The answer might be little complicated. The first issue is: Do you know if your iron is low? The fancy name for this is “iron deficiency anemia”. It’s estimated that iron deficiency causes half of anemia cases worldwide, and affects women much more than men. The World Health Organization lists low iron as the number one nutritional deficiency in the world (1). Proper iron levels are required for production of hemoglobin required for oxygen transport throughout our bodies, as well as for regulation of cell growth and differentiation - important functions to say the least.
How do I know if my iron is low?
You need a blood test. There are certain markers tested in your blood that will determine if your iron is low. The two most common are hemoglobin and ferritin. Ferritin is a protein in the body that binds to iron, with most iron being stored in the body tissues (liver, spleen, muscle, bone) and bound to ferritin. Levels of ferritin are lower in the blood but still used as a measure of iron levels in the body. One issue with measuring ferritin for iron levels in the blood is that the range is very broad. Depending on the lab, ranges can be 10-300 ug/L. So, if you come back with a reading of for example 17 ug/L, you are “in range” and technically not anemic, yet you are likely not at a range that is functional for you.
What are some common signs of low iron?
- Feeling tired and weak
- Decreased work and school performance
- Slow cognitive and social development during childhood
- Difficulty maintaining body temperature
- Decreased immune function, which increases susceptibility to infection
- Glossitis (an inflamed tongue)
- Heart palpitations
Who may need extra iron to prevent a deficiency? Here are some potential candidates:
- Pregnant women
- Preterm and low birth weight infants
- Older infants and toddlers
- Teenage girls
- Women of childbearing age, especially those with heavy menstrual losses
- People with renal failure, especially those undergoing routine dialysis
- People with gastrointestinal disorders who do not absorb iron normally (e.g. Celiac, Crohn’s, Colitis, IBS)
So how long should I take iron? and in what form?
The answer to the first question is, if your iron is low you take it until your level raises into normal range both via blood test analysis and how you are feeling functionally (i.e. until your symptoms have improved). If you are in one of the risk groups for low iron noted above, you may want to take it on an ongoing basis to ensure proper levels are maintained long term.
The answer to the second question is interesting. Absorption of iron can be a challenging issue. Dietary sources of iron from proteins (beef, poultry, seafood), green vegetables, beans, lentils and soy are the most readily absorbed, yet they may not be enough in many cases. This leaves us with the question of a supplemental form of iron. Common forms of iron supplementation include ferrous fumarate, sulphate and gluconate. The levels of elemental (active) iron in these forms range from 12-33% (2). Common prescribing practice could have patients looking to get their levels of elemental iron in the 30-60 mg range twice per day for adults, depending on deficiency. Unfortunately, common side effects for iron supplements include; nausea, constipation, diarrhea, dark stools and abdominal pain. All create issues with absorption and compliance.
AOR has taken a novel approach with its iron supplement formulation, Ortho Iron. This combination formula, utilizes a form of iron known as ferric pyrophosphate. This form has a reduced particle size that has been shown in research to increase its biological value (how well it is absorbed) to levels of 84-94% (3). In addition, it has also been shown to be gentler on the digestive tract than the other common forms. Combined with some other vitamins (C,B6, B12) and minerals(copper) to help absorption, this product also contains the iron carrying molecule lactoferrin. Animal studies have revealed that lactoferrin alone can lead to a 23% improvement in iron levels (4). Thus, a combination formula like Ortho Iron can be clinically therapeutic yet gentle on the digestive tract – a definite win/win.
Moving forward, it is important to recognize the signs of low iron, liaise with your health professional so that you can get tested and have a baseline for treatment, and then to find a form of iron that suits your needs both from a therapeutic and digestive perspective.
1. CDC Recommendations to prevent and control iron deficiency in the United States. Centers for Disease Control and Prevention. MMWR Recomm Rep 1998;47:1-29.
2. Kumpf VJ. Parenteral iron supplementation. Nutr Clin Pract 1996;11:139-46.
3. Fidler MC et al. A micronised, dispersible ferric pyrophosphate with high relative bioavailability in man. Br J Nutr. 2004 Jan;91(1):107-12.
4. Paesano R et al. Oral administration of lactoferrin increases hemoglobin and total serum iron in pregnant women. Biochem Cell Biol. 2006;84:377-380.
Institute of Medicine. Food and Nutrition Board. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium and Zinc. Washington, DC: National Academy Press, 2001.
Haas JD, Brownlie T 4th. Iron deficiency and reduced work capacity: a critical review of the research to determine a causal relationship. J Nutr 2001;131:691S-6S.