Iron Deficiency

What is iron deficiency, and why is it important to address?

Our health is the foundation upon which all of our successes are built. Iron is one of the building blocks of this foundation, and helps us to perform at our best both mentally and physically. It is a mineral that is essential to ensuring our body is nourished with enough oxygen, affecting everything from head to toe.

What is iron deficiency, and why is it important to address?

Despite the importance of this mineral, iron deficiency remains the most common nutritional deficiency in the world, including in Canada. The consequences of lacking iron may be felt across the full spectrum of our daily lives, including our ability to work, study and play.

The average adult has 3 to 4 grams of iron in their body. Our diet provides us with iron, but sometimes it is not enough. Our iron requirements, our lifestyles and our risk factors for iron deficiency vary from person to person. A pregnant woman will need more iron to support the developing baby than a woman that is post-menopausal. A vegetarian will have a harder time consuming enough iron in their diet compared with someone who regularly eats meat. A marathon runner exercising several hours a day will need more iron than someone that doesn’t exercise frequently.

When a person is iron deficient and continues to lose more than they can replenish, they may begin to show symptoms of iron deficiency anemia (IDA). This means that the amount of iron in the body is too low to create enough healthy red blood cells, to the point where it affects their quality of life.

How does Iron Deficiency Anemia affect me?

We live in a busy world where we are expected to function at our best, both physically and mentally. Iron plays an important role in our ability to function optimally. Iron deficiency has been linked with a number of undesirable outcomes, including:

Decreased academic performance: Research has shown that low ferritin levels, which indicate insufficient body iron stores, may be linked with lower academic grades in students compared with students that have normal ferritin levels¹.

Decreased workplace productivity: Research has demonstrated that iron deficiency anemia may negatively impact work performance, while iron supplementation to restore optimal iron levels can result in productivity gains².

Decreased mental and emotional health: Research has linked iron deficiency with psychopathology throughout the human lifespan. Iron deficiency anemia has been associated with mood disorders and ADHD in children and adolescents, while low ferritin levels have been linked with symptoms of depression in adults³.

¹Scott S., De Souza M.J., Koehler K., Murray-Kolb L. (2016, November). Combined Iron Deficiency and Low Aerobic Fitness Doubly Burden Academic Performance among Women Attending University. The Journal of Nutrition. 147:104–9.

²Marcus H., Schauer C., Zlotkin S. (2021, June). Effect of Anemia on Work Productivity in Both Labor- and Nonlabor-Intensive Occupations: A Systematic Narrative Synthesis. Food and Nutrition Bulletin. 42(2): 289-308.

³Levin S., Gattari T. (2023, March). Iron deficiency in psychiatric patients. Current Psychiatry. 22(3): 25-29

What are common symptoms of Iron Deficiency Anemia?

Lowered cognitive functioning: Iron deficiency anemia (IDA) can decrease our attention span, mental acuity and motor skills. It can also affect academic performance¹.

Worsened mood: IDA has been linked to anxiety, depression, and irritability in both children and adults.

Exercise intolerance: IDA decreases oxygen supply to muscles and can cause early fatigue during exercise and lowered exercise capacity.

Lowered resistance to infection: IDA is associated with decreases in innate and adaptive immunity, leading to reduced ability to fight infections.

Hair loss: You may notice more hair falling out while washing or brushing your hair, since the cells supporting hair growth are receiving less oxygen.

Restless leg syndrome: Low iron is associated with restless leg syndrome, which may affect quality of sleep and cause discomfort.

General weakness and fatigue: The lack of oxygen to our brain and muscles mean we may tire more easily, both mentally and physically, while performing routine activities.

Pale coloring of the inside of lower eyelids, and skin that is paler than usual: When pulling your eyelid down in front of the mirror, the inside layer should be a healthy, vibrant red color. In iron deficiency anemia, lower hemoglobin may make this appear more pale. The rest of your skin may appear more pale as well.

Shortness of breath: Low oxygen due to IDA means the muscles may not receive enough oxygen to perform adequately. As a result, your breathing rate will increase as your body tries to get more oxygen, which may result in shortness of breath.

How does Iron Deficiency lead to Anemia?

Iron is needed to form hemoglobin, a protein that binds to oxygen. The hemoglobin is packed into red blood cells, which allows fresh oxygen from the lungs to be carried to all the cells in the body. Iron deficiency decreases hemoglobin production. If allowed to continue, there will not be enough hemoglobin to form a healthy red blood cell.

Anemia occurs when the body does not have enough healthy red blood cells. Iron deficiency is the most common cause of anemia, and can lead to many symptoms that affect quality of life.

Who is at risk for Iron Deficiency Anemia?

The three main causes of IDA are increased iron loss, increased iron requirements and decreased iron intake or poor absorption. For individuals where these factors overlap, the risk is dramatically increased.

Increased Iron Loss

Consistent blood loss, such as through menstruation or regular blood donation.
Athletes may lose significant amounts of iron through sweat, depending on intensity and volume of training.
Medications that increase the risk of bleeding and / or bruising, such as blood thinners or anti-inflammatories.

Increased Iron Requirements

Children aged 0 to 5, who need enough iron for proper brain and body development.
Adolescent girls and women of childbearing age, who experience regular blood loss through menstruation.
Pregnancy due to increased blood requirements to supply the developing fetus.
It is important to note that the average adult female requires 18mg of dietary iron per day and up to 27mg daily in pregnancy, whereas an average adult male requires only 8mg of dietary iron daily. As a result, iron deficiency anemia is more frequently observed in women.

Decreased Iron Intake and /or Poor Absorption

Vegetarian or vegan diet. Heme iron from meat is much more absorbable than plant-based, non-heme iron. You would require a greater volume of food from plants to obtain the same amount of absorbable iron from meat, which may be hard to achieve on a daily basis.
Poor nutrition. Lack of iron-rich foods in the diet is the most prevalent cause of iron deficiency in the world.
Medications that decrease stomach acidity. Iron needs to be in the reduced or ferrous form to be absorbed, and acidity helps with this. Medications used for heartburn such as antacids and proton pump inhibitors will decrease acidity and reduce iron absorption.
Taking certain foods at the same time as iron supplements. Tea, coffee, dairy, mineral supplements, seeds, nuts, legumes, and unprocessed whole grain contain compounds which bind to iron, making it hard to absorb.

How is Iron Deficiency Anemia Diagnosed?

Serum ferritin is the diagnostic test of choice, but results need to be interpreted in the context of your symptoms

Serum ferritin is the standard test for estimating the iron stores in your body, and is conducted with a simple blood test. However, the readings need to be interpreted in the context of your symptoms. There is a difference between iron levels that produce a definitive diagnosis of IDA, and optimal iron levels that support quality of life.

From the chart below, serum ferritin under 15ug/L is diagnostic of IDA on the basis of lab values. However, the signs and symptoms of IDA may appear at levels well above this number. Your healthcare practitioner may recommend iron supplementation to treat and prevent IDA at ferritin levels above 15, especially if your quality of life is affected by symptoms of iron deficiency anemia.

What can I do to fix Iron Deficiency?

Diet

For vegetarians / vegans, eat more iron-rich foods such as soybeans, lentils, pumpkin seeds, kidney beans, spinach, edamame, tofu and chickpeas.
For non-vegetarians, foods high in iron include pork liver, chicken liver, beef liver, oysters, mussels, lamb and tuna.

Non-Prescription Oral Iron Supplements

Oral iron supplements are available without a prescription. Consultation with a healthcare provider is recommended to ensure a proper dosing regimen. Regular follow-up blood tests should be done to gauge progress.
Iron supplements are available as heme-iron (animal-derived) or in non-heme (vegetarian) forms.
Oral iron supplements typically require 3 to 6 months of consistent use to correct IDA. However, tests of hemoglobin levels may show an increase in as early as 4 weeks, with some noticing an improvement in symptoms during this 4 week period.

Prescription Intravenous Iron Infusions

These iron infusions rapidly raise ferritin levels over the span of a few weeks
A detailed consultation with your doctor is needed to determine if this option is right for you

Introducing FERAPRO™: A Gentle and Effective Oral Iron Supplement

Iron deficiency is the most common nutritional deficiency in the world, including in Canada. Despite the abundance of iron supplements available in pharmacies, an alarming number of Canadians are still suffering from symptoms of iron deficiency anemia. Why is this the case, and what can be done about it?

We at Replete present FERAPRO™, a gentle and effective approach for treating and preventing iron deficiency anemia. FERAPRO™ overcomes common obstacles to effective iron supplementation through the following:

Improved Tolerability: An iron supplement is only effective if taken consistently. Iron supplements, especially at higher doses, often cause side effects such as stomach upset, constipation and nausea. This is a common obstacle that hinders many from taking iron supplements regularly. FERAPRO™ was created to be gentle on the gut. The key to consistency is tolerability, and improved tolerability is what FERAPRO™ was designed for.

Increased Absorption: Oral iron supplements are often poorly-absorbed. FERAPRO™ supplies iron in the ferrous form, which expedites absorption through the intestine. In addition, Vitamin C enhances the absorption of iron significantly. FERAPRO™ includes an ample amount of Vitamin C with each capsule, to help ensure you are getting the most from each dose of iron.

Individualized dosing: One size does not fit all when it comes to iron supplementation, because we all have different iron requirements. A pregnant woman who is vegetarian will need more iron than a teenage male who eats red meat, for example. FERAPRO™ comes in three strengths - 30mg, 75mg and 150mg of elemental iron per capsule, suitable for once daily or every other day dosing. This allows for six different dosing regimens, providing optimal dosing for a broad spectrum of iron requirements.

Obstacles to effective iron supplementation hold many Canadians back from achieving optimal iron levels. By designing an iron supplement that is more tolerable on the gut, FERAPRO™ encourages consistent intake. By creating a formula with enhanced absorption, FERAPRO™ improves the effectiveness of iron supplementation. By providing a line-up with three different strengths, FERAPRO™ enables optimal dosing for a wide range of iron needs.

FERAPRO™ has successfully treated thousands of Canadians with iron deficiency anemia, and is recommended by physicians, naturopathic doctors, nurses, midwives and pharmacists.

The FERAPRO™ Formula

FERAPRO™ contains 5 active ingredients for a comprehensive approach to preventing and treating iron deficiency anemia

Ferrous fumarate: Iron needs to be in the reduced, or ferrous form in order for it to be transported across the intestinal barrier and into the blood. Oral non-heme iron can be found in either the ferrous or ferric form, but must be reduced to the ferrous form to be absorbed. FERAPRO™150 contains 150mg of elemental iron (from 500mg of ferrous fumarate), the highest amount available in a single capsule.

Vitamin C: Also known as ascorbic acid, vitamin C is recommended when taking non-heme iron supplements. This is because the acidity keeps iron reduced in the ferrous form, increasing its overall absorption by 50%, and often by significantly more.

Vitamin B12 (Methylcobalamin): FERAPRO™ contains the biologically active, methylated form of Vitamin B12. This vitamin helps support the proper development and functioning of red blood cells. A significant number of people have difficulty converting B12 into the biologically active form. That is why we have included the active form in FERAPRO™, to ensure more Canadians are able to benefit from this important vitamin.

Folic Acid (L-5-Methyltetrahydrofolate): Folic acid supports proper red blood cell development and functioning. FERAPRO™ includes the biologically active form of folic acid to ensure more are able to benefit from this important vitamin.

Glycine: Glycine is an amino acid that has been shown by research to enhance iron absorption. Moreover, glycine is an essential building block of hemoglobin.

FERAPRO™ contains only 1 non-medicinal ingredient

FERAPRO™ employs only one non-medicinal ingredient - hypromellose, a plant-sourced, long-chain fibre. This reduces the chances of hypersensitivity or intolerances that may occur due to unnecessary additives.

How do I take FERAPRO™?

FERAPRO™ is designed for Individualized Dosing

Everyone has different iron requirements. Our goal is to match the appropriate dose of iron with your unique needs. FERAPRO™ comes in three different strengths of iron:

FERAPRO™ 30: Each capsule contains 30mg of elemental iron to help prevent iron deficiency anemia.

FERAPRO™ 75: Each capsule contains 75mg of elemental iron to help treat iron deficiency anemia.

FERAPRO™: Each capsule contains 150mg of elemental iron to help treat iron deficiency anemia, and is the highest strength of iron that is commercially available in a single capsule.

FERAPRO™ is intended for once daily dosing. It can also be taken every other day if your healthcare practitioner recommends this.

If you have known intolerances to iron such as stomach upset, we recommend taking it with food. To get the most absorption, avoid consuming leafy greens, dairy, high-fibre foods, tea/coffee, eggs, and calcium or magnesium containing antacids at the same time as FERAPRO™. Avoid these foods for at least 1 hour before and 2 hours after taking FERAPRO™ for optimal results.

Check with your pharmacist to see if FERAPRO™ should be spaced apart from other medications you may be taking.

Alternatively, you may try taking FERAPRO™ on an empty stomach. If stomach upset occurs, take it with food.

How long until I see results?

In some cases of iron deficiency anemia, improvement in symptoms may be noticed as early as four weeks after starting treatment. Your doctor may order blood work at 4 weeks to monitor your response to oral iron supplementation.

It may take 3 to 6 months of consistent iron supplementation for IDA to be corrected, and in some cases longer. A serum ferritin test should be done by your doctor to gauge your progress, at least every 3 months. The frequency of monitoring should be determined by the clinician based on the severity of the anemia and the underlying cause of iron deficiency.

Speak to your doctor or pharmacist about iron deficiency today!

LET US HELP YOU ACHIEVE YOUR IRON GOALS TODAY

Can I take FERAPRO™ more than once daily?

FERAPRO™ is intended for once daily dosing, or every other day per your healthcare practitioner’s recommendation. Your body naturally protects you from iron overload by decreasing the amount of iron absorbed for a period of time after taking an iron supplement. Therefore, do not take FERAPRO™ more than once daily.

Optimal versus normal ferritin levels

‘Normal’ ferritin readings may not reflect optimal levels. Readings should be interpreted in the context of your symptoms. Serum ferritin under 15 is diagnostic of IDA, but symptoms may appear at levels above this, in which case your healthcare practitioner may recommend iron supplementation. It can take a lengthy period of time to increase your ferritin levels, so it is a good idea to begin supplementing as soon as your healthcare provider recommends it. Achieving optimal iron levels will help improve your quality of life.

My serum ferritin is 50. Which dose of FERAPRO™ should I choose?

It is best to first ask your healthcare practitioner for a recommended dose. However, there is room for flexibility as well. FERAPRO™ comes in 30mg, 75mg and 150mg doses of elemental iron. A higher dose will raise ferritin levels faster, but can also increase the chance of gut issues. Since tolerability is key to consistency, you can ask your pharmacist for dosing strategies to help improve tolerability if you experience gut issues.

Can I open the capsule?

Opening the capsule is not recommended, but if you have no other options, then you can mix the contents of the capsule with a semi-solid such as applesauce, stir and consume the full amount. Minimize contact with teeth and rinse mouth after use, as contact with iron powders or liquids may stain the teeth. Be aware that there may be a strong metallic taste. Do not mix FERAPRO™ contents with water as this creates an unpalatable gel mixture.

Can I give FERAPRO™ to a child?

Health Canada currently approves FERAPRO™ for those 12 years of age and older. However, you may ask your doctor if it is appropriate to give it to your child, along with a suitable dosing regimen.

Why does the powder inside FERAPRO™ capsules have a rough and non-uniform appearance?

FERAPRO™ does not color the capsule and hide its contents. This is how powders containing iron salts may appear. As some individuals have sensitivities to dyes, FERAPRO™ is suitable for these customers.

A Message from Replete

Dear valued customer,

Iron is indispensable for your well-being, playing a pivotal role in creating hemoglobin and forming robust red blood cells that distribute vital oxygen to tissues throughout your body. This oxygenation ensures your body functions optimally. Iron deficiency, however, hinders this process, leading to feelings of lethargy, lack of motivation, mental fog, and easy fatigability, among other symptoms. Our steadfast goal is to inspire, educate, and empower you to take charge of your health, preventing iron deficiency anemia from curtailing your quality of life.

Selecting the appropriate supplement can be daunting. Despite diligent efforts, a significant number of individuals continue to grapple with iron deficiency. This is where FERAPRO™ distinctly stands out. Conscientiously developed, FERAPRO™ adeptly strikes a balance between effectiveness, tolerability, and purity — a term embodying our commitment to formulating the supplement without unnecessary non-medicinal ingredients and common allergens.

FERAPRO™ is a premier oral iron supplement, incorporating not only iron but also vital vitamins and cofactors. This synergy amplifies the benefits of oral iron therapy while mitigating potential drawbacks. Every component of FERAPRO™ is intentional, catering to your body’s specific needs and tolerances, thereby accommodating a broad spectrum of dietary preferences and sensitivities.

Distinctive in its approach, FERAPRO™ offers personalized dosing options and addresses your unique health requirements, while meticulously incorporating only essential active ingredients.

We are firmly committed to enhancing our distribution channels and increasing the accessibility of FERAPRO™ for all customers across Canada, offering a lifeline to those contending with iron deficiency anemia. With a track record of aiding thousands in their battle against iron deficiency, our mission is crystal clear: to assist you in preventing and managing iron deficiency, facilitating a journey towards a healthier, more joyous version of yourself.

Embark on this transformative health journey with us. Should you have any questions about FERAPRO™, please know they are always welcome.

To a healthier, more vibrant you,
Bob Mehr, B. Sc. (Pharm), FIACP
CEO, Replete Labs

Cautions and warnings

Iron supplements are potent and should only be taken after a discussion with your healthcare provider. For your safety and to ensure the best experience, we recommend the following:

Follow a dosage and dosing regimen recommended by your healthcare practitioner.
Follow the treatment duration recommended by your healthcare practitioner.
Be sure to monitor your progress through a regularly scheduled blood test.
If you are pregnant or breastfeeding, have a discussion with your healthcare practitioner prior to using.
Consult a health care practitioner before using if you have peptic ulcer disease, regional enteritis or ulcerative colitis.
For some, iron supplements may cause abdominal cramping, constipation, diarrhea and/or vomiting.
Discontinue use and consult a health care practitioner if you experience symptoms of iron toxicity, which may include nausea, vomiting, abdominal pain, hematemesis (vomiting of blood), and diarrhea.
Keep out of reach of children. There is enough iron in this supplement to cause serious harm to a child.