Overview Iron Supplements and Vitamin D

Heme iron, found in red meat, is associated with a 26% increased risk of type 2 diabetes - Aug 2024

SciTechDaily

• " In line with previous studies, the researchers found no significant associations between intakes of non-heme iron from diet or supplements and risk of T2D."

PDF is behind a $30 paywall

Type of iron is very important

• Ferrus sulfate is the most common, lowest cost, and worst form of supplementation
• Heme iron polypeptide appears to be 23X better than Ferrous fumarate
  • Heme iron is absorbed and put to use 3-4 times more efficiently by than plant iron
• Ferrochel is better in many ways than ferrous sulfate

Proferrin ES Heme Iron at least 2X better than Liposomal Iron

No such attachment on this page

91% increase in fracture risk if serum ferritin levels >1000 μg/L - Dec 2024

20,000 people, MD Edge FREE PDF

1 in 400 people will accumulate Iron

Iron, like Vitamin D is regulated by the body. In the case of Iron, the regulation happens at the input
And, like Vitamin D, a mutated gene will prevent the regulation
In the case of Iron. the global prevalence of the deregulation mutation is about 1 in 400 people
   (vs 1 in 10,000 people for Vitamin D deregulation)
Suspect the Iron deregulation prevalence is higher (say 1 in 2,000) for meat-eating cultures.
Need to investigate excess iron characteristics:

More Than a Third of Women Under 50 Are Iron-Deficient - Oct 2023

New York times
 Download the PDF from VitaminDWiki

Seniors get half as much Iron from plants than younger adults

From Claude-2 Aug 2023
Yes, there is evidence that seniors absorb less iron from plant sources compared to younger adults:

• Age-related changes in stomach acid secretion lead to reduced iron absorption, as stomach acid helps convert plant iron into a form that's more bioavailable.
• A study in the American Journal of Clinical Nutrition found that iron absorption from spinach was 54% lower in elderly subjects compared to young adults.
• Another study published in the British Journal of Nutrition showed that iron absorption from wheat, spinach, and lentils was 36-61% lower in the elderly versus young women.
• The phytate content in whole grains, legumes, nuts and seeds binds to iron and inhibits absorption. Phytate degradation declines with age, exacerbating the problem.
• Elderly populations have a higher prevalence of atrophic gastritis, which impairs iron absorption, especially from plant sources.
• Inflammation and increased hepcidin levels that occur with aging block iron absorption and transport.

So in summary, yes multiple factors including

• reduced stomach acid,
• impaired phytate breakdown,
• inflammation and age-related digestive changes

result in significantly lower iron bioavailability from plant foods for seniors compared to younger adults. Seniors should be especially mindful of iron intake from plants vs animal foods.

The most common mineral deficiency in the world - Video Dec 2022

Dr. Berg 15 minute YouTube
He has 18 million followers
0:00 Introduction: The most common mineral deficiency in the world
0:58 Iron deficiency symptoms
3:48 What causes iron deficiency?
12:10 How to fix an iron deficiency
13:20 What about too much iron?
15:17 Learn more about how to improve digestion!
Symptoms of iron deficiency:
• Hair loss
• Arrhythmias
• Fatigue and weakness
• Dark circles under the eyes
• Restless leg syndrome
• Difficulty sleeping
• Low cold tolerance
• Split nails
• Trouble concentrating
• Fibromyalgia
Iron deficiency causes:
• Not consuming enough iron (animal products)
• IBS
• Inflammation
• Stress or trauma
• Bleeding or ulcers
• Low hydrochloric acid
• Menstruation
• Gastric bypass surgery
• Excessive exercise
• Antacids
• Fibroids
• Pregnancy
• Breastfeeding
• Puberty
• Eating disorders
• Phytic acid
• Tannins (tea, coffee, red wine)
• Chocolate
• Polyphenols (turmeric, red wine)
• Polymorphism
• Too much calcium or magnesium
• Infection
• Oxalates

Iron Supplement in WikiPedia

Iron can be supplemented by the oral route using various pharmacological forms, such as iron(II) sulfate (this is the most common and cheapest salt, e.g. Feratab, Fer-Iron, Slow-FE,…) and in complex with gluconate, dextran, carbonyl iron, and other salts. Sometimes ascorbic acid is added for better absorption.

Heme iron polypeptide (HIP) (e.g. Proferrin ES and Proferrin Forte) can be used when regular iron supplements such as ferrous sulfate or ferrous fumarate are not tolerated or absorbed. A clinical study demonstrated that HIP increased serum iron levels 23 times greater than ferrous fumarate on a milligram-per-milligram basis. Click here for details or studies and purchase also patented

Another alternative is ferrous glycine sulfate or ferroglycine sulfate, has less gastrointestinal side-effects than standard preparations such as iron fumarate, It is unusual among oral preparations of iron supplements in that the iron in this preparation has very high oral bio-availability esp in the liquid version (e.g. Hemfer by Alkem). This option should be evaluated before resorting to parenteral therapy. It is especially useful in iron deficiency anemia associated with autoimmune gastritis and Helicobacter pylori gastritis, where it generally has satisfactory effect.

Since iron stores in the body are generally depleted, and there is a limit to what the body can process (about 2–6 mg/kg of body mass per day; i.e. for a 100 kg/220 lb man this is equal to a maximum dose of 200–600 mg/per day) without iron poisoning, this is a chronic therapy which may take 3–6 months.

Due to the frequent intolerance of oral iron and the slow improvement, parenteral iron is recommended in many indications

Click here for more on HIP Iron at VitaminDWiki

A Patient’s Guide to Oral Iron Supplements Anemia.org 2008

• Adults will usually require a dose of 60-200 mg of elemental iron daily, depending on the severity of the anemia.2
  Since the amount of iron absorbed decreases as doses get larger, most people should take their daily iron supplement in two or three equally spaced doses.
• Iron supplements are available in regular tablets and capsules, liquid, drops, and coated or extended-release tablets and capsules.

Iron deficiency without anemia - a clinical challenge - April 2018

Does not seem to consider HIP Iron
 Download the PDF from VitaminDWiki

Non-daily ferrous sulfate appears to be better than daily - July 2020

Comparison of the effects of oral iron treatment every day and every other day in female patients with iron deficiency anemia
https://doi.org/10.1111/imj.14766 $14 paywall
Methods: For a month,

• Group I received 270 mg ferrous sulfate twice a day (total elemental iron dose: 160 mg/day),
• Group II received 270 mg ferrous sulfate once a day (total elemental iron dose: 80 mg/day), and
• Group III received 270 mg ferrous sulfate every other day (total elemental iron dose: 80 mg/every other day).

Intragroup and intergroup statistical analyses were carried out.

Results: Haemoglobin (Hb) increased significantly in all three groups (P = 0.00). The increase in Hb levels was similar among the groups (P = 0.09). Ferritin significantly increased in all three groups after the treatment (P = 0.00). The increase in ferritin in Group I was significantly higher than those in Groups II and III (P < 0.05). Gastrointestinal tract (GIS) side effects were also significantly higher in Group I in comparison to the others (P = 0.001).

Conclusions: A low-dosage of iron treatment every other day may be used in the place of providing iron once or twice every day with similar effectiveness and lower rates of GIS side effects.

Amazon Top rated Iron

• Heme-iron polypeptide (HIP) appears to be better absorbed and tolerated than ferrous sulfate
• polysaccharide-iron complex (PIC) is tolerated better than sulfate
• Iron protein succinylate nicely just dissolved in the intestine, rather than the stomach – less gastric irritation and more iron into the blood (LEF sells it)

Consumer Labs review of Iron supplements Updated Jan 2022 free 5 day trial

• cost of 25 mg varied from 2 cents to $2.00 (Floradex with Herbs)

Iron supplements for fatigue Science-Based Medicine

• Comment by one person: Vitamin C – its role in aiding iron absorption is with dietary iron, not as useful for iron supplements.

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Enhancers of iron absorption: ascorbic acid and other organic acids. PubMed 2005

• lots of excellent information in the abstract

Ferrochel better ferrous sulfate during pregnancy PubMed 2001

• 2X more taken the treatment adequately
• 2X fewer still had Iron deficiency
• none of Ferrochel patients had taste problems vs 29% of ferrous sulfate
• Ferrochel had only 15 mg of Iron vs ferrous sulfate had 40 mg of Iron

Suppression of Iron-Regulatory Hepcidin by Vitamin D.

J Am Soc Nephrol. 2013 Nov 7. [Epub ahead of print]
Bacchetta J, Zaritsky JJ, Sea JL, Chun RF, Lisse TS, Zavala K, Nayak A, Wesseling-Perry K, Westerman M, Hollis BW, Salusky IB, Hewison M.
Department of Orthopaedic Surgery, UCLA Orthopaedic Hospital, and.

The antibacterial protein hepcidin regulates the absorption, tissue distribution, and extracellular concentration of iron by suppressing ferroportin-mediated export of cellular iron. In CKD, elevated hepcidin and vitamin D deficiency are associated with anemia. Therefore, we explored a possible role for vitamin D in iron homeostasis. Treatment of cultured hepatocytes or monocytes with prohormone 25-hydroxyvitamin D or active 1,25-dihydroxyvitamin D decreased expression of hepcidin mRNA by 0.5-fold, contrasting the stimulatory effect of 25-hydroxyvitamin D or 1,25-dihydroxyvitamin D on related antibacterial proteins such as cathelicidin. Promoter-reporter and chromatin immunoprecipitation analyses indicated that direct transcriptional suppression of hepcidin gene (HAMP) expression mediated by 1,25-dihydroxyvitamin D binding to the vitamin D receptor caused the decrease in hepcidin mRNA levels. Suppression of HAMP expression was associated with a concomitant increase in expression of the cellular target for hepcidin, ferroportin protein, and decreased expression of the intracellular iron marker ferritin. In a pilot study with healthy volunteers, supplementation with a single oral dose of vitamin D (100,000 IU vitamin D2) increased serum levels of 25D-hydroxyvitamin D from 27±2 ng/ml before supplementation to 44±3 ng/ml after supplementation (P<0.001). This response was associated with a 34% decrease in circulating levels of hepcidin within 24 hours of vitamin D supplementation (P<0.05).
These data show that vitamin D is a potent regulator of the hepcidin-ferroportin axis in humans and highlight a potential new strategy for the management of anemia in patients with low vitamin D and/or CKD.

Wikipedia
Hepcidin is a peptide hormone produced by the liver.
It was discovered in 2000 and appears to be the master regulator of iron homeostasis in humans and other mammals.

See also VitaminDWiki

• Iron deficiency is a cause of Vitamin D deficiency also reviews other forms of Iron
• Anemia 1.9X more likely in white children having lowish vitamin D – Jan 2014
• Iron and Vitamin D deficiencies are synergistic - April 2015
• Iron supplementation with much less nausea (Polysaccharide and heme forms) – Jan 2016
• Anemia in pregnant teens 7X more likely if low vitamin D – April 2015
• All items in category Iron and Vitamin D 74 items

Diseases associated with Iron (both low and high)

• Serum Ferritin and GGT — Two Potent Health Indicators You Need to Know Sept 2017
  "Iron Overload Is More Common Than Iron Deficiency"
  "In recent years, scientists have discovered GGT is highly interactive with iron, and when both your serum ferritin and GGT are high, you are at significantly increased risk of chronic health problems, because then you have a combination of free iron, which is highly toxic, and iron storage to keep that toxicity going"

Vitamin D deficiency increased risk of Iron Deficiency by 2x (children in Africa) - March 2022

Vitamin D Deficiency and Its Association with Iron Deficiency in African Children
Nutrients 2022, 14(7), 1372; https://doi.org/10.3390/nu14071372
by Reagan M. Mogire 1,2,*ORCID,John Muthii Muriuki 1ORCID,Alireza Morovat 3ORCID,Alexander J. Mentzer 4,5,Emily L. Webb 6,Wandia Kimita 1,Francis M. Ndungu 1,Alex W. Macharia 1,Clare L. Cutland 7,Sodiomon B. Sirima 8,Amidou Diarra 8,Alfred B. Tiono 8ORCID,Swaib A. Lule 6,9ORCID,Shabir A. Madhi 10ORCID,Andrew M. Prentice 11ORCID,Philip Bejon 1,12,John M. Pettifor 13ORCID,Alison M. Elliott 9,14,Adebowale Adeyemo 15,Thomas N. Williams 1,12,16 andadd

Vitamin D regulates the master iron hormone hepcidin, and iron, in turn, alters vitamin D metabolism. Although vitamin D and iron deficiency are highly prevalent globally, little is known about their interactions in Africa. To evaluate associations between vitamin D and iron status we measured markers of iron status, inflammation, malaria parasitemia, and 25-hydroxyvitamin D (25(OH)D) concentrations in 4509 children aged 0.3 months to 8 years living in Kenya, Uganda, Burkina Faso, The Gambia, and South Africa. Prevalence of iron deficiency was 35.1%, and prevalence of vitamin D deficiency was 0.6% and 7.8% as defined by 25(OH)D concentrations of <30 nmol/L and <50 nmol/L, respectively. Children with 25(OH)D concentrations of <50 nmol/L had a 98% increased risk of iron deficiency (OR 1.98 [95% CI 1.52, 2.58]) compared to those with 25(OH)D concentrations >75 nmol/L. 25(OH)D concentrations variably influenced individual markers of iron status. Inflammation interacted with 25(OH)D concentrations to predict ferritin levels. The link between vitamin D and iron status should be considered in strategies to manage these nutrient deficiencies in African children.
 Download the PDF from VitaminDWiki

See also web

• https://www.scientificamerican.com/article/the-global-iron-deficiency-crisis/ Scientific American May 2021
• *Real World Efficacy and Tolerability... - 2018
• Heme iron polypeptide for the management of anemia of chronic kidney disease - Aug 2015 PDF
• The Association between Iron and Vitamin D Status in Female Elite Athletes Jan 2018
  • Those deficient in Iron were 1.75 X at higher risk of also being deficient in Vitamin D, free PDF online
• Feosol Amazon - appears to be the lowest cost
  • 6 mg of Hemi + 22mg PIC (regular) $16 for 30 caplets - similar to other Iron supplements may cause intestinal problems
• Proferrin has a great discount sample offer as of Aug 2013: $10 for 14 tablets of 12 mg
  • 23X more bio-available than ferrous fumarate
• US National Institute of Health - Iron snips as of April 2015
  • Dietary iron has two main forms: heme and nonheme
  • Recommended Dietary Allowances for Iron (just infant and middle age)
• Heme Iron Dr. Greger 10 videos
  • Concerned about long-term supplementation
  • "Once ingested and absorbed, the body has no mechanism to remove excess iron"
• Iron and vitamin D deficiency in children living in Western-Europe Oct 2017
  PHD dissertation, full text online
  "Secondly, we describe prevalence rates of ID and VDD in healthy young children, moderately preterm infants, and in children with inflammatory bowel disease or diabetes type 1."
  "Furthermore, we also describe associations with ID and VDD that clinicians can use to detect patients at risk for deficiency."

See also Hepcidin

• VITAMIN D AND IRON, THE CONNECTION YOU NEVER KNEW ABOUT April 2017
  Kerri Knox April 2017 "VITAMIN D AND IRON ARE COFACTORS OF EACH OTHER, Case in point is our discussion here. Interestingly, the relationship between Vitamin D and Iron possibly runs both ways, as the research suggests that each are cofactors for each other. If you don’t have enough vitamin D, you can’t absorb iron properly; if you don’t have enough iron, you can’t have adequate vitamin D levels."

• Suppression of Iron-Regulatory Hepcidin by Vitamin D Nov 2013
  Free PDF on-line with many charts. 100,000 IU of vitamin D2 decreased Hepcidin level by 34% in 24 hours
• The role of vitamin D in regulating the iron-hepcidin-ferroportin axis in monocytes March 2014
  "Chronic kidney disease affects 40% of adults aged 65 and older. Anemia of CKD is present in 30% of patients with CKD and is associated with increased cardiovascular risk, decreased quality of life, and increased mortality. Hepcidin-25 (hepcidin), the key iron regulating hormone, prevents iron egress from macrophages and thus prevents normal recycling of the iron needed to support erythropoiesis. Hepcidin levels are increased in adults and children with CKD. Vitamin D insufficiency is highly prevalent in CKD and is associated with erythropoietin hyporesponsiveness. Recently, hepcidin levels were found to be inversely correlated with vitamin D status in CKD. " Free PDF online
• Molecular study of hepcidin in chronic hepatitis C genotype 4 patients treated with pegylated interferon/ribavirin with vitamin D 2016
  2,000 IU Vitamin D daily ( a small amount), PDF online, does not seem to indicate % of non-responders

• High-dose vitamin D3 reduces circulating hepcidin concentrations: A pilot, randomized, double-blind, placebo-controlled trial in healthy adults Aug 2017
  • 250,000 IU of vitamin D significantly reduced hepcidin in 1 week.
  •  Download the PDF from VitaminDWiki
• Search VitaminDWiki for hepcidin 106 items as of July 2020
• Search VitaminDWiki for ANEMIA & AFRICAN-AMERICAN 211 items as of July 2020
• Sickle Cell treated by Vitamin D - many studies
• Low vitamin D - anemia 2.2X more likely (no surprise) – meta-analysis Aug 2015
• Sickle Cell children need more than 7,000 IU of vitamin D daily – May 2015 - adding Iron would probably help

How Much per person

The only difference between chlorophyll and hemoglobin is
   Magnesium vs Iron in the center

Iron Deficiency symptoms

Top10HomeRemedies

Iron Deficiency estimated by Smartphone photos - Nov 2018

Smartphone app for non-invasive detection of anemia using only patient-sourced photos

This appears to be the 3rd smartphone application to detect anemia

Did not notice if any of these are ready to be used by the general public

Doubt that this, and similar tests that eliminate use of doctors, has been accepted by the FDA

 Download the PDF from VitaminDWiki

Anemia while pregnant

Aug 2017

Mercola and IRON

Excessive Ferretin increases the risk of bone fractures - Mercola Jan 2025

Mercola

Iron: Not too much and not too little - Mercola Aug 2020

Your Iron Levels Could Be a Key to Slow Aging and Long Life

• "... an excessive amount of iron is more common than having a deficiency."
• "In one study, researchers estimated 40% to 70% of people with the defective genes will eventually have iron overload."

Too Much, Too Little - Mercola May 2017

Why Managing Your Iron Level Is Crucial to Your Health Mercola May 2017

• Not too much or too little. includes interview and transcript
  "I believe it can be every bit as dangerous to your health as vitamin D deficiency." Mercola
• Videos discussing the importance of many blood tests, including Ferritin (Iron) Sept 2018
  Test annually to confirm that you do not have too little or too much

VitaminDWiki - Anemia and Vitamin D - many studies 19 as of Feb 2025

Iron category associations: Zinc 16 (studies), Magnesium 14, Omega-3 10, Infant-Child 9, Vitamin B12 9, Women 8, Iodine 7, Calcium 7, Pregnancy 6, Vitamin K 6, Vitamin A 6 etc.

Supplement 5, Vitamin C 5, Virus 4, Cancer - Breast 3, Interactions 3, Boron 3, Skin - Dark 2, Sports 2, Immunity 2, Cognitive 2, Resveratrol 2, Curcumin 2, Liver 2, Sleep 2   as of April 2024