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IRON THERAPY ­ WITHOUT PROBLEMS 
 
 
 
 
White paper 
 
IRON THERAPY ­ WITHOUT PROBLEMS 
 
MediTec FerroCare Division | 
FerroCare@MediTec.SE 
 
1.3 2016  
 
 
 
 
ABSTRACT 
 
Low iron counts is according to WHO one of the most common and life threatening                             
conditions worldwide. Iron cannot be substituted by any other nutrients in your food. 
 
Suffering from low iron, no amount of vitamins or any other supplement is going to                             
assist to improve the lack of iron.  
 
The symptoms of iron deficiency are so common that they are not always fully                           
recognized and may hence lead to further cause of health issues. 
 
This white paper will discuss iron therapy in general, why it is sometimes                         
problematic,mainly due to tolerance and practical issues for those suffering from iron                       
deficiency.  
 
Important groups that are discussed in this aspect are children, young girls, fertile                         
females, seniors and people with chronic diseases such as IBD, CHF, CKD that affect the                             
iron metabolism and how Heme‐Iron supplementation change this situation. 
 
The target is to inform the medicinal and pharmaceutical communities of this relatively                         
new form of therapy and why it has great benefits compared to the traditional methods. 
 
 
 
 
 
 
 
IRON THERAPY ­ WITHOUT PROBLEMS 
 
PART 1. THE PRESENT SITUATION 
 
­ Low iron counts are one of the most common conditions worldwide 
­ Iron cannot be substituted by anything else 
­ Common symptoms 
­ The general iron uptake and causes of iron need 
­ The importance of supplementation avoiding side­effects 
­ All iron comes from the diet 
 
 
Low iron counts are one of the most common conditions worldwide  
 
More than one‐quarter of the world's population is anemic. Approximately one‐half of                       
this burden is a result of iron deficiency anemia, being most prevalent among preschool                           
children and women.  
 
Globally, anemia affects 1.62 billion people (95% CI: 1.50–1.74 billion),which                   
corresponds to 24.8% of the population (95% CI: 22.9–26.7%). 
 
The highest prevalence is in preschool‐age children (47.4%, 95% CI: 45.7–49.1), and the                         
lowest prevalence is in men (12.7%, 95% CI: 8.6–16.9%). However, the population                       
group with the greatest number of individuals affected is non‐pregnant women (468.4                       
million, 95% CI: 446.2–490.6). (WHO).  
 
The diagnosis, prevention, and treatment of iron deficiency is obviously a major public                         
health goal, especially in low‐ and middle‐income countries. 
 
 
Iron cannot be substituted by anything else 
 
Iron is the most important part of the hemoglobin in the red blood cells that carry                               
oxygen to all the cells of the body. In case of shortage of iron in the body we easily run                                     
short of breath, get tired and have problems concentrating even at low deficiency.  
 
Our bodies contain 4‐5 grams of iron. It may be difficult to get enough of this important                                 
nutrient unless meat courses are part of the continuous diet. Fruit, cereals and                         
vegetables contain very little of useful iron and so if you are suffering from low iron, no                                 
amount of vitamins or any other supplement will assist the situation. 
 
 
Common symptoms 
 
Almost every third woman has low iron values. The risk is especially high if                           
menstruation lasts longer than three days, during pregnancy and lactation. During                     
menstruation the woman loses an average of 35‐40 mg of iron, or around 10 mg per day.  
 
 
IRON THERAPY ­ WITHOUT PROBLEMS 
 
This is why women need more iron intake on a regular bases than men. 
 
The symptoms of iron depletion are so common that they are often not recognized.                           
Except for weakness and shortage of breath it will also affect appearance. The skin                           
grows pale and hair and nail lose strength and luster. 
 
Iron deficiency can give the following symptoms: 
‐ Tiredness, fatigue, passivity and drowsiness 
‐ Concentration difficulties and increased need for sleep 
‐ Impaired physical performance 
‐ Lessened learning ability and decreased cognitive performance 
 
 
The general iron uptake and causes for iron need 
 
In healthy individuals the average iron absorbed is 1 mg daily for men, 1.5 ‐ 2.5 mg daily                                   
for women and during pregnancy 2‐3 mg daily corresponding to a total of 500 ‐ 1 000                                 
mg per month. Iron requirements should compensate for demand during growth,                     
pregnancy and physiological and pathological losses. 
 
 
The importance of iron supplementation avoiding side­effects 
 
Many iron supplementation treatments fail because synthetic iron produces painful,                   
uncomfortable and even dangerous due to gastro‐intestinal side‐effects. Iron is however                     
absolutely vital to life and bodily functions and hence the therapy must continue. 
 
Heme‐Iron preparations avoid these harmful side‐effects as they have a virtually perfect                       
tolerance and as this will not change even in longer therapy use when necessary. 
 
 
All iron comes from the diet 
 
There are only two kinds of iron that we can use; Heme iron from meat, poultry, fish                                 
and non‐heme iron from vegetables, dairy products and chemically bonded synthetic                     
iron in regular supplements. 
Heme iron is taken up along the whole gastro‐intestinal tract (not only the first part)                             
and, unlike non‐heme iron, absorption is not affected by other chelating components of                         
the diet such as phytates, tannates and phosphate. 
 
 
 
 
 
 
 
 
 
IRON THERAPY ­ WITHOUT PROBLEMS 
 
PART 2. PATIENT GROUPS 
 
­ Chronic diseases that affect iron metabolism 
­ Importance of iron during pregnancy 
­ Non­heme/synthetic iron is not absorbed when using Omeprazole 
­ Anemia and Diabetes 
­ Anemia and Heart Disease 
­ Anemia and Chronic Kidney Disease 
­ Anemia and Inflammatory bowel disease and iron depletion 
­ Anemia and Inflammatory Diseases 
­ Iron deficiency in young girls 
­ Nutritional status and birth weight 
­ It takes time to correct the situation of iron deficiency 
­ Effect of supplementation on blood donors. 
 
 
Chronic diseases that affect the iron metabolism 
 
There is a large number of chronics in various diseases with anemia for instance Chronic                             
kidney disease, Inflammatory bowel disease and Coronary heart disease.  
 
Chronics usually receive synthetic oral iron tablets in high doses until treatment fails                         
due to side‐effects. The remaining alternative is very expensive and inconvenient                     
intravenous iron. There are potential risks with repeated iron injections over a longer                         
period of time: overdosing and increased oxidative stress. 
 
 
Importance of iron during pregnancy 
 
Iron status of pregnant women and women who plan pregnancy determines the weight                         
of the fetus to such a degree that it affects the health status during the whole lifetime.   
 
A negative iron balance causes not only physical and mental fatigue, but may also lead to                               
anemia. Iron deficiency in children may disturb the learning ability, which cannot be                         
substituted along the way. This concerns mainly psycho‐motor and cognitive                   
development plus further cognitive performance in life. 
 
 
Non­heme/synthetic iron not absorbed when using Omeprazole 
 
Achlorhydria refers to states where the production of gastric acid in the stomach is                   
absent or low and impairs protein digestion by inhibiting the activation of the                         
enzyme pepsin, whose activation is dependent upon a low gastric pH. 
 
As acid facilitates non‐heme iron absorption, about 25% of achlorhydric patients  
 
 
IRON THERAPY ­ WITHOUT PROBLEMS 
 
develop iron‐deficiency anaemia.  Because gastric acid releases Fe3+ from food and                     
reduces it to ferrous iron (Fe2+), achlorhydria reduces iron absorption. 
Omeprazole is an acid‐reducer that is used to treat acid reflux and stomach ulcers and is                               
taken by iron‐deficient individuals as part of the treatment for upper GI tract disorders                           
that may or may not have been the primary cause of their anemia. 
 
Lack of stomach acid caused by chronic use of Omeprazole can affect the absorption of                             
nutrients such as iron from foods. Patients taking Omeprazole for chronic stomach                       
disorders may require iron injections to prevent iron deficiency anemia which can be                         
substituted with Heme‐Iron therapy with no side‐effects and excellent efficiency. 
 
 
Anemia and Heart Disease 
 
Anemia, or a low hemoglobin level in the blood, is often linked to heart disease because                               
the heart has to work harder to pump more blood and oxygen through the body. 
 
Heart failure is a very common disease, with severe morbidity and mortality, and a                           
frequent reason of hospitalization. Anemia and a concurrent renal impairment are two                       
major risk factors contributing to the severity of the outcome and consist of the                           
cardio‐renal anemia syndrome.  
 
Anemia in heart failure is complex and multi‐factorial. Hemodilution, absolute or                     
functional iron deficiency, activation of the inflammatory cascade, and impaired                   
erythropoietin production and activity are some patho‐physiological mechanisms               
involved in anemia of the heart failure.  
 
Cardiovascular diseases are among the most frequent causes of death worldwide.  Heart                       
failure is an enormous medical and societal burden and a leading cause of                         
hospitalization. It is estimated that 2.6 millions hospitalizations annually in the USA are                         
due to heart failure as a primary or secondary diagnosis. 
 
Anemia of chronic inflammation is the most common cause of anemia and occurs in 58%                             
of heart failure patients with anemia. Anemia of inflammation and chronic disease is a                           
type of anemia that commonly occurs with chronic, or long term, illnesses or infections.  
 
Anemia is common in patients with heart disease. It is present in approximately one                           
third of patients with congestive heart failure (CHF) and 10% to 20% of patients with                             
coronary heart disease (CHD).  
 
 
Anemia and Chronic Kidney Disease 
 
Chronic Kidney Disease (CKD) is a gradual and usually permanent loss of kidney                         
function over time. This happens over time, usually months to years.  
 
 
IRON THERAPY ­ WITHOUT PROBLEMS 
CKD is divided into 5 stages of increasing severity. Stage 5 chronic kidney failure is also                               
referred to as end‐stage renal disease. In Stage 5 there is total or near‐total loss of                               
kidney function and patients need dialysis or transplantation to stay alive.                     
(http://www.aakp.org) 
 
CKD may be the result of physical injury or a disease that damages the kidneys, such as                                 
diabetes or high blood pressure. When the kidneys are damaged, they do not remove                           
wastes and extra water from the blood as well as they should. 
 
Anemia develops when the kidneys fail to produce enough erythropoietin, EPO, the                       
hormone that directs the bones to make red blood cells.  
Anemia tends to worsen as CKD progresses and  can itself cause heart problems.  
 
CKD patients become anaemic primarily due to impaired absorption of iron, blood loss                         
into the gastro‐intestinal tract, and inadequate production of erythropoietin from the                     
kidneys. The management of patients not undergoing dialysis involves stepwise                   
treatment with oral iron, intravenous iron, and erythropoietin stimulating agents                   
(ESA’s).  
 
 
Anemia and Inflammatory bowel disease and iron depletion 
 
Inflammatory Bowel Disease, (IBD), is a condition that causes irritation and ulcers in                         
the gastrointestinal tract. It is a group of inflammatory conditions of the large intestine                           
and, in some cases, the small intestine.  
 
The most common for IBD are ulcerative colitis and Crohn's disease. Anemia caused by                           
iron deficiency due to gastrointestinal blood loss and reduced iron absorption due to                         
inflammation is often present.  
 
Inflammatory Bowel Disease (IBD), diseases that cause inflammation and irritation in                     
the intestines is often associated with iron deficiency and anemia. 
 
It may also be exacerbated by a restrictive diet. In the US it is estimated that currently 1                                   
– 1,3 million people are suffering from IBD. Crohn's disease and Ulcerative Colitis have                           
together and incidence of 339 per 100 000 adults (cdc.gov) and the number is higher in                               
Europe and increasing everywhere in the world. 
 
Treatment today consists mainly of oral synthetic iron prior to intravenous iron and                         
erythropoietin treatment. The prevalence of intolerance towards oral synthetic iron is                     
however high, around 25‐30 %.  
  
The absorption of Heme‐Iron is several times higher and the side‐effects rate                       
significantly lower than for non‐heme synthetic oral iron as heme iron is absorbed                         
through a separate pathway and does not have to be discontinued when intravenous                         
treatment is started. This can allow for longer intervals between resource‐heavy,                     
inconvenient and painful injections. Intravenous treatment is usually started only when                     
oral non‐heme treatment fails due to side‐effects.  
 
IRON THERAPY ­ WITHOUT PROBLEMS 
 
 
Anemia and Inflammatory Diseases 
 
Inflammatory diseases that can lead to AI/ACD (Anemia of Inflammation and Anemia                       
Chronic Disease) including rheumatoid arthritis, which causes pain, swelling, stiffness,                   
and loss of function in the joints, lupus, which causes damage to various body tissues,                             
such as the joints, skin, kidneys, heart, lungs, blood vessels, and brain. 
 
 
Iron deficiency in young girls 
 
Low iron counts and even anaemia due to iron deficiency is a widespread problem.                           
Among adolescent girls, it will bring negative consequences on growth, school                     
performance, morbidity and reproductive performance. It also has several negative                   
physical symptoms such as tiredness, headaches and difficulty to concentrate.  
 
Adolescents, especially girls, are particularly vulnerable to iron deficiency. ​The highest                     
prevalence is between the ages of 12‐15 years when requirements are at a peak. In all                               
Member States of the South‐East Asia Region, except Thailand, more than 25% of                         
adolescent girls are reported to be anaemic; in some countries as high as 50%.                           
(WHO,http://www.searo.who.int/entity/child_adolescent/documents/sea_cah_2/en/) 
While approximately 8% of women are estimated to be iron deficient in the west, Dr                             
Mike Nelson, a nutritionist at King's College, London University, believes that between                       
10 ‐ 20 % of younger girls are affected. Although these girls often appear to be in good                                   
health, low iron levels profoundly affect many aspects of their day to day lives, including                             
an ability to concentrate, and thus learn, in school. Nelson tells us, "In tests we have                               
carried out we think that the IQ in British girls who get enough iron in their diets and                                   
those who are anaemic can mean the difference of a whole grade in school exams". 
"Girls who are dieting and those switching to a vegetarian diet are particularly at risk",                             
explains Nelson: "New vegetarians need to be very careful in the first year of conversion                             
because they often cut out meat and don't know how to replace the iron with other                               
foods. Women and girls who diet and go vegetarian at the same time should think about                               
eating iron fortified foods or even taking a modest supplement". (European Food                       
Information Council, http://www.eufic.org/article/en/artid/iron‐common‐deficiency/) 
Foods containing heme iron (meat, poultry, and fish) enhance iron absorption from                       
foods that contain non‐heme iron. ​Adolescent girls and fertile females in general are at                           
risk for iron deficiency mainly due to a small constant loss of blood through                           
menstruation. Another factor today is a diet with little or no meat​, poultry, and fish since                               
heme iron from meat products is central for a normal iron balance. 
 
The problem is compounded when an adolescent girl gets a recommendation for                       
supplement iron and the product brings side‐effects, like the regular synthetic                     
supplements regularly do. The effect is a termination of the therapy and the situation for                             
the young female remains the same. 
 
 
 
IRON THERAPY ­ WITHOUT PROBLEMS 
 
Nutritional status and birth weight 
 
English Professor David Barkers epidemological research studies show that the                   
nutritional status of the mother, mainly as hemoglobin count has an effect on fetal                           
development. This has also been tied to the health of the infant throughout life.  
 
From the beginning of the century new‐born babies weight as well as the placenta has                             
been recorded.  
 
We know today that a low nutritional status, above all low hemoglobin values in the                             
mother, is reflected in placental weight versus baby weight. By combining these data for                           
more than 5 000 persons and comparing them with health development throughout life                         
certain conclusions could be drawn.  
 
It turns out that those born by mothers with low nutritional status suffered from various                             
internal diseases such as low blood pressure and diabetes to a higher degree, an                           
increased risk of coronary heart disease and the disorders related to it: stroke,                         
non‐insulin dependent diabetes, raised blood pressure, and the metabolic syndrome 
 
A substantial number of studies show that mineral and vitamin supplements especially                       
during the vital first trimester has a decisive influence on maternal nutritional status                         
and birth weight of the baby. 
 
The "fetal origins hypothesis", states that cardiovascular disease and non‐insulin                   
dependent diabetes originate through adaptations that the fetus makes when it is                       
undernourished. These adaptations may be cardiovascular, metabolic or endocrine and                   
include slowing of growth, they permanently change the structure and function of the                         
body. 
 
 
It takes time to correct the situation of iron deficiency 
 
The process of building up adequate iron stores takes months, much in the same way                             
that depletion does not happen overnight.  
 
This is why supplementary dosage usually is enough. If the dosage is higher than 50 mgs                               
per day zinc absorption will be blocked. 
 
The success of any iron therapy is closely related to user friendliness. This means that                             
tolerance and dosage‐related compliance is of central importance. 
 
 
Effect of supplementation on blood donors. 
 
Since blood donation is voluntary and this is a free service for the fellow man it is                                 
natural to ”guard the sources”. This means that blood donors should receive iron                         
supplementation to compensate for iron loss from the blood donated, especially if​ ​low  
 
IRON THERAPY ­ WITHOUT PROBLEMS 
 
values are detected. This is not always the case because of low efficacy and frequent                             
side‐effects from the synthetic iron given. 
 
Side effects often lead to the donors stopping taking the supplements, which in turn                           
means that they can only donate blood perhaps once or twice a year instead of normally                               
three times.  
 
There are factors influencing synthetic iron absorption itself. Among these are tannins                       
in tea and coffee. Phytates in whole grain bread, milk proteins, albumin and soy proteins                             
may also reduce absorption.  
 
This means that a regular diet and synthetic supplements may not be enough to                           
compensate for iron loss. 
 
Heme‐Iron absorption is not affected by any of these factors. 
 
Synthetic supplements at 100 mg Fe++ per dose regularly have an incidence of                         
side‐effects leading to termination of the therapy of around 30 %. Donors that have                           
previous negative experiences will usually not take the supplements at all. 
 
It has been observed that after a blood donation absorption of non‐heme iron practically                           
ceases for  around four days. Heme‐Iron, however is absorbed normally. 
 
 
 
 
PART 3. HEME IRON 
 
 
Heme iron in meat courses is the most important source of iron 
Heme iron uptake is five times more efficient than non­heme iron 
You can avoid side­effects with heme iron 
Heme iron is 100 % natural, not synthetic. 
Heme iron is economical because.. 
Hemoglobin iron in therapy. What do we know?  Clinical studies. 
 
 
Heme iron in meat courses is the most important source of iron 
 
There are two pathways for dietary iron. Heme iron, which is found in all meat products,                               
is absorbed efficiently and neatly as a whole unit.  
 
The other kind is simply non‐heme iron and has to be broken down in the gut before the                                   
iron can be absorbed. Most of the highly reactive free iron ions remains in the gut and                                 
cause side‐effects such as constipation, diarrhea and stomach cramps. The uptake of                       
non‐heme iron is also affected by other foods consumed. 
 
 
IRON THERAPY ­ WITHOUT PROBLEMS 
 
All regular supplements are synthetic. They feature chemically bonded iron.  
Heme‐Iron supplements are made with natural bovine hemoglobin. 
 
 
Heme iron uptake is five times more efficient than non­heme iron 
 
Heme iron is natural for man and still is the best and most efficient way of absorbing the                                   
iron we all need to live and for our bodies to function properly. 
 
In a normal diet heme iron from meat products play a large role. The synthetic iron                               
supplements today are often produce gastro‐intestinal side‐effects which in many cases                     
terminate the important therapy 
 
Heme‐Iron therapy is reasonably priced and much lower than for instance intravenous                       
therapy in chronic cases. As Heme‐Iron has virtually no Side‐effects this will not ruin the                             
therapy and therefore Heme‐Iron therapy has a much higher success rate due to better                           
tolerance than non‐heme iron therapy. 
 
Heme‐Iron is natural for man and still is the best and most efficient way of absorbing  
the iron we all need to live and for our bodies to function properly. In a normal diet                                   
heme iron from meat products plays a large role.  
 
Unlike non‐heme iron, absorption is not affected by other chelating components of the                         
diet such as phytates, tannates and phosphate as Heme‐Iron will always be absorbed ‐                           
in all clinical situations. Heme‐Iron is absorbed from the beginning of the intestine,                         
which means it will work also for example with patients, who have had gut surgery. 
The uptake and tolerance of Heme‐Iron will not change even over a longer time period.  
This is good news for chronics, since synthetic iron will usually give problems with                           
uptake sooner or later. This means another form of therapy must be considered. 
 
The absorption of Heme‐Iron is several times higher and the side‐effects rate                       
significantly lower than for non‐heme oral iron. Heme‐Iron is absorbed through a                       
separate pathway and does not have to be discontinued when intravenous treatment is                         
started. This can allow for longer intervals between resource‐heavy, inconvenient and                     
painful injections. Oxidative stress is also avoided. Heme‐Iron does not need to be                         
discontinued during injection or EPO therapy like non‐heme oral iron. 
 
Heme‐Iron therapy has the simplest possible dosage: One or more tablets once per day,                           
at anytime and there is no need to consider other simultaneously ingested foodstuff or                           
drink.  
 
Uptake for Heme‐Iron is 20 ‐ 40 %.   
 
Heme‐Iron is very well tolerated. There are no known unpleasant side‐effects. Uptake or                         
tolerance will not change over time. 
 
 
 
IRON THERAPY ­ WITHOUT PROBLEMS 
 
Heme‐Iron has been used in large scale as an iron supplement in Scandinavia for over 30                               
years with no reported serious side‐effects or poisonings. 
 
 
You can avoid side­effects with ​Heme­Iron 
 
In studies the incidence of side‐effects with heme iron products is at placebo level. 
The mechanism of uptake for heme iron does not leave free iron ions in the gut that may                                   
cause disturbances and are potentially carcinogenic. 
 
 
Heme iron is natural 
 
All regular supplements are synthetic. They feature chemically bonded iron.  
Heme iron supplements are made with natural bovine hemoglobin. 
 
 
Heme iron is economical because. 
 
With a dosage of one or two tablets once per day Heme‐Iron therapy is economical                             
compared to the alternatives. 
 
Dosage will stay the same even over longer therapy. 
 
There are considerably less potentially therapy‐ruining side‐effects. This is a major                     
problem when it comes to synthetic iron supplements. It is very common that side                           
effects force the therapy to be terminated and something else tried.  
The last alternative when not consulting Heme‐Iron is the very expensive and                       
inconvenient, potentially infectious causing intravenously given iron.  
 
By Heme‐Iron therapy with or two tablets at a single administration per day this steals                             
no working time. It is also convenient in other ways. There are no special precautions                             
over simultaneously ingested food, drink or medicine. 
 
Heme‐Iron therapy can build up adequate iron storage in a natural and gentle fashion.                           
There is no change in tolerability or efficacy over longer time.  
 
With synthetic supplements side‐effects are usually, even after initial good tolerance,                     
slowly accumulating until the therapy has to be discontinued. 
 
Using Heme‐Iron very little is wasted. What is not taken up is completely inert in the                               
gastro‐intestinal channel as opposed to non‐adsorbed free iron ions from synthetic iron,                       
which are reactive and strongly irritating. 
 
 
Hemoglobin iron in therapy. What do we know?  
 
IRON THERAPY ­ WITHOUT PROBLEMS 
 
Some published studies of heme iron supplementation. ​The following texts present and                       
comment some of the published scientific studies on Heme iron. 
 
Conclusions: 
‐ Heme‐Iron is better taken up than all other forms (non‐heme/synthetic) palatable iron 
‐ Heme‐Iron causes significantly fewer therapy‐destroying side‐effects 
‐ Heme‐Iron is safe and works well as supplement for chronics, pregnants etc. 
‐ Heme‐Iron is natural in all forms of iron deficiency. 
‐ Heme‐Iron can successfully replace current medications and ease on the Side‐Effects.  
 
“For targeted prophylaxis of iron deficiency with small, side­effect­free doses,                     
heme­iron is thus a valuable component which increases the absorption by about                       
40%. Heme­iron does not cause high concentrations in the intestinal lumen of free                         
radical inducing, possibly harmful ferric iron.” 
 
Comparative Absorption of Ferrous and Heme‐Iron with Meals in Normal and Iron                       
Deficient Subjects. Zeitschrift für Ernährungswissenschaft 1993 Mar; 32 (1): 67‐70                   
Ekman M, Reizenstein P. Hematology Laboratory, Karolinska Hospital and Institute,                   
Stockholm, Sweden. 
 
“The study demonstrates that a low­dose iron supplement containing both heme                     
iron and non­heme iron (Hemofer) has fewer side effects when compared with an                         
equipotent, traditional non­heme iron supplement.” 
 
Side Effects of Iron Supplements in Blood Donors: Superior Tolerance of Heme Iron.                         
Frykman E.  J  Laboratory Clinical Medicine 1994 April; 123(4): 561‐4. 
 
“A daily dose of 27 mg elemental iron, containing a heme component, given in the                             
second half of pregnancy, prevents depiction of iron stores after birth in most                         
women. An equivalent dose of pure inorganic iron seems less effective, but the                         
sample size in this study was too small to demonstrate significant differences                       
between the two treatment groups.” 
 
Iron Supplementation in Pregnancy: Is less enough? A randomised, placebo Controlled                     
Trial of Low Dose Iron Supplementation with and without Heme Iron. Eskeland B. Acta                           
Obstet Gynecology Scandinavia  1997 Oct 76(9);822‐828. 
 
“Heme iron is absorbed from meat more efficiently than dietary inorganic iron                       
and in a different manner. Thus, iron deficiency is less frequent in countries                         
where meat constitutes a significant part of the diet.“ 
 
Seminars in Hematology 1998 Jan; 35 (1): 27‐34. Absorption of heme iron. Uzel C,                           
Conrad ME. USA Cancer Center, University of South Alabama, Mobile 36688, USA. 
 
 
 
 
 
IRON THERAPY ­ WITHOUT PROBLEMS 
 
CONCLUSION 
 
The problems in practice with the therapy have mainly to do with tolerance. Getting                           
side‐effects in a therapy form will soon ruin it. Iron is however necessary for life and the                                 
traditional synthetic iron forms such as Ferrous sulphate, Ferrous fumarate or similar                       
will bring serious side‐effects sooner or later.  
 
Using synthetic iron therapy the only remaining alternative is inconvenient, even                     
painful, and costly intravenously given iron. ​There are risks with iron injections over a                           
longer period of time. Intravenous iron injections cause periods of exacerbation of                       
oxidative stress in the circulation and potentially also infections. 
 
Safe and well tolerated ​Heme‐Iron ​does not have these problems. Both efficacy and                         
tolerance remain stable over longer time. Administration is the easiest possible: One                       
dose per day at any given time, without having to consider other medication, food or                             
drink. It also gives for instance chronics freedom to travel. 
 
 
ADDITIONAL RESOURCES 
 
MediTec Group AB: ​www.MediTec.se 
 
Heme­Iron Informtation: ​www.hemeiron.com 
 
OptiFer® Series Information:​ ​www.optifer.international 
 
Heme­Iron E­Book: ​eBook “Heme Iron, the natural way of iron supplementation” 
 by Michael Collan 
 
For more information, please contact ​FerroCare@MediTec.SE 
 
Copyright Information  
© 2016 MediTec FerroCare Division All Rights Reserved 

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White paper "Iron Therapy without problems"

  • 1.   IRON THERAPY ­ WITHOUT PROBLEMS          White paper    IRON THERAPY ­ WITHOUT PROBLEMS    MediTec FerroCare Division |  FerroCare@MediTec.SE    1.3 2016           ABSTRACT    Low iron counts is according to WHO one of the most common and life threatening                              conditions worldwide. Iron cannot be substituted by any other nutrients in your food.    Suffering from low iron, no amount of vitamins or any other supplement is going to                              assist to improve the lack of iron.     The symptoms of iron deficiency are so common that they are not always fully                            recognized and may hence lead to further cause of health issues.    This white paper will discuss iron therapy in general, why it is sometimes                          problematic,mainly due to tolerance and practical issues for those suffering from iron                        deficiency.     Important groups that are discussed in this aspect are children, young girls, fertile                          females, seniors and people with chronic diseases such as IBD, CHF, CKD that affect the                              iron metabolism and how Heme‐Iron supplementation change this situation.    The target is to inform the medicinal and pharmaceutical communities of this relatively                          new form of therapy and why it has great benefits compared to the traditional methods.             
  • 2.   IRON THERAPY ­ WITHOUT PROBLEMS    PART 1. THE PRESENT SITUATION    ­ Low iron counts are one of the most common conditions worldwide  ­ Iron cannot be substituted by anything else  ­ Common symptoms  ­ The general iron uptake and causes of iron need  ­ The importance of supplementation avoiding side­effects  ­ All iron comes from the diet      Low iron counts are one of the most common conditions worldwide     More than one‐quarter of the world's population is anemic. Approximately one‐half of                        this burden is a result of iron deficiency anemia, being most prevalent among preschool                            children and women.     Globally, anemia affects 1.62 billion people (95% CI: 1.50–1.74 billion),which                    corresponds to 24.8% of the population (95% CI: 22.9–26.7%).    The highest prevalence is in preschool‐age children (47.4%, 95% CI: 45.7–49.1), and the                          lowest prevalence is in men (12.7%, 95% CI: 8.6–16.9%). However, the population                        group with the greatest number of individuals affected is non‐pregnant women (468.4                        million, 95% CI: 446.2–490.6). (WHO).     The diagnosis, prevention, and treatment of iron deficiency is obviously a major public                          health goal, especially in low‐ and middle‐income countries.      Iron cannot be substituted by anything else    Iron is the most important part of the hemoglobin in the red blood cells that carry                                oxygen to all the cells of the body. In case of shortage of iron in the body we easily run                                      short of breath, get tired and have problems concentrating even at low deficiency.     Our bodies contain 4‐5 grams of iron. It may be difficult to get enough of this important                                  nutrient unless meat courses are part of the continuous diet. Fruit, cereals and                          vegetables contain very little of useful iron and so if you are suffering from low iron, no                                  amount of vitamins or any other supplement will assist the situation.      Common symptoms    Almost every third woman has low iron values. The risk is especially high if                            menstruation lasts longer than three days, during pregnancy and lactation. During                      menstruation the woman loses an average of 35‐40 mg of iron, or around 10 mg per day.    
  • 3.   IRON THERAPY ­ WITHOUT PROBLEMS    This is why women need more iron intake on a regular bases than men.    The symptoms of iron depletion are so common that they are often not recognized.                            Except for weakness and shortage of breath it will also affect appearance. The skin                            grows pale and hair and nail lose strength and luster.    Iron deficiency can give the following symptoms:  ‐ Tiredness, fatigue, passivity and drowsiness  ‐ Concentration difficulties and increased need for sleep  ‐ Impaired physical performance  ‐ Lessened learning ability and decreased cognitive performance      The general iron uptake and causes for iron need    In healthy individuals the average iron absorbed is 1 mg daily for men, 1.5 ‐ 2.5 mg daily                                    for women and during pregnancy 2‐3 mg daily corresponding to a total of 500 ‐ 1 000                                  mg per month. Iron requirements should compensate for demand during growth,                      pregnancy and physiological and pathological losses.      The importance of iron supplementation avoiding side­effects    Many iron supplementation treatments fail because synthetic iron produces painful,                    uncomfortable and even dangerous due to gastro‐intestinal side‐effects. Iron is however                      absolutely vital to life and bodily functions and hence the therapy must continue.    Heme‐Iron preparations avoid these harmful side‐effects as they have a virtually perfect                        tolerance and as this will not change even in longer therapy use when necessary.      All iron comes from the diet    There are only two kinds of iron that we can use; Heme iron from meat, poultry, fish                                  and non‐heme iron from vegetables, dairy products and chemically bonded synthetic                      iron in regular supplements.  Heme iron is taken up along the whole gastro‐intestinal tract (not only the first part)                              and, unlike non‐heme iron, absorption is not affected by other chelating components of                          the diet such as phytates, tannates and phosphate.                 
  • 4.   IRON THERAPY ­ WITHOUT PROBLEMS    PART 2. PATIENT GROUPS    ­ Chronic diseases that affect iron metabolism  ­ Importance of iron during pregnancy  ­ Non­heme/synthetic iron is not absorbed when using Omeprazole  ­ Anemia and Diabetes  ­ Anemia and Heart Disease  ­ Anemia and Chronic Kidney Disease  ­ Anemia and Inflammatory bowel disease and iron depletion  ­ Anemia and Inflammatory Diseases  ­ Iron deficiency in young girls  ­ Nutritional status and birth weight  ­ It takes time to correct the situation of iron deficiency  ­ Effect of supplementation on blood donors.      Chronic diseases that affect the iron metabolism    There is a large number of chronics in various diseases with anemia for instance Chronic                              kidney disease, Inflammatory bowel disease and Coronary heart disease.     Chronics usually receive synthetic oral iron tablets in high doses until treatment fails                          due to side‐effects. The remaining alternative is very expensive and inconvenient                      intravenous iron. There are potential risks with repeated iron injections over a longer                          period of time: overdosing and increased oxidative stress.      Importance of iron during pregnancy    Iron status of pregnant women and women who plan pregnancy determines the weight                          of the fetus to such a degree that it affects the health status during the whole lifetime.      A negative iron balance causes not only physical and mental fatigue, but may also lead to                                anemia. Iron deficiency in children may disturb the learning ability, which cannot be                          substituted along the way. This concerns mainly psycho‐motor and cognitive                    development plus further cognitive performance in life.      Non­heme/synthetic iron not absorbed when using Omeprazole    Achlorhydria refers to states where the production of gastric acid in the stomach is                    absent or low and impairs protein digestion by inhibiting the activation of the                          enzyme pepsin, whose activation is dependent upon a low gastric pH.    As acid facilitates non‐heme iron absorption, about 25% of achlorhydric patients    
  • 5.   IRON THERAPY ­ WITHOUT PROBLEMS    develop iron‐deficiency anaemia.  Because gastric acid releases Fe3+ from food and                      reduces it to ferrous iron (Fe2+), achlorhydria reduces iron absorption.  Omeprazole is an acid‐reducer that is used to treat acid reflux and stomach ulcers and is                                taken by iron‐deficient individuals as part of the treatment for upper GI tract disorders                            that may or may not have been the primary cause of their anemia.    Lack of stomach acid caused by chronic use of Omeprazole can affect the absorption of                              nutrients such as iron from foods. Patients taking Omeprazole for chronic stomach                        disorders may require iron injections to prevent iron deficiency anemia which can be                          substituted with Heme‐Iron therapy with no side‐effects and excellent efficiency.      Anemia and Heart Disease    Anemia, or a low hemoglobin level in the blood, is often linked to heart disease because                                the heart has to work harder to pump more blood and oxygen through the body.    Heart failure is a very common disease, with severe morbidity and mortality, and a                            frequent reason of hospitalization. Anemia and a concurrent renal impairment are two                        major risk factors contributing to the severity of the outcome and consist of the                            cardio‐renal anemia syndrome.     Anemia in heart failure is complex and multi‐factorial. Hemodilution, absolute or                      functional iron deficiency, activation of the inflammatory cascade, and impaired                    erythropoietin production and activity are some patho‐physiological mechanisms                involved in anemia of the heart failure.     Cardiovascular diseases are among the most frequent causes of death worldwide.  Heart                        failure is an enormous medical and societal burden and a leading cause of                          hospitalization. It is estimated that 2.6 millions hospitalizations annually in the USA are                          due to heart failure as a primary or secondary diagnosis.    Anemia of chronic inflammation is the most common cause of anemia and occurs in 58%                              of heart failure patients with anemia. Anemia of inflammation and chronic disease is a                            type of anemia that commonly occurs with chronic, or long term, illnesses or infections.     Anemia is common in patients with heart disease. It is present in approximately one                            third of patients with congestive heart failure (CHF) and 10% to 20% of patients with                              coronary heart disease (CHD).       Anemia and Chronic Kidney Disease    Chronic Kidney Disease (CKD) is a gradual and usually permanent loss of kidney                          function over time. This happens over time, usually months to years.    
  • 6.   IRON THERAPY ­ WITHOUT PROBLEMS  CKD is divided into 5 stages of increasing severity. Stage 5 chronic kidney failure is also                                referred to as end‐stage renal disease. In Stage 5 there is total or near‐total loss of                                kidney function and patients need dialysis or transplantation to stay alive.                      (http://www.aakp.org)    CKD may be the result of physical injury or a disease that damages the kidneys, such as                                  diabetes or high blood pressure. When the kidneys are damaged, they do not remove                            wastes and extra water from the blood as well as they should.    Anemia develops when the kidneys fail to produce enough erythropoietin, EPO, the                        hormone that directs the bones to make red blood cells.   Anemia tends to worsen as CKD progresses and  can itself cause heart problems.     CKD patients become anaemic primarily due to impaired absorption of iron, blood loss                          into the gastro‐intestinal tract, and inadequate production of erythropoietin from the                      kidneys. The management of patients not undergoing dialysis involves stepwise                    treatment with oral iron, intravenous iron, and erythropoietin stimulating agents                    (ESA’s).       Anemia and Inflammatory bowel disease and iron depletion    Inflammatory Bowel Disease, (IBD), is a condition that causes irritation and ulcers in                          the gastrointestinal tract. It is a group of inflammatory conditions of the large intestine                            and, in some cases, the small intestine.     The most common for IBD are ulcerative colitis and Crohn's disease. Anemia caused by                            iron deficiency due to gastrointestinal blood loss and reduced iron absorption due to                          inflammation is often present.     Inflammatory Bowel Disease (IBD), diseases that cause inflammation and irritation in                      the intestines is often associated with iron deficiency and anemia.    It may also be exacerbated by a restrictive diet. In the US it is estimated that currently 1                                    – 1,3 million people are suffering from IBD. Crohn's disease and Ulcerative Colitis have                            together and incidence of 339 per 100 000 adults (cdc.gov) and the number is higher in                                Europe and increasing everywhere in the world.    Treatment today consists mainly of oral synthetic iron prior to intravenous iron and                          erythropoietin treatment. The prevalence of intolerance towards oral synthetic iron is                      however high, around 25‐30 %.      The absorption of Heme‐Iron is several times higher and the side‐effects rate                        significantly lower than for non‐heme synthetic oral iron as heme iron is absorbed                          through a separate pathway and does not have to be discontinued when intravenous                          treatment is started. This can allow for longer intervals between resource‐heavy,                      inconvenient and painful injections. Intravenous treatment is usually started only when                      oral non‐heme treatment fails due to side‐effects.  
  • 7.   IRON THERAPY ­ WITHOUT PROBLEMS      Anemia and Inflammatory Diseases    Inflammatory diseases that can lead to AI/ACD (Anemia of Inflammation and Anemia                        Chronic Disease) including rheumatoid arthritis, which causes pain, swelling, stiffness,                    and loss of function in the joints, lupus, which causes damage to various body tissues,                              such as the joints, skin, kidneys, heart, lungs, blood vessels, and brain.      Iron deficiency in young girls    Low iron counts and even anaemia due to iron deficiency is a widespread problem.                            Among adolescent girls, it will bring negative consequences on growth, school                      performance, morbidity and reproductive performance. It also has several negative                    physical symptoms such as tiredness, headaches and difficulty to concentrate.     Adolescents, especially girls, are particularly vulnerable to iron deficiency. ​The highest                      prevalence is between the ages of 12‐15 years when requirements are at a peak. In all                                Member States of the South‐East Asia Region, except Thailand, more than 25% of                          adolescent girls are reported to be anaemic; in some countries as high as 50%.                            (WHO,http://www.searo.who.int/entity/child_adolescent/documents/sea_cah_2/en/)  While approximately 8% of women are estimated to be iron deficient in the west, Dr                              Mike Nelson, a nutritionist at King's College, London University, believes that between                        10 ‐ 20 % of younger girls are affected. Although these girls often appear to be in good                                    health, low iron levels profoundly affect many aspects of their day to day lives, including                              an ability to concentrate, and thus learn, in school. Nelson tells us, "In tests we have                                carried out we think that the IQ in British girls who get enough iron in their diets and                                    those who are anaemic can mean the difference of a whole grade in school exams".  "Girls who are dieting and those switching to a vegetarian diet are particularly at risk",                              explains Nelson: "New vegetarians need to be very careful in the first year of conversion                              because they often cut out meat and don't know how to replace the iron with other                                foods. Women and girls who diet and go vegetarian at the same time should think about                                eating iron fortified foods or even taking a modest supplement". (European Food                        Information Council, http://www.eufic.org/article/en/artid/iron‐common‐deficiency/)  Foods containing heme iron (meat, poultry, and fish) enhance iron absorption from                        foods that contain non‐heme iron. ​Adolescent girls and fertile females in general are at                            risk for iron deficiency mainly due to a small constant loss of blood through                            menstruation. Another factor today is a diet with little or no meat​, poultry, and fish since                                heme iron from meat products is central for a normal iron balance.    The problem is compounded when an adolescent girl gets a recommendation for                        supplement iron and the product brings side‐effects, like the regular synthetic                      supplements regularly do. The effect is a termination of the therapy and the situation for                              the young female remains the same.     
  • 8.   IRON THERAPY ­ WITHOUT PROBLEMS    Nutritional status and birth weight    English Professor David Barkers epidemological research studies show that the                    nutritional status of the mother, mainly as hemoglobin count has an effect on fetal                            development. This has also been tied to the health of the infant throughout life.     From the beginning of the century new‐born babies weight as well as the placenta has                              been recorded.     We know today that a low nutritional status, above all low hemoglobin values in the                              mother, is reflected in placental weight versus baby weight. By combining these data for                            more than 5 000 persons and comparing them with health development throughout life                          certain conclusions could be drawn.     It turns out that those born by mothers with low nutritional status suffered from various                              internal diseases such as low blood pressure and diabetes to a higher degree, an                            increased risk of coronary heart disease and the disorders related to it: stroke,                          non‐insulin dependent diabetes, raised blood pressure, and the metabolic syndrome    A substantial number of studies show that mineral and vitamin supplements especially                        during the vital first trimester has a decisive influence on maternal nutritional status                          and birth weight of the baby.    The "fetal origins hypothesis", states that cardiovascular disease and non‐insulin                    dependent diabetes originate through adaptations that the fetus makes when it is                        undernourished. These adaptations may be cardiovascular, metabolic or endocrine and                    include slowing of growth, they permanently change the structure and function of the                          body.      It takes time to correct the situation of iron deficiency    The process of building up adequate iron stores takes months, much in the same way                              that depletion does not happen overnight.     This is why supplementary dosage usually is enough. If the dosage is higher than 50 mgs                                per day zinc absorption will be blocked.    The success of any iron therapy is closely related to user friendliness. This means that                              tolerance and dosage‐related compliance is of central importance.      Effect of supplementation on blood donors.    Since blood donation is voluntary and this is a free service for the fellow man it is                                  natural to ”guard the sources”. This means that blood donors should receive iron                          supplementation to compensate for iron loss from the blood donated, especially if​ ​low  
  • 9.   IRON THERAPY ­ WITHOUT PROBLEMS    values are detected. This is not always the case because of low efficacy and frequent                              side‐effects from the synthetic iron given.    Side effects often lead to the donors stopping taking the supplements, which in turn                            means that they can only donate blood perhaps once or twice a year instead of normally                                three times.     There are factors influencing synthetic iron absorption itself. Among these are tannins                        in tea and coffee. Phytates in whole grain bread, milk proteins, albumin and soy proteins                              may also reduce absorption.     This means that a regular diet and synthetic supplements may not be enough to                            compensate for iron loss.    Heme‐Iron absorption is not affected by any of these factors.    Synthetic supplements at 100 mg Fe++ per dose regularly have an incidence of                          side‐effects leading to termination of the therapy of around 30 %. Donors that have                            previous negative experiences will usually not take the supplements at all.    It has been observed that after a blood donation absorption of non‐heme iron practically                            ceases for  around four days. Heme‐Iron, however is absorbed normally.          PART 3. HEME IRON      Heme iron in meat courses is the most important source of iron  Heme iron uptake is five times more efficient than non­heme iron  You can avoid side­effects with heme iron  Heme iron is 100 % natural, not synthetic.  Heme iron is economical because..  Hemoglobin iron in therapy. What do we know?  Clinical studies.      Heme iron in meat courses is the most important source of iron    There are two pathways for dietary iron. Heme iron, which is found in all meat products,                                is absorbed efficiently and neatly as a whole unit.     The other kind is simply non‐heme iron and has to be broken down in the gut before the                                    iron can be absorbed. Most of the highly reactive free iron ions remains in the gut and                                  cause side‐effects such as constipation, diarrhea and stomach cramps. The uptake of                        non‐heme iron is also affected by other foods consumed.   
  • 10.   IRON THERAPY ­ WITHOUT PROBLEMS    All regular supplements are synthetic. They feature chemically bonded iron.   Heme‐Iron supplements are made with natural bovine hemoglobin.      Heme iron uptake is five times more efficient than non­heme iron    Heme iron is natural for man and still is the best and most efficient way of absorbing the                                    iron we all need to live and for our bodies to function properly.    In a normal diet heme iron from meat products play a large role. The synthetic iron                                supplements today are often produce gastro‐intestinal side‐effects which in many cases                      terminate the important therapy    Heme‐Iron therapy is reasonably priced and much lower than for instance intravenous                        therapy in chronic cases. As Heme‐Iron has virtually no Side‐effects this will not ruin the                              therapy and therefore Heme‐Iron therapy has a much higher success rate due to better                            tolerance than non‐heme iron therapy.    Heme‐Iron is natural for man and still is the best and most efficient way of absorbing   the iron we all need to live and for our bodies to function properly. In a normal diet                                    heme iron from meat products plays a large role.     Unlike non‐heme iron, absorption is not affected by other chelating components of the                          diet such as phytates, tannates and phosphate as Heme‐Iron will always be absorbed ‐                            in all clinical situations. Heme‐Iron is absorbed from the beginning of the intestine,                          which means it will work also for example with patients, who have had gut surgery.  The uptake and tolerance of Heme‐Iron will not change even over a longer time period.   This is good news for chronics, since synthetic iron will usually give problems with                            uptake sooner or later. This means another form of therapy must be considered.    The absorption of Heme‐Iron is several times higher and the side‐effects rate                        significantly lower than for non‐heme oral iron. Heme‐Iron is absorbed through a                        separate pathway and does not have to be discontinued when intravenous treatment is                          started. This can allow for longer intervals between resource‐heavy, inconvenient and                      painful injections. Oxidative stress is also avoided. Heme‐Iron does not need to be                          discontinued during injection or EPO therapy like non‐heme oral iron.    Heme‐Iron therapy has the simplest possible dosage: One or more tablets once per day,                            at anytime and there is no need to consider other simultaneously ingested foodstuff or                            drink.     Uptake for Heme‐Iron is 20 ‐ 40 %.      Heme‐Iron is very well tolerated. There are no known unpleasant side‐effects. Uptake or                          tolerance will not change over time.     
  • 11.   IRON THERAPY ­ WITHOUT PROBLEMS    Heme‐Iron has been used in large scale as an iron supplement in Scandinavia for over 30                                years with no reported serious side‐effects or poisonings.      You can avoid side­effects with ​Heme­Iron    In studies the incidence of side‐effects with heme iron products is at placebo level.  The mechanism of uptake for heme iron does not leave free iron ions in the gut that may                                    cause disturbances and are potentially carcinogenic.      Heme iron is natural    All regular supplements are synthetic. They feature chemically bonded iron.   Heme iron supplements are made with natural bovine hemoglobin.      Heme iron is economical because.    With a dosage of one or two tablets once per day Heme‐Iron therapy is economical                              compared to the alternatives.    Dosage will stay the same even over longer therapy.    There are considerably less potentially therapy‐ruining side‐effects. This is a major                      problem when it comes to synthetic iron supplements. It is very common that side                            effects force the therapy to be terminated and something else tried.   The last alternative when not consulting Heme‐Iron is the very expensive and                        inconvenient, potentially infectious causing intravenously given iron.     By Heme‐Iron therapy with or two tablets at a single administration per day this steals                              no working time. It is also convenient in other ways. There are no special precautions                              over simultaneously ingested food, drink or medicine.    Heme‐Iron therapy can build up adequate iron storage in a natural and gentle fashion.                            There is no change in tolerability or efficacy over longer time.     With synthetic supplements side‐effects are usually, even after initial good tolerance,                      slowly accumulating until the therapy has to be discontinued.    Using Heme‐Iron very little is wasted. What is not taken up is completely inert in the                                gastro‐intestinal channel as opposed to non‐adsorbed free iron ions from synthetic iron,                        which are reactive and strongly irritating.      Hemoglobin iron in therapy. What do we know?  
  • 12.   IRON THERAPY ­ WITHOUT PROBLEMS    Some published studies of heme iron supplementation. ​The following texts present and                        comment some of the published scientific studies on Heme iron.    Conclusions:  ‐ Heme‐Iron is better taken up than all other forms (non‐heme/synthetic) palatable iron  ‐ Heme‐Iron causes significantly fewer therapy‐destroying side‐effects  ‐ Heme‐Iron is safe and works well as supplement for chronics, pregnants etc.  ‐ Heme‐Iron is natural in all forms of iron deficiency.  ‐ Heme‐Iron can successfully replace current medications and ease on the Side‐Effects.     “For targeted prophylaxis of iron deficiency with small, side­effect­free doses,                      heme­iron is thus a valuable component which increases the absorption by about                        40%. Heme­iron does not cause high concentrations in the intestinal lumen of free                          radical inducing, possibly harmful ferric iron.”    Comparative Absorption of Ferrous and Heme‐Iron with Meals in Normal and Iron                        Deficient Subjects. Zeitschrift für Ernährungswissenschaft 1993 Mar; 32 (1): 67‐70                    Ekman M, Reizenstein P. Hematology Laboratory, Karolinska Hospital and Institute,                    Stockholm, Sweden.    “The study demonstrates that a low­dose iron supplement containing both heme                      iron and non­heme iron (Hemofer) has fewer side effects when compared with an                          equipotent, traditional non­heme iron supplement.”    Side Effects of Iron Supplements in Blood Donors: Superior Tolerance of Heme Iron.                          Frykman E.  J  Laboratory Clinical Medicine 1994 April; 123(4): 561‐4.    “A daily dose of 27 mg elemental iron, containing a heme component, given in the                              second half of pregnancy, prevents depiction of iron stores after birth in most                          women. An equivalent dose of pure inorganic iron seems less effective, but the                          sample size in this study was too small to demonstrate significant differences                        between the two treatment groups.”    Iron Supplementation in Pregnancy: Is less enough? A randomised, placebo Controlled                      Trial of Low Dose Iron Supplementation with and without Heme Iron. Eskeland B. Acta                            Obstet Gynecology Scandinavia  1997 Oct 76(9);822‐828.    “Heme iron is absorbed from meat more efficiently than dietary inorganic iron                        and in a different manner. Thus, iron deficiency is less frequent in countries                          where meat constitutes a significant part of the diet.“    Seminars in Hematology 1998 Jan; 35 (1): 27‐34. Absorption of heme iron. Uzel C,                            Conrad ME. USA Cancer Center, University of South Alabama, Mobile 36688, USA.         
  • 13.   IRON THERAPY ­ WITHOUT PROBLEMS    CONCLUSION    The problems in practice with the therapy have mainly to do with tolerance. Getting                            side‐effects in a therapy form will soon ruin it. Iron is however necessary for life and the                                  traditional synthetic iron forms such as Ferrous sulphate, Ferrous fumarate or similar                        will bring serious side‐effects sooner or later.     Using synthetic iron therapy the only remaining alternative is inconvenient, even                      painful, and costly intravenously given iron. ​There are risks with iron injections over a                            longer period of time. Intravenous iron injections cause periods of exacerbation of                        oxidative stress in the circulation and potentially also infections.    Safe and well tolerated ​Heme‐Iron ​does not have these problems. Both efficacy and                          tolerance remain stable over longer time. Administration is the easiest possible: One                        dose per day at any given time, without having to consider other medication, food or                              drink. It also gives for instance chronics freedom to travel.      ADDITIONAL RESOURCES    MediTec Group AB: ​www.MediTec.se    Heme­Iron Informtation: ​www.hemeiron.com    OptiFer® Series Information:​ ​www.optifer.international    Heme­Iron E­Book: ​eBook “Heme Iron, the natural way of iron supplementation”   by Michael Collan    For more information, please contact ​FerroCare@MediTec.SE    Copyright Information   © 2016 MediTec FerroCare Division All Rights Reserved