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Large oral doses of iron acutely increase SHep in a dose-dependent fashion, with the increase in SHep persisting for ~24 hours (h).178 The increase after iron administration is distinct18 from the natural circadian increase in SHep over the day.19 We previously showed that twice daily administration of 60 mg oral iron sharply augments the circadian SHep increase and results in higher SHep on the next day compared to once daily dosing with 120 mg iron.17 In iron-depleted young women given doses 60 mg of oral iron in the morning, SHep increases and is followed by a decrease in iron absorption on the following day.8 Consequently, alternate day dosing results in a higher FIA compared to daily dosing.8 In a study comparing iron absorption from 60 mg doses during 28 days of alternate day versus 14 days of consecutive day supplementation, FIA was significantly higher (+33%) with alternate day dosing.17 In addition, due to the acute SHep increase after an oral iron dose, splitting a dose into two daily divided doses did not increase iron absorption.17 However, these studies were conducted in iron-depleted women without anemia

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Learn more about the causes of vitamin B12 deficiency

The good news is that these side effects are often mild and temporary