Brooke Thai, PharmD Student
The motivation behind this article today is that there seem to be a few common misconceptions and unknown facts about iron supplements. Today, I would like to debunk a few myths so that anyone who reads the article has a better understanding of the different types and appropriate use of iron supplements.
For example, have you ever thought you needed iron but were turned down by a pharmacy staff when you asked them for it, and you still don’t know why? Or, when told by your doctor you need to take iron, and when you go to the pharmacy to pick some up, have you ever been frustrated that there doesn’t seem to be any on the shelves? And when you do find it, have you ever been overwhelmed by the large selection before you? Keep reading to have these questions answered.
Different Types of Iron Supplements
One very common misconception is that all iron supplements are the same. This is not true because they all differ from each other based on how much elemental iron there is per tablet. For example, 300mg of ferrous gluconate has ~35mg elemental iron whereas 300mg of ferrous fumarate has ~100mg of elemental iron. They’re made this way so that those who need less iron have an option to take a supplement that delivers the right amount to their bodies without giving them too much.
Speaking of different types of iron, it’s important to note that they’re divided into two categories:1
- Unscheduled: Iron products containing 30 mg or less of elemental iron in each pill or per 5 mL of oral liquid are considered unscheduled. Meaning, you can find these in the pharmacy aisles that you can easily pick off the shelf and buy.
- Schedule 2: Iron products containing more than 30 mg of elemental iron in each pill or per 5 mL of oral liquid are considered schedule 2. These are the types that you have to talk to a pharmacist and have it recorded onto your profile before you’re able to purchase it. Some examples include:2
- Ferrous gluconate (~12% elemental iron)
- Ferrous sulfate (~30% elemental iron)
- Ferrous fumarate (Palafer) (~33% elemental iron)
You might be wondering why tablets with less iron are treated differently than tablets with more iron. Simply put, it’s a safety measure. There is less risk that comes with taking iron supplements containing less iron per tablet. On the other hand, when tablets contain more iron per tablet, there is more potential for damage to be done (see more later). Therefore, the iron supplements containing more iron per tablet (schedule 2 iron supplements) requires a pharmacist to record it onto your pharmacy profile to ensure that your healthcare team knows you’re taking it. This way, they can monitor for its appropriateness and safety.
When Not to Take Iron
The only people who should be taking iron supplements are those who have gotten bloodwork done that confirms iron deficiency anemia, and/or those who are directed to do so by their physician. Everyone else who doesn’t fall into this category has no reason to be taking iron because they simply don’t need it.
“What’s the big deal if I just take iron without getting bloodwork done?”
Another common misconception about iron is that it’s harmless… This simply isn’t true. If someone supplements their body with iron when they don’t need it, it’s possible to have iron overload/toxicity, which can cause a number of harmful events such as:3
- Liver damage
- Joint pain
- Abdominal pain
- Diabetes
- Skin pigmentation
“But I am feeling fatigued and taking iron supplements have helped me before.”
Many people also believe that if they’re feeling more tired than normal, the solution is to start taking iron. What’s important to consider is that fatigue is a very general and non-specific symptom that could be caused by a large number of different issues: sleep deprivation, low thyroid, diabetes, viral cold infection, depression, liver disease, heart failure, and the list goes on. If people assume that the reason for fatigue is due to iron deficiency, and begin to self-treat with iron supplements without consulting their healthcare provider, they’re putting themselves at risk of iron toxicity and leaving the underlying cause untreated.
“Do I have to be on iron supplements forever?”
It depends. If the cause of the iron deficiency isn’t or can’t be corrected, this may be the case (e.g. heavy menstruation causing excessive loss of blood, vegetarian diet). But some cases of iron deficiency are acute and will only require iron supplementation for 3-6 months before the iron levels are corrected and supplementation is stopped. Regular bloodwork and continuous monitoring while taking iron will help determine if you need to take iron continuously long term or if you can safely stop taking iron and have stabilized iron levels in your blood.
The Bottom Line
Today, we’ve targeted a few myths and misconceptions regarding iron supplements. Here are the takeaway points:
- Not all iron is the same
- Some iron can be bought off the shelves whereas others will need to be recorded onto your pharmacy profile
- Iron is not harmless
- Feeling more tired and fatigued than usual does not always mean you have an iron deficiency – it could be due to something else that’s worth getting checked out
- Iron supplementation is not always forever
In case you missed it, we previously covered the topic of iron deficiency anemia. Click the link to read more!
We hope you took away something valuable from this piece. If you have any questions or concerns regarding this article or others, feel free to reach out to us on Instagram, Facebook, or at ask@orbishealth.ca with your feedback. We’d love to hear from you.
RESOURCES
- National Association of Pharmacy Regulatory Authorities. (n.d.). Iron and its salts and derivatives. Retrieved August 19, 2018, from https://napra.ca/nds/iron-and-its-salts-and-derivatives
- National Association of Pharmacy Regulatory Authorities. (n.d.). Iron and its salts and derivatives. Retrieved August 19, 2018, from https://napra.ca/nds/iron-and-its-salts-and-derivative
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