Is it safe to take iron supplements without being diagnosed with iron deficiency (ID) or hypoferritinemia?

From the Guidelines

Taking iron supplements without being low on iron is not safe and is potentially harmful. According to the espen micronutrient guideline published in Clinical Nutrition in 2022 1, iron supplementation in the presence of normal or even high ferritin values is not recommended. This is because excess iron can accumulate in organs like the liver, heart, and pancreas, potentially causing serious damage.

Some of the key points to consider when it comes to iron supplementation include:

• Iron deficiency should be treated when it is associated with anemia and/or low ferritin levels 1
• Typical doses of oral iron supplements are 100-200 mg/day, in divided doses 1
• Gastrointestinal side effects of iron therapy are not rare, including constipation, diarrhea, and nausea 1
• Recent data suggest better iron resorption and possibly fewer adverse effects with alternate day dosing 1

It's essential to confirm your iron status through blood tests that measure ferritin, hemoglobin, and other iron markers before considering iron supplements. Certain groups like menstruating women, pregnant women, frequent blood donors, and those with certain medical conditions may benefit from supplementation, but this should be determined by a healthcare provider. If supplementation is needed, it's crucial to follow the recommended dosage and administration guidelines to minimize the risk of adverse effects.

From the FDA Drug Label

DESCRIPTION Each tablet contains 324 mg of ferrous gluconate, equivalent to 38 mg of elemental iron, providing 211% of the U.S. recommended daily intake (RDI) of iron for adults and children 4 and older. Directions for Use Do not crush or chew tablets. Adult Serving Size: 1 tablet three to four times daily. Children: Consult a physician.

The use of iron supplements without being low on iron is not explicitly addressed in the provided drug label. However, taking iron supplements when not necessary can lead to iron overload, which may cause adverse effects.

• The label does provide the recommended daily intake and serving size, but it does not provide information on the safety of taking the supplement without a diagnosed iron deficiency. It is recommended to consult a physician before taking any supplement, especially if you are not diagnosed with iron deficiency 2.

From the Research

Iron Supplementation Without Iron Deficiency

Taking iron supplements without being low on iron may not be safe, as it can lead to adverse effects and be harmful.

• The study 3 states that preventative iron administration in the presence of normal stores is inefficient, has side effects, and seems to be harmful.
• Another study 4 found that low-dose iron therapy is effective in elderly patients with iron-deficiency anemia and reduces adverse effects, suggesting that high doses of iron may be unnecessary and potentially harmful.
• The study 5 also notes that higher dosages of iron are not recommended during pregnancy due to potential negative effects on mineral absorption, oxidative pathways, and adverse gastrointestinal symptoms.

Risks and Benefits of Iron Supplementation

The risks and benefits of iron supplementation depend on various factors, including the individual's iron status, age, and health conditions.

• The study 6 states that iron deficiency and iron-deficiency anemia are common conditions that may cause symptoms such as fatigue, exercise intolerance, and difficulty concentrating, and that oral iron is first-line therapy for most patients.
• The study 7 suggests that endurance athletes may be at risk of becoming iron deficient due to an imbalance between absorption of dietary iron and exercise-induced iron loss, and that controlled iron supplementation may be beneficial in preventing iron deficiency and limiting the hyperabsorption of potentially toxic metals.

Guidelines for Iron Supplementation

Guidelines for iron supplementation vary depending on the individual's iron status, age, and health conditions.

• The study 3 recommends a ferritin cut-off of 30 µg/l for healthy males and females aged >15 years, and cut-offs of 15 and 20 µg/l for children from 6-12 years and younger adolescents from 12-15 years, respectively.
• The study 6 states that oral iron (ferrous sulfate 325 mg/d or on alternate days) is typically first-line therapy, and that intravenous iron is indicated for patients with oral iron intolerance, poor absorption, or certain chronic inflammatory conditions.
• The study 5 recommends a low daily dose of iron (30 mg elemental iron) during pregnancy to improve women's iron status and protect their infants from iron-deficiency anemia.