Iron Supplementation in Anemia: A Comprehensive Guide to Treatment and Prevention

by Maxion Nutrition

Introduction

Iron deficiency anemia is a widespread health concern affecting millions globally, including many Canadians. The WHO has recognized iron deficiency anemia (IDA) as the most common nutritional deficiency in the world, with 30% of the population being affected with this condition. Iron is an essential mineral necessary for oxygen transport in the blood, and its deficiency can lead to fatigue, weakness, and cognitive impairment. This article explores the role of iron supplementation, comparing different supplement types, discussing the prevalence of iron deficiency, and examining effective strategies for diagnosis and treatment. This blog post will introduce you to the great tasting liquid Iron supplement, Max Iron.1

Understanding Iron Deficiency: The Physiological Impact

Iron is a crucial component of hemoglobin, the protein in red blood cells responsible for binding and carrying oxygen. When the body's iron stores are depleted, hemoglobin production decreases, resulting in iron deficiency anemia. 2,14

Iron deficiency occurs in three stages:

  1. Depletion of Iron Stores – Reduced ferritin levels but normal hemoglobin.
  2. Iron-Deficient Erythropoiesis – Decreased iron transport and diminished red blood cell production.
  3. Iron Deficiency Anemia – Marked by low hemoglobin levels and symptoms of anemia.

Iron Deficiency Anemia Symptoms

Initially, iron deficiency anemia can be so mild that it goes unnoticed. But as the body becomes more deficient in iron and anemia worsens, the signs and symptoms intensify. This condition can lead to symptoms such as:2.

  1. Extreme fatigue
  2. Weaknesses
  3. Pale skin
  4. Chest pain, fast heartbeat, or shortness of breath
  5. Headache, dizziness, or lightheadedness
  6. Cold hands and feet
  7. Inflammation or soreness of your tongue
  8. Brittle nails
  9. Unusual cravings for non-nutritive substances, such as ice, dirt or starch
  10. Poor appetite, especially in infants and children with iron deficiency anemia
  11. Reduced cognitive function.

Iron Supplementation: Comparing Ferrous Fumarate vs. Iron Polysaccharide

Two commonly used forms of iron supplementation include:

  • Ferrous Fumarate (Solid Dose Tablets or Capsules): A widely prescribed form with high bioavailability. It is cost-effective and provides substantial elemental iron per dose. However, one major drawback is gastrointestinal distress, including constipation, which affects up to 35% of users.
  • Iron Polysaccharide (Liquid Form): Designed to be gentler on the digestive system with lower reported rates of constipation (approximately 14%). It is often recommended for individuals with gastrointestinal sensitivities or difficulty swallowing pills. This is the precise reason Max Iron is so well tolerated.

There are Two Types of Iron

Two naturally occurring forms of iron exist in food and are absorbed differently in the small intestine. They are: 

  1. Heme iron: Found in animal products and is easily absorbed.
  2. Non-heme iron: Found in plant-based foods and is less efficiently absorbed than heme iron. It is also sensitive to other nutrients: calcium and tannins can interfere with absorption, while ascorbic acid (Vitamin C) may help.

The Challenge of Iron Supplement-Induced Constipation

Constipation is a frequent side effect of iron supplementation, particularly with ferrous salts such as ferrous fumarate and ferrous sulfate. This occurs due to the unabsorbed iron interacting with gut bacteria, leading to digestive discomfort. To mitigate this, healthcare providers often suggest:

  • Gradually increasing iron dosage to improve tolerance.
  • Taking iron with food to reduce irritation (though absorption may decrease slightly).
  • Using stool softeners or fiber-rich diets to counteract constipation.

Iron Deficiency in Canada: Who Is Most at Risk?

The prevalence of iron deficiency varies across different demographic groups in Canada:5,6

  • Women: Approximately 18.2% of Canadian women aged 19-50 are iron deficient, primarily due to menstruation and pregnancy.
  • Children: Studies indicate that 12%-64% of infants and young children in Canada experience iron deficiency, with anemia affecting up to 79% in certain populations.13
  • Men: Iron deficiency is less common in men due to lower iron requirements and minimal blood loss.

Global Trends in Iron Deficiency

According to the World Health Organization (WHO):7

  • 29.9% of women aged 15-49 globally are anemic, with iron deficiency being a primary cause.
  • 39.8% of children aged 6-59 months worldwide suffer from anemia, often linked to poor dietary iron intake. WHO estimates that 40% of children 6–59 months of age,
  • 37% of pregnant women worldwide are anemic.
  • Iron fortification programs have been implemented in over eighty countries to combat deficiency in staple foods.

Risk Factors for Iron Deficiency

Several factors contribute to inadequate iron levels:

  • Dietary Choices: Vegetarians and vegans are at a higher risk due to the lower bioavailability of plant-based non-heme iron.
  • Metabolic Disorders: Conditions like celiac disease, inflammatory bowel disease (IBD), and Helicobacter pylori infections impair iron absorption.
  • Increased Physiological Demand: Pregnancy, menstruation, and rapid growth phases in childhood increase iron needs.

Diagnosing Iron Deficiency: Current Clinical Practice Guidelines

Physicians rely on various diagnostic tests to confirm iron deficiency:

  • Complete Blood Count (CBC): Assesses hemoglobin and mean corpuscular volume (MCV).
  • Serum Ferritin: Indicates iron stores, with low levels confirming deficiency.
  • Transferrin Saturation and Serum Iron Levels: Help assess iron availability in circulation.

Complementary Interventions for Managing Iron Deficiency

In addition to iron supplementation, other interventions can help optimize iron levels:

  • Dietary Adjustments: Increasing consumption of heme iron (red meat, poultry, fish) and non-heme iron (legumes, spinach, fortified cereals), paired with vitamin C to enhance absorption. 3,4.
  • Vitamin C: It has been found that vitamin C can increase the amount of non-heme iron from plant sources the body absorbs from duodenum and proximal jejunum. Enhancers of iron absorption are controlled by the effect of ascorbic acid (vitamin C), which can overcome the effects of all dietary inhibitors when it is included in a diet with high non-heme iron availability (usually a meal heavy in vegetables). ; this is another reason for the remarkable results people experience when taking Max Iron 8,9,10,11,12.
  • Intravenous (IV) Iron Therapy: Recommended for individuals with severe deficiency or malabsorption issues.
  •  Prebiotics, Probiotics, Postbiotics and Gut Health Optimization: There is strong research data that some probiotics, such as Lactobacillus acidophilus and Bifidobacterium longum improve iron absorption by improving gut microbiota balance and influence the course of anemia. Prebiotics, including Galactooligosaccharides (GOS) and Fructooligosaccharides (FOS), increase iron bioavailability and decrease its destructive effect on the intestinal microbiota. In addition, multiple postbiotics, which are probiotic metabolites, including vitamins, short-chain fatty acids (SCFA), and tryptophan, participate in the regulation of intestinal absorption and may influence iron absorption.15,16.
  • Lifestyle Modifications: Regular monitoring of iron levels in high-risk groups and addressing underlying health conditions.

Conclusion

Iron deficiency remains a significant global and national health challenge, but with proper diagnosis, supplementation, and dietary strategies, it is manageable. Whether choosing solid-dose ferrous fumarate or liquid iron polysaccharide, individualized treatment plans can help minimize side effects like constipation while ensuring adequate iron intake. Physicians and healthcare providers continue to refine guidelines to improve patient outcomes and reduce iron deficiency-related health risks.

References

  1. World Health Organization Hemoglobin concentrations for the diagnosis of anemia and assessment of severity. Vitamin and Mineral Nutrition Information System 2011 https://www.who.int/vmnis/indicators/haemoglobin.pd
  2. https://www.mayoclinic.org/diseases-conditions/iron-deficiency-anemia/symptoms-causes/syc-20355034
  3. Kumar A, Sharma E, Marley A, et al Iron deficiency Anaemia: pathophysiology, assessment, practical management BMJ Open Gastroenterology 2022;9: e000759. doi: 10.1136/bmjgast-2021-000759
  4. Lopez A, Cacoub P, Macdougall IC, Peyrin-Biroulet L. Iron deficiency anaemia. Lancet. 2016 Feb 27;387(10021):907-16. doi: 10.1016/S0140-6736(15)60865-0. Epub 2015 Aug 24. PMID: 26314490.
  5. https://www.canada.ca/en/health-canada/services/nutrients/iron.html
  6. https://www150.statcan.gc.ca/n1/pub/82-003-x/2012004/article/11742-eng.htm
  7. https://www.who.int/health-topics/anaemia#tab=tab_1
  8. https://www.stlukes-stl.com/health-content/medicine/33/000009.htm#:~:text=Folic%20acid%20can%20be%20taken,B12%20when%20taking%20folic%20acid.
  9. Lynch SR, Cook JD. Interaction of vitamin C and iron. Ann N Y Acad Sci. 1980; 355:32-44. doi: 10.1111/j.1749-6632. 1980.tb21325. x. PMID: 6940487.
  10. https://www.webmd.com/drugs/2/drug-158960/iron-plus-vitamin-c-oral/details
  11. Ems T, St Lucia K, Huecker MR. Biochemistry, Iron Absorption. [Updated 2023 Apr 17]. In: Stat Pearls [Internet]. Treasure Island (FL): Stat Pearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448204/
  12. https://cdhf.ca/en/iron-absorption-understanding-factors-that-enhance-or-inhibit-uptake/
  13. Hartfield D. Iron deficiency is a public health problem in Canadian infants and children. Paediatr Child Health. 2010 Jul;15(6):347-50. doi: 10.1093/pch/15.6.347. PMID: 21731416; PMCID: PMC2921732.
  14. Piskin E, Cianciosi D, Gulec S, Tomas M, Capanoglu E. Iron Absorption: Factors, Limitations, and Improvement Methods. ACS Omega. 2022 Jun 10;7(24):20441-20456. doi: 10.1021/acsomega.2c01833. PMID: 35755397; PMCID: PMC9219084.
  15. Zakrzewska Z, Zawartka A, Schab M, Martyniak A, Skoczeń S, Tomasik PJ, Wędrychowicz A. Prebiotics, Probiotics, and Postbiotics in the Prevention and Treatment of Anemia. Microorganisms. 2022 Jun 30;10(7):1330. doi: 10.3390/microorganisms10071330. PMID: 35889049; PMCID: PMC9317605.
  16. Rusu IG, Suharoschi R, Vodnar DC, Pop CR, Socaci SA, Vulturar R, Istrati M, Moroșan I, Fărcaș AC, Kerezsi AD, Mureșan CI, Pop OL. Iron Supplementation Influence on the Gut Microbiota and Probiotic Intake Effect in Iron Deficiency-A Literature-Based Review. Nutrients. 2020 Jul 4;12(7):1993. doi: 10.3390/nu12071993. PMID: 32635533; PMCID: PMC7400826.

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