Oral Iron Supplements, how much and when

I see so much false information. I think it's time for the whole story on iron supplementation. This is going to be long. I will try to include links. I will update if someone has better info.

(I apologize for the fast format, feel free to comment and I will try to fix stuff)

TLDR: at the bottom

**TESTING:**

Testing is so important for lots of reasons. First to see if you body is even capable of absorbing the iron. I tried multiple over the counter iron supplements and retested after 6 months. Did it again for a second time and then my doctor prescribed Liquid Ferrous Sulfate. That was the first supplement that worked for me. Since then I have found more convenient and more effective forms.

I test every 4-6 months. If you haven't started supplementing it is always best to test first. Once oral supplements are started the numbers will be skewed.

However, if it is difficult to get a test, oral iron supplements are considered safe except for a few people who have hemochromatosis. The body produces a substance called hepcidin to prevent iron overload. This will be explained later. Supplement for 3 - 4 months and see if the symptoms RLS get better.

Ask for a morning fasted full iron panel. In the morning because ferritin is lowest in the morning, shoot for first appointment of the morning.

Fast for at least 12 hours prior to the blood draw. What is eaten directly affects ferritin levels.

Do not supplement at all before test. Once oral supplements are started the numbers will get skewed.

A full iron panel consists of four numbers

Ferritin needs to be above 100, not "Fine" at 30.

Serum iron

Transferrin Saturation Percentage may be more important than Ferritin. If TSP is less than 20% an infusion should be considered. It would take years of oral supplements to get iron levels up.

TIBC - Total iron binding capacity

**Types of iron:**

Iron sulfate and ferrous bisglycinate are two different forms of iron supplements. Both are effective at increasing iron levels in the body, but they have different absorption rates and side effects.

**Iron sulfate** is the most common form of iron supplement. It is inexpensive and widely available. However, it is also the least well-absorbed form of iron, and it can cause gastrointestinal side effects such as constipation, nausea, and diarrhea.

**Ferrous bisglycinate** is a newer form of iron supplement that is chelated with the amino acid glycine. This makes it more easily absorbed by the body and less likely to cause gastrointestinal side effects.

This study compares Ferrous Bisglycinate to Ferrous Fumerate

[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8839493/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8839493/)

"One in particular, ferrous bisglycinate, has been demonstrated to have at least two-fold higher bioavailability and absorption compared to conventional iron salts, including ferrous sulfate and ferrous fumarate, while also resulting in improved oral tolerability during pregnancy."

"The role of ascorbic acid in iron homeostasis relates to its prolific ability to enhance enteric iron absorption. It is effective at restoring iron balance and imparts metabolic benefits, owing to its antioxidant and anti-inflammatory properties. Ascorbic acid alone over a two-month period has been definitively shown to correct IDA in supplemented subjects ."

Ascorbic Acid is Vitamin C.

Some iron is tolerated better than others. I started with liquid ferrous sulfate, it worked well for me.

**When should you take iron?**

Take iron at night when the brain needs it the most. Seriously, there is a circadian rhythm to iron. Serum iron is lowest in the morning and highest at night. A great video to watch explains this around the 26 minute mark.

[https://youtu.be/VVlQKOOrRVs?si=Uc1KygQHqvh5mW\_L](https://youtu.be/VVlQKOOrRVs?si=Uc1KygQHqvh5mW_L)

Take iron about 2 hours before bedtime, works best for me. However 1-3 hours may work better for others.

**Should I take iron every day?**

Yes, everyday, why? The goal is to raise ferritin as quickly as possible. Yes there was a study that showed that iron was better absorbed. The amount percentage of iron absorbed was more, the amount of iron was less. This was explained as the body's response to iron is to produce hepcidin.

**So what about that Hepcidin? (The importance of Vitamin D in iron absorption)**

Clinical Anesthesia (SAE): This textbook states that "vitamin D blocks hepcidin production, a hormone that inhibits iron absorption." (Source: [books.google.com/books?id=M...](https://healthunlocked.com/redirect?url=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DMrwLEAAAQBAJ%26pg%3DPA1859%26lpg%3DPA1859%26dq%3Dvitamin%2Bd%2Bblocks%2Bhepcidin%2Breputable%2Bsources%26source%3Dbl%26ots%3D-Klxao_mcm%26sig%3DACfU3U2Sn-StuNWgu0Vq0AEkpQWC86Z2pA%26hl%3Den))

Frontiers in Physiology: This peer-reviewed journal article states that "vitamin D deficiency has been shown to increase hepcidin levels, which can lead to iron deficiency anemia." (Source: [frontiersin.org/articles/10...](https://healthunlocked.com/redirect?url=https%3A%2F%2Fwww.frontiersin.org%2Farticles%2F10.3389%2Ffphys.2019.01294))

PMC - NCBI: This peer-reviewed journal article states that "vitamin D deficiency is a common cause of anemia, and vitamin D supplementation has been shown to improve iron absorption and reduce hepcidin levels." (Source: [ncbi.nlm.nih.gov/pmc/articl...](https://healthunlocked.com/redirect?url=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2855274%2F))

In addition to these sources, a number of clinical trials have also shown that vitamin D supplementation can reduce hepcidin levels. For example, a 2018 study published in the journal Nutrients found that vitamin D supplementation for 12 weeks significantly reduced hepcidin levels in people with chronic kidney disease.

It has been harder for me to raise my Vitamin D than it has been to raise my ferritin. For the record I take at least 10000IU a day sometimes more.

**This may explain why vitamin D is so effective for RLS!**

Sleep Medicine: A peer-reviewed journal article published in Sleep Medicine in 2015 found that vitamin D supplementation significantly improved RLS symptoms in patients with vitamin D deficiency.

PLOS One: A peer-reviewed journal article published in PLOS One in 2016 found that vitamin D supplementation was effective in reducing RLS symptoms in patients with chronic kidney disease.

Journal of Clinical Sleep Medicine: A peer-reviewed journal article published in the Journal of Clinical Sleep Medicine in 2017 found that vitamin D supplementation improved RLS symptoms and sleep quality in patients with moderate to severe RLS.

Neurology: A peer-reviewed journal article published in Neurology in 2018 found that vitamin D supplementation was associated with a reduction in RLS symptoms in patients with Parkinson's disease.

**How much iron should I take?** It depends on the type of iron being taken.

Ferrous Sulfate 325mg equals 65mg of elemental iron.

Ferrous Bisglysinate 120milligrams is the amount used in the study above. Since the biggest tablet I can find it 45mg, I take three of them or 3 \* 45mg = 135mg a day!

**TLDR;**

1) Test first, but not necessary if unavailable.

2) There are different types of iron supplements. Ferrous Sulfate, ferrous bisglysinate, ferrous fumerate etc.. Ferrous Sulfate comes in a liquid form and can be easier on the stomach, one study called it the "Gold Standard". However a newer form seems to be more tolerable, have less gastro side effect and is more bioavailable called **Ferrous Bisglysinate.**

3) Take enough iron, start with either 325 mg of Ferrous OR 120 mg of Ferrous Bisglysinate. This is to get started. After testing it may be ok to trim back

4) Take iron at night about 1-3 hours before bed. Take iron an empty stomach. Nothing to eat two hours or one hour after. The iron binds with the proteins in the stomach and can cause black tarry stools. I have never had issues if I follow this rule.