Iron deficiency and how to boost it

Iron deficiency is one of the most common nutritional deficiencies, and is often on people’s minds when they think of transitioning to plant-based diets. The truth is, surveys have found vegans/vegetarians to be no more likely to have iron deficiency anemia than meat eaters.

Yep, you heard that right – vegans and vegetarians are no more common to have iron deficiency anemia. What they do find, however, is that iron ‘stores’ (aka ferritin levels) are lower in vegans and vegetarians (but that might not be a bad thing since iron is actually a pro-oxidant and creates oxidative stress – and oxidative stress leads to chronic diseases like metabolic syndrome, heart disease and cancer.

So although you don’t want to be iron deficient, you also don’t want an excess of iron in your body).

Many people think that, to correct iron deficiency they just need more iron in their diets. Some people even go buy over the counter iron supplements without consulting a doctor first – but that is like ladling water out of a sinking boat with holes. You must patch up those holes first, THEN you can take the water out.

To correct iron deficiency, we must first understand what is causing it.

Is it really that you don’t have enough in your diet or is there something else going on?

Here are the common causes I used to encounter as a family physician:

1️⃣ Poor digestion and absorptionyou are not what you eat – you are what you digest and absorb. You could be eating the best diet in the world, but if your gut health is poor, you cannot digest or absorb nutrients efficiently. So gut health must be assessed and tackled (see also below points on what stops iron being absorbed)

2️⃣ Blood loss – in women, heavy periods is the commonest cause of iron deficiency. This should be addressed before/at same time as increasing the iron in your diet. There could also be blood loss from other organs and this should be excluded if appropriate.

Now, let’s look at removing things that can block iron absorption: tea, coffee, MILK, medications like antacids, PPI (for reflux), and calcium supplements.
So if you have a habit of drinking tea/coffee with your meals, try to move it until at least 1-2 hours after your meal (or avoiding altogether if you can). That goes for milk too. Iron deficiency is very common in children, and although not formally proven in clinical studies, I bet the habit of drinking a glass of milk with meals is inhibiting iron absorption.

Let’s turn to how to boost absorption: whilst it is true that plant based iron is non-heme and therefore harder to absorb, lots of plant foods are packaged with vitamin C which helps the absorption. (Isn’t nature clever). The best suggestion I have would be to add more vitamin C into your meals (even if you are eating meat) – squeeze of lemon, or adding bell peppers, strawberries, cantaloupe etc into your meals.

Also – if you are relying on legumes as your source of iron, make sure to soak them first or better still, sprout them. Legumes contain phytic acid, which is an anti-nutrient, and can inhibit the absorption of nutrients. Soaking for 24 hours will reduce the phytic acid, and pressure cooking also helps reduce the phytic acid levels. Sprouting is a another great way to unlock the nutrients from legumes. Try to incorporate more iron rich foods into your diet e.g. black beans, leafy greens, lentils, dried dates/apricots.

Here are some additional ways I use to ensure we get enough iron:

  • Spirulina and moringa… both are great sources of iron and if you throw the powder into a smoothie, the vitamin C will boost absorption too

  • Dried apricot, dates and blackstrap molasses to sweeten my baking instead of maple syrup or sugar. These are iron-rich and so much more nutrient dense than syrups and sweeteners.

  • Plenty of cumin in my cooking

  • Cooking with a cast iron pan

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