Iron Supplements: Who Needs Them and How to Take Them Well

6 min read · Medicines · By the Asthra Health Care team

Why iron matters

Iron helps the body make haemoglobin, the part of red blood cells that carries oxygen. When iron is low, haemoglobin falls and you develop iron-deficiency anaemia. This is one of the most common nutrition problems in India, especially in adolescent girls, pregnant women and young children. Common symptoms are tiredness, breathlessness on climbing stairs, pale skin, headaches, brittle nails and poor concentration.

Common causes of low iron

Low iron often comes from a diet low in iron-rich foods, heavy menstrual periods, pregnancy, and growth spurts in children. Worm infections, piles, stomach ulcers and long use of some painkillers can cause slow blood loss. Some people cannot absorb iron well because of conditions such as celiac disease. In older adults, unexplained iron deficiency must be investigated, because it can be a sign of bleeding in the gut.

Test before you take

Tiredness has many causes, and not all anaemia is due to low iron. Vitamin B12 or folate deficiency, thalassaemia trait and chronic illnesses can also lower haemoglobin. Taking iron when it is not needed will not help and may cause harm, particularly in people with thalassaemia or iron overload conditions.

A doctor will usually order a complete blood count and iron studies such as serum ferritin before starting treatment. If needed, stool tests for worms or hidden blood may also be advised. These tests are usually repeated after some weeks or months to check that haemoglobin is rising and iron stores are recovering properly.

Types of iron supplements

Iron comes as tablets, capsules, syrups and drops. Common forms include ferrous sulphate, ferrous fumarate, ferrous ascorbate and carbonyl iron, often combined with folic acid. For people who cannot tolerate tablets or need faster correction, doctors may give iron through an injection or drip in a clinic or hospital. The choice and amount depend on how low your iron is, your age, pregnancy and other health conditions, so follow your doctor's advice.

Getting the most from iron

Iron is absorbed best on an empty stomach, but some people feel sick when taking it this way, so your doctor or pharmacist may suggest taking it with a little food. Vitamin C-rich foods like lemon, amla, guava or orange help absorption. Tea, coffee, milk and calcium tablets reduce absorption, so keep them apart from your iron.

• Do not take iron at the same time as antacids or calcium supplements
• Some antibiotics and thyroid tablets should be taken apart from iron; ask your pharmacist
• Keep taking it for as long as advised, since stores refill slowly
• Include iron-rich foods such as green leafy vegetables, ragi, dals, jaggery in moderation, eggs, meat and fish

Side effects and safety

Iron can cause constipation, nausea, stomach discomfort and dark or black stools. Black stools from iron are expected, but black, tarry, sticky stools with weakness or dizziness can mean bleeding and need urgent care. Liquid iron may stain teeth, so rinsing the mouth or using a straw helps.

Iron overdose is dangerous, especially for young children, who may mistake coloured tablets for sweets. Even a small number of adult tablets can poison a child. Always store iron supplements in their original container, out of sight and reach of children, and seek emergency help at once if a child swallows any.

Anaemia in pregnancy and childhood

Pregnancy greatly increases the body's need for iron, because the mother's blood volume rises and the baby builds its own iron stores. Untreated anaemia in pregnancy can make the mother very tired and increase risks during delivery. Regular antenatal check-ups include haemoglobin testing so that iron can be started or adjusted in time.

Children with anaemia may be irritable, eat poorly and struggle to concentrate at school. Deworming as advised by government programmes and a diet with iron-rich foods help prevent it, but any child with suspected anaemia should be checked by a doctor.

Special groups and follow-up

Pregnant women commonly receive iron and folic acid through antenatal care, as advised by their doctor. Children should only be given iron in the form and amount a doctor recommends. People with kidney disease, stomach ulcers or inflammatory bowel disease need individual advice.

If you feel persistently tired or breathless, consult a doctor or pharmacist to find the cause before starting iron. Return for the follow-up blood tests your doctor suggests, and do not continue or stop iron on your own for long periods, since both untreated anaemia and unnecessary iron can cause problems. Your doctor or pharmacist can guide you at every step.

This article is general health information, not medical advice. Do not start, stop or combine medicines on your own — always follow your doctor's prescription and ask your pharmacist if unsure.