How to increase iron saturation?

From the Guidelines

To increase iron saturation, focus on both dietary changes and possibly iron supplements, with the most recent guidelines suggesting the addition of vitamin C to oral iron supplementation to improve absorption, as recommended by the 2024 AGA clinical practice update on management of iron deficiency anemia 1.

Key Recommendations

• Consume iron-rich foods like lean red meat, poultry, fish, beans, lentils, tofu, and fortified cereals.
• Include vitamin C sources (citrus fruits, strawberries, bell peppers) with meals to enhance iron absorption, as supported by the 2024 AGA clinical practice update 1.
• If supplementation is needed, ferrous sulfate (325 mg, containing 65 mg elemental iron) taken 1-3 times daily is commonly prescribed, but the 2024 AGA clinical practice update suggests that taking iron once a day may be sufficient and reduce side effects 1.
• Take supplements on an empty stomach with vitamin C, but avoid taking with calcium, dairy, coffee, tea, or antacids, which inhibit absorption, as noted in the 2020 AGA clinical practice guidelines 1.

Important Considerations

• Iron saturation reflects the percentage of transferrin (iron-carrying protein) that's bound to iron, with normal levels being 20-50% 1.
• Low saturation indicates iron deficiency, which can lead to anemia, fatigue, and weakened immunity.
• If experiencing symptoms like unusual fatigue or weakness, consult a healthcare provider for proper diagnosis before starting supplements, as excessive iron can be harmful.
• For severe deficiency, a doctor might recommend intravenous iron formulations like iron sucrose or ferric carboxymaltose, as suggested by the 2021 British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults 1.

From the FDA Drug Label

16 HOW SUPPLIED Ferrous Sulfate Tablets are available as follows: Each tablet contains 324mg of ferrous sulfate, equivalent to 65mg of elemental iron, providing 362% of the U.S. recommended daily intake (RDI) of iron for adults and children 4 and older.

The FDA drug label does not answer the question.

From the Research

Increasing Iron Saturation

To increase iron saturation, several strategies can be employed, including:

• Taking iron supplements on alternate days instead of daily, as this can help maximize fractional iron absorption and reduce side effects 2, 3
• Consuming iron supplements in the morning, as serum hepcidin is lower in the morning, allowing for better iron absorption 2, 3, 4
• Taking iron supplements with ascorbic acid (AA), which can increase iron absorption by up to 30% 4
• Avoiding consumption of coffee and meals with iron supplements, as they can decrease iron absorption by up to 66% 4
• Considering lower doses of iron supplements, such as 19-38 mg, which may be equivalent to higher doses in mitigating iron deficiency 5

Dietary Factors and Iron Absorption

Dietary factors can significantly impact iron absorption from oral iron supplements. Key findings include:

• Ascorbic acid (AA) can increase iron absorption, but high doses (500 mg) may not provide additional benefits 4
• Coffee can decrease iron absorption by up to 54% 4
• Breakfast, including coffee and orange juice, can decrease iron absorption by up to 66% despite the presence of AA 4
• Orange juice alone can increase iron absorption by up to 4-fold compared to consuming iron with coffee or breakfast 4

Timing of Iron Supplementation

The timing of iron supplementation can also impact absorption. Studies suggest that:

• Taking iron supplements in the morning can result in higher iron absorption compared to taking them in the afternoon 4
• Serum hepcidin is higher in the afternoon, which can decrease iron absorption 4