Anemia, a condition, when red blood cells’ count is below the norm or the amount of hemoglobin in red cells is below the norm – is a very common problem. According to the World Health Organization, about one fourth of the world´s population suffer from anemia. The most common type of anemia is iron deficiency anemia – a condition where there is too little iron in the body. The main ways of diagnosing anemia are measuring hemoglobin and ferritin levels in the blood.

Katrin Nõukas, doctor of internal medicine at East Tallinn Central Hospital, explains: „“The best way to define iron stores is to check ferritin – a low ferritin level is always a sign of iron deficiency. Different laboratory reference ranges may differ a little, but a result of < 12 μg/L generally indicates iron deficiency. It is said that iron deficiency can even be diagnosed with a result of < 22μg/L. Unfortunately, ferritin values are not always trustworthy due to ferritin being an acute phase protein. This means that the value of ferritin is higher in case of infections, liver pathologies, tumors, and other inflammatory diseases and thus, can hide iron deficiency.

A newer analysis to diagnose iron deficiency is checking transferrin soluble receptors (sTfR) – unlike checking ferritin levels, this analysis is not influenced by related illnesses. An increased level of sTfR indicates iron deficiency.”

However, iron is a tricky mineral. A slight iron deficiency is safer than having excessive iron in the body. Therefore, iron food supplements should not be consumed just in case. Before using iron food supplements, iron deficiency must be diagnosed. Aune Rehema, an assistant at the Biochemistry Institute of the University of Tartu and family physician, explains: “Iron is needed to transport oxygen between tissues (oxygen binds with iron found in hemoglobin) and for cell breathing (in mitochondria). Many important enzymes contain iron and in case of iron deficiency, the normal functioning of cells is disturbed. Real iron deficiency, including iron deficiency anemia, should be treated. It just has to be diagnosed adequately first.

Iron is a very responsive mineral, which means that it binds easily with biomolecules, whose function it may change (making them more active or inactive or even causing them to malfunction). Oxidative stress – defined as the dominance of oxidative stressors in relation to antioxidants – is a threat often mentioned in ads on TV. It is the dominance of mainly oxygen and nitrogen based free radicals and other reactive parts, which are not controlled by enough participants of the antioxidative system. The processes of free radicals are difficult to control and when there is an excess, it can cause illnesses.”

In Estonia, bivalent iron salts are used in OTC drugs. Aune Rehema: “Vitamin C increases the pro-oxidation of iron. For example, if a food supplement contains vitamin C and bivalent iron, then at least 95% of that iron (i.e. the amount not absorbed) will actively damage gastrointestinal mucosa. This may cause nausea, diarrhea or constipation, even gastrointestinal ulcers. The iron, which has already been absorbed (it does not depend on in which form it was originally consumed), is deposited and thus, cannot exit the body.”
Vitamin C increases iron absorption and therefore, has an important role in iron food supplements.

So, in case of bivalent iron salts, it is important what kind of iron salt has been used. Iron salts with poor absorption that are therefore more toxic are iron sulphate, -fumarate, -gluconate and -citrate. These should be avoided, if possible.

Due to its molecular structure, iron bisglycinate is less prone to respond and thus, its oxidative effect is smaller and irritation of gastric mucosa is less likely. Read from our blog, how Rando Tuvikene, a chemistry associate professor and senior research fellow of the University of Tallinn, describes iron bisglycinate. In addition to the four toxic iron salts mentioned above, also synthetic ascorbic acid should be avoided in OTC drugs. Why? The answer can be found from our blog.

The question that we hear most often is how much iron should be consumed and for how long?

“In case of an existing iron deficiency anemia, 150-200 mg of elemental iron a day should be consumed, which normalizes hemoglobin in 6-8 weeks. In order to fill iron stores, treatment should be continued for 3-4 months. In case of latent iron deficiency (a condition, where the blood test is still normal but iron stores have decreased), 60-80 mg of iron a day for 2-3 months is enough,” explains Dr. Katrin Nõukas from East Tallinn Central Hospital.

Various scientific research has proved that iron bisglycinate is absorbed 2-4 times better than commonly used iron sulphate, which often causes side effects. So, when treating iron deficiency anemia with iron bisglycinate, 75-100 mg of elemental iron a day should be consumed (in case of latent iron deficiency 30-40 mg a day). When using iron sulphate, the amounts should be at least double. Iron fumarate, -gluconate and -citrate also have poor absorption similarly to iron sulphate.

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