The Dangers and Benefits of Iron Supplements

by

Wassim Boustani

Nutrition, Section V2

Professor Lasher

24 October 2004

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Outline

Thesis statement: Taking iron supplements should not be done irresponsibly; however,

your doctor may find a need for them; and with proper monitoring, it can provide you

with important health benefits.

I. Introduction to iron

A. Description

B. Types of iron

C. Foods with high iron content

II. Iron intake

A. Iron intake in America

B. Conditions requiring increased intake

C. Iron deficiency

D. Iron overload

III. Iron supplementation

A. Types of iron supplements

B. Conditions that affect supplement absorption

C. Foods that affect supplement absorption

D. Side effects of iron supplements

E. Child cautions about iron supplements

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The Dangers and Benefits of Iron Supplements

I was eleven years old when I accompanied my mother to her doctor’s

appointment. She wanted to talk to the doctor about how I always felt cold, my pallor,

and lack of energy. She told the doctor that I may be lacking some iron, and the doctor

agreed. The doctor then prescribed some iron supplements for me, without the benefit of

a blood test or further questioning. It is now 20 years later, and medicine has come a

long way. My recent blood examinations have revealed thalassemia, a genetic blood

disorder which can cause anemia, caused by the low production of hemoglobin. This was

found during a red blood cell count in which my red blood cells appeared smaller than

normal. My condition is considered mild and does not require any iron supplementation.

The disorder is common in people from the Middle East, Italy, and Greece (NCCTC).

Iron is a trace mineral that the body needs to produce red blood cells. It is an

essential nutrient for the formation of hemoglobin—the protein that carries oxygen in the

blood, and myoglobin—a protein that carries oxygen in the muscle. About 30% of the

iron in the body is stored in order to replace lost iron. Iron plays a role in energy

metabolism, neurotransmitter production, collagen formation and immune system

function. (MedlinePlus; Supplement Watch; NIH)

Healthy adults will absorb 10% to 15% of iron from their diet. Iron is found in

the diet in two forms—heme iron with an absorption from 15% to 35%, and nonheme

iron with an absorption from 2% to 20%. The best source of heme iron is lean red meat,

poultry, and fish. Nonheme iron sources include cereals, beans, and some vegetables.

Combining nonheme iron rich foods with vitamin C improves their absorption. People

consuming only vegetarian nonheme food sources should include vitamin C sources with

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their meal. Iron can also be added from cooking in iron pots. Some foods, such as; milk,

eggs, spinach, coffee, legumes, soybeans, whole grains, and tea can decrease the amount

of nonheme iron absorbed from foods. Iron absorption is increased when body levels are

low, and decreased when body levels are high, to help protect against iron overload.

(Supplement Watch; NIH; UMM)

In the United States, only about 20% of women and 65% of men receive their

daily recommended value of iron. Another survey has shown that 20% of adults aged 20

to 59, from food insufficient households, consumed less than 50% of the RDA for iron,

compared to 13% of those from food sufficient households. Iron intake is reduced by

food with a low nutrient density, as many Americans consume during their struggle with

proper nutrition. Although iron-fortified foods can help meet intake values, sugar-

sweetened foods that are more desirable to children make this less likely. (Supplement

Watch; NIH; CDC)

Normally menstruating women have the highest iron requirements. Others that

may need an increased intake of iron include pregnant women, preterm and low birth

weight infants, older infants and toddlers, teenage girls, and those who regularly exercise

intensely. Some medical conditions that increase your need for iron include bleeding

problems, burns, intestinal diseases, stomach problems, the use of medicines to increase

your red blood cell count, genetic disorders such as thalassemia, renal failure or

gastrointestinal disorders that inhibit iron absorption.

Unusual conditions requiring more iron include pica and hookworm. Pica is the

craving of substances such as ice, starch, dirt, or clay. Starch and clay especially

interfere with the absorption of iron in the stomach. Hookworm, a parasite that attaches

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itself to the small intestine to ingest blood, infects about one billion people worldwide,

mostly in tropical and subtropical countries. (MedlinePlus; Supplement Watch; NIH;

UMM)

Iron deficiency in industrialized nations is uncommon among adult men and

postmenopausal women. Nevertheless, the World Health Organization has found that

iron deficiency is the leading nutritional disorder in the world, with up to 80% of the

population having an iron deficiency and 30% having anemia. Iron deficiency develops

over time when iron intake does not meet the recommended daily values. The stores of

iron in the body can be depleted while the blood hemoglobin levels, a measure of iron

status, remains normal. Iron deficiency anemia sets in when the stage of depletion is so

severe that the body does not receive its daily needs.

Symptoms of anemia include constant tiredness and weakness, decreased work

and school performance, slow cognitive and social development during childhood,

difficulty maintaining body temperature, decreased immune function, inflamed tongue,

shortness of breath, headache, irritability, and lethargy.

Anemia can bring more severe complications to older people. Studies have

shown that affected seniors had a higher mortality rate, an increase of cardiac conditions,

cancer, peptic ulcers, vascular dementia, and an increase incidence of falls. Anemia may

also increase the toxicity of chemotherapy in senior cancer patients. (NIH; UMM; UMM)

An accumulation of excess iron in the body tissues will cause iron overload. This

can lead to toxic damage and increased risk of diseases of the heart, liver, spleen, and

pancreas. Hemochromatosis, a condition found mostly in middle-aged men, leads to

excessive iron absorption. This can result in early symptoms of weakness, fatigue,

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abdominal pain, and weight loss; with more severe cases resulting in liver cancer, liver

cirrhosis, arthritis, diabetes, gray or bronze skin pigmentation, and heart failure. In the

United States, it is estimated that 1 of 10 people carries the gene mutation that can lead to

iron overload. Preventative measures can be taken when blood tests reveal early cases of

hemochromatosis, but many blood tests do not include iron overload parameters.

The reduction of iron stores in hemochromatosis patients is usually done through

therapeutic phlebotomy. The procedure removes a unit of iron-rich blood once or twice

weekly until iron levels are normalized. The patient then follows a regiment to ensure

that iron levels remain in the normal range. (Supplement Watch; CDC)

The need for iron supplementation should only be determined by your doctor,

because of the risks of iron overload. The benefits of iron supplementation for those with

iron deficiency anemia is justified, however there is little benefits in people without

anemia. Supplementation is usually only needed when diet alone cannot keep normal

storage levels of iron in the body. Your doctor will often measure serum ferritin, the

storage form of iron which should be above 15 micrograms per liter of blood.

Some medicines can affect your absorption of iron, or their combination with iron

can cause harmful chemicals to form in the body. Your doctor should know if you are

taking medicines that contain acetohydroxamic acid, antacids, calcium supplements,

dimercaprol, etidronate, fluoroguinolones, or tetracyclines.

Your doctor should also be informed of some medical problems that can affect

your use of iron supplements. These include alcohol abuse, blood transfusions, kidney

infection, liver disease, porphyria cutaneous, rheumatoid arthritis, asthma, allergies, heart

disease, intestinal problems, stomach ulcer, iron overload problems, or other anemia.

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Injectable iron is only administered by a health care professional, but liquid and

tablet forms taken orally are also available. The best absorbed iron supplements are

ferrous fumarate, ferrous sulfate, and ferrous gluconate. Liquid forms of iron may stain

your teeth; so it is best to mix it with water, fruit juice, or tomato juice, or use a straw to

keep the liquid away from your teeth. Stains on teeth can be removed by brushing with

baking soda.

Iron supplements are best absorbed on an empty stomach with a full glass of

water or fruit juice, about 1 hour before or 2 hours after meals. However, it can be taken

with food or after meals if your stomach is upset by it, but certain foods can reduce its

value. These foods include cheese and yogurt, eggs, milk, spinach, tea or coffee, and

whole-grain breads and cereal and bran. These should be avoided 1 hour before or 2

hours after taking iron.

As your body adjusts to iron supplementation, you may experience some side

effects. Common ones include constipation, diarrhea, leg cramps, nausea, and vomiting.

Less common ones include darkened urine, heartburn, stained teeth, and skin

discoloration. If your iron is consumed in tablet form and your stools have not become

dark green or black, then you may not be breaking down the tablet properly in your

stomach. You may need to take the supplement in liquid form, or by injection.

It is important to take iron supplements as directed, since iron absorption can

decrease with increasing dosages, you may be asked to separate your intake in two or

three equally spaced dosages. Your doctor will monitor the effectiveness of iron

supplements by measuring the levels of newly formed blood cells (reticulocyte count),

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hemoglobin levels, and ferritin levels. Blood cell counts should begin to rise after a few

days, while hemoglobin counts increase within two to three weeks.

Accidental overdose of iron pills are a leading cause of poisoning death among

young children, with more than 110,000 cases reported and 35 deaths of children under 6.

It is very important to keep your iron supplements away from children, and in a child-

proof container. Packages now come with warning labels, and most products with more

than 30 mg of iron per dosage come packaged as individual doses to limit the number of

pills a small child could consume. Death to a child under 6 can occur by ingesting as

little as 200 mg, with some found to have ingested as much as 5850 mg of iron. The

RDA for iron for children in this age group is only 10 mg.

Children who are poisoned face immediate and long-term problems. They may

suffer nausea, vomiting, diarrhea, and gastrointestinal bleeding which can progress to

shock, coma, and death. Even if the child appears to recover, severe gastrointestinal

bleeding, lethargy, liver damage, heart failure, and coma can occur from 12 hours to two

days later. Surviving patients can later suffer from gastrointestinal obstruction or more

severe liver damage. Any ingestion of your supplements by a child should be taken care

of immediately by calling your physician or poison control center, or by visiting the

closest emergency room. (MedlinePlus; Supplement Watch; NIH; FDA)

Iron is abundant for most of us, but if you are found to be deficient, there are

many ways to reduce health risks by normalizing your iron blood levels. With proper

care by a doctor, and an understanding of iron supplementation, you can ensure good

health for your future.

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Works Cited

Center for Disease Control. "Assessing the Iron Status of the U.S. Population"

Environmental Health 1 Aug. 2001. 18 Oct. 2004 <http://www.cdc.gov/

nceh/dls/factsheets/pdfs/iron.pdf>.

---. "Iron Overload and Hemochromatosis" Nutrition & Physical Activity 1 Oct. 2004.

18 Oct. 2004 <http://www.cdc.gov/

hemochromatosis/>.

MedlinePlus. "Iron Supplements (Systemic)" Drug Information 20 Nov. 2001. 18 Oct.

2004 <http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202305.html>.

National Institute of Health. "Iron" Dietary Supplement Fact Sheet 28 Jul. 2004. 18

Oct. 2004 <http://ods.od.nih.gov/factsheets/iron.asp>.

Northern California Comprehensive Thalassemia Center. "Thalassemia Trait" What is

Thalassemia? 18 Oct. 2004 <http://www.thalassemia.com>.

Supplement Watch. "Iron" Supplements A-Z 18 Oct. 2004

<http://www.supplementwatch.com/supatoz/supplement.asp?supplementId=367>.

University of Maryland Medicine. "How Serious is Anemia?" Patient Education 31

Dec. 2001. 18 Oct. 2004 <http://www.umm.edu/patiented/articles/

how_serious_anemia_000057_3.htm>.

---. "Iron in diet" Health Info: Nutrition 15 Feb. 2001. 18 Oct. 2004

<http://www.umm.edu/ency/article/002422.htm>.

U.S. Food and Drug Administration. "Preventing Iron Poisoning in Children" FDA

Backgrounder 15 Jan. 1997. 18 Oct. 2004 <http://www.cfsan.fda.gov/~dms/

bgiron.html>.

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