Correct way to take iron tablets

[Wombat27A]

Was told to pick up a prescription of iron tablets, as my iron levels are low.

Asked the pharmacist if it would interfere with other tablets and when to take, etc. He said no problems and to take with food.

Read the leaflet and it says it does affect uptake of levothyroxine and to take on an empty stomach. No caffeine at the same time.

Read the NHS guidelines and it says empty stomach before meals.

I'm now trying to jiggle 5 pills a day (1 thyroxine, 3 iron, 1 statin at night) and food intake and my poor little brain is fried by the inconsistant information.

Is there a correct way to take iron supplements? Ferrous Fuminate (sp?) The pharmacist also said to take 2 and the box says 3.

Should I have a blood test after 4 weeks like the Nice guidelines suggest? GP said to take for 3 months.

I've done a search for this but most posts are about iron in preganancy, I'm menopausal and definitely not pregnant.

Not sure why you have asked about folic acid @HappyHamsters as I have clearly written about iron

Anyway this is a more accessible link explaining why research shows having one iron tablet (any iron tablet) every other day is more effective than 3 a day - episode of Radio 4's Inside Health from back in 2018.

www.bbc.co.uk/programmes/b09ply54

It's the second story discussed.

Thanks. 😁👍

I was prescribed the 3 x iron tablets a day for being 'severely anaemic'. There was no way I was going to tolerate that

Luckily I found the research @AnnaMagnani linked to and I've been taking 1 tablet every second day. With an effervescent vit c. No caffeine or dairy an hour either side.

I haven't been retested but I feel better at least.

Is an Iron infusion a thing to consider?

Will only be offered if you absolutely can't take iron tablets - so have tried more than one type and really can't tolerate them.

I was thinking private, mainly because we have quite a few personal challenges with family coming up & apparently, low ferritin has an effect on my other health issues. Feel like I'm playing whack- a-mole! 😊

I've spent the last few years sorting out my gut health too, don't want it trashed.

It sounds like you have an underactive thyroid and high blood pressure? Me too. It's likely all linked to the thyroid issue, as are your iron deficiency and gut issues. I'm in exactly the same boat (minus the gut issues but I have high cholesterol). My understanding is that we need to get to the bottom of the thyroid stuff in order for everything else to be able to fall into place. Have you been on the Health Unlicked thyroid forums? They are quite useful for all this stuff. I'm trying to get to grips with it as well.

How are they linked please?

I have had low iron for years. And now no thyroid.

Oh, my cholesterol is always over 8 left alone, regardless of diet...

Yep, everything affects everything else.

I created a thread the other day 'low ferritin queries' and just found this thread and it has been so helpful, thank you! Just been prescribed second lot of iron tablets and will try one a day this time.

No worries! I'm also trying the every other day regime.

Yep, been on the Health Unlocked forum. My GP wasn't impressed, there was no chance I was getting anything other than a very low dose of levothyroxine.

Yep. My GP is also utterly useless on this stuff.

I'll be honest, I would still be prescribing iron 3x a day if I hadn't randomly been in the car, listening to Radio 4 when that episode of Inside Health was on.

It's not a topic you would sign up to a teaching session on given how many trillion other things you need to keep up to date with.

You absorb 4 times as much iron if you take it with vitamin c. So you can take less and have fewer side effects. Take your thyroid meds with breakfast and iron with lunch or dinner.

Levothyroxine needs to be taken on an empty stomach and no caffeine for an hour (health unlocked) or 30 mins (prescription).

I think the one every other day is going to be ok. I don't want to wreck my gut as I've spent ages getting it sorted after a low carb diet a few years ago.

I'm also thinking about an infusion but that would be private and apparently can have some other side effects.

Anyone know anything about "gentle iron"?

So a chelated iron compound, supposed to be better on the gut.

Just my experience. I had very low haemoglobin due to an acute gastric bleed. Was transfused and had an iron infusion. Worked great. Was prescribed ferrous fumarate 305 mg daily to maintain hg levels.

OMG I could not tolerate them, sick, constipated, you name it. So I stopped them and got otc Active Iron and Iron Fizz effervescent tabs. I take both with fizzy vit C every second day. Iron levels are being maintained thankfully and zero side effects anymore. The gastro consultant was sceptical about my changing HIS preferred script, but the blood results were fine.

I know my anaemia is probably caused by a different issue to those of you with thyroid or other problems. Am just telling my story!

@Wombat27A Thank you for starting this thread, I think it's provided help to many, including myself. Sorry for highjacking with the below query. I hope you are now doing ok?

@AnnaMagnani Thank you for providing up to date research.

I've just had blood test results back and have a serum ferritin level of 9. My GP has simply suggested I buy some ferrous sulphate from the chemist and take 200mg 2/3 times a day. I have IBS, just had a colonoscopy (so all the after effects of the prep to recover my gut from!) and am awaiting a CT scan due to weight loss. Obviously, having read the study and listened to Zimmerman on the podcast, I'm not keen to take that amount. Should I show my GP the research or just go ahead and follow the more up to date research? Not sure how receptive the Dr's will be 🤔
One question though, do you/anyone know if this research is still applicable to Non anaemic iron deficiency, which is what mine seems to be. My haemoglobin was within normal range.

Oh and also, is anyone else taking probiotics alongside iron tablets and if so, which? That's another information minefield I've fallen into 😂

I would do it your way, as it doesn't sound as if your bowel will be up to 3x a day! Whether you want to tell your GP about the research is up to you and what you think your GP is like.

Low ferritin is just really an extension of iron-deficiency anaemia. So first you use up all your stored iron and your ferritin goes down, and then eventually the stores are gone and your capacity to make blood cells falls and you get anaemic.

It used to be thought that having a low ferritin was asymptomatic without anaemia but it's now known this is very much not the case.

I went with the protocol of 1 pill every other day ish, taken with a vit c tablet. Other than an occasional bit of black pudding to supplement my otherwise veggie diet, nothing else changed but now up to 37.

Had a blood test 2 weeks ago & heard nothing else from the GP, other than the number, so assuming things are going ok.

It was very useful as I got pretty ill on 3x a day & given I've spent the last couple of years on gut health improvements was not happy.

Probiotics, my thing is kefir in yoghurt with nuts & fruit most days. Also, eating ad wide as range as possible of different plants, as advocated on the Zoe blog. 👍

@AnnaMagnani Thank you for the explanation about low ferritin, that really helps. I am in the process of getting some iron tablets. Zimmerman stated 60mg every other day so maybe I'll start with that and see how my stomach copes.
@Wombat27A Is it better to take Vitamin C via tablet then? I was going to have orange juice, a fresh pressed one to increase absorption.
I really need to research kefir and probiotics. There are so many varieties! Will check out Zoe blog too, thanks.

Erm, don't know, just find it easier. I started off with OJ but that's not good for me either.

I make my own kefir, lives indefinitely in the fridge after fermentation.

This is the advice from The Iron Protocol (which is incredibly successful at raising iron levels if you follow it):

Vitamin C (HUGE. Makes all of the difference. Taking iron with Vit C is part of The Iron Protocol. You basically cannot take non-heme elemental iron without it. This is what makes The Iron Protocol so successful. This is also why it works better than the alternate day, or every-other-day method that some have heard about.)
One "must" take preferably several cups of water and 1,000mgs of Vitamin C with each iron dose. One can scrape by with 500mgs and even 200mgs, but will absorb more and have fewer negative side effects if one supplements with 1,000 mgs+. ORANGE JUICE IS NOT ENOUGH UNITS.

And what to avoid:
The following are not recommended to be taken within 1-4 hours of iron, because of blocking absorption of iron or reducing effectiveness of medication.
Magnesium, Calcium, Zinc, Manganese, phosphorous
Tannins and polyphenols (Coffee & Black Tea are common ones)
Tumeric, Curcumin, Quercetin
Phytates of Phytic Acid (for example whole grains, cereals, soy, nuts and legumes)
Fibers, and oxalates
Polyphenols (for example some cereals and legumes, tea, coffee and wine)
Phosphoproteins (Eggs are an example)
Low stomach acid
Cholestyramine and Colestipol
Proton pump inhibitors (or example fomeprazole (Prilosec))
Medications used to treat ulcers or other stomach problems (for example cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid), and nizatidine (Axid))
Levodopa (Sinemet® and Stalevo®), Levothyroxine (Levothroid®, Levoxyl®, Synthroid®, Tirosint®, and Unithroid®)
ACE inhibitors These are a class of medications used to treat high blood pressure. Examples include captopril (Capoten), enalapril (Vasotec), and lisinopril (Zestril or Prinivil).
Quinolones -- These are a class of antibiotics that include ciprofloxacin (Cipro), norfloxacin (Noroxin), and levofloxacin (Levaquin).
Tetracyclines -- These are a class of antibiotics that include doxycycline (Vibramycin), minocycline (Minocin), and tetracycline (Sumycin).

I take Life Extension Iron Protein Plus (1-2 capsules daily) with Solgar 1000mg Vit after lunch each day (so avoiding my breakfast coffee) and doing this has raised my ferritin from 44 to 86 over 4 months.