Iron is an essential nutrient for human health and wellbeing. This means that we must consume it from our diet to ensure we have enough for our body to function. Unfortunately, one of the most common presentations I see in the clinic is low iron, particularly among vegan and vegetarians.
The main reasons you may have low iron are:
You are not consuming enough from food
You are losing iron from blood loss (eg: menstruation)
You are not absorbing the iron
You are using up your iron stores (eg: pregnancy)
There are two types of iron that we can consume.
Heme iron: Comes from animal products such as meat, seafood and poultry. It is absorbed in the gut much easier thanks to certain transporters that allow it to cross through our cell walls.
Non-heme iron: This is found in plant foods such as green leafy vegetables, legumes and some nuts and grains. Non-heme iron cannot use the same transporters as heme iron and therefore is not absorbed as well into the body.
As a vegan or vegetarian, you will be consuming all of your iron from non-heme sources. For some people this is sufficient because they are also consuming other foods that help absorb the iron, they are not experiencing heavy menstrual periods or other blood loss, their gut is functioning well and their genetic make-up allows them to follow this particular style of eating.
However, for many people following a plant-based diet, iron levels can drop quite dramatically.
Having low iron can present as:
Feeling dizzy or light-headed
Shortness of breath
Brittle nails and hair
The most important first step is to get your iron levels tested through a simple blood test. If you have been experiencing any of the symptoms above, I suggest going to your GP right away and asking for an iron study. If you are following a vegan or vegetarian diet, I recommend having an iron study done every 6-12 months to keep an eye on your levels, even if you haven’t been experiencing any of the above symptoms.
When you get your iron results there will be a few different numbers tested. We are focusing mainly on your ferritin levels - the amount of iron stored in your body for use. I want to see this number above 50. Even though many tests will suggest as low as 15 is sufficient, this is not the case. If your ferritin levels are less than 50, you will need to start thinking about some of the following options.
How to improve your iron levels?
Supplementation: this is not always necessary but if your levels are very low, this should be where you start so that we can raise them up while also working out why you have low iron. Not only will this make you feel a lot better, it helps to resolve the issue quicker. Some people may need to remain on iron supplements if they decide to pursue a vegan or vegetarian diet long-term. Iron infusions are another option whereby iron is given intravenously (straight into the bloodstream). This is usually reserved for those who are anaemic or very very low in iron. There is some evidence that suggests taking an iron supplement every second day can help with absorption but I suggest speaking with your naturopath about what dose is best for you.
Increasing dietary intake: many people following a plant-based diet haven’t examined what they are eating for its nutrient content. It is essential, no matter what diet you are following, that you consume adequate amounts of all nutrients. The recommended dietary intake of iron in Australia is 8mg per day for men and 18mg per day for women. This number increases with pregnancy and breastfeeding. To understand if you are hitting this target, I recommend doing a food diary, writing down the amounts of all ingredients you are consuming throughout the day. Once you have this data, punch it into an app such as Cronometer or My Fitness Pal to see the nutrient content. This should show you how close you are to hitting your targets.
Consuming co-factors: interestingly there are certain things that help the absorption of iron. One of those is Vitamin C which can be found easily in many fruits and vegetables. If you are consuming iron-rich foods, I suggest also consuming Vitamin C-rich foods at the same time. This could look like squeezing some lemon onto your spinach. Lactoferrin is another co-factor that helps absorb iron, however, as it is a protein found in milk this would only be suitable for vegetarians who are happy to ingest dairy compounds.
Avoiding inhibitors: just like there are foods that help absorb iron, there are certain foods that reduce its absorption. Many of these foods contain tannins such as black tea, coffee and wine. If you are consuming iron-rich foods or taking supplements, I recommend ensuring you separate it from tannin-containing foods by at least an hour or two.
Gut work: one of the main reasons people of any diet have low iron is because they are struggling to absorb it in their gut. Conditions such as coeliac disease, Crohn’s and IBS mean there is a level of inflammation along the digestive tract, making it hard for iron to cross over into our bloodstream. Taking iron supplements for a period of time but not seeing a rise in ferritin levels is a sure sign that you likely have some gut healing work to do. If you experience any digestive issues or gut complaints, it is important to address these for the sake of your iron levels.
Menstrual cycle work: as mentioned above, women have an almost three times higher recommended daily iron intake requirement compared to men. This is because of menstrual cycles and the loss of iron through blood. If you have heavy periods, the likelihood of you having low iron, regardless of your diet, is greatly increased. There are many reasons why your period may be heavy and by working with a naturopath, this can likely be gradually supported and improved. For many women who are having medium to heavy periods, I suggest taking an iron supplement on your bleed days.
It is possible to have nice healthy iron levels on a vegan or vegetarian diet but it may require some investigating and work to get you there. If you would like some support with raising iron levels or general health, please book in for a consultation and we can begin our work together.