I am anemic and have been taking iron tablets forever; why don't they help?

There are many answers to this question. First of all, there are many causes of anemia, and if your anemia is not the result of iron deficiency, taking iron won't be helpful. You need to have your doctor determine the cause of the anemia before undertaking treatment for it. If you are taking over the counter iron pills or vitamins with iron, these preparations have less iron than prescription strength iron. It can take a very long time (months or years) to correct iron deficiency. Iron absorption takes place in the duodenum, the beginning of the small intestine. It is a very inefficient process with only about 2% of ingested iron being absorbed under the best of circumstances. If you have any disease of the first part of the small bowel, iron absorption will be even less efficient with maybe as little as 0.5% of the ingested iron being absorbed. Iron absorption in the duodenum also requires the presence of stomach acid to convert the ingested iron to a form which is absorbed more efficiently. If you need to take acid lowering medications for other gastrointestinal problems such as gastroesophageal reflux or ulcer, the reduction of stomach acid will also reduce the efficiency of iron absorption from your duodenum.