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Iron Deficiency – the benefits of intermittent iron dosing and certain forms of iron

Iron deficiency effects almost 1/3 of non-pregnant women in the world. Some symptoms include fatigue, pale skin, shortness of breath, heavy periods, cold hands and feet, spoon shaped nails and a sore tongue. This article explains why we become iron deficient, why intermittent dosing is important, food sources and considerations and why some supplements are better than others

Why do we become iron deficient?

There are 4 main reasons for low iron levels:

  1. Insufficient intake – e.g. vegetarians, picky eaters, elderly
  2. Increased demands – e.g. pregnancy, breastfeeding, athletes, children
  3. Poor absorption – e.g. coeliac disease, Inflammatory bowel disease, some gut infections
  4. Bleeding – e.g. heavy periods, bleeding from the bowel

How much iron should I aim for each day?

Table 1: Recommended Dietary Allowances (RDAs) for Iron (6)
Age Male Female Pregnancy Lactation
Birth to 6 months 0.27 mg* 0.27 mg*
7–12 months 11 mg 11 mg
1–3 years 7 mg 7 mg
4–8 years 10 mg 10 mg
9–13 years 8 mg 8 mg
14–18 years 11 mg 15 mg 27 mg 10 mg
19–50 years 8 mg 18 mg 27 mg 9 mg
51+ years 8 mg 8 mg

*Adequate intake

What can I do about my diet?

There are two types of iron that come from our diet, haem iron and non-heam iron. Haem Iron is found in animal derived foods and non-haem iron is found in plant foods. The body absorbs haem iron much more easily than non-haem iron. A diet relying heavily on non-heam iron (e.g. vegetarian diets) as the main source of iron should be combined with foods or drinks that are high in vitamin C to help with iron absorption.  Examples of foods that are high in Vitamin C are strawberries, Brussels sprouts, tomatoes, capsicum, cabbage, citrus fruit or any brightly coloured fruits and vegetables. So for example, lentil soup or salad greens in a meal drizzled with fresh lemon juice would improve the amount of iron absorbed.

Iron-rich foods and amount of iron per serve:

Haem Sources:

  • Roast beef, steak (75g) 5mg
  • Lamb chops – 2 (75g) 1mg
  • Sardines – 4 1mg
  • Chicken – 2 slices (75g) 6mg
  • Fish- 1 piece (120g) 6mg

Non-Haem Sources:

  • Soy beans- ½ cup 6mg
  • Baked beans- ½ cup 0mg
  • Almonds- ¼ cup 0mg
  • Wholegrain bread – 2 slices 9mg
  • Prunes -5 or 6 8mg
  • Broccoli- 1 stalk 4mg
  • Leafy Vegetables- 1 cup 4mg

Certain foods can inhibit iron absorption; these include coffee and tea, calcium-rich dairy foods and soy foods. If you have concerns with  low iron stores,  it is better to consume these foods separate from iron-rich foods.

Are all iron supplements the same?

No, different forms are absorbed better than others, and some can cause constipation, nausea, stomach cramps and black tarry stools. The absorption of Iron Sulphate is under 27%, while the biglycinate forms around 90%. The practitioner-only supplements we stock at All Degrees of Health are highly absorbed, with minimal (if any) side-effects

Why intermittent supplementation?

A large study published this year (1) has shown that intermittent iron supplementation is as effective as daily supplementation, with less side-effects.

A protein called hepcidin is responsible for regulating iron absorption. In times of iron availability, levels of hepcidin are higher to reduce the amount taken into red blood cells (4). The classical schedule of daily doses of iron is associated with a rapid response in hepcidin production that limits the absorption of a second dose given too early. By contrast, an alternate day regimen allows enough time for hepcidin return to baseline, hence maximising fractional iron absorption (5) Doses greater than 45mg  can cause gastrointestinal upset, inflammation, oxidative stress and changes in our gut microbiome (the good bacteria in our digestive system).

The concluding recommendation is to prescribe a  dose of 20-25mg of a well absorbed biglycinate form on alternate days to maximise iron absorption.

If you are low in iron you are welcome to discuss your individual needs with one of our Naturopaths to ensure you not only address the immediate deficiency effectively, but look at the underlying reason why you became deficient in the first place.

Call reception on 9331 0951 or book online https://all-degrees-of-health.cliniko.com/bookings#service

References:

  1. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009218.pub3/abstract
  2. O’Neil-Cutting MA. Blocking of Iron Absorption by a Preliminary Oral Dose of Iron. Arch Intern Med. 2011;147(3):489. doi:10.1001/archinte.1987.00370030093018.
  3. Shinoda S, Arita A. Regulatory mechanisms of intestinal iron absorption: Iron-deficient mucosal cells respond immediately to dietary iron concentration. J Phys Fit Sport Med. 2014;3(4):399-407. doi:10.7600/jpfsm.3.399.
  4. Nemeth E, Ganz T. The role of hepcidin in iron metabolism. Acta Haematol. 2009;122(2-3):78-86. doi:10.1159/000243791.
  5. D. G, S. U, F. B, G. M, A. C. Modern iron replacement therapy: clinical and pathophysiological insights. Int J Hematol. 2018;107(1):16-30. doi:10.1007/s12185-017-2373-3.
  6. 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 : a Report of the Panel on Micronutrientsexternal link disclaimer. Washington, DC: National Academy Press; 2001.