Iron is an essential mineral for human health. The body uses iron to help synthesize its oxygen transport proteins, including hemoglobin in red blood cells and myoglobin in muscle cells. We also have heme enzymes and other iron containing enzymes that are essential for electron transfer and oxidation-reduction reactions, needed to build energy and keep our systems running effectively. Almost two thirds of our body’s iron is found in hemoglobin, the protein in red blood cells that binds to oxygen and moves it around our bodies. Another 10-20% is found in a storage protein, called ferritin, where iron is kept mainly in the liver for later use. The remaining amounts of iron are found in myoglobin, in muscle cells, and other enzymatic reactions throughout the body.
Many folks are familiar with ferritin, as that is what is commonly tested via a blood sample, to see what your iron levels are. There are also other iron markers that can help us make sense of your total iron picture, including serum iron, total iron binding capacity, and transferrin saturation.
Iron absorption (or lack there of):
An average diet contains approximately 10-20mg of iron daily, and depending on the intestinal health and type of iron, only 5-35% is actually absorbed. First off, iron is absorbed by the enterocytes in the small intestine (specifically the duodenum and upper jejunum). The body wants to absorb ferrous iron (Fe+2 ), which at a physiological pH, it gets rapidly oxidized to the insoluble ferric form (Fe+3). The low pH of gastric acid reduces iron to its absorbable Fe+2 state, where it can be absorbed. Therefore, gastric acid production is crucial for iron absorption and can be impaired by states of stress, infection, multiple digestive conditions and medication use (proton pump inhibitors, for example).
Secondly, there are absorption differences between heme and nonheme iron. Heme iron is found in animal proteins and nonheme iron is found in plant based sources of iron. Heme iron is highly bio available, 15-35% is absorbed, versus only 2-20% of nonheme iron. Nonheme iron also has more dietary competitors and inhibitors that can prevent iron’s ability to be bound and absorbed.
Causes of iron deficiency:
Bleeding (heavy menses, GI bleeding / ulcers)
Pregnancy / postpartum (due to increased physiological demand and post delivery)
Depending on your individual health parameters, it is likely that you have tried oral supplementation if you have been diagnosed with iron deficiency anemia or iron deficiency (without anemia). Generally speaking, it is recommended to try oral supplements for 6-12 months before considering an infusion. However, there may be compliance issues, due to iron side effects (nausea, constipation, diarrhea) or underlying digestive conditions (crohn’s, colitis, IBS, SIBO, etc) that prevents you from successfully taking oral iron. As we discussed above, the absorption, metabolism, and storage of iron is a very complex process and some people will never get their ferritin levels up by taking oral supplements. Iron infusions offer a safe and effective solution in these scenarios. Ferritin levels under 50 should be evaluated in combination with signs and symptoms and a discussion around oral versus IV iron should be considered.
What to expect during your iron infusion?
Before your appointment:
Your lab results (from the last 3 months) have already been discussed with you and we have gone ahead and prescribed the appropriate iron dose for you, if not please book an appointment to order or review recent labs. Prepare to be at the clinic for 45-90 minutes, longer for your first treatment, as the first IV will be ran slowly to ensure patient comfort and tolerance.
We will either be using Venofer or Monoferric iron preparations. Venofer is the preferred choice in pregnancy and comes in smaller doses (starting at 200mg / infusion) and may take a few treatments to get your desired dose. Monoferric is done in 500 or 1000mg doses and often just one infusion is needed. Based on your symptoms, your iron labs (ferritin, hemoglobin and other iron studies if applicable), and your individual past medical history, we will prescribe the iron dose best suited for you. We will then call this prescription into your pharmacy and you will bring this prescription to your IV appointment with you. Depending on your extended health insurance, the prescription may be covered, and we can direct bill for the IV appointment itself.
During your appointment:
We will go over the informed consent for IV iron with you and give you an opportunity to ask any questions. You will have brought in your prescribed iron, so we will make up the appropriate IV with your specific dose. We will now take your blood pressure and heart rate and go over any other questions you may have.
The most common side effects:
Headache
Muscle cramping
Joint ache
Metallic taste
Nausea
Dizziness
Low blood pressure
Please let your ND know if any of these symptoms arise, we will stop the IV and wait for 15 minutes to see if it can be restarted at a slower rate. There are other more severe rare side effects that will be discussed with you in your appointment.
After your appointment:
Please note that some adverse side effects can take up to 72 hours to present. If you have any muscle aches, joint pain, headache, fever, vomiting, or abdominal pain please get in touch with the clinic at (250) 837 - 6084 and they will get your ND to get back to you.
Hopefully you will be feeling better within a few weeks of your iron infusion and that is a great time to check in with your practitioner. We will also retest your iron levels within 1-3 months of the infusion to see how effective the treatment was and if repeat infusions are needed.
