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helvella - Iron Document

This is a summary of what I have read up and found out about iron supplements over the past few years. I am not in any way medically trained. You are strongly encouraged to check every detail before making any decisions for yourself.

Products are mentioned by name but this is not intended as an endorsement or promotion. Other products might be as good or better. There are no affiliate links.

Iron Blood Tests

If you are unfamiliar with the various iron-related blood tests, you might find a reasonable and fairly short introduction here:

https://labtestsonline.org.uk/tests/iron-tests

There are equivalent sites in several other countries.

Types of Iron Supplement

There are six forms of oral iron supplement -

  • The simple, soluble substances like ferrous sulphate through ferrous fumarate, ferrous gluconate

  • Chelated iron such as ferrous bisglycinate

  • Various forms of haem iron (also spelled heme)

  • Ferritin

  • Iron in the form of pure iron or carbonyl iron

  • Ferric pyrophosphate 

  • Liposomal iron

Simple supplements, haem and ferritin are each absorbed by different mechanisms. These three mechanisms appear not to interfere with each other at ordinary dose levels.

Ferritin has usually been animal sourced however there are some plant source ferritin products:

https://www.florahealth.com/products/ferritin

https://uk.iherb.com/pr/flora-ferritin-plant-based-ferritin-iron-30-delayed-release-vegan-capsules/105249

In addition, there is are oral sprays. The best known in the UK is from Better You though other products are available.

https://betteryou.com/products/iron-10-oral-spray

There are also patches. There are variable reports from working well to not working at all. For that reason, there is no link. 

One product sometimes reported to work well contains:

Vitamin C (as Ascorbic Acid), Iron (from Certified Organic Curry [Murraya koenigii] extract)

Simple Iron Supplements

The simple substances do vary with the more complex molecules often regarded as being gentler and less constipating than the basic - that is, bisglycinate is usually preferred to sulphate.

Some people suffer side effects from the simple iron supplements which may include some or all of:

  • nausea (feeling sick)

  • sickness

  • abdominal (tummy) pain

  • heartburn

  • constipation (feeling unable to empty your bowels)

  • diarrhoea

  • black stools (faeces)

Some report good results from the branded liquid products such as Spatone and Floradix. If you need multiple sachets or doses and have to take them for a long time, these can be expensive.

https://www.spatone.com/

https://floradix.co.uk/our-products/

It is often suggested that you take vitamin C with these simple iron supplements to aid with absorption.

All these iron supplements are relatively poorly absorbed. That means the iron which has not been absorbed travels through the rest of our intestines. This excess iron can cause many side effects such as affecting the biome (bacteria, etc., in our gut).

Some research has suggested alternate day dosing can be helpful.

Haem and Ferritin

Haem is a protein which binds iron and enables the iron to perform numerous functions in our bodies. The most commonly discussed one being carrying oxygen in our blood. (There are several types of haem but although they have different functions they are broadly similar.)

Ferritin is a protein which binds iron and enables it to be stored and distributed safely. Often, the level of ferritin in our blood does indicate whether or not we have enough iron. However, ferritin usually rises when we have inflammation.

Haem and Ferritin Supplements

Haem iron and ferritin both wrap the iron up in more complex molecules and they have much less impact on the gut. Some people report doing very well on one or the other.

Some plants contain haem iron but usually at very low levels.

Those who cannot tolerate the simple supplements but need iron, should consider at least trying haem and/or ferritin supplements.

A snippet about why ferritin and haem might be particularly important:

Absorption of iron from ferritin is independent of heme iron and ferrous salts in women and rat intestinal segments.

Ferritin iron is absorbed by a different mechanism than iron salts/chelates or heme iron. Recognition of a second, non-heme iron absorption process, ferritin endocytosis, emphasizes the need for more mechanistic studies on ferritin iron absorption and highlights the potential of ferritin present in foods such as legumes to contribute to solutions for global iron deficiency.

https://www.ncbi.nlm.nih.gov/pubmed/22259191

Haem and ferritin supplements will be more expensive than the cheapest supplements but compared to some supplements, they are not particularly expensive.

Don't forget that black pudding and chicken livers are still available as a good dietary sources! As well as many other meat products.

Supplement Sources:

The simple supplements can be obtained from numerous sources such as pharmacies, and on-line.

Haem

The products that will be found by this search vary in time and could, at times, list no heme supplements.

https://uk.iherb.com/search?kw=heme

One threearrows capsule contains around 20 milligrams of elemental iron.

https://threearrowsnutra.com/en-uk/pages/simplyheme

Ferritin

The products that will be found by this search vary in time and could, at times, list no ferritin supplements.

https://uk.iherb.com/search?kw=ferritin

Dosing

Iron supplements usually state their elemental iron content. If you are taking an iron supplement, it is the iron content that is important. However, it is possible that a greater effect can be had if your tolerance and absorption are better, even if on a lower dose (in terms of elemental iron).

Recent research has suggested that some might do better taking their iron supplement on alternate days.

Iron supplement and dose

Approximate elemental iron

200 mg Ferrous sulphate

65 mg elemental iron

300 mg Ferrous gluconate

35 mg elemental iron

210 mg Ferrous fumarate

65-70 mg elemental iron

75 mg Ferrous bisglycinate

15 mg elemental iron

How long to treat?

One of the recurring stories is of someone diagnosed iron-deficient. They take their iron supplementation until test results show they have adequate iron. Then they stop.

A few months later, they are suffering from iron-deficiency again.

If you are not absorbing adequate iron from your usual diet, then this cycle of supplementing for a while then becoming deficient again is exactly what would be expected. If that is the case, then instead of stopping the supplementation completely, consider continuing on a lower dose.

There are several reasons for continually losing iron. If this is happening, you must get properly assessed.

Testing

When supplementing with iron it is important to have regular tests. Although iron levels usually change quite slowly, excess iron is very definitely something to avoid. The precise tests used may well vary from one GP surgery or area to another.

Storing iron supplements

Very high doses of iron can be fatal, particularly if taken by children, so always keep iron supplements out of the reach of children.

https://www.nhs.uk/conditions/vitamins-and-minerals/iron/#what-happens-if-i-take-too-much-iron


BNF: Oral Iron Supplements

Brief summary of the products listed in the British National Formulary (not all variations, not all brands) and NHS prices. Some products cannot be prescribed on the NHS, or only in specific circumstances. Data looked up 25/04/2015

Ferrous sulphate with ascorbic acid (Ferrograd)

https://bnf.nice.org.uk/drug/ferrous-sulfate-with-ascorbic-acid.html 

Electronic Medicines Compendium

Links to Summary of Prescribing Characteristics and Patient Information Leaflets for each of the main types of iron supplement:

Ferrous gluconate

https://www.medicines.org.uk/emc/search?q=ferrous+gluconate

Other References:

NICE

Clinical Knowledge Summary > Anaemia - iron deficiency

Last revised in September 2023

Serum ferritin level is the biochemical test that most reliably correlates with relative total body iron stores. In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency.

https://cks.nice.org.uk/topics/anaemia-iron-deficiency/

NHS

https://www.nhs.uk/conditions/iron-deficiency-anaemia/

USA Office of Dietary Supplements (ODS)

These links are produced for the USA but contain much that is of potential use wherever you are.

If you wish to link to this page on HealthUnlocked, copy the entire dark red text below and paste into a post or reply.

[i][b]helvella - Iron Document[/b] 

This is a summary of what I have read up and found out about iron supplements over the past few years. I am not in any way medically trained. You are strongly encouraged to check every detail before making any decisions for yourself. 

Last updated 02/04/2024[/i]

https://helvella.blogspot.com/p/helvella-iron-document.html

If you find anything incorrect, misleading, typos, links that don’t work, etc., please let me know. Go to my profile and use the contact details there:

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