5

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Girlfriend has very low iron and the doctor prescribed iron pills causing stomach pain and nausea - suggestions on iron supplements?

Answered on August 19, 2014
Created August 21, 2012 at 12:19 PM

Girlfriend has very low iron and the doctor prescribed iron pills causing stomach pain and nausea so she stopped taking it (it has lactose and other crappy fillers in it). Her iron has decreased over 3 months so she needs to take some sort of iron supplement (or maybe a good food source?)

Anyone have suggestions on iron supplements or sources that are the least likely to cause gut problems?

121a16aded2bed8dca492d3c9662ef4c

(1327)

on September 08, 2012
at 01:34 AM

Even a ferritin level of 37 ng/mL is low. I think avoiding supplementation - particularly if she has anemia - is a mistake. There are different formulations available, and often people find that they tolerate one better than the others. Unfortunately, the most common reason iron replacement fails is because people don't stick with it long enough.

121a16aded2bed8dca492d3c9662ef4c

(1327)

on September 08, 2012
at 01:13 AM

Sometimes supplements are medically indicated, UncleLongHair.

E12ead3bf63c94b5b619b03722ef554f

on August 22, 2012
at 09:43 PM

yes, many minerals compete for absorption so it is best to avoid taking other mineral supplements, especially calcium, at the same time.

A2c38be4c54c91a15071f82f14cac0b3

(12682)

on August 22, 2012
at 05:46 PM

Why do you say avoid calcium? Does it decrease iron absorption?

Ed71ab1c75c6a9bd217a599db0a3e117

(25472)

on August 22, 2012
at 02:24 PM

They are higher than even liver because of their density/mass/size ratio.

74d3afd30ebc0d604d56c6de897bb9a8

(100)

on August 22, 2012
at 01:11 PM

so maybe she can cut some coffee and sugar and dairy and treat them as dessert foods, once in a while? To bring mine back up, I seriously ate a lot of chicken liver, a lot of hamburger and steak for breakfast. You really have to try to eat those foods alone to let the iron and other vitamins do their work. I know it seems like a pill is the best option but I had to go through an endoscopy and colonoscopy when I had low iron/hemoglobin and guess what? they found nothing. I feel passionately about this! I ate the same as your GF. Please, let the food, not the pills be the medicine.

9a5e2da94ad63ea3186dfa494e16a8d1

(15833)

on August 22, 2012
at 04:25 AM

Eat food, not supplements.

91882203467f64f68f25f58f1caeee68

(1017)

on August 21, 2012
at 11:40 PM

She follows a mostly paleo diet since she's often eating with me, but also eats dairy (yogurt and cheese), a cup of coffee every morning (with sugar), oatmeal some mornings, and occasionally gluten free processed foods but it's not a huge part of her diet.

91882203467f64f68f25f58f1caeee68

(1017)

on August 21, 2012
at 08:22 PM

@Dave S - good point! I see that all the time.

91882203467f64f68f25f58f1caeee68

(1017)

on August 21, 2012
at 08:22 PM

@ Jaych - 24, not very physically active/athletic.

4b05d725a8332e8e917a4ca58b6e8a1e

(1239)

on August 21, 2012
at 05:55 PM

I just have to ask. Is she an athlete? And how old is she? Ever since I started battling my own severe anemia problems, I've noticed that the vast majority of my young, athletic female friends are also struggling with symptoms.

A968087cc1dd66d480749c02e4619ef4

(20436)

on August 21, 2012
at 05:23 PM

Totally off topic. I simply find it fascinating that 15 people answered this question (so far), but none have upvoted it. I would think a question that generates so many answers must be worthy of upvoting. What am I missing?

32f5749fa6cf7adbeb0b0b031ba82b46

(41747)

on August 21, 2012
at 04:57 PM

What's her typical diet look like? Perhaps Cronometer it to make sure something isn't terribly out of proportion and causing iron absorption problems.

91882203467f64f68f25f58f1caeee68

(1017)

on August 21, 2012
at 04:01 PM

It was around 24 or 26, and 3 months prior was around 37. She is not paleo/primal, only strictly gluten free. She is anemic, but the doctor doesn't know the cause yet. She doesn't eat red meat very often (probably rarely) but eats a pretty balanced gluten free diet.

91882203467f64f68f25f58f1caeee68

(1017)

on August 21, 2012
at 04:00 PM

@ashley - she doesn't have heavy bleeding, but does have extremely bad cramps during her period.

91882203467f64f68f25f58f1caeee68

(1017)

on August 21, 2012
at 03:59 PM

@arugula - She has been tested (blood and biopsy) and it all came out negative. She is gluten sensitive and I am diagnosed with Celiac so we both follow a strict gluten free diet (me for 11 months since diagnoses, her for about the last 5 months).

153c4e4a22734ded15bf4eb35b448e85

(762)

on August 21, 2012
at 03:01 PM

Floradix is regular iron, it just has herbs etc. added to it. They like to market is as "natural" iron, but it's the same as iron pills.

9426eec8c8385c90bdf843aa44bd5a4b

(200)

on August 21, 2012
at 02:27 PM

Does she have menstrual problems such as heavy bleeding? Sometimes it can make you anemic. Dark greens such as kale and spinach have iron as well help with the absorption too.

32f5749fa6cf7adbeb0b0b031ba82b46

(41747)

on August 21, 2012
at 02:18 PM

Malabsorption seems like a very likely issue. Supplementation is a waste of time/effort if it cannot be properly absorbed.

Bb3d1772b28c02da2426e40dfcb533f5

(5381)

on August 21, 2012
at 12:45 PM

You need a moderate amount of vit c and also copper to absorb iron. Id suggest some form of liver which has high iron, along with those co-factors.

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21 Answers

7
Baa413654789b57f3579474ca7fa43d7

(2349)

on August 21, 2012
at 12:41 PM

Beef and organ meats are high in iron.

If she still needs a supplement, she could try Slow Fe. Before switching to Paleo, my wife had anemia and used to take it. Regular iron supplements caused her problems, but she was able to take these no problem.

http://www.amazon.com/Slow-Fe-Release-Tablets-90-Count/sim/B000052YTI/2

9a5e2da94ad63ea3186dfa494e16a8d1

(15833)

on August 22, 2012
at 04:25 AM

Eat food, not supplements.

121a16aded2bed8dca492d3c9662ef4c

(1327)

on September 08, 2012
at 01:13 AM

Sometimes supplements are medically indicated, UncleLongHair.

4
E12ead3bf63c94b5b619b03722ef554f

on August 22, 2012
at 07:50 AM

it's called liver! 2-3 times a week should work fine!

  • combine each meal with vitamin C to enhance absorption
  • avoid high-calcium food or calcium supplements with meals
  • avoid taking tea/coffee within 2 hours of your meals
  • supplement with betaine HCL if low stomach acid

and of course, deal with the underlying issue... digestive problems?

A2c38be4c54c91a15071f82f14cac0b3

(12682)

on August 22, 2012
at 05:46 PM

Why do you say avoid calcium? Does it decrease iron absorption?

E12ead3bf63c94b5b619b03722ef554f

on August 22, 2012
at 09:43 PM

yes, many minerals compete for absorption so it is best to avoid taking other mineral supplements, especially calcium, at the same time.

4
3b0b95dfc6dc5c18e535945f4aab0866

on August 21, 2012
at 12:30 PM

Beef, taken with high dose vitamin-C to increase absorption.

Anything cooked in cast iron, and cooked on a regular basis.

Beef cooked in cast iron.

3
8292546789ca48c32ead34c6e884d059

on August 21, 2012
at 01:08 PM

She may also need B12 to use the iron.

3
31d847cdba887d7f5663b2e8899601cc

on August 21, 2012
at 12:53 PM

Floradix, iron from vegetable sources. Get it at the health food store. It comes in liquid and pills. Liquid is more absorbable.

153c4e4a22734ded15bf4eb35b448e85

(762)

on August 21, 2012
at 03:01 PM

Floradix is regular iron, it just has herbs etc. added to it. They like to market is as "natural" iron, but it's the same as iron pills.

2
Ed71ab1c75c6a9bd217a599db0a3e117

(25472)

on August 22, 2012
at 03:23 AM

Get her gut tested. I bet she has a flora issue. Want to see real life proof of Brain Gut 9? Watch this: http://www.fecalmicrobiotatransplant.com/

2
489d6842b84b920fabcb9eeb83783c91

on August 21, 2012
at 02:35 PM

If she isn't eating enough iron-rich foods, then she may want to increase those (plenty of suggestions here and throughout the web).

If she is, or may want to do this anyway, she may want to:

(a) increase foods that contain factors that promote the actual absorption of the iron (meat protein and vitamin c for example), and/or

(b) reduce foods that contain factors that reduce the actual absorption of the iron (tannins, calcium, polyphenols, and phytates)

Also, she should read up on heme and non-heme iron. Heme iron (found in meats and organs) is pretty efficiently absorbed, while non-heme isn't as much. Non-heme iron is also most affected by the factors discussed in (b) above.

That said, my understanding is that one of the most important determinants to absorption is how much the body has stored of it, given that iron is toxic in excess. The beauty of homeostasis.

Thus, it's also important to note that vitamin A is known to affect how iron is mobilized out of storage. A vitamin A deficiency may then also give the impression that (via a blood test) that one is deficient (even though there is enough stored). I would read up on this as well to help her and her docs determine what may be the cause.

2
94480caec9fbbaacc386d86a45efa720

(1007)

on August 21, 2012
at 01:28 PM

Has she been tested for celiac disease and checked for other malabsorption issues? We gave our son a liquid iron supplement mixed in juice after he was diagnosed with celiac disease. His pediatrician recommended it based on his ferritin # at the time. That seemed a palatable way of getting iron.

91882203467f64f68f25f58f1caeee68

(1017)

on August 21, 2012
at 04:00 PM

@ashley - she doesn't have heavy bleeding, but does have extremely bad cramps during her period.

32f5749fa6cf7adbeb0b0b031ba82b46

(41747)

on August 21, 2012
at 02:18 PM

Malabsorption seems like a very likely issue. Supplementation is a waste of time/effort if it cannot be properly absorbed.

9426eec8c8385c90bdf843aa44bd5a4b

(200)

on August 21, 2012
at 02:27 PM

Does she have menstrual problems such as heavy bleeding? Sometimes it can make you anemic. Dark greens such as kale and spinach have iron as well help with the absorption too.

91882203467f64f68f25f58f1caeee68

(1017)

on August 21, 2012
at 03:59 PM

@arugula - She has been tested (blood and biopsy) and it all came out negative. She is gluten sensitive and I am diagnosed with Celiac so we both follow a strict gluten free diet (me for 11 months since diagnoses, her for about the last 5 months).

2
5e5ff249c9161b8cd96d7eff6043bc3a

(4713)

on August 21, 2012
at 12:54 PM

Oysters are also high in iron. You might want to read some dannyroddy.com as well, as he talks about iron and iron absorption in one way or another in several articles. Also avoid drinking coffee with meals, as this would inhibit iron absorption.

Ed71ab1c75c6a9bd217a599db0a3e117

(25472)

on August 22, 2012
at 02:24 PM

They are higher than even liver because of their density/mass/size ratio.

2
88c498aadc71cdebf6aea33ec11a8199

on August 21, 2012
at 12:50 PM

When I was pregnant with my third my iron got low. Midwife had me take Chlorofresh instead of iron supplements. You can get it in pill form or liquid form. I suggest the pills, but you'll have to take them more often than the liquid.

2
31ef66bfed0aea4975292d4eb0e9b943

on August 21, 2012
at 12:34 PM

Kidneys, liver, offle all of that kind of stuff. My Dad was very sick & the doctors actually prescribed a diet high in liver & kidneys instead of tablets, as they believed the iron was better absorbed if taken as a food instead of a supplement. Spinach also has a high iron count also. Iron tablets do actually cause nausea if taken on an empty stomach or without food, so if she does intend to stick on them, make sure she eats with the tablets. Hope she's on the mend :-)

1
Cc3ce03985eac5ebcbb95fc2329f13b0

on August 21, 2012
at 07:37 PM

Have her cook with only cast iron pots and pans, particularly acidic foods like tomatoes.

1
74d3afd30ebc0d604d56c6de897bb9a8

(100)

on August 21, 2012
at 06:44 PM

so she is gluten free - does that mean she eats dairy with meat? that can decrease absorption of iron... does she eat pseudo grains, like quinoa, buckwheat, etc? those can have inhibitory substances, concerning absorption and bioavailability of nutrients.

sorry if I sound rude, but gluten free ,pretty balanced, it can mean a lot of things, and believe it or not a lot of things can affect iron absorption - including coffee with meals, cheese, sugar.

Those things are all gluten free! So you're talking a pretty wide range here, unless it's more specific. some people say oats are gluten free, others no. In general, I'm pretty sure it's not just fixing the iron that's going to help her.... I would say, like others here, she needs to eat liver. freeze it and chop it up really tiny with stir-fried cauliflower to make paleo dirty rice. make pate.

Liver, hands down, is one of the best sources of iron AND B-vitamins, which are likely low too. I don't want to counter your doctor, and so maybe don't drop the pills, but go SLOW bringing her levels back up. she didn't get here overnight, you shouldn't try to dose overnight either.

the less of those pills she can take and the more she can get through food, the better. (PS raw Greens can also affect iron absorption - better to cook them for the folate, vitamins, etc.). I wouldn't be surprised if her folate is also low.... it's really complex how to bring this back up and a lot of factors are at play, so try to keep it meat and veggies first.

91882203467f64f68f25f58f1caeee68

(1017)

on August 21, 2012
at 11:40 PM

She follows a mostly paleo diet since she's often eating with me, but also eats dairy (yogurt and cheese), a cup of coffee every morning (with sugar), oatmeal some mornings, and occasionally gluten free processed foods but it's not a huge part of her diet.

74d3afd30ebc0d604d56c6de897bb9a8

(100)

on August 22, 2012
at 01:11 PM

so maybe she can cut some coffee and sugar and dairy and treat them as dessert foods, once in a while? To bring mine back up, I seriously ate a lot of chicken liver, a lot of hamburger and steak for breakfast. You really have to try to eat those foods alone to let the iron and other vitamins do their work. I know it seems like a pill is the best option but I had to go through an endoscopy and colonoscopy when I had low iron/hemoglobin and guess what? they found nothing. I feel passionately about this! I ate the same as your GF. Please, let the food, not the pills be the medicine.

1
61844af1187e745e09bb394cbd28cf23

(11058)

on August 21, 2012
at 03:22 PM

I take Blood Builder by Mega Food. It's a whole food iron supplement and does not contain any gluten, dairy, soy, corn, pesticides, or herbicides. It causes me no discomfort and I take it before bed, about 2 hours after eating. It has not caused any constipation. I have always battled anemia and this keeps my levels in the "normal" range.

1
A3c56c85290f748410a6f340ddd552b3

on August 21, 2012
at 02:53 PM

Liver! Calves' is good, chicken is even OK and tastes better to a lot of people. But then there's mussels and lamb and stuff. Even shrimp, yum.

I eat fair amounts of iron rich foods yet I am very low on both iron and ferritin, so I am working out this stuff myself, thanks to some recent research and watching AHS lectures. :-)

Avoid the things that mess with absorption: calcium (for meat iron - "heme"), eggs, tea/coffee, nuts (for plant iron - "non-heme").

Per Chris Kresser: http://chriskresser.com/wp-content/uploads/enhance-iron.jpeg?d9c344

Eat/take more things that enhance absorption: Betaine HCL, Zinc, Vitamin C and alcohol(!).

Also per Chris Kresser (ignore the "comments" column because his talk was on how to SLOW absorption for folks with iron that is too high): http://chriskresser.com/wp-content/uploads/enhance-iron.jpeg?d9c344

And, foods highest in iron: http://chriskresser.com/wp-content/uploads/food-sources.jpeg?d9c344

Hope this helps your girlfriend AND me! :-)

1
74d3afd30ebc0d604d56c6de897bb9a8

(100)

on August 21, 2012
at 01:13 PM

how low is her iron? I took iron supplements and I wish I hadn't. Iron can be inflammatory, and I think caused my acne, the website adventures in nutritional therapy is another who had a problem with this. Chris Kresser, I think, is also against iron supplementation because he says it's extremely inflammatory. I'm not saying not to take it, but consider the source.

You say the last 3 months, it has gone down - Is she paleo/primal? what caused her low iron in the first place? is she anemic?

Anyway, was it low stomach acid, was she not eating meat, fish and chicken? Does the supplement have other minerals in it - if she is low in iron probably B12 too. And consider the fact that high iron can throw off zinc, copper, other minerals... You can't dose the problem away.

if she is anemic, might want to read this from chris kresser, he says it's one of the most misunderstood diagnoses:

http://chriskresser.com/rhr-testing-for-sibo-graves-disease-and-all-about-anemia

91882203467f64f68f25f58f1caeee68

(1017)

on August 21, 2012
at 04:01 PM

It was around 24 or 26, and 3 months prior was around 37. She is not paleo/primal, only strictly gluten free. She is anemic, but the doctor doesn't know the cause yet. She doesn't eat red meat very often (probably rarely) but eats a pretty balanced gluten free diet.

1
B69c7d0092dc4642c30542ae3e7a7289

(10)

on August 21, 2012
at 12:45 PM

Look for ferrous gluconate tablets.

The ferrous sulfate, ferrous fumarate and the other types of iron are the problem, not the actual iron itself. I get ferrous gluconate tablets from Puritan Pride and have never had a GI issue when I take them.

0
96d0f148db40114c8e27f130bbbfae18

on February 12, 2014
at 08:18 PM

Blood sausage!

0
Fc6a9e07f6056d465573c8969d3a2ddd

(370)

on August 22, 2012
at 05:33 PM

Bifera. It literally changed my life. I've had no digestive issues with it, and my body absorbs iron from it much better than from traditional supplements.

0
153c4e4a22734ded15bf4eb35b448e85

(762)

on August 21, 2012
at 03:09 PM

I use spatone, been very happy with it, but I don't think you can get in the US.

Meat, liver etc. never did shit all for my iron levels, I have been severly anemic when eating meat every single time, but my levels are normal when the iron comes from veggie sources, and/or raw oysters etc. Meat also tanks my metabolism, so it could be because of that, anemia is often the same as low thyroid. Never had anemia even without supplementation as a vegan for example. I've had several blood transfusions as a meat eater because my anemia got so bad.

Blackstrap is also good, and the plus side is other minerals as well, often anemia is a result of more than just "iron deficiency".

All and all, I would look after the general wellness of the body (high metabolism), good thyroid function etc. and find a diet which produces those results.

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