their vocal cords were also very sensitive, making them cough and choke easily, such as after vigorous laughing. Iron supplements were give to the women to treat their iron deficiency. After iron supplementation, coughing and signs of inflammation in the mouth and vocal cords were improved or completely resolved.


Removing excess iron stores, overload
If one had iron overload and wanted to detox the body what would he or she normally do? I heard that bloodletting / donating or chelating drugs are used, and IP-6, what are your thoughts?
   I have not studied this topic in great detail but my impression is that donating blood would be the best way to reduce iron overload and it would be of help to someone who needs it.  In 2011 we did a search for iron overload ip6 in Medline and could not find any published studies.
A boxed warning highlighting serious safety concerns, including reported deaths, with the use of Novartis AG's Exjade drug to remove excess iron from the blood, has been added to the medicine's label. In a message on its website, the FDA said the prescribing information for Exjade would now carry a highlighted warning, often called a black box, noting that the drug may cause renal impairment, including kidney failure; hepatic impairment, including liver failure; and gastrointestinal hemorrhage. Exjade is approved to treat chronic iron overload due to blood transfusions. The drug works by binding to excess iron and removing it from certain cells in the body, such as liver cells, before being excreted. 2010.

I read on a web site that one needs to check their blood iron level before taking chlorella.
   It makes no sense to me that one has to check their iron level before taking chlorella. It's like saying one has to check their iron level before eating a 12 ounce steak. There are several milligrams of iron in a few ounces of meat. Three capsules of chlorella will have less than one mg of iron. Unless you plan to take half a bottle of chlorella capsules a day for months and years, forget about the silly advice of checking iron levels.

I eat iron rich foods, but my iron level is still low. I have heard a report about hepcidin, have you heard about it, is it an iron supplement?
   See hepcidin for more information.

Now Foods, Iron, 18 mg, 120 Veggie Caps

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Supplement Facts
Serving Size: 1 Veg Capsule
  Amount Per Serving % Daily Value
Iron (from Ferrochel Iron Bisglycinate) 18 mg 100%

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