The chemistry of iron absorption
Iron is an essential mineral vital for producing hemoglobin, a protein in red blood cells that carries oxygen throughout the body. The journey of iron from our food into our bloodstream is a complex process primarily controlled in the small intestine, specifically the duodenum. This process is highly dependent on the iron's chemical form, which can be either ferrous ($Fe^{2+}$) or ferric ($Fe^{3+}$).
Ferrous iron, with a +2 oxidation state, is the more soluble and reactive form at the neutral pH found in the small intestine. This chemical property makes it readily available for transport into the intestinal cells (enterocytes). Ferric iron, with a +3 oxidation state, is less soluble and tends to form insoluble compounds at neutral pH, making it poorly absorbed. For ferric iron to be absorbed, it must first be reduced to the ferrous state.
The mechanism of iron uptake
Our bodies are designed to primarily absorb ferrous iron. The process involves several steps within the enterocytes:
- Reduction of ferric iron: Before it can enter the intestinal cell, any dietary ferric iron ($Fe^{3+}$) must be converted to ferrous iron ($Fe^{2+}$). An enzyme on the surface of the duodenal cells, called duodenal cytochrome b (Dcytb), performs this critical reduction.
- Transport into the cell: The newly reduced ferrous iron ($Fe^{2+}$) is then transported across the cell membrane by a protein called Divalent Metal Transporter 1 (DMT1). This transporter is highly specific for divalent metals, including iron.
- Handling of heme iron: Heme iron, which is predominantly ferrous, is absorbed through a different, though not fully understood, pathway involving the Heme Carrier Protein 1 (HCP1). It is then metabolized within the cell to release ferrous iron.
Heme vs. non-heme iron
Dietary iron is categorized into two main types based on its source and bioavailability:
- Heme iron: Found exclusively in animal products like meat, poultry, and seafood, this form of iron is part of the hemoglobin and myoglobin proteins. Its absorption is highly efficient, ranging from 15% to 35% of intake. Heme iron is absorbed intact and is not significantly affected by most dietary inhibitors.
- Non-heme iron: Present in plant-based foods such as leafy green vegetables, legumes, and fortified cereals, non-heme iron is absorbed much less efficiently than heme iron. Its absorption can be influenced by various dietary factors.
Factors influencing non-heme iron absorption
Since most non-heme iron is in the ferric state, its absorption can be dramatically influenced by what you eat with it. Here are some key enhancers and inhibitors:
Enhancers:
- Vitamin C (Ascorbic Acid): This powerful enhancer helps reduce ferric iron to the more absorbable ferrous state in the stomach. Combining a glass of orange juice with an iron-fortified cereal can significantly boost iron uptake.
- Meat, Fish, and Poultry: Eating animal protein with plant-based iron enhances non-heme iron absorption, an effect often referred to as the "meat factor".
- Acids: Gastric acid in the stomach helps solubilize iron from food. For older adults with reduced stomach acid, this can be a factor in lower absorption rates.
Inhibitors:
- Phytates: Found in whole grains, cereals, nuts, and legumes, phytates can form complexes with non-heme iron, significantly decreasing its absorption.
- Polyphenols: Compounds present in coffee, tea, and red wine can inhibit non-heme iron absorption. It is recommended to drink these beverages between meals rather than with them.
- Calcium: High intake of calcium, whether from dairy products or supplements, can interfere with the absorption of both heme and non-heme iron. It's advisable to take iron and calcium supplements at different times of the day.
Comparison of ferrous and ferric iron
To summarize the key differences in how the body handles these two forms of iron, consider the following comparison table:
| Feature | Ferrous Iron ($Fe^{2+}$) | Ferric Iron ($Fe^{3+}$) |
|---|---|---|
| Oxidation State | +2 | +3 |
| Solubility at Neutral pH | Higher solubility; more bioavailable. | Lower solubility; less bioavailable. |
| Absorption Pathway | Absorbed directly via DMT1 and as part of heme. | Must be reduced to ferrous iron by Dcytb before absorption. |
| Dietary Sources | Found in animal products (heme iron) and certain supplements. | Found in plant-based foods (non-heme iron) and some fortified foods. |
| Influence of Inhibitors | Heme iron absorption is less affected by dietary factors. | Non-heme iron absorption is easily inhibited by phytates, polyphenols, etc.. |
| Common Supplement Forms | Ferrous sulfate, ferrous fumarate, ferrous gluconate. | Ferric citrate, ferric maltol (newer forms). |
Oral iron supplementation: choosing the right form
When it comes to treating iron deficiency anemia, ferrous salts are the standard and most commonly prescribed oral supplements due to their superior bioavailability and efficacy. Ferrous sulfate, for example, is a widely used and inexpensive option. However, oral iron supplements can cause gastrointestinal side effects like nausea and constipation.
Some newer ferric formulations, such as ferric maltol and ferric citrate, have emerged and are sometimes used in specific patient populations, such as those with inflammatory conditions or chronic kidney disease. While some studies show effectiveness, their overall bioavailability is often considered lower than that of conventional ferrous salts. For maximizing absorption from supplements, some studies suggest taking iron supplements on an alternate-day schedule, which can increase overall iron absorption by minimizing the body's hepcidin response.
Conclusion
In the ongoing discussion about iron absorption, the evidence is clear: ferrous iron is significantly better absorbed than ferric iron. This understanding is fundamental to effectively managing dietary iron intake. For most people, this means focusing on obtaining adequate iron from a variety of sources and paying attention to dietary combinations that enhance absorption, such as pairing vitamin C with plant-based iron. While the rise of new supplement formulations offers alternatives for specific needs, ferrous salts remain the gold standard for oral iron supplementation due to their proven bioavailability. By understanding the chemical nature of iron and how our bodies process it, individuals can make informed decisions to optimize their nutrition diet and prevent or treat iron deficiency.