Will I Become Anemic And Iron Deficient on a Plant-based Diet?
By Dr. Silvia Odorcic, MD, FRCSC, DipABLM (IG: @dr.silvia.md)
I remember the surprised looks on the faces of my family and friends when I excitedly announced I was transitioning to a plant-based lifestyle. “Won’t you become anemic! Maybe you need to eat just a little meat?” Fast forward four years and I still get asked the same question. Does adopting a plant-based diet put you at risk of iron deficiency anemia? After diving into the literature and research for the past four years and becoming certified in both Lifestyle Medicine and Plant-Based Nutrition, let me dispel the myth for you here and now: Quite simply...No. Adopting a plant-based lifestyle does not automatically put you at increased risk of iron deficiency anemia. Studies have shown that vegans and vegetarians are not at increased risk of iron deficiency anemia compared to omnivores. Meat and other animal products are simply not necessary to maintain adequate iron levels. That being said, the most common nutrient deficiency worldwide is iron deficiency. As many as 1.2 billion people worldwide suffer from iron deficiency based on 2019 statistics. So, are you at risk? Well that depends on your gender, age, and several other factors. Those at most risk include women of childbearing age, anyone undergoing surgery, women who are pregnant and those that are menstruating. Without iron, the body is unable to produce normal red blood cells which can result in iron deficiency anemia. Causes of anemia include iron malabsorption, insufficient iron in the diet, and even acute or chronic blood loss as would happen during menstruation, childbirth or surgery. Therefore, it is important to get your iron level (hemoglobin), as well as your body’s iron stores (ferritin) checked regularly with your healthcare provider, especially as a woman. This is a recommendation that I give to my patients and clients irrespective of their dietary choices. A very interesting phenomenon that has emerged from the evidence-based literature is a condition called Iron Deficiency without Anemia. Can you be iron deficient but have a normal hemoglobin? Surprisingly, you can. Iron deficiency without anemia is when your hemoglobin levels are in the normal range but your iron stores (ferritin levels) are in the low range. Sometimes this may be discovered on routine blood work and a physician may advise iron supplementation to increase your iron stores, even if you aren’t experiencing any symptoms of iron deficiency like fatigue or shortness of breath. Those individuals consuming a plant-based diet tend to have lower serum ferritin compared to omnivores. However, lower iron stores often do not affect how someone feels. In fact, having lower serum ferritin with normal hemoglobin may be an advantage. Literature has shown that lower serum ferritin can reduce the risk for insulin resistance and type 2 diabetes, cardiovascular disease, and oxidative stress in the body. Iron supplementation in those individuals with lower serum ferritin levels but normal hemoglobin may or may not be warranted and depends on symptoms, ferritin levels, and even physical activity. For example, there are studies supporting iron supplementation in high performance athletes with lower serum ferritin levels. If you fall into this category, then discussing your individualized case with a healthcare professional that has a background in plant-based nutrition and/or lifestyle medicine would be very beneficial. Eating a varied and well-balanced whole foods plant-based diet will provide you with ample sources of iron. For information on plant based iron sources, please click here. If you aren’t sure if you are hitting your mark, try using Cronometer. It is an excellent app that tracks your nutrients, including iron, and can give you an idea if you are hitting your RDI. The RDI or recommended daily intake of iron for omnivores is 8 mg/day for men and 18 mg/day for women. If you are predominantly or exclusively plant-based, your RDI will be higher due to the lower bioavailability of plant-based iron. However, the lower bioavailability of plant-based iron is not necessarily a bad thing. Let me explain. Iron is found in both animal and plant sources although the type of iron found in plants versus animal products and its bioavailability differs. Animal products contain a type of iron called heme iron while plants have non-heme iron. The issue with obtaining all of your iron from predominantly animal sources is that excess heme-iron is inflammatory, causes oxidative stress in the body and has a role in insulin resistance, leading to diabetes. Also, animal products come packaged with saturated fat, nitrates found in processed meats, and a lack of fibre. On the other hand, plant sources of iron contain minerals, antioxidants, phytonutrients and lots and lots of fibre!
Read the iron article here to learn how to ensure you meet your iron RDI from plant sources and several ways to maximise your iron absorption from plant sources.
So now when someone asks you whether you are worried about becoming anemic on a plant-based diet, you will have the evidence-based knowledge to back up your answer with confidence! I congratulate you for deciding to put more plants on your plate - a decision that promotes health, and is a win-win for the animals and our beautiful planet.
References
Clénin GE. The treatment of iron deficiency without anaemia (in otherwise healthy persons). Swiss Med Wkly. 2017 Jun 14;147:w14434.
Haider LM, Schwingshackl L, Hoffmann G, Ekmekcioglu C. The effect of vegetarian diets on iron status in adults: A systematic review and meta-analysis. Crit Rev Food Sci Nutr. 2018 May 24;58(8):1359-1374.
Henjum S, Groufh-Jacobsen S, Stea TH, Tonheim LE, Almendingen K. Iron Status of Vegans, Vegetarians and Pescatarians in Norway. Biomolecules. 2021 Mar 18;11(3):454.
Pawlak R, Berger J, Hines I. Iron Status of Vegetarian Adults: A Review of Literature. Am J Lifestyle Med. 2016 Dec 16;12(6):486-498.