The Iron Rules: How To Take Oral Iron Successfully

  1. Vitamin C and/or a high-protein snack will improve iron absorption
  2. Calcium, coffee and tea all decrease iron absorption (tea by 90%!).  Watch out, therefore, for calcium-fortified orange juice or multivitamins containing calcium.
  3. Take iron on an empty stomach (except for the vitamin C or protein above).
  4. Stay upright for 30 minutes or so after taking it to ensure it does not lodge in the esophagus, where it can be an irritant.
  5. Plan on constipation:  have docusate or another stool softener available.
  6. Plan on dark stools, and don’t panic.
  7. Recheck an H/H in a month, which should show improvement if the Fe is being absorbed.
  8. The better tolerated the iron preparation, the less it’s being absorbed (sadly).  Ferrous gluconate, for example, is well-tolerated, but not as well-absorbed.  Whereas ferrous sulfate is poorly tolerated, but better absorbed.  It’s a trade-off.
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