Iron substitution
Iron deficiency is the most common nutrient deficiency worldwide: according to the World Health Organisation (WHO), about a quarter of humanity suffers from iron deficiency [1]. Severe iron deficiency and iron deficiency anaemia are treated with iron substitution. What are the options? Can you also take in too much iron?
Options for iron substitution
Food supplements, iron-containing juices, tablets, infusions - the choice of iron substitution is large. Higher-dose preparations are available from pharmacies, but do not require a prescription. The basic rule is: do not self-medicate, because an iron over-supply can also endanger the body.
An apple studded with iron nails to remedy an iron deficiency?
In fact, this old household remedy is not so far-fetched. Brown spots form in the spiked apple after some time: iron malate, the salt of malic acid. Together with the apple's vitamin C, the iron compound is well absorbed by the body. Experts nevertheless advise against it, because the amount of iron is difficult to dose. Because an oversupply of iron is also harmful.
Food supplements
Numerous iron-containing food supplements are available in supermarkets, drugstores, pharmacies and on the internet. They contain a concentrate of nutrients to supplement the human metabolism. The Food Supplements Ordinance specifies which vitamins and minerals are permitted for German products. So far, however, there are no legally stipulated maximum amounts, although efforts are being made to establish uniform European maximum amounts [4]. Currently, the recommendations of the Federal Institute for Risk Assessment (BfR) apply; for iron, this is a maximum daily dose of 6 mg for women between 14 and 50 years. Men, postmenopausal women and pregnant women should only take iron after consulting their doctor [2]. However, these are only recommendations, and many of the products offered have a significantly higher iron content.
Natural iron preparations also belong to the food supplements. They consist of plants with a high iron content without the addition of other active ingredients. They are not high dosed, well tolerated, over-the-counter and effective. They include
- Hemp protein: a holistic food supplement with many minerals and vitamins. A daily portion of 30 g contains about 7.5 mg of iron. Don't worry, edible hemp is free of the narcotic THC!
- Microalgae: Chlorella algae are available as powder or in tablet form. The iron content of a daily dose is 3 to 9 mg, depending on the manufacturer. Spirulina algae, also available as powder or tablets, contain 0.2 to 8 mg of iron per daily dose, depending on the manufacturer.
- Barley grass: The powder or tablets are obtained from dried leaves of the young barley plant. It contains up to 4 mg of iron per daily dose.
Taking vitamin C at the same time increases the availability of iron.
Curry leaf preparations are a special form of natural iron supplements. Capsules made from curry leaf extract consist of about 50 percent curry leaf extract and are mixed with vitamin C to improve the availability of the iron. They contain up to 15 mg of iron per daily dose.
The iron compound iron bisglycinate, also called chelated iron, is particularly easy to digest. It is the salt of the amino acid glycine. Iron chelate is often available as a capsule in combination with acerola cherry extract as a vitamin C supplier with up to 45 mg of iron per capsule.
Iron tablets
Iron tablets come in high concentrations of up to 200 mg per tablet. They are used to treat iron deficiency or iron deficiency anaemia. They contain the readily utilisable bivalent iron in various compounds: Ferrous (II) fumarate, ferrous (II) sulphate, ferrous (II) bisglycinate, ferrous (II) glycine sulphate. For the best possible utilisation of the iron, it is recommended to take the preparation in the morning on an empty stomach one hour before breakfast, if possible with juice containing vitamin C. This way, the absorption rate can reach values of 1.5 to 1.5. In this way, the absorption rate can reach values of up to 40 %. If the iron stores are empty, the therapy takes several months until the stores are replenished.
Iron tablets are often not particularly well tolerated: many patients suffer from nausea, vomiting, diarrhoea, constipation or abdominal pain.
Iron juices
Iron juices can be divided into two groups: Juices from iron-containing fruits, possibly enriched with a small amount of iron, and highly concentrated iron juices, which are traded as food supplements. Iron-containing juices can easily be made by oneself with the right press or juicer. They are low-dosed and can also be drunk as a preventive measure against iron deficiency. Highly concentrated juices are a good alternative to iron tablets; the iron is organically bound as iron gluconate and is better tolerated.
Intravenous iron administration
If there is a severe iron deficiency or iron deficiency anaemia, iron administration as an injection or infusion is the quickest way to supply the body with the necessary iron and thus correct the iron deficiency. The doctor either injects the iron solution directly into the vein or it is administered as an infusion. The iron is thus 100% and directly available. Intravenous therapy is limited to patients in whom oral therapy is not sufficiently effective, e.g. due to intolerance of the oral preparation, in patients with iron absorption disorders or in patients with kidney damage and tumours. There is a risk of allergic reactions, up to and including allergic shock, and a risk of iron overload due to inaccurate dosing.
Danger of overprovision
Food supplements are in vogue - about every third adult in Germany regularly takes food supplements [5]. As a rule, healthy adults can do without food supplements because a balanced and varied diet contains sufficient vitamins and minerals. Some vitamins and minerals are excreted unused when the body is sufficiently supplied. Not so iron: the body can only regulate the iron status to a limited extent via the resorption rate. When the store is full, less of the iron on offer can be utilised, but if too much iron is absorbed, the regulating intestinal cells are damaged and iron enters the blood unhindered.
Only with a few nutrients is the margin between vital intake and harmful dose as narrow as with iron. A study showed that in Germany the number of people with iron surplus is almost as large as the number of people with iron deficiency. In addition to genetically predisposed haemochromatosis, excessive iron supplementation is responsible for this. The increased iron intake leads to iron deposits in the liver, pancreas and heart and thus increases the risk of coronary heart disease, cancer and diabetes.
Iron supplements should therefore only be taken to treat iron deficiency or iron deficiency anaemia under medical supervision. A balanced diet is sufficient to prevent iron deficiency.
Iron and zinc are absorbed in the same way through the intestinal mucosa. If you take high doses of iron, it blocks the common transport pathway for zinc, so that less zinc can be absorbed. You should therefore take iron supplements at a time when you are eating a meal.
Iron storage disease
In Germany, an estimated two to three hundred thousand people suffer from the iron storage disease haemochromatosis [7]. This hereditary disease usually only appears after the age of 50. The protective mechanisms of the intestinal cells do not function, so that the iron content in the body cannot be regulated by the absorption rate. More iron is absorbed in the small intestine and transported to the organs. There are pronounced deposits of iron in the liver, pancreas, pituitary gland, heart and other organs and joints. Taking iron supplements over a longer period of time can lead to serious consequences.
If the iron level in the blood is elevated (above 168 µg/dl), fatigue, hair loss, infection susceptibility and abdominal cramps can occur. Many sufferers experience joint pain in their knees, hips or fingers. In the long term, excess iron is deposited in the organs, which can cause diabetes or damage to the liver, pancreas, heart and joints.
The Hämoglobin (Hb) value indicates how much blood pigment is contained in the red blood cells. The normal value is between 13 and 17 g/dl (grams per decilitre) for men and between 12 and 16 g/dl for women.
The normal Hb value is between 13 and 17 g/dl (grams per decilitre) in men and between 12 and 16 g/dl in women. The most important function of hämoglobin is the transport of oxygen. If the levels are lower, the body can no longer be supplied with sufficient oxygen and symptoms such as tiredness, dizziness or palpitations occur. If the levels are too high, there is an increased risk of vascular occlusion due to the thicker blood.
The normal value for ferritin (abbreviation: FERR, FER or FT) in the blood is between 6 and 120 µg/l in women and between 10 and 400 µg/l in men. Elevated ferritin levels can indicate hemochromatosis (iron storage disease), hepatitis (liver inflammation), anaemia, infections, tumours or overdose of iron supplements.
Ferritin is one of the non-specific tumour markers. In some types of cancer, the ferritin levels in the blood can be elevated. These include breast cancer, pancreatic cancer, liver cell cancer, lung cancer and kidney cancer. Melanoma and neuroblastoma (a type of tumour that arises from nerve tissue cells) can also cause elevated levels.
Conclusion
An iron deficiency or iron deficiency anaemia is treated with iron substitution. Various preparations with different iron compounds and iron contents are available for this purpose. In addition to oral substitution, there is also the option of intravenous therapy, which is, however, only used with justification. Too much iron can lead to health-threatening iron deposits in some internal organs and thus increase the risk of secondary disease.
