The term “anemia” often gets tossed around by omnivores who are concerned that their newly-vegan friends will become anemic without slabs of red meat. Furthermore, most people automatically assume anemia is related to iron deficiency, but anemia can in fact be caused by deficiencies of other nutrients, such as vitamin B12, folate, vitamin E, and copper. Here I’ll just discuss some things to consider about iron. Iron is involved in energy production, thyroid hormone production, transport of oxygen, immune function, and DNA synthesis. Numerous chronic diseases and conditions put individuals at risk of iron deficiency such as Celiac disease, bariatric surgery / gastrectomy, hypothyroidism, COPD, chronic kidney disease, Crohn’s, H. pylori infections, ulcerative colitis, and heart failure. Medications (proton pump inhibitors, anticonvulsants, metformin, chemotherapy) can also decrease iron absorption or utilization.
The recommended daily allowance (RDA) for iron for vegans is 1.8X the amount recommended for omnivores because vegans must get iron exclusively in the form of non-heme iron (animal products contain heme iron which is absorbed a bit easier). Technically this means vegan women should get 32 mg/d, a high bar for women to obtain and one I think is too high. The tolerable upper intake level is 45 mg/d for adult men and women which isn’t much higher than the 32 mg/d recommendation. Some people (myself included) are genetically predisposed to have higher than normal levels of iron which will likely show up on a blood test, so care must be taken not to overload.
Measuring iron stores:
Investigating anemias and iron status isn’t always as simple as just looking at hemoglobin/hematocrit, as those are the last markers to change when iron stores are low. One of the best markers of iron status is ferritin (an iron storage protein), but note the wide reference range labs may use. Always obtain a copy of your labs from your doctor to check your values to make sure you’re not at the very bottom or top of the reference range. Ferritin can skyrocket in the presence of inflammation so it’s not always reliable. Your doctor might run an iron panel measuring things like the amount of free iron circulating in your blood and the affinity of your cells for iron.
Getting enough iron:
If your doctor recommends getting iron through food and not supplementing, great vegan food sources of iron are: bran flakes, cream of wheat, dried prunes, spinach, tofu, extra dark chocolate (yes!), soybeans, and dried beans or lentils. Check out this post for other food sources of iron. If you’ve gone through a thorough workup and your doctor has uncovered an iron-deficiency anemia, they may prescribe a specific dose of iron to correct the deficiency. Certain forms of iron can be quite constipating and harsh on the digestive tract though, so if you can’t tolerate one form do try another such as ferrous bisglycinate or look for a label that indicates “gentle,” “well-tolerated” or controlled-release forms.
Bottom line: Iron status can be a tricky beast in the setting of veganism, chronic disease, medication usage, and genetic predisposition. If you don’t need to restrict iron, focus on the iron-containing foods above and get labs checked yearly. Your doctor should let you know if you either need to restrict iron or if you need to supplement it.
Sources and Further information: