Our gut has tightly controlled entry gates for Iron (Fe) guarded by a menacing bouncer – molecules called “Hepcidin” 😈 – with two roles: 1. Reducing the amount of Iron entering from the duodenum & jejunum AND 2. Attacking any gut-bacteria trespassing. Makes logical sense for the same molecule to have both roles when you think bacteria love Iron. Hepcidin levels in our blood go up in inflammatory / Infection states ( one explanation of anemia of chronic disease with Hepcidin always high) but the bummer is excess Iron in our gut also raises Hepcidin levels and reduces Iron entry. So while it sounds logical to eat more iron pills in a day to raise iron levels quicker, Hepcidin is like – “Nope” 😐
Besides Hepcidin, many factors interfere Iron absorption biggest being that most of the abundant iron in nature is in oxidized state as Ferric which we can’t absorb. The end-result is that only a small percentage of Iron is absorbed daily with an upper ceiling. If you take much more, not only is it just pooped & wasted as a nasty black color but also overloads the gut-lining cells causing toxic GI side-effects. Good clinical trials have shown every other day Iron dosing gives us a better bang for the buck in raising Iron levels with much lower side effects like studies done here and here. This has been known now for sometime and yet I keep seeing twice-a-day and three-times-a-day dosing of Ferrous sulphate or other iron pills on admitted patient’s home med lists. They often are on proton pump inhibitors or other antacids which reduce iron absorption even further with more side-effects 🤷🏼♂️
Learning Point 💡: Save your patients and your loved one side-effects & some money by switching their Iron pills to every other day. A day’s pause likely makes Hepcidin levels go down allowing better Iron absorption again. If remembering every other day is too much to remember, then daily dosing is still better than BID or TID. To make Iron absorption even more effective, have them take a cheap over-the-counter Vitamin C pill along with it. In fact Vit. C pill taken with each big meal will enhance dietary Iron absorption too
Don’t miss these fun posts! Subscribe via email 📩 | |
