The Iron Controversy – What We Do Different About Iron
Iron is essential for immune system responses (1) (2) (3) and it plays a number of critical roles in enzymes around the body (4). This includes the antioxidant enzyme catalase. As we have mentioned on our other pages, antioxidant enzymes are important for the capacity of the immune system to kill bacteria and viruses. It’s commonly known to be important for red blood cells to help carry oxygen where it’s needed but it also helps with many other bodily processes like cell growth and neurological function (1) (2) (3).
As a result, it is commonly thought that iron supplements would be beneficial in a multivitamin.
Iron deficiency is the most common deficiency worldwide, with 4.7 million people per year getting iron deficiency anaemia in the UK (5).
In many low-income countries over 50% of mothers and young children are deficient in iron. (6).
The World Health Organisation (WHO) recommends iron supplementation in all countries where iron deficiency is more than 40% (6).
A scientific paper from the world’s most reputable scientific journal, shows us why our beliefs around the benefits of iron supplements may be misplaced.
A large trial in Tanzania was prematurely stopped when it was found that the iron supplements were related to significant increases in hospitalisations and deaths. How? It increased the rates of malaria, respiratory infections, severe diarrhoea and febrile illness. The scientific paper set out to find out why this was happening. It was shown that taking modest doses (130mg) of iron markedly increased bacterial growth, causing an increased risk of bacteria in the blood (6).
We believe this cannot be good for the immune system.
In fact, digestive side effects are a well-known part of giving iron supplements to people. Constipation, diarrhoea, gastrointestinal discomfort and nausea are common (1 in 10) or very common (more than 1 in 10) side effects for standard iron supplements (7). These side effects are thought to be due to the negative effect these forms of iron have on the gut bacteria (8). The number of “good bacteria” go down whereas the number of “bad bacteria” goes up.
We know that one’s gut bacteria is a very important part of the immune system. In fact, researchers believe that a poor gut microbiome may explain why some are at increased risk of poor COVID-19 outcomes (9). These researchers also believe that the gut microbiome may offer a potential treatment target for COVID-19. It has also been found that removal of certain gut bacteria by antibiotics can increase susceptibility to viral infections like influenza (10).
So, if we want to have a good gut microbiome and have better immunity, it doesn’t seem like taking standard iron supplements is a good idea.
Iron deficiency is common, so we thought it would be good to find a solution. Fortunately, there’s a really amazing form of iron out there called iron bisglycinate (A.K.A ferrous bisglycinate). This form of iron is chelated/bound to an amino acid similar to iron from red meat. This makes it less soluble. Why is this important? The forms of iron that were shown to have the negative side effects were highly soluble forms of iron (EG ferrous sulfate). In fact, when taken at the same dose, iron bisglycinate produces roughly half the amount of gastrointestinal side effects as ferrous sulfate (the most common form of iron used in multivitamins) (11).
Iron bisglycinate has been found to be more effective at raising iron stores than the forms of iron found in most supplements (12), with the effects being longer lasting. On average, it is absorbed about 4 times better than commonly used ferrous sulphate or ferrous fumarate (13) (14).
This allows us to use 4 times less iron in our ThinkPharm Formula. We originally wanted to put 6mg of iron into the supplement but now to account for the increased absorption we put in 1.5mg. This is why we think our supplement is safer than most iron containing vitamins out there. It has 20 times less iron than the lowest dose known to cause side effects (16).
Isn’t 1.5mg too little?
Not really. The RDA in the UK for females 19-50 is 14.8mg and the RDA for other adults (females aged over 50 and males) is 8.7mg (4). Remember that 1.5mg is the same as 6mg due to the higher absorption of iron bisglycinate. This means the ThinkPharm Formula makes a pretty good contribution to the daily requirement. The dietary RDAs take into account the inherently poor absorption of iron through the diet. In fact, published estimates state that from an average daily intake of 12-15mg only 1-2mg is absorbed! (15). If all the iron was coming from iron bisglycinate the RDAs would be much lower.
The other great thing about iron bisglycinate is that its absorption is partly dependent on the amount of iron you already have in your body (13). The data shows that absorption is strongly inversely related with ferritin levels (a measure of iron stores).
This means if you’re low on iron, you’ll absorb more. If you’re already high on iron, you’ll absorb less. This makes it safer and more effective.
It isn’t a perfect association, however, so you will still absorb some, even if your levels are high to start. The body has no way of getting rid of excess iron in the body, so it is important we make sure we don’t absorb too much. This is why we don’t want to put higher levels of iron into our supplement.
Unfortunately, it is not possible to make a multivitamin that meets everybody’s iron needs because requirements can vary dramatically depending on one’s levels. If you think you need more iron, you can get some iron from iron rich foods (such as shellfish, meat, leafy greens, legumes) or from a supplement containing iron bisglycinate. In the case of iron, getting it through food is best where possible.
Eating high vitamin C foods with plant sources of iron will improve absorption. If you’re going to supplement, get a supplement containing iron bisglycinate. Remember that a little goes a long way and that long term a dose more than 3.7mg may lead to overly high levels because it is equivalent to the female RDA of 14.8mg and you’ll be getting some iron in your diet already.
If you have low iron levels it may be necessary to have more than 3.7mg for a limited period of time but try to not overdo it. Even though 30mg of iron bisglycinate didn’t have side effects that caused participants to drop out, 10.4% of participants still had GI side effects lasting for one day or more like diarrhoea, abdominal pain, nausea or constipation (16). Not ideal.
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