Iron Health

If you suspect that you have iron deficiency or iron deficiency anemia, consult your healthcare practitioner.

If you have signs and/or symptoms of iron deficiency or iron deficiency anemia, your healthcare practitioner would recommend bloodwork to check the levels of hemoglobin and serum ferritin, among other blood factors. Lower than normal hemoglobin levels may indicate anemia, and lower than normal serum ferritin levels may indicate iron deficiency.

Management of iron deficiency and iron deficiency anemia depends on the underlying cause and severity. Treatment commonly includes dietary modification and iron supplementation, with oral iron frequently used as an initial approach. Intravenous iron may be considered in certain clinical situations. Treatment decisions are individualized and guided by a healthcare professional [2,12].

The duration of oral iron therapy depends on how severe the deficiency is and the underlying cause. Hemoglobin levels often improve within two to four months, but restoring iron stores may take longer. Iron supplements are often continued for a period after hemoglobin levels return to normal to help rebuild iron stores 1,2,12.

According to the approved label, iron supplements may be used for 3–6 months after hemoglobin levels have returned to normal.

Consult your health care provider prior to use and for prolonged use. A healthcare professional can monitor blood tests and determine the appropriate duration of treatment.

Oral iron supplements may cause nausea, vomiting, dyspepsia, constipation, diarrhea or dark stools [1].

Vitamin C can help improve the absorption of non-heme iron, particularly iron salts such as ferrous sulfate, ferrous fumarate, and ferrous gluconate. Taking vitamin C at the same time as these forms of iron may help the body absorb more iron. In some cases, about 600–1200 mg of vitamin C has been used to help improve absorption 1. Certain foods, supplements, and medications may reduce iron absorption. For example, calcium, tea, coffee, and some acid-reducing medications can affect how well iron is absorbed [1]. Recommendations on how to take iron and whether vitamin C should be used may vary depending on the type of iron and individual needs. A healthcare professional or pharmacist can provide guidance on how to take iron supplements appropriately.

Iron absorption can be influenced by certain foods, beverages, supplements, and medications. Foods and beverages that may reduce iron absorption include [1]:

• Tea and coffee, due to their polyphenol content
• Foods high in calcium, such as milk and dairy products
• Foods high in phytates, including whole grains, legumes, nuts, and seeds
• Foods high in fiber when consumed at the same time as iron

Substances that may increase iron absorption 1:

• Meat, poultry and seafood can enhance non-heme iron absorption
• Medications and supplements that may reduce iron absorption include:
  • Calcium supplements
  • Antacids and acid-reducing medications, including proton pump inhibitors and H2 blockers
  • Some antibiotics and medications that bind iron in the gastrointestinal tract

The effect of food and medications on iron absorption can vary depending on the type of iron, dose, and individual clinical factors. A healthcare professional or pharmacist can provide guidance on how to take iron based on individual needs.

Several forms of oral iron supplements are available in Canada. These include iron salts, iron complexes, polysaccharide iron formulations, polydextrose iron complex, and heme-based iron products. These products differ in how iron is bound and delivered in the body [8]. The choice of iron supplement depends on clinical considerations, tolerability, and guidance from a healthcare professional.

Iron deficiency is one of the most common nutritional deficiencies in Canada. It affects certain populations more frequently, including women of reproductive age, pregnant individuals, infants, children, adolescents, and older adults. National survey data indicate that iron deficiency and iron deficiency anemia remain public health concerns, particularly among groups with increased iron requirements or risk of inadequate intake. The prevalence varies by age, sex, physiological status, and dietary patterns. Assessment and diagnosis require evaluation by a healthcare professional using clinical and laboratory information [13].

Foods containing heme iron [14]:

• Heme iron is found in animal-based foods and is generally absorbed more efficiently.
• Red meat (beef, lamb)
• Poultry
• Fish and shellfish

Foods containing non-heme iron 14:

• Non-heme iron is found in plant-based foods and some fortified products.
• Legumes such as lentils, chickpeas, and beans
• Dark leafy greens such as spinach and kale
• Whole grains and iron-fortified cereals
• Nuts and seeds
• Tofu and other soy products

People following a vegan or vegetarian diet can obtain iron from a variety of plant-based foods. These foods contain non-heme iron, which is absorbed less efficiently than heme iron but can still contribute meaningfully to iron intake. Plant-based sources of iron include [14]:

• Legumes such as lentils, chickpeas, beans, and split peas
• Tofu, tempeh, and other soy products
• Dark leafy greens such as spinach, kale, and Swiss chard
• Whole grains and iron-fortified cereals and breads
• Nuts and seeds, including pumpkin seeds, sesame seeds, and cashews
• Dried fruits such as raisins, apricots, and prunes

A healthcare professional or registered dietitian can provide individualized dietary advice, particularly for those with higher iron requirements.