When people talk about low energy and fatigue, one of the first things that often comes to mind is anaemia and possibly being low in iron.  We learn at an early age that we need iron to make haemoglobin, the protein that carries oxygen around our blood stream and that fatigue can be a sign of anaemia or low red blood cell count.

However, in the past 24 hours I’ve had two encounters with clients that lead me to write this article regarding iron supplementation.  As many people choose to self-supplement, it is important to be aware that some supplements can be harmful if taken unnecessarily, at the incorrect dose or in conjunction with certain medications.  Even the wrong multivitamin may be harmful if inappropriate, as outlined below.

Men should not take iron supplements

It is rare for men to be low in iron.  Unless diagnosed with anaemia or low ferritin levels men should avoid any supplements that contain iron, including a standard multivitamin.  Most good quality brands offer  ‘No Iron’ versions of their multivitamins for this reason.   

The body is very good at recycling iron and loss of iron through excretion is low.  This means that a balanced diet coupled with a healthy digestive system usually provides enough iron for men.  Exceptions may be for those who donate blood regularly, have digestive issues that impact absorption (such as coeliac’s disease) or have experienced a recent injury resulting in loss of blood.  

The majority of men enjoy red meat, which means that their diet is rarely lacking in iron.  

Post-menopausal women should not take iron supplements

Once women have ceased menstruation, loss of iron is greatly reduced and just like men, post-menopausal women should look for multivitamins that are free from iron.

What is wrong with iron overload?

As with most things in life, a little can be good but too much of anything often results in imbalance of some kind.  Iron overload occurs if excess iron builds up in the blood.  Over time, the iron gets stored in organs such as the liver and heart.   

Excess iron is now considered to be a possible trigger for increased oxidative stress, leading to arterial inflammation.  High levels of iron in the blood may also lead directly to oxidation of LDL (low density lipoproteins), resulting in an increase in vLDL (very low density lipoproteins). vLDL is identified as the type of cholesterol which carries the greatest risk to cardiovascular health.

Haemochromatosis

The genetic disease haemochromatosis affects approximately 1 in 250 individuals of northern European descent. Individuals with this condition absorb iron very efficiently.  This results in an excess of iron and can lead to organ damage such as cirrhosis of the liver and heart failure. Haemochromatosis is often not diagnosed until symptoms linked to organ damage has already started to show.  As iron supplementation may exacerbate the effects of haemochromatosis, this illustrates why adult men and postmenopausal women who are not iron deficient should avoid iron supplements. Individuals that receive frequent blood transfusions are usually also advised to avoid iron supplementation.

Athletes

It has been identified that both male and female athletes may require additional iron.  This is thought to be a result of increased loss of blood through gastrointestinal distress caused by endurance sports.  Many athletes are also likely to have increased blood turnover and possibly micro-tears to capillaries in the feet from long distance running.  Female athletes who are menstruating should be able to take iron without too much worry.  Male athletes who wish to supplement iron should seek professional advice and periodically check their iron stores by looking at ferritin levels to ensure that levels remain with in a healthy range.

Of course, if working with a practitioner trained in the functional medicine approach to sports nutrition, the right diet and gastrointestinal support should negate much of the gastrointestinal stress which can be caused through endurance sports.  This results in improved nutritional status, reduced GI discomfort and ultimately improved sports performance.

Children

Due to their size and curiostiy in putting small coloured pills in their mouths, children are at a much greater risk of iron toxicity.  All supplements, should be kept out of reach of children, especially those containing iron.

Conclusion

If you suspect that you are deficient in a vitamin or mineral, or have read that a particular nutrient can support a symptom you are wanting to address, discuss your concerns with someone trained in supplementation prior to commencing any supplement programme.

Many individuals come to me already taking supplements - most of the time, their choices are fine.  However, every now and then I come across a supplement programme which has negative health implications and I am reminded of the importance of being well informed and understanding the whole picture before simply taking the nutritional advice given by a magazine or well-meaning friend. 

It is not uncommon to find men or post-menopausal women taking iron supplements.  However, given the risks and how easily rectified this issue is, I find it strange that many of the iron supplements sold over the counter do not provide a basic warning to advise men to check their ferritin levels with their GP prior to supplementation.

References

Cogswell ME, Burke W, McDonnell SM, Franks A. Public Health Strategies to Prevent the Complications of Hemochromatosis. Genetics and Public Health in the 21st Centry: using genetic information to improve health and prevent disease. Oxford University Press, 2000.

Bothwell TH, MacPhail AP. Hereditary hemochromatosis: etiologic, pathologic, and clinical aspects. Semin Hematol 1998;35:55-71.

Brittenham GM. New advances in iron metabolism, iron deficiency, and iron overload. Curr Opin Hematol 1994;1:101-6