11

Iron

Iron is sold over the counter in supplement form, but it’s a naturally occurring mineral found in many foods. Even though the World Health Organization considers iron deficiency the number one nutritional disorder in the world, I don’t frequently recommend iron supplements for people complaining of fatigue because most US citizens have an adequate supply. Iron can be hard on the gut, causing nausea, cramping, and diarrhea or constipation. That said, if you have a blood test that shows that you are deficient in iron or if your doctor recommends an iron supplement, then by all means please take it.

Your body must have iron in order to make a protein called hemoglobin, which acts like a tow truck and lugs oxygen all over your body. It’s amazing that humans can stash away some iron until it’s needed again, so you might say it’s recyclable. And speaking of going green, your stool can turn this color when you take iron supplements of any type. They can also simply darken, or even turn almost black. It’s easy to overdo iron since it accumulates, making it particularly dangerous to tots. So if you do take an iron supplement, make sure to lock it up in your medicine cabinet.

In addition to fatigue, a number of other symptoms could signal an iron deficiency. For example, you may feel cranky, depressed, and have trouble concentrating. Pale skin and a pale or sore tongue are dead giveaways. You might have brittle nails or be prone to infections as a result of a weakened immune system. And your heart may beat like crazy upon very little exertion. Other conditions and nutritional deficiencies paint the same picture, so teasing out iron deficiency from other health issues is not always easy, but it’s incredibly important if you ever want to build up your energy reserves.

Iron is so important to your energy level that without enough of this metal, you will develop hypothyroidism (low thyroid hormone). So if you’ve been told that you have low thyroid, it may stem from an iron deficiency. You need adequate amounts of iron for your inactive precursor thyroid hormone (T4) to be converted into your active, energizing thyroid hormone (T3). Iron also helps carry T3 across cell membranes so it can do its energy-producing job inside the cells. In fact, iron deficiency anemia is one commonly overlooked cause of hypothyroidism. It makes me sad that many people receive a prescription for Synthroid or Armour Thyroid that they need to take for the rest of their lives (and have to increase the dose over time) when what they really need is iron! It’s important to note that you should not make a decision to switch from your prescription medication to an iron supplement on your own. You need appropriate testing and your doctor’s expertise to determine whether you fall into this category.

Doctors utilize many tests to determine iron levels. Two fairly reliable ones are the serum ferritin and transferrin saturation ratio tests. If appropriate blood testing finds that you are legitimately deficient in iron, then this nutrient will breathe life back into you very quickly—in about 3 to 6 months. Please note, though, that some people can take iron supplements orally for many months and not respond, meaning their blood levels stay low or they still feel very tired or have hypothyroidism. This may be the result of undiagnosed leaky gut, which I’ll explain momentarily.

By the way, if you must take both a prescription thyroid hormone and an iron supplement, do not take them together. Separate the iron from the thyroid by 4 to 6 hours, or they could cancel each other out. Drug interactions aren’t the only situation that will cause you to not absorb the iron. It can occur for other reasons related to medical conditions, like low stomach acid or a leaky gut. Leaky gut is the term used when the intestinal lining becomes damaged and large openings develop in the gut wall as a result. Normally, the walls of the colon remain tightly sealed to protect you from reabsorbing waste that is about to get eliminated. Some of the toxic debris (such as undigested food particles and toxins) breaks through the walls of the gut, hence the syndrome is called leaky gut. It’s not well recognized by conventional physicians; however, the condition definitely exists, and having leaky gut may be the cause of hundreds of diseases because the toxins that leak through your gut can lodge in any organ of your body and cause symptoms. Most people understand that a gluten allergy results from wheat proteins that leak out of the gut; this is, perhaps, the most common example of damage done by a leaky gut. Also, the yeast known as Candida albicans is a common cause of leaky gut. This fungus is the cause of hundreds of diseases.

Finally, people who are allergic to milk may be allergic because the casein protein has found its way into their bloodstreams from their leaky guts! Are you getting the picture? Holes in your colon will cause you to leak out toxins that make mayhem in your body. Leaky gut syndrome prevents proper absorption of vitamins and minerals, iron included.

In my book, leaky gut is a known drug mugger for all sorts of nutrients because it causes malabsorption. Hypochlorhydria, or low stomach acid, will also cause iron deficiency. It’s easy enough to test for low stomach acid; your doctor can order a blood test known as a gastrin test. If the test shows that you need acid, you can buy healthy digestive acids variously labeled trimethylglycine, betaine HCl, or betaine hydrochloride at any health food store. Follow the label directions closely to enjoy the benefits without getting heartburn. Testing for leaky gut can be done through either Genova Diagnostics or Metametrix Clinical Laboratory. (See information about these companies in Resources on page 327.)

Certain groups of people seem to run out of iron most easily. They include:

You can see that there are a lot of people who can become iron deficient. When I interviewed oncologist John Lohrey, MD, a physician who has experience with patients suffering from anemia and who practices in Tulsa, Oklahoma, he had a lot to share with my readers. He makes this great point in regard to iron: “Anyone besides a menstruating female who is iron deficient should have a colonoscopy in order to rule out colon cancer. It doesn’t matter if the stools don’t show blood in them, as bleeding can be very slight or noncontinuous.”

Having this test done could save your life because it could detect colon cancer early on. If a premenopausal woman finds blood in her stool, she should have a colonoscopy, too, according to Dr. Lohrey. “A less common place to lose blood is the genitourinary tract,” he says. “Iron-deficient patients should also have a urinalysis to rule out blood in the urine as well.”

People with kidney disease (especially if they are undergoing dialysis) tend to run out of iron because their kidneys are no longer able to create a hormone (erythropoietin) that forms red blood cells. People who drink a lot of dark grape juice or red wine also need additional iron.

Unless your doctor advises taking a supplement, you may be able to replenish your iron stores simply by eating iron-rich foods such as clams, oysters, mussels, liver, beans, lentils, and pumpkin seeds. And do drink some orange juice along with these foods, as the vitamin C bolsters iron absorption.

One more note of caution: There is a new theory on multiple sclerosis that suggests that iron accumulation in the brain causes lesions and symptoms. If you have MS, please watch my video on “The Liberation Treatment for MS and CCSVI,” which is posted at www.youtube.com, and read my article “New Discovery: Liberation Treatment for Multiple Sclerosis,” which is posted at my Web site, www.DearPharmacist.com. Iron supplementation in this group of people should perhaps be avoided.

Drug Muggers of Iron

Acid Blockers

Cimetidine (Tagamet)

Esomeprazole (Nexium)

Famotidine (Pepcid and Pepcid Complete)

Nizatidine (Axid)

Omeprazole (Prilosec OTC)

Pantoprazole (Protonix)

Rabeprazole (Aciphex)

Ranitidine (Zantac)

Analgesics

Butalbital-containing drugs (Fiorinal, Fioricet, Zebutal)

Carisoprodal and aspirin (Soma Compound)

Hydrocodone and aspirin (Lortab ASA, Alor 5/500)

Oxycodone and aspirin (Percodan)

Antacids

Aluminum and magnesium hydroxide (Maalox, Mylanta)

Aluminum carbonate gel (Basaljel)

Aluminum hydroxide (Amphojel, AlternaGEL)

Calcium carbonate (Tums, Titralac, Rolaids)

Magnesium hydroxide (Phillips’ Milk of Magnesia)

Sodium bicarbonate (Alka-Seltzer, baking soda)

Antibiotics (a few examples)

Amoxicillin (Amoxil)

Azithromycin (Z-Pak)

Cefaclor (Ceclor)

Cefdinir (Omnicef)

Cephalexin (Keflex)

Ciprofloxacin (Cipro)

Clarithromycin (Biaxin)

Doxycycline (Doryx)

Erythromycin (E.E.S.)

Levofloxacin (Levaquin)

Minocycline (Minocin)

Neomycin (found in some eyedrops, eardrops, and antibiotic ointments)

Sulfamethoxazole and trimethoprim (Bactrim Septra)

Tetracycline (Sumycin)

Anti-inflammatory drugs

(NSAIDs)

Celecoxib (Celebrex)

Diclofenac (Voltaren)

Ibuprofen (Motrin, Advil)

Indomethacin (Indocin)

Ketoprofen (Orudis)

Methocarbamol and aspirin (Robaxisal)

Naproxen (Aleve, Anaprox, Naprosyn)

Sulindac (Clinoril)

Antivirals

Delavirdine (Rescriptor)

Foscarnet (Foscavir)

Lamivudine (Epivir)

Nevirapine (Viramune)

Zidovudine, AZT (Retrovir)

Zidovudine and Lamivudine (Combivir)

Bisphosphonate Bone-Building Drugs (Iron can prevent their absorption, so an iron supplement should be taken 2 to 4 hours later.)

Alendronate (Fosamax)

Etidronate (Didronel)

Risedronate (Actonel)

Tiludronate (Skelid)

Blood Pressure Drugs

Methyldopa (Aldomet)

Diuretics, loop:

Bumetanide (Bumex)

Ethacrynic acid (Edecrin)

Furosemide (Lasix)

Diuretics, potassium-sparing:

Amiloride (Midamor)

Spironolactone (Aldactone)

Triamterene (Dyazide, Dyrenium. Maxzide)

Diuretics, sulfonamide:

Indapamide (Lozol) This is a “sulfonamide” medication, and those types of drugs deplete iron; however, there is not a direct study for this medication and the depletion effect.

Chelating Agent

Penicillamine (Cuprimine)

Cholesterol Agents

Cholestyramine resin (Questran)

Colestipol (Colestid)

Parkinson’s drugs

Levodopa (L-dopa or Larodopa)

Levodopa and carbidopa (Sinemet)

Levodopa, carbidopa, and entacapone (Stalevo) (Stalevo has not been shown to deplete iron; however, it contains levodopa as one of its ingredients.)

Salicylates

Aspirin (Bayer, Ecotrin, St. Joseph)

Aspirin and dipyridamole (Aggrenox)

Sulfonamides

Sulfa antibiotics, some diabetic medications

Thyroid Medicine

Armour Thyroid (Thyroid hormone)

Levothyroxine (Levoxyl, Synthroid, Unithroid)

MISC:

Alcohol

Allopurinol (not a drug mugger; it boosts absorption of iron)

Coffee and tea (even decaf!) (It’s okay to drink coffee or tea, but separate the beverage from your iron supplement by a couple of hours.)

Dairy products (These reduce absorption of iron supplements.)

Excess zinc supplementation (zinc and iron have to stay in balance, excess zinc inhibits iron uptake)

Hypochlorhydria (low levels of stomach acid)

Grape juice

Low ferritin levels

Red wine

Riboflavin muggers (See Chapter 19 on page 233)

Iron: Put This on Your Plate

Meat, poultry, and fish all contain iron in a form that’s easy to absorb. Other sources include Swiss chard, spinach, thyme, turmeric, dill weed, cinnamon, parsley, rosemary, blackstrap molasses, mustard greens, turnip greens, green beans, shiitake mushrooms, asparagus, chickpeas, leeks, tofu, olives, lentils, kelp, and sesame seeds. Tea may reduce the absorption of iron from fruits and vegetables, so drink it 1 to 2 hours away from eating produce.

An Absurdly Inexpensive Way to Feel Better

For general health: Just eat iron-rich foods because excessive iron supplementation can backfire and turn into free radicals, which then have a toxic oxidative effect on tissues, especially the lining of your blood vessels. This is one of those moments when too much of a good thing turns bad, so unless you are known to be deficient in iron as measured by a serum ferritin blood test, don’t supplement for longer than 3 months. Men need approximately 10 to 20 mg per day, whereas menstruating, pregnant, or lactating women tend to need more, approximately 20 to 30 mg per day.

Drug mugger dose: About 20–30 mg elemental iron each day for up to 3 months. Don’t take your iron supplement within 2 hours of other minerals (like calcium or dairy products). It may take several weeks to months before optimal benefits are seen. A harmless discoloration of the stool often occurs, turning it dark green or black. This is normal and caused by iron that fails to get absorbed. Remember, the mineral itself is very dark.

Just So You Know

Don’t take your iron with dairy products. Typical side effects of most iron supplements include stomach upset, gas, constipation (or diarrhea), heartburn, cramps, and nausea. These problems can be minimized or eliminated altogether by taking your supplement in the form of iron bisglycinate, iron glycinate, or ferrous bisglycinate. These are chelated forms of iron, which means that amino acids are attached to the mineral. In these examples, two molecules of the amino acid glycine are bound to one molecule of iron. This unique form is absorbed through the intestinal tract like any other amino acid without the usual irritation and constipation that most forms of iron cause. This is why I often recommend taking minerals in chelated form. Generally, this type is taken up easily and causes fewer side effects.

The human body appears to have a built-in limit for chelated iron bisglycinate and won’t take up more than you need. So you are also safer when you take iron bisglycinate. This is important since iron is toxic in large quantities and is one of the leading causes of poisoning and death in young children. In adults, excessive amounts can cause oxidative damage because it can form free radicals.

While various brands of iron bisglycinate may be found in many health food stores and doctors’ offices, the average family physician or pharmacist may not have heard of it. There is plenty of research regarding its safety and efficacy available on the Internet, and I prefer this form myself, having taken iron on and off for more than a year. I noticed that my nails grew like crazy and became beautiful for the first time in my life.

It’s ideal to take iron supplements on an empty stomach, but minerals are irritating to the gut, so if it upsets your stomach, take it with food. The bisglycinate form should not affect you, however. With any type of iron supplement, don’t take it within 2 hours before or after consuming antacids, eggs, whole grain breads, milk, cereal, tea, or coffee. With most OTC brands of iron sold in pharmacies (i.e., ferrous sulfate, ferrous gluconate, ferrous fumarate, and others), it’s relatively easy to get too much, unlike with iron bisglycinate. As noted earlier, you are safer with iron bisglycinate because it is nonconstipating and also because your body has a mechanism to keep you from absorbing too much. Nevertheless, I hardly ever recommend taking an iron supplement unless blood tests confirm that you are deficient and your symptoms support the test results.

There are a few instances in which supplementation is safe and advised, when the right amount can make a tremendous difference in your life. For example, if you are being mugged by a drug, if you are truly iron deficient, or if you are a regular blood donor or have heavy periods, then I feel it’s okay to supplement with low doses for a short period of time. Remember, if you have children, be especially vigilant about your medicine cabinet because iron overdose is extremely dangerous to kids.

Install a Nutrient Security System

Although orange juice does not contain iron, it is considered helpful to drink a glass of orange juice each day to help boost the amount of iron your body absorbs; the vitamin C in OJ increases the absorption rate. Drinking OJ may not be enough for some individuals who need a real boost. If your doctor really wants you to drive the iron into your body, he or she may suggest vitamin C supplements instead of juice. In this case (and it’s not for everyone), take about 200 mg of vitamin C along with your 20 to 30 mg elemental iron dose. I’m not recommending supplemental vitamin C for everyone, though, because it increases the side effects of iron, but if you are trying to install a tight security system, this is one way.

The other way is to take the supplement betaine hydrochloride or trimethylglycine (sold at health food stores) with your meals and your iron supplement. Take them all together. This supplement provides a little stomach acid. Many people today have low stomach acid (hypochlorhydria), so they don’t absorb their iron well and they burp a lot after eating. This supplement improves digestion and iron absorption for most people.

There should be no side effects, but if you develop heartburn after doing this, you may not need the betaine after all. And if you take an acid blocker, naturally you’ll want to avoid the acid these supplements provide. (That opens up another can of worms because many people who take acid blockers actually need acid. For more information about this, you’ll have to read my article “Heartburn? My Gut Feeling Is That You Need More Acid,” which is posted on my Web site.)

What’s in My Cupboard?

Iron 18 mg Capsules: Non Constipating Iron Bisglycinate by Bluebonnet: These are easy-to-swallow, small, tasteless capsules that provide elemental iron in the nonconstipating chelated form. You can find this product at health food stores.

Iron Glycinate by Xymogen: This brand is sold in doctors’ offices. It provides 29 mg of pharmaceutical-grade iron per capsule. You’ll have to ask your physician to order it for you.

Comfort Iron (Iron Bisglycinate) by Vitamin Shoppe: This product can be found at Vitamin Shoppes nationwide. It is called Comfort Iron because it is the iron bisglycinate form. Each veggie cap provides 25 mg elemental iron.

Easy Iron by Country Life: This is another easy-to-find brand of iron bisglycinate. Like the others, it is a pure form of bioavailable iron, so it’s easy on the tummy.

Ferrochel Iron with B Vitamins by Nutraceutical Sciences Institute (NSI): This brand of iron bisglycinate is sold at Vitacost.com. I like it because it also contains all the B vitamins—thiamine, riboflavin, niacin, folic acid, pyridoxine, and B12 (as methylcobalamin). This product could be extremely helpful if you are anemic and stressed out, because the iron helps the anemia and the B vitamins help you cope by supporting your adrenal glands. Remember, the Bs are called stress vitamins for a reason. It’s a powerful combination. Contact information: www.vitacost.com.

Energizing Iron with Eleuthero by Enzymatic Therapy: This product contains a highly absorbable form of iron derived from beef liver, along with the right amounts of B12 and trace minerals to help you absorb it. The herb eleuthero is great for energy. Even though this iron is animal derived, it’s absorbable and does not raise your cholesterol.

Polysaccharide Iron by Niferex, Nu-Iron, or a store brand: This form of iron is slightly better tolerated than ferrous sulfate, and it’s easy to find at pharmacies. If it’s not in the vitamin aisle, ask the technician because sometimes these brands are kept behind the pharmacy counter. One capsule offers 150 mg polysaccharide iron complex. I like this brand, but it’s not quite as digestible as the bisglycinate forms.

Spirulina Pacifica by Nutrex Hawaii: Spirulina is a blue-green alga that occurs naturally in the ocean, and it’s one of those supplements I take every day because it is so energizing and detoxifying. This company is dedicated to production of spirulina, which many experts call a superfood. They offer both tasteless softgels and a powder that can be mixed in juice (because it has a unique flavor). Spirulina contains a lot of iron along with other minerals and proteins that work in a synergistic manner. To produce this product, the company uses pristine water that is dedicated to growing algae. It’s going to give you iron and other minerals, but if you have severe iron deficiency anemia, it’s also okay to take an iron bisglycinate supplement. You can check with your doctor.

Spirulina is believed to have anticancer effects, plus it acts as an antihistamine, antiviral, and anti-inflammatory agent. It protects against stroke, too. See why I take it every day?

Ocean’s Alive Marine Phytoplankton by Sunfood: This is concentrated raw food containing phytoplankton straight from the ocean, and it will give you amazing nutritional benefits. The intense chlorophyll content detoxifies the body, neutralizes (chelates) heavy metals, sends fuel to the muscles, and increases energy, heart health, and mental clarity. Although it does not contain a large amount of iron, the combination of all the minerals together in their live forms is synergistic. I take a dropperful in water each day when I’m not taking spirulina. It’s completely tasteless. You can do one or the other each day (spirulina or phytoplankton) to keep your system running in tip-top shape.