:Iron:

80% of iron is in the red blood cells as the metal cofactor in hemoglobin, the oxygen-carrying protein. Iron-deficiency causes fatigue because of hypoxia. Iron is similarly catalytic in myoglobin, helping muscles hold oxygen. Without enough iron, ATP is not produced efficiently, causing fatigue even if hemoglobin levels are normal (i.e. without overt anemia).

Iron is part of the antioxidant enzyme catalase, yet free iron causes oxidative damage.

Sources: The most absorbable form of iron, called “heme” iron, is found in oysters, meat, poultry and fish. Non-heme iron is also found in these foods, as well as in dried fruit, molasses, leafy green vegetables, wine and iron supplements. Acidic foods (such as tomato sauce) cooked in an iron pan can also be a source of dietary iron.

Well documented uses:

• Athletic performance (for treatment of iron-deficiency only)
• Depression (for deficiency)
• Iron-deficiency anemia
• Menorrhagia (heavy menstruation) (for treatment of iron- deficiency only)

Additional science-based uses:

• Canker sores
• Celiac disease (for treatment of iron-deficiency only)
• Pre- and post-surgery health (if deficient or for major surgery)
• Restless legs syndrome (only if iron-deficiency)

Traditional clinical uses:

• Alzheimer’s disease (in combination with coenzyme Q10 and vitamin B6 )
• Dermatitis Herpetiformis
• HIV support
• Infertility (female) (for treatment of iron-deficiency only)

Deficiency: Vegetarians eat less iron than non-vegetarians, and the iron they eat is somewhat less absorbable. As a result, vegetarians are more likely to have reduced iron stores. 1 However, iron deficiency is not usually caused by a lack of iron in the diet alone. An underlying cause, such as iron loss in menstrual blood, often exists.

Pregnant women, marathon runners, people who take aspirin, and those who have parasitic infections, hemorrhoids, ulcers, ulcerative colitis, Crohn’s disease, gastrointestinal cancers, or other conditions that cause blood loss or malabsorption are likely to become deficient.

Infants living in inner city areas may be at increased risk of iron-deficiency anemia 2 and suffer more often from developmental delays as a result. 3 4 Supplementation of infant formula with iron up to 18 months of age in inner city infants has been shown to prevent iron-deficiency anemia and to reduce the decline in mental development seen in such infants in some, 5 but not all, 6 studies.

Breath-holding spells are a common problem affecting about 27% of healthy children. 7These spells have been associated with iron-deficiency anemia, 8and several studies have reported improvement of breath-holding spells with iron supplementation. 9 10 11 12

People who fit into one of these groups, even pregnant women, shouldn’t automatically take iron supplements. Fatigue, the first symptom of iron deficiency, can be caused by many other things. A doctor should assess the need for iron supplements, since taking iron when it isn’t needed does no good and may do some harm.

Which forms of supplemental iron are best? All iron supplements are not the same. Ferrous iron (e.g. ferrous sulfate) is much better absorbed than ferric iron (e.g. ferric citrate). 13 14 The most common form of iron supplement is ferrous sulfate, but it is known to produce intestinal side effects (such as constipation, nausea and bloating) in many users. 15 Some forms of ferrous sulfate are enteric-coated to delay tablet dissolving and prevent some side effects, 16 but enteric-coated iron may not absorb as well as iron from standard supplements. 17 18 19 Other forms of iron supplements, such as ferrous fumarate, 20 21 ferrous gluconate, 22 heme iron concentrate, 23 24 25 26 and iron glycine amino acid chelate 27 28 are well-absorbed and less likely to cause intestinal side effects.

Dosage: If a doctor diagnoses iron deficiency , iron supplementation is essential. To treat iron deficiency, a common recommended amount for an adult is 100 mg per day; that amount is usually reduced after the deficiency is corrected. When iron deficiency is diagnosed, the doctor must also determine the cause. Usually it’s not serious (such as normal menstrual blood loss or blood donation). Occasionally, however, iron deficiency signals ulcers or even colon cancer.

Some premenopausal women become marginally iron deficient unless they supplement with iron. However, the 18 mg of iron present in many multivitamin-mineral supplements is often adequate to prevent deficiency. A doctor should be consulted to determine the amount of iron that is needed.

Are there any side effects or interactions? Iron (ferrous sulfate) is the leading cause of accidental poisonings in children. 29 30 31 The incidence of iron poisonings in young children increased dramatically in 1986. Many of these children obtained the iron from a child-resistant container opened by themselves or another child, or left open or improperly closed by an adult. 32 Deaths in children have occurred from ingesting as little as 200 mg to as much as 5.85 grams of iron. 33 Keep iron-containing supplements out of a child’s reach.

Hemochromatosis, hemosiderosis, polycythemia, and iron-loading anemias (such as thalassemia and sickle cell anemia ) are conditions involving excessive storage of iron. Supplementing iron can be quite dangerous for people with these diseases.

Supplemental amounts required to overcome iron deficiency can cause constipation . Sometimes switching the form of iron (see “Which forms of supplemental iron are best?” above), getting more exercise, or treating the constipation with fiber and fluids is helpful, though fiber can reduce iron absorption (see below). Sometimes the amount of iron must be reduced if constipation occurs.

Some researchers have linked excess iron levels to diabetes, 34 cancer ,35 increased risk of infection ,36 systemic lupus erythematosus (SLE), 37 exacerbation of rheumatoid arthritis ,38 and Huntington’s disease. 39 The greatest concern has surrounded the possibility that excess storage of iron in the body increases the risk of heart disease .40 41 42 Two analyses of published studies came to different conclusions about whether iron could increase heart disease risk. 43 44 One trial has suggested that such a link may exist, but only in some people (possibly smokers or those with elevated cholesterol levels). 45 The link between excess iron and any of the diseases mentioned earlier in this paragraph has not been definitively proven. Nonetheless, too much iron causes free radical damage , which can, in theory, promote or exacerbate most of these diseases. People who are not iron deficient should generally not take iron supplements.

Patients on kidney dialysis who are given injections of iron frequently experience “oxidative stress”. This is because iron is a pro-oxidant, meaning that it interacts with oxygen molecules in ways that can damage tissues. These adverse effects of iron therapy may be counteracted by supplementation with vitamin E .46

Supplementation with iron, or iron and zinc, has been found to improve vitamin A status among children at high risk for deficiency of the three nutrients. 47

People with hepatitis C who have failed to respond to interferon therapy have been found to have higher amounts of iron within the liver. Moreover, reduction of iron levels by drawing blood has been shown to decrease liver injury caused by hepatitis C. 48 Therefore, people with hepatitis C should avoid iron supplements.

In some people, particularly those with diabetes ,insulin resistance syndrome , or liver disease, a genetic susceptibility to iron overload has been reported. 49

Many foods, beverages and supplements have been shown to affect the absorption of iron. 50

Interference with iron absorption:

• Tea (Camellia sinensis) 51 52 53, including green tea. 54 Drinking green tea (Camellia sinensis) with meals reduces absorption of iron by about 70%. This may benefit hemochromatosis.
• Coffee (Coffea arabica, Coffea robusta) 55 56 57
• Red wine polyphenols (similar to those in tea) 58 59
• Phytates (phytic acid) in unleavened wheat: matzoh, pita, wheat germ; some rye crackers; oats; nuts; cacao powder; vanilla extract; beans and other foods, as well as IP-6. 60 61 62
• Whole wheat bran, independent of phytates, inhibits iron absorption. 63
• Calcium interferes with heme-iron absorption. 64 65
• Unfermented soy protein 66 67
• Eggs 68 69

Enhancement of iron absorption:

• Meat, poultry and fish.70 71 72 73 74
• Vitamin C slightly increases iron absorption, 75 76 77 78 79
• Vitamin A taken with iron improves absorption and/or utilization of iron. 80 81
• Fermented soy foods (e.g. tofu, miso, tempeh) significantly improve iron absorption. 82 Some soy sauces enhance iron absorption. 83
• Alcohol, but not red wine, increases absorption of ferric, but not ferrous, iron. 84 85

Iron has been reported to potentially interfere with manganese absorption. In one trial, women with high iron status had relatively poor absorption of manganese. 86 In another trial studying manganese/iron interactions in women, increasing intake of “non-heme iron,” the kind of iron found in most supplements, decreases manganese status. 87 These interactions suggest that taking multiminerals that include manganese may protect against manganese deficiencies that might otherwise be triggered by taking isolated iron supplements.

Certain medications may interact with iron:

• Aspirin (Depletion or interference)
• Carbidopa (Reduced drug absorption/bioavailability)
• Carbidopa/Levodopa (Reduced drug absorption/bioavailability)
• Chlorhexidine (Adverse interaction)
• Cimetidine (Depletion or interference)
• Ciprofloxacin (Reduced drug absorption/bioavailability)
• Deferoxamine (Adverse interaction)
• Dipyridamole (Depletion or interference)
• Doxycycline (Reduced drug absorption/bioavailability)
• Etodolac (Depletion or interference)
• Famotidine (Depletion or interference)
• Haloperidol (Depletion or interference)
• Hyoscyamine (Depletion or interference)
• Ibuprofen (Depletion or interference)
• Indomethacin: Iron supplements can cause stomach irritation, increasing risk of stomach irritation and bleeding from Indomethacin. Stomach bleeding causes iron loss. If iron and indomethacin are both prescribed, take with food to reduce stomach irritation and bleeding risk.
• Levofloxacin (Reduced drug absorption/bioavailability)
• Magnesium Hydroxide (Depletion or interference)
• Methyldopa (Reduced drug absorption/bioavailability)
• Minocycline (Depletion or interference)
• Nabumetone (Depletion or interference)
• Neomycin (Depletion or interference)
• Nizatidine (Depletion or interference)
• Ofloxacin (Reduced drug absorption/bioavailability)
• Oral Contraceptives: Menstrual bleeding and cleansing is typically reduced increasing risk of excess iron. 3 Premenopausal women on OCs should check iron levels before taking any iron supplementation.
• Oxaprozin (Depletion or interference)
• Penicillamine (Reduced drug absorption/bioavailability)
• Ranitidine (Depletion or interference)
• Risedronate (Reduced drug absorption/bioavailability)
• Sodium Bicarbonate (Depletion or interference)
• Stanozolol (Depletion or interference)
• Sulfasalazine (Reduced drug absorption/bioavailability)
• Tetracycline (Reduced drug absorption/bioavailability)
• Tetracyclines (Reduced drug absorption/bioavailability)
• Thyroid Hormones: Iron deficiency impairs thyroid hormone production.
  
  Beard JL, Borel MJ, Derr J. Impaired thermoregulation and thyroid function in iron-deficiency anemia. Am J Clin Nutr 1990;52:813–9.
  
  This could increase need for thyroid hormone substitution. Iron supplementation for iron-deficient women with low thyroid partially normalizes hormone levels.
  
  Beard JL, Borel MJ, Derr J. Impaired thermoregulation and thyroid function in iron deficiency anemia. Am J Clin Nutr 1990;52:813–9.
  
  Thyroid hormone production is also low with a low-calorie diet. Iron supplementation (27 mg per day) in a control study helps maintain normal thyroid hormone levels in obese patients even on a very low-calorie diet.
  
  Beard J, Borel M, Peterson FJ. Changes in iron status during weight loss with very-low-energy diets. Am J Clin Nutr 1997;66:104–10.
• Warfarin (Reduced drug absorption/bioavailability)

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34. Cutler P. Deferoxamine therapy in high-ferritin diabetes. Diabetes 1989;38:1207–10.
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41. Kechl S, Willeit J, Egger G, et al. Body iron stores and the risk of carotid atherosclerosis. Circulation 1997;96:3300–7.
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47. Muñoz EC, Rosado JL, Lopez P, et al. Iron and zinc supplementation improves indicators of vitamin A status of Mexican preschoolers. Am J Clin Nutr 2000;71:789–94.
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52. Derman D, Sayers M, Lynch SR, et al. Iron absorption from a cereal-based meal containing cane sugar fortified with ascorbic acid. Br J Nutr 1977;38:261–9.
53. Hallberg L, Rossander L. Effect of different drinks on the absorption of non-heme iron from composite meals. Hum Nutr Appl Nutr 1982;36:116–23.
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55. Derman D, Sayers M, Lynch SR, et al. Iron absorption from a cereal-based meal containing cane sugar fortified with ascorbic acid. Br J Nutr 1977;38:261–9.
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57. Morck TA, Lynch SR, Cook JD. Inhibition of food iron absorption by coffee. Am J Clin Nutr 1983;37:416–20.
58. Bezwoda WR, Torrance JD, Bothwell TH, et al. Iron absorption from red and white wines. Scand J Haematol 1985;34:121–7.
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Low levels of iron are associated with increased longevity.

If you need to take a specific iron supplement, try Ferrasorb. Because iron is hard to absorb, most iron supplements cause constipation. Not Ferrasorb, due to its high absorbability.

How Can You Boost Iron Absorption?

If you have had your blood tested and you know you are not getting
enough iron, then eating a diet of iron-rich foods is the best next
step.
The Recommended Dietary Allowance for iron is 10 mg daily for
men and postmenopausal women and 15 mg for women of childbearing age.
Women need more iron daily to replace the iron lost each month during
menstruation. Pregnant women need 18 mg daily (and sometimes more).
The body absorbs only about twenty percent of the iron available in
vegetarian sources.
You can increase the amount of iron that is absorbed by eating foods
high in vitamin C along with foods high in iron.
Vegetables such as broccoli, Brussels sprouts, cabbage, cauliflower,
dark leafy greens,kohlrabi, organic potato (white), sweet pepper, and
organic tomatoes are all good sources of vitamin C.
The best fruit sources of vitamin C are
cantaloupe, guava, honeydew melon, mango, strawberries, and watermelon.
More Tricks For Iron
Another way to promote iron absorption is to eliminate coffee
with meals, especially when eating foods that contain significant
amounts of iron.
Coffee has been shown to decrease iron *absorption* by
as much as 39 percent and tea by 64 percent.
This is thought to be due to tannins and other substances that bind with
the iron and make it less absorbable.
This effect has been shown to occur even when coffee was
consumed one hour after the meal.
Adding milk to coffee further decreases iron absorption.
You can partially counteract this effect with vitamin C rich foods,
but why not enjoy a glass of orange juice with your breakfast instead of
a cup of coffee?
Cooking with cast iron pots can significantly increase the iron content
of food.
This is especially true when cooking acidic foods like tomatoes.
----------------------------
Dried beans and dark leafy green vegetables are especially good
sources of iron, better on a per calorie basis than meat. Iron
absorption is increased markedly by eating foods containing vitamin C
along with foods containing iron.
Heme vs. Non-heme Iron
Iron is an essential nutrient because it is a central part of
hemoglobin which carries oxygen in the blood.
Iron deficiency anemia is a worldwide health problem which is especially
common in young women and in children.
Iron is found in food in two forms, heme and non-heme iron.
Non-heme iron, 60 percent of the iron in animal tissue and all the
iron in plants (fruits, vegetables, grains, nuts) is less absorbed.
Vitamin C acts to markedly increase absorption of non-heme iron.
Adding a vitamin C source to a meal increases non-heme iron absorption
up to six-fold which makes the absorption of non-heme iron as good or
better than that of heme iron.
Fortunately, many vegetables, such as broccoli and bok choy, which
arehigh in iron are also high in vitamin C so that the iron in these
foods is very well absorbed.
Commonly eaten combinations, such as beans and tomato sauce or
stir-fried tofu and broccoli, also result in generous
levels of iron absorption.
Both calcium and tannins (found in tea and coffee) reduce iron
absorption.
Tea should be used several hours before a meal which is high in iron.
FOOD AMOUNT IRON
(mg)
organic Soybeans, cooked 1 cup 8.8
Blackstrap molasses 2 Tbsp 7.0
Lentils, cooked 1 cup 6.6
Tofu 4 oz 0.7-6.6
Quinoa, cooked 1 cup 6.3
Kidney beans, cooked 1 cup 5.2
Chickpeas, cooked 1 cup 4.7
Lima beans, cooked 1 cup 4.5
Pinto beans, cooked 1 cup 4.5
Black-eyed peas, cooked 1 cup 4.3
Swiss chard, cooked 1 cup 4.0
Tempeh 1 cup 3.8
Black beans, cooked 1 cup 3.6
Turnip greens, cooked 1 cup 3.2
Prune juice 8 oz 3.0
Spinach, cooked 1 cup 2.9
Beet greens, cooked 1 cup 2.7
Tahini 2 Tbsp 2.6
Raisins 1/2 cup 2.2
Cashews 1/4 cup 2.0
Figs, dried 5 medium 2.0
Seitan 4 oz 2.0
Bok choy, cooked 1 cup 1.8
Bulgur, cooked 1 cup 1.7
Apricots, dried 10 halves 1.6
Tomato juice 8 oz 1.4
Almonds 1/4 cup 1.3
Peas, cooked 1 cup 1.3
Green beans, cooked 1 cup 1.2
Kale, cooked 1 cup 1.2
Sesame seeds 2 Tbsp 1.2
Sunflower seeds 1/4 cup 1.2
Broccoli, cooked 1 cup 1.1
Brussels sprouts,cooked 1 cup 1.1
Millet, cooked 1 cup 1.0
Prunes 5 medium 1.0
Watermelon 1/8 medium 1.0
[Sources: USDA Nutrient Data Base for Standard Reference, Release 12,
1998. Manufacturer's information.
The RDA for iron is 10 mg/day for adult men and for post-menopausal
women and 15 mg/day for pre-menopausal women.]
Comparison of Iron Sources
FOOD IRON (mg/100
calories)
Spinach, cooked 5.4
Collard greens, cooked 3.1
Lentils, cooked 2.9
Broccoli, cooked 2.1
Chickpeas, cooked 1.7
Figs, dried 0.8
Flounder, baked 0.3

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Not Getting Enough Iron
Iron deficiency is the most prevalent nutrient deficiency in this
country. It is estimated to affect about ten percent of the
population.
Pregnant women, women of childbearing age, teenage girls, and infants
are at highest risk of not getting enough iron. It can lead to
anemia,fatigue, irritability, headaches, and lack of energy.
To prevent iron deficiency, every effort should be made to maximize
iron from food sources. A good diet will safely help decrease the risk
of inadequate iron and at the same time cause the least potential damage
to those at risk for iron excess. A well planned vegetarian diet
provides adequate iron.
Boosting Iron Absorption
Eating a varied diet with emphasis on iron-rich foods is a good start to
getting enough iron. Dried beans, dark green leafy vegetables,
blackstrap molasses, bulgur, and prune juice are good vegetarian
sources of iron.Supplements vs. Food
Iron supplements can do more harm than good. Iron supplements should
be taken only with the advice of a physician in cases where iron
deficiency or an increased need for iron has been diagnosed. During
pregnancy low-dose iron supplements are commonly recommended because it is difficult to meet iron needs through diet alone. .
The golden rule, still, is that it is best to get the nutrients your
body needs, including iron, from the food you eat. A well planned diet
can provide adequate iron, minimizing the risk of iron deficiency.

Iron Deficiency Anemia	Iron Overload
Pale skin	Dark, bronze skin: iron storage
Fatigue: especially mental; frequent naps	Fatigue
Cold extremeties	Elevated liver enzymes, cholesterol
Craving for acid foods, e.g. tomato	Elevated sugar
Lack of infections	Frequent infections