The Problems With Ferro-grad C & Maltofer

Unfortunately the standard recommendations for low iron are almost always:

  1. Ferro-grad C;
  2. Maltofer;
  3. A Mirena;
  4. An iron infusion.

Today, let’s take a closer look at the first two.

Quite simply, no one should be prescribing Maltofer or Ferro-grad C at 100mg (1 tablet)/day. And most certainly, no one should be prescribing 200mg or 300mg/day when the initial dose fails to work.

And why does the initial dosage fail? The dosage is part of the problem.

High iron causes hepcidin, the key regulator of iron entry into circulation, to rise and this will cause serum iron levels to drop due to iron trapping. The real irony is that as hepcidin is a negative regulator of intestinal iron absorption, iron entry is blocked for some time and the deficiency worsens. See: mucosal block mechanism.

An additional problem is that the specific forms of iron can be problematic for many. Maltofer is iron polymaltose and Ferro-grad C is a ferrous sulphate. Both claim to reduce gastro-intestinal side effects, but in reality they cause constipation in the majority. This has led to a common belief that all iron supplementation causes constipation, when it can be purely related to the form. 

These recommendations simply do not reflect a true understanding of the complex nature of iron physiology. And the fact that they can actually make your deficiency worse and negatively impact your microbiome via inflammation and/or feeding harmful pathogens should be a big concern.

Have you been prescribed either of these products? Please share your experience below.

For support interpreting your iron studies and resolving your iron deficiency, book a complimentary 15-minute Zoom consultation here:


Galy B, Ferring-Appel D, Becker C, et al. Iron regulatory proteins control a mucosal block to intestinal iron absorption. Cell Rep. 2013;3(3):844-857. doi:10.1016/j.celrep.2013.02.026

Tolkien Z, Stecher L, Mander AP, Pereira DI, Powell JJ. Ferrous sulfate supplementation causes significant gastrointestinal side-effects in adults: a systematic review and meta-analysis. PLoS One. 2015;10(2):e0117383. Published 2015 Feb 20. doi:10.1371/journal.pone.0117383

Verma S, Cherayil BJ. Iron and inflammation – the gut reaction. Metallomics. 2017;9(2):101-111. doi:10.1039/c6mt00282j

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