Archive for the ‘Iron’ Category

Response to 2 of Christina Sterbenz’s 7 Reasons to Keep Eating Meat

Tuesday, October 1st, 2013

On September 30, Christina Sterbenz had an article on Business Insider, 7 Reasons Why I Refuse To Stop Eating Meat. I’d like to quickly respond to a couple of her reasons.

Iron is the number one reason Sterbenz gives for continuing to eat meat:

“Yes, vegetables contain iron — but not the good kind. Consuming plants gives your body nonheme iron, a version less easily absorbed by the body….Heme iron, the better type, only comes from life forms with hemoglobin, such as red meat, pork, poultry, and fish.”

While it is true iron from meat is more absorbable than from plants, this would only be a problem for people who are prone to iron-deficiency anemia. I have not come across a vegetarian man diagnosed with iron deficiency anemia that I can remember and none have been reported in the studies on vegetarians and iron deficiency. Some vegetarian women are iron deficient but this can be corrected by changing some habits, like eating foods higher in iron combined with vitamin C, and avoiding coffee and tea at meals. But if you are absorbing enough iron (as most vegetarians are), the iron from plants works just as well as the iron from meat.

In fact, while vegetarians normally do not have iron deficiency, they do have lower levels of iron which may reduce their risk of diabetes. And the good type of iron that Sterbenz touts, heme iron, is associated with colon cancer while the iron from plants is not (more information on iron and chronic disease).

Sterbenz writes, “Also, spinach, considered one of the most iron-rich leafy greens, doesn’t have as much as many believe. But we grew to love it after a German chemist made a typo back in the day.”

Spinach is an excellent source of iron with 3 mg per 1/2 cup cooked. A full cup of cooked spinach (not hard at all to eat) meets almost the entire RDA for men (8 mg) and 1/3 the RDA for menstruating women (18 mg).

Sterbenz: “3. Vitamin B12 only comes from animals.”

Actually, B12 only comes from bacteria. But it’s true that only animal foods naturally contain vitamin B12 in any reliable amounts. This hasn’t been a boon for spreading veganism, but it has actually given vegans who supplement better vitamin B12 status than many meat-eaters. Because it’s harder to absorb vitamin B12 from animal products (due to it being attached to proteins) the Institute of Medicine recommends that all people over the age of 50 get half of the RDA for vitamin B12 from fortified foods or supplements (citation). Vegans get the “good” type of vitamin B12. :)

Sterbenz then says, “Almost all multi-vitamins contain B12, as well. But recent research suggests vitamins might be useless,” and links to the article, Vitamin pills ‘are useless’, which describes a study that found supplementing with beta-carotene, vitamin E, and vitamin C did not prevent cancer, heart disease or stroke. This is completely different than showing that vitamin B12 supplements are useless. On the contrary, it is well-documented, conclusive, and without controversy in the mainstream medical and nutrition community, that vitamin B12 supplements work at preventing and correcting vitamin B12 deficiency.

“Much of the pro-vegetarian research out there will try to convince you that humans are natural herbivores, that we’re not meant to eat meat. In reality, our digestive characteristics show we’re omnivorous,..”

Finally, something I agree with. But I don’t believe we’re “meant” to eat anything. We evolved eating certain foods (including lots of insects) and now that we are more ethically evolved some of us are moving society away from killing animals for food.

Referring to a picture of oysters, Sternbenz says, “You know you want them too.”

Sterbenz might be surprised to know that, no, we really don’t want them. Rather than wanting them, I think, “You’re going to put that in your mouth and swallow it?”

That said, since Sterbenz says she cares about animals, I hope she will experiment with at least replacing more meat with oysters! Since she can stomach them, and apparently loves to eat them, she could help prevent animal suffering by eating oysters instead of pigs, cows, and chickens.

Even better, eat some spinach for iron, and try a nice juicy Tofurky sausage for protein and fat. I know meat-eaters don’t think it’s the same thing, but it’s pretty close and without the entrails.

Ginny Messina also responded to this article in her post 7 Reasons to Eat Meat? Here Is Why They Are All Wrong.

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Iron Supplements Improve Unexplained Fatigue in Premenopausal Women

Saturday, June 15th, 2013

A reader (thanks, Dan!) pointed out a follow-up study to one I had included in VeganHealth’s article Iron, about iron supplementation in women with unexplained fatigue who have low iron stores but do not technically have anemia. I updated the article:

“Two studies from Switzerland have shown that iron supplementation can reduce fatigue in premenopausal women (1, 2) whose hemoglobin levels are above 120 g/l (and thus not diagnosed with anemia). The most recent, from 2012 (2), was a double-blinded, randomized controlled trial in which 80 mg of ferrous sulfate (an iron supplement) per day for 12 weeks increased hemoglobin in women who had average serum ferritin levels of 22.5 µg/l. This increase in hemoglobin was matched with a 50% reduction in symptoms of fatigue (compared to only 19% for placebo). Improvements in hemoglobin were seen after 6 weeks.”

This study got me thinking… I remember back around 2001 when I was doing my dietetic internship at Georgia State. I was able to spend some time working at a couple of alternative health clinics that specialized in helping people with chronic fatigue. At that time, they were putting pretty much everyone on a low carb diet, which translated to more meat. I actually don’t know if many people made any sort of recovery from the fatigue – my memory is that one person I counseled had made a significant recovery while another hadn’t made any improvement, but I have no idea what the success rates were for the clinics. To the extent that a low carb diet helped, I wonder if it was merely due to the women getting more heme iron and curing an undetected deficiency.

Improving iron status is worth considering for anyone with fatigue whose hemoglobin is on the lower end of normal and who has a serum ferritin less than 50 µg/l.

Iron does seem to be a possible culprit in three of higher profile cases of young women becoming ex-vegan that come to mind, and perhaps it’s something to which our movement needs to be paying more attention.

While the studies above used iron supplements to increase iron status, don’t forget that adding a significant amount of vitamin C to meals has been shown to be better for increasing iron absorption than increasing iron (more info).

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References

1. Verdon F, Burnand B, Stubi CL, Bonard C, Graff M, Michaud A, Bischoff T, de Vevey M, Studer JP, Herzig L, Chapuis C, Tissot J, Pécoud A, Favrat B. Iron supplementation for unexplained fatigue in non-anaemic women: double blind randomised placebo controlled trial. BMJ. 2003 May 24;326(7399):1124. | link

2. Vaucher P, Druais PL, Waldvogel S, Favrat B. Effect of iron supplementation on fatigue in nonanemic menstruating women with low ferritin: a randomized controlled trial. CMAJ. 2012 Aug 7;184(11):1247-54. | link

VeganHealth Update: Iron and Vegetarian Diets

Thursday, June 13th, 2013

I have been silent lately due to updating the Iron article at VeganHealth.org. In the past, it has been just a mishmash of bits I’ve written as needed. It is now a well-organized, tight piece (I hope).

One new addition worth mentioning is on type 2 diabetes. Excerpt:

“There is evidence that the beta cells of the pancreas, which produce insulin, are particularly susceptible to oxidation from iron due to their weak antioxidant defense mechanisms. A 2012 meta-analysis of prospective studies found that higher iron stores (6 studies) and higher intakes (5 studies) of heme iron [a type of iron found only in meat] at baseline were strongly associated with a higher risk of type 2 diabetes (1). Higher intakes of non-heme iron were not associated.

“A cross-sectional study from the USA found lower ferritin [stored iron] levels in lacto-ovo vegetarians (35 µg/l) than meat-eaters (72 µg/l). The vegetarians also had higher insulin sensitivity. Upon giving phlebotomies to 6 male meat-eaters to reduce their ferritin levels, their insulin sensitivity increased. The authors suggested that the lower ferritin levels could be a reason why vegetarians had greater insulin sensitivity (2).

“It is possible that the lower risk of type 2 diabetes in vegetarians (see Type 2 Diabetes and the Vegan Diet), which has been shown to be independent of body mass index, could be partially explained by their lower iron stores.”

Link to full article: Iron. Warning: It’s long and not required reading. :)

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I haven’t checked out any new music lately, so I’m going to highlight some of my favorite music to work to:

Juana Molina: Vive Solo

Marco Beltrami & Buck Sanders: I Wanna Hold Your Hand

Philip Glass: Wichita Sutra Vortex

Philip Glass: Facades

Philip Glass: Metamorphosis: Metamorphosis Four

Philip Glass: Opening

Consider a gift basket from Pangea through the link below for Father’s Day or some other holiday!

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Vegan for Life: Everything You Need to Know to Be Healthy and Fit on a Plant-Based Diet from Amazon.com

References

1. Bao W, Rong Y, Rong S, Liu L. Dietary iron intake, body iron stores, and the risk of type 2 diabetes: a systematic review and meta-analysis. BMC Med. 2012 Oct 10;10:119. | link

2. Hua NW, Stoohs RA, Facchini FS. Low iron status and enhanced insulin sensitivity in lacto-ovo vegetarians. Br J Nutr. 2001 Oct;86(4):515-9. | link

Iron Status of Polish Vegetarian Children

Sunday, June 2nd, 2013

This past week, a study was released from Poland in which the diet and iron status of vegetarian children were investigated (1). To the researchers knowledge, it was the first study to examine the diet and iron status of Caucasian children, and I know of only one other study on any vegetarian children, a study from India that I mention below.

Some quick background: Meat contains about 40% of its iron as heme-iron, which is more easily absorbed than non-heme iron. Non-heme iron is the only iron found in plants. Because iron deficiency anemia is the most common nutrient deficiency in Western countries, especially among menstruating women who lose blood (and, therefore, iron) every month, there is a concern about vegetarians getting enough iron.

The study from Poland compared 22 vegetarian children (5 ate fish, none were vegan) to 18 omnivores, aged 2 to 18 years old. Of the vegetarian girls of menstruating age, 2 of the 5 had iron deficiency anemia, whereas none of the 4 omnivore menstruating girls had iron deficiency anemia. The researchers noted that their anemia was not due to menstrual period disorders, and that they had been trying to lose weight for “quite a long time.” Of the vegetarians, 36% (8) had iron deficiency compared to only 11% (2) of the omnivores.

Median iron intake in vegetarians was only 65% of the RDA, but the omnivores was even lower at 60%. 82% of vegetarian children did not meet the iron RDA while none of the omnivore children met it. As for vitamin C, which increases plant iron absorption, the vegetarians had higher intakes (171% vs. 95% of the RDA). The average vitamin C intake for the vegetarians was 69 mg per day.

As the vegetarian children got older, their iron intake decreased (as a percentage of the RDA). The researchers suggested that as the kids got into their teens, parents had less input on their food choices and the quality of their diets suffered.

There was no association found between vitamin C intake and iron status. A significant amount of other research has shown that vitamin C can greatly increase iron absorption from plants when eaten at the same meal. It’s possible that you need more vitamin C at meals than these children were getting. The research showing that vitamin C increases iron absorption uses doses from 50 mg up 500 mg per meal. In the study from India mentioned above, vegetarian children with iron deficiency anemia (and low vitamin C intakes) were given 100 mg of vitamin C at both lunch and dinner for 60 days. They saw a drastic improvement in their anemia, with most making a full recovery (2).

It might be a good idea for vegetarian kids, and especially teenage girls, to make sure they eat a food that has a large amount of vitamin C with at least two meals each day, especially meals with legumes. Some foods that are high in vitamin C per typical serving are orange juice and grapefruit juice (80 mg per cup), oranges (50 mg per small orange), broccoli (50 mg per 1/2 cup cooked, chopped), strawberries (85 mg per 1 cup of whole berries), grapefruit (40-50 mg per 1/2 fruit), yellow peppers (70 mg per 1/4 cup chopped), and red peppers (50 mg per 1/4 cup chopped).

I just added a large table of iron amounts in plant foods to the the article, Iron, at VeganHealth.org.

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As an aside, the note I had in my post about supporting JackNorrisRD.com by purchasing music through Amazon links might have seemed strange given that if you get my blog as an email via Feedburner, it did not include the links. So, I have reproduced them below. Thank you!

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Music I’m listening to:

Daft Punk: Contact

Daft Punk: Doin’ it Right

Dusty Springfield: I Found My Way (Previously unissued Version)

Justin Timberlake: Pusher Love Girl

Justin Timberlake: That Girl

Neko Case: Nothing To Remember

Lana del Rey: Paradise (album)

Lana del Rey: Burning Desire

The Guards: Ready To Go

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1. Gorczyca D, Prescha A, Szeremeta K, Jankowski A. Iron Status and Dietary Iron Intake of Vegetarian Children from Poland. Ann Nutr Metab. 2013 May 25;62(4):291-297. [Epub ahead of print] | link

2. Seshadri S, Shah A, Bhade S. Haematologic response of anaemic preschool children to ascorbic acid supplementation. Hum Nutr Appl Nutr. 1985 Apr;39(2):151-4. (Abstract only) | link

Iron Deficiency in a Vegan: Cured

Thursday, April 4th, 2013

Here’s some good news.

In March of 2012, a vegan woman wrote me saying that her serum ferritin levels were 8 ng/ml. The reference range for her laboratory was 10-232 ng/ml. Generally, a healthy level is above 18 ng/ml with levels as low as 12 ng/ml being associated with complete depletion of iron stores.

Instead of supplementing with iron, she:

• Increased beans and spinach from once every two weeks to two to three times a week (yes, she had been eating surprisingly few beans for a vegan)

• Replaced brown rice with quinoa (which has about twice the amount of iron)

• Stopped drinking coffee with meals

• Added a 500 mg vitamin C tablet or an orange to a couple of her high-iron meals a week

She just got her iron tested again and it was 28 ng/ml. A big increase which puts her well above iron deficiency!

As fate would have it, Ginny Messina has also written an article today about iron in vegan diets, Iron Nutrition: Why the Rules are Different for Vegans.

And since this was my first post in awhile in which I wasn’t highlighting some sort of screw-up on my part, it’s time to bring out the request for support! See below.

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Do vegan women get enough iron?

Wednesday, December 12th, 2012

Question:

Have you found women with iron absorption issues? For example, too many other minerals or not enough vitamin C? Or is absorption usually OK, and just the amount of iron the issue?

Answer:

Yes, many women have iron absorption issues. Almost all vegans get enough iron and enough vitamin C, so if they have iron issues, it’s probably from poor absorption. This is usually not a problem for men, but is for women who menstruate due to blood loss.

Someone might not be eating vitamin C at the optimal times for it to increase iron absorption – eat foods with vitamin C with whole grains, leafy greens, legumes and other high-iron foods. I often eat a small orange or two with my meals to increase iron absorption.

And you also need to remember that many people drink tea with all their meals, which inhibits absorption. Coffee does the same thing.

Tea lowers iron status in women with low levels

Thursday, March 22nd, 2012

A reader pointed out a paper that will be published in the May issue of Food Research International on tea and iron absorption.

The study tested black tea and green tea (1 liter per day with meals), independently for four weeks each, on both vegetarian and omnivore women. It found:

  • Black tea lowered serum ferritin levels in omnivore women, but not vegetarian women.
  • Both teas lowered serum ferritin levels in both omnivore and vegetarian women who began the study with serum ferritin levels below 20 µg/l.
  • Male vegetarian and omnivore ferritin levels were not affected, but none started with serum ferritin levels below 20 µg/l.

This study supports my suggestion from earlier this month:

“If your iron status is always fine when tested, then I don’t see a need to change your tea drinking habits; but if you have a tendency towards iron deficiency, it’s probably a good idea to avoid drinking tea with meals.”

Reference

Schlesier K, Kühn B, Kiehntopf M, Winnefeld K, Roskos M, Bitsch R, Böhm V. Comparative evaluation of green and black tea consumption on the iron status of omnivorous and vegetarian people. Food Research International. 2012 May;46(2):522-27. | link

Herbal Teas Inhibit Iron Absorption

Friday, March 2nd, 2012

Breaking news from 1999:

Many herbal teas inhibit iron absorption. I hate to hear bad news about people’s good habits, and I particularly don’t like it when it’s from 1999 and I’m just finding out about it now! As I’ve mentioned before, I have been working on an iron article for the Vegetarian Nutrition Practice Group and one of the reviewers pointed me to the study below showing that herbal teas inhibit iron absorption. In the past, I had thought herbal tea did not inhibit iron absorption. Sadly, I was wrong.

The herbal teas tested were camomile, vervain, lime flower, pennyroyal, and peppermint. Cocoa also inhibited iron absorption, as did coffee and black tea. The iron absorption was tested against iron-enriched white bread with only water, and these beverages reduced iron absorption by 50% or more (usually more), with black tea being the worst offender cutting iron absorption by about 80%+.

The good news is that this study pinpoints a benefit of iron-enriched white bread! Who would have thought that white bread could be healthier than herbal tea? Guess it all depends on your perspective.

If your iron status is always fine when tested, then I don’t see a need to change your tea drinking habits; but if you have a tendency towards iron deficiency, it’s probably a good idea to avoid drinking tea with meals.

I have updated the Iron section of VeganHealth.org to reflect this study.

Reference

Hurrell RF, Reddy M, Cook JD. Inhibition of non-haem iron absorption in man by polyphenolic-containing beverages. Br J Nutr. 1999 Apr;81(4):289-95. | link

VeganHealth.org Update: Vitamin C and Iron

Monday, January 30th, 2012

I have been reviewing the research on iron and vegetarians (lacto-ovo and vegan). It appears that the iron status of vegetarian men is fine, but that, roughly, about 10% of vegetarian women have iron deficiency anemia and another 15 to 40% have low iron stores. These rates are not much different than the meat-eating women in the same studies.

From the research I’ve reviewed, vitamin C appears to be the most important factor in absorbing plant iron. I have added a few paragraphs to the Iron page at VeganHealth.org and am reproducing that section here:

“In meat, 65% of iron is bound to the heme molecule (from hemoglobin and myoglobin), which is relatively easily absorbed. The rest of the iron in meat and all iron in plants is non-heme iron. Non-heme iron requires being released from food components by hydrochloric acid and the digestive enzyme pepsin in the stomach. Non-heme iron also needs to be shuttled from the digestive tract into the bloodstream by a protein called transferrin.

“The phytates, found in legumes and grains, and polyphenols (including tannins found in coffee and green and black tea), can inhibit the absorption of plant iron. On the other hand, vitamin C is a strong enough enhancer of plant iron and can overcome the inhibitors in plant foods.

“One study found that various doses of phytate reduced iron absorption by 10 to 50%. But adding 50 mg of vitamin C counteracted the phytate, and adding 150 mg of vitamin C increased iron absorption to almost 30%. Similarly, in the presence of a large dose of tannic acid, 100 mg of vitamin C increased iron absorption from 2 to 8% (13).

“In another study, vegetarian children with iron deficiency anemia and low vitamin C intakes in India were given 100 mg of vitamin C at both lunch and dinner for 60 days. They saw a drastic improvement in their anemia, with most making a full recovery (2).

“Researchers used 500 mg of vitamin C twice daily after meals to increase hemoglobin and serum ferritin in Indian vegetarians. They concluded that vitamin C was more effective at increasing iron status than iron supplements (12).

“Vitamin C is found in citrus fruits, strawberries, green leafy vegetables (broccoli, kale, collards, Swiss chard, Brussels sprouts), bell peppers (yellow, red, and green), and cauliflower.

“Calcium supplements, coffee, and black and green tea inhibit iron absorption if eaten at the same time as iron, so avoid them at meals in which you are trying to increase iron absorption.”

References

2. Seshadri S, Shah A, Bhade S. Haematologic response of anaemic preschool children to ascorbic acid supplementation. Hum Nutr Appl Nutr. 1985 Apr;39(2):151-4. (Link)

12. Sharma DC, Mathur R. Correction of anemia and iron deficiency in vegetarians by administration of ascorbic acid. Indian J Physiol Pharmacol. 1995 Oct;39(4):403-6. PMID: 8582755. (Abstract only)

13. Siegenberg D, Baynes RD, Bothwell TH, Macfarlane BJ, Lamparelli RD, Car NG, MacPhail P, Schmidt U, Tal A, Mayet F. Ascorbic acid prevents the dose dependent inhibitory effects of polyphenols and phytates on nonheme-iron absorption. Am J Clin Nutr. 1991 Feb;53(2):537-41. PMID: 1989423.

What Should I Be Tested For?

Tuesday, November 30th, 2010

I am regularly asked by vegans what they should be tested for. Here is a run down:

Vitamin B12

As I say in Should I Get My B12 Status Tested?

Vegans do not need to get their homocysteine or B12 levels checked merely because they are vegan. Rather, being vegan means that you should get a regular, reliable source of vitamin B12 from fortified foods and/or supplements. (Though if you’ve gone a month or so without a reliable source of B12, you should replenish your stores as described in Step 1 of the Recommendations.)

About 2% of people do not absorb B12 well. While this has nothing to do with being vegan, it is nice to know if you are such a person. You will not be able to tell unless you first have a reliable source of B12 for at least a few weeks before your B12 level is checked. Additionally, there are specific tests that directly measure B12 absorption.

If you get your B12 level checked, please note that eating seaweeds can falsely inflate B12 levels. Methods for determining B12 levels do not distinguish between B12 and some inactive B12 analogues. Many seaweeds contain a variety of inactive B12 analogues. Someone who is eating large amounts of seaweed may have serum B12 levels well above normal, but much of it could be inactive B12 analogues.

Vitamin D

This is probably the one nutrient that vegans really can benefit from getting tested even if they do not have any symptoms of poor health.

Calcium

The body keeps blood calcium levels relatively constant regardless of your diet, so getting calcium levels tested doesn’t tell you much of anything (other than that you are not seriously ill). Getting your bone mineral density tested is the best way to find out what shape your bones are in. I don’t necessarily recommend this, unless you have reason to believe you might have osteoporosis. I’ve said it many times before, but I’ll say it again – most vegans should drink calcium-fortified non-dairy milks (or other foods) or take a calcium supplement.

Omega-3s

If you are taking a DHA supplement, then you are probably fine. If you are not and want to see what your DHA levels are, here are some testing places.

There is a more common test that could shed some light on your EPA status – blood clotting time. Most doctors test for this routinely. If your blood is clotting too fast, you might be lacking EPA. But, I rarely hear from a vegan whose blood is clotting too fast. If blood clotting time is normal, it doesn’t necessarily mean you have enough DHA.

Iron

If a doctor is going to draw blood, getting an iron panel to see if you have enough (or too much) iron is a good idea, especially for menstruating women.

Iodine

There is no direct test for iodine. Like B12, it’s best to just make sure you’re getting enough (but not too much). Iodine deficiency (and excess) can lead to thyroid problems, so getting your thyroid tested would be an indirect indicator. Click here for more on iodine.

And that covers it for any routine nutrients to test for regarding the vegan diet.