Can anyone take iron supplements?

Many of us use iron supplements to help reduce tiredness and fatigue in our daily life – but is it the right choice for everyone? 

While iron deficiency is a widespread issue, iron overload is an equally serious medical concern. Before starting any supplementation, it’s vital to know if you fall into a high-risk category so that you can follow the best medical guidance for your situation.

Who cannot take iron supplements?

Iron is a vital mineral, crucial for oxygen transport and immune health among other benefits. For those with a confirmed deficiency, supplementation is often the most ideal perfect solution. 

However, there can be dangers if you take too much. Iron is unique among nutrients because it’s difficult for the body to get rid of excess iron, which means it can accumulate in your tissues and cause further health problems.

Because of this, it’s important to confirm whether you’re actually low in iron before making the decision to take supplements. If you have underlying health conditions, that decision becomes even more crucial, as some conditions can put you at a higher risk of overload side effects.

If this affects you, know that this isn’t a blanket issue. While some people may need to avoid iron supplements altogether to prevent serious problems, many others are able to supplement under medical supervision. The key is to find the right solution for you and your health – and professional medical advice is the best way to do that. 

Those with iron overload conditions

This category refers to a group of conditions which, one way or another, lead a person to naturally have too much iron in their body. This means they’re at risk of suffering high-iron side effects even without taking supplements. 

The most common of these conditions is hereditary haemochromatosis, which causes you to absorb too much iron from your diet. With this condition, your body lacks the normal regulatory “brakes” that stop iron absorption once stores are full.¹ Over time, this excess iron accumulates in vital organs like the heart, liver and pancreas.

If you have haemochromatosis or a similar condition, adding more iron via supplementation is generally advised against. Unless you’re told otherwise by your doctor, you should avoid iron supplements entirely.

 

Those with certain red blood cell disorders

For many, the term ‘anaemia’ is assumed to be synonymous with ‘iron deficiency’ – but this isn’t always true. There are many different types of anaemia, and not all of them involve a lack of iron.

Some forms of anaemia, such as thalassaemia or sickle cell anaemia, are caused by the destruction or malformation of red blood cells.² If you have one of these conditions, you might actually have high iron levels due to your red blood cells breaking down and releasing iron. 

Additionally, many anaemia patients receive blood transfusions to help manage their condition. Transfusions typically supply significant amounts of iron, meaning there’s no need to take supplements as well. 

If you suspect you have anaemia, never assume iron supplements will fix the problem. Instead, speak to your doctor about your symptoms, and they’ll help you to find the cause. If iron supplements would help, your doctor can help you to find the best dosage; if your iron levels are good as they are, a different treatment can be recommended.

 

Those with liver damage

The liver is the body’s primary storage facility for iron. When your liver is healthy, it manages these stores safely. However, liver diseases, such as hepatitis or alcohol-related liver damage, may reduce the storage capacity.³ A damaged liver releases enzymes and iron into the bloodstream in an uncontrolled manner, which can lead to overly high levels if you’re taking supplements as well. 

On top of that, taking too much iron can cause even more damage to the liver. Excess iron is known to be hepatotoxic (toxic to the liver) and can cause targeted oxidative stress. This can make existing liver injury or disease worse.

If your liver function is compromised in any way, the safest thing is to avoid iron supplements. Only ever take them if a hepatologist (liver doctor) advises you to and monitors you while you take them. 

Those with stomach or bowel problems

Iron supplements are notoriously difficult to digest and can irritate the lining of the stomach and intestines. For someone with a healthy gut, this might just mean mild nausea. For someone with an existing gastrointestinal condition, on the other hand, it can cause a severe flare-up.

People with inflammatory bowel disease (IBD), such as Crohn’s disease or ulcerative colitis, often have difficulty digesting iron tablets. Unabsorbed iron can increase inflammation in the gut lining, making symptoms worse.⁴ 

Similarly, those with active stomach ulcers or gastritis (inflammation of the stomach) may find that iron tablets exacerbate pain and bleeding.

If you have a gastrointestinal condition, you should speak to your doctor before starting iron supplements. They might recommend alternative treatments, such as liquid or intravenous iron, that can avoid the gut entirely.

Those who are pregnant or breastfeeding

While it’s true to say that iron is an important mineral during pregnancy, not everyone who’s pregnant needs to supplement their intake. 

Pregnancy is a time when iron needs increase significantly to support the growing baby. However, these needs may be met through an iron-rich diet, or through existing iron stores in the body.

Taking high-dose supplements unnecessarily can cause oxidative stress and gastrointestinal distress.⁵ Additionally, high haemoglobin levels (caused by excess iron) have been associated with adverse pregnancy outcomes in some studies, including low birth weight or preterm birth.

The simple solution? Don’t self-prescribe. Always wait for your midwife or doctor to check your blood iron levels, and only start iron supplementation if you’re advised to do so. 

If you’re breastfeeding, it’s still vital to make sure you’re as healthy as possible in order to look after your baby. Speak to your doctor to make sure your iron dosage is safe when breastfeeding. 

Those with other underlying conditions

There are several other specific scenarios where iron intake requires caution, such as kidney disease or active bacterial infections.

Ultimately, safety comes down to professional guidance. If you have any known underlying condition, you should speak with a medical professional before taking iron supplements. It’s a simple step to help protect yourself against unwanted side effects. 

Iron supplements can be an excellent way to boost your iron levels, but they should only be taken if you have a diagnosed deficiency. Your doctor can review your full medical history, including medications you’re currently taking, to decide whether supplements are the right choice for you. 

 

References

1. Hemochromatosis. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
2. Thalassemia. National Heart, Lung, and Blood Institute (NHLBI).
3. Iron overload and the liver. Journal of clinical and translational hepatology vol. 11,4 (2023)
4. Management of Iron Deficiency Anemia in Inflammatory Bowel Disease. Medicine vol. 94,23 (2015)
5. Iron intake and iron status during pregnancy and risk of congenital heart defects: A case-control study. Yang, Jiaomei et al. International journal of cardiology vol. 301 (2020)