Ora Iron-Rich Tonic+ 300ml

Iron is one of the few things on our shelves where the honest answer starts with a blood test. So here is the triage our naturopaths run before anyone buys a bottle.

A good fit if

• An iron study or ferritin result has shown your stores are low and your doctor agrees you should top them up
• You are vegetarian or vegan, or eat little meat, and have had your iron status checked rather than assumed
• You have heavy periods and a documented low result, and want a maintenance dose between reviews
• A stronger iron product left you constipated or nauseated and you want a lower-dose alternative
• You want to understand elemental iron on a label before comparing products on price

Check with us first if

• Taking levothyroxine. NIH notes simultaneous ingestion can clinically reduce its effect, so timing must be separated.
• Taking a proton pump inhibitor. Reduced stomach acid means people on them often respond poorly to oral iron.
• Taking tetracycline or quinolone antibiotics, or levodopa. iron binds these in the gut and reduces their absorption.
• Pregnant or breastfeeding. Needs rise steeply, but the dose belongs to your antenatal team.
• Coeliac disease, inflammatory bowel disease, or previous gastrointestinal surgery. Absorption is altered and the cause needs investigating.
• Donating blood regularly. Repeat donation depletes stores and warrants monitoring.
• Taking calcium supplements, or tea, coffee or wine with meals. All reduce absorption, so spacing matters.
• Already taking a multivitamin. Check whether it contains iron first.

• Ferrous sulfate. Best known for: The cheapest iron salt and the comparator used in most published trials. Absorption: 20 per cent elemental iron by weight, so 100 mg of the salt supplies about 20 mg of iron. Typical use: Tablets. Also the form the gastrointestinal side-effect evidence was built on, and the one people most often abandon.
• Ferrous fumarate. Best known for: The highest elemental yield of the common salts, so fewer milligrams of compound are needed. Absorption: 33 per cent elemental iron by weight. Typical use: Tablets and combination products, where tablet size matters.
• Ferrous gluconate. Best known for: Low elemental dose per unit of compound, which is why it appears in liquids. Absorption: 12 per cent elemental iron by weight. The lowest yield of the three classic salts. Typical use: Liquid iron tonics and lower-strength tablets, often taken in divided doses.
• Iron amino acid chelate. Best known for: The wording most often printed on Australian labels, where elemental iron is declared separately. Absorption: The Determination caps iron in the chelate at 25 per cent, so compound weight is several times the iron weight. Typical use: Modest elemental doses; presented as gentler, though head-to-head tolerability evidence is limited.
• Iron bisglycinate (ferrous bisglycinate). Best known for: A specific glycine chelate, listed in Schedule 1 in its own right rather than as generic chelate. Absorption: Two glycine molecules are proposed to shield the iron from inhibitors such as phytate; comparative human evidence is thinner than the marketing suggests. Typical use: Lower elemental doses, and the form most often chosen after a stronger salt was not tolerated.
• Iron polymaltose. Best known for: A non-ionic iron–carbohydrate complex rather than a simple salt, familiar from pharmacy brands. Absorption: Iron is held inside a polymaltose shell, so less free iron is released in the gut. Typical use: Not available in Australian listed complementary medicines. Absent from Schedule 1, so products containing it hold their own ARTG registrations.

Reference values. NHMRC Nutrient Reference Values set the iron RDI at 8 mg a day for adult men of every age band, 18 mg a day for women aged 19–50 and 8 mg a day for women 51 and over. Pregnancy is 27 mg a day, lactation 9–10 mg. Younger ages: 9 mg (1–3 years), 10 mg (4–8), 8 mg (9–13), 11 mg for boys 14–18 and 15 mg for girls 14–18. Infant Adequate Intake is 0.2 mg a day to six months and 11 mg from seven to twelve months.

Typical supplemental range. Australian over-the-counter products sit inside the 24 mg ceiling, and most single-ingredient tablets supply 5 mg to 24 mg of elemental iron; liquid tonics are lower again per dose. Compare the elemental iron figure, never the milligrams of the compound. 24 mg of iron and a 24 mg tablet of an iron salt are not the same thing.

Upper level. The NHMRC Upper Level of Intake is 45 mg a day for adults, and much lower for children: Better Health Channel states that for children "20 mg per day is the safe upper limit", while noting "most iron supplements contain around 100 mg per tablet". Which is why iron is a leading cause of accidental paediatric poisoning.

Worth knowing. Doses used to correct a diagnosed deficiency sit above the over-the-counter ceiling and belong to a treating doctor. The number that decides whether any of this is relevant to you is a ferritin result, not a milligram figure. Your needs depend on your age, diet and health circumstances. Talk to one of our naturopaths.

Food first, where the diet allows it.

• Oysters, cooked: about 8 mg per 85 g serve: haem iron, the most readily absorbed
• Beef liver: about 5 mg per 85 g serve
• White beans, canned: about 8 mg per cup: non-haem, so pair with a vitamin C source
• Lentils, boiled: about 3 mg per half cup
• Tofu, firm: about 3 mg per half cup
• Broccoli: cooking changes the maths: about 6 per cent of the iron is absorbed from raw broccoli, against 30 per cent from cooked

This list is the part of the page we will not shorten. If any of it applies to you, talk to one of our naturopaths or your doctor before starting.

• Haemochromatosis and iron-overload conditions. Avoid; surplus iron cannot be excreted.
• Repeated blood transfusions. Avoid unless a specialist directs it.
• Children. Never without a doctor's direction; an overdose can cause death (Better Health Channel).
• Suspected iron ingestion by a child. Emergency; Poisons Information Centre 13 11 26.
• Self-treating tiredness without a blood test. Healthdirect: an iron study is the only reliable test.
• Levothyroxine. Simultaneous ingestion can clinically reduce its efficacy (NIH).
• Proton pump inhibitors. Less gastric acid, lower absorption, blunted response.
• Tetracycline and quinolone antibiotics, and levodopa. iron binds them in the gut.
• Calcium supplements, tea, coffee, wine and wholegrain phytates. All reduce absorption.
• Pregnancy and breastfeeding. The dose belongs to the antenatal team.
• Coeliac disease, inflammatory bowel disease, gastrointestinal surgery. Altered absorption; investigate the cause.
• Regular blood donors. Stores deplete; monitor them.
• Constipation, nausea, vomiting, diarrhoea and dark stools are common effects (Better Health Channel).
• 45 mg a day or more raises gastrointestinal effects (NIH); it is also the NHMRC adult Upper Level.
• If you take prescription medicines, check with your doctor, pharmacist or our naturopaths before starting.