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Iron is an element necessary for oxygen transport to bodily tissues. Normally, the typical American diet contains adequate iron for nutritional needs, mostly in meat. However, at different periods of their lives some individuals will experience iron deficiency anemia due to a lack of hemoglobin, the oxygen carrying component of red blood cells of which iron is a critical part. The two main culprits of this condition are a nutritional deficiency of iron and chronic blood loss. Nutritional deficiencies frequently occur during infancy, adolescence, pregnancy, as well as in the elderly. Chronic blood loss results from conditions such as peptic ulcer disease or excessive bleeding during menstruation. The symptoms of iron deficiency included a pale appearance and fatigue. Since there are a host of other ailments that may also cause these conditions, diagnosis should be confirmed by a health professional with proper blood tests.
Fortunately, iron deficiency anemia can be easily treated with iron supplementation. Iron is relatively affordable and is available over-the-counter. Nevertheless, there are several forms of commercially available iron which can be a source of confusion to the uninformed consumer.
Commercially available iron comes in three primary formulations, ferrous sulfate, ferrous gluconate, and ferrous fumarate. This simply means it is combined with different compounds to aid in its absorption by the body and to make it less irritating on the GI tract. In the end, your body is still getting elemental iron, but in differing amounts and with slightly different side-effects depending on the individual. A summary of the different iron formulations follows.
Ferrous Sulfate (FeosolTM, FeratabTM) is the most commonly prescribed form of iron and the standard to which the other forms are compared. It is approximately 20 percent elemental iron by weight. In other words, a 325 mg tablet will contain about 60 mg of actual iron, of which an iron-deficient individual will absorb only about
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20 percent or 12 mg. Since 36 to 48 mg of elemental iron daily is enough for maximum incorporation into red blood cells, the typical adult dose is two to four 325 mg tablets daily for three months.
Ferrous Gluconate (FergonTM, SimronTM) is approximately 12 percent elemental iron by weight. Because of its lower iron content it may require either an increase in dosage or a longer duration of treatment to replenish iron stores. The typical adult dose is 325 mg four times daily increasing as needed and tolerated up to 650 mg four times daily. It is claimed to cause less stomach irritation though a recent clinical trial in the journal of family practice showed it to be equally tolerant to ferrous sulfate.
Ferrous Fumarate (FemironTM, FeostatTM) contains 33 percent elemental iron. Like ferrous gluconate, it is touted as having fewer adverse effects than ferrous sulfate though this has not been demonstrated in clinical trials. Because it is composed of a larger percentage of iron, dosing is lower compared to the other iron formulations.
All forms of iron share a similar side-effect profile which includes nausea, abdominal pain, black stools and constipation, which can be reduced with a stool softener such as docusate sodium. It is recommended that iron be taken on an empty stomach as food can decrease absorption by as much as 50 percent. However, if a patient simply cannot tolerate their iron formulation it may be given with meals. Additionally, vitamin C aids in the absorption of iron and many practitioners encourage patients to take their iron with a vitamin C tablet or fruit juice. All types of iron come in controlled release formulations, however, these are not typically recommended as absorption is much more erratic since it is dependent on GI transit time which can vary considerably between individuals. Tolerance to a particular formulation and the amount of elemental iron per dose are the primary factors in deciding what type of iron to use.
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It should be noted that older persons may require higher doses because their decreased stomach secretions can reduce iron absorption3. Because iron induced constipation is common in this patient population, it is important to follow a proper diet and to utilize stool softeners to minimize these effects.
Always remember to keep iron formulations in a child-resistant container and out of the reach of children. Iron intoxication is a leading cause of poisoning in children and ingestion of only a few tablets can be life threatening.
In summary, while all forms of iron have been shown to demonstrate equal tolerability across a population, inter-patient variability may vary widely. For this reason it is important to consider patients on an individual by individual basis when implementing iron therapy.
For additional information talk with your pharmacist or physician or visit http://dietary-supplements.info.nih.gov
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