Vegetarian Iron Inquiry

Q:  I want to know more about iron.   I know women need it during our fertile years.  I have a lot of vegetarian clients, and it seems several of them are anemic. Why aren’t they absorbing the iron?  What can I do to help?

A:  Iron is an essential mineral in all diets but especially for women because we lose blood on a monthly basis.  The body must have additional iron to make new red blood cells.  Inside each molecule of hemoglobin (the oxygen-carrying portion of red blood cells), there is a “heme” group that must include iron.  You can get a common bloodwork panel called a “CBC” or Complete Blood Count to understand a person’s levels of hemoglobin and whether they have iron-deficiency anemia.  But you can also get a much better feel for their iron reservoir by getting a blood test for ferritin (the body’s storage form of iron).  These are straightforward tests to request if someone has symptoms of anemia (feeling cold, pale complexion, lethargy, perhaps some dizziness, low energy).  In some cases, a CBC may appear normal, but low ferritin levels below the surface indicate iron deficiency or malabsorption in the diet.

Yes, there are different types of iron.  Iron from animal sources (e.g. egg yolks, beef) is called “heme iron” and is typically absorbed much better than most iron from vegetable sources.  However, iron deficiency is about as common in vegetarians as it is in carnivores.   Conscientious vegetarians without digestive issues who consume regular amounts of dark leafy greens should be fine (e.g. kale, spinach, turnip greens).  Natural molasses is also an excellent source (the highest in the plant world).   If not, organic eggs would be a good source to consider.  If ferritin is very low (< 20-25), I recommend using liquid heme iron drops (always on a full stomach) – or at least an amino acid chelate (e.g. iron bisgyclinate) if your vegetarian client is not open to heme iron even for short-term therapeutic use – until levels are > 50 and then supplementing with a focus on iron-rich food until levels are >75.

As an aside, I recommend you make sure your clients never take iron supplements (of any kind) along with calcium supplements (or foods high in calcium), as these two nutrients block absorption of one another.

Please realize that for a vegetarian with suboptimal digestion, anemia may be caused by B12 deficiency as well as (or instead of) iron.  This is called macrocytic anemia (as opposed to microcytic) – macro meaning “large” because insufficient B12 causes red blood cells (RBCs) to be synthesized that are larger than ideal.  Larger RBCs have difficulty fitting into our smallest capillaries and can thus inhibit tissue oxygenation, causing coldness, numbness, or tingling, especially in hands, toes, feet, and fingers.  Serum B12 is not a particularly useful marker of B12 sufficiency because it only indicates the amount of B12 in the blood, not the level inside the cells.  In the CBC test mentioned above, look for the “MCV” (mean corpuscular volume) marker; if it is larger than 93, suboptimal B12 is likely an issue (regardless of what serum B12 indicates).  Be sure to supplement with methyl forms of B12 in this case (not cyano-).  All Vitamin B12 comes from animal-derived sources (even if only bacteria).  I recommend starting with 1000mcg/daily (always on a full stomach as B12 requires strong stomach acid to prepare it for absorption in the intestines).