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Guide Health: Which iron is the right iron?

Symptoms of iron deficiency and choosing the right supplement for your needs

You need iron in your body for your red blood cells to have enough hemoglobin to carry oxygen through the blood system to your cells. A reduced number of red blood cells (i.e. erythrocytes) is called anemia. Iron-deficient anemia is the result of low iron levels.

Your body contains about 3.5 grams of iron, of which 2.5 grams are in the red blood cells. A blood test will determine your iron levels and help diagnose iron-deficient anemia.

Incidentally, there are other types of anemia depending upon what is causing your drop in red blood cell numbers. Causes range from excessive bleeding (from trauma, heavy periods, or even a bleeding ulcer) to low levels of vitamin B12 or kidney disease.

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Anywhere from nine to 13 per cent of Canadians have iron-deficient anemia, with women being the most commonly affected. Anemia usually develops slowly. Paleness and tiredness are the most commonly noticed symptoms, although you may mis-attribute these symptoms to overwork, stress, not eating well, lack of sleep or the like.

Weakness, dizziness, increased heart rate, and decreased capacity for any physical activity are signs of more severe anemia. People often overlook the symptoms of anemia, but if they do happen to you, don’t ignore them. Get them checked out.

Iron is the treatment choice, but there are several formulations. Ferrous sulphate which comes in red tablets is 20 per cent elemental iron; ferrous fumarate, which is a dark-red tablet, is 33 per cent; and the green tablets of ferrous gluconate are 11 per cent.

Ideally, you want to take the formulation that gives you the most elemental iron, but ferrous sulphate and ferrous fumarate can cause more stomach irritation than ferrous gluconate. Taking the iron with food or a meal will reduce this adverse effect. Because iron is better absorbed in an acidic environment, drinking a glass of orange juice along with the iron will increase both the acidity of your stomach and the iron’s absorption.

Antacids, calcium, and even some drugs such as the tetracylcine antibiotics can impair the absorption of iron, and it can be advisable to avoid taking your iron within three hours before or two hours after taking these drugs to avoid the problem. (Some multi-vitamin and mineral-combination products include both calcium and iron in their formulations, which means neither mineral is being absorbed. Choose a multiple vitamin product with either calcium or iron, not both, then take the other mineral as a single-ingredient tablet separately from the multiple vitamin.)

If you do not want to take iron tablets, then dietary sources of iron may be an option along with treating any underlying cause, for example a bleeding ulcer. Meat is high in iron content and it contains a type of iron known as heme-iron which is well absorbed by the body. Non-heme-iron is iron found in plant sources such as beans, green leafy vegetables, and dried fruits such as raisins. Unfortunately, non-heme-iron is less compatible with your body and you need two to three times as much. As well, many cereals and foods are fortified with iron.

If you do take an iron supplement, remember to store it safely out of reach of any children because iron is among the top 10 medications involved in accidental childhood poisonings. The tablets themselves are brightly coloured and a child may think they are candy.

When children are given iron, their dose needs to be calculated based on their weight. Both drops and liquid iron preparations are available, but the two do not have the same concentration of elemental iron. Before you give a child any iron supplement, it is essential that the child needs the iron, that you have accurately calculated the dose based on your child’s weight, and that you have the correct concentration.

If you are not sure, ask your pharmacist to check your numbers. You certainly do not want to add to the accidental poisoning statistics!

Marie Berry is a lawyer/pharmacist interested in health and education.

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Marie Berry is a lawyer/pharmacist interested in health and education.

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