If you are low on iron, hematocrit < 33, ferritin < 30, or TSAT < 20, you need more iron. You can increase your levels through pills, food, or IV methods. If you need to increase your levels quickly, or need a bigger change, IV iron may be the best route. Read below for more detailed information.
How can you increase your iron levels?
FOOD of course is the primary source. Iron is found in animal products and plant based foods and fortified cereals.
MEAT is the best, most easily absorbed source of iron.
- RED MEAT like beef, lamb, pork.
- Organ meats: liver (especially chicken liver)
- Poultry: chicken and turkey are moderate amounts of heme iron
- Seafood: Shellfish (clams, oysters, mussels)
- Fish: tuna
PLANT SOURCES
- Legumes: lentils, beans
- Leafy greens: spinach, kale, greens
- Nuts and seed: pumpkin, seasame, flax, almond, cashew, hemp
- Fortified cereals and grains
- Vegetables: broccoli, string beans, potatoes
- Dried fruit
- Tofu
- Quinoa
- Dark chocolate
Ways to improve iron absorption
- Avoid things that prevent iron absorption during meals: Tea, coffee, and high-calcium foods
- Mixing heme and non-heme iron in meals can improve overall absorption.
Iron pills
Iron pills are also a way to treat deficiency. They vary based on type of iron, which affects side effects and strength, and can be pills or liquid. Most over the counter supplements are based on ferrous salts- ferrous sulfate (most common, inexpensive), ferrous gluconate (gentler on stomach), ferrous fumarate (higher elemental iron), or ferrous bisglycinate (chelated iron- thought to be better tolerated).
Side effects of iron pills
- GI symptoms. Iron can cause tummy upset, nausea, abdominal pain, vomiting, diarrhea, or constipation. Why? Iron can irritate the stomach lining and affect gut motility. Helpful hint: take iron with food.
- Dark or black stool. Why? Unabsorbed iron turns stool dark. It is harmless, but may be alarming
- Metallic taste. The iron salts can make a metallic aftertaste
- Tooth staining. This is seen mostly in the liquid form. Helpful hint: Dilute the liquid iron with water and drink through a straw.
- Affects absorption of other nutrients. High doses of iron can reduce zinc absorption.
- Gut microbiome changes. Unabsorbed iron changes the gut microbiome, which can lead to bloating, gas, or changes in bowel habits.
Iron sucrose went generic 6 months ago. Prior to that, it was over $1000 a dose, but now we can offer it at Biohackr Health for $250 at our Palo Alto and San Francisco clinics.
- IV iron does a more rapid correction of low iron levels.
- Who needs iron? If your Ferritin is below 30, hemoglobin under 11.0gm/dl or hematocrit under 33% documented by a blood test within the last 30 days, you need to increase iron. You must be cleared for the infusion by a Biohackr physician or nurse practitioner.
- IV therapy increases blood counts by about 300% more compared to oral iron therapy.
- We usually recommend 1-3 iron infusions 5-7 days apart, with repeat blood work at one month depending upon your level of deficiency.
- True allergic reactions to IV iron are very rare (~1:200,000 for major reactions); most reactions are complement activation–related “pseudo-allergies” which are managed by pausing and restarting the infusion at a slower rate