Supplemental Iron

Here you can share your experiences with substances that are ingested, inhaled, or otherwise consumed for the purpose of relieving RLS/WED, other than prescription medications. For example, herbal remedies, nutritional supplements, diet, kratom, and marijuana (for now) should be discussed here. Tell others of successes, failures, side effects, and any known research on these substances. [Posts on these subjects created prior to 2009 are in the Physical Treatments forum.]

Important: Posts and information in this section are based on personal experiences and recommendations; they should not be considered a substitute for the advice of a healthcare provider.
Rustsmith
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Supplemental Iron

Postby Rustsmith » Sat Feb 25, 2017 7:37 pm

Since the use of supplemental iron has been a frequent topic of discussion lately, I thought I should provide a bit of background information on the use of these pills. Please bear with me if the discussion gets a bit too technical (alright, if the chemistry gets a lot too technical), and just jump over those parts.

There are basically two different approaches used for iron supplementation, iron sulfate and iron bisglycinate. Both are generally sold as pills that deliver a total of 28 to 65mg of iron, although there may be a different number that provides the mg total of iron sulfate or iron bisglycinate per pill in addition to the amount of actual iron. The difference in the numbers is the amount of sulfate or bisglycinate in each pill.

Iron Sulfate - Iron sulfate pills are generally less expensive than iron bisglycinate. These pills should be taken on an empty stomach and should ALWAYS be taken with either a vitamin C pill or a glass of orange juice. For individuals who have a sensitive stomach, iron sulfate can cause discomfort. This is the reason why iron bisglycinate pills are often marketed as "gentle iron".

When you take an iron sulfate pill, it dissolves in the stomach. Once dissolved, it forms free iron and free sulfate. As the stomach contents enter the intestinal tract, they are exposed to the colony of bacteria that we all carry. This colony contains a variety of types of bacteria and in about 50% of us there is a type of bacteria that is able to use the sulfate ions from the pill (and probably even our last meal as well) as a source of nutrient. As these bacteria do so, they release small quantities of hydrogen sulfide, the chemical responsible for the rotten egg smell (and many other sour smelling gases). This is important because the iron from the pill can react with the hydrogen sulfide to form iron sulfide, a chemical that cannot be adsorbed by the intestines. Any iron sulfide that is formed will pass out of the intestinal tract and will have been wasted. This iron sulfide (which is black) is the reason why a side effect of taking iron sulfate can be black stools.

If any of the sulfate eating bacteria are present and are "fed" with a dose of sulfate from the pill, their temporary feeding frenzy can result in intestinal discomfort and bloating from the gas they produce and the temporary upset in the balance with our our more friendly bacteria.

However, if the iron sulfate pill was taken with orange juice or a vitamin C pill, a second reaction occurs in the stomach prior to entry into the intestines. The dissolved iron reacts with the citric acid in the orange juice or the ascorbic acid of the vitamin C to form a chelated iron compound. This chelated form of iron is still dissolved in the stomach fluids, but is not able to react with the hydrogen sulfide in the intestines. All of the chelated iron is therefore available for adsorption into the blood stream and only minimal amounts end up being lost as iron sulfide.

Iron bisglycinate - Iron bisglycinate is a form of iron where the iron is already chelated with glycine, an amino acid. Since the iron is already chelated, it is not necessary to take iron bisglycinate pills with orange juice or a vitamin C pill. These pills are also easier on the stomach because they do not contain the sulfate that is needed by the sulfate eating bacteria that can cause intestinal distress.

Finally, neither form of iron should be taken with milk or heartburn relief products that contain calcium carbonate. Both of these will neutralize the acidity of the stomach contents, which can dramatically reduce both the formation of the chelated iron compounds, and thereby the availability iron for absorption by the intestines.
Steve

Augmentation Evaluation http://bb.rls.org/viewtopic.php?f=4&t=9005

Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

ViewsAskew
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Re: Supplemental Iron

Postby ViewsAskew » Sat Feb 25, 2017 8:18 pm

So, essentially, assuming acid for the sulfate, they both create bioidentical chelated iron that is absorbed?
Ann - Take what you need, leave the rest

Managing Your RLS

Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

Rustsmith
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Re: Supplemental Iron

Postby Rustsmith » Sat Feb 25, 2017 9:51 pm

Not quite identical, but both all three forms (ascorbate, citrate and bisglycinate) are all bioavailable because the are still dissolved.
Steve

Augmentation Evaluation http://bb.rls.org/viewtopic.php?f=4&t=9005

Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

Polar Bear
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Re: Supplemental Iron

Postby Polar Bear » Sat Feb 25, 2017 11:28 pm

Thank you for background information presented in a people friendly way.
Betty
http://www.willis-ekbom.org/about-rls-wed/publications
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legsbestill
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Re: Supplemental Iron

Postby legsbestill » Sun Feb 26, 2017 7:34 pm

Thank you, Steve. I really enjoyed the detail and although I had a rough idea of the science before reading it is fixed much more firmly in my mind. I wonder if I could ask you to clarify - and I do apologise that this involves some gory detail: if I notice the typical blackening of the stools when I take iron sulfate (I always take with vit C or OJ) but no blackening when taking comparable amounts of iron bisglycinate, am I correct in deducing that this suggests a better absorption of the iron bisglycinate as less is escaping into the intestine? Thanks again, Rachel

Rustsmith
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Re: Supplemental Iron

Postby Rustsmith » Sun Feb 26, 2017 8:34 pm

No, the black is due to the formation of iron sulfide, which is a byproduct of the bacteria utilization of the sulfate part of the iron sulfate. So, with iron bisglycinate there is no sulfate and so there is no production of the black iron sulfide.
Steve

Augmentation Evaluation http://bb.rls.org/viewtopic.php?f=4&t=9005

Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

badnights
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Re: Supplemental Iron

Postby badnights » Fri Mar 03, 2017 5:10 am

i.e. if your stools don't turn black after taking iron sulfate, it tells you that the iron was absorbed (probably). Whereas, if your stools don't turn black after taking iron bisglycinate, it doesn't tell you anything about whether the iron was absorbed.
Beth - Wishing you all restful sleep tonight
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peanut1
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Re: Supplemental Iron

Postby peanut1 » Thu Mar 16, 2017 4:37 am

What's worked best for me is using a combination iron that includes vitamin B, vitamin C and iron. I cannot use an iron with a vitamin b at night since B pumps you up, but I take this type of iron throughout the day and stop around 5ish or 6 and it works well.

yawny
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Re: Supplemental Iron

Postby yawny » Thu Mar 16, 2017 5:23 pm

Am I missing a fun new pastime because it seems everyone is more aware of their business than I am. My naturopath is always very interested in my business and what it's been up to, but I always report "I don't wear my glasses."

Steve, I take Iron Bisglycinate with Vitamin C...so I really don't need to? And if I do, do you think it affects the iron in any way?

rvjimzhr1
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Re: Supplemental Iron

Postby rvjimzhr1 » Thu Mar 23, 2017 5:37 am

Can I ask those of you who are taking iron supplements ...are your iron levels low otherwise or are you just trying to take extra iron while looking for that 'magic bullet'?

I'm new to this forum and really getting an education as I spend hours, lately, reading various posts. I'm so thankful for all those who share so much about their experiences with RLS and the drugs involved.

Jim

ViewsAskew
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Re: Supplemental Iron

Postby ViewsAskew » Thu Mar 23, 2017 8:44 am

Hi Jim - I remember reading as much as I could when I joined - and being SO grateful to those who had shared. I honestly believe that coming here was what kept me sane and gave me hope that I could get out of my deep hole. We are all paying it forward or paying it back.

So - the short of it is....people supplement when:
A) hemoglobin is low. People with anemia get RLS at a much higher rate. Treating the anemia often makes the RLS stop.
B) serum ferritin is truly low - as in below 20. There are different scales used, but anything below 15-20 is considered low. Mine, for example, was 8 on one test and 15 or 16 on another back when I joined the forum. It is ESSENTIAL that people with serum ferritin this low get it up ASAP.
C) serum ferritin is low for RLS. For us, serum ferritin needs to be higher than for those who do not have RLS*. Doctors vary on what the minimum level is and some have increased it over time. 11-12 years ago when I joined here, docs were saying it should be 50. Now some say 75 and others 100. Those at Johns Hopkins say that it is individual - some of us may need 40, some 80, and some closer to 200. As long as it doesn't get to the 250-300 range, all should be OK.
D) their ferritin is not terribly low or high but when they take iron, their symptoms are lessened. Doesn't happen for a lot of us, but enough that it is worth trying.

BUT - always get hemoglobin and serum ferritin tested before taking iron. Even though we have issues with iron some of us can actually have hemachromatosis - a deadly condition when you have too much iron.

Do a search, if you have the energy and time, on iron infusions. There are posts and research here that should tell you a LOT more than I just did. In a nutshell, our bodies appear to eliminate iron much faster than other people. And, the iron we do have doesn't get where it needs to be - in our brains. So, the cells in our brains related to dopamine do not work right. But, taking iron isn't always the solution. First, it has to get past the blood brain barrier. You could have high serum ferritin, but it might not get to the brain where we need it. From the first studies at Johns Hopkins about iron, it was found that about 20% had complete remission of symptoms after an infusion - the iron clearly got to the brain! Another 40% had reduced symptoms. And 40% had no change. There is new research to suggest that for some of us (we do not know how many - still a theory, I believe) there is a defect in the protein that carries the iron to the brain and it cannot get it there. That could be why it helps some and not others.

Have fun reading!
Ann - Take what you need, leave the rest



Managing Your RLS



Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

badnights
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Re: Supplemental Iron

Postby badnights » Fri Mar 24, 2017 7:31 am

Yup. What she said.

My ferritin was low 20's initially. My other iron measures were good. My ferritin is now over 100. When I stop taking iron, it drops again. I'm not sure how fast. People who are anemic or otherwise need iron can usually take iron for a while then stop and be ok. We, as Ann explained, seem to dump iron continually so we need to keep taking it.
Beth - Wishing you all restful sleep tonight
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SLEEPY ANGEL
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Re: Supplemental Iron

Postby SLEEPY ANGEL » Fri Mar 24, 2017 5:06 pm

Rustsmith---

In reading your thorough description of the types of iron (Feb. 25 at 2:37 PM), I wondered about something... namely: I take an acid reducer (Omeprazole, 20 mg delayed release tablets) and the Pharmacist told me to take it in the AM because I was concerned about whether it would prevent the absorption of my Requip or my Gabapentin. Do you think that there's ENOUGH time lapsed between taking the acid reducer and taking my RLS meds and my iron (from 5:30 PM onward til bedtime)? It's a slow release Ferrous Sulphate USP, 45 mg tablet.

Rustsmith
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Re: Supplemental Iron

Postby Rustsmith » Fri Mar 24, 2017 7:15 pm

The acid reducer should not impact absorption of the iron sulfate as long as you are taking Vitamin C at the same time. It isn't the acidity that is important for the absorption, it is the interaction between the iron and the vitamin C (so long as you are taking iron sulfate and not iron glycinate, which also shouldn't be impacted by the acid reducer.
Steve

Augmentation Evaluation http://bb.rls.org/viewtopic.php?f=4&t=9005

Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

peanut1
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Re: Supplemental Iron

Postby peanut1 » Sat Mar 25, 2017 5:46 am

Fascinating that we dump iron more than most and I'm curious why. Would love to see a study on that one. I was anemic most of my life and only had mild RLS. I always wonder what kicked it into severe when I was only getting 1.5 hours a night.


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