By Melanie Nolan
More than 1 billion people worldwide are suffering from iron deficiency. And despite supplementing, so many people are finding their iron status doesn’t shift, or only moves very slowly over months and months.
As a naturopath, the main deficiency I see in my clients is iron-deficiency. And a large portion of my clients have been dealing with iron-deficiency for months or years, despite supplementing for most of this time.
So the question that many ask us is: “I’m taking iron supplements, so why aren’t my iron levels coming up?”.
And there is a lot to explore within iron supplementing; it’s not just as simple as going to the chemist and grabbing the first iron supplement you see.
As a naturopath, the main deficiency I see in my clients is iron-deficiency. And a large portion of my clients have been dealing with iron-deficiency for months or years, despite supplementing for most of this time.
Let’s explore all the possibly reasons why your iron levels are not coming up despite supplementing…
1. The first reason – the form of iron you are taking has low absorption. The type of iron matters. Some have a low absorption rate (like ferrous sulphate), some are highly absorbed (like iron bisglycinate).
Ferrous bisglycinate has a bioavailability of 2 to 4 times more compared to ferrous sulphate! In clinical trials, only those treated with ferrous bisglycinate had significant changes in ferritin levels compared to those taking ferrous sulphate.
Ferrous sulphate, found in most chemist brands, has also been shown in research to irritate the stomach lining, causing gastrointestinal side effects such as cramping, nausea and constipation, which may also contribute to colonisation of pathogens and changes in your gut flora profile.
2. You are taking it with other products that are hindering absorption – like calcium supplements, dairy products, zinc, caffeine and black tea, which have all been shown to potentially impact absorption of iron in your gut. Ideally, you should be taking your iron supplement away from all other supplements. I find the best time can be after dinner.
3. Hepcidin levels – Hepcidin is the master regulator of systemic iron. It is a protein made by your liver, that makes sure you don’t overdose on iron, which would be very toxic. Humans and other mammals lack effective mechanisms to excrete excess iron, and therefore the sole means of maintaining iron balance is by regulating intestinal iron absorption to match systemic iron requirements.
Ideally, you should be taking your iron supplement away from all other supplements. I find the best time can be after dinner.
How does hepcidin regulate iron levels?
High hepcidin levels block intestinal iron absorption. Dietary iron is absorbed predominantly in the duodenum (gut). Hepcidin reduces the iron entry to our blood from the absorptive duodenal cells. Absorption increases in response to increased iron requirements like iron deficiency or anaemia.
So if you are iron-deficient, or anaemic, hepcidin levels will naturally go lower so you get more iron from your diet/supplements, in comparison to someone’s hepcidin levels if they had very high iron levels.
Hepcidin also increases when in an inflammatory state, or infection state.
Hepcidin synthesis is greatly increased during inflammation, autoimmune diseases or chronic infections, which means in these states a person will struggle to get the adequate amount of iron from their diet or supplements, and the majority will be iron-deficient or anaemic. In these cases, we need to treat the inflammation levels to lower the hepcidin. Not just give them more and more iron, because this would worsen their hepcidin levels.
Research shows that higher dose iron supplements at doses of 60 mg Fe or higher increase hepcidin for up to 24-48 hours and are associated with lower iron absorption on the following day. A study completed showed an oral dose of 65 mg of iron in healthy volunteers caused a 5-fold increase in hepcidin within 1 day!
This shows that with increasing dose of iron, absorption of iron decreased. This is an interesting find, as people usually think taking more iron, is better.
The duration of the hepcidin response – lasting around 48 hours – supports alternate day supplementation. So if we skip every second day, we are allowing our hepcidin to naturally go back down, so we maximise absorption from our supplement.
4. Your output of iron is too high – like your periods are heavy, or you have internal blood loss. This is something to chat to your doctor about.
5. Gut absorption issues – iron absorbs within the duodenum (gut) so when our gut lining is inflamed or damaged, such as in cases of IBS, food intolerances, low stomach acid production, IBD or coeliac disease – you will have trouble in absorbing the maximum amount of iron.
