Iron Absorption Enhancers and Blockers

Nelson Vergel

Founder, ExcelMale.com
For those of you who donate blood too frequently and have to take an iron supplement.

 
 
Proton Pump Inhibitors (Antiacids) May Interfere with Iron Absorption

Non-heme iron is the predominant form of iron found in plant foods and must be reduced prior to absorption in the small intestine. Therefore, PPI use may affect its absorption. However, there is little conclusive evidence of an increased risk of iron deficiency in PPI users in the short term. A few case reports have documented that omeprazole-induced achlorhydria may impair the response to iron supplementation in patients who were previously iron-deficient [23]. No cases of impaired iron response with omeprazole use have been reported in iron-replete individuals. Furthermore, a small, exploratory, cross-over intervention study in nine healthy adults found no difference in iron absorption between the control phase and a four-day omeprazole treatment phase [208]. In a study of patients with Zollinger Ellison syndrome, a disease in which tumors cause the stomach to produce too much acid, PPI use was not associated with diminished iron status [209].

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However, in a retrospective cohort study of adult patients, chronic PPI therapy for >1 year was associated with a significant decrease in hemoglobin, hematocrit, and mean corpuscular volume from baseline, while no hematological changes were observed in matched controls [210]. In a large case–control study of 77,046 patients diagnosed with iron deficiency, the odds ratio (OR) for developing this condition was 2.49 fold higher (95% confidence interval (CI): 2.35–2.64) for patients taking PPI for ≥2 years [211]. Additionally, PPI use for >1 year was found to decrease phlebotomy requirements for hereditary hemochromatosis patients. This same study also found that the use of PPIs for one week decreased the absorption of non-heme iron by 50% in these individuals [212].

In summary, there is some evidence to indicate PPI use may negatively impact iron absorption. PPI users already at elevated risk for iron-deficiency or those with pre-existing iron deficiency may be at greater risk for impaired iron absorption during PPI therapy. Similar to its stance on the routine monitoring of vitamin B12 status in those taking PPI, the AGA does not currently recommend routine monitoring of iron status [207].

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Understanding Your Hormones

Estradiol (E2)

A form of estrogen produced from testosterone. Important for bone health, mood, and libido. Too high can cause side effects; too low can affect well-being.

DHT

Dihydrotestosterone is a potent androgen derived from testosterone. Affects hair growth, prostate health, and masculinization effects.

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The biologically active form of testosterone not bound to proteins. Directly available for cellular uptake and biological effects.

Scientific Reference

Lakshman KM, Kaplan B, Travison TG, Basaria S, Knapp PE, Singh AB, LaValley MP, Mazer NA, Bhasin S. The effects of injected testosterone dose and age on the conversion of testosterone to estradiol and dihydrotestosterone in young and older men. J Clin Endocrinol Metab. 2010 Aug;95(8):3955-64.

DOI: 10.1210/jc.2010-0102 | PMID: 20534765 | PMCID: PMC2913038

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