Iron

NOTICE: This health information was not created by the University of Michigan Health System (UMHS) and may not necessarily reflect specific UMHS practices. For medical advice relating to your personal condition, please consult your doctor. Complete disclaimer

Iron

Uses

Iron

Related Topics

Iron is an essential mineral. It is part of hemoglobin, the oxygen-carrying component of the blood. Iron-deficient people tire easily in part because their bodies are starved for oxygen. Iron is also part of myoglobin, which helps muscle cells store oxygen. Without enough iron, adenosine triphosphate (ATP; the fuel the body runs on) cannot be properly synthesized. As a result, some iron-deficient people become fatigued even when their hemoglobin levels are normal (i.e., when they are not anemic).

What Are "Star" Ratings?

a7_3star   Reliable and relatively consistent scientific data showing a substantial health benefit.

a7_2star   Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.

a7_1star   For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.

Our proprietary “Star-Rating” system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by the medical community, and whether studies have found them to be effective for other people.

For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.

This supplement has been used in connection with the following health conditions:


Used for Amount Why
Anemia and Iron Deficiency
 If deficient: 100 mg daily for up to one year under medical supervision 3 stars   Taking iron may help prevent and treat anemia; ask your doctor if it’s right for you. Deficiencies of iron, vitamin B12, and folic acid are the most common nutritional causes of anemia.

3 stars  Anemia and Iron Deficiency

If deficient: 100 mg daily for up to one year under medical supervision

Deficiencies of iron, vitamin B12, and folic acid are the most common nutritional causes of anemia.1 Although rare, severe deficiencies of several other vitamins and minerals, including vitamin A,2 , 3 vitamin B2,4 vitamin B6,5 , 6 vitamin C,7 and copper,8 , 9 can also cause anemia by various mechanisms. Rare genetic disorders can cause anemias that may improve with large amounts of supplements such as vitamin B1.10 , 11

Used for Amount Why
Depression and Iron Deficiency
 See a doctor for evaluation 3 stars   A lack of iron can make depression worse; check with a doctor to find out if you are iron deficient.

3 stars  Depression and Iron Deficiency

See a doctor for evaluation

Iron deficiency is known to affect mood and can exacerbate depression, but it can only be diagnosed and treated by a doctor. While iron deficiency is easy to fix with iron supplements, people who have not been diagnosed with iron deficiency should not supplement iron.

Used for Amount Why
Iron-Deficiency Anemia
 Consult a qualified healthcare practitioner 3 stars   Supplementing with iron is essential to treating iron deficiency.

3 stars  Iron-Deficiency Anemia

Consult a qualified healthcare practitioner

Caution: People should not supplement with iron unless diagnosed with iron deficiency, because taking iron when it isn’t needed has no benefit and may be harmful.

Before iron deficiency can be treated, it must be diagnosed and the cause must be found by a doctor. In addition to addressing the cause (e.g., avoiding aspirin, treating a bleeding ulcer, etc.), supplementation with iron is the primary way to resolve iron-deficiency anemia.

If a doctor diagnoses iron deficiency, iron supplementation is essential. Though some doctors use higher amounts, a common daily dose for adults is 100 mg per day. Even though symptoms of deficiency should disappear much sooner, iron deficient people usually need to keep supplementing with iron for six months to one year until the ferritin test is completely normal. Even after taking enough iron to overcome the deficiency, some people with recurrent iron deficiency—particularly some premenopausal women—need to continue to supplement with smaller levels of iron, such as the 18 mg present in most multivitamin-mineral supplements. This need for continual iron supplementation even after deficiency has been overcome should be determined by a doctor.


Used for Amount Why
Menorrhagia and Iron Deficiency
 100 to 200 mg daily under medical supervision if deficient 3 stars   Supplementing with iron decreases excess menstrual blood loss in iron-deficient women who have no other underlying cause for their condition.

3 stars  Menorrhagia and Iron Deficiency

100 to 200 mg daily under medical supervision if deficient

Since blood is rich in iron, excessive blood loss can lead to iron depletion. Iron deficiency can be identified with simple blood tests. If an iron deficiency is diagnosed, many doctors recommend 100–200 mg of iron per day, although recommendations vary widely.

The relationship between iron deficiency and menorrhagia is complicated. Not only can the condition lead to iron deficiency, but iron deficiency can lead to or aggravate menorrhagia by reducing the capacity of the uterus to stop the bleeding. Supplementing with iron decreases excess menstrual blood loss in iron-deficient women who have no other underlying cause for their condition.12 , 13 However, iron supplements should be taken only by people who have, or are at risk of developing, iron deficiency.

Used for Amount Why
Athletic Performance and Iron Deficiency
 Consult a qualified healthcare practitioner 2 stars   Iron is a component of hemoglobin, which transports oxygen to muscle cells. In cases of iron deficiency, taking iron may restore levels and improve athletic performance.

2 stars  Athletic Performance and Iron Deficiency

Consult a qualified healthcare practitioner

Iron is important for an athlete because it is a component of hemoglobin, which transports oxygen to muscle cells. Some athletes, especially women, do not get enough iron in their diet. In addition, for reasons that are unclear, endurance athletes, such as marathon runners, frequently have low body-iron levels.14 , 15 , 16 However, anemia in athletes is often not due to iron deficiency and may be a normal adaptation to the stress of exercise.17 Supplementing with iron is usually unwise unless a deficiency has been diagnosed. People who experience undue fatigue (an early warning sign of iron deficiency) should have their iron status evaluated by a doctor. Athletes who are found to be iron deficient by a physician are typically given 100 mg per day until blood tests indicate they are no longer deficient. Supplementing iron-deficient athletes with 100 to 200 mg per day of iron increased aerobic exercise performance in some,18 , 19 , 20 though not all,21 , 22 double-blind studies. A recent double-blind trial found that iron-deficient women who took 20 mg per day of iron for six weeks were able to perform knee strength exercises for a longer time without muscle fatigue compared with those taking a placebo.23

Used for Amount Why
Attention Deficit–Hyperactivity Disorder and Iron Deficiency
 Consult a qualified healthcare practitioner 2 stars   In one study, iron levels were significantly lower in a group of children with ADHD than in healthy children. In the case of iron deficiency, supplementing with the mineral may improve behavior.

2 stars  Attention Deficit–Hyperactivity Disorder and Iron Deficiency

Consult a qualified healthcare practitioner

Iron status, as measured by the serum ferritin concentration, was significantly lower in a group of children with ADHD than in healthy children. Ferritin levels were below normal in 84% of the children with ADHD, compared with 18% of the healthy children.24 Since iron deficiency can adversely affect mood and cognitive function, iron status should be assessed in children with ADHD, and those who are deficient should receive an iron supplement. In a case report, a young boy with both ADHD and iron deficiency showed considerable improvement in behavior after receiving an iron supplement.25 Iron supplementation was also beneficial in a double-blind study of children with ADHD and iron deficiency.26

Used for Amount Why
Breast-Feeding Support and Iron Deficiency
 Consult a qualified healthcare practitioner 2 stars   Iron may be required for infants with low iron stores or anemia.

2 stars  Breast-Feeding Support and Iron Deficiency

Consult a qualified healthcare practitioner

If a doctor diagnoses iron deficiency, iron supplementation is essential. Though some doctors use higher amounts, a common daily dose for adults is 100 mg per day. Even though symptoms of deficiency should disappear much sooner, iron deficient people usually need to keep supplementing with iron for six months to one year until the ferritin test is completely normal. Even after taking enough iron to overcome the deficiency, some people with recurrent iron deficiency—particularly some premenopausal women—need to continue to supplement with smaller levels of iron, such as the 18 mg present in most multivitamin-mineral supplements. This need for continual iron supplementation even after deficiency has been overcome should be determined by a doctor.

Used for Amount Why
Canker Sores and Iron Deficiency

Consult with your doctor

2 stars   Talk to your doctor to see if your recurrent canker sores might be related to iron deficiency.

2 stars  Canker Sores and Iron Deficiency

Consult with your doctor

Several preliminary studies,27 , 28 , 29 , 30 though not all,31 have found a surprisingly high incidence of iron and B vitamin deficiency among people with recurrent canker sores. Treating these deficiencies has been reported in preliminary32 , 33 and controlled34 studies to reduce or eliminate canker sore recurrences in most cases. Supplementing daily with B vitamins—300 mg vitamin B1, 20 mg vitamin B2, and 150 mg vitamin B6—has been reported to provide some people with relief.35 Thiamine (B1) deficiency specifically has been linked to an increased risk of canker sores.36 The right supplemental level of iron requires diagnosis of an iron deficiency by a healthcare professional using lab tests.


Used for Amount Why
Celiac Disease and Iron Deficiency
 Consult a qualified healthcare practitioner 2 stars   The malabsorption that occurs in celiac disease can lead to multiple nutritional deficiencies. Supplementing with iron may correct a deficiency.

2 stars  Celiac Disease and Iron Deficiency

Consult a qualified healthcare practitioner

The malabsorption that occurs in celiac disease can lead to multiple nutritional deficiencies. The most common nutritional problems in people with celiac disease include deficiencies of essential fatty acids, iron, vitamin D, vitamin K, calcium, magnesium, and folic acid.37 Zinc malabsorption also occurs frequently in celiac disease38 and may result in zinc deficiency, even in people who are otherwise in remission.39 People with newly diagnosed celiac disease should be assessed for nutritional deficiencies by a doctor. Celiac patients who have not yet completely recovered should supplement with a high-potency multivitamin-mineral. Some patients may require even higher amounts of some of these vitamins and minerals—an issue that should be discussed with their healthcare practitioner. Evidence of a nutrient deficiency in a celiac patient is a clear indication for supplementation with that nutrient.

After commencement of a gluten-free diet, overall nutritional status gradually improves. However, deficiencies of some nutrients may persist, even in people who are strictly avoiding gluten. For example, magnesium deficiency was found in 8 of 23 adults with celiac disease who had been following a gluten-free diet and were symptom-free. When these adults were supplemented with magnesium for two years, their bone mineral density increased significantly.40

Used for Amount Why
Night Blindness and Iron Deficiency
 30 mg of iron and 6 mg of riboflavin per day 2 stars   If a person has deficiencies of iron and riboflavin, supplementing with these nutrients may increase the benefits of vitamin A.

2 stars  Night Blindness and Iron Deficiency

30 mg of iron and 6 mg of riboflavin per day

In a study of women in Nepal, where there is a high prevalence of iron and riboflavin deficiencies, supplementation with 30 mg per day of iron and 6 mg per day of riboflavin for six weeks enhanced the effectiveness of vitamin A in the treatment of night blindness.41 It is not known whether these nutrients would be helpful for night blindness in people who are not deficient.

Used for Amount Why
Pre- and Post-Surgery Health
 Consult a qualified healthcare practitioner 2 stars   Iron supplementation prior to surgery was found in one trial to reduce the need for postoperative blood transfusions.

2 stars  Pre- and Post-Surgery Health

Consult a qualified healthcare practitioner

One preliminary study found iron levels to be reduced after both minor and major surgeries, and iron supplementation prior to surgery was not able to prevent this reduction.42 A controlled trial found that intravenous iron was more effective than oral iron for restoring normal iron levels after spinal surgery in children.43 One animal study reported that supplementation with fructo-oligosaccharides (FOS) improved the absorption of iron and prevented anemia after surgery,44 but no human trials have been done to confirm this finding. Some researchers speculate that iron deficiency after a trauma such as surgery is an important mechanism for avoiding infection, and they suggest that iron supplements should not be given after surgery.45

Patients who have undergone major surgery frequently need blood transfusions to replace blood lost during the procedure. Studies have found that 18 to 21% of surgery patients were anemic prior to surgery,46 , 47 and these anemic patients required more blood after surgery than did non-anemic surgery patients. Supplementation with iron prior to surgery was found in a controlled trial to reduce the need for blood transfusions, whether or not iron deficiency was present.48 Iron supplements (99 mg per day) given before and for two months after joint surgery in another controlled trial improved blood values but did not change the length of hospitalization or the risk of post-operative fever.49 Pre-operative iron supplementation in combination with a medication that stimulates red blood cell production in the bone marrow is considered by some doctors to be an effective way to minimize the need for post-operative blood transfusions.50

Used for Amount Why
Pregnancy and Postpartum Support
 Consult a qualified healthcare practitioner 2 stars   Iron requirements increase during pregnancy, making iron deficiency in pregnancy quite common. Supplementation may help prevent a deficiency.

2 stars  Pregnancy and Postpartum Support

Consult a qualified healthcare practitioner

Iron requirements increase during pregnancy, making iron deficiency in pregnancy quite common.51 Iron supplement use in the United States is estimated at 85% during pregnancy, with most women taking supplements three or more times per week for three months.52 Pregnant women with a documented iron deficiency need doctor-supervised treatment. In one study, 65% of women who were not given extra iron developed iron deficiency during pregnancy, compared with none who received an iron supplement.53 However, there is a clear increase in reported side effects with increasing supplement amounts of iron, especially iron sulfate.54 , 55 Supplementation with large amounts of iron has also been shown to reduce blood levels of zinc.56 Although the significance of that finding is not clear, low blood levels of zinc have been associated with an increased risk of complications in both the mother and fetus.57

Iron supplementation was associated in one study with an increased incidence of birth defects,58 possibly as a result of an iron-induced deficiency of zinc. Although additional research needs to be done, the evidence suggests that women who are supplementing with iron during pregnancy should also take a multivitamin-mineral formula that contains adequate amounts of zinc. To be on the safe side, pregnant women should discuss their supplement program with a doctor.

Used for Amount Why
Restless Legs Syndrome and Iron Deficiency
 Consult a qualified healthcare practitioner 2 stars   When iron deficiency is the cause of restless leg syndrome, supplementing with iron may reduce the severity of the symptoms.

2 stars  Restless Legs Syndrome and Iron Deficiency

Consult a qualified healthcare practitioner

Mild iron deficiency is common, even in people who are not anemic. When iron deficiency is the cause of RLS, supplementation with iron has been reported to reduce the severity of the symptoms. In one trial, 74 mg of iron taken three times a day for two months, reduced symptoms in people with RLS.59 In people who are not deficient in iron, iron supplementation has been reported to not help reduce symptoms of RLS.60 Most people are not iron deficient, and taking too much can lead to adverse effects. Therefore, iron supplements should only be taken by people who have a diagnosed deficiency.

Used for Amount Why
Alzheimer’s Disease
(Coenzyme Q10, Vitamin B6)
 Refer to label instructions 1 star   A combination of coenzyme Q10, iron (sodium ferrous citrate), and vitamin B6 may improve mental status in people with Alzheimer’s disease.

1 star  Alzheimer’s Disease

In a preliminary report, two people with a hereditary form of Alzheimer’s disease received daily: coenzyme Q10 (60 mg), iron (150 mg of sodium ferrous citrate), and vitamin B6 (180 mg). Mental status improved in both patients, and one became almost normal after six months.61

Used for Amount Why
Dermatitis Herpetiformis and Iron Deficiency
 Refer to label instructions 1 star   Talk to your doctor to see if supplementing with iron can counteract the nutrient deficiency that often occurs as a result of malabsorption.

1 star  Dermatitis Herpetiformis and Iron Deficiency

People with DH frequently have mild malabsorption (difficulty absorbing certain nutrients) associated with low stomach acid (hypochlorhydria) and inflammation of the stomach lining (atrophic gastritis).62 Mild malabsorption may result in anemia63 and nutritional deficiencies of iron, folic acid,64 , 65 vitamin B12,66 , 67 and zinc.68 , 69 , 70 More severe malabsorption may result in loss of bone mass.71 Additional subtle deficiencies of vitamins and minerals are possible, but have not been investigated. Therefore, some doctors recommend people with DH have their nutritional status checked regularly with laboratory studies. These doctors may also recommend multivitamin-mineral supplements and, to correct the low stomach acid, supplemental betaine HCl (a source of hydrochloric acid).

Used for Amount Why
Female Infertility and Iron Deficiency
 Refer to label instructions 1 star   Even subtle iron deficiencies have been tentatively linked to infertility. Women who are infertile should consult a doctor to rule out the possibility of iron deficiency

1 star  Female Infertility and Iron Deficiency

In preliminary research, even a subtle deficiency of iron has been tentatively linked to infertility.72 Women who are infertile should consult a doctor to rule out the possibility of iron deficiency.

Used for Amount Why
HIV and AIDS Support
 Refer to label instructions 1 star   Iron deficiency is often present in HIV-positive children. Supplementing with it, under a doctor's supervision, may support immune function.

1 star  HIV and AIDS Support

Iron deficiency is often present in HIV-positive children.73 While iron is necessary for normal immune function, iron deficiency also appears to protect against certain bacterial infections.74 Iron supplementation could therefore increase the severity of bacterial infections in people with AIDS. For that reason, people with HIV infection or AIDS should consult a doctor before supplementing with iron.

How It Works

How to Use It

If a doctor diagnoses iron deficiency, iron supplementation is essential. To treat iron deficiency, a common recommended amount for an adult is 100 mg per day; that amount is usually reduced after the deficiency is corrected. When iron deficiency is diagnosed, the doctor must also determine the cause. Usually it’s not serious (such as normal menstrual blood loss or blood donation). Occasionally, however, iron deficiency signals ulcers or even colon cancer.

Some premenopausal women become marginally iron deficient unless they supplement with iron. However, the 18 mg of iron present in many multivitamin-mineral supplements is often adequate to prevent deficiency. A doctor should be consulted to determine the amount of iron that is needed.

Where to Find It

The most absorbable form of iron, called “heme” iron, is found in oysters, meat and poultry, and fish. Non-heme iron is also found in these foods, as well as in dried fruit, molasses, leafy green vegetables, wine, and iron supplements. Acidic foods (such as tomato sauce) cooked in an iron pan can also be a source of dietary iron.

Possible Deficiencies

Vegetarians eat less iron than non-vegetarians, and the iron they eat is somewhat less absorbable. As a result, vegetarians are more likely to have reduced iron stores. However, iron deficiency is not usually caused by a lack of iron in the diet alone. An underlying cause, such as iron loss in menstrual blood, often exists.

Pregnant women, marathon runners, people who take aspirin, and those who have parasitic infections, hemorrhoids, ulcers, ulcerative colitis, Crohn’s disease, gastrointestinal cancers, or other conditions that cause blood loss or malabsorption are likely to become deficient.

Infants living in inner city areas may be at increased risk of iron-deficiency anemia and suffer more often from developmental delays as a result. Supplementation of infant formula with iron up to 18 months of age in inner city infants has been shown to prevent iron-deficiency anemia and to reduce the decline in mental development seen in such infants in some, but not all, studies.

Breath-holding spells are a common problem affecting about 27% of healthy children. These spells have been associated with iron-deficiency anemia, and several studies have reported improvement of breath-holding spells with iron supplementation.

People who fit into one of these groups, even pregnant women, shouldn’t automatically take iron supplements. Fatigue, the first symptom of iron deficiency, can be caused by many other things. A doctor should assess the need for iron supplements, since taking iron when it isn’t needed does no good and may do some harm.

Best Form to Take

All iron supplements are not the same. Ferrous iron (e.g. ferrous sulfate) is much better absorbed than ferric iron (e.g. ferric citrate). The most common form of iron supplement is ferrous sulfate, but it is known to produce intestinal side effects (such as constipation, nausea, and bloating) in many users. Some forms of ferrous sulfate are enteric-coated to delay tablet dissolving and prevent some side effects, but enteric-coated iron may not absorb as well as iron from standard supplements. Other forms of iron supplements, such as ferrous fumarate, ferrous gluconate, heme iron concentrate, and iron glycine amino acid chelate are readily absorbed and less likely to cause intestinal side effects.

Interactions

Interactions with Supplements, Foods, & Other Compounds

Many foods, beverages, and supplements have been shown to affect the absorption of iron.

Foods, beverages and supplements that interfere with iron absorption include

  • Green tea  (Camellia sinensis). This effect may be desirable for people with iron overload diseases, such as hemochromatosis. The inhibitory effect of green tea on iron absorption was 26% in one study.

  • Coffee (Coffea arabica, C. robusta).

  • Red wine, particularly the polyphenol component (also found in tea). Since wine is also a dietary source of iron, it is not clear whether drinking red wine would lead to a deficiency of iron.

  • Phytate (phytic acid), found in unleavened wheat products such as matzoh, pita, and some rye crackers; in wheat germ, oats, nuts, cacao powder, vanilla extract, beans, and many other foods, and in IP-6 supplements.

  • Whole wheat bran, independent of its phytate content, has been shown to inhibit iron absorption.

  • Calcium from food and supplements interferes with heme-iron absorption.

  • Soy protein.

  • Eggs.

Foods and supplements that increase iron absorption include

  • Meat, poultry, and fish.

Although vitamin C increases iron absorption, the effect is relatively minor.

Taking vitamin A with iron helps treat iron deficiency, since vitamin A improves the absorption and/or utilization of iron.

Although soy protein has been shown to decrease iron absorption (see above), certain soy-containing foods (e.g. tofu, miso, tempeh) have significantly improved iron absorption. Some soy sauces may also enhance iron absorption.

Alcohol, but not red wine, has been reported to increase the absorption of ferric, but not ferrous, iron.

Iron has been reported to potentially interfere with manganese absorption. In one trial, women with high iron status had relatively poor absorption of manganese. In another trial studying manganese/iron interactions in women, increased intake of “non-heme iron”—the kind of iron found in most supplements—decreased manganese status. These interactions suggest that taking multiminerals that include manganese may protect against manganese deficiencies that might otherwise be triggered by taking isolated iron supplements.

Interactions with Medicines

Certain medicines interact with this supplement.

May Be Beneficial: Some medicines may increase the need for this supplement.
Avoid: Some medicines interact with this supplement, so they should not be taken together.
Check: Some interactions between this supplement and certain medicines require more explanation. Click the link to see details.

Note: The following list only includes the generic or class name of a medicine. To find a specific brand name, use the Medicines Index.

May Be Beneficial: Amlodipine-Benazepril
May Be Beneficial: Aspirin
May Be Beneficial: Benazepril
May Be Beneficial: Cimetidine
May Be Beneficial: Dipyridamole
May Be Beneficial: Enalapril
May Be Beneficial: Etodolac
May Be Beneficial: Famotidine
May Be Beneficial: Fosinopril
May Be Beneficial: Haloperidol
May Be Beneficial: Hyoscyamine
May Be Beneficial: Ibuprofen
May Be Beneficial: Lisinopril
May Be Beneficial: Magnesium Hydroxide
May Be Beneficial: Moexipril
May Be Beneficial: Nabumetone
May Be Beneficial: Naproxen
May Be Beneficial: Neomycin
May Be Beneficial: Nizatidine
May Be Beneficial: Oxaprozin
May Be Beneficial: Perindopril
May Be Beneficial: Quinapril
May Be Beneficial: Ramipril
May Be Beneficial: Ranitidine
May Be Beneficial: Sodium Bicarbonate
May Be Beneficial: Stanozolol
May Be Beneficial: Trandolapril
Avoid: Carbidopa
Avoid: Carbidopa-Levodopa
Avoid: Ciprofloxacin
Avoid: Deferoxamine
Avoid: Demeclocycline
Avoid: Doxycycline
Avoid: Gemifloxacin
Avoid: Levofloxacin
Avoid: Methyldopa
Avoid: Ofloxacin
Avoid: Penicillamine
Avoid: Risedronate
Avoid: Sulfasalazine
Avoid: Tetracycline
Avoid: Warfarin
Check: Captopril
Check: Desogestrel-Ethinyl Estradiol
Check: Dessicated Thyroid
Check: Ethinyl Estradiol and Levonorgestrel
Check: Ethinyl Estradiol and Norethindrone
Check: Ethinyl Estradiol and Norgestimate
Check: Ethinyl Estradiol and Norgestrel
Check: Indomethacin
Check: Levonorgestrel
Check: Levonorgestrel-Ethinyl Estrad
Check: Levothyroxine
Check: Liothyronine
Check: Liotrix
Check: Mestranol and Norethindrone
Check: Minocycline
Check: Norgestimate-Ethinyl Estradiol

Side Effects

Side Effects

Caution: Iron (ferrous sulfate) is the leading cause of accidental poisonings in children. The incidence of iron poisonings in young children increased dramatically in 1986. Many of these children obtained the iron from a child-resistant container opened by themselves or another child, or left open or improperly closed by an adult. Deaths in children have occurred from ingesting as little as 200 mg to as much as 5.85 grams of iron. Keep iron-containing supplements out of a child’s reach.

Hemochromatosis, hemosiderosis, polycythemia, and iron-loading anemias (such as thalassemia and sickle cell anemia) are conditions involving excessive storage of iron. Supplementing iron can be quite dangerous for people with these diseases.

Supplemental amounts required to overcome iron deficiency can cause constipation. Sometimes switching the form of iron (see “Which forms of supplemental iron are best?” above), getting more exercise, or treating the constipation with fiber and fluids is helpful, though fiber can reduce iron absorption (see below). Sometimes the amount of iron must be reduced if constipation occurs.

Some researchers have linked excess iron levels to diabetes,cancer, increased risk of infection,systemic lupus erythematosus (SLE), exacerbation of rheumatoid arthritis, and Huntington’s disease. The greatest concern has surrounded the possibility that excess storage of iron in the body increases the risk of heart disease. Two analyses of published studies came to different conclusions about whether iron could increase heart disease risk. One trial has suggested that such a link may exist, but only in some people (possibly smokers or those with elevated cholesterol levels). The link between excess iron and any of the diseases mentioned earlier in this paragraph has not been definitively proven. Nonetheless, too much iron causes free radical damage, which can, in theory, promote or exacerbate most of these diseases. People who are not iron deficient should generally not take iron supplements.

Patients on kidney dialysis who are given injections of iron frequently experience “oxidative stress”. This is because iron is a pro-oxidant, meaning that it interacts with oxygen molecules in ways that can damage tissues. These adverse effects of iron therapy may be counteracted by supplementation with vitamin E.

Supplementation with iron, or iron and zinc, has been found to improve vitamin A status among children at high risk for deficiency of the three nutrients.

People with hepatitis C who have failed to respond to interferon therapy have been found to have higher amounts of iron within the liver. Moreover, reduction of iron levels by drawing blood has been shown to decrease liver injury caused by hepatitis C. Therefore, people with hepatitis C should avoid iron supplements.

In some people, particularly those with diabetes, insulin resistance syndrome, or liver disease, a genetic susceptibility to iron overload has been reported.

References

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3. Bloem MW. Interdependence of vitamin A and iron: an important association for programmes of anaemia control. Proc Nutr Soc 1995;54:501–8 [review].

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5. Orehek AJ, Kollas CD. Refractory postpartum anemia due to vitamin B6 deficiency. Ann Intern Med 1997;126(10):834–5 [letter].

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11. Neufeld EJ, Mandel H, Raz T, et al. Localization of the gene for thiamine-responsive megaloblastic anemia syndrome, on the long arm of chromosome 1, by homozygosity mapping. Am J Hum Genet 1997;61:1335–41.

12. Samuels, AJ. Studies in patients with functional menorrhagia: the antimenorrhagic effect of the adequate replication of iron stores. Isr J Med Sci 1965;1:851–3.

13. Taymor ML, Sturgis SH, Yahia C. The etiological role of chronic iron deficiency in production of menorrhagia. JAMA 1964;187:323–7.

14. Mechrefe A, Wexler B, Feller E. Sports anemia and gastrointestinal bleeding in endurance athletes. Med Health R I 1997;80:216–8.

15. Clarkson PM. Micronutrients and exercise: anti-oxidants and minerals. J Sports Sci 1995;13:S11–24 [review].

16. Smith JA. Exercise, training and red blood cell turnover. Sports Med 1995;19:9–31.

17. Smith JA. Exercise, training and red blood cell turnover. Sports Med 1995;19:9–31 [review].

18. Brownlie T 4th, Utermohlen V, Hinton PS, et al. Marginal iron deficiency without anemia impairs aerobic adaptation among previously untrained women. Am J Clin Nutr 2002;75:734–42.

19. Friedmann B, Weller E, Mairbaurl H, Bartsch P. Effects of iron repletion on blood volume and performance capacity in young athletes. Med Sci Sports Exerc 2001;33:741–6.

20. Hinton PS, Giordano C, Brownlie T, Haas JD. Iron supplementation improves endurance after training in iron-depleted, nonanemic women. J Appl Physiol 2000;88:1103–11.

21. Zhu YI, Haas JD. Altered metabolic response of iron-depleted nonanemic women during a 15-km time trial. J Appl Physiol 1998;84:1768–75.

22. Nielsen P, Nachtigall D. Iron supplementation in athletes. Current recommendations. Sports Med 1998;26:207–16 [review].

23. Brutsaert TD, Hernandez-Cordero S, Rivera J, et al. Iron supplementation improves progressive fatigue resistance during dynamic knee extensor exercise in iron-depleted, nonanemic women. Am J Clin Nutr 2003;77:441–8.

24. Konofal E, Lecendreux M, Arnulf I, Mouren MC. Iron deficiency in children with attention-deficit/hyperactivity disorder. Arch Pediatr Adolesc Med 2004;158:1113–5.

25. Konofal E, Lecendreux M, Deron J, et al. Effects of iron supplementation on attention defecit hyperactivity disorder in children. Pediatr Neurol 2008; 38:20-6.

26. Konofal E, Lecendreux M, Deron J, et al. Effects of iron supplementation on attention deficit hyperactivity disorder in children. Pediatr Neurol 2008;38:20–6.

27. Porter SR, Scully C, Flint S. Hematologic status in recurrent aphthous stomatitis compared to other oral disease. Oral Surg Oral Med Oral Pathol 1988;66:41–4.

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