Iron Deficiency

Comment:

While I was leafleting about vegetarianism, someone told me they tried to be vegetarian but got iron deficiency.

Answer:

When someone says this, you might want to ask them if a medical doctor diagnosed them. A lot of people diagnose their own iron deficiency and are likely wrong about it. It’s good to get people to reconsider whether they really had iron deficiency because my suspicion is that a lot of them actually didn’t.

And then you might suggest that they try eating spinach and oranges at the same meal, on a regular basis. The spinach for iron, and the orange for vitamin C which increases iron absorption. Other iron tips:

* Avoiding black or green tea and coffee at meals.
* Adding a source of vitamin C at meals.
* Increasing legume (peanuts, beans, lentils, peas) intake.
* Cooking foods (especially water based acidic foods like tomato sauce)
in cast iron skillets.

More info can be found on the Iron page of VeganHealth.org.

18 Responses to “Iron Deficiency”

  1. Godan Says:

    I am told by some Indian doctors that they see the iron level of Indians who are vegetarians have been found low. May be it is nothing to worry about since the range have been developed with a whole lot of meat eating people as a sample. ..or is it?

  2. Jack Norris RD Says:

    There are two issues: iron-deficiency and iron-deficiency anemia. In either case, they are not average levels.

    In the case of anemia, the numbers are pretty specific and if you fall into the anemia range you normally start having other symptoms.

    Iron-deficiency is when your iron stores become depleted to dangerously low levels. Not all sources agree on the exact cut-off but they are relatively close. Bias towards meat-eaters’ levels doesn’t seem to be part of the equation.

  3. Mahi Says:

    I hear that spinach is not a very good source of iron as it contains oxalates who prevent the iron from being metabolized. Do you have details on that, Jack?

  4. Jack Norris RD Says:

    Mahi,

    Spinach isn’t a good source of calcium because of the oxalates, but they don’t affect the iron.

  5. Johanna Says:

    One explanation I have read is that a lot of new lacto-ovo-vegetarians replace much or most of the meat they had been eating with dairy, and since dairy contains very little iron, their iron levels plummet. The implication is that switching from a vegetarian diet to a vegan one would fix the problem, rather than compounding it.

  6. Jack Norris RD Says:

    Johanna,

    How I wish it were so! In studies I’ve seen, lacto-ovo vegetarians get about the same amount of iron as meat-eaters. For example, in the EPIC-Oxford study, iron intakes were:

    Men
    Regular meat-eaters 13.4 g
    Lacto-ovo 13.9 g
    Vegan 15.3 g

    Women
    Regular meat-eaters 12.6 g*
    Lacto-ovo 12.6 g*
    Vegan 14.1 g

    *Not a typo, they were the same.

    Iron from meat is absorbed through different mechanisms than plant iron. My sense is that people who have eaten meat for a long time can sometimes lose the ability to absorb enough iron from plants. In other cases, it might take some time for their plant-iron-absorption mechanisms to ramp up. This is distinct from people who are vegetarian from birth and whose bodies never adjusted to relying on meat iron for any of their needs.

  7. Tamara Says:

    Thanks for the info! I am a long-time vegan who was recently told by my doctor that my iron levels are low – not too bad – just below the cutoff for ‘normal’ I guess. I drink a lot of green smoothies so incorporating spinach and oranges into one of those a few times a week should be an easy way to increase my levels!

  8. Vegan Iron Says:

    […] Norris, RD, has a blog about vegan nutrition. His latest post is about iron. He offers some suggestions to increase your iron intake and absorption: “try eating spinach and oranges at the same […]

  9. essie Says:

    great post, as usual! thanks, jack!

    i’m wondering if you have any advice on finding a vegan-friendly doctor? i saw a new physician for a physical last week, who said she was going to order a “full blood work up since you are vegan” and seemed pretty closed minded about my being vegan. i don’t expect all doctors to be vegan of course, but my last two docs were pretty much thrilled i had such a plant-strong diet, so i was sort of surprised by her reaction.

    she also basically grilled me on what supplements i take (vegetarian support multi incl B12, vegan DHA, and sometimes calcium + D in winter and when i feel i’m not getting in enough greens). i think she is expecting my results to come up wonky or something, like she’s going to prove i’m missing nutrients even though i’m perfectly healthy and feel great. so weird!

    anyway, if you’ve written on the topic, i’ve missed it, and i’d love to hear your thoughts. i tried the PCRM site, which has a holistic practitioner referral, but didn’t find anyone suitable in my area (central NJ).

  10. Jack Norris RD Says:

    Hi Essie,

    I’m afraid I do not know of a list of vegan-friendly doctors and do not personally know any in New Jersey. Hopefully the good results of your tests will change her attitude.

  11. xzebrasx Says:

    According to my calculations, I’m currently getting about 60-70mg of iron a day from legumes, seeds and veggies – is that too much? I heard that excessive dietary iron intake has lots of detrimental health effects.

  12. Jack Norris RD Says:

    The average vegan gets about 15 mg a day, so that’s pretty darn high. Are you sure you’re calculating it correctly? I don’t know what iron intakes that high might do. I would try to avoid getting that much iron.

  13. xzebrasx Says:

    Thanks for the reply!

    I can’t say I’m certain, but even if it’s a little off, I doubt the difference is much more than 10 or 20 mg. But yeah, I’ll try to cut it down a tad.

    Love the blog!

  14. Aine_Eire Says:

    Hi Jack,
    Great blog!
    I have been iron decifient since mid 2007 – first serrum ferritin was 11 (range 20-300) yet the silly GP just told me I was a little low 🙁 I was presenting with anxiety/ fatigue
    Again I presented in 2008 (still with the same symptoms) my readings were 19 and then 25 at the end of ’08, despite taking suppliments and improving my iron intake.
    “Helpfully” my GP recommended I see a counsellor as he maintaned it was depression. The lovely lady I saw reckons there is a co-relation between iron deficiency and anxiety. She also reckoned I should be tested for Celiac disease (something my doc won’t test me for). She also concluded that I was not depressed.
    I’ve been diagnosed as having a dairy intolerance and am on a vegan diet as it best suits (i never liked red meat).
    I’m at my wits end on how to improve my iron. Have you any comments on this?
    Unfortunately my GP won’t test me for iron again and when I last asked for assistance with this he just told me to stop taking the suppliments if they dont agree with me 🙁
    I’m currently seeking a new GP but in Ireland we don’t have a great “pool” t choose from 🙁

  15. Jack Norris RD Says:

    I’m sorry to hear about your troubles. You should read this article if you haven’t yet:

    http://www.veganhealth.org/articles/iron/

    It has tips on increasing iron absorption.

  16. Recipe: Peanut Butter Cookies | One Green Planet Says:

    […] and tofu –  hello, protein! Peanuts, a member of the legume family, are also a good source of iron. That’s a nice bonus, but who are we kidding – the main draw here is the scrumptious taste […]

  17. Yoav Says:

    Hi Jack,

    Have you heard about research regarding the effect of beta-carotene on the absorption of non-heme iron?
    Specifically, these studies / articles:
    1. http://jn.nutrition.org/content/128/3/646.full
    2. http://jn.nutrition.org/content/130/1/5.full
    3. http://www.researchgate.net/publication/11990792_New_property_of_vitamin_A_and_-carotene_on_human_iron_absorption_Effect_on_phytate_and_polyphenols_as_inhibitors_of_iron_absorption

    What do you make of these? could vegans who struggle to maintain adequate ferritin levels benefit from adding beta-carotene rich foods to their iron-rich meals?

    Thanks,
    Yoav

  18. Jack Norris RD Says:

    Yoav,

    It seems reasonable, but I’m not sure when I’ll have time to get those studies and look at them more carefully.

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