How does Iron from your diet compare to an iron supplement?

April 25, 2018 6:25 PM

I’m anemic and my Ob prescribed 325mg ferrous sulfate twice daily, which contains 65mg elemental iron. I don’t want to take the pills and would rather try to get more iron in my diet. When I look at food labels, 100g of steak contains 3mg of iron. So, I would need to eat the equivalent of 40 steaks, or cups of cooked spinach or whatever, to get the amount of iron in those pills?

Am I comparing apples to oranges? It seems like it’s impossible for me to get the prescribed amount of iron through diet alone.

FWIW I have accepted this and am just taking the damn pills but I am still curious.

posted by pintapicasso to Health & Fitness (16 answers total)

Best answer: There are two types of iron, heme (usually animal-based) and non-heme (usually plant-based). The iron in steak is much more easily absorbed by your body compared to the iron in your pills, so even though the absolute amount of iron in the steak is lower than the iron supplements, you may be better off eating iron-rich foods for a while. Iron from food sources is also less likely to cause side effects.
posted by gemutlichkeit at 6:34 PM on April 25, 2018 [5 favorites]

Desiccated liver pills are the closest thing I've found to an iron pill that's not actually an iron pill, fwiw. I also second supplementing with lots of non-pill iron sources.
posted by tooloudinhere at 6:41 PM on April 25, 2018 [1 favorite]

Lucky Fish cooked with cast iron cookware .
posted by hortense at 6:47 PM on April 25, 2018 [7 favorites]

Ferrous sulfate can be really harsh on your digestive system. If you find the side effects to be too much to take, I've found that this brand of ferrous fumarate is a lot easier to tolerate. If you still find the side effects to be a bit much, Proferrin is a heme iron supplement that gave me absolutely no side effects, but it's really spendy.
posted by elsietheeel at 6:53 PM on April 25, 2018 [5 favorites]

Oh also 325mg of ferrous sulfate only contains 20% elemental iron, so if your doctor wants you to take that amount, in reality you only need to get 65mg of iron from food (twice daily).
posted by elsietheeel at 6:59 PM on April 25, 2018 [1 favorite]

Given that you are anemic, maybe take supplemental iron for a week or so, while you start the dietary enrichment.
posted by theora55 at 7:19 PM on April 25, 2018

Your body only absorbs a tiny bit of the iron you ingest. Iron from animals is more easily absorbed than iron from plants. And frankly if you’re anemic, I would not recommend only trying to absorb iron through diet or using cast iron skillets. If that were sufficient, you wouldn’t be anemic in the first place, but it isn’t for the vast majority of menstruating women because we bleed more iron than we ingest. And don’t take the pills only for a week. It takes months of consistent daily supplementation to raise iron levels. It took me a year.

By all means, consume more iron in foods too, but I highly recommend taking the pills. It will help increase your iron much more quickly than through diet alone, even if you *could* eat enough iron to make up the difference, which you can’t. A BAG of spinach has 8 mg and a can of tuna has 2mg, and you need 18mg per day just to maintain, much less improve your iron levels. I mean you could spend $20 a day choking down spinach and steak and tuna and eggs in massive quantities, or you could spend $10 on a 6-month supply of iron pills. Better living through chemistry.

If the pills make you nauseous, I would recommend taking them with a glass of OJ, because vitamin C helps the absorption of iron and having food in your stomach will help prevent nausea. I take mine with OJ and a vitamin C pill. One of the ferrous fumarate pills linked above would be a better choice. (I now take a lower dose of ferrous fumarate that’s 26mg since I’m basically maintaining.)

Also keep in mind that calcium blocks iron absorption and vice versa. So take your iron 2 hours or so away from taking calcium or eating any foods rich in calcium.
posted by Autumnheart at 7:44 PM on April 25, 2018 [23 favorites]

Pick up a can of baby clams & cook them up in a pasta sauce, red or white, hold the cheese, save milk for another meal and you have a sizeable iron boost. Skip your iron pill that day!
posted by childofTethys at 8:05 PM on April 25, 2018

I successfully stopped being a lifelong anemic with a combination of supplements and diet changes/additions over about two years and now just eat a lot of iron rich foods on a regular basis. There are different forms of iron and your body absorbs them differently. Also if you have some vitamin C at the same time as something rich in iron you will be able to absorb it more efficiently, be that a pill or a plate of beef liver or a bowl of kale. According to my doctor it doesn't have to be much, she said to drink a little glass of OJ with a pill, or squeeze lemon liberally over a bowl of greens.

Also apparently by combining iron from animal sources with iron from plant sources you absorb the plant based iron more, so trying to be balanced in your diet can help minimize the amount of supplements you'll end up taking in the long run. It's also just a good idea and makes for delicious meals. Also importantly dairy inhibits iron absorption, so skip the cheese and cream and all that - you can still eat it, just give it a few hours before and after eating iron rich things or taking your pills. It's a little like keeping kosher! Avoid cheeseburgers, but enjoy a nice burger with grilled onions at lunch and have some cheese and fruit for dessert after dinner. That kind of thing.

There are many forms of iron supplements and some might be absolute torture on your system while others might be almost nothing. I think I went through about seven different OTC iron pills until I hit one where, if I cut it in half and took it before bed with a little chewable vitamin c supplement, it didn't trigger any of my gastro problems and I was pleasantly regular in the morning. If you find that what you're taking now is deeply unpleasant, try other formulations and amounts. It might take longer to recover from your anemia, but unless you're pregnant or otherwise on some kind of time limit, I think it's worth it to go slow. You might also find that you can increase your daily supplement amount over time a bit.

When I got the doctor's print out of foods that are high in iron that I should include in my diet, it was like a revelation because she had just handed me a list of nearly all my favorite foods. Straight up, my body had been screaming at me to eat iron for years. Dried apricots and figs, barley, sesame seeds, caraway seeds, livers of all animals, beets, cruciferous veggies, eggs, mackerel and other oily fishes, sardines, chickpeas, olives, seaweed, onions, potato skins, the list went on and on and the only thing on there I didn't crave regularly was spinach, which I don't like the texture of. I love to cook so I had fun making iron rich meals. Here are a few that are still in my regular rotation:

Chicken livers stewed with dried apricots, chickpeas, green olives, onions, garlic, and a combination of spices (caraway, fennel, sesame, cinnamon, turmeric, ginger, paprika, whatever I've got in the spice drawer honestly), on a bed of barley simmered in chicken broth

Roasted beets sliced and dressed with lemon juice and fancy olive oil with fresh parsley, grilled whole sardines with sea salt, good crusty bread

Broccoli salad with bacon and grapes. Cook a couple slices of bacon in a big pan. Take them out and leave a couple tablespoons of fat, drain and chop the slices. Chop your broccoli up super small (or grate it on a large grater) and briefly saute it in the bacon fat. Add halved red grapes (quartered if they're huge) and a splash of apple cider vinegar and salt to taste, warm it all through and then mix your bacon bits back in. Great warm but also better when kept overnight in the fridge.

Collard wraps, just have collard greens on hand and use them to wrap up your lunch meats and tortilla fillings but also cut additional collards into ribbons and stuff them into the wrap for extra bulk and crunch. Excellent with lemony tuna salad inside.

Breakfast is often a bowl of pearled barley that I've simmered in chicken stock with a handful of frozen kale and whatever other veggies I have chopped into small bites, with a couple fried eggs on top.
posted by Mizu at 9:19 PM on April 25, 2018 [16 favorites]

Best answer: Came in to recommend Ferrous Fumerate.

Legit I have no idea why it isn't standard. It's in a GNC women's formula.

Please please consider taking a supplement temporarily. I'm prone to anemia and it's no joke when you are pregnant. Ferrous Fumerate. Be well.
posted by jbenben at 10:21 PM on April 25, 2018 [2 favorites]

Note that Tums and other antacids can also hinder iron absorption (common interaction during pregnancy).

Palafer (a brand of ferrous fumarate) is tolerated well by a lot of people.

Pregnancy exacerbates anemia and anemia can increase your risk of haemorrhage and needing a blood transfusion after giving birth, so it's worthwhile to take the pills diligently.
posted by pseudostrabismus at 10:42 PM on April 25, 2018

Better than all of these? Iron IV infusions. If you can handle a drip, try it. Revolutionary! First time I had energy in... years. My levels were in normal range after three treatments, which are about an hour and a half each, and I was able to maintain those levels with diet alone afterward.
posted by fritillary at 12:43 AM on April 26, 2018 [2 favorites]

Midwife here (TINMA/etc): liver is, indeed, a great source of heme iron but not safe to eat in pregnancy due to high levels of vitamin A. This is especially true in the first trimester, but we generally recommend avoiding it throughout pregnancy. So I would stay away from any meat or liver pills. Another option is Floradix, a liquid preparation that's sometimes tolerated better than the constipating and nausea-provoking iron pills. And of course, eating iron-rich foods is always good. One final word: if you're having a lot of trouble with the iron tabs, check with your provider whether you can take them every other day, etc. Some providers have a pretty low threshold for giving iron (eg, if your Hgb is 11.6 and we want it to be 12.0, you probably don't need to be on daily iron!)
posted by stillmoving at 5:01 AM on April 26, 2018

You already said you’ve decided to take the pills so as an FYI—vitamin C helps with (non-heme, supplement) iron absorption and *also* helps counteract the constipating effects that iron has on some people.
posted by needs more cowbell at 5:41 AM on April 26, 2018

I had a coworker who was mildly anemic and she said that her doctor recommended a spoonful of molasses every day to help gently nudge up her iron levels. I thought that sounded a little bit woo at first, but my cursory internet research on the subject has indeed turned up a reputable medical center saying that molasses is legit, and can be stirred into hot water to make "pregnancy tea". It apparently has some other nice benefits as well in addition to iron.
posted by helloimjennsco at 7:07 AM on April 26, 2018

Ferrous fumarate is what gets prescribed for iron deficiency in the UK. However, some find it can mess around with the digestive system. Do you have liquid supplements like Floradix or Spatone where you are? Those are easier to digest in my experience.

Also, if you are a heavy caffeine drinker, this can affect your iron absorption.
posted by mippy at 1:56 PM on April 26, 2018