Iron supplements can effectively address deficiencies in certain people, but carefully selecting the right type and adhering to best practices is important to maximize the benefits and minimize risks.

Iron Supplements; Who Needs Them?

To supplement, or not to supplement, that is the question.

Current evidence suggests that the populations who benefit most from iron supplementation are those who have iron deficiency (ID) or iron deficiency anemia (IDA), and those who are the most at risk for developing ID and IDA. Iron supplementation should be guided by a physician because there are potential risks associated with iron overdose in those who do not actually need supplementation, and interactions with other drugs to keep in mind.

Populations who benefit most from iron supplementation include:

• Patients with ID and IDA
• Pregnant people
• Frequent blood donors
• Infants and young children
• Individuals who menstruate (especially low income and minority individuals)
• Individuals who have recently lost a lot of blood or undergone surgery
• Vegan or vegetarians
• Endurance athletes

Additionally, those with certain chronic diseases (such as Crohn’s disease, celiac, cancer, kidney failure, or heart failure) may be good candidates for iron supplements due to their conditions impacting iron absorption, which decreases the likelihood they will meet the daily requirements through diet alone (3,4).

Benefits of Iron Supplements

• Reverse low iron levels and treat IDA
• Faster results than dietary intervention
• Increased energy levels 
• Improved physical and psychological performance (due to sufficient iron)
• Numerous options for supplementation including oral and IV

Risks of Iron Supplements

• Common side effects include GI discomfort, nausea, constipation or diarrhea, and metallic taste
• Risks associated with iron overload (ie. cell damage or oxidative stress)
• Decreased absorption of certain medications (ie. Levodopa, Penicillin, Levothyroxine or tetracyclines)

Choosing the Right Iron Supplement

Due to the variety of options for iron supplements, selecting the right one for you can be overwhelming. Some key considerations are:

Form of Iron

Iron supplements come in two main forms: ferrous and ferric. Ferrous iron (ferrous sulfate, ferrous gluconate, ferrous fumarate) is more easily absorbed by the body and is often recommended over ferric iron. They can be purchased in tablet or liquid form.

Ferrous bisglycinate is a newer iron supplement known as an iron chelate that has been shown to be more bioavailable (meaning more iron will be absorbed) and decrease the occurrence of GI discomfort compared to other iron supplements.

Dosage

The recommended dose varies depending on your age and the level of iron deficiency. Generally, the Tolerable Upper Intake Level (UL) is 45 mg/d in adults, as doses higher than this can cause gastrointestinal side effects. It’s important to follow your doctor’s recommendations to avoid risks and ensure the supplement's effectiveness.

Oral vs. IV

Oral iron supplementation is more cost-effective and accessible for the general public. IV supplementation is more potent, however is usually reserved for more severe or emergency cases, and requires visiting a physician’s office or hospital.

Best Practices for Iron Supplementation

For optimal absorption and effectiveness, follow these tips:

1. Take Iron on an Empty Stomach: Iron is best absorbed when taken on an empty stomach, at minimum 30 minutes before a meal and around 2 hours before other medications. However, if you experience discomfort or nausea, it can be taken with a small amount of food or orange juice.
2. Avoid Certain Foods and Drinks: Calcium, dairy products, coffee, tea, antacids, and high-fiber foods can interfere with iron absorption. Avoid these around the time you take your supplement.
3. Pair with Vitamin C: Vitamin C enhances iron absorption. Some evidence has shown taking your supplement with a glass of orange juice or a vitamin C supplement can improve absorption.
4. Managing Side Effects: Start slow with a lower dose and gradually increase to the recommended daily intake, especially if you are new to taking iron supplements. 

Monitoring Your Progress

Summarizing Supplements 

Iron supplementation can be a key component in managing and correcting iron deficiency. The goals of a treatment plan for ID and IDA typically aim to increase the intake of bioavailable iron, increase absorption of iron, and reduce the loss of iron (in certain conditions). Iron supplementation can help to address the first two goals of treatment, and by following the best practices listed above, you can effectively improve your iron levels and overall health.

As a reminder, always consult with your healthcare provider to tailor a plan specific to your needs and monitor your progress regularly.

Disclaimer*

The reference ranges and insights presented in Chromacare Wellness Hub articles are meant to improve understanding and provide context, however you should consult with your physician for a formal interpretation of your own results. None of the information within these Chromacare blog posts are meant to be or should be taken as personal medical advice. 

References and Further Reading

Scientific Studies and Articles:

1. Cogswell, M. E., Kettel-Khan, L., & Ramakrishnan, U. (2003). Iron supplement use among women in the United States: Science, policy and practice. The Journal of Nutrition, 133(6), 1974S-1977S. https://doi.org/10.1093/jn/133.6.1974s
   
   
2. Puga, A. M., Samaniego-Vaesken, M. de, Montero-Bravo, A., Ruperto, M., Partearroyo, T., & Varela-Moreiras, G. (2022). Iron supplementation at the crossroads of nutrition and gut microbiota: The state of the art. Nutrients, 14(9). https://doi.org/10.3390/nu14091926
   
   
3. Vaucher, P., Druais, P.-L., Waldvogel, S., & Favrat, B. (2012). Effect of iron supplementation on fatigue in nonanemic menstruating women with low ferritin: A randomized controlled trial. Canadian Medical Association Journal, 184(11), 1247–1254. https://doi.org/10.1503/cmaj.110950
   
   
4. Karregat, J., Sweegers, M. G., Quee, F. A., Weekamp, H. H., Swinkels, D. W., Novotny, V. M., Zaaijer, H. L., & van den Hurk, K. (2022). Ferritin-guided iron supplementation in whole blood donors: Optimal dosage, donor response, return and efficacy (forte)—a randomised controlled trial protocol. BMJ Open, 12(3). https://doi.org/10.1136/bmjopen-2021-056316
   
   
5. Mora, J. O. (2002). Iron supplementation: Overcoming technical and practical barriers. The Journal of Nutrition, 132(4), 853S-855S. https://doi.org/10.1093/jn/132.4.853s
   
   
6. Ministry of Health. (2023, November 2). Iron deficiency – diagnosis and management. Province of British Columbia. https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/bc-guidelines/iron-deficiency
   
   

Additional Educational Resources:

1. Petre, A. (2020, August 24). Iron supplements: Who should take them?. Healthline. https://www.healthline.com/nutrition/iron-supplements-who-should-take
   
2. Harvard T.H. Chan School of Public Health. (2023, March 9). Iron. The Nutrition Source . https://nutritionsource.hsph.harvard.edu/iron/
   
3. Nguyen, M., & Tadi, P. (2023, July 3). Iron Supplementation. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK557376/
4. Iron - Fact sheet for health professionals. Office of Dietary Supplements. https://ods.od.nih.gov/factsheets/Iron-HealthProfessional/. Accessed June 12, 2024.