All right, so we're moving on with the third lecture on iron deficiency anemia.

And I want to start with something that a listener pointed out to me in an email after the last

lecture, and that is an article from the American Journal of Medicine in 2005.

And the article is titled, Low Low Dose Iron Supplementation was

effective in older patients with iron deficiency anemia. So if you remember from the last

lecture, I said, I am not going to tell you exactly what I do for oral iron replacement because I'm not sure it's any

better than what you do. And this randomized controlled small study of about 90 patients, and they

were all older patients, all greater than 80 years old, showed that we really have to take a lot of things into account

when we decide what is the ultimate dosing of oral iron.

And that conventional dosing, 150 milligrams a day, and I'm talking about elemental iron given in a day.

So if you were going to give 150 milligrams a day of total elemental iron, it's not surprising

that the side effects of that dosage would be worse than giving 50 milligrams a day or 15

milligrams a day. And in this study, they looked at all three

of those dosings, 150 milligrams versus 50 milligrams versus 15 milligrams of elemental iron in a day.

And while the follow-up period was rather short, meaning they only followed up these patients

for 60 days, which probably

is not long enough, and that's one of the many criticisms of this study. It was interesting

to note that whether you got the 150 milligrams of elemental iron a day or 15 milligrams of

elemental iron a day, the hemoglobin levels really did

not differ between those two groups at the end of 60 days. Again, the dropout rate's pretty high

if you go with high dose iron. So what we may want to be doing is starting with lower dose iron orally, and if it's

tolerated, then we can move on to the higher dose and higher frequency of iron. And then there is some

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