Kids Smart Vita Gummies Iron Vitamin C 120s

Ferrous fumarate is the iron most Australians take without realising, because it's already in their multivitamin. These are the questions our naturopaths ask in store before you add more.

A good fit if

• An iron study or ferritin test has shown your stores are low and your doctor agrees you should top them up
• Tablet size or taste is what stopped you last time, and a smaller tablet would help you keep going
• You want to check how much iron is already in your multivitamin before adding a separate product
• You'll keep your dose away from tea, coffee, calcium and wholegrain meals, and you've booked a date to review it

Check with us first if

• Constipation, nausea or stomach pain stopped you on another iron. In the largest combined review, fumarate came out worst of the three classic iron salts for side effects.
• You take levothyroxine, tetracycline or quinolone antibiotics, or levodopa. Iron binds to all of these in your gut and makes them work less well, so the doses need to be spaced apart.
• You take a proton pump inhibitor (a reflux medicine). This form needs stomach acid to dissolve, and people on acid-lowering medicine often don't respond well to iron tablets.
• You're pregnant or breastfeeding. Fumarate is the iron in many pregnancy formulas and your needs rise steeply, so let your antenatal team set the dose.
• You have coeliac disease, inflammatory bowel disease or have had stomach or bowel surgery. Your absorption is affected, and the cause of low iron needs looking into.
• You already take a multivitamin or give blood regularly. Check how much iron your multivitamin has first, and because regular donation lowers your stores, it's worth having them monitored.
• You take any prescription medicine. Check with your doctor, pharmacist or our naturopaths first.

• Ferrous fumarate, Schedule 1 item 2201. Best known for: Fitting the most iron into the least powder, so the tablet or chewable can be small. Absorption: It dissolves in stomach acid and releases iron in one go; roughly a third of its weight is iron. Typical use: Multivitamins, pregnancy formulas, children's chewables and a few iron-only capsules.
• Ferrous gluconate, item 2202. Best known for: The form behind most Australian liquid iron tonics. Absorption: It gives the least actual iron of the classic salts, so you need much more of it for each milligram of iron. Typical use: Liquids and sachets. A review of 111 studies found side effects in 30.9 per cent of users, the lowest of the three classic salts.
• Ferrous sulfate, item 2208. Best known for: The standard iron salt, and the one most trials compare against. Absorption: In the middle of the three for actual iron, released all at once. Typical use: Tablets, and the form most of the evidence on how well people tolerate iron comes from.
• Iron bisglycinate and iron amino acid chelate, items 2726, 2727 and 2729. Best known for: The forms Australian labels most often describe as gentler. Absorption: The iron is held by amino acids rather than released free; direct comparisons of comfort against the simple salts are thin. Typical use: Moderate iron doses, and where people often go after stopping a simple salt.

Reference values. The NHMRC recommended iron intakes are set out in full on our iron page. They refer to the iron itself, not this compound. On a fumarate label, look for the iron figure: 200 mg of ferrous fumarate gives you roughly 66 mg of iron.

Typical supplemental range. Products using this form tend to sit at two ends. Multivitamins, women's formulas and children's chewables usually give about 5 mg of iron from it, while single-ingredient capsules go up to 24 mg, the maximum for a listed medicine. Not much sits in between, because fumarate is chosen either to fit into a crowded tablet or to carry a full dose on its own.

Upper level. The NHMRC upper limit is 45 mg a day for adults. A 5 mg multivitamin and a 24 mg capsule are each under it, but they add up, and people often take both without noticing.

Worth knowing. Doses used to correct a diagnosed deficiency are higher than the over-the-counter maximum and should be managed by your doctor. What you need depends on your age, diet and health, so talk to one of our naturopaths.

Food first, where the diet allows it.

• Dark chocolate, 45 to 69 per cent cacao: about 3.4 mg of iron per 28 g
• Sardines, canned in oil with bones: about 2.4 mg per 85 g serve
• Kidney beans, canned: about 2 mg per half cup
• Cashew nuts, roasted: about 2 mg per 28 g

If any of these sound like you, talk to one of our naturopaths or your doctor before you start.

• Children. Never give it without a doctor's direction. Accidental overdose of iron products is a leading cause of fatal poisoning in children under six; an iron overdose can cause death (Better Health Channel). Chewables and gummies with this salt carry extra risk.
• If you think a child has swallowed iron, treat it as an emergency. Call the Poisons Information Centre on 13 11 26 or 000.
• Haemochromatosis, iron-overload conditions or repeated blood transfusions. Don't take it; your body can't get rid of extra iron.
• Treating tiredness yourself without a blood test. Healthdirect advises an iron study is the only reliable test.
• Stomach and bowel complaints were recorded in 47 per cent of people taking ferrous fumarate across 111 studies, the highest rate of the six preparations compared.
• Levothyroxine, tetracycline and quinolone antibiotics, and levodopa. Iron binds to them in the gut and reduces their effect (NIH).
• Proton pump inhibitors. Less stomach acid means the iron dissolves poorly and works less well.
• Tea, coffee, calcium supplements, dairy and wholegrains (phytates). All reduce absorption, so take them at a different time from your iron.
• Pregnancy and breastfeeding. This salt is common in pregnancy formulas, but your dose should come from your antenatal team.
• Coeliac disease, inflammatory bowel disease or stomach or bowel surgery. Absorption can change, so find out the cause first.
• Regular blood donors. Your iron stores run down, so have them monitored.
• Doubling up. Multivitamins and iron-only products both often use this salt, and the amounts add up.
• 45 mg a day or more increases stomach and bowel side effects (NIH); it is also the NHMRC upper limit for adults.
• Severe stomach pain, ongoing vomiting, or black tarry stools with pain. Stop and get medical advice.
• If you take prescription medicines, check with your doctor, pharmacist or our naturopaths before you start.