Iron deficiency is common and can be debilitating. It mainly affects women. One in three premenopausal women are low in iron compared to just 5% of Australian men. Iron deficiency particularly affects teenage girls, women who do a lot of exercise and those who are pregnant.

The body needs iron to make new red blood cells, and to support energy production, the immune system and cognitive function. If you’re low, you may experience a range of symptoms including fatigue, weakness, shortness of breath, headache, irregular heartbeat and reduced concentration.

If a blood test shows you’re iron deficient, your doctor may recommend you start taking an oral iron supplement. But should you take a tablet or a liquid? With food or not? And when is the best time of day?

Here are some tips to help you work out how, when and what iron supplement to take.

How do I pick the right iron supplement?

The iron in your body is called “elemental iron”. Choosing the right oral supplement and dose will depend on how much elemental iron it has – your doctor will advise exactly how much you need.

The sweet spot is between 60-120 mg of elemental iron. Any less and the supplement won’t be effective in topping up your iron levels. Any higher and you risk gastrointestinal symptoms such as diarrhoea, cramping and stomach pain.

In Australia, iron salts are the most common oral supplements because they are cheap, effective and come in different delivery methods (tablets, capsules, liquid formulas). The iron salts you are most likely to find in your local chemist are ferrous sulfate (~20% elemental iron), ferrous gluconate (~12%) and ferrous fumarate (~33%).

These formulations all work similarly, so your choice should come down to dose and cost.

Many multivitamins may look like an iron supplement, but it’s important to note they usually have too little iron – usually less than 20 mg – to correct an iron deficiency.

Should I take tablets or liquid formulas?

Iron contained within a tablet is just as well absorbed as iron found in a liquid supplement. Choosing the right one usually comes down to personal preference.

The main difference is that liquid formulas tend to contain less iron than tablets. That means you might need to take more of the product to get the right dose, so using a liquid supplement could work out to be more expensive in the long term.

What should I eat with my iron supplement?

Research has shown you will absorb more of the iron in your supplement if you take it on an empty stomach. But this can cause more gastrointestinal issues, so might not be practical for everyone.

If you do take your supplement with meals, it’s important to think about what types of food will boost – rather than limit – iron absorption. For example, taking the supplement alongside vitamin C improves your body’s ability to absorb it.

Some supplements already contain vitamin C. Otherwise you could take the supplement along with a glass of orange juice, or other vitamin C-rich foods.

On the other hand, tea, coffee and calcium all decrease the body’s ability to absorb iron. So you should try to limit these close to the time you take your supplement.

Should I take my supplement in the morning or evening?

The best time of day to take your supplement is in the morning. The body can absorb significantly more iron earlier in the day, when concentrations of hepcidin (the main hormone that regulates iron) are at their lowest.

Exercise also affects the hormone that regulates iron. That means taking your iron supplement after exercising can limit your ability to absorb it. Taking your supplement in the hours following exercise will mean significantly poorer absorption, especially if you take it between two and five hours after you stop.

Our research has shown if you exercise every day, the best time to take your supplement is in the morning before training, or immediately after (within 30 minutes).

My supplements are upsetting my stomach. What should I do?

If you experience gastrointestinal side effects such as diarrhoea or cramps when you take iron supplements, you may want to consider taking your supplement every second day, rather than daily.

Taking a supplement every day is still the fastest way to restore your iron levels. But a recent study has shown taking the same total dose can be just as effective when it’s taken on alternate days. For example, taking a supplement every day for three months works as well as every second day for six months. This results in fewer side effects.

Oral iron supplements can be a cheap and easy way to correct an iron deficiency. But ensuring you are taking the right product, under the right conditions, is crucial for their success.

It’s also important to check your iron levels prior to commencing iron supplementation and do so only under medical advice. In large amounts, iron can be toxic, so you don’t want to be consuming additional iron if your body doesn’t need it.

If you think you may be low on iron, talk to your GP to find out your best options.

Alannah McKay, Postdoctoral Research Fellow, Sports Nutrition, Australian Catholic University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Back pain is common. One in thirteen people have it right now and worldwide a staggering 619 million people will have it this year.

Chronic pain, of which back pain is the most common, is the world’s most disabling health problem. Its economic impact dwarfs other health conditions.

If you get back pain, how long will it take to go away? We scoured the scientific literature to find out. We found data on almost 20,000 people, from 95 different studies and split them into three groups:

• acute – those with back pain that started less than six weeks ago
• subacute – where it started between six and 12 weeks ago
• chronic – where it started between three months and one year ago.

We found 70%–95% of people with acute back pain were likely to recover within six months. This dropped to 40%–70% for subacute back pain and to 12%–16% for chronic back pain.

Clinical guidelines point to graded return to activity and pain education under the guidance of a health professional as the best ways to promote recovery. Yet these effective interventions are underfunded and hard to access.

More pain doesn’t mean a more serious injury

Most acute back pain episodes are not caused by serious injury or disease.

There are rare exceptions, which is why it’s wise to see your doctor or physio, who can check for signs and symptoms that warrant further investigation. But unless you have been in a significant accident or sustained a large blow, you are unlikely to have caused much damage to your spine.

Even very minor back injuries can be brutally painful. This is, in part, because of how we are made. If you think of your spinal cord as a very precious asset (which it is), worthy of great protection (which it is), a bit like the crown jewels, then what would be the best way to keep it safe? Lots of protection and a highly sensitive alarm system.

The spinal cord is protected by strong bones, thick ligaments, powerful muscles and a highly effective alarm system (your nervous system). This alarm system can trigger pain that is so unpleasant that you cannot possibly think of, let alone do, anything other than seek care or avoid movement.

The messy truth is that when pain persists, the pain system becomes more sensitive, so a widening array of things contribute to pain. This pain system hypersensitivity is a result of neuroplasticity – your nervous system is becoming better at making pain.

Reduce your chance of lasting pain

Whether or not your pain resolves is not determined by the extent of injury to your back. We don’t know all the factors involved, but we do know there are things that you can do to reduce chronic back pain:

• understand how pain really works. This will involve intentionally learning about modern pain science and care. It will be difficult but rewarding. It will help you work out what you can do to change your pain
• reduce your pain system sensitivity. With guidance, patience and persistence, you can learn how to gradually retrain your pain system back towards normal.

How to reduce your pain sensitivity and learn about pain

Learning about “how pain works” provides the most sustainable improvements in chronic back pain. Programs that combine pain education with graded brain and body exercises (gradual increases in movement) can reduce pain system sensitivity and help you return to the life you want.

These programs have been in development for years, but high-quality clinical trials are now emerging and it’s good news: they show most people with chronic back pain improve and many completely recover.

But most clinicians aren’t equipped to deliver these effective programs – good pain education is not taught in most medical and health training degrees. Many patients still receive ineffective and often risky and expensive treatments, or keep seeking temporary pain relief, hoping for a cure.

When health professionals don’t have adequate pain education training, they can deliver bad pain education, which leaves patients feeling like they’ve just been told it’s all in their head.

Community-driven not-for-profit organisations such as Pain Revolution are training health professionals to be good pain educators and raising awareness among the general public about the modern science of pain and the best treatments. Pain Revolution has partnered with dozens of health services and community agencies to train more than 80 local pain educators and supported them to bring greater understanding and improved care to their colleagues and community.

But a broader system-wide approach, with government, industry and philanthropic support, is needed to expand these programs and fund good pain education. To solve the massive problem of chronic back pain, effective interventions need to be part of standard care, not as a last resort after years of increasing pain, suffering and disability.

Sarah Wallwork, Post-doctoral Researcher, University of South Australia and Lorimer Moseley, Professor of Clinical Neurosciences and Foundation Chair in Physiotherapy, University of South Australia

This article is republished from The Conversation under a Creative Commons license. Read the original article.