Q: When should we take the elemental iron supplements? How many mgs can be taken in a day? Should I get any test done to check on my haemoglobin count? I think I have iron deficiency?

A:Normally, the body concentration of iron is regulated carefully by cells in the proximal part of the small intestine, which change iron absorption to compensate body losses. Iron deficiency is caused by either reduced intake of oral iron or excessive loss of iron from the body. Iron-deficiency anaemia may be caused by consuming diets low in iron (iron is obtained from foods in our diet but only 1 mg of iron is absorbed for every 10 to 20 mg of iron ingested. A person unable to have a balanced iron-rich diet may suffer from some degree of iron-deficiency anaemia). Absorption of iron from food is influenced by multiple factors. One important factor is the form of the iron. Dietary iron is available in two valency states, Fe 2+ (ferrous) and Fe 3+ (ferric). The majority of ferrous form is found in haeme iron (as haemoglobin & myoglobin in meat and meat products) while most ferric iron is found in non-haeme iron (plant foods like cereals, vegetables, pulses, dried fruits etc.) Haeme iron, found in animal sources, is highly available for absorption in contrast to non-haeme iron found in vegetable sources. Haeme iron is readily available and usually 20-30% of it is absorbed from the diet. This can increase upto 40% when an individual is iron deficient. The level of haeme iron absorption is relatively unaffected by other dietary factors. Non-haeme iron, in contrast, is relatively poorly absorbed (usually less than 10% of dietary intake and often under 5%). Its absorption is markedly influenced by an individuals iron status and dietary factors that can either inhibit or enhance it. Vegetarians need more iron in their diets than non-vegetarians because the iron from plant foods is not as well absorbed as it is from animal foods. Vegetarians should choose several iron-rich plant foods daily. Grains, beans and lentils, vegetables (green-leafy ones, tomato, potato, green & red chillies etc), fruits, nuts and seeds are rich sources of non-haeme iron. The absorption of non-haeme iron can be improved when a source of haeme iron meat/fish/poultry is consumed in the same meal or iron absorption enhancing foods like fruits/fruit juices are consumed. But coffee/tea and calcium if consumed along with a meal impair iron absorption. Treatment of most patients with iron deficiency is with oral iron therapy. The underlying cause too is corrected so that deficiency does not recur. The cheapest and most effective form is ferrous iron. The side effects experienced on taking iron tablet are proportional to the amount of iron available for absorption. The iron preparation you take should contain between 30-100 mg elemental iron. Avoid enteric-coated or prolonged-release preparations. The dose you take should be sufficient to provide between 150-200 mg elemental iron per day and the tablet may be taken 2 to 3 times a day about 1 hour before meals. Though ferrous sulphate is recommended to treat iron deficiency, often patients complain of gastrointestinal discomfort, bloating and other distress. Ferrous gluconate, which is roughly equivalent in cost, produces fewer problems, and is preferable as the initial treatment of iron deficiency. Ascorbic acid supplementation enhances iron absorption. Polysaccharide-iron complex is a more recent option. The polar oxygen groups in the polysaccharide form complexes with the iron atoms and the well-hydrated microspheres of polysaccharide iron remain in solution over a wide pH range. Most patients tolerate this form of iron better than the iron salts, even though the 150 mg of elemental iron per tablet is substantially greater than that provided by iron salts (50 to 70 mg per tablet). The treatment should be continued for 3 months after the haemoglobin has returned to normal so that the body iron stores are replenished. Response to treatment is confirmed by doing a reticulocyte count after 10-12 days of treatment and the rate of rise of haemoglobin (with adequate dose of iron) is about 1 g/dl per week. A low serum iron and ferritin with an elevated total iron binding capacity (TIBC) are diagnostic of iron deficiency. While a low serum ferritin is virtually diagnostic of iron deficiency, a normal serum ferritin can be seen in patients who are deficient in iron and have coexistent diseases.