Does orange juice enhance the absorption of iron supplements?

From the Guidelines

Drinking orange juice with iron supplements can significantly enhance iron absorption due to its vitamin C content, as recommended by the latest clinical practice update on management of iron deficiency anemia 1. When taking an iron supplement, drinking a glass of orange juice at the same time can increase iron absorption by up to 3-6 times. For best results, take your iron supplement (such as ferrous sulfate, ferrous gluconate, or ferrous fumarate) with 8 ounces of orange juice on an empty stomach. However, avoid taking iron supplements with milk, coffee, tea, or calcium supplements, as these can decrease absorption, as noted in a recent study 1. If you experience stomach upset from iron supplements, you can take them with food, though this may slightly reduce absorption. The enhanced absorption occurs because vitamin C helps convert dietary iron from the ferric (Fe3+) to the ferrous (Fe2+) state, which is more readily absorbed in the intestines. Some key points to consider when taking iron supplements include:

• Take iron supplements no more than once a day, as increased frequency does not improve absorption but may increase side effects 1
• Avoid taking iron supplements with tea and coffee, as they are powerful inhibitors of iron absorption 1
• Consider taking iron supplements every other day to improve tolerance, although more research is needed to confirm this approach 1

From the Research

Iron Absorption and Orange Juice

• The absorption of iron supplements can be influenced by the consumption of orange juice, according to a study published in the Journal of pediatric gastroenterology and nutrition 2.
• This study found that iron absorption increased from 5.5% to 8.2% when ferrous fumarate was consumed with orange juice compared to apple juice.
• The presence of ascorbic acid in orange juice is thought to be responsible for the enhanced iron absorption, as it helps to reduce ferric iron to ferrous iron, making it more soluble and bioavailable.

Comparison with Apple Juice

• A study published in the Archives of pediatrics & adolescent medicine compared the effect of orange and apple juices on iron absorption in children 3.
• This study found that median iron absorption from a meal ingested with apple juice was 7.17%, while median iron absorption from a meal ingested with orange juice was 7.78%, although this difference was not statistically significant.
• The study suggests that children can absorb iron well from a meal that includes either orange or apple juice, and a preference for apple juice does not pose a concern with regard to iron-deficiency anemia.

Age-Related Effects

• The study published in the Journal of pediatric gastroenterology and nutrition found that the effect of orange juice on iron absorption was age-related, with children older than 6 years of age experiencing a nearly 2-fold increase in iron absorption from ferrous fumarate given with orange juice 2.
• This suggests that older children may benefit more from consuming orange juice with iron supplements to enhance absorption.