This week's article came from a patient medication meeting. This patient was concerned that her levels of iron were dropping, despite her regular iron supplementation. She was wondering if her medications or diet were causing this low iron status. After a sit down with her Heart Pharmacist we did find a potential cause. It involves the fact that certain minerals require stomach acid for absorption. This is of interest for anyone who is taking medications to reduce the amount of acid your stomach produces.
Our patient was taking a medication to help treat ongoing heartburn. In her case, she was taking a medication called a PPI (proton pump inhibitor). Medications in this drug family include Losec, Pariet and Nexium. These medications help to reduce the amount of acid produced by your stomach. For many people these medications can reduce symptoms of heartburn or gastric distress. With reduced stomach acid and symptoms of heartburn gone, why would there be an issue? This is a good question. Our bodies still need stomach acid for digestion and absorption of certain vitamins and minerals.
There are certain nutrients that require stomach acid for proper absorption from the gastrointestinal tract. The most notable are the macro minerals, calcium, iron and to a lesser extent magnesium and zinc. Vitamin B12 can sometimes be an issue as well. This is why taking PPIs is associated with an increased risk of osteoporosis. Your body requires stomach acid to make calcium more absorbable. If you can’t absorb calcium, you might be at greater risk for osteoporosis. This is why I recommend my patients that are taking a PPI to take adequate vitamin D (2000iu per day) and calcium citrate. Calcium citrate has better absorption for people taking a stomach acid reducing drug.
Iron is another story. There are many factors that interfere or enhance the absorption of iron. Things that help iron absorption are healthy stomach acid and vitamin C. Things that reduce iron absorption are low stomach acid, food, wheat and other grains, other minerals and tea. So you can see many factors work against iron absorption. So talk with your Heart Pharmacist to see if there is a way to help increase your iron absorption or if iron conflicts with your current medications.
If you are low in iron and your Physician or Pharmacist recommends that you take more, here are few tips we offer our patients. In theory, iron is best absorbed on an empty stomach, but this might cause some distress. In which case, take with a small meal or snack. If you can tolerate taking iron before bed, that is optimal. Watch out for iron’s four main side effects: stomach upset, constipation, constipation and a fourth which I seem to forget. Right, the fourth is also constipation. If this happens, don’t take your iron for a few days and regularity should return. For some people, constipation can be lessened by taking it every other day or twice weekly. Also take your iron supplement away from breads and cereal and tea. Also with iron absorption you do get what you pay for. The most expensive naturopathic and heme-based iron formulations are better absorbed, but their cost is significantly more. Do not take iron at the same time as other vitamin supplements or antacids.