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Iron: Vegetarian Nutrient of Concern #4

Jennifer Hanes MS, RDN, LD

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Hey there, fellow food enthusiasts and nutrition aficionados! Today, we’re discussing a nutrient that’s often in the spotlight for vegetarians: iron.

Iron plays a crucial role in our bodies, helping with oxygen transport, energy production, and more. But for those of us following a plant-based diet, getting enough iron can sometimes feel like a tricky balancing act.

Fear not, though! In this post, we’ll unravel the mysteries of iron, explore why it’s a hot topic for vegetarians, and dish out some deliciously iron-rich solutions to keep you feeling strong and energized.

Many people think iron deficiency is specific to women and only problematic during pregnancy.

However, iron absorption and needs are fickle, changing under various circumstances and demands. Iron deficiency, when mild, is typically noted on annual blood work, but if severe, symptoms will lead a person to seek medical attention.

Meat is the most commonly cited source of dietary iron, and iron from meat (called heme-iron) is typically better absorbed. 

However, it is possible to get all of your iron from a vegetarian diet if you know what you’re looking for. 

Understanding Iron

There are two types of dietary iron: heme iron and non-heme iron.

Heme iron is found only in blood and muscle, so is only present in meat.   This iron is so named because it is attached to a protein called heme.  This attachment causes the iron to be more quickly and more completely absorbed.

Non-heme iron is found in plants and in the muscle tissue of those animals that eat plants.  Because it isn’t attached to the heme iron, it is absorbed more slowly, and less iron is absorbed through digestion.

In addition to what type of iron, other factors influence how much dietary iron you absorb.

Factors that increase iron absorption:

  • Vitamin C is the best way to increase iron absorption. So pair your iron-containing foods with produce, such as citrus, strawberries, bell peppers, and tomatoes.
  • Low iron levels – your body absorbs more iron when your iron stores are lower than needed.

Factors that reduce iron absorption

  • Tannins in tea and coffee – consider keeping tea and coffee consumption between meals rather than with them.
  • Phytate in whole grains, beans, nuts, and legumes – make sure that all beans and legumes are soaked and cooked completely to remove the phytate and allow the absorption of the iron they contain.
  • High calcium intake in the same meal as your iron – the effect is mild, but if you already have problems with iron deficiency, this is something to think about.

Recommended Daily Intake

Men aged 19-50 should aim for 8 mg per day. Women in that age group should take in at least 18mg! Blood loss is the primary cause of iron loss, making menstruating women require higher intake.

Pregnancy increases iron needs to 27mg per day, mainly due to a large increase of red blood cells and the growth of the fetus. 

After the age of 51, the RDA for men and women is 8mg.

Function

Iron is a component of hemoglobin, a protein in your red blood cells, which is responsible for carrying oxygen throughout your body.

It is also a component of myoglobin, another protein that is responsible for oxygen transport as well as muscle metabolism and healthy connective tissues.

Other roles include growth, neurological development, and the formation of some hormones.

iron containing cashews in a bowl on a black table
Photo by Jenn Kosar on Unsplash

Vegetarian Sources of Iron

As mentioned above, this mineral comes in 2 forms: heme and nonheme.

Nonheme iron is found in plants and fortified foods. 

The best vegetarian sources of iron are:

  • 1 serving Fortified breakfast cereal – 18mg
  • 1 cup Canned white beans – 8 mg
  • 1/2 cup boiled lentils – 3 mg
  • 1/2 cup boiled spinach – 3 mg
  • 1/2 cup firm tofu – 3 mg
  • 1 oz 45-69% dark chocolate – 2 mg
  • 1/2 cup canned kidney beans – 2 mg
  • 1/2 cup stewed tomatoes – 2 mg
  • 1 medium potato, with skin – 2 mg
  • 1 oz cashews – 2 mg

Non-food sources of iron:

  • Use of a cast iron skillet (affiliate link) – this can increase the non-heme iron in your food by 2 to 5 mg.  The effect is higher in foods that are acidic and that contain liquid
  • Iron Fish (affiliate link) – similar to a cast iron skillet, just drop the iron fish into soups, stews, and sauces to get more iron.

Maximizing Iron Absorption

Essentially, we want to pair our iron-containing food with vitamin C-containing foods and avoid compounds that can reduce iron absorption.

If you struggle with iron deficiency anemia, then make sure to separate tea and coffee from your iron-containing meals by at least 2 hours.

Next, we want to make sure to include vitamin C. This is actually quite natural, and something you may already be doing without noticing. 

Here are some vegetarian examples of pairing iron-rich foods with vitamin-C-rich foods:

  • Salad – Base of mixed greens with black beans, cheese, and tomatoes.
    • You’re getting iron from the greens and beans and vitamin C from the tomatoes. You can increase vitamin C by choosing a citrus vinaigrette dressing.
  • Salad – Strawberry Fields side salad
    • This time, you’re getting iron from the greens and walnuts and vitamin C from the strawberries and dressing.
  • Sauce – Use your cast iron skillet to make a sauce to go on pasta or over tofu.  Include tomato sauce or lemon juice in the sauce to increase the absorption of iron into the food and into your bloodstream.
  • Chili – Make a vegetarian chili in your slow cooker and toss in an iron fish.
    • You’ll get iron from the “fish” and the beans and vitamin C from the tomatoes.
  • Cereal – iron-fortified cereal with sliced berries on top
  • Corn, black bean, and feta salad with a side of fruit.
  • Guinness Shepherd’s Pie with a baked apple for dessert.
  • Smoothie made with various fruits, spinach, and peanut butter (or almond, or cashew)
  • Oatmeal made with milk and topped with chopped walnuts and served with apple juice.
White bowl with iron fortified cereal
Photo by Yvens Banatte on Unsplash

Assessing Iron Status

So now we know what iron does in our body, where we can get it, and how to maximize iron absorption.

But what happens when things go wrong?  If we get in too little or too much.  Should we take a supplement? Avoid iron-rich foods? When should we talk to a doctor?

Symptoms of Iron Deficiency

Deficiency is most likely to occur in children and premenopausal women. 

Poor diet, malabsorptive disorders, and blood loss can also increase your risk of deficiency. In developing countries, this blood loss can often be the result of intestinal parasites.

In developed countries, blood loss is sometimes a result of poor GI health or injury.

Iron deficiency can be progressive among a few phases:

  1. Mild deficiency leads to a depletion of your iron stores. In this stage, you may not have any outward symptoms, but blood work can reveal low serum ferritin concentrations, and your bone marrow will have low iron stores.
  2. Marginal deficiency (or mild functional deficiency) can lead to decreased production of red blood cells. Blood work will reveal low transferrin saturation, but hemoglobin levels will still be normal.
  3. Iron-deficiency anemia – Hematocrit and hemoglobin levels are low. Your red blood cells are small and lack their normal color. 

Symptoms of iron deficiency anemia include fatigue, weakness, difficulty concentrating, brain fog, decreased immune system function, reduced work and exercise performance, difficulty regulating body temperature, and gastrointestinal distress.

In children, iron deficiency anemia can lead to learning disabilities that follow them into adulthood.

Note that the symptoms of iron deficiency are very similar to the symptoms of vitamin B12 deficiency.  And they can both cause anemia. 

It is important that if you have any of these symptoms or annual lab work shows anemia, you have further testing to determine what type of anemia you have.

vegan iron deficiency myth

It is a common belief that vegetarians, particularly vegans, are at risk for iron deficiency anemia.  This stems from the belief among some that meat is the only source of iron and the fact that plant-based iron sources are poorly absorbed compared to animal-based sources.

Research is actually mixed on this topic.  You can find studies that show depleted iron stores among vegetarians as well as studies that show no difference in iron status between vegans, vegetarians, and omnivores.

Among all of these studies, however, what stands out is that the presence of menstruation seems to be a stronger predictor of iron deficiency than dietary patterns.

Pre-menopausal, cis-gendered women are the demographic most likely to lose excessive amounts of blood. And women, in general, are more likely to be vegetarian than men.

This seems to indicate that blood loss has a bigger impact on iron status than diet does.

It is believed that because vegetarians and vegans tend to have a higher vitamin C intake, they absorb iron more readily, accounting for a higher non-heme-iron intake compared to the more easily absorbed heme-iron.

Obviously, though, a poorly balanced vegetarian or vegan diet can have less iron intake than needed if it doesn’t include iron-rich food sources in the diet.

Conditions that increase iron needs

Frequent blood donations can deplete your iron stores. Those that donate every 8 weeks should aim to increase their intake. 

Heavy menstrual bleeding, cancer (all, but particularly colon cancer), heart failure, gastrointestinal disorders (Celiac, Crohn’s, ulcerative colitis), and colon or stomach surgery can all cause depletion of iron stores for various reasons.

These patients should aim to increase their intake of this mineral.

Various beans in large bags.
Photo by v2osk on Unsplash

Treatments for iron deficiency

Treatment for a deficiency depends on the severity. Mild deficiency can be corrected by changes in the diet or oral supplementation.  Make sure to include vitamin C with any iron supplements.

Avoid drinking black tea and coffee with meals, as this can decrease absorption.

Use an iron fish when cooking liquids. Or boil water with an iron fish and use that water for cooking.

If the deficiency is secondary to another cause, treatment of that condition can replenish your iron stores.

In severe cases, or in cases where the cause of deficiency cannot be reversed with diet and supplements, you may require IV iron infusions or blood transfusions.

Symptoms of iron toxicity

Toxicity is not common. However, taking large doses of an iron supplement on an empty stomach can cause constipation, abdominal pain, nausea, vomiting, and faintness.

A genetic condition called hemochromatosis causes an excessive build-up of iron in the body. Symptoms of toxicity typically present in the person’s early 30s and include liver cirrhosis, liver cancer, heart disease, and reduced functioning of the pancreas.

These patients should avoid all supplements that contain iron and vitamin C.

oranges on white table
Photo by Adam Śmigielski on Unsplash

Treatment for toxicity

Hemochromatosis is treated with periodic chelation of iron in the blood or blood draws.

Chelation is taking a medication that binds to the iron in your blood and removes it. Alternatively, blood removal (similar to a blood donation) to remove excess iron from the bloodstream is effective.

Should I take a supplement?

Vegetarian iron supplements, even including vegan iron gummies, are readily available in most stores and online.

Those with chronic anemia, heavy menstrual cycles, kidney or heart failure, or cancer should talk to their doctor about their need for a supplement.

Please note that iron supplementation can interfere with many other medications, including Levodopa (for Parkinson’s) and Levothyroxine (for thyroid disease). Additionally, certain heartburn medications can reduce the absorption of iron.

Those with hemochromatosis should actively avoid supplementation with iron.

avocado, lentil, and tomato toast on wood background. Lentils are a good source of iron and tomatoes contain vitamin c, increasing absorption.
Photo by Anna Pelzer on Unsplash

What supplementation won’t do

Oral supplementation won’t treat severe iron deficiency.

In addition, if low iron stores are the result of bleeding, supplementing won’t correct the problem until the source of blood loss is identified and treated. 

All underlying medical conditions should be addressed, in addition to supplementation, if needed.

Any concern for the omnivores?

Yes, potentially. While iron deficiency is less likely in omnivores than vegetarians, it is still possible due to low absorption rates, interfering medications, or foods/beverages. 

However, other causes of deficiency and anemia are not directly related to diet and can happen to anyone, regardless of dietary intake.

And there you have it, folks – the lowdown on iron and how to keep those plant-powered engines running smoothly!

Whether you’re a seasoned veggie veteran or just dipping your toes into the world of vegetarian nutrition, remember that nourishing your body with iron-rich foods isn’t about restriction or eating foods you don’t like.

It’s about embracing a delicious variety of plant-based goodies, listening to your body’s hunger cues, and savoring each bite with joy and gratitude.

So, let’s raise our forks (or spoons – no judgment here!) to vibrant health and tasty adventures on the vegetarian path. Cheers to you and your iron-rich journey ahead! 🌱💪

References

National Institutes of Health

National Heart, Blood, and Lung Institute

Interested in reading more? Try the other articles in my series!

Vitamin B12

Protein

Calcium

What vegetarian foods are high in iron?

Fortified breakfast cereal, beans/lentils, spinach, tofu, dark chocolate, tomatoes, potatoes, and nuts/seeds are the best iron sources from plant foods.

How can I increase my iron levels as a vegetarian?

First, you need to figure out if you are losing too much iron.
If you have very heavy periods or have gut problems that may be causing you to lose blood, then you absolutely need to talk to your doctor.

If you aren’t losing blood or are still struggling with managing the reason you are using blood, then you need to look at your diet and consider supplementation.

Make sure you are eating plenty of the iron-rich vegetarian foods listed above. Try your best to include a source of vitamin C with each iron-containing meal.

Finally, consider using iron fish or cast iron cookware whenever possible. This is particularly effective if the food you are cooking includes an acidic component, such as tomato sauce.

Are vegetarians iron deficient?

Not necessarily. Studies are mixed on iron status based on dietary patterns. The female gender, and more specifically, the presence of menstruation, seems to be a better determinant for identifying individuals at risk for iron deficiency.

Are iron tablets vegetarian?

Many iron supplements are vegetarian. Check the label. If it states the iron is heme-iron, that is likely not a vegetarian product.
Most supplement companies will also label their products as vegetarian or vegan-friendly if they are.

If the product you are looking at is a gummy instead of a tablet, make sure that there isn’t any gelatin in it!

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