How to avoid gastro issues from iron supplements

April 8, 2022 9:58 AM

My hematologist has prescribed 325 mg of OTC ferrous sulfate for anemia. I have not purchased them yet, but I am concerned about taking them since my digestive systems hates everything. Is there anything I can do to minimize potential side effects?

My instructions are to take with food and a source of vitamin c. And if I am unable to tolerate them, I will have to get IV treatments, which I'd prefer to avoid.

I'm wondering if anyone has any tips or tricks for preventing nausea, vomiting, bloating and constipation while on oral iron. I'm thinking of taking a daily stool softener. Any other ideas?

posted by Serene Empress Dork to Health & Fitness (28 answers total)

Hydration, activity, soluble fiber (which may increase bloating/nausea, ymmv), and colace is a fine stool softener. If you use a magnesium-based laxative or calcium antacids in close proximity to the iron, it may hinder absorption.

They also have liquid iron now, which may be better tolerated.
posted by sibboleth at 10:11 AM on April 8, 2022 [1 favorite]

I never tolerated the ferrous sulfate pills. Just did horrible things to my stomach. Let me reassure you that the infusions aren't terrible and you should only need a few (or maybe even just one or two) to be good for many years to come.
posted by cooker girl at 10:13 AM on April 8, 2022 [8 favorites]

There are other forms of iron supplements that you can try. Many people have luck with liquid iron supplements. You can also try cooking all your food on an iron skillet.

But mostly I’m just commenting to say that iron supplements suck and I’ve had plenty of iv iron infusions they are A+ not a problem and worked just fine.
posted by bq at 10:23 AM on April 8, 2022 [4 favorites]

There are forms of iron that are supposedly easier to tolerate (I’ve never had a problem tolerating iron supplements, so it’s hard for me to endorse a specific one). I don’t remember at the moment which forms these are, but iron bisglycinate is going well for me. I recommend doing some searching.

It helps to gradually increase your dose. You could eat prunes instead of taking stool softener, if you like them. Ginger helps with nausea, as does huffing rubbing alcohol. But if you’ve never taken iron before, it’s possible you’ll be like me and not have trouble. I have plenty of digestive problems, too.
posted by Comet Bug at 10:30 AM on April 8, 2022 [1 favorite]

I tried several types when I was anemic a few years ago and had the least digestive disruption with Vitron-C, recommended here.
posted by zepheria at 10:38 AM on April 8, 2022 [2 favorites]

MegaFood's Blood Builder didn't upset my stomach at all. Based on the amount of Iron in 325 mg of ferrous sulfate, you'd probably have to take two Blood Builders a day which you might want to talk to your doctor about.
posted by gregr at 11:15 AM on April 8, 2022 [3 favorites]

My doctor has me taking them every other day.
posted by blue suede stockings at 11:21 AM on April 8, 2022 [1 favorite]

I have a friend who had better luck taking them at night.
posted by gideonfrog at 11:49 AM on April 8, 2022 [1 favorite]

I take them every other day. I will say that I don't have as many problems if I take them in chewable form?
posted by Countess Sandwich at 11:59 AM on April 8, 2022 [1 favorite]

Floradix liquid iron
posted by St. Peepsburg at 12:17 PM on April 8, 2022 [5 favorites]

I’ve tried about 20 kinds of iron.

IV infusions of iron sucrose (aka intravenous iron) is hands-down the best, so don’t overlook that! The difference in symptoms after two infusions was life-changing for me. Nothing else works as well. It’s shocking how much better I feel with a few IV iron infusions a year.

Palafer CF is the second best- it’s gentle on the stomach and has vitamin C right in it. It’s intended as a prenatal but it’s ok to take when not pregnant.

Floradix is very low in iron so it did nothing for me.
posted by nouvelle-personne at 12:57 PM on April 8, 2022 [3 favorites]

Iron infusions are awesome. I get a series of two every year and would never ever go back to the misery (and ineffectiveness) of oral supplementation. Floradix did nothing for me and tastes like bloody prunes but it didn't give me constipation or diarrhea which is more than I can say for every other form of oral supplementation I tried. Seriously, just get the infusions.
posted by HotToddy at 1:21 PM on April 8, 2022 [2 favorites]

Careful with liquid iron if you try that as it can stain the teeth, so use a straw. I administer it to anemia patients in the hospital from time to time, toleration varies. Persistent anemia cases or people with GI problems just get infused, if that doesn't work they get blood.

Personally I take iron bisglycinate capsules w/ a vitamin c tablet after a meal, which I find I can absorb without the GI irritation I got from ferrous sulfate. If you can get infusions that is the best way, you only have to do it a few times a year and it won't have any GI issues. Eating dates as a snack and cooking with the iron fish may help with more dietary iron intake as well.
posted by zdravo at 1:37 PM on April 8, 2022 [2 favorites]

Check out Proferrin. It's heme iron rather than the usual non-heme iron. My excellent doctor recommended this particular brand after I'd had the usual issues with all the others. I've been taking it for years, and it has absolutely no unpleasant effect on my stomach or gut. It can be taken with or without food, and it doesn't need the vitamin C supplementation.
posted by Corvid at 2:37 PM on April 8, 2022 [2 favorites]

Echoing all the others who say the iron infusions are WAY better than the oral supplements! The pills caused me immediate stomach pains, no matter how I tried to take them, and honestly, I am not sad that the inability to tolerate them cleared me for having the infusions instead!
posted by lysimache at 5:39 PM on April 8, 2022 [1 favorite]

I too could not tolerate oral iron. (And if I did there's no guarantee my broken gut would actually absorb it.) My GP said I had to "try" it before insurance would want to cover infusions. I did try it, for a few days, felt like shit, and said "insurance can come at me then, cause I can't take these." Insurance ended up covering the infusions. I did short ones because I was not technically anemic. Two short 20-minute sessions in an infusion chair. Worth it.
posted by Crystalinne at 7:17 PM on April 8, 2022 [1 favorite]

When you get iron infusions check with your insurance- some brands are more affordable. Even in Canada, check if your employer covers it. In Canada some kinds are about $100 per dose (which I have gladly paid out of pocket before and it’s worth every penny - cheaper than a daily coffee and the energy it gives me is far superior) but my current insurance makes it just $4 per dose!!
posted by nouvelle-personne at 7:34 PM on April 8, 2022 [1 favorite]

My annoying doctor won’t prescribe IV iron even though I meet the guidelines for it, so I have had to find workarounds for my delicate gastric situation. Seconding the Proferrin. It never bothers my stomach (well, any more than anything else does). Heme iron is much gentler than non-heme iron. However it is decidedly not vegetarian, just as a heads up.
posted by hurdy gurdy girl at 8:03 PM on April 8, 2022 [2 favorites]

I’ve tried a lot of oral iron and had by far the best luck with these rainbow light mini tabs

(And also succeeded in raising my iron levels!)
posted by suviko at 8:50 PM on April 8, 2022 [2 favorites]

In Canada some kinds are about $100 per dose (which I have gladly paid out of pocket before and it’s worth every penny - cheaper than a daily coffee and the energy it gives me is far superior) but my current insurance makes it just $4 per dose!!

Are you fucking kidding me. I have before me a bill for over a thousand dollars for two doses. That’s the insurance price. In the US, obviously.

Anyway, word of advice for those whose doctors won’t prescribe infusions: hematologists will, and they know how to get insurance to cover it (for all the good it will do you in the US).
posted by HotToddy at 9:05 PM on April 8, 2022 [3 favorites]

Schiff makes a prenatal vitamin with very well formulated Iron. Iron is not well absorbed in the presence of milk, dairy products, tea or eggs. Lunch is the best time for it and a vitamin C source. Cottage cheese has most of the Calcium removed with the whey, so it is not such a worry. I took the Schiff suppliment every other day, and just had an iron rich meal at noon. If you are taking Lisinipril, find a different blood pressure med, aside from anemia, it makes you feel crappy in many other ways. Here is about ACE inbibitors and anemia. Best to you. I taught Iron Instructions to new moms for 17 years.
posted by Oyéah at 10:40 PM on April 8, 2022 [2 favorites]

There are two types of iron supplements you can take: heme and non-heme. Most iron supplements are non-heme. Non-heme is pretty tough on the stomach and the absorption rate is actually pretty abysmal, particularly because it’s affected by other factors (e.g. coffee really inhibits absorption of non-heme iron, and ideally you need to take with vitamin C).

Heme iron supplements are more expensive and not vegan/vegetarian so they’re not for everyone. They are however the only iron supplements that significantly increased my iron levels pretty rapidly with *no* side effects whatsoever. Also unlike non-heme iron, absorption isn’t inhibited by other foods and drinks like coffee and you don’t need to take vitamin C with them. I took Simply Heme and would recommend them but there may be more on the market you could look into. I would at least recommend looking at the Simply Heme website for some useful guidance on increasing your iron levels.

(I honestly can’t believe that ferrous sulfate is still being prescribed seeing how badly it’s tolerated by so many people. It leads lots of people to mistakenly think they can’t tolerate iron supplements at all which isn’t true.)
posted by rose selavy at 10:40 PM on April 8, 2022 [1 favorite]

I tried lots of different iron supplements including some that stained my teeth badly. I was very happy to get the IV treatments, which finally helped a bit with the fatigue without destroying my stomach.
posted by PardonMyFrench at 1:39 AM on April 9, 2022 [1 favorite]

When I was prescribed iron supplements, I took ferrous gluconate at night, just after dinner. I couldn't tolerate citrus juices so I just made sure to drink lots of water. I took them for 16 years and finally brought my hemoglobin levels up to an acceptable level. Good luck!
posted by Lynsey at 8:57 AM on April 9, 2022 [1 favorite]

Response by poster: I honestly can’t believe that ferrous sulfate is still being prescribed seeing how badly it’s tolerated by so many people

After reading this thread, I'm now wondering if she prescribed that assuming I probably wouldn't be able to tolerate it, and then we could go ahead with infusions. They told me up front if I couldn't tolerate it they'd give me IV. I may go ahead and try it in hopes that it does bother me, since others have spoken so highly of infusions!

Meanwhile, I got a bottle of the Vitron-C zephyria recommended, and the one I've taken so far did not bother my stomach (we'll see what happens on the other end...) The Proferrin recommended by Corvid also looks interesting, so I may give that a try as well.

I wish there were some way of testing my blood iron at home so I'd know what was working without having to wait until my next lab appointment in June.
posted by Serene Empress Dork at 12:14 PM on April 9, 2022

From a mefite who wishes to remain anonymous:

Here's my post

I’ve been dealing with these issues for a long time. I’ve tried Ferrous succinate, Ferrous gluconate, various drug-store brands, liquid iron (I think it was Fer-in-Sol), Palafer, Eurofer, Feramax, etc., and IV infusions.

Apparently, I’m some kind of weirdo, because my experiences run counter to seemingly everybody else’s. The liquid iron made my stomach queasy. I kept trying to take it, but eventually gave up, because the idea of throwing up every time I took it was off-putting.

When it comes to the iron pills, again, I’m the odd duck, because rather than getting constipated, I react in the exact opposite manner. And yes, spending extra time in the washroom is no fun, but it’s better than an unsettled stomach. (Also, for the record, I also have some kind of GERD/reflux/other stomach issue that I have yet to get properly diagnosed.)

I read about IV infusions here on MetaFilter, and I thought that was going to be the solution to my issues. They work for everybody! They’re simple and painless and they have no harmful side-effects.
Except that’s not at all true in my case.

My doctor was totally against the idea (honestly, I don’t think she had ever heard of them). My hematologist offered up the treatment possibility as practically the first words out of her mouth. Based on what I read on the green, I said, ‘sign me up immediately.’

My treatment was done in a hospital, in the same room cancer patients were getting their treatments. The cancer patients were all calm, relaxed, chatting on their phones, doing crosswords, etc. (Believe me, I’m not belittling cancer treatments, I’m just setting this up as a point of comparison.)

I’ve never had any kind of IV before. The nurse said to expect it to be cold. Okay, I thought I could deal with a bit of cold. They had warmed blankets to drape over my arm. I said, I didn’t think that would be necessary.

The needle went in and the iron started to flow. Yup, it was cold, but it wasn’t terrible—until it was.

I started to feel intense pain. My whole arm started to ache. My chest started to ache. I was on the verge of a big ugly crying fit (tears were definitely streaming out of my eyes). All I could think was that something was seriously going wrong inside my arm. The thought “collapsed vein” was flashing through my mind, even though I knew that wasn’t what happened, but it the only pseudo-medical explanation that came to mind. I curled up into a ball as much as possible.
I did ask for the heated blankets, but they didn’t really help. I told the nurse, repeatedly, I was in increasing amounts of pain. My heart was pounding out of my chest (or that’s what it felt like).

At one point, the nurse asked me if I wanted to stop. I was barely though one-fifth or one-sixth of the treatment. I said no, in part because I didn’t want to waste the money, in part because I thought it might get better, and in part, because I was embarrassed I was acting like such a big baby, when there were cancer patients going through much worse and not making any kind of fuss.

The nurse said she could try my other arm, but there was no way in hell I was going to let her do that and damage the arm of my dominant hand. I didn’t realize until later that she suspected I didn’t want that because she thought I was afraid of needles. (I can to that conclusion because she, much to my confusion, kept saying things like “there isn’t a needle in your arm, it’s just a tiny piece of plastic.” At the time, however, I just wasn’t able to drawn the conclusion.)

The soreness in my arm lasted for weeks, but that wasn’t the worst of it. I began experiencing heart palpitations at random. My entire upper arm not only bruised from the initial treatment, but after that (eventually) went away, random bruises kept on appearing. Even today, more than two years after the treatment, I woke up with a brand new bruise this morning that has no physical cause (I didn’t hit myself or bang my arm or anything.) I’m prone to skin conditions, but until I had the IV treatment, I never experienced any skin problems on my upper arm. Ever since the treatment, however, I’ve developed some kind of ongoing pimpling/eczema/something, that is unique to the treatment area.

I spoke briefly to my hematologist after the treatment. She wanted to send me for test to see if my heart had suffered any damaged. Unfortunately, I was scheduled to make a cross-country move, and she couldn’t schedule the test before I departed, so to this day, I have no idea what (if anything) the treatment did to my heart.

Currently, I’m back on Eurofer, as that seems to offer the best balance between what I can absorb and what kind of side effects I experience. I may have to grab a bottle of Ferramax, just to give me a bit of a kick as my iron levels are ridiculously, stupidly low.

I moved back to my original jurisdiction, so I think I’m going to give my hematologist a call to see if we can come up with some better solution, but I know for a fact it won’t be an IV one.
After all this, my advice is try to do what you can to find an oral solution that works for you, because even though I know IV has been a godsend for everybody else, it was a terrible experience for me and not one I would wish for anybody else to suffer through, and that’s why I’ve requested that this be posted. I want it on the record, somewhere in MetaFilter that while IV iron may be great for the majority, there are people for whom it is a bad choice.

posted by Eyebrows McGee at 1:28 PM on April 10, 2022 [1 favorite]

Any form, and I mean any, of concentrates iron sends my stomach from ow to help me please God take me to the hospital, cut it out in the space of several days. And we're not talking constipation--I don't struggle with that under any conditions. We're talking acid burn pain and erosion.

Browse medical studies. Iron supplements are well-known for causing GI bleeding. For some people they cause actual damage, and I can attest the damage gets worse every time you take one. Read the studies. I suspect that even in healthy people iron can do damage that accrues for a long time before it gets bad enough to cause pain.

I've taken IV iron when necessary for years. It's annoying and slightly risky, but for me it's 10k times less risky than any form of iron I've ever ingested. On the plus side, after ~5 total hours plus transit and waiting room time and I don't have to think about it for a few years until I need it again.

I've tried every form imaginable by they way, always switch food, and it always leads to clawing, burning pain, where I'm literally writhing and screaming. If I had the nerve to keep doing that I'd end up in the hospital hemorrhaging blood.

What's kind of nuts is that none of my doctors ever told me it oral iron can cause internal bleeding, and every time I move and get a new doc even after hearing me describe the pain, they try to get me to take pills at first. Like a compliant jellyfish I always tried it for a new doc, until a round of crying and clawing helped me grow spine. The last time I tried it I ended up with a lasting side effect for the first time --terrible heartburn and recurrent pain that's lasted for over a year.

My advice is to not fuck around with pills if you have any GI issues at all.

Iron causes free radical damage. That is, it will damage even a healthy stomach. But most people aren't on a ton of other medications or are younger and their tissues repair more rapidly, and they started from a thicker/better/healthier base.

I feel like way more people need to know this. I was never told, through a lifetime of anemia. I finally started digging around in medical papers trying to figure out why it was like taking a pill was like walking through the gates of hell. I am so angry that no hematologist or GP ever bothered to tell me that.

I've been having infusions for years, but every time I need one, EVERY time, they ask me to try pills again, and it's a shit-show. I've stopped doing it.

Now, if you're determined to damage your stomach and all you're dealing with is constipation, that's insanely easy to deal with: dramatically up your fluid intake and raise your fiber intake to 35-40 grams a day (not the recommended 20-25--youre taking abnormal doses or iron and you're countering the side effects). Yes, it's possible and yes it's annoying to track. Fwiw, fiber supplements don't work a tenth as well as whole food sources with both types of fiber. Next, MIRALAX. Not colace. Colace can make you have oily anal leakage. Not fucking fun. MIRALAX will take some experimentation to get the timing you need right, but it's the best solution.
posted by liminal_shadows at 7:34 AM on April 12, 2022 [1 favorite]

Response by poster: Meanwhile, I got a bottle of the Vitron-C zephyria recommended, and the one I've taken so far did not bother my stomach (we'll see what happens on the other end...) The Proferrin recommended by Corvid also looks interesting, so I may give that a try as well.

Just an update for posterity: I've been taking the Vitron-C for two weeks now, and seem to be tolerating it well. No stomach issues that I've noticed. I do seem to be slightly more prone to constipation but I've been taking a stool softener nightly and I poop most days, so I'm glad for that.

Of course, I have no idea if it is actually doing anything for my anemia. I will find that out in June. I feel ok, not noticing any unusual fatigue or anything. So maybe it is helping.
posted by Serene Empress Dork at 7:00 AM on April 24, 2022 [3 favorites]