Iron: how to take it correctly and not cause harm

Iron: the most important and most dangerous mineral

Iron is a double-edged sword. Deficiency = fatigue, hair loss, weak immunity, anemia. Excess = oxidative stress, liver, heart, pancreas damage. Iron is the only mineral that the body cannot actively remove (only through blood loss and desquamation of cells).

This is why never take iron without testing. It is not vitamin C that will be excreted in urine. Excess iron accumulates and generates free radicals.

When you need iron: tests

One test decides everything - ferritin. This is a protein that stores iron reserves.

• Ferritin less than 15 ng/ml - depletion of reserves, anemia is possible
• Ferritin 15-30 ng/ml - hidden deficiency (low iron, but no anemia yet)
• Ferritin 30-40 ng/ml—borderline (there may be symptoms)
• Ferritin 40-60 ng/ml - optimal
• Ferritin 70+ ng/ml - for hair (trichologists recommend)
• Ferritin above 200 ng/ml - possible excess, examination

Important: Ferritin is an acute phase protein. It increases with inflammation, infection, and liver disease. If ferritin is high, but you feel symptoms of deficiency, also testtransferrin, TJSS and hemoglobin.

Who is at risk for deficiency

• Women with heavy periodsis the #1 cause of iron deficiency
• Pregnant - the need increases by 2-3 times
• Vegetarians/vegans - plant (non-heme) iron is absorbed 5-10 times worse
• Blood donors
• Athletes - destruction of red blood cells during shock loads
• People with gastrointestinal diseases - malabsorption

Forms of iron: detailed analysis

Iron bisglycinate - the best form

Chelated form: iron is bound to the amino acid glycine. Advantages:

• Does not cause constipation - the main problem of other forms is solved
• Does not cause nausea
• High bioavailability - absorbed through amino acid transporters, does not compete with other minerals
• Does not turn stool black (or significantly less)
• Brands: Thorne, Solgar Gentle Iron, NOW Iron Bisglycinate

Ferrous sulfate - obsolete standard

The most common form in pharmacies (Sorbifer, Tardiferon). Cheap, but terribly portable:

• Constipation (in 30-50% of patients)
• Nausea and vomiting
• Black chair
• Stomach pain

Result: up to 50% of people quit taking it due to side effects without making up for the deficiency. If you have been prescribed sulfate, ask for bisglycinate.

Revolution: taking it EVERY other day is more effective than taking it daily

It's counterintuitive, but it's proven. Study (Stoffel et al., Lancet Haematology, 2017): taking iron every other day gives better absorptionthan daily.

Mechanism: hepcidin. This is a liver hormone that controls iron absorption. After taking a dose of iron, hepcidin levelsincrease for 24 hoursblocking further absorption. If you take iron every day, the second dose is absorbed 35-45% worse.

• Taking every other day: hepcidin has time to decrease → absorption is maximum
• Taken every day: hepcidin is increased → the second dose is poorly absorbed → more side effects in the intestines

Practice: Monday, Wednesday, Friday - better than every day.

How to take correctly

• On an empty stomach - 1 hour before meals or 2 hours after. Food (especially calcium, tea, coffee) reduces absorption by 50-90%
• With vitamin C (200-500 mg) - increases absorption by 2-3 times. You can drink it with orange juice
• Every other day - better absorption (see hepcidin above)
• In the morning - hepcidin levels are lowest in the morning on an empty stomach

What BLOCKS absorption (do not combine!)

• Calcium is the main antagonist (spread over 2+ hours)
• Zinc - competes for transporters
• Coffee and tea - tannins bind iron (spread for 1-2 hours)
• Dairy products - casein blocks
• Antacids and PPIs (omeprazole) - reduce acidity → worse absorption
• Phytates - in whole grains, legumes (vitamin C partially neutralizes)

Dosages

• Hidden deficiency (ferritin 15-30):25 mg bisglycinate every other day, 2-3 months
• Severe deficiency (ferritin less than 15):50 mg every other day, 3-4 months
• Anemia (low hemoglobin):As prescribed by a doctor, possibly daily
• Control:Retest ferritin after 3 months

When NOT to take iron

• No tests - never, this is not a vitamin
• Hemochromatosis - genetic accumulation of iron (1 in 200 people!). Taking iron can be deadly
• Ferritin above 100 - excess, needs examination
• Thalassemia - chronic iron overload
• During an infection - iron “feeds” the bacteria. The body specifically hides iron during infection (therefore ferritin increases during inflammation)

Iron from food

Two types of dietary iron:

Heme (from animal products) - 15-35% absorbed

• Beef liver - 6.5 mg per 100 g (champion)
• Red meat - 2.5-3.5 mg per 100 g
• Oysters - 7 mg per 100 g

Non-heme (from plants) - 2-5% absorbed

• Spinach - 3.6 mg per 100 g (but oxalates block up to 95%)
• Lentil - 3.3 mg per 100 g
• Tofu - 5.4 mg per 100 g

For vegetarians: Combine plant sources with vitamin C and avoid tea/coffee within 1 hour of food.

Resume from Novird

• Step 1: Get your ferritin test - it all starts with a test
• Step 2:If deficiency - iron bisglycinate 25-50 mg
• Step 3:Every other day, on an empty stomach, with vitamin C
• Step 4:Control after 3 months

Golden Rule: Iron is the only supplement that requires testing BEFORE taking it. Don't guess by the symptoms. Ferritin costs inexpensive and can prevent both the consequences of deficiency and the toxicity of excess.