Iron Status of Polish Vegetarian Children

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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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

16 Responses to “Iron Status of Polish Vegetarian Children”

  1. Andrea Says:

    Jack,

    Can hypochlorhydria lead to anemia?

    Vitamin D increases absorption of Iron and other minerals.
    http://jn.nutrition.org/content/80/3/332.long

  2. Dan Says:

    Orange juice and other fruit juices are really liquid sugar, and partly responsible for the diabesity epidemic we are seeing in teens today (together with sugary soda). It would be preferable to eat whole fruit, but these days the cultivars are particularly enriched in fructose and poor in fiber so as to please the average consumer’s palate (read: SAD). I stay away from most fruit with the exception of avocados, olives and tomatoes. How are those for vitamin C?

  3. Jack Norris RD Says:

    Dan,

    > with the exception of avocados, olives and tomatoes. How are those for vitamin C?

    Not aware of them being high in vitamin C, but you should look them up if you want to be sure:

    http://peacounter.com/

  4. Bertrand Russell Says:

    Really? People eat *too much* fruit in the US, and *that* is why they are obese?
    Wow. I suggest you go to the mall, or the grocery store, and watch what people are actually buying.

  5. Idan Says:

    Jack what about red pepper or even better yellow pepper ?

    They are by far much richer sources of vitamin C .

  6. Jack Norris RD Says:

    Idan,

    Good catch. I added them. I’m not sure many teenagers are going to be into eating them, but for those who are, they are good sources.

  7. Andreas Says:

    Dan,

    Please learn to distinguish the difference between “artificial” processed foods and natural 90%+ water rich whole foods, and not hold them to the same standard. Please also learn the truth; that is that people with health problems have hyperlipidemia from eating too much processed crap. Cooked meat is also considered processed crap.

    http://en.wikipedia.org/wiki/Dyslipidemia
    http://en.wikipedia.org/wiki/Hyperlipidemia
    http://en.wikipedia.org/wiki/Polycyclic_aromatic_hydrocarbon
    http://en.wikipedia.org/wiki/Heterocyclic_amine
    http://en.wikipedia.org/wiki/Gluten_sensitivity

  8. Dave Says:

    Some bell peppers are much, much better now than the ones I grew up with. Seek out the Canadian-grown hothouse red bell peppers. They are the best tasting, imo, and my daughter and the rest of us eat them raw as snacks all the time.

    Some and probably many commercial juices are no better than soda, but I believe you would be hard pressed to prove that eating whole fruit is anything but healthful.

  9. Dan Says:

    Let me play devil’s advocate here.

    Dave, why do you need to snack at all? Why eat between (presumably substantive and satiating) meals? There is ever greater evidence linking serum insulin and C-peptide levels to cancer, dementia, diabetes and vascular disease. I am not entirely successful at it but I try not to snack between meals, and keep these spaced at least 5 hours apart. I consolidate and make the meals satiating.

    Also, whole fruit is not necessarily healthy. Modern cultivars have been cross-bred to ensure maximum sweetness and minimum fiber content (to please the North American consumer’s palate). A few major corporations (like Dole) control most of this. Even if you are buying locally, you do not know the origin of the seeds used to grow that fruit – likely from Monsanto or ADM.

    And fructose is scary! PET-MRI studies show it is truly non-satiating and triggers hunger craving (even in comparison with table sugar – sucrose), as well as excess liver fat accumulation (leading to NASH) and gout. Check out this website for what you are eating: http://www.sugarstacks.com/fruits.htm

    I’m sorry. There’s nothing natural about the copious quantities of fructose-rich fruit we are consuming. Fruit juice is even worse. Best to get vitamin C from vegetables or a supplement. I do eat some fruit in limited quantities (e.g. blueberries), but I do not go overboard and I avoid anything with a deleterious glycemic index. Basically I view the fruit imported here, and even grown locally, as not much better than glorified junk food (sorry!). I know I am not alone in this belief.

  10. Dave Says:

    Hi Dan,

    Thanks for your thoughts on this.

    Anyway, snacking = eating in my mind. We eat when we are hungry. Most of that occurs at mealtimes, some of it does not. (For example, consider that eating small frequent meals is a common practice with bodybuilders and with also with small children.)

    I think perhaps you have extrapolated this too far in your analysis. That is, perhaps what you say is true but placed in its proper context, not ultimately a major factor. It reminds me of the person that buys a huge fast food meal and then follows it with a diet coke because they are worried about the calories. Or the cigarette smoker who worries about pesticides in their food. Valid concerns yes, but misguided efforts, and miscalculated risk. Taking a vitamin C supplement instead of eating fruit because of perceived risk sounds a lot the same to me.

    Refined grains, animal-based foods, fries/chips, sugar/HCFS, frozen convenience food — I think these are the true culprits making everyone sick and fat these days. That and lots of passive entertainment.

    Fruit is much more than just sugar and much more than just one compound like Vitamin C. To just talk sugar content is misleading….what about the fiber, the antioxidants, all the other vitamins? There is no pill equivalent to an apple, for example. You are trying to lump most fruit into the junk carbs category, but I think it’s a stretch.

    Limiting refined carbs is good for health, however, and I think we can agree on that!

  11. Dan Says:

    Jack, great comments and I readily agree with all of them.

    I think overconsumption of anything is bad (including fruit); the middle way – moderation – seems most sensible. You can die from drinking too much water, and water is pretty benign (and necessary for life – we are 70% water). You can certainly exacerbate prediabetes by consuming too much fruit (unless you want to shoot insulin with it, but that is not treating the cause of the problem, only its consequence). I will say minimization of carbs has worked wonders for me and for many others, including reversing a tendency towards type 2 diabetes. Many types of fruit, if they are overconsumed, carry a large sugar load. Especially so in juice form.

    For a much more eloquent and elaborate review of this subject, see: http://eatingacademy.com/nutrition/how-can-carbohydrate-restriction-be-healthy-if-it-means-limiting-natural-foods-like-fruits-and-vegetables

    As to the antioxidants in fruit, I agree these are potentially beneficial, although this has never been proven in randomized trials. Even if you look at experimental data, there are murine studies showing that mice exposed to antioxidant-rich chow have significant brain tumor progression while mice exposed to antioxidant-poor chow experience tumor regression. Totally opposite of what we would normally think. See http://www.sciencebasedmedicine.org/index.php/antioxidant-hype-and-reality/ for a general overview.

    Fact of the matter is that 70% of the population has an elevated BMI and many of the remaining 30% have “metabolic” obesity. We attribute this to different things. I think the explosion in obesity/diabetes over the past 30 years is consequent to dramatic changes in dietary composition – fewer fats, more carbs in their many forms. Industry has complied with dietary recommendations by manufacturing “low fat” products that are highly enriched in sugar. Certainly we didn’t suddenly start driving 30 years ago, or watching TV 30 years ago. Thus sedentarism is unlikely to be a major cause for the explosion. Just look around next time you are at the gym.

    No point belaboring this subject much further, in my view. Reasoned debate is useful, but I doubt very much we will change each other’s mind.

  12. Jack Norris RD Says:

    > Jack, great comments and I readily agree with all of them.

    Dan, I think you meant “Dave, Great commments…”

  13. Dan Says:

    OOPS, you’re right. Blushing here.
    By the way, my Bulgarian research article finally came in. A quarter of the population was vitamin A deficient in the 1970′s (mismanaged communistic food supply system, no doubt). Angular stomatitis was 4x more common in those who were vitamin A deficient. However, they said this was probably due to concomitant B2 deficiency, as they found a similar risk increase (2-fold) in angular stomatitis in vitamin C deficiency. In fact, they believe the population was deficient in multiple vitamins. The paper is “Early signs of vitamin A deficiency in Bulgaria”, and unfortunately does not have an online abstract in medline.

  14. Dan Says:

    It’s nice to see a nod from the European Society of Cardiology (in their latest guidelines for hypertension) on the importance of limiting excessive fruit intake for certain people with high blood pressure. (http://www.escardio.org/guidelines-surveys/esc-guidelines/Pages/arterial-hypertension.aspx)

    Verbatim quote:

    “Hypertensive patients should be advised to eat vegetables, low-fat dairy products, dietary and soluble fibre, whole grains and protein from plant sources, reduced in saturated fat and cholesterol. Fresh fruits are also recommended—although with caution in overweight patients because their sometimes high carbohydrate content may promote weight gain.”339,356

    (and yet, patients always tell me that they have been told that fruit is healthy for them, and that you need x servings per day to meet current guidelines)

    Low glycemic index fruit is probably best.

  15. Josh Says:

    Hi
    I am curious about the iron absorption rate in sprouted legumes, pulses etc. is it better to eat non sprouted and with vit. C or sprouted and vit. C?
    Thanks !

  16. Jack Norris RD Says:

    Josh,

    I do not know how much iron is in a typical serving of sprouted legumes. My sense is that legumes are eaten at much lower amounts when sprouted than when merely cooked. My understanding is that sprouting reduces the phytic acid, thus lowering the need for vitamin C, but I haven’t seen research on this and do not know the details. Finally, as a male, you are not at risk for iron deficiency so unless you have a reason to worry about it, I probably wouldn’t.

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