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Intended for Healthcare Professionals INTRODUCTION The purpose of this paper is to inform women, healthcare professionals and birth workers of the importance of iron during pregnancy, treatment failure with traditional iron supplementation and why low dose iron during pregnancy could become the best preventative measure to avoid lapsed usage. It provides quotes, data driven information and offers solutions that enable healthcare professionals and women to take ownership of their health throughout pregnancy and beyond. BACKGROUND In general, iron deficiency anaemia (IDA) is more likely in women of reproductive age because of menstrual blood loss. The challenges of pregnancy also markedly increases the risk of iron deficiency in this cohort.¹ Anaemia is the most common nutritional disorder in pregnancy.² An iron-deficient diet in pregnancy is common and may compound the problem.³ There is a 2-3 fold increase in requirement of iron and 10-20 fold increase in folate requirement in pregnancy. The WHO Global health repository data describes largely unchanged rates of anaemia in pregnancy over time with rates of 41% in 2000 dropping to only 37% in 2019.⁴ In the UK, the prevalence of anaemia was found to be 24% in a multicentre national study.⁵ Anaemia in pregnancy has been associated with increased maternal mortality and postpartum haemorrhage risk globally. The signs and symptoms are often non-specific with tiredness being the most common. Women may also experience weakness, headaches, palpitations, dizziness, dyspnoea and hair loss. Postpartum anaemia has been linked to fatigue, impaired cognition, lactation failure, early cessation of breastfeeding and there is a growing body of evidence linking postpartum anaemia with depression.⁶ For the infant, maternal IDA is a recognised risk factor for preterm labour, low birthweight, and small-for-gestational-age (SGA) neonates. It is also associated with increased perinatal and neonatal mortality as well as long-term measurable deficits in neurodevelopment.⁷ RECOMMENDATIONS Current recommendations for iron intake and screening: Iron intake recommendations vary between organisations: CDC Recommend 27mg Iron daily in pregnancy ⁸ WHO Recommend 30-60 mg⁹ Achieving 60mg of iron intake through diet alone can be particularly difficult, especially for mums experiencing food aversions. Pregnant women should be offered screening for anaemia. In line with the National Institute for Health and Care Excellence (NICE) screening for anaemia should be offered at booking and at 28 weeks, with an additional full blood count at 20–24 weeks for women with multiple pregnancies. This allows enough time for treatment prior to birth if anaemia is detected. Pregnancy anaemia can be asymptomatic and may be diagnosed following routine screening. A serum ferritin level may also support clinicians to identify those mothers more at risk of developing IDA, enabling earlier intervention and advice regarding options for low dose oral iron.  TREATMENT Oral iron is often the preferred first-line treatment for iron deficiency. It is currently recommended to take 100-200mg of elemental iron / day. Parenteral iron is indicated when oral iron is not tolerated or absorbed, if patient compliance is in doubt or if the woman is approaching term and there is insufficient time for oral supplementation to be effective.¹⁰ Treatment with IV iron requires admission, poses risk and is costly and invasive. The common side effects of iron supplementation, such as stomach pain, nausea, constipation and dark or black poo, have become normalised, even in maternity settings. However these side effects are far from desirable or even tolerable for mums to put up with. Therefore, it is important to consider other options and preventative measures to ensure mothers do not become anaemic and need to endure such side effects or invasive treatment. In the UK, the prevalence of anaemia was found to be 24% in a multicentre national study.⁵ Preventative supplementation and early intervention encourages maintenance of iron levels throughout pregnancy and may avoid progression to IDA. Lapsed usage is the most common reason for treatment with IV iron. Up to 50% of patients are thought to discontinue iron supplements because of adverse effects.¹¹ Pregnancy is already associated with many unpleasant symptoms including nausea or vomiting, stomach discomfort or heartburn and constipation. Women regularly require support and or medication to manage symptoms of pregnancy, and the side effects of iron supplementation may compound these already unpleasant symptoms. An expectation of mothers to take medication as prescribed, whilst they contend with such discomfort, may not be realistic, achievable or fair for mums. One study confirmed that pregnant women were more likely to report side effects when taking daily iron supplements than controls (25.3% versus 9.9%), particularly at doses of 60mg or more of elemental iron.¹³  The treatment dosage of oral iron is increased depending on the severity of anaemia. Leading to a separate challenge, the more anaemic a woman becomes, the more treatment she will require but is possibly unable to withstand. The higher and more frequent the dose the more likely it is that she will experience symptoms, as adverse effects are dose dependent.¹⁴ Because iron absorption from oral supplements tends to be low, higher doses increase side effects due to excess iron remaining in the GI tract.¹⁵ This leads to a vicious stop-start cycle, and ultimately treatment failure.  A systematic review comparing intermittent versus daily iron supplementation showed that intermittent supplementation produced a similar risk of anaemia at term, prematurity and low birthweight babies, but was associated with fewer side effects.¹⁶  PROPOSED SOLUTION Early intervention through preventative measures could be instrumental in avoiding treatment failure. IDA is progressive and can be prevented. And so early intervention with lower dose iron may reduce lapsed usage, discomfort for women and aids in avoiding more invasive treatment. Active Iron is highly absorbed compared to other iron supplements,¹⁷ making it gentle on the stomach. Recent clinical data shows that patients taking Active Iron were 4 times more likely to be compliant versus previous oral iron.¹⁸ It is clinically proven to increase ferritin levels by 94% within 6 weeks, and significantly increases energy levels.¹⁸ Checking serum ferritin may help to identify those more at risk and allow for earlier intervention. Currently, UK guidelines do not recommend iron supplementation during pregnancy, unless clinically advised.¹⁹ Conversations with mums about their iron intake alongside preventive measures in the form of early intervention with low dose iron should be considered. CONCLUSION Preventative supplementation and early intervention encourages maintenance of iron levels throughout pregnancy and may avoid progression to IDA and the need for unpleasant high dose oral iron or costly IV iron. Use of low dose iron may also preclude the risk of pregnant mothers experiencing a range of unpleasant symptoms. When women experience healthier pregnancies, there are better outcomes for both mothers and babies. This paper was written with the hope that healthcare professionals can use it to provide consistent and high-quality care, whilst taking into consideration each family’s individual situation and needs, in order to reduce the impacts of anaemia during pregnancy and the postnatal period to support families in this new phase.  REFERENCES Coad et al. Curr Opin Clin Nutr Metab Care. 2011 Nov;14(6):625-34. doi: 10.1097/MCO.0b013e32834be6fd. PMID: 21934611. Zhang et al. 2022 Oct 14;10:1041136. doi: 10.3389/fpubh.2022.1041136. PMID: 36311562; PMCID: PMC9615144.https://cks.nice.org.uk/topics/menorrhagiaheavy-menstrual-bleeding/background-information/definition Rooney et al. Arch Gynecol Obstet. 2023. doi:10.1007/s00404-023-06916-x Hasan et al. Bull World Health Organ. 2022; 100(3): 196-204. Barroso et al. Eur J Obstet Gynecol Reprod Biol. 2011;159(1):99–105. Xu et al. BMC Psychiatry 18, 224 (2018). https://doi.org/10.1186/s12888-018-1796-6 O Toole et al. 2023. Screening and treatment of iron deficiency anaemia in pregnancy: A review and appraisal of current international guidelines https://doi.org/10.1002/ijgo.15270 https://www.cdc.gov/grand-rounds/pp/2019/20190618-early-childhoodnutrition.pdf WHO. Developing and validating an iron and folic acid supplementation indicator for tracking progress towards global nutrition monitoring framework targets. Final report - June 2018. Geneva: World Health Organization; 2018 (https://www.who.int/nutrition/publications/iron-folic-indicator-GNMF/en/). Blood Transfusion in Obstetrics Green-top Guideline No. 47 May 2015 Tolkien Z, et al. PLOS ONE 2015. https://www.nhs.uk/medicines/ferrous-fumarate/side-effects-of-ferrousfumarate/ Pena-Rosas et al. Cochrane Database Syst Rev 2012, 7:CD009997. Doi:10.1002/14651858. Pavord et al. Br J Haematol 2020; 188:819–830. Stoffel NU et al. Haematol 2020; 105:1232–1239. Pena-Rosas et al. 2012. Cochrane Database Syst Rev 2012;(7):CD009997. Wang et al. 2017, Acta Haematologica, 138: 223-232. Ledwidge, M. et al. PRECISION Study. Int J Clin Pharm (2023) https://doi. org/10.1007/s11096-023-01640-7 UK guidelines on the management of iron deficiency in pregnancy. Sue Pavord,Jan Daru, Nita Prasannan, Susan Robinson, Simon Stanworth, Joanna Girling, on behalf of the BSH Committee First published: 02 October 2019 https://doi.org/10.1111/bjh.16221 Citations: 139

Intended for Healthcare Professionals INTRODUCTION Iron is a major component of haemoglobin, a type of protein in red blood cells that carries oxygen from your lungs to all parts of your body. Without sufficient iron, there are not enough red blood cells to transport oxygen, leading to low energy and fatigue. Iron has further functions, including cognitive development, as well as supporting immune function.  BACKGROUND Good iron levels and stores are critical for athletes, due to the key role iron plays in the production of myoglobin, a protein that carries and stores oxygen specifically in muscle tissue. Thus, low levels or a depletion will have a significant negative impact on performance. Iron deficiency is a common phenomenon in athletes, particularly those involved in endurance sports. It has been reported to impact up to 11% of male athletes and up to 35%  of female athletes.¹ But why is this the case? In the first instance, athletes have higher requirements of iron due to the increase in production of erythropoietin (EPO). This increased production of EPO is an advantageous training adaptation, optimising performance. This is also the key reason many endurance athletes aim to spend some time at high altitude, ahead of big races, as this accelerates this process. Furthermore, iron losses are exaggerated in athletes due to high training loads that result in haemolysis (that is the breakdown of red blood cells), sweating and potential  gastro-intestinal bleeding, especially during periods of high intensity training. In addition, after endurance exercise,  as part of an acute inflammatory response, there is an up regulation of an iron regulating hormone, hepcidin which reduces overall iron absorption.² Female athletes are at further risk of low iron due to monthly menstrual losses. Monthly periods are the most common cause of iron loss, with women of childbearing age needing almost two times more daily iron than men³. While this varies from female to female, most women will lose 20-90 ml of blood during their period. Those who have heavy periods, can have losses in excess of 160ml during their monthly cycle.⁴ It has been reported that 1 in 3 women suffer with heavy menstrual bleeding. ⁵ In more recent years, the awareness around low energy availability (LEA) has also increased. Especially in athletes, LEA results in a reduced energy intake which restricts iron intakes but also, compromises iron absorption and red blood cell production. While all athletes can be at risk of LEA, there is still a much higher prevalence of it in female athletes, which puts them at higher risk of all nutrient deficiencies, including iron deficiency anaemia (IDA). Nutrient deficiencies leave them more vulnerable to injuries such as bone stresses. Iron deficiency affects athletes’ physical performance.  While aerobic metabolism is directly impacted by low iron levels, it has a multifaceted impact. Iron deficiency is associated with⁶: Reduced overall capacity for strength Poor coordination  Reduction in power and speed Depressed immune system Increased fatigue Low mood Overall reduced recovery Iron deficiency is one of the most common nutrient deficiencies in sport⁷and although widely studied in endurance sports, it remains a concern across all sports. However, those in weight category/dependent sport, such as climbing, lightweight rowing, or aesthetic sports, such as ballet and rhythmic gymnastics, may also be at increased risk due to higher prevalence of LEA associated with these sports. WHAT DEFINES DEFICIENCY? The RNI for dietary iron in the UK and Ireland is 14.8mg of  iron per day, with the RDA in the US set at 18mg a day.  Whilst additional iron intakes are recommended for pregnancy and lactation, to date, there are no actual additional recommendations for female athletes. However, studies on female runners repeatedly show a need for an additional 10mg of iron a day due to training losses and adaptation.⁸ This is an increase of approximately 70%. Iron deficiency can occur with or without anaemia. The WHO defines iron deficiency without anaemia when ferritin levels  are low (<30 mg/L) but haemoglobin levels are normal  (above 120g/L in women, and 130g/L in men). Iron deficiency with anaemia occurs when both ferritin and haemoglobin  levels are low. In sport, we tend to define iron deficiency without anaemia when ferritin levels are <50mg/L, and haemoglobin labels are > 130g/L for women and >140g/L for males⁹. Iron deficiency with anaemia is defined when haemoglobin levels are lower than the recommended values. PROPOSED SOLUTION FOOD FIRST In order to prevent iron deficiency in the first instance, education to athletes about their increased requirements is necessary as well as information on the most appropriate dietary sources. The best sources of iron are animal sources, such as red meat, poultry, and fish, but many female athletes have reduced their consumption of foods such as red meat for other health reasons. Plant based sources of iron include pulses and legumes, dark green leafy vegetables, nuts and seeds, and foods fortified with iron such as cereal and bread, except wholemeal. In general, iron from plant-based options is much more difficult to absorb, so plant-based athletes may need to pay particular attention to their iron intakes. Additionally, some foods can inhibit iron absorption including foods containing phytates (wholegrains/cereal) and tannins (tea and coffee). Calcium-rich foods (dairy products like milk, cheese, and yogurt) can also interfere with iron absorption, so it is advisable to avoid consuming these foods alongside iron rich foods to maximise absorption. Absorption of iron can also be improved by consuming iron rich foods with a source of Vitamin C (citrus fruits and juices, peppers, strawberries, tomatoes) or an animal protein. For example, beans on toast with a glass of orange juice will help to maximise iron absorption from both the beans and wholegrain bread. Aim to consume tea or coffee either an hour before or after iron rich meals. SUPPLEMENTATION Supplementation is also a key consideration in both male and female athletes. However, supplementation with traditional oral iron supplements has its challenges. Unfortunately, most oral iron supplements are poorly absorbed in the gut. This often leads to gastrointestinal distress such as constipation, bloating, and nausea. Some studies have shown that compliance with supplementation can be poor. It is estimated that 8/10 people who take iron supplements report side effects¹⁰, with 50% stopping taking their supplements entirely.¹¹ There have been some alternative formulations developed in recent years that aim to increase iron levels without the negative side effects often associated with oral iron. One such solution that I recommend to athletes is Active Iron, as it is highly absorbed compared to standard ferrous sulfate,¹² making it gentle on the stomach. Recent clinical data shows that those taking Active Iron were 4 times more likely to be compliant versus previous oral iron.¹³ It is clinically proven to increase ferritin levels by 94% within 6 weeks, and significantly increases resulting energy levels.¹³ Active Iron also work with Informed Sport to ensure that their products are certified to be free from any banned substances, providing reassurance to athletes and exercisers that they can trust Active Iron to support their training without any risk of failing a drug test. When supplementing with iron, it is recommended that repeat blood tests should occur 6-8 weeks from starting to monitor outcome and also control the dose. Some data suggests that there is little performance benefit of taking an iron supplement if iron deficiency is not indicated. It has been proven however that the most pronounced effects on iron status by supplementation occur in athletes with low ferritin levels. If athletes are training at altitude, iron supplementation can be of benefit regardless of ferritin stores. CONCLUSION Good iron levels and stores are critical for all athletes, especially in endurance sports and particularly amongst females. Low iron levels can have a significant negative impact on performance. While there is no set protocol for optimising female athletes iron status, it is clear that supplementation is indicated when ferritin levels are low. High dose oral iron can cause gastrointestinal distress in some people. Use of low dose iron may preclude the risk of athletes experiencing a range of unpleasant symptoms, and the resulting lapsed usage. This paper was written with the hope that healthcare professionals can use it to provide consistent and high-quality advice to female athletes on the importance of optimised iron levels for better performance. REFERENCES  Sims. S. et al; High Prevalence of Iron Deficiency Exhibited in Internationally Competitive, Non-Professional Female Endurance Athletes—A Case Study Int J Environ Res Public Health; 2022 Enrico Rossi. Hepcidin - the Iron Regulatory Hormone.  Clin Biochem Rev; 2005 https://www.nhs.uk/conditions/vitamins-and-minerals/iron/ Heavy Periods: Overview Informedhealth,org; 2017  Heavy periods. WOMEN’S HEALTH CONCERN FACT SHEET; 2022.  www.womens-health-concern.org Damian et al. Anemia in Sports: A Narrative Review. Life 2021. Pedlar et al. Iron balance and iron supplementation for the female athlete:  A practical approach. European Journal of Sport Science; 2018 Alunyte. L et al; Iron and the female athlete: a review of dietary treatment methods for improving iron status and exercise performance JISSEN; 2015 https://www.ais.gov.au/__data/assets/pdf_file/0014/1000490/Sportsupplement-fact-sheets-Iron-v4.pdf Pereira et al. A rapid, simple questionnaire to assess gastrointestinal symptoms after oral ferrous sulphate supplementation.  BMC Gastroenterol; 2014 Tolkien et al. Ferrous Sulfate Supplementation Causes Significant Gastrointestinal Side-Effects in Adults: A Systematic Review and  Meta-Analysis. PLoS ONE; 2015 Wang et al. Novel Iron-Whey Protein Microspheres Protect Gut Epithelial Cells from Iron-Related Oxidative Stress and Damage and Improve Iron Absorption in Fasting Adults. Acta Haematologica, 138: 223-232; 2017 Ledwidge, M. et al. Management of iron deficiency in women of childbearing age with oral iron intolerance: a prospective, randomised, controlled trial of three doses of an iron-whey-protein formulation. Int J Clin Pharm; 2023 

Intended for Healthcare Professionals Introduction Heavy menstrual bleeding during the menopause transition is a leading cause of low iron in women across the developed and developing world.¹ According to the World Health Organisation (WHO), almost 30% of women of reproductive age – equivalent to over half a billion women aged 15-49 years – are anaemic.² The goal of this white paper is to highlight common symptoms linked with low iron levels, the impact it has on women’s health and wellbeing, particularly during perimenopause, and recommendations for minimising the associated health outcomes.Iron deficiency has a variety of consequences and can cause: Tiredness, chronic fatigue and lack of energy Dizziness Difficulty concentrating Being prone to illness. ³ A 2024 survey by Active Iron demonstrates the physical, emotional and societal impact of heavy periods and resulting low iron, with 74% of the 1500 women surveyed reporting exhaustion or tiredness.⁴ Low iron puts all organ systems under stress as they work harder to respond and make up for the deficit. The effects of low iron on quality of life during the menopause transition and beyond are increasingly apparent. In current clinical care, more recognition of these features is needed so healthcare providers and patients can be informed and motivated to act on iron levels as early as possible. Promoting optimal levels of iron in women has far reaching benefits for health, day to day performance and overall wellbeing. Background Menopause is a retrospective diagnosis. Natural (non-surgical and non-chemical) menopause is defined as no menstrual bleeding for one full year. This occurs when ovaries have no remaining follicles and a woman’s primary source of oestrogen production is gone.⁵ Perimenopause includes both the transition to menopause and the first year following a woman’s final menstrual period. The menopause transition is a time of hormonal fluctuations that can result in irregular menstrual periods and a myriad of physiological and psychological symptoms. The average age of menopause in the UK and Ireland is 51 years old, though this can be 4-6 years earlier in some ethnicities.⁶ The length of time from the transition to the final menstrual period varies greatly, sometimes lasting over 10 years. Menopause is not something that only affects older women, we need to be mindful of early menopause (which affects women under the age of 45) and POI too (Primary Ovarian Insufficiency, where a woman’s ovaries stop working normally under the age of 40). No matter when it occurs, it’s often at a time when women are juggling demanding jobs, school age children and elderly parents. Every woman experiences the menopause transition differently, with up to 80% of women undergoing physical and/or emotional symptoms. These symptoms vary greatly and include hot flushes and sweats, tiredness and sleep disturbance, joint and muscle aches, heart palpitations, mood swings, anxiety and depression, forgetfulness, lack of concentration, genitourinary conditions, dyspareunia, low libido and increased urinary frequency or urgency.⁷ Symptoms can have a significant impact on health and wellbeing, personal and social relationships, as well as work and careers. According to Active Iron’s survey, 64% of women reported changes in mood as the most common symptom of perimenopause, with tiredness and fatigue being the second most common (63%). In addition, 44% of women find their methods to manage fatigue ineffective, with 80% reporting feeling tired all the time.⁴ There are a number of ways that hormonal changes during perimenopause can influence iron regulation: Menorrhagia Menorrhagia or heavy periods is a common side effect of fluctuating levels of hormones - often due to unopposed oestrogen building up in the uterine lining - and frequently coexists alongside anovulatory cycles and irregular menstrual bleeding. Prolonged or heavy bleeding (flooding) can lead to iron loss, potentially resulting in low iron over time.⁸ Decreased iron absorption Oestrogen plays a role in promoting the absorption of iron in the intestines. As oestrogen levels decline during perimenopause, the body may become less efficient at absorbing iron from the diet.⁹ This can lead to reduced iron levels in the body, increasing the risk of iron deficiency. Reduced iron storage Oestrogen influences the production of ferritin, which stores iron in tissues. Declining oestrogen levels can lower ferritin levels, reducing the body’s iron reserves.⁹ This in addition to insufficient dietary intake of iron to compensate, can contribute to reduced overall iron levels. Reduced thyroid function Thyroid hormones are essential for regulating iron utilisation. If thyroid function is disrupted during perimenopause, it can affect the body’s ability to metabolise and absorb iron efficiently, potentially leading to iron deficiency.¹⁰ CONSEQUENCES OF LOW IRON Along with low energy and fatigue, the consequences of low iron levels can extend to dizziness, difficulty concentrating and an increased risk of reduced immune function.³ It’s not hard to see how these symptoms might impact a women’s quality of life, making daily activities such as work, relationships and exercise increasingly difficult. Iron deficiency may also exacerbate a number of perimenopause symptoms, including fatigue and cognitive changes. An added complication to identifying iron deficiency during perimenopause is that symptoms often overlap those attributed to hormonal changes. PROPOSED SOLUTION Talking with a healthcare provider is a likely first step in managing low iron caused by heavy periods, however, a societal aversion to discussing menstruation means many women report not feeling comfortable doing so. 48% of women surveyed said they’d rather talk to friends and family than a medical professional, and 1 in 4 had never sought support or advice for the symptoms of their heavy periods.⁴ For those who do take action, supplementation is a key consideration. However, traditional iron supplements have their challenges and are often shunned or short-lived due to the long list of side effects, such as nausea, constipation and gastro intestinal discomfort. This may cause people to be poorly compliant with the treatment, thus reducing the likelihood of improving iron stores. There have been some alternative formulations developed in recent years that aim to increase iron levels without the negative side effects often associated with oral iron. One such solution is Active Iron, as it is clinically proven to increase iron levels by 94% while avoiding troublesome side effects such as nausea and constipation.¹¹ Active Iron is also clinically proven to increase energy levels and can be used as a tool to support menstrual fatigue.¹¹ The clinical studies completed by Active Iron target women with an unmet need for iron; the latest study was carried out in women of childbearing age with periods (including perimenopausal women).¹¹ Conclusion Iron deficiency anaemia is a common clinical presentation with a prevalence in women, but often goes undetected. There is a strong association between heavy periods and low iron in perimenopausal women. Unfortunately, there doesn’t seem to be enough awareness that iron deficiency can be a problem in women in this demographic, as symptoms can be non specific in nature and often overlap or mimic those of perimenopause itself. Greater awareness of heavy menstrual bleeding and its relationship with low iron is needed in this population, as well as tighter diagnostic and management guidelines. Supplementation with products carefully formulated to support the needs of women, such as Active Iron, can be a valuable tool in helping to avoid low iron in women with periods in this lifestage. Active Iron is clinically proven to be effective in increasing iron and energy levels with minimal gastrointestinal side effects¹¹, allowing women a better quality of life, workplace performance, and physical, social and cognitive function. References Palacios S. The management of iron deficiency in menometrorrhagia. Gynecol Endocrinol. 2011; 27(Suppl 1): 1126-1130. https://www.who.int/data/gho/data/themes/topics/anaemia_in_women_and_ children NHS: Iron deficiency anaemia https://www.nhs.uk/conditions/iron-deficiencyanaemia/ Active Iron Survey 2024. n =1500 women. Data on File. BRITISH MENOPAUSE SOCIETY Tool for clinicians. https://thebms.org. uk/wp-content/uploads/2023/08/17-BMS-TfC-What-is-the-menopauseAUGUST2023-A.pdf https://www.swanstudy.org/ NHS inform: Signs and symptoms of menopause. https://www.nhsinform. scot/healthy-living/womens-health/later-years-around-50-years-and-over/ menopause-and-post-menopause-health/signs-and-symptoms-of-menopause/ Petraglia et al. Iron deficiency anemia: Impact on women’s reproductive health. Fertil Steril. 2022; DOI: 10.1016/j.fertnstert.2022.08.850 Qian et al. Estrogen contributes to regulating iron metabolism through governing ferroportin signaling via an estrogen response element. Cell Signal. 2015; DOI: 10.1016/j.cellsig.2015.01.017 Garofalo et al. Relationship between Iron Deficiency and Thyroid Function: A Systematic Review and Meta-Analysis. Nutrients. 2023; DOI: 10.3390/ nu15224790 Ledwidge. et al. PRECISION Study. Int J Clin Pharm. 2023; https://doi. org/10.1007/s11096-023-01640-7  

Intended for Healthcare Professionals Introduction The purpose of this paper is to inform women and healthcare professionals (including midwives, GPs, pharmacists and birth workers) of the often overlooked, vital importance of iron during pregnancy and the postpartum period. It provides quotes, data-driven information and offers solutions that enable women and their families to take ownership of their postpartum health. Historically, there has been a lack of integrated physical and mental health care for women during the weeks and months following birth and, most recently, a lack of specialist services to support women and their families at this time. Background There is a significant increase in iron requirements during pregnancy and the postpartum period. Physiological iron requirements are around three times higher in pregnancy than they are in menstruating women. Iron absorption is regulated by the size of body iron stores. The diets of women in developing countries do not contain sufficient bioavailable iron to meet these needs during the second and third trimesters even if iron stores are adequate at the beginning of pregnancy.¹ Iron deficiency anaemia (IDA) is more likely in women of reproductive age because of menstrual blood loss. However, extremes of blood loss such as regular blood donation, diets of low bioavailability and the challenges of pregnancy all markedly increase the risk of iron deficiency.² Pregnancy is associated with an increase in blood volume of 48% leading to haemodilution and physiological anaemia. The heart is displaced upwards, the myocardium thickens and cardiac output increases.³  These haemodynamic changes are essential during pregnancy because they supply extra blood to the fetoplacental unit and the expanding maternal organs, such as the breasts, uterus, skin and kidneys. A recent meta-analysis study examined blood volume changes in 347 women across the three trimesters of uncomplicated pregnancies and noted volume increases of 6% in the first trimester, rising to 26% in the second and peaking at 48% in the third trimester just prior to delivery.⁴ Extensive literature review revealed that iron deficiency is a global nutritional problem. The WHO reports the global prevalence of IDA is 37% in pregnant women,⁵ and NICE guidelines 2023 report the UK prevalence of anaemia is estimated to be 23% in pregnant women.⁶. This indicates that IDA in pregnant women is a problem both in developed and developing nations. Maternal Iron Deficiency Anaemia increases the risk of serious pregnancy complications, including maternal death, postpartum haemorrhage, stillbirth, and preterm birth⁷, and emerging data also suggests that maternal IDA can also affect the mental health of pregnant women. IDA during pregnancy may also increase the risk of neonatal anaemia and neurodevelopmental, cognitive and behavioural disorders. ⁸,⁹ Gastrointestinal side effects of standard oral iron are common, such as constipation and nausea or in severe cases, vomiting. Compliance with oral iron supplementation is lower during pregnancy, with many women reporting the side effects of oral iron to be worse than those related to anaemia. During pregnancy IDA is identified via standard care pathways including routine blood tests. However, postnatally women do not receive blood tests unless there is further clinical indication. Usually stemming from suspected infection or postpartum hemorrhage (PPH). Yet all women bleed after birth and many become anaemic. NHS Blood and Transplant (NHSBT) found the prevalence of iron deficiency anaemia in pregnancy, in some centres, to be as high as 30.4% and 41.3% in the puerperium.⁷ Postpartum care has long been described as the ‘Cinderella’ service maternity care offers – by women and healthcare professionals alike. In a National Childbirth Trust (NCT) survey: left to your own devices – the postnatal care experiences of 1,260 first-time mothers, 1 in 8 women were highly critical of their postnatal care. Their feedback reflects fragmentation of care, poor planning and communication between healthcare professionals, and insufficient advice about emotional recovery. Furthermore, women continue to report receiving insufficient or inconsistent information on baby’s feeding, particularly after giving birth to their first baby.¹⁰ These findings highlight the importance of supporting new mothers, and their families, to better understand postpartum recovery. A lack of postnatal care has far reaching consequences. Reports of postnatal mental health problems recently hit record level highs. Up to 20% of mothers experience a mental health problem and many go unreported in fear of repercussions. Postpartum depression is one of the most common mental disorders in the postnatal period. Iron is of central importance to many vital processes because iron is a catalytic component of crucial metabolic enzymes in the citric acid cycle, mitochondrial respiration, replication, or neurotransmitter synthesis.¹³ According to NHS 2021 ¹⁴: Untreated iron deficiency anaemia: Can make you more at risk of illness and infection, as a lack of iron affects the immune system. May increase your risk of developing complications that affect the heart or lungs, such as an abnormally fast heartbeat (tachycardia) or heart failure. In pregnancy, can cause a greater risk of complications before and after birth. Furthermore, IDA can impact cognitive function alongside mood. Following childbirth, anemia is associated with fatigue. There is also a growing body of evidence emerging that suggests a relationship between anemia during pregnancy and after pregnancy and increased risk of postnatal depression.¹⁵ ¹⁶ Recommendations Preventive measures could be instrumental in changing this narrative. Currently, UK guidelines do not recommend iron supplementation during pregnancy, unless clinically advised. ¹⁷ As women are recommended to take vitamin D and folate (folic acid) low dose iron should be considered as standard during pregnancy. Although not routinely recommended postnatally, iron supplementation can be helpful for energy levels and repair whilst bleeding and recovering from birth. If a woman is not taking iron, healthcare professionals need to consider the impact of IDA on both mental and physical wellbeing. Mothers typically focus on caring for their newborn and often neglect their needs, which can become catastrophic. Healthcare professionals need to remind postnatal mothers to report symptoms, investigate maternal concerns and encourage mothers to address their symptoms – considering the role of iron supplementation. Active iron is clinically proven to increase iron levels by 94% whilst avoiding gastrointestinal symptoms such as nausea and constipation.¹⁸ Conclusion The postnatal period does not really end at eight weeks; many mothers are often recovering from birth emotionally and physically for some time. Equipping new mothers with knowledge surrounding the importance of iron at this stage in their life may reduce postnatal anaemia and could even impact the prevalence and severity of postnatal depression and other health implications, previously outlined, easing the transition to motherhood. This guideline was written with the hope that healthcare professionals can use it to provide consistent and high-quality care whilst taking into consideration each family’s individual situation and needs in order to reduce the impacts of anaemia postnatally and to support families in this new phase. References Tapiero et al, 2001. Iron: deficiencies and requirements. Biomed Pharmacother; 55(6):324-32. Coad et al. 2011. Iron deficiency in women: assessment, causes and consequences. Curr Opin Clin Nutr Metab Care. 14(6):625-34. Knight 2023. Pregnancy 1: e ects on hematological and cardiovascular systems. Nursing Times [online] Aguree et al, 2019. Plasma volume expansion across healthy pregnancy: a systematic review and meta-analysis of longitudinal studies. BMC Pregnancy and Childbirth; 19: 508. WHO global anaemia estimates: Anaemia in women and children (2021) https://www.who.int/data/gho/data/themes/topics/ anaemia_in_women_and_children NICE Guidelines 2023. https://www.nice.org.uk/guidance/ published?from=2023-01-01&to=2023-01-31&pa=2 The Royal College of Pathologists, 2021, ‘Anaemia in Pregnancy and the Postpartum Period’, The Bulletin of the Royal College of Pathologists, Vol 195 . Available at:https://www.rcpath.org/profession/publications/collegebulletin/july-2021/anaemia-in-pregnancy-and-the-postpartum-period.htmll Janbek et al, 2019. A systematic literature review of the relation between iron status/anemia in pregnancy and o spring neurodevelopment. Eur J Clin Nutr. 73(12):1561-1578. O’Toole et al, 2023. Screening and treatment of iron deficiency anemia in pregnancy: A review and appraisal of current international guidelines. Int J Gynecol Obstet. 2023;00:1–14. National Institute for Health and Care Excellence, 2021. Postnatal care NICE Guideline (NG194), https://www.nice.org.uk/guidance/ng194 Centre for Mental Health, LSE Personal Social Services Research Unit, 2015. The costs of perinatal mental health problems – report summary http:// eprints.lse.ac.uk/59885/ MBRRACE-UK Saving Lives Improving Mothers’ Care - Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2019-21 Zhukovskaya et al, 2019. Neurocognitive Dysfunctions in Iron Deficiency Patients. Iron Deficiency Anemia. Iron deficiency anaemia NHS 2021 https://www.nhs.uk/conditions/ iron-deficiency-anaemia Azami et al, 2019. The association between anemia and postpartum depression: A systematic review and meta-analysis. Caspian J Intern Med. 10(2): 115–124. Cheng et al, 2023. Exploring the Relationship between Anemia and Postpartum Depression: Evidence from Malawi. Int. J. Environ. Res. Public Health https://doi.org/10.3390/ijerph20043178 Pavord et al, 2020. UK guidelines on the management of iron deficiency in pregnancy. Br J Haematol. 188(6):819-830. Ledwidge et al. 2023. PRECISION Study: Management of iron deficiency in women of childbearing age with oral iron intolerance: a prospective, randomised, controlled trial of three doses of an iron-whey-protein formulation. International Journal of Clinical Pharmacy, https://doi.org/10.1007/s11096-023-01640-7

Originally developed to help manage type 2 diabetes, GLP-1 medications are now widely used for weight loss₁. While GLP‑1 medications offer clear benefits, they’ve also been linked to broader nutritional and physiological changes, including impacts on body composition, lean mass and gastrointestinal physiology that may influence how nutrients are absorbed³ . However, direct evidence linking GLP-1 medications to iron deficiency is currently limited³.  What Are GLP‑1 Medications?  GLP‑1 receptor agonists (such as semaglutide and liraglutide) mimic a natural hormone that helps regulate appetite, blood sugar and gastric emptying (how quickly food leaves your stomach). These effects can lead to reduced calorie intake and significant weight loss.   The Importance of Iron  Iron plays a crucial role in*:  Oxygen transport   Red blood cell formation  Energy metabolism  Cognitive performance  Immune function  When iron levels become low, symptoms may include the following:   Physical fatigue and low energy  Mental fatigue and reduced concentration  Impaired immunity  Cold intolerance   For many, these symptoms can be subtle and easy to blame on busy lifestyles or the adjustment period of a new medication, but they may be a result of low iron levels.  How GLP‑1 Medications May Impact Iron Levels  While GLP‑1 drugs do not directly cause iron deficiency, several mechanisms may increase the risk of iron deficiency over time:   1. Reduced Appetite = Lower Iron Intake  GLP‑1 therapies suppress appetite, leading to reduced food intake and dietary variety³. This may decrease consumption of iron‑rich foods such as red meat and green leafy vegetables.   2. Slower Digestion May Affect Absorption  GLP‑1 medications slow gastric emptying₃, which can alter digestion and change how nutrients are absorbed and impact the efficiency of iron uptake in the gut.   3. Gastrointestinal Side Effects  Common side effects include nausea, vomiting, and reduced food tolerance, affecting up to 40–65% of users³. These effects can reduce nutrient intake and dietary quality, making it harder to maintain optimal nutrient levels, including iron.  Are You at Risk of Low Iron?  You may be more likely to experience low iron while using GLP‑1 medications if you:  Already have inadequate iron levels  Have regular and/or heavy periods  Follow a vegetarian or restricted  Have absorption issues, e.g. coeliac disease, Crohn’s disease  Are losing weight quickly  Note: These risks are general, not GLP‑1 specific.  Supporting Your Iron Levels While on GLP‑1s  There are many ways to ensure you are getting sufficient iron in your diet. This can include:  1. Prioritising Iron-Rich Foods  Focus on incorporating:  Lean red meat, poultry, and fish (heme iron sources)  Iron-rich plant foods like lentils, beans, and spinach (non-heme iron sources)  Vitamin C-rich foods to enhance absorption  2. Monitoring Symptoms  Dietary strategies such as increasing intake of heme and non‑heme iron sources and combining with vitamin C are well supported for improving iron intake and absorption⁴.   3. Iron Supplementation  For many people, especially those struggling with appetite or dietary intake, a supplement can help bridge the gap. However, not all iron supplements are created equally. Traditional iron products can sometimes cause:  Stomach cramps  Nausea & Constipation  Diarrhoea  Black stools  Poor compliance  If you’re navigating GLP‑1 treatment, it’s important to choose an iron supplement that works with your body and is easy to take.   Active Iron is clinically proven to:   Be highly absorbed⁵   Be gentle on the stomach & non-constipating  Increase iron levels by 94% in six weeks⁶ Active Iron can be especially beneficial for individuals already managing digestive changes from GLP‑1 medications due to its highly absorbed yet gentle formula.  Summary   GLP‑1 medications come with nutritional considerations. While a direct cause and effect link is still being studied, there is a clear potential connection between GLP‑1 use and an increased risk of low iron due to reduced food intake, digestive changes and rapid weight loss.  By staying aware and supporting your iron levels proactively, you can help support your energy and wellbeing throughout your health journey.  References: Gul U, et al. A Comprehensive Review of the Role of GLP-1 Agonists in Weight Management and Their Effect on Metabolic Parameters. Cureus. 2024.  Rossi G, et al. Muscle loss and GLP-1R agonists use. Acta Diabetologica. 2025.  Drucker DJ. Efficacy and Safety of GLP-1 Medicines for Type 2 Diabetes and Obesity. Diabetes Care. 2024. WHO guideline on use of ferritin concentrations to assess iron status in individuals and populations, 2020. Wang et al. 2017, Acta Haematologica, 138: 223-232. 6. Ledwidge, M. et al. PRECISION Study. Int J Clin Pharm (2023). *Iron contributes to normal energy-yielding metabolism, normal function of the immune system, normal cognitive function, normal formation of red blood cells and haemoglobin and normal oxygen transport in the body. Food supplements are not a substitute for a varied diet and a healthy lifestyle. Contact your doctor/pharmacist if you have any concerns.   

*Intended for Healthcare Professionals Introduction This white paper aims to describe some of the common features of endometriosis and menorrhagia (heavy menstrual bleeding), appreciating them both through the lens of iron deficiency. Understanding the social and personal context of these conditions and how women experience them is vital to offer satisfactory treatments. A recent survey by Active Iron on 1500 women across Ireland, the UK and USA, provides a contemporary insight into the impact of these conditions and iron deficiency on women’s lives.¹ While significant strides have been made to mitigate iron deficiency (via blood loss) associated with these conditions, the progress in the formulation of novel oral supplements to ameliorate iron deficiency, ensuring both effectiveness and tolerability, has been comparatively gradual. Background Endometriosis is a condition characterised by the abnormal growth of endometrial tissue outside of the uterine cavity. It is estimated to have a prevalence amongst women of around 10% and can take years to formally diagnose despite its impact on quality of life². It has a varied range of symptoms which do not always relate to the severity of the disease, and it has the potential to spread across the pelvic cavity and to extra-pelvic areas such as the bowel, diaphragm and even lungs. Although the main symptom of endometriosis is pain, according to the survey menorrhagia was the second most common symptom, affecting 74% of respondents. As the most common cause of iron deficiency in women of childbearing age, menorrhagia is a key contributor to morbidity and poor quality of life. Menorrhagia can occur at any time in a woman’s reproductive life but is most common during the teenage years and when perimenopausal. 58% of perimenopausal women surveyed experienced heavier periods. Menorrhagia is a clinical diagnosis which is characterised by menstrual blood loss of >80mls. ³ Whilst this figure may be useful for research purposes, it is also important to consider the wider impact of heavy bleeding, and how normal life can become restricted due to menorrhagia.² Heavy periods can cause a considerable physical and mental burden, with 74% of survey participants feeling tiredness and fatigue, 46% experiencing lower productivity at work/school and 45% stating that they do not want to exercise. Common themes and challenges between endometriosis sufferers and those experiencing menorrhagia are stigma, impact on quality of life and delay in diagnosis. Endometriosis sufferers wait an average of 7.5 years before being diagnosed, and many women with menorrhagia may not even seek medical help as they assume their heavy bleeding is normal.⁴ ⁵ As menstruation is the leading cause of iron loss worldwide, heavy menstrual bleeding is a major contributor to iron deficiency.⁶ The most common symptoms of iron deficiency are vague, which means it can and does go undiagnosed. Fatigue, shortness of breath, and brain fog are particularly common but may not be attributed to low iron levels.³ When you combine this with symptoms of menorrhagia such as flooding, and passing of large clots it’s not hard to understand how this may lead to withdrawal from normal activities, and negatively impact on interpersonal relationships and mental health. Alongside physical symptoms, there is also a drop in haemoglobin levels and the oxygen carrying capacity of the blood is therefore reduced. Over time, repeated episodes of blood loss (such as with menstruation) can deplete iron stores and compound the symptoms experienced. Even if someone is not profoundly anaemic, they may complain of tiredness, irritability, problems with concentration and shortness of breath. This in turn may lead to a reduction in quality of life. Continued blood loss without adequate replacement (such as in menorrhagia) can lead to iron deficiency anaemia.⁷ In the longer term, untreated iron deficiency increases the risk of infections, cardiac abnormalities and paradoxically, increases the risk of bleeding.⁸ The main symptom of endometriosis is pain. Menorrhagia is the second most common symptom, affecting 74% of respondents¹. Menorrhagia is most common during the teenage years and when perimenopausal. 58% of perimenopausal women surveyed experienced heavier periods. Heavy periods can cause a considerable physical and mental burden, with 74% of survey participants feeling tiredness and fatigue, 46% experiencing lower productivity at work/school and 45% stating that they do not want to exercise. • Over time, repeated episodes of blood loss (such as with menstruation) can deplete iron stores and compound the symptoms experienced. Proposed Solution Addressing the course of symptoms with a healthcare professional is always the first aim when assessing a patient. However, we know that over 50% of women with menorrhagia will be classified as having dysfunctional uterine bleeding, as no cause is found. For women in this position, increasing iron levels in the blood is vital, and iron supplementation supports in achieving optimum iron levels. Traditional iron supplements are often poorly tolerated due to the myriad of side effects associated with them⁷,⁸, such as nausea, constipation and change in bowel habit. This may cause people to be poorly compliant with the treatment, reducing the chance of their iron stores improving. ⁹ Although iron supplements are one of the most commonly prescribed medications for women experiencing menorrhagia, for many the side effects of these can be off-putting.  Active Iron is clinically proven to increase iron levels by 94% whilst avoiding troublesome side effects such as nausea and constipation,¹⁰ meaning people can improve their quality of life in the longer term and improve their overall health at the same time. Active Iron is also clinically proven to increase energy levels¹⁰ and can be used as a tool to support menstrual fatigue. The clinical studies completed by Active Iron target women with an unmet need for iron; the latest study was carried out in women of childbearing age with periods (including perimenopausal women).¹⁰ Conclusion The significant impact of both endometriosis and menorrhagia on women’s health cannot be underestimated. The pervasive nature of these gynaecological conditions invades women’s lives, impacting on their social, emotional, and professional environments. A holistic understanding of the interplay between physiological aspects and women’s experiences is vital. The range of symptoms alongside the often-underestimated burden of managing them, highlights the need for simple and well tolerated treatments like Active Iron. As we continue to highlight inequities in women’s health, it is key to prioritise solutions that target symptomatic relief and also improve quality of life. This white paper is a further step towards continued collaboration between the stakeholders who can empower women to be at the forefront of taking control of their health and wellbeing.  References Active Iron Survey 2024. n=1500 https://www.bsge.org.uk/wp-content/uploads/2022/02/ ESHRE-GUIDELINE-ENDOMETRIOSIS-2022.pdf https://cks.nice.org.uk/topics/menorrhagia-heavy-menstrual-bleeding/ background-information/definition  NICE GUIDELINE NG88 Heavy Menstrual Bleeding, published 14th March 2018, Last updated May 2021 https://www.endometriosis-uk.org/getting-diagnosed-0 Munro et al. (2023). American Journal of Obstetrics and Gynecology. doi:https://doi.org/10.1016/j.ajog.2023.01.017. Pasricha et al. (2021) Iron deficiency. Lancet 16;397(10270):233-248. doi: 10.1016/S0140-6736(20)32594-0. https://www.nhs.uk/conditions/iron-deficiency-anaemia/ https://www.bsg.org.uk/clinical-resource/guidelines-for-the-management of-iron-deficiency-anaemia/ Ledwidge, M. et al. PRECISION Study. Int J Clin Pharm (2023) https://doi.org/10.1007/s11096-023-01640-7

Haem iron is a form of iron that’s rarely talked about. You find haem iron in animal products, such as red meat, poultry, seafood, and muscle tissue. But let’s rewind a little bit.  There are two types of iron: Haem iron – found in meats. Non-haem iron – found in plant-based foods. Your body absorbs haem iron quicker and more effectively than non- haem iron, meaning that those on a vegetarian or plant-based diet may find they struggle to consume adequate amounts of iron on a daily basis. In this article, we are going to discuss everything you need to know about haem iron, including: The different types of iron. The health considerations of haem iron. Foods that have haem iron. Foods that have non-haem iron. Supplementing with iron. Let’s start with differentiating between the two types of Iron. What are the Different Types of Iron? As already mentioned, there are two types of iron – haem and non-haem iron. Meat is recognised by most as being a primary source of iron, but plenty of vegetarian-friendly foods are high in iron as well, including spinach, beans, and even chocolate! haem iron is best found in sources of red meat, which contains blood proteins and haemoglobin. The name “haem iron” comes from the haem protein that’s attached to a lone iron atom. The primary source of non-haem iron is plant-based food. The majority of the iron we consume is non-haem iron. Foods like rice, oats, wheat, nuts, fruits, beans all have high amounts of non-haem iron. Your body absorbs haem iron at a higher rate compared to non-haem iron, meaning that those on a plant-based diet may not get enough iron through their diet alone. If you are a vegetarian or a vegan, you should keep in mind that your body only absorbs 2-20% of non-haem iron, whereas haem iron from animal-based sources has a 15-35% absorption rate. Becaues of this, vegetarians and vegans have to consume twice as much iron in their diet as meat-eaters, to absorb the same amount of iron.Fortunately, there are lots of great sources for non-haem iron.  Foods like beans and leafy greens are one of the best vegetarian/vegan sources of iron. Whole-grain foods like cereals have plenty of iron in them, which makes them another attractive option for vegetarians. Certain foods can reduce non-haem iron absorption. Dairy products, eggs, fibre, as well as tea and coffee, can all interfere with the way you absorb non-haem iron.  The good news is that you can improve your absorption of non-haem iron from food by taking vitamin C.   The most common form of supplementary iron is non-haem iron, if you are unsure when to take iron, you can check out our post on the best time to take iron. Which Foods Have Haem Iron? All haem iron comes from animal-based sources. Red meat and organ meats, in particular, have high amounts of haem iron. Also, foods like clams, oysters, mussels, venison and lamb chops all have a healthy amount of haem iron (between 2-23 mg). Red meat is not only an excellent source of haem iron, but it is also a source of high-quality protein as well. If you want to increase your intake of iron, and specifically haem iron, you should aim to include more animal-based foods in your diet.    Sources of Haem Iron As we have seen, the main source of haem iron is meat. This is because meat has many blood proteins and haemoglobin, which help the body transport oxygen. If you want to increase the amount of haem iron in your diet, here are the best foods to include. Organ meats: Kidneys, liver, brain and heart are incredibly nutritious and score highly for haem iron. The liver, in particular, is one of the most nutrient-dense organ meats and contains plenty of haem iron. Red meat: Often given bad press, red meat is, however, packed full of protein and essential vitamins and minerals, including iron. When it comes to haem iron, all red meats pack a punch. Including lots of steaks, chops and mince in your diet will increase your haem iron intake. Poultry: Although not as iron-rich as red meat, chicken and turkey are nevertheless good sources of haem iron. Fish and shellfish: Other excellent choices rich in haem iron include fish and shellfish. Canned varieties of fish, especially sardines and tuna, are excellent choices. And clams, oysters and mussels will also deliver a healthy dose of haem iron. Most people get enough haem iron from their diet. However, others find it difficult to get sufficient iron from food alone. These people may choose to increase their intake of iron supplements. Which Foods Contain Non-Haem Iron?  For vegetarians and vegans, there are plenty of good options to get enough iron from plant-based sources.  Here are some of the best sources of non-haem iron: Legumes  Foods like tofu, tempeh and soybeans are packed with high-quality iron. They are rich in fibre as well as protein, so they can definitely support your healthy lifestyle. Other great sources of non-haem iron are lentils and beans. Nuts Nuts and seeds are not only packed with iron but with high-quality protein and fats as well. They can help you increase your iron and omega-3 fatty acids intake. Veggies Vegetables including leafy greens, potatoes, tomatoes and mushrooms are all non-haem iron-rich foods. Leafy green vegetables such as spinach contain oxalates which can make the iron in these foods difficult to absorb. Eating non haem iron rich foods with haem iron rich foods such as meat can also help increase absorption. Fruits Most people aren’t aware that fruits have high amounts of iron. Foods like prunes, olives and mulberries are all great sources of iron. They are also rich in fibre and other vitamins, which means that adding them to your diet will help your healthy lifestyle. Whole Grains Whole grains are incredibly beneficial as long as they aren’t processed. When they are processed, they lose fibre, antioxidants and minerals like iron. That’s why whole grains typically have more iron than processed grains. Coconut Milk Coconut milk is high in fat and it’s also an excellent source of vitamins and minerals like magnesium, copper, manganese and iron. Dark Chocolate One of the most delicious foods containing non-haem iron is dark chocolate. It’s full of nutrients like magnesium, copper and iron. Also, dark chocolate has a lot of fibre which will keep you full.   What are the Health Risks of Haem Iron? While iron is an essential mineral for your body, massively increasing your absorption of haem iron can cause a few problems. Too much iron can lead to problems like inflammation and even DNA damage because of the production of a dangerous free radical that’s called hydroxyl.  It’s all about striking the right balance. If you don’t have enough iron in your system, you’re risking not giving your body the resources it needs to function properly.  Your body can naturally regulate the iron you absorb from plant-based foods which prevents iron overload. Haem iron from animal-based foods is more easily absorbed, but your body does not regulate it very well.     Conclusion To summarise, you can find haem iron in animal-based foods like red meat, chicken and fish.  Plant-based foods, on the other hand, contain non-haem iron (which is harder to absorb). Your body has systems in place to regulate your non-haem iron intake, but it doesn’t regulate the intake of haem iron as easily, so it is all about getting the right balance between eating animal and plant-based foods.  Excellent sources of non-haem iron are foods include nuts, whole grains, leafy greens and dark chocolate. Another great way to ensure you get a healthy amount of iron is by taking iron supplements; however, many people complain of side effects from poorly absorbed iron supplements. One way to combat this problem is taking vitamin C along with your iron supplement. However, Active Iron doesn’t have this issue. Active Iron works with your body to give you the right amount of iron without upsetting your stomach.  *Wang et al. 2017, Acta Haematological, 138: 223-232

Haem Iron Supplements: The Complete Guide If you are considering haem iron supplements, this guide is for you. Using easy-to-understand language and terms, we will take you through all you need to know. We will answer all your questions, including the following: What is haem iron? What are the main dietary sources of haem iron? What are the different types of iron supplements? How much haem iron do I need? What are the best types of iron supplements? Let’s get started by looking at what haem iron is and why it’s such an important mineral.   What is Haem Iron? Iron is an essential mineral and plays a vital role in the body. It’s used to make red blood cells, which carry oxygen around the body, and it also contributes to normal cognitive function, normal energy metabolism and the normal formation of red blood cells. There are two different types of iron: haem and non-haem iron. Haem iron mainly comes from animal sources. Red meat, offal, poultry and fish are all excellent sources of iron. Non-haem iron comes from plant-based sources. These include fortified cereals and breads, rice, oats, nuts, beans and leafy greens. Best of all, dark chocolate is also rich in non-haem iron. Haem iron is more easily absorbed by the body than non-haem iron. Therefore, vegetarians have to eat twice as much iron as meat-eaters to get the same amount.   The Different Types of Iron Supplements There are several different types of iron supplements available – which are non haem sources of iron.These include: Ferrous sulfate Ferrous gluconate Ferric citrate Ferric sulfate Usually available as tablets and capsules, these iron supplements also come as salts or liquids. However, different types of iron supplements contain varying amounts of elemental iron. Most iron supplements contain non-haem iron.   Haem vs Non-Haem Iron When it comes to haem vs non-haem iron, the main difference is the body’s rate of iron absorption. Haem iron is absorbed at a much higher rate than non-haem iron. It’s estimated that the body absorbs only 2-20% of non-haem iron. In comparison, haem iron has a 15-35% absorption rate. Non-haem-based iron supplements are also more likely to result in side effects. Indigestion, stomach upset, flatulence, constipation and diarrhoea are common complaints associated with some types of iron supplements. While iron is essential to your overall health, some problems are associated with overdoing your intake of haem iron. Dramatically increasing the amount of haem iron in your diet can lead to inflammation, as well as causing damage to gut cells due to the production of hydroxyl, a free radical. Your body finds it much easier to regulate iron absorption from plant-based foods, meaning that although haem iron is more easily absorbed, the body is not so good at regulating this process. As a result, it’s important to find the right balance of haem vs non-haem iron. Are They Absorbed Differently? Just as there’s a difference in how the body absorbs haem and non-haem iron, absorption of iron supplements also varies.  A lot depends on how and when you take your iron supplements. Vitamin C is known to help with iron absorption, and some supplements must be taken with a glass of orange juice to maximise their performance. To get the best absorption, other iron supplements need to be taken alongside food. Even with these measures, lots of people still experience the unwanted side effects of nausea or an upset stomach. By contrast, Active Iron has twice the absorption compared to standard ferrous sulphate supplements, and its gentle formula means you can take it on an empty stomach. Liquid iron supplements are often proposed as an alternative for those who experience side effects such as constipation or nausea. It’s suggested the liquid format is gentler on the stomach and easier for the body to absorb. However, manufacturers tend to make liquid iron supplements with low potency, as a safety precaution in case a child accidentally drank the liquid iron, which could cause serious health complications. Furthermore, some foods are known to affect your body’s ability to absorb iron. Healthcare professionals usually advise avoiding taking iron supplements with tea, coffee, milk and dairy products. Wholegrain cereals with high levels of phytic acid are also best avoided.   How Much Haem Iron Do You Need?  How much iron you need depends on your sex, age and lifestyle. Generally, women need more iron than men due to menstruation, pregnancy and breastfeeding. The EU uses a system called Nutrient Reference Value (NRV), which sets out the average daily amount of vitamins and minerals needed for good health. The NRV for iron is currently 14mg. The US Department of Health has set out the following recommended daily allowance (RDA) for males and females depending on age. Age Male Female Pregnancy Breastfeeding 1-3 years 7 mg 7 mg     4-8 years 10 mg 10 mg     9-13 years 8 mg 8 mg     14-18 years 11 mg 15 mg 27 mg 10 mg 19-50 years 8 mg 18 mg 27 mg 9 mg 51+ years 8 mg 8 mg     The RDA covers iron from all sources, haem and non-haem, plus any iron supplements. Vegetarians and vegans need to eat twice as much iron in their diet as meat-eaters to achieve their RDA. Haem iron from meat and haem iron supplements is more easily absorbed by the body. Furthermore, if you are an active athlete, then you may need more iron in your diet, as the body’s muscles use iron to make energy. If you participate in endurance sports such as running, rowing and cycling, increasing your iron intake may enhance your overall performance. Iron helps by transporting oxygen to tired muscles more efficiently. The Best Types of Iron Supplements  So, what are the best types of iron supplements? When selecting the right supplement for you, the main things to consider are: iron absorption potential side effect When selecting an iron supplement, it is important to focus on one which provides the maximum amount of absorption of iron, while also minimising the side effects. Now that you know all about haem and non-haem iron, it’s time to discuss iron supplements. In an ideal world, you should get most of your iron intake from your diet. However, some people may be unable to do this or may decide that they need to complement their dietary intake of iron. That’s where iron supplements come in. Iron supplements provide an easy and convenient way for people to increase their iron intake, but many oral irons on the market are difficult for the body to absorb. Many manufacturers recommend taking their supplements with a source of vitamin C to better aid absorption, although they can still lead to side effects like an upset stomach, constipation, or diarrhoea. Active Iron is a superior choice to other iron supplements although it is also a non haem source, it is formulated to be both kind and gentle to the stomach. Active Iron increases the amount of iron absorbed by targeting the body’s natural site of iron absorption, in the intestine. In fact, Active Iron is clinically proven to be more highly absorbed compared to standard iron supplements.* The ground-breaking technology in Active Iron protects the iron with a special whey layer allowing it to bypass the stomach, where most iron supplements are broken down and oxidised. This means whatever your needs, you will be getting the maximum amount of iron with the satisfaction of reduced side effects. If you want to increase your iron intake without unwanted side effects, try Active Iron today. For Athletes Active exercisers often find they need additional iron in their diets, and they can top up their iron intake during periods of sustained and heavy training with supplements. Intense exercise can put your body under stress, affecting your ability to absorb iron, leading to an ever-increased need. Active Iron is the answer for many athletes. Active Iron Advance is Certified by the Informed-Sport programme, so athletes can be confident that Active Iron is free from prohibited sports substances. The unique formulation Active Iron will help increase iron absorption, which in turn helps you give your best performance. Vegetarians Many vegetarians, particularly women with periods, find it hard to get enough iron from food sources alone. As we have seen, plant-based non-haem iron is less easily absorbed by the body. However, for ethical reasons, many vegetarians do not want to take heme iron supplements, as this comes from animal sources. The good news is that Active Iron is a vegetarian-friendly supplement. The unique whey protein formula is also free from artificial preservatives, sugar, wheat and gluten. Active Iron is the preferred choice for many vegetarians wanting to supplement their iron intake. Pregnant Women During pregnancy, the body needs more iron to transport oxygen around the body and to support your growing baby. The iron RDA for pregnant women increases from 18 mg to 27 mg. Many women find it a struggle to get all the iron they need during this time, and it can be very easy for pregnant women to develop inadequate iron levels. Once levels have become inadequate, it is nearly impossible to rebuild these levels through diet alone. Active Iron is a great solution for Pregnant women. Active Iron is safe for consumption prenatally, during pregnancy, and while breastfeeding. Its gentle formula is kind on your stomach, delivering much-needed iron in a non-constipating formula.  Active Iron Pregnancy Plus is specially formulated for pregnancy, and is widely recommended by midwives and healthcare professionals. Haem Iron Supplements Conclusion Eating a healthy, balanced diet is the best way to ensure you get enough iron – both haem and non-haem. However, sometimes you might need some extra help. Athletes, vegetarians, and pregnant women all have an increased need for iron. Selecting the right iron supplement is a big decision, as we must consider factors like lifestyle, side effects, and personal iron requirements. Active Iron is recommended by healthcare professionals and loved by consumers. Its non-constipating formulation is clinically proven to provide a high amount of absorption of iron*, and is gentle on the stomach,*** helping to avoid unwanted side effects. Active Iron is safe for pregnancy, is vegetarian-friendly, and can even be taken on an empty stomach. *Wang et al. 2017, Acta Haematological, 138: 223-232

Shining a Spotlight on Iron for Female Athletes This month, we’re shining a spotlight on the importance of iron for women who train and compete, as we roll out our latest campaign for Active Iron. Female athletes face a higher risk of developing inadequate iron levels for several reasons. Alongside the physical demands of training and competition, women can lose iron through menstruation, pregnancy and lactation, as well as through sweat during exercise. Despite this, iron awareness and routine screening are still not prioritised enough in sport. The insights driving this campaign highlight just how widespread the issue is: 40% of inter-county Camogie players are low in iron, based on research conducted in partnership with Atlantic Technological University¹. 88% of active UK women report symptoms linked to low iron, according to a survey conducted by Active Iron². These findings highlight a clear and pressing need for a more proactive approach to routine iron screening, as well as greater education around menstruation and the importance of iron and other key nutrients needed to support female athletes. Iron plays a crucial role in energy production, oxygen transport and overall performance. When iron levels are low, athletes may experience fatigue, reduced endurance and difficulty maintaining peak performance. That’s why this campaign aims to spark an important conversation around iron awareness, menstrual health and the nutritional needs of women in sport. Lower iron levels can impact energy and performance - don't let it hold you back. By prioritising routine screening, better education and proper nutritional support, we can help ensure female athletes are equipped to train, compete and recover at their best. Why Young Female Athletes are More Likely to Struggle with their Iron Levels Growth & Development Adolescent female athletes require more iron for rapid growth, muscle development, and increased blood volume. Menstrual Blood Loss – once menstruation begins, iron loss increases monthly. Heavier periods and other women’s health issues can impact iron levels even further. High-Intensity Training: can increase iron loss through sweat and a condition known as foot-strike haemolysis. Foot-strike haemolysis is caused by the repeated impact of feet hitting the ground, particularly when running, which leads to the destruction of red blood cells and the release of haemoglobin into the bloodstream³. Lifestyle: skipped meals, picky-eating, limited red-meat and other iron-rich foods intake, along with overall busy lifestyles, can all impact iron levels. Advice for Parents of Teenage Girls For many girls, iron levels are impacted as soon as menstruation begins. Combine this with the physical demands of sports, and the risk of declining energy levels and performance increases further. As a parent, understanding the connection between periods, iron levels, and performance can make a significant difference. Practical Steps Parents Can Take 1. Encourage Open Conversation Normalising discussions around periods and menstrual health will help build trust; most teenagers won’t volunteer this information unless asked. Creating a safe environment to openly talk about these topics will encourage your teenager to be honest about how they’re feeling, both physically and mentally. 2. Iron-Rich Nutrition Make iron-rich foods a regular part of family meals. Consistent intake helps support your child’s daily iron needs and plays an important role in maintaining healthy iron levels over time. 3. Consider Period Tracking Apps or simple calendar tracking can help identify heavy cycles or patterns linked to lower iron levels. Active Iron have partnered with the period tracking app, Clue. When you purchase any pack of Active Iron, you will get a free annual subscription to Clue. For steps on how you can avail of the offer, click here 4. Test When Appropriate If there are signs of persistent fatigue or heavier periods, please consult your healthcare professional, who may recommend checking ferritin and haemoglobin levels. If your teen has lower iron levels, your GP may recommend supplementing with Active Iron*. How Active Iron Can Help Active Iron is an iron supplement that is clinically proven to increase iron levels⁴ and fight menstrual fatigue⁵. Most iron supplements break down in the stomach, triggering oxidation and gut inflammation – leading to constipation, nausea and other unwanted side effects. Active Iron is powered by a whey protein formula and delivers iron directly to the DMT-1, the sweet spot for absorption. This reduces oxidation and protects your gut, making it gentle & non-constipating. Active Iron Advance is Informed Sport certified, meaning that every batch is tested for banned substances, making it safer for athletes to take. The Informed Sport program assures that products have been tested for a wide range of substances prohibited in sport. Let’s keep the conversation going, and remember, don’t accept menstrual fatigue.  Keep an eye out on our social media platforms and website throughout March for loads of educational content, real people sharing their stories, exclusive discounts, and much more! ¹Atlantic Technological University: Active Iron Research Project 2-25. N=44 inter-county Camogie players. ²Active Iron survey 2026. Conducted by Obsurvant. N=1,000. ³Oxfordshire Chiropody & Podiatry (2025) Understanding foot strike haemolysis: causes, symptoms and management. Available at: https://www.oxfordshirechiropody.co.uk/post/understanding-foot-strike-hemolysis-causes-symptoms-and-management (Accessed: 24 February 2026). ⁴Ledwidge, M. et al. PRECISION Study. Int J Clin Pharm (2023). ⁵Iron contributes to normal energy-yielding metabolism and the reduction of tiredness and fatigue.

Solvotrin Therapeutics, the Irish healthcare developer behind Ireland’s #1 iron supplement, has announced an exclusive partnership with USL to launch Active Iron in New Zealand.

Pregnancy is a critical time for both mum and the developing baby. Vitamins and nutrients play a significant role in supporting a healthy pregnancy. In this blog I explore why vitamins are important during pregnancy, the key vitamins and nutrients needed, foods to eat and avoid, the best supplements for pregnancy, potential side effects of multivitamins, and when to start taking vitamins. Why Take Vitamins During Pregnancy? During pregnancy, the body requires more nutrients to support the growing baby and maintain mum’s health. Vitamins and minerals are vital for various bodily functions, including cell growth, immune function, and brain development. Prenatal vitamins may help fill nutritional gaps, particularly those with restricted diets, ensuring that both mum and baby receive essential nutrients. Most Important Vitamins During Pregnancy Vitamin D Vitamin D contributes to normal absorption/utilisation of calcium and phosphorus supporting the baby’s bone development. Vitamin C Vitamin C is an antioxidant that supports normal function of the immune system, improves iron absorption, and supports normal collagen formation for the normal function of bones and cartilage. B Vitamins B vitamins, including B6, B12, and folic acid (B9), are essential for energy production, brain function, and the formation of red blood cells. Folic acid, in particular, is critical in reducing the risk of neural tube defects in the developing baby, This beneficial effect is obtained with a supplemental folic acid daily intake of 400 μg for at least one month before and up to three months after conception. Vitamin E Vitamin E acts as an antioxidant, protecting cells from oxidative stress (cell damage). Other Essential Nutrients Omega-3 Fatty Acids (DHA) Docosahexaenoic acid (DHA) maternal intake contributes to the normal development of the eye and brain of the foetus and breastfed infants. Calcium Calcium is necessary for the development of the baby’s bones and teeth. It also supports the mother’s bone and teeth health throughout pregnancy. Iron Iron is an essential mineral and supports maternal red cell production. Iron is one of the most recommended vitamins in pregnancy by doctors and midwives, as up to 40% of pregnant women worldwide have low iron levels* Probiotics Probiotics promote a healthy gut microbiome, which can improve digestion. Zinc Zinc contributes to normal DNA synthesis and has a role in the process of cell division.   Foods to Eat During Pregnancy Eating a balanced diet rich in vitamins and minerals is crucial. Here are some nutrient-dense foods to include: Leafy greens (spinach, kale): Rich in folate and iron. Citrus fruits (oranges, strawberries): High in vitamin C. Dairy products (milk, yogurt): Good sources of calcium and probiotics. Fatty fish (salmon, sardines): High in omega-3 fatty acids. Nuts and seeds (almonds, sunflower seeds): Provide vitamin E and healthy fats. Lean meats (chicken, turkey): Excellent sources of B vitamins and protein.   Foods to Avoid During Pregnancy Certain foods can pose risks during pregnancy and should be avoided: Raw or undercooked seafood: Risk of foodborne illnesses. Unpasteurized dairy products: Can contain harmful bacteria. High-mercury fish (shark, swordfish): Mercury can harm the baby’s developing nervous system. Processed meats (deli meats): Risk of listeria contamination. Caffeine and alcohol: Limit caffeine intake to 200mg per day and avoid alcohol to prevent developmental issues.   Best Supplements for Pregnancy Prenatal Vitamins Prenatal vitamins are specially formulated to provide the essential nutrients needed during pregnancy. They typically contain folic acid, iron, calcium, vitamin D, and other vital vitamins and minerals. Active Iron Pregnancy contains non-constipating Active Iron plus a complete time-release multivitamin providing all the key nutrients for mum and baby. DHA Supplements DHA supplements ensure adequate omega-3 intake, supporting the baby’s brain and eye development. For pregnant and lactating women the beneficial effect is obtained with a daily intake of 200mg of DHA in addition to the recommended daily intake of omega-3 fatty acids for adults, i.e: 250mg DHA and EPA. Calcium Supplements If dietary intake is insufficient, calcium supplements can help meet the increased needs during pregnancy.   Side Effects of Multivitamins During Pregnancy While multivitamins are generally safe, some women may experience side effects such as nausea, constipation, or stomach upset. To minimise these effects, take vitamins with food and stay hydrated. If mums are concerned about any side effects occur, consult a with your doctor or midwife. When Should You Start Taking Vitamins for Pregnancy? It’s recommended to start taking prenatal vitamins before conception and continue throughout pregnancy and breastfeeding. This ensures that the body has adequate nutrient stores to support the baby’s development from the earliest stages. To find out the best time of day to take vitamins, read more here. Additional Nutrients and Minerals for a Healthy Pregnancy Beyond the essential vitamins and nutrients mentioned, consider including: Iron: Supports increased blood volume. Active Iron Advance contains 25mg of iron, helping to support women’s iron levels throughout pregnancy Magnesium: Contributes to normal muscle function and normal function of the nervous system, as well as the reduction of tiredness and fatigue. Iodine: Crucial for thyroid function and the baby’s brain development. Selenium: Plays a role in the normal function of the immune system, and normal thyroid function. Conclusion Maintaining proper nutrition through a balanced diet and prenatal vitamins is essential for a healthy pregnancy. Ensure you get adequate amounts of vitamin D, C, B vitamins, vitamin E, omega-3 fatty acids, iron, calcium, and zinc. Consult with a healthcare professional to tailor your supplement regimen and address any concerns about side effects. Starting prenatal vitamins early and focusing on a nutrient-rich diet can significantly contribute to the health and well-being of both mum and baby. All our bodies are different, but having the informed knowledge is power when it comes to making the best decisions for you and your body. *WHO global anaemia estimates: Anaemia in women and children (2021)

The best time to take iron is on an empty stomach, so ideally at least one hour before or two hours after eating. Taking an iron supplement will depend on a number of factors which we’ll explore in full detail. This article is for you if: You want to find out the best times to take iron for women, men and vegetarians/vegans. You want to learn why you need iron. How it is absorbed in your body. When is the best time to take iron for women? For adult and teenage females, the recommended minimum daily intake of iron is between 10 and 15 mg. The best way to ensure that your body completely absorbs iron is to take it in the morning on an empty stomach. When is the best time to take iron tablets during pregnancy? When you’re pregnant, you need at least 27 mg of iron every day, which is almost twice the amount you normally need. That’s because your body has an increased blood volume. Around 40% of pregnant women have inadequate iron levels throughout their pregnancy.* Taking an iron supplement can help you reach your daily iron needs. A sustained suboptimal intake of iron can lead to suboptimal iron levels which can result in your baby being born with low birth weight or being born too early. Pregnant women with morning sickness or a sensitive stomach should take iron later in the day to ease their digestion. When you’re breastfeeding, you’ll need at least 9 mg of iron every day. However, for some women postpartum their needs may be higher. If you don’t have problems with your stomach (morning sickness, reflux, etc.), take your iron supplement first thing in the morning. When is the best time to take iron for men? Adult and teenage males need about 10 mg of iron per day to maintain healthy levels. Typically, men store more iron in their bodies than women. However, they might still need to take iron, especially if they are participating in high-intensity exercise such as cycling or running. Also, if you have malabsorption issues such as IBS or low stomach acid, you may benefit from an increased iron intake. If you decide to supplement with iron because you are feeling tired, experience low concentration or any other signs you could benefit from increasing your iron levels, make sure you’re taking it first thing in the morning. When is the best time to take iron when you’re vegetarian or vegan? As a vegetarian or vegan, it’s likely that you have less iron in your body than people who follow an omnivorous diet. Many iron-rich, plant-based foods decrease your intake due to the high levels of oxalates in your food which block iron absorption. This is also true for iron supplements, so we would recommend taking iron away from your meals. Experts recommend that vegans and vegetarians take an iron supplement each morning on an empty stomach. For better absorption, take it with a drink containing vitamin C. When is the best time to take iron (before or after exercise?) Lower iron intake is common in endurance athletes such as triathletes, marathon runners etc., with almost 60% of all female athletes and 40-50% of all male athletes being affected by inadequate iron levels in any given year. Researchers believe that athletes may need more red blood cells to carry oxygen during exercise. If you have a low intake of iron-rich foods, supplementing to bring them up can improve your energy levels, as well as your physical and mental performance. If you’ve checked your levels and you’ve realized that you need to supplement with iron, take them at least one hour before your workout or two hours post-workout to ensure optimum absorption. Tips on how to take iron supplements correctly Our bodies absorb iron best on an empty stomach. Active Iron is clinically proven to improve iron absorption while reducing the likelihood of cramps, nausea, and diarrhoea. It is a good idea to wait at least two hours after having food if you forget to take your iron supplement on an empty stomach. Why do you need iron? Iron is an essential micronutrient. Your body needs iron to produce haemoglobin, a necessary ingredient in the production of red blood cells. Haemoglobin carries oxygen from your lungs to the rest of your body. Iron also contributes to the reduction of tiredness and fatigue and supports the normal function of the immune system. Given how essential iron is for your body, it is a good idea to figure out if you’re getting enough iron from your diet. Keeping a diet diary or using an app to monitor your intake can be useful. If you are not meeting your body’s iron needs, you might experience some of the following*: Tiredness Paleness Shortness of breath Headaches Irregular heartbeats Weakness Poor appetite This could be for a variety of reasons – too much exercise, malabsorption issues, or just a diet that’s low in iron. Whatever the case may be, if you are unable to close the gap through diet alone, an iron supplement can help you to ensure that you’re getting an adequate amount of iron to meet your daily need. How is Iron absorbed? There are two types of iron – haem and non-haem iron. Haem iron can only be found in animal proteins, while non-haem iron is found in both animal and plant-based foods. Haem iron absorbs easier compared to non-haem iron. Some foods, such as tea and milk, diminish your absorption of iron. (That’s why people who take iron supplements usually avoid these foods in the hours after taking their supplement.) Because of this, the safest way to take iron supplements is on an empty stomach with water or a drink that contains vitamin C. Research suggests that 80% of the world’s population don’t consume enough iron to meet their bodies needs. To naturally increase your iron intake, you can start incorporating more iron-rich foods into your diet. These include: Shellfish All shellfish are incredibly nutritious. Mussels, clams and oysters are excellent sources of dietary iron. The US Department of agriculture reports that 100 grams of clams contain up to 17% of your daily iron requirement – or around 3 mg.  They are also incredibly high in vitamin C, which naturally eases absorption. Spinach Spinach is a source of non-haem, which means it usually doesn’t absorb well. However, spinach is also high in vitamin C, which is known to significantly improve iron absorption. 100 grams of spinach equal 2.7 mg of iron. Red meat Red meat is highly nutritious, and 100 grams of ground beef has 2.7 mg of iron. Meat is abundant in high-quality protein, several B vitamins, zinc, and selenium. It’s one of the most accessible sources of haem iron. Turkey Turkey meat, especially dark turkey, is chock-full of protein and iron. It’s a great source of a variety of vitamins and minerals. 100 grams of turkey meat will give you an average of 1.43 mg iron. Dark Chocolate Tasty, nutritious, and rich in iron, 28 grams of dark chocolate contains, on average, 3.4 mg of iron. It also works as an antioxidant, promoting friendly bacteria in your gut. Make sure you’re aiming for dark chocolate with at least 70% cocoa. Conclusion As a rule, people that take an iron supplement should take it in the morning, on an empty stomach, with water or a drink containing vitamin C. For those who have a sensitive stomach, their best bet is to take their iron right after a meal. But as you know, not all supplements are created equal. When choosing your iron supplement, you should be aware of two major problems: Low absorption Stomach irritation Finding and using an iron supplement that is easy on your stomach and improves your absorption will make it easier for you to stay consistent with a schedule. Active Iron is clinically proven to provide higher absorption of iron than other oral irons on the market*. * Note: These symptoms may indicate a medical condition, and this should be ruled out before deciding to increase your iron intake. * Garzon et al, Oman Med J. 2020 Sep; 35(5): e166** Wang et al. 2017, Acta Haematological, 138: 223-232*** ¹Ledwidge, M. et al. PRECISION Study. Int J Clin Pharm (2023) https://doi.org/10.1007/s11096-023-01640-7

Active Iron Partners with Clue to Help Women Combat Menstrual Fatigue and Manage Reproductive Health

Pictured left to right: (Front) Pat O Flynn (Solvotrin Therapeutics), Mark Lotter (Nuance Pharma), (Back) Eva Su (Nuance Pharma), Libin Song (Enterprise Ireland), Tadhg O'Callaghan (Enterprise Ireland), Micheál Martin (Taoiseach), Ronan McClafferty (Solvotrin Therapeutics), Dr. Nicholas O'Brien (Ambassador of Ireland) and David Murphy (Consulate General of Ireland). SHANGHAI, January 7, 2026 - Solvotrin Therapeutics, a leading Irish healthcare developer, has officially announced an exclusive agreement with Nuance Pharma to distribute Active Iron in China. This partnership leverages Nuance Pharma’s robust commercial expertise in iron deficiency and women’s health to bring Ireland’s premier iron technology to a broader patient base.  The announcement was made during a Consulate General of Ireland Business Dinner at the Fairmont Peace Hotel, held on the occasion of the visit of An Taoiseach, Mr. Micheál Martin T.D. The event was hosted by the Consul General of Ireland, Mr. David Murphy, alongside Enterprise Ireland, IDA Ireland, and Bord Bia. Key attendees included Pat O’Flynn (CEO) and Ronan McClafferty (COO) of Solvotrin Therapeutics, and Mark Lotter (CEO) and Eva Su (VP, Commercial Excellence) of Nuance Pharma.  Pictured left to right: Pat O Flynn (Solvotrin Therapeutics), Mark Lotter (Nuance Pharma), Micheál Martin (Taoiseach),  A Breakthrough in Iron Supplementation Developed in collaboration with Trinity College Dublin, Active Iron’s patented SCFA Protein Iron technology marks a major breakthrough. This clinically proven product is renowned for superior tolerability and efficacy, solving the long-standing challenges of "iron intolerance" and "absorption bottlenecks." By delivering iron directly to the most active site of absorption via a unique protein-protected formula, it maximizes uptake while significantly minimizing side effects like nausea and constipation.  “We are pleased to announce this strategic partnership with Nuance,” said Pat O’Flynn, CEO of Solvotrin Therapeutics. “Nuance’s agile, innovation-led model makes them the ideal partner to introduce our trusted, clinically driven solutions to China. We also acknowledge the support of Enterprise Ireland in facilitating the initial engagement. Active Iron is now a leading brand across Europe and the United States, and we look forward to bringing a trusted, clinically driven solution to consumers in China.”  Mark G. Lotter, CEO of Nuance Pharma, added: “Partnering with Solvotrin represents an exciting opportunity to address a broader spectrum of iron-related health needs, particularly in women’s health. We look forward to making this standout product accessible to patients across China.” 

Many people feel the positive effects of taking an iron supplement after three weeks, but it may take up to 12 weeks to feel a noticeable increase in iron and energy levels¹.  Iron needs differ from person to person; as such, everyone feels the effects of iron supplementation on their own timelines. Each person will experience different levels of sensitivity, side effects, and positive improvements from iron supplements.  Here we will break down some of the most common questions about restoring iron levels, so you can be confident that you are getting the most from your iron supplement.   How Long Will My Iron Supplement Take To Work & What Does That Mean?  If you were to Google “How long does it take for iron supplements to work?” the current AI-generated answer suggests one to four weeks. However, it’s impossible to predict exactly when you’ll feel the effects. Several factors influence iron absorption and the rate at which your body responds, including the time of day you take iron, your overall iron requirements, and your individual metabolism. It’s also important to distinguish between how long it takes for iron to “work” (typically when you notice improved energy) and how long it takes for your body to absorb iron.  How Long Does It Take Active Iron To Work?   Active Iron is clinically proven to increase iron and energy levels within six weeks¹, though many people notice improvements after about three weeks. The timing depends on how efficiently your body absorbs iron. Active Iron is formulated for optimal absorption², helping your body gradually build iron stores so you can start feeling the benefits within a few weeks, depending on individual differences. Active Iron is also clinically proven to be gentle and non-constipating and can be taken on an empty stomach. How Long Does It Take For Your Body To Absorb Iron?  The time it takes to restore iron in your body depends on several factors:  Reason for low iron levels: Low iron due to poor diet, heavy periods, or blood loss can affect how quickly your levels recover.  How low your levels are: The further below normal your iron levels are, the longer it takes to replenish them.  For example, if you experience regular or heavy periods, it may take longer to rebuild iron stores because you continue to lose iron. On the other hand, if dietary intake is low but supplementation is consistent, iron levels can improve more steadily, especially with supplements designed for good absorption.  What To Consider When Taking Iron Supplements  Maintaining an iron-rich diet can be challenging, especially if you follow a restricted diet, e.g. vegetarian.   Foods that can reduce iron absorption  Certain foods and nutrients naturally inhibit iron absorption, making it harder to reach optimal iron levels. These include:  Phytic acid (commonly found in grains and legumes)  Tannins  Polyphenols (found in tea, coffee and matcha)  Milk  Caffeine  Some proteins present in soybeans  Given that many people start their day with a cup of coffee or a bowl of milk and cereal, it’s easy to see why getting enough iron can be a challenge.  Foods That Can Increase Iron Absorption  Some foods can increase your body’s ability to absorb iron and are often recommended alongside iron supplements. These include:  Citrus fruits and citric acid – lemons, oranges, orange juice  Vitamin C-rich foods  Foods containing vitamin A and beta-carotene  Incorporating these foods into your diet can help improve iron absorption and support your overall iron levels.  If you feel tired and fatigued all the time or suspect having low iron levels, the best step is to consult your GP. They can perform a blood test to identify whether low iron is contributing to your wellbeing and determine the underlying cause. When you speak to your GP, we would recommend asking them to check both your ferritin and haemoglobin levels, as these give a fuller picture of your iron stores and overall iron status. Based on the results, your GP can advise if an iron supplement would be suitable for you.  Conclusion: How Long do Iron Supplements take to Work?  Iron supplementation can take several weeks to show noticeable effects, with timing varying based on individual needs, absorption efficiency, and dietary factors. Combining supplements with an iron-friendly diet can support faster recovery. Active Iron is a good choice for those looking for a supplement, as it is clinically proven to increase iron and energy levels¹ while being gentle on the stomach.   Iron Absorption FAQ’s  How quickly do iron supplements work?  Many people feel the positive effects of taking an iron supplement after three weeks, but it may take up to 12 weeks to feel a noticeable increase in iron and energy levels.  How long should I take iron supplements for?  Iron supplements should be taken for at least 6 months and up to 12 months. The best way to ensure adequate absorption is to take them on an empty stomach or allow 2 to 3 hours between meals, as certain foods, drinks, and medicines may inhibit iron absorption.  How long does it take to raise iron levels with food?  Raising iron through diet alone can be difficult, especially for those with increased needs, e.g. restricted diets, pregnancy, and heavier periods. Dietary iron comes in two forms: Haem and Non-Haem. Haem iron, found in red meat, offal, and poultry, is absorbed more easily and is best for boosting iron levels. Non-Haem iron sources include fortified cereals and leafy greens like broccoli and cabbage.   How do you know if iron tablets are working?  Everybody responds to iron supplements differently, but most people can expect to see an improvement in their energy levels, an improvement in their ability to concentrate and a healthier immune system.   These signs may not be very pronounced, so it’s still important to review how much iron you consume through your diet and how well your iron pills are being absorbed.  If you have any concerns that your iron pills are not working, you should consult your GP.     Sources:   Ledwidge, M. et al. PRECISION Study. Int J Clin Pharm (2023) https://doi.org/10.1007/s11096-023-01640-7   Wang et al. 2017, Acta Haematologica, 

Among the body’s essential minerals, iron and calcium stand out as two of the most important. Iron’s main role is to help transport oxygen around the body. It’s also important for brain function¹ and a healthy immune system. Calcium is vital for maintaining strong bones and teeth², and it also plays an important role in normal blood clotting. For optimal health and well-being, calcium and iron are essential components of a balanced diet.  Calcium & Iron Absorption  Calcium can affect iron absorption, especially non-haem iron found in plant-based foods. In some studies, ³⁴ calcium has been shown to bind to iron in the gut, making it more difficult for the body to absorb. This effect is stronger with larger amounts of calcium, such as from supplements or dairy products. Calcium can also slightly reduce the absorption of haem iron from animal sources, but the effect is generally smaller. Over the long term, and in the context of a normal diet, calcium’s impact on iron absorption is usually minor.  Can you take Calcium & Iron Together?  As part of a balanced diet, it’s perfectly safe to consume calcium and iron together. However, to maximise iron absorption, it can help to consume high-calcium foods or supplements a few hours apart from iron-rich meals. In an ideal world, we would get all the calcium and iron we need from our diet. However, some people struggle to meet their needs through food alone, so they take calcium and iron supplements to help maintain healthy levels of both nutrients.  When it comes to taking calcium and iron supplements, it’s best not to take them at the same time. Calcium can have a short-term effect on iron absorption. To avoid this, take your iron supplement separately from your calcium supplement. It is recommended to allow 3-4 hours between taking your iron and calcium supplements. Generally, the best time to take your iron supplement is between meals or 30-60 minutes before eating. This includes tea, coffee, and dairy products.  Foods Rich In Iron & Calcium  Here’s a list of the best foods to eat if you want to increase calcium and iron in your diet.  Food Group Examples Nutrient Focus  Meat, Fish & Eggs  Red meat, canned tuna, sardines, eggs  High in both iron and calcium (especially sardines with bones)  Beans & Lentils  Lentils, chickpeas, kidney beans, black beans  High in iron; moderate in calcium  Vegetables  Kale, spinach, broccoli, bok choy  High in calcium; leafy greens also contain iron  Nuts & Seeds  Pumpkin seeds, almonds, walnuts, sesame seeds  Moderate to high in both iron and calcium  Fruits  Dried fruits (raisins, apricots, prunes)  High in iron  Oranges, blackcurrants, blackberries   High in calcium    Can I Take Active Iron with a Calcium Supplement?   Yes, you can take Active Iron and a calcium supplement, but it’s best to take them at different times. Try to leave about 3–4 hours between each to support optimal absorption. Taking iron on an empty stomach can also help your body absorb it more efficiently. Active Iron’s ground-breaking formula is gentle on the stomach and easy to absorb³. Active Iron’s clinically proven formula provides a higher rate of absorption of iron than other oral irons on the market. Active Iron is so gentle that you can take it on an empty stomach.  Conclusion: Iron & Calcium   Iron and calcium are essential minerals, vital to our health and wellbeing. With today’s busy lifestyles, getting enough from the food we eat alone can be a challenge. For many people, iron and calcium supplements offer the perfect solution. And the good news is, it is possible to take calcium and iron together. Just make sure you take them at different times of the day to get the best results.  Our expert team is here to help. If you have any concerns about taking Active Iron with your calcium supplement, please email us at info@activeiron.com  References: ¹Iron contributes to normal cognitive function  ²Calcium is needed for the maintenance of normal bones and teeth  ³The Journal of Nutrition doi: 10.1093/jn/nxaa437  ⁴The American Journal of Clinical Nutrition, Volume 53, Issue 1, January 1991, Pages 112–119, https://doi.org/10.1093/ajcn/53.1.112  ⁵Wang et al. 2017, Acta Haematologica, 138: 223-232   

This article is for you if: You want to learn the best time to take vitamins You want to learn more about each vitamin inside your average multivitamin Should You Take Vitamins in the Morning or at Night? To answer the first question right off the bat, the best time to take vitamins and supplements will largely depend on what vitamins you are taking. Not all vitamins are created equal. Moreover, when most people say vitamins, they mean micronutrients that fall into both the vitamin and mineral categories. Some of them should be taken in the morning with a meal to maximise absorption. Others are best taken in the evening before bed. Let’s talk about vitamins and minerals for each of the main groups you can find in the store: Multivitamins Vitamin B Vitamin D Vitamin C Vitamin E Folic acid  Magnesium Omega-3 Fatty Acid Zinc Getting adequate levels of vitamin C, D, and iron is essential for a healthy immune system. Your immune system is your body’s natural defence against illness. If you are unable to meet your nutritional needs solely through food, supplementing with multivitamins in conjunction with iron supplementation is an effective way to support your immune system. However, Food supplements are not a substitute of a healthy and balanced diet and lifestyle CTA HERE Best Time to Take Multivitamins You should take your multivitamins in the morning with a meal to maximise absorption. However, if this causes any stomach issues, try taking them before bed. Remember, consistency is key here! People who can benefit the most from taking multivitamins are: Adults Vegans & Vegetarians When is the Best Time of Day to Take Prenatal Vitamins? Pregnant and breastfeeding women may benefit from taking prenatal vitamins because of their increased requirement for essential nutrients. However, it is advised that pregnant women or those on medication check with a healthcare professional before taking vitamin or mineral supplements.  As with traditional multivitamins, prenatal vitamins are best taken in the morning, with a meal, and consistently. According to the Cleveland Clinic, the best time to take vitamins D, C, and B, are as follows: Best Time to Take Vitamin D: Vitamin D is fat-soluble, meaning it doesn’t dissolve in water, so you should pair it with high-fat foods to ensure proper absorption. It is essential to incorporate Vitamin D into your routine, ideally alongside breakfast or as part of your bedtime snack (as long as it doesn’t interfere with your sleep). Vitamin D is best taken in the morning, lunchtime, or evening, when you have high-fat foods such as a glass of whole-fat milk, avocado, olive oil, or flax. Best Time to Take Vitamin CVitamin C is a water-soluble vitamin, meaning it is best taken with water. You should take vitamin C in the morning, on an empty stomach.  Best Time to Take B Vitamins The best time to take B vitamins is after you wake up, preferably with a meal to maximise absorption¹.  What role does each B vitamin play?Vitamin B-1 is known as Thiamine. Thiamine contributes to normal energy-yielding metabolism, normal functioning of the nervous system, psychological function, and the normal function of the heart. Good sources of Vitamin B-1 include: Pork Fish (like salmon and tuna) Legumes (like beans and lentils) Nuts (like sunflower seeds and pecans) Whole grains (like brown rice and oatmeal), fortified cereals, and eggs. Vitamin B-3 is also called Niacin. Can be incorporated into your diet through peanuts, fish, brown rice, and whole grains. Vitamin B-6 contributes to normal protein and glycogen metabolism. It is vital for the efficient breakdown of food - particularly carbohydrates - into smaller units the body can utilise. Additionally, Vitamin B6 helps regulate hormonal activity. Good sources include bananas, tuna, chickpeas, and pistachios. Vitamin B-9, also known as Folate, contributes to normal blood formation. It’s one of the building blocks of DNA and RNA. Good sources include avocados, leafy greens, broccoli, green peas, and more. Vitamin B-12 is only found in animal products. Vitamin B-12 is crucial to the normal functioning of the nervous system. It helps to create and regulate RNA, and it’s also involved in the formation of red blood cells. The best time to take vitamin B-12 is in the morning, similar to all B vitamins. Best Time to Take Omega-3 Fatty Acids (Fish Oils)Omega-3 fatty acids are “healthy fats” and can be taken at any time of the day. To improve the absorption of omega-3, you should take it with a meal that includes fats² such as avocado, flax, or whole-fat milk. This can help reduce the side effects as well as enhance the effectiveness of the supplement. Omega-3 (EPA & DHA), found in fish oil and seeds like flaxseed, is a vital nutrient for your body. DHA contributes to normal brain and eye function, while both EPA and DHA contribute to normal heart function. Best Time to Take Folic Acid Folic acid is the man-made version of Vitamin B9 (Vitamin Folate). Folate contributes to maternal tissue growth during pregnancy and normal blood formation. Supplemental folic acid intake increases maternal folate status. Low maternal folate status is a risk factor in the development of neural tube defects in the developing foetus. This beneficial effect is obtained with a supplemental folic acid daily intake of 400μg for at least one month before and up to three months after conception. You can take folic acid at any time of the day. Folic acid is a water-soluble supplement, meaning it is best to take it with water. Best Time to Take Magnesium Most healthcare professionals would recommend taking magnesium with a meal due to the possible gastrointestinal side effects if a high dose is taken, which could cause diarrhoea on an empty stomach³. As a result, you can split the dose into two (breakfast and dinner). Magnesium is an essential nutrient that affects many functions in the body. Magnesium contributes to electrolyte balance, normal protein synthesis, psychological function, the maintenance of normal bones and teeth, normal muscle and nervous system function and reduction of tiredness and fatigue. Magnesium is such an important mineral that, even if you’re not taking it at the “perfect time”, just the fact that you’re taking it consistently is more than enough. Best Time to Take Vitamin E Vitamin E contributes to the protection of cells from oxidative stress. Vitamin E is a fat-soluble vitamin that requires natural fat in our meals for absorption and works best when taken with a meal containing fat. Best Time to Take Zinc Zinc contributes to the normal function of the immune system. It is best to take zinc one or two hours before meals, with a glass of water. You can take zinc at any time of day. Best Time to Take Water-Soluble vs Fat-Soluble Vitamins In this guide, we have already touched upon several fat-soluble and water-soluble vitamins individually. For example, Vitamin D is a fat-soluble vitamin, meaning it is best taken with high-fat foods. As a result, the best time of day to take fat-soluble vitamins should be based on your eating pattern and when this type of vitamin will be most easily absorbed. This can mean taking them after your breakfast or your last meal of the day. On the other hand, water-soluble vitamins are best taken on an empty stomach. This can mean taking them as soon as you wake up or more than two hours after eating. An example of water-soluble vitamins includes Vitamin C, which also occurs naturally in several popular products, including orange juice. Can I take my Vitamins at Night? You can choose to take any vitamin at night that does not interrupt your sleep or will not affect the absorption of the vitamin. As a result, you can take the following vitamins at night: Iron Vitamin D Vitamin C Vitamin E Magnesium When to Take Vitamins Chart Our easy-to-follow table has combined all of the content above to show the best time of day to take each type of vitamin supplement.  Type of Vitamin Best Time of Day to Take Multivitamins Morning - with a meal. Prenatal Vitamins Morning - with a meal. Vitamin B  Morning - with a meal. Vitamin D  Any time - with a meal containing fat, like avocado or whole-fat milk. Vitamin C Morning - empty stomach, with water. Folic Acid Any time - with water. Iron Any time - on an empty stomach, or 1-2 hours between meals. Magnesium Any time - with a meal. Omega-3 Fatty Acids Any time - with a meal containing fat, like avocado or whole-fat milk. Vitamin E Any time - with a meal containing fat, like avocado or whole-fat milk. Zinc Any time - 1-2 hours between meals with water.   Conclusion Some vitamins and minerals have golden windows that reduce irritation or boost effectiveness, so check with your doctor for interactions with medications. The takeaway here is consistency is key - make them part of your morning or bedtime routine to build the habit and maximise benefits. References: ¹Cleveland Clinic, 2021 https://health.clevelandclinic.org/the-best-time-to-take-vitamins ²Veronica Zambon, 2025 https://www.medicalnewstoday.com/articles/when-to-take-fish-oil ³Rachael Ajmera and Sandra Silva, 2025 https://www.healthline.com/nutrition/best-time-to-take-magnesium

Tired of the gastrointestinal side effects associated with most iron supplements? In this article, we will explore ways to increase your iron levels, without the nasty side effects!

Iron-rich cereals offer a simple, delicious way to support your iron levels! In this article, we will explore cereals that have a high iron content. Pair your bowl with vitamin C-rich fruits like strawberries or oranges to maximise absorption, and you’ve got a powerhouse breakfast that fuels both your body and mind.

At Active Iron, we aim to provide the best possible support for your health, especially during pregnancy and beyond into the postnatal period. With this in mind, we have an important update regarding our Active Iron Pregnancy range. We have decided to discontinue our Active Iron Pregnancy 17mg product and Active Iron Pregnancy Plus and have launched a new and improved Active Iron Pregnancy.  During pregnancy, the amount of blood in your body increases by up to 50%. This increases the requirement for iron as it is needed to make haemoglobin, which carries oxygen around your body. We are recommending Active Iron Advance 25mg for those looking for an iron-only product in pregnancy, and the new Active Iron Pregnancy for those looking for a complete nutritional solution for mum & baby. Why Active Iron Advance? Active Iron Advance offers the same great formula in a higher 25mg dose to fulfil the increased iron requirements during pregnancy. It is specially formulated to help avoid side effects such as nausea and constipation, making it kind on the stomach while also being strong enough to increase iron levels. Active Iron Advance is clinically proven to increase iron levels by 94% in 6 weeks*, making it a comfortable and more effective iron supplement for expectant mothers. Why Active Iron Pregnancy? Active Iron Pregnancy provides the essential nutrients mum and baby need throughout each trimester. During pregnancy, your blood volume expands by up to 50% and nutritional requirements increase to support the healthy development of your growing baby. This boosts your requirement for iron and other key nutrients. Active Iron Pregnancy contains non-constipating Active Iron plus a complete time-release multivitamin providing all the key nutrients mum and baby need throughout pregnancy, including: Iron and B Vitamins (B2, B5, B6, B12, and biotin) to support energy production and help fight tiredness and fatigue Iron to support blood building and oxygen transport Folic acid as highly absorbable L-Methylfolate to help support foetal development** Vitamin D, vitamin C, zinc, and iron to support immune function Vitamin B5 to support mental performance and iron, iodine, and zinc to support cognitive function Calcium, magnesium, vitamin D, and vitamin K to support bone and muscle health Vitamin B6 to help regulate hormonal activity Vitamin E, copper, and selenium to help protect cells from oxidation. New Clinical Study To continue supporting our claims on Active Iron, in 2024, we initiated a brand-new clinical study with pregnant women. This study, conducted in partnership with Ulster University, will focus on the impact of iron supplementation during pregnancy, and the benefits of early intervention of iron supplementation on outcomes for mum & baby. *Ledwidge, M. et al. PRECISION Study. Int J Clin Pharm (2023) https://doi.org/10.1007/s11096-023-01640-7