All About Iron

Mar 26, 2010

I am hoping by posting this to my home page it may be an easier place for people to find the answer to a question I read about frequently.  Honestly I believe the longest period of time that passed from my answering this question to the next was 2 weeks. . .14 days.  So here it is.

Let me qualify this information by Stating that I work for the Ontario Blood Conservation Program known as ONTraC.  I am one of 27 nurses in Ontario who specialize in the care of patient's with pre-operative anemias.  Where I work I accept referrals of clinically anemic patients regardless of their diagnosis(ie oncology patients, pre-op patients, medical patient's etc)  One of the largest tool in my chest is iron rich diet and iron supplements.  That being said I am about to launch into a bit of a diatribe.

Iron Rich Diet

This is a rather difficult source of iron for WLS patients but I thought I would mention it here anyhow.

There are two sources of dietary iron:

Heme Iron:  Which is readily used by the body and not effected by what you eat and drink.  Heme Iron is what is found in Poultry, Meat and Fish.  There is significantly more iron in the dark meat of poultry (thighs and legs) than the white meat (breast).  Red Meat and Organ meats are the best source of iron, however those with high cholesterol must be mindful of dietary restrictions.

Non-Heme Iron:  Are not so readily used by the body and are effected by what you eat and drink.  Non-Heme irons are found in Nuts, seeds, green leafy vegetables, legumes and eggs.  The absorption of non-heme iron can be maximized if they are taken with heme containing foods and foods rich in vitamin C (citrus fruit, cantelope, bell peppers or brocoli).  The consumption of oxalate containing foods (coffee, tea, chocolate and cola) with in an hour before or after consuming a non-heme iron will block the absorption of the iron contained in that food.

Iron Supplements

There are three main divisions of Iron Supplements Iron Salts (ferrous Sulfate, Ferrous Gluconate, and Ferous Fumarate), HEME Iron (proferrin) and Polysaccharide Iron (TriFerrex, FeraMAX).

Iron Salts are the most commonly prescribed supplement as they are frequently covered by government and personal drug plans.  These however are not the best option for WLS patients.  Iron Salts are absorbed high in the digestive tract specifically the stomach.  The most common side effect is heart burn and gastric irritation, followed closely by constipation and diarrhea.  They need to be taken on an empty stomach (1 hours before you eat or 2 ours after you eat, personally and professionally I would recommend the two hours after you eat as there will hopefully still be something in your stomach to buffer it) which just proliferates thes two rather nasty and common side effects.  Like Non-Heme Irons taking them with something rich in vitamin C or even with your vitamin C supplement will actually increase the amount of iron you absorb from the supplement.  Also like Non-heme Irons taking them with Oxalate rich foods such as coffee, chocolate, cola or tea will block the supplement's absorption.  I like to suggest to my patients who insist on taking the Iron Salts preparations that they take it with a mouth full of prune juice as its natural laxative nature will assist with Iron Induced Constipation and is itself rich in iron.  If however you are a "dumper" and those of you who are know what this means, this is not the best suggestion as Prune Juice is also laced with natural sugars.  Patient's who are on Iron Salts also need to be mindful of  not taking their Calcium within an hour of their Iron Salts supplement.  You also cannot take Maalox of a similar aluminum Salts preparation with in 30 minutes as it will block the Iron Salts absorption.  If you can get all of this wedged into your daily schedule there is one more consideration:   if you are on a Proton Pump or H2 inhibitor (Lrevacid, Nexium, Losec, Pantaloc etc) these medications alter the pH of the stomach.  That change in pH actually will block the absorption of the Iron Salts.

HEME Irons and Polysaccharide Irons information for these types of iron is very similar.  Both are absorbed lower in the digestive tract so are not effected by what you eat and drink.  They also do not cause gastric distress and constipation from these is very rare.  Because more of it is absorbed and available to the body often the dose (mg strength) is considerably less than that of Iron Salts.  If you consciously abstain from the use of animal products you should be aware that HEME IRON such as proferrin is infact derived from beef.  Some private drug plans will cover the cost of HEME Irons if they are prescribed.  Polysaccaride Irons are not currently covered by any drug plan that I am aware of.  Again with HEME Iron and Polysaccharide Irons there is no need to take them on an empty stomach, their absorption will not be enhanced by taking Vitamin C with it.  There is no need to avoid oxalate containing foods (coffee, tea, cola or chocolate).  They may be taken with Aluminum Salts prepartions (Maalox) and Calcium.  Their absorption is not effected by Protn Pump and/or H2 inhibitors.

I hope this is helpful.  If you would like any addiitonal information or if your have any further questions or concerns regarding this information, please feel free to message me privately.

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