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Every Other Day Dosing for Iron Deficiency

About iron deficiency, potential causes, and symptoms:

There is a high prevalence of iron deficiency and iron deficiency anemia worldwide! Iron deficiency without anemia will have blood work that shows low ferritin (iron storage) and low transferrin saturation (iron in the bloodstream). With anemia, there is insufficient hemoglobin (which uses iron to carry oxygen to organs) and low red blood cells as well. There are also many other tests to determine the extent of iron deficiency. Causes of iron deficiency and iron deficiency anemia include lack of iron in the diet (high iron foods include red meat, shellfish, spinach, and legumes), sudden loss of blood due to trauma, malabsorption from chronic diseases such as Crohn’s disease, heavy menstruation, stomach ulcers (possibly caused by daily NSAID use or stress), or colorectal cancer. Signs and symptoms of iron deficiency include cold intolerance, feeling depleted after exercise, muscle cramps, ice cravings, cracks in the corners of the mouth, a glossy tongue, spoon-shaped nails, difficulty swallowing food, low energy/fatigue, or a reduced ability to fight infections.

What to do:

If you are experiencing any of the symptoms listed in the previous paragraph or if believe you have inadequate dietary iron (such as a vegetarian), impaired absorption, heavy menstruation, or have a history of anemia- it is important to let your health care provider know so you can get the proper blood work. It is best to have iron stores checked at least 1-2 times per year. Iron deficiency precedes iron deficiency anemia- so don’t let yourself get there, as it may take months to recover! It is crucial to get blood work BEFORE supplementing iron, as too much iron can cause serious health risks including an abnormal heart rhythm.

Iron dosing:

Recent studies have been looking at something called serum hepcidin. Hepcidin regulates the amount of iron that goes into circulation. Studies show that doses >60mg of elemental iron given to those with iron deficiency and >100mg of elemental iron in those with iron deficiency anemia, will have an increase in hepcidin for 24-48 hours. What this means is that while hepcidin is high, intestinal iron absorption gets blocked. If absorption is blocked, the unabsorbed iron in the intestines may cause irritation, inflammation, and dysbiosis (microbe imbalance). To mitigate this issue, it is best to do a morning SINGLE dose of iron EVERY OTHER DAY. A second dose should NOT be taken on the same day in the afternoon or evening after the first dose. Once in the morning on alternate days- will maximize absorption and reduce side effects.

To further maximize absorption, it is best to take oral iron on an empty stomach at least one hour before meals since many foods and drinks contain substances that inhibit iron absorption such as tannins found in tea, coffee, or wine. Furthermore, NSAIDs, antacids, carbonates, casein, whey, phytic acid in whole grains, egg whites, calcium, zinc, and aluminum also inhibit iron absorption. While many substances block absorption, Vitamin C INCREASES absorption. Quality oral iron products will contain Vitamin C. Quality products will also utilize a form of iron such as iron bisglycinate which is quickly absorbed without causing typical side effects including constipation, nausea, or dark stools- commonly caused by forms like ferrous gluconate or sulfate.

Once your health care provider starts you on supplemental iron, be sure to follow-up with blood work to reassess iron levels to adjust the dose or discontinue supplementing if necessary. It generally takes 3 weeks to improve hemoglobin levels and 4-6 months to improve ferritin.

You may book an appointment with Dr. Hamilton at for blood work, supplement recommendations, and lifestyle tips to improve iron status!


1. Abbas AM, Abdelbadee SA, Alanwar A, Mostafa S. Efficacy of ferrous bis-glycinate versus ferrous glycine sulfate in the treatment of iron deficiency anemia with pregnancy: a randomized double-blind clinical trial. J Matern Fetal Neonatal Med. 2019 Dec;32(24):4139-4145. doi: 10.1080/14767058.2018.1482871. Epub 2018 Jun 20. PMID: 29843553.

2. Stoffel NU, von Siebenthal HK, Moretti D, Zimmermann MB. Oral iron supplementation in iron-deficient women: How much and how often? Mol Aspects Med. 2020 Oct;75:100865. doi: 10.1016/j.mam.2020.100865. Epub 2020 Jul 7. PMID: 32650997

3. Pagani A, Nai A, Silvestri L, Camaschella C. Hepcidin and Anemia: A Tight Relationship. Front Physiol. 2019 Oct 9;10:1294. doi: 10.3389/fphys.2019.01294. PMID: 31649559; PMCID: PMC6794341.

4. Warner MJ, Kamran MT. Iron Deficiency Anemia. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:

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1 Comment

I am curious if there is a connection between iron deficiency and trauma or perhaps drug abuse. I see many clients that suffer from it. I will say that we encourage our clients to take their iron with orange juice to help their body absorb it. Im thankful that you look into these aspects. I find that too many health professionals forget about the importance of diet.

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