Iron and Acid Suppressing Medications

Have you been prescribed an acid reducing medication and wondered what kind of side effect it may have on nutrient absorption that is not commonly talked about?

Let’s talk about iron.

Why would taking an acid suppressing medication possibly cause me to be deficient in iron?

Stomach acid helps to separate iron salts from food. Therefore, when acid suppressing medications are used, there is less stomach acid to help break up iron salts from the food and our bodies may then absorb less iron from the foods we consume.

Is there evidence to support that taking an acid suppressing medication may interfere with the absorption of iron in the body?

Historically, there have been some controversial opinions on whether or not acid suppressing medications can lead to iron deficiency. Some studies show that longer use of PPIs (greater than 2 years) can lead to a risk of iron deficiency and other studies show there is little data to support iron deficiency with acid suppressing medication use. 

However, there are numerous newer studies that are linking iron deficiency with acid suppressing medications. If you are ever concerned that an acid suppressing medication may lead you to a diagnosis of iron deficiency, always talk to your healthcare provider.

What are signs that I may be deficient in iron?

Fatigue, headache, pale colored skin, and shortness of breath upon exertion.

If you have issues with iron deficiency, here are a few tips:

Try to include a source of iron at each meal. You can get iron from a variety of foods however, iron from meat, fish, and chicken are better absorbed than plant-based iron sources. Some plant-based sources of iron include dried beans (kidney, lentils, lima, navy), fortified oatmeal, potato with the skin on, soybeans, tofu, spinach, dried prunes, whole wheat bread, and nuts (cashews, walnuts).

Pair vitamin C food sources with iron food sources to help your body absorb the iron from the foods you are eating. For example, pair taco meat (ground beef, which would be your iron source) with salsa (tomatoes would be your vitamin C source).

Try drinking milk, coffee and tea in between meals (when you are not consuming iron) to better help your body absorb iron from the meals you are eating. Milk, coffee, and tea may decrease iron absorption.

Try cooking out of a cast iron skillet.

If you take a multivitamin that has calcium, you will want to take it separately from your iron supplement as it is recommended to take iron and calcium containing supplements at least 2 hours apart. The reasoning behind this is because calcium can interfere with the body’s ability to absorb iron.

If you have concerns regarding other nutrient malabsorption/deficiency while taking an acid suppressing medication, check out this article on vitamin B12 and acid suppressing medications!

Tran-Duy, A., Connell, N. J., Vanmolkot, F. H., Souverein, P. C., de Wit, N. J., Stehouwer, C. D., Hoes, A. W., de Vries, F., & de Boer, A. (2018). Use of proton pump inhibitors and risk of iron deficiency: A population-based case-control study. Journal of Internal Medicine, 285(2), 205–214. https://doi.org/10.1111/joim.12826

McColl, K. E. (2009). Effect of proton pump inhibitors on vitamins and iron. The American Journal of Gastroenterology, 104(S2). https://doi.org/10.1038/ajg.2009.45

American Dietetic Association. Nutrition Care Manual®. Iron Deficiency Anemia Nutrition Therapy. https://www.nutritioncaremanual.org/client_ed.cfm?ncm_client_ed_id=94. Accessed [May 26, 2022].

Foods with Vitamin C to Help Increase Iron Absorption:

Mini Seedless Watermelon

Honeydew Melon

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