From the Guidelines
Ferrous fumarate is a reasonable choice for increasing ferritin levels, as it is a ferrous iron salt that can effectively raise iron stores. The most recent and highest quality study, published in 2024 in Clinical Gastroenterology and Hepatology 1, suggests that ferrous iron salts, including ferrous fumarate, are a reasonable choice for oral iron supplementation due to their effectiveness and low cost. Some key points to consider when using ferrous fumarate to increase ferritin levels include:
- Typical dosing ranges from 200-300 mg (providing 65-100 mg of elemental iron) taken 1-3 times daily, depending on the severity of iron deficiency.
- For optimal absorption, take ferrous fumarate on an empty stomach with vitamin C (such as orange juice), and avoid taking it with calcium supplements, dairy products, coffee, tea, or antacids, which can reduce absorption.
- Side effects may include constipation, nausea, and black stools.
- It typically takes 2-3 months of consistent supplementation to significantly raise ferritin levels, though improvements in other markers like hemoglobin may occur sooner. Another study published in 2021 in Gut 1 also recommends the use of ferrous sulphate, fumarate, or gluconate as the initial treatment for iron deficiency anemia, with a suggested dosing of one tablet per day. However, the 2024 study 1 provides more recent and detailed guidance on the use of ferrous fumarate for increasing ferritin levels.
From the Research
Iron Deficiency and Ferritin Levels
- Iron deficiency is a common condition that affects approximately 2 billion people worldwide, with 14% of adults in the US being affected 2.
- Ferritin levels are used to diagnose iron deficiency, with low serum ferritin (typically <30 ng/mL) indicating iron deficiency in individuals without inflammatory conditions 2.
Treatment of Iron Deficiency
- Oral iron supplements are typically the first-line therapy for iron deficiency, with ferrous sulfate 325 mg/d or on alternate days being a common treatment 2.
- However, there is no direct evidence on the effectiveness of ferrofumarate in improving ferritin levels.
Vitamin C and Iron Supplementation
- Vitamin C can enhance iron absorption, but studies have shown that oral iron supplements alone are equivalent to oral iron supplements plus vitamin C in improving hemoglobin recovery and iron absorption 3.
- A systematic review and meta-analysis found that the addition of vitamin C or ascorbate to iron supplements did not significantly improve hemoglobin or serum ferritin levels 4.