Updated: May 26, 2022
“If you are not your own doctor, you are a fool” – Hippocrates
This time last year, I learnt I was iron deficient, again. Often when I tell people I am iron deficient they assume it is because I don’t eat meat. The truth is, since puberty I have struggled to maintain healthy iron levels. Before a blood donation in grade 12, I found my haemoglobin was so low I was refused donation and advised to consult my GP. After some blood tests I found that I was not only iron deficient, but anaemic. That year would have been my heaviest year of red meat consumption, two years prior to going vegan. According to the Australian Health Survey data, I am not alone in this:
“Females were much more likely to have inadequate iron intakes from foods than males, with one in four (23%) not meeting their requirements compared with one in thirty males (3%)”
We are often told that being vegetarian or vegan is a risk factor for iron deficiency, despite various studies which indicate that while veggos tend to have slightly lower iron stores, they are no more likely to be iron deficient than meat eaters. I feel that I am living proof of this. As iron is important in many bodily functions, this association can lead people to believing that a vegan lifestyle is an unhealthy one, one which must include deficiency and sickly looking anemia.
But first things first, what is iron?
Iron is an important mineral that helps transport oxygen around the body in red blood cells, playing a vital role in producing energy, supporting immune function and supplying oxygen to muscles. Hemoglobin tests, such as those done at the blood bank, are the most commonly used measures to screen for iron deficiency. The last stage of iron deficiency, called iron-deficiency anemia (IDA), occurs when the proportion of red blood cells in blood by volume are low. Hemoglobin concentrations which are lower than 13 g/dL in men and 12 g/dL in women indicate IDA.
There are two sources of iron; heme iron derived from blood and muscle and non-heme derived from plant-based sources. Dr Michael Greger describes iron as a double-edge sword; non-heme is not as easily absorbed but heme iron is strongly associated with several diseases including cancer, stroke and heart disease. Therefore, non-heme iron can be considered safer in that it is less likely to cause disease.
When you eliminate heme-iron from your diet you may notice your iron stores decrease, or like me, your iron stores may significantly increase! Shortly after going vegan, having previously been refused at the blood bank, I went in and my hemoglobin reading was the highest it had ever been in about five years of donations. Though my iron stores have remained in the low range over the years I have been vegan, I haven’t again been anemic since I was as a red meat eater. This is not unusual as a vegan diet is rich in non-heme iron and vitamin C, meaning that many vegans are able to get adequate iron from their diets alone. However, in the years since I have returned to a baseline in the low range. I have accepted that low iron is something I will have to manage for the rest of my life, particularly during menstruation and pregnancy.
Plant-based foods that are good sources of iron, such as spinach, have low iron bio-availability because they contain iron-absorption inhibitors, called polyphenols. For this reason, a common nutritional recommendation is to combine a plant-based iron source with a plant-based source of vitamin C, for example add a tomato or the juice of an orange when sauteing leafy greens. Although due to consuming only non-heme iron some recommend vegans aim to consume 1.8 times more iron than is recommended to non-vegans (which by the way, is 18mg per day for women aged 18-59).
There are many great plant-based sources of iron. However, iron is a one of two vitamins I choose to supplement (the other is B12, see What is B12? for this blog post). Anyone that has been iron deficient or anemic would be well acquainted with Ferro-Grad C, an iron supplement commonly prescribed by doctors which is fortified with vitamin C to assist with absorption of iron. I have learnt a lot about iron supplements over the years.
Not all supplements are made equal.
After watching a Four Corners report regarding the safety of supplements I am reluctant to use them generally (read: expensive urine). However, due to my predisposition to anemia I feel obliged too. The trouble with supplements such as Ferro-Grad C is its low bio-availability. Bio-availability for dietary supplements can be defined as the proportion of the administered substance capable of being absorbed and available for use or storage. Historically, I tried liquid iron supplements ingested orally, which were effective in managing nutritional deficiency but tasted horrible. I have also tried BioCeuticals Iron Sustain, which provides 24mg of highly bio-available iron, activated with B vitamins and vitamin C. These days, I enjoy an even higher quality practitioner-only prescribed iron supplement from my naturopath. For those with chronic anemia, iron infusions are often necessary; they are 100% bio-available given that it is administered straight into the bloodstream.
I hope you have a little more insight into this very important mineral and the vegan lifestyle. Even though I can be the epitome of the anemic vegan at times, many vegans have no problem maintaining healthy iron stores. If you do, at least there are plenty of means in which to manage deficiency; speak to your doctor, or better yet, a specialist naturopath.
Thanks for reading.
References and Resources
iron – Better Health Channel: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/iron
Iron and the Vegan Diet: http://www.vrg.org/nutrition/iron.php
The Safety of Heme vs. Non-heme Iron; http://nutritionfacts.org/video/the-safety-of-heme-vs-non-heme-iron/
The Australian Bureau of Statistics (2013). Australian Health Survey: Usual Nutrient Intakes, 2011-12. Retrieved from http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4364.0.55.008~2011-12~Main%20Features~Key%20findings~100 (Iron)
Iron – Dietary Supplement Fact Sheet: https://ods.od.nih.gov/factsheets/Iron-HealthProfessional
Four Corners Repoort into the dangers of supplements: http://www.abc.net.au/4corners/supplements-and-safety/7409646
To read more about iron infusions: https://www.niim.com.au/clinic/services/iron-infusions