Help me figure out how to maximize my iron uptake

May 5, 2014 9:36 AM

My ferritin is low. Low enough to destroy my concentration and stamina and make my hair fall out among other things. I'm doing tons of research and apparently there is a bunch of stuff that inhibits uptake and Im having a hard time NOT cultivating anxiety and obsessive thoughts about this. help.

I've written this question three times, but I think I'm adding way too much detail which is really just underscoring the fact that I'm thinking about this way too much to be healthy.

I'm taking 100mg elemental iron twice daily - morning and night. Caffeine, calcium and tannins all inhibit uptake. How can I best arrange my diet to maximize iron uptake? Is there a threshold for calcium thats "safe" (like can I still eat 1/2 cup of yogurt for breakfast)? Is there a window if time I need to avoid these substances around my pills? (for instance, one study says coffee 1 hour before iron is fine, but up to 2 hours after will inhibit uptake.)

Most importantly - am I driving myself crazy for nothing? My doctor gave me NO specific advice other than to take the pills with orange juice (vitamin C enhances uptake, does this effect cancel out inhibitory effects of other substances??) and said to take on an empty stomach if I can tolerate it (what's the window of time for "empty"?). Does it not really make that big of a difference? Is that why they prescribe megadoses of iron - with the understanding that only a fraction makes it into the system? Can I build up stores faster if I micromanage this stuff? Real talk: Am I driving myself crazy for nothing?

I understand the easy thing to do would be to just eliminate dairy and coffee and green tea from my diet completely, but tbh this process is distressing enough and since I understand that I'm looking at a process that will take somewhere between months and forever, I'd like to just figure out how to schedule my diet appropriately.

posted by lilnublet to Health & Fitness (20 answers total)

I think you are really over-thinking this. Iron deficiency is really common in women. Take the pill in the morning with juice, before you've had breakfast. That's all you need to do.
posted by Houstonian at 9:44 AM on May 5, 2014 [7 favorites]

You are driving yourself crazy for nothing. Follow your doctor's instructions -- and change nothing else -- until your next check up. If your iron levels are still low at that point, your doctor will have more suggestions or possibly refer you to a specialist (a hematologist) for more sophisticated treatment.

Your doctor didn't give you non-specific advice to drive you crazy, she gave you non-specific advice specifically intended to keep you sane. As you have already discovered there is a strong urge for certain people to go down the rabbit hole with things like this, when most of the time it is unnecessary and you really can reverse your issues with a treatment that takes all of 30 seconds per day.

I've come to this philosophy not by being naturally chill but by having the same personality type as you and emerging on the other side pretty unhappy with how I've reacted to certain situations in the past, so here is the mantra I have for you: Don't borrow trouble.
posted by telegraph at 9:48 AM on May 5, 2014 [5 favorites]

You're really overthinking this. Take the pill prescribed, as prescribed, and then have your doctor schedule a followup blood test check at some point if you're really freaked out about absorption issues. I have lousy absorption in general, followed none of the restrictions you're stressing out about (other than following the orange juice rule), and got my ferritin up from 10 to 27 in two weeks.
posted by blue suede stockings at 9:48 AM on May 5, 2014 [1 favorite]

It's not so much that Vitamin C, specifically, enhances uptake, it's that iron is absorbed more effectively in an acidic environment, thus the empty stomach. Ascorbic acid (Vit C) helps that. Take it with juice before breakfast and give it half an hour or so to absorb before you put food in your stomach.
posted by Pantengliopoli at 9:49 AM on May 5, 2014 [1 favorite]

You can also look to add watermelon or other iron-rich snacky foods to your diet. A cup of Total cereal. Seaweed. Spinach. Green onions.
posted by tilde at 9:55 AM on May 5, 2014 [1 favorite]

How long has this been going on? Unless you have been taking those iron pills for a few weeks or a month already and aren't seeing any improvement, I'd chill out a little bit. For what it's worth, when I had low serum ferritin I took iron with vitamin C and tried to up my intake of red meat, but I didn't avoid any of those other foods. And my ferritin levels still went up.
posted by needs more cowbell at 9:59 AM on May 5, 2014 [1 favorite]

Vitamin C inhibits and slows the absorption of calcium (buffered vitamin c, for example, contains calcium), so you'll want to make sure you don't take your Vitamin C and Iron within 2 hours of calcium ingestion.
posted by stubbehtail at 10:28 AM on May 5, 2014

Are you taking pills?

DO NOT TAKE PILLS.

Take a liquid iron supplement, and take it with vitamin C.

Liquid absorbs so much more.
posted by St. Peepsburg at 10:30 AM on May 5, 2014 [3 favorites]

Sorry, I got excited there. Yes take your pills but: I have heard that iron pills are constipating and do not absorb very well. Your pill may be 100mg but you will only absorb a fraction of that.

I had problems with iron and liquid supplements have made them a distant memory for me.

Also don't worry. 1-2h after you've taken the iron should be fine to ingest other substances.
posted by St. Peepsburg at 10:33 AM on May 5, 2014 [2 favorites]

Yeah you are over thinking it. (Which I do too, see my embarrassing askme history). I've taken both the pills and the liquid with orange juice, both helped, I tried to take them a little apart from breakfast because I usually have milk on my cereal but otherwise no real change.

I do personally think the liquid is better, but it's also ridiculously expensive, so I only used that when I was pregnant and ill and my stomach couldn't tolerate tablets. If money weren't an issue I would definitely go for the floradix, though.
posted by celtalitha at 11:02 AM on May 5, 2014 [2 favorites]

Came in to suggest liquid iron but St. Peepsburg beat me to it! You can find it at health food stores and some Whole Foods. Floradix is the standard, I prefer the taste of Gaia brand, but it is pricey, and needs to be refrigerated once opened. I'm 8 months pregnant, and when I switched to liquid iron a couple months ago I noticed a huge change in my energy level from when I was taking the pills.
posted by hungrybruno at 11:32 AM on May 5, 2014 [3 favorites]

I took iron glycinate. Most forms of iron supplements contain sulfur and I don't do well with sulfur. Iron glycinate is not sulfurous and is more bioavailable (thus absorbs better) than most other chemical forms. I tried liquid and it did not work well for me.

I mostly avoided combining beef and cheese (or other high iron foods with high calcium foods) in my diet. No cheeseburgers for me. (Also, no cheese with broccoli or cheese with spinach dishes.) I tried to keep milk and cheese and the like away from my iron supplements by 2 hours but I didn't worry too much. I did make sure to have a buffer of at least 30 minutes. That's usually pretty do-able without making yourself nuts.

As I became less deficient, I got more lax about things. So I think if you set a high-ish standard for a bit, this will get better and then once this is resolved, you can quit being so picky about it - unless it becomes a vicious cycle of getting better, letting up on being picky, getting worse, etc. If that happens, I recommend you just make it a habit to be picky about this.
posted by Michele in California at 11:59 AM on May 5, 2014

Start using cast iron skillets and cookware.
posted by Jairus at 12:03 PM on May 5, 2014 [2 favorites]

I had the same issue back in December. I took the pills (and also tried a liquid) for 90 days, with vitamin C or OJ, and...nothin'. Didn't have any caffeine, avoided dairy when I took the iron, etc. For some reason, I didn't absorb it (had a GI workup done, too, but they still couldn't determine why). Friday I'm getting a Venofer infusion.

Try it for a bit and get another blood panel, but it sounds like you have pretty serious deficiency symptoms. There are other options. Your doctor should provide them, or if not, see a hematologist.
posted by OneSmartMonkey at 12:03 PM on May 5, 2014

Consider what stress is doing to your uptake... then make liver (and other organ meats, from real animals) part of your life.
posted by larry_darrell at 1:23 PM on May 5, 2014

Seriously, if you are doing what your doctor told you, you will probably be fine. Get a follow-up test done after an appropriate amount of time and you will know for sure. If your levels are still too low, you doctor will give you new instructions.
posted by Juffo-Wup at 1:34 PM on May 5, 2014

Are you a tea lover? Nettle tea contains around 10%-15% daily recommended intake of iron per cup and I personally just love it. I buy this loose leaf from Frontier, if you need a recommendation.
posted by rada at 1:39 PM on May 5, 2014 [1 favorite]

Hi! Here's an article about ferritin deficiency from a doctor who diagnosed me with a condition that dozens of others missed. I trust him and have followed this advice for managing my own tendency towards this problem. My (non medical) opinion: get aggressive. You'll feel better. What your doctor recommended is not aggressive. It's important that your iron levels not get high. You can order your own lab tests in most states to monitor if needed.
posted by Kalatraz at 4:11 PM on May 5, 2014 [1 favorite]

I've just been through this. I took an elemental iron supplement from Walgreens once a day for 6 weeks and now I take a one a day multivitamin. I feel so much better than I did, it is quite a radical change - and that's how you'll know the supplements are working.
posted by poissonrouge at 5:48 PM on May 5, 2014

I will nth Floradix and cast iron skillets.

I replaced morning milk for awhile with almond milk (almond milk + fortified cereal + OJ + iron supplement), and pushed my morning coffee (with real milk - I dislike anything else in it, and don't want it black) back to mid-morning (about 10am is when I tend to dip anyway!).

I took all my iron at once in the AM, so that I only had to worry about one iron-friendly meal. For a few months I took an iron pill in the morning, and Floradix at bedtime (when I hadn't eaten in a few hours, and wouldn't be, anyway).

I made sure I was eating more meat (I had a mostly vegetarian diet, inadvertantly).
Eat lots of broccoli and squeeze lemon juice on things to whatever extent you can remember to, but...

Am I driving myself crazy for nothing?
Yes. Give it time. As you know, there is no one answer for this, and I nearly drove myself crazy micromanaging it too. It took me almost a year to get them from almost non-existant to in the normal range. Hang in there!

FWIW, the Floradix worked best for me, and the first few weeks I took it I felt like I was on speed (or how I imagine speed would feel). Things normalized a bit after, but I do feel better!
posted by jrobin276 at 7:59 PM on May 5, 2014 [1 favorite]