Getting the bang for my iron

We want the best we can get for our money. Then why wouldn’t we ask for the most we can get out of our iron supplement? I mentioned briefly in the previous post why I don’t always go for iron-rich food. Because it’s a pain, that’s why! If you only need a daily routine providing a token of iron, iron-rich foods are great. Of course, that means that you already have enough iron and you only maintain the steady-state. But that wouldn’t be the case to get you preoccupied with iron supplementation. If you are trying to replenish lost iron, then you may be out of luck going the natural route. First, you should have a very good understanding of what to eat, how to cook it and how to combine it. Secondly, timing properly the iron-rich diet cannot be neglected either. Trying to enjoy a drink that’s otherwise a part of your daily routine may become your daily burden and regular frustration. Chances are that you will quit the iron supplementation plan in 9 out of 10 tentative instances. In fact, that is why most people fail.

Citruses
Iron-friendly

Our body’s anatomy and physiology, combined with our natural diet and the environment we get it from, are all designed in purpose to avoid iron absorption. There are many evolutionary reasons for such a tight control, two of which are limiting pathogen development and protecting the main organ responsible for body’s detox – the liver. These are only hypotheses, but the fact of the matter is that we can’t really get much iron! So, whatever the real reason is, I can tell you for sure: there is at least one!  It may simply be a system in place to open a fair chance for gathering minerals other than iron (calcium, magnesium, manganese, and zinc), which are all essential “cores” of very important systems and/or enzymes. The vast majority of the metabolic processes in a human body relay solely on chemical charge changes and molecular re-positioning that accommodates new contacts. Micronutrient minerals are of particular value because their electrical charge helps to hold in place protein folding that determines vital functions. One of them is the contribution of the iron element to the oxygen and CO2 carrying capacity of the hemoglobin. Fascinating, isn’t it?

 

CatCoffee
Iron-unfriendly

 

Phytate – the key molecule

Well, if you want the bang for the iron, then you should remember a few tricks, like the rule of no army in the way. The fastest, simplest way to win big is having no opposition at all. That’s why you keep hearing to take the iron on empty stomach. This means first thing in the morning! If you are like me and drink coffee in the morning, then you are in a particular kind of trouble. Happy that you are in fact a tea drinker? Don’t be! Tea isn’t better either. For the entire duration of the iron supplementation, you cannot have neither coffee nor tea in the morning. These wonderful drinks that we enjoy that much contain phytic (i.e. phytate or inositol hexaphosphate, or IP6) and oxalic acids. An otherwise spectacular source of energy and immune stimulation, IP6 is also key for preventing minerals’ absorption and it takes this job very seriously! Not only that it binds iron, mag, calcium, but it also binds cadmium and lead poisons helping to prevent their accumulation in the body – good stuff, right? More than half of the ingested phytate gets degraded in the stomach, but given its wide abundance in vegetable food sources, a considerable amount will still be available to bind and remove minerals before they get to be absorbed in the body. If bound to IP6, when iron makes it to the gut it, instead of being absorbed in our system for hemoglobin and red blood cells making, it becomes a great food source for the gut bacteria. Why? Because IP6 is inositol HEXAPHOSPHATE – meaning that it is a bomb of energy supply that they surely need. Iron is highly sought after by bacteria as well. Thus, an IP6-iron supply will lead to a sudden population growth and a local fight for dominance. Many bacteria will die – at times, exactly the good ones. That event will change the gut motility and the way water is re-absorbed, both leading to constipation and abdominal discomfort.

TeaLemon
Iron-unfriendly

Phytate complexes and constipation

Follow me carefully. What led to the occurrence of constipation? The iron-IP6 complex, right? Watching my IP6 intake is a very important part of getting the best bang for my iron! The more iron I will have available to waste in IP6-binding (i.e. bigger doses, too much phytate intake, etc.), the higher my constipation risk will be. That will mean that I will waste more iron and I will have a quite unhappy supplementation experience (and poop!). A bigger dose of iron will upset my stomach, too. Why would I bother? If my hemoglobin would be 10 or 11g/dL and my life would hang on that iron, then I will surely design the plan around that goal. Call me if that’s your case because I can make that work too. It requires much more stringent conditions relying on heat-degrading the IP6 and switching to omnivorous diets that provide active phytase with all the fresh vegetables ingested. High iron doses require intense stomach buffering, but not with antacids! Best options are crackers or yeast-fermented bread. White bread is better than whole bread in this case as the milling process eliminates the bran and with it goes a good chunk of the IP6. Regular bread is better than sweet bread or anything like challah. While delicious and coating, the milk traces in these types of bread will allow too much calcium competition. Well, I’m sure you got the point!

MuesliBreakfast
Contains iron. Zero gets absorbed!

Other ways to enhance phytase activity and accommodate higher iron doses include adding sprouts and malt vinegar to any fresh salad. Given the requirement of energy for the young plant development, sprouts have naturally enhanced phytase activity because they are naturally suited to detach the phosphorous from the IP6 and use it for growth and development. The malting process and the vinegar maximize the activation of these massive stores of phytase enzyme allowing as much as possible phytate removal from the meal so that any iron remainder that is still in your stomach will be enabled for absorption. Would there be any iron remainder after the morning dose? Very possible. If not, that’s ok. But, if yes, I really-really don’t want it to go to waste! We take a similar approach with higher doses of vitamin C in the morning when the sprouts and malt vinegar are less likely to be added (no contraindication though if you would enjoy them for breakfast!). If your meal would not accommodate another salad with oil and vinegar, a 500mg dose of vitamin C can do the job activating just enough phytase to wreck about 150mg of IP6 (quite all that one may find in a meal). I always thought that the classic oil and vinegar dressing had an iron-driven rationale in the Italian cuisine. The same I think about alternating omnivorous and vegan diets in the tradition of certain cultures across the globe. Traditions such as grain milling, beans or grain soaking or cabbage fermentation, all lead to foods with a lower IP6 content. Yes, same as you, I can point at many disadvantages of these processes, but at least from an iron-absorption perspective, these traditions seem to be essential for the prevention of iron deficiency anemia. These are all key facts that we need to stay mindful of and never hesitate to use them to our advantage!

MuesliYoghurt
Don’t even think about it!

Don’t hesitate to contact me at any time if you face more complicated circumstances and need to deal with high dose iron supplementation – I’m really good at making iron behave the way I want! Please note that I did not even bring up here the iron-drug interactions – that is an even more insane part of getting the bang for the iron. Ideally, don’t take any other meds at the same time you take the iron; but if you have to, you know by now: give me a call.  Back to the IP6 (phytate) story: vegans do not have an easy time getting or supplementing their iron because of the big amounts of IP6 they account for in their diet. Luckily, fresh vegetables bring their own phytase and we can enhance it with vitamin C, orange juice, lemon juice, or vinegar. However, we need to remember that vegan diet provides far more than 200mg phytate daily, which, to inactivate, may turn the day quite soury!

CaffeineGum03
Read my review before considering it!

The case will be somehow more complicated if I would be a vegetarian due to the dairy foods intake. A cup of milk or the equivalent amount of cheese provides roughly 300mg of calcium which will likely prevent the absorption of the entire dose of iron. In such cases, timing is everything and my personal preference is to have at least one meal between the iron dose and the cheese or milk serving. Should I be vegetarian and require a dose of 100mg elemental iron, I would wake up at 6am, eat a slice of white bread toast (absolutely NOT for whole grain!), drink a cup of OJ and take the iron. Then I will go ahead with my morning routine. Since I always need my caffeine dose in the morning, I will go for a caffeine gum instead of my cup of coffee for the whole duration of the iron supplementation. Having such a light breakfast, I could snack on crackers afterward and have a mid-morning consistent sandwich (dairy-free), ideally with fresh sprouts. For the lunch and dinner, I should be fine having any type of dairy product. Hope this makes sense, send me your questions if not and I will do my best to clarify.

Yeah, I didn’t give you the blurb with the green poop because I know you heard about it. The greener it is, the better the absorption. The darker it is, the more iron got wasted. Poop color is a good monitoring parameter, but it’s quite challenging to describe and involve in a conversation. I have to say that, although I had some patients share the weirdest (absolute weirdest!) pieces of information with me, none yet took pictures of their green poop. It wasn’t needed yet. The pep talk above must have made sense and… it worked without having to share pics of green poops. He-he! I may be wrong, but – obviously! – optimistic 🙂 Not to miss the most important part: drugs such as opiates and cannabinoids are notorious for causing constipation. Avoid using them at the same time with iron. It won’t be a pleasant experience, just sayin’…

That’s all for today’s post, let me know your thoughts and click like if you found it useful. Stay healthy and don’t hesitate to share what you learned: you’d be surprised how little it takes to make a positive change in someone’s life!

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Dr. Alice

I teach people how drugs work, when they are needed, and why. My expertise as a pharmacist and researcher allows me to determine whether taking or not taking a drug will pose any risk given all current circumstances that apply at this moment. Many times we don't know unless we try, but other many times walking the extra mile pays off giving in return more wonderful moments and more to give to others.

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