Iron plays an incredibly important role in the body. According to the Mayo Clinic, iron is responsible for helping your body produce hemoglobin, a substance in red blood cells that allows them to carry oxygen throughout the body. If you have iron deficiency, it can lead to symptoms like low energy, shortness of breath, pale skin, brittle nails and hair, headaches, and cold hands and feet. Taking an iron supplement can reverse a deficiency, but only if your body is absorbing all the iron. That’s why it’s key to know the best time to take iron supplements to get the most benefits.
As important as iron is and as eager as you may be to prevent or combat a possible deficiency, you shouldn’t load up on supplements without first speaking with your doctor. “Do not take iron just because you are experiencing these symptoms, or you risk iron overload, which can bring different problems to the surface,” said Indhira Ghyssaert, M.D., a family medicine physician and nutritionist.
Meet the experts: Indhira Ghyssaert, M.D., a family physician and nutritionist; Gregory Castelli, Pharm.D., an associate professor of family medicine at the University of Pittsburgh School of Medicine.
Your doctor may suggest a blood test to check your iron levels. Once they have confirmed that an iron supplement is appropriate for you, here’s what you need to know about iron supplements, including the best time of day to take yours and what medications to avoid while taking iron.
The best time to take iron supplements
Ideally, you should take your iron supplement first thing in the morning and before foods or other medications to get the best results, said Gregory Castelli, Pharm.D., an associate professor of family medicine at the University of Pittsburgh School of Medicine.
In addition to the best time of day, Castelli said the frequency at which you take your iron supplements can also play a role in absorption. “Some experts might recommend iron supplementation every other day instead of taking it every day,” he said, which some studies back up. “It may lead to more iron absorption in the long run.” More research needs to be done on the subject, so it’s best to seek advice from your doctor and act accordingly.
Should you take iron in the morning or at night?
Because of the potential interactions between different foods and medications, Castelli said that taking your iron supplement in the morning is always preferred. But that’s not the only consideration that makes the start of the day ideal.
“It also can help an individual digest better if they do not lay down immediately after,” explained Dr. Ghyssaert. “So if you do take it at night, stay upright and active for an hour or so before bed. This way you can also keep track of symptoms and any negatives to bring up with your doctor.”
Factors that influence iron absorption
The type of supplement
Iron supplements typically come in tablet/capsule or liquid form. According to Castelli, there isn’t much difference between the way your body absorbs iron when taken in a tablet vs. liquid form. That being said, Dr. Ghyssaert noted that some people may have a harder time taking the liquid dose because of the taste.
Your stomach pH
“Having a stomach pH that is slightly more acidic increases absorption [of iron],” Castelli said. “So foods or products that increase pH will decrease absorption.” Some examples of things that are lower in pH (more acidic) and can help with absorption if you eat them regularly include citrus-based juices and foods like tomatoes or bell peppers.
Vitamin C
While the common advice may be to take iron without other medications, Dr. Ghyssaert said that adding one vitamin in particular could actually help you make the most out of your daily dose of iron. “It is highly recommended that you take your iron supplement with your vitamin C supplement,” she said. “This has been proven to help absorption.”
Some foods
Castelli said that there are also foods that may keep your body from properly absorbing the iron in your supplement, so you should avoid having these shortly before or after taking your supplement. “Calcium-containing products can bind the iron and limit absorption,” he cautioned. “Products that contain calcium like dairy, yogurt, cheese, and fortified products decrease iron absorption.”
Additionally, Castelli said that a high intake of eggs, coffee, and tea may also decrease absorption. As such, he said it’s typically best that iron be taken without food if possible.
Certain health conditions
Pre-existing health conditions may also impact iron absorption. Dr. Ghyssaert said that those with chronic infections, such as hepatitis C, HIV, malaria, ulcerative colitis, or Crohn’s disease, shouldn’t take iron supplements unless directed to do so by their doctor, as it may “increase the risk of infection, and excessive iron can accumulate in the liver and cause damage.”
Medications that can interact with iron
Over-the-counter medications like antacids (calcium-containing) and acid suppressors like PPIs and histamine blockers can also decrease iron absorption, according to Castelli. “Patients should separate iron supplementation from the products by a few hours or discontinue these if possible.”
Additionally, Castelli said you’ll need to be mindful of possible interactions if you’re taking the following prescribed medications:
- Antibiotics like tetracycline, doxycycline, and ciprofloxacin
- Levothyroxine (thyroid hormones)
- Bisphosphonates like alendronate, etidronate, and risedronate, which are used to treat weak bones
- Cholestyramine, which is used to treat high cholesterol
Side effects of iron supplements
Like with many medications and supplements, there is a chance that you’ll experience side effects. Castelli said the most common side effect people experience is constipation, which has a lot to do with the amount of “elemental iron” in the supplement.
“There are many different formulations of iron supplementation including ferrous sulfate, ferrous gluconate, and ferrous citrate,” Castelli explained, noting that there is not much difference between these formulations, except for the amount of elemental iron within them. A formulation with less elemental iron may result in lower iron levels and less constipation, he said.
Another potential side effect is stomach upset, which may be exacerbated by taking the supplement on an empty stomach. “If you do have digestive issues, try to find a healthy medium,” Dr. Ghyssaert said. “Take it two hours after your first meal and two hours before your next meal so it can absorb as much as possible.”
Of course, if you’re struggling with the timing of your iron dosage it’s always best to reach out to your doctor or pharmacist and ask them for help determining what time of day is the best time for you to take your iron supplements in order to help with your own specific needs and situation.
Dietary supplements are products intended to supplement the diet. They are not medicines and are not intended to treat, diagnose, mitigate, prevent, or cure diseases. Be cautious about taking dietary supplements if you are pregnant or nursing. Also, be careful about giving supplements to a child, unless recommended by their healthcare provider.
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