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Eating iron-rich foods is a key part of treating iron deficiency anaemia. However, if you are anaemic you are also likely to need iron supplements to build up the iron stores in your body.
Your health care provider is the person who should decide whether you need iron supplementation. Although there is no single laboratory test that specifically indicates iron deficiency ‘anaemia’, several tests are used to determine iron status and the presence of anaemia.1 Iron supplements may be taken as capsules, tablets, elixirs, chewable tablets and liquids. The suggested supplemental iron dosage for healthy adults and adolescents is 10 - 15 mg elemental iron (the amount of iron in a supplement that is available for absorption) a day. Pregnant women can take up to 30 mg, dropping down to 15 mg during breast-feeding. For treating anaemia, the US Centers for Disease Control and Prevention (CDC) recommend a dosage of 60 mg elemental iron twice a day (120 mg per day in total).1 However, if you are anaemic, your doctor should individually evaluate your condition and prescribe the amount of iron you need. Make sure your doctor explains how many pills you should take each day and when you should take them. Taking in more iron than your body needs can cause serious medical problems. TIPS FOR TAKING IRON Iron is absorbed best when taken on an empty stomach. However, some people find that this gives them stomach cramps, constipation, nausea or diarrhoea, and they may need to take their iron with a small amount of food. Milk, calcium and antacids should NOT be taken at the same time as iron supplements. You should wait at least 2 hours after ingesting these before taking your iron supplement. Foods that you should NOT eat at the same time as you take your iron include: ■ high-fibre foods, such as whole grains, raw vegetables and bran ■ foods or drinks containing caffeine. Some doctors suggest taking a vitamin C supplement or drinking orange juice with your iron pill to improve absorption. It’s fine to drink about 250 ml of fluid with an iron pill. Your health care provider should be told what other medicines you are taking. Iron tablets may compromise the effect of other drugs. Examples are antibiotics such as tetracycline, penicillin and ciprofloxacin and drugs for Parkinson’s disease and seizures. At least 2 hours should elapse between doses of these drugs and iron supplements. If you miss a dose or forget to take your iron supplement, take it as soon as you can. If it is almost time for your next dose, wait until then to take it and skip the missed dose. SIDE-EFFECTS AND SAFETY Constipation and diarrhoea are very common in people taking iron supplements. If constipation becomes a problem, take a stool softener such as Movicol. Nausea and vomiting may occur with higher doses, but they can be controlled by taking the iron in smaller amounts. Ask your health care provider about switching to another form of iron rather than just stopping. Black stools are normal when taking iron; in fact, this is considered to be a sign that the tablets are working properly. If the stools are tarry looking as well as black, if they have red streaks, or if you have cramps, sharp pains or pain in the stomach, talk to your health care provider immediately. Liquid forms of iron may stain the teeth ■ Try mixing the iron with water or other liquids (such as fruit juice or tomato juice) and drinking the medicine with a straw. ■ Iron stains can be removed by brushing your teeth with baking soda. Store iron tablets in a cool place. Bathroom medicine cabinets may be too warm and humid, which can cause the pills to fall apart. Keep iron supplements out of the reach of children. If your child swallows an iron pill, contact a poison control centre immediately. Most people recover from iron deficiency anaemia after 6 - 8 weeks of treatment. You’ll need to pay a follow-up visit to your doctor, who will do a haemoglobin test to check your iron level. After the haemoglobin has returned to normal, continue to take 30 mg a day for an additional 1 - 2 months. This will ensure replacement of iron stores and decrease the likelihood that your anaemia will recur. After that you can drop to 10 - 15 mg a day. Editor’s note: Look out for a more in-depth article on iron supplementation by Dr Dawie van Velden in a future issue. CONSEQUENCES OF IRON DEFICIENCY Tiredness Shortness of breath Decline in physical performance Impaired cognitive function and memory Lowered endurance Depressed immune function Compromised growth and development Here are a few suggestions of iron supplements from either your local health shop or pharmacy. Astyfer (Activo Health) contains the mineral Ferrous Fumarate (150,0 mg) and includes Amino acids and Vitamins. Chela-Fer (Arctic Healthcare) tablets 30 mg, of which 1 tablet per day can be taken for the treatment or as therapeutic dose for iron deficiency anaemia. For maintenance: Chela-fer tablets 15 mg (dosage: 1 - 2 tablets per day). Paediatric dose - Chela-fer syrup: Optimal iron amino acid chelate for children. 15 mg / 5 ml dose for children over 2 years old. Also contains 250 mcg/5 ml folic acid and has a pleasant tutti-fruitti flavour. All tablets contain 250 mcg folic acid, are lactose, sucrose, gluten and tartrazine free and are suitable for vegetarians. Ferrimed (Nycomed) is a registered treatment for iron deficiency and iron deficiency anaemia and has 4 variants: Ferrimed injection, Ferrimed capsules, which contain 50 mg elemental iron and 150 IU folic acid, Ferrimed DS chews, which contain 100 mg elemental iron and Ferrimed syrup, which contains 50 mg per 5 ml. Ferrous Forte tablets (Georen Pharmaceuticals) contains 20 mg iron, 350 mcg folic acid, 15 mcg vitamin B12, 60 mg vitamin C. Ferrous Forte syrup contains 20 mg iron, 350 mcg folic acid, 15 mcg vitamin B12. Floradix (Peppina) contains 15 mg iron per 20 ml. Floradix contains no alcohol, no nuts, lactose or dairy and can be used by vegetarians.
DALEEN TOTTEN is editor, publisher and founding member of Natural Medicine. For Daleen natural medicine is more than taking a pill for an ill philosophy. She has a passion for knowledge and believes that the physical body is the last manifestation of disease. Natural medicine also encompasses nutrition, lifestyle, spiritual health, exercise, and emotional and mental wellbeing.
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