Iron Supplements

Identifying the cause requires a medical history, a physical exam, and often a fecal occult blood test. Other possible tests include an upper endoscopy (using a narrow lighted tube down the esophagus to view and take samples of the upper gastrointestinal tract) or a colonoscopy (to examine the large intestine).

Pumping up iron

The goal of treatment isn't simply to improve blood counts, but also to replenish iron stores. This usually takes 6–12 months. While investigating the cause of the iron deficiency, most doctors will recommend a diet rich in iron and other nutrients. Iron supplements may help, but physicians turn to these only when a blood test confirms iron deficiency and after dietary measures have failed. Taking iron when you don't need it isn't a good idea. In people who are at risk due to genetic factors, excess iron intake can lead to an increased risk for heart disease, diabetes, and some cancers.

Optimize your iron intake

Premenopausal women should make an effort to consume enough iron-rich foods (see box, below).

Iron found in meat, fish, and poultry is in a chemical structure called heme that allows the iron to be easily absorbed. Iron from vegetable sources (nonheme iron) is not. But you can boost the absorption of iron from these foods by including in the same meal some meat or vitamin C-rich foods such as orange or grapefruit juice, broccoli, cabbage, and tomatoes.

Vitamin E, calcium, and medicines such as proton-pump inhibitors or H₂-receptor agonists (taken for heartburn symptoms) can interfere with iron absorption. So can dairy products, tea, and coffee. So eat these foods either one hour before or two hours after you take your iron. Some iron-rich foods such as spinach, kale, beets, and Swiss chard also contain oxalic acid, which reduces iron absorption, so consumption of these foods should be limited.

Iron supplements are best absorbed when taken between meals, on an empty stomach. Because this may cause distressing side effects such as nausea, diarrhea, constipation, or cramping, your doctor may suggest taking half the recommended dose at mealtime. Stool softeners or laxatives can help with constipation. Some supplements come with vitamin C, which promotes iron absorption. Iron injections are an option if oral therapy is intolerable or blood loss persists.

Iron supplements can alter the effectiveness of certain medications. These include etidronate (taken for osteoporosis); penicillamine (commonly prescribed for arthritis); cimetidine (taken for ulcer symptoms); and certain antibiotics including oral tetracycline and quinolones. Some studies also suggest that iron supplements reduce the absorption of zinc. Staggering your doses may help, so ask your physician about how to do so.

Postmenopausal women don't need as much iron as younger women. In fact, healthy older women who take a multivitamin with iron should consider switching to one that doesn't have iron.