I've been struggling with low iron going on two decades now, caused by heavy menstrual losses. I'm able to keep my ferritin levels above 25 most of the time, but only with a lot of work. I already cook on cast iron and have never been a vegetarian. I take oral iron almost daily.
Optimizing your absorption of iron can get pretty complicated.
To enhance absorption: Take it with B12+folate, Vitamin C, and heme-iron containing animal foods. Darker red meats are good, liver is the best. I get a pate at the farmer's market at least once a month. Chelated (with amino acids) or carbonyl forms of iron supplements are not as harsh on the stomach and GI tract as iron salts (ferrous sulfate, gluconate, whatever-ate).
Avoid taking it with: Certain medications are negatively affected by being taken within 6 hours of iron (most notably for me is thyroid medication). Molecularly similar metals (zinc, cobalt, molybdenum, etc.) compete with iron receptors and reduce absorption of iron. Most importantly, avoid taking it with foods that are high in polyphenols, because these bind non-heme iron and reduce absorption as well. Notable sources of polyphenols include berries, tea, beer, grapes/wine, olive oil, chocolate/cocoa, coffee, walnuts, peanuts, borojo, pomegranates, popcorn, yerba mate, and other fruits and vegetables.
Because of everything I've just mentioned, I'm talking to my doctor about an iron sucrose (Venofer) infusion. The older Dextran forms of intravenous iron have a higher high potential for anaphylaxis, but newer iron sucrose seems to be much better tolerated by lots of patients. It's still only officially approved for anemia management in dialysis patients, but more and more healthcare practitioners are realizing that it's extremely useful for people with chronic low iron as well as acute iron depletion (postpartum, surgery, etc).



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) just not within a few hours of taking your oral iron supplements.
