• Michael Greger M.D.
    • HemoDynamic, M.D.

      You are becoming the physicians physician.

      This is extremely helpful for anybody in the healthcare industry that deals with iron abnormalities.  A must watch.

      It is fascinating to me that our bodies cannot regulate animal sources of iron but it can plant sources.  I was never taught that in medical school (Am I surprised? No!). 

      Now I may be incorrect but that means to me that we have evolved eating plants and not animals; for if we had been eating animals throughout time, our bodies would have surely created a regulatory mechanism for absorption of animal based sources of iron. 

      I have never tried to treat IDA (Iron Deficiency Anemia) with a plant based diet.  But come to think about it all my patients that are on a plant based diet don’t have IDA.  Interesting!

      • SJ M.D.

        Agree – surprise! ;-) - strong indicator that humans are not built to get iron from meat.

        • Gale

          OK Doctors. I think this topic isn’t so black and white. I wish it was. 

          There really are some people who tend to be anemic–me for one. Northerns European Grandfather/Grandmother the cause? 

          Either way, as a serious runner I can’t stand that feeling of heavy legs while out on a 10 mile run. We don’t know  whether runners tend to be anemic due to sweating or the red blood cells getting beat up in our feet (a couple of theories). I do all the right things–I eat a ton of greens, a ton of beans, pistachio nuts and I include vitamin C foods. And still I am on the low side. (Ferritin levels hover around 20 if no supplement taken.) Even when I take a supplement I am just barely normal. So in cases like my own, one pill a day (taken with Vit. C)  can’t be too much of a concern. Obviously I must have some kind of absorption problem. “Toxins” suggested garlic may help. So one more addition to my morning smoothy! 

          • SJ M.D.

            Gale – sorry – I am just an enthusiastic plantstrong guy….

            Did you have the same problem when you ate meat (if ever)?

            I am from Northern Europe – no problem with hgb

          • Gale

            Yes always. College was a bear. Try sitting down to a neurophysiology test and not be able to concentrate.

          • Lebepotter

             I’m another runner on plant-based diet, also tending toward anemia– even though I’ve been taking iron supplements twice a day for a couple years. I’ve had AIDS for decades, too– so I’m not typical of the general population. I also don’t get to indulge in the sort of plant-strong pride that would let me think I can run this body w/o medicine. I’ve been thinking I need to boost my iron supplementation (Iron sulphate) again– but am a little unhappy about this video’s report of increased oxidative stress apparently resulting from iron supplementation. Maybe it’s back to pumpkin seeds, which I’d cut out owing to their poor omega3/omega 6 fatty acid ratio and the general Esselstyn dietary recommendation to limit nuts and seeds…. (chickpeas are also have a high omega 6 level, compared to other beans).
            I do include vitamin C rich foods at all meals, including those at which I take the iron pills.

            Gale seems so right to me that this topic’s not simple.

          • Thea

             Lebepotter:  I can’t address the main point of your post, but I did want to respond to: “Maybe it’s back to pumpkin seeds, which I’d cut out owing to…”

            I believe that there are several videos on this site concerning nuts which list studies which point to positive benefits of eating nuts and seeds.  I’m familiar with Dr. Esselstyn’s book and really liked it, but I wonder if this particular recommendation of his is still valid. 

            I saw from the table of contents that Dr. Greger will be addressing nuts once again in volume 10/upcoming videos.  I do not yet know the content of those videos, but perhaps all of these videos will put your mind at rest concerning the consumption of nuts.  Maybe?

            Good luck in whatever you decide to do.

          • Lebepotter

             Thea, thanks so much for your thoughtful and exquisitely tactful reply! I have noted Dr. Greger’s consistent nut endorsements. Those help keep me eating a few walnuts– which even Dr. Esselstyn calls okay for patients w/o heart disease. Quite low levels of nut consumption seem to be sufficient to provide the benefits. Maybe that’s the sweet spot. Pumpkin seeds are, of course, not nuts, so who knows where they fit in? They haven’t, on their own, been enough to replete my iron stores in the past. But I’ve just been reading around on iron supplementation and oxidative stress and not at all liking what I see: “Iron supplements: the quick fix with long-term consequences” is a representative title, though that paper’s particular target is combined supplementation with (non-food) iron and (non-food) vitamin C. I’ll be watching for Dr. Greger’s upcoming items on nuts, and listening with mind open. Thanks, thanks again.

          • Thea

            Lebepotter:  You sure do your homework.  I’m impressed.  I admire people who take responsibility for their health *and* go about it in a thoughtful and open-minded manner.  (I also admire people who run.  I’m hopeless…)  Thanks for taking my comments in the spirit in which they were intended.  :-)

            I had to mention: the walnut dressing from Dr. Esselstyn’s book has become one of my parent’s favorites.  They put it over all sorts of things.

          • Lebepotter

            Thea, Yes! that Esselstyn  walnut dressing is delicious . Glad your parents like it and use it. Good w chopped scallions in place of all or part of the garlic, too., too. ons ins using is  is

          • Ginger

             I don’t run but have had lots of trouble with low iron for decades whether eating meat or not. Floridix is a non-heme iron suppliment from 100% plant sources. I take it off and on as need arises.

          • Gale

            If I didn’t eat nuts and seeds and avocado I would be too skinny. I think the idea is that processed foods have high levels of omega 6. Therefore the average SAD is high in omega 6. If you don’t eat that crap I think you are ok adding nuts and seeds. There are plenty of videos by Dr. Greger under topics regarding nuts and seeds. (or google)

            FYI I just read the best books written by athletes (runners) who are also vegans. Eat and Run by Scott Jurek and Finding Ultra by Rich Roll.

          • AlexanderBerenyi

            Say what? Nuts, seeds, and soy are fantastic sources of omega 6—probably why the SAD is so laden with them.

          • Gale

            The SAD is high in refined vegetable oils primarily from soybean oil used in packaged crackers, cookies, sweets, snacks. Therefore Americans get too much omega 6 and not enough omega 3. Does that clarify it for ya?

          • AlexanderBerenyi

            Try to find the greatest imbalance of ω-3/ω-6. Hint: it’s not salmon or grass-fed beef.

            http://paleozonenutrition.com/wp-content/uploads/2011/06/omega-3-and-6-in-fats-oils-nuts-seeds-meat-and-seafood-2.pdf

          • jhnycmltly

            “Hereditary hemochromatosis is the most common inherited single-gene disorder in people of northern European descent.”
            “Secondary iron overload should be suspected in patients with chronic anemia”

          • Gale

            Hi jhnycmitly, (mouth full)

            Man I just came back from the beach working on my vitamin D. What a beautiful day. OK explain that second comment. 

            I am very interested. 

            Gale

          • Rachael D

            Gale,

            I found the articles below to be helpful for starting the process of improving my iron levels. I used to jog, but had to switch to powerlifting and resistance training (love it!) because the drain on my iron from jogging led to serious Restless Leg Syndrome, profuse hair loss, and the feeling of running into a wall of water after jogging for one block after a month of consistent jogging. I have never had anemia, am a long-time pescatarian, eat my veggies, and have chronic iron deficiency without anemia (normal hemoglobin, borderline ferritin) that I treat with ferrous bisglycinate and Vitamin C. I have no Northern European ancestry. I still have occasional issues, and had them even before becoming physically active, but seem to be gradually improving after starting Vitamin A supplementation several months ago at the maximum safe dosage of 10,000 IU/day.

            Articles:
            http://nutrition.highwire.org/content/128/3/646.short
            http://ajcn.nutrition.org/content/36/1/87.full.pdf+html
            http://ajcn.nutrition.org/content/71/6/1563.short

            Applicable for some women of childbearing age:

            http://jama.jamanetwork.com/article.aspx?articleid=1161803

            http://archive.samj.org.za/1977%20VOL%20LI%20Jan-Jun/Articles/02%20February/2.4%20VITAMIN%20A%20IN%20THE%20TREATMENT%20OF%20MENORRHAGIA.%20D.M.%20Lithgow%20and%20W.M.%20Politzer.pdf

          • Veganrunner

            Thank you Rachael. I’ll check out the articles above when I get a chance. I am still working on this issue.

      • http://www.facebook.com/darryl.roy.752 Darryl Roy

        “The paradox of anemia with high meat intake: a review of the multifactorial etiology of anemia in the Inuit of North America”
        was on one of Dr. Greger’s prize CDs: http://missclasses.com/mp3s/Prize%20CD%202010/Previous%20years/Fish/anemia%20inuit.pdf

      • Sarah V Lucas

        I actually have successfully treated my own IDA with a plant based diet. I’m a nutrition student and a vegan, and so after some particularly strapped-for-cash months spent living off of bread, rice and potatoes, my iron levels plummeted. I wrote myself up a nutrition plan and shortly after my iron has returned to normal. I also wrote up a nutrition plan for a friend whose iron levels had dropped not quite to the extent of anemia, and her levels returned to normal pretty much straight away.

        • Michelle Mulcrone

          Sarah, I’m curious, what type of foods did you include in these meal plans?

          • Sarah V Lucas

            Hi Michelle. It included plenty of kale, parsely, rocket (arugula), broccoli, red split lentils, chickpeas, black beans, nuts, pepitas and sunflower seeds as well as quinoa and brown rice. Recipes like kale and chickpea salad with tahini lime dressing, tabouleh, masoor dahl, chickpea curry, green smoothies, stir fried vegetables, black beans and tempeh/tofu, lentil & black bean patties with steamed veggies and salad.

          • Sarah V Lucas

            I also avoided tea, coffee, wine, spinach and silverbeet (chard) due to their iron inhibiting natures/poor iron bioavailability.

  • BPCveg

    In the sources cited, I could not find support for the claim “our digestive system cannot regulate the iron in ingested blood…” 

    I read the article “Mechanisms of Heme Iron Absorption” by West and Oates and could not find support for this claim.

    Perhaps someone can point out where this claim is specifically made… If anything, it seems to me that all of the cited articles are recommending heme sources (i.e. meat sources) of iron to prevent anemia.

    • Thea

       BPCveg:  Really great question.  Thanks for doing this research.  I hope someone answers your question, because I am interested too.  I often repeat information I learn from this site.  I want to be able to back it up anything I say.  Otherwise if people can say, “prove it” and I can’t to any one thing, then they think that everything I say is of questionable value.  (It is my experience that “throwing the baby out with the bathwater” is human nature.)

      • HemoDynamic, M.D.

        Thea please see my response to BPCveg above.
        ;-}

        • Thea

           Thanks so much for taking the time to answer this question!!  I feel much better when I know these kinds of questions can be answered.  Your help is much appreciated.

        • Micah

          Was your response removed? I would really like to know what was said. This is a very interesting topic!

          • HemoDynamic, M.D.

            No it wasn’t removed it is below because of this thread.  Just look for responses to BPC from me.  My response wasn’t anything special ;-(

      • BPCveg

        Thanks, Thea. I agree with you.

    • HemoDynamic, M.D.

      BPCveg,
      Just a quick response.  I just scanned the “Mechanisms of Heme Iron Absorption”.   The following statement is from the Cartoon caption in the article:

      “Any iron released from heme inside the enterocyte, regardless of the mode of uptake, ultimately joins the labile iron pool and is transferred to the  bloodstream by FPN1 in the same fashion as non-heme iron.”

      This is what Dr. Greger mentioned in his video.  Mouth, to gut, to iron pool.  Our bodies cannot regulate the iron absorbed from animals.
      ;-}

      • BPCveg

        Not so fast, HemoDynamic.

         The sentence that you have cited relates to transport of iron after it is absorbed and does not distinguish between heme (meat-based) and non-heme (plant based) iron! I don’t think it is relevant.

        I think that the article is arguing the exact opposite of what Dr. Greger is claiming.

        Please note that not all heme (i.e. meat-based) iron is absorbed, as explained on page 2, paragraph 3: 

        “up to 19% of an equivalent dose of heme was absorbed[36]. This strongly suggests that heme uptake is a facilitated process, as opposed to simple diffusion. ”

        –> read that again, heme uptake is a FACILITATED process — i.e. it is regulated!

        Furthermore on page. 2, paragraph 2 the author’s state:

        “…the absorption of heme iron cannot upregulate to the same extent as non-heme iron during iron deficiency[14,15,21-25]. This is possibly due to rate limitations at the step of heme catabolism”

        Moreover on page 5, paragraph 2 the author’s state:

        “…the ability to upregulate heme iron absorption is limited compared to non-heme iron[14,15,21-25], and heme splitting is speculated to be rate limiting[67]. ”

        –> clearly even the rate at which meat iron is digested is regulated!

        Overall the authors of this paper very clearly argue in favour of consuming heme iron (i.e. meat-based iron), as they state on page 1,
        paragraph 2-3:

         ” Currently, the importance of heme iron in the diet cannot
        be underestimated. Studies estimate that in Western societies, iron derived
        from heme sources such as myoglobin and hemoglobin make up two thirds of the
        average person’s total iron stores despite only constituting one-third of the
        iron that is actually ingested[4-6]. This likely explains why vegetarians are
        more prone to iron deficiency than those who regularly consume red meat[7]. The
        relative importance of dietary heme is attributable to its high
        bioavailability compared with non-heme iron in the predominantly alkaline
        conditions found in the lumen of the small intestine. ”

        I fail to see the connection that Dr. Greger is trying to make and do not understand why he selected this article.

        I hope that others will be encouraged by my comment to read this article and try to interpret it for themselves.

        • HemoDynamic, M.D.

          BPC,
          I’m not disagreeing with you. And you make a good point that there is some regulation.
          But I’m trying to figure out exactly what Dr. Greger is talking about.  And after watching the video again, he specifically points out the mechanism on the left side of the cartoon in the article showing that “Intact heme may be transported across the basolateral membrane (going straight into the blood) by FLVCR where it binds circulating hemopexin.” 

          And maybe there is more to this that he understands. 

           It is clear that our bodies uptake more Heme iron than Non-Heme Iron that’s why “myoglobin and hemoglobin make up two thirds of the average person’s total iron stores despite only constituting one-third of the iron that is actually ingested[4-6].”
          And if this is the case does this happen because there is less regulation of Heme iron compared to non-heme iron or is Heme-iron a preferred source by the body?

        • Kate Scott

           BPCveg: I think the confusion arises because Dr Greger is summarising a complicated process in a 2minute video. The sentence you quote from the article that “the ability to upregulate heme iron absorbtion is limited compared to non-heme iron” is consistent with what Dr Greger is saying, because the flip side of that statement is that the ability to downregulate heme iron absorbtion is also limited. Experiements have shown that absorption of non-heme iron is highly sensitive to how deficient the individual is and also to how much iron is in the meal (absorption of non-heme iron goes down with a higher amount of iron in the meal) but heme iron absorption tends to be much less sensitive to these factors. So if you eat a lot of red meat and have quite high iron stores, that is a problem because you will just keep absorbing the heme iron regardless. However, even though non-heme iron absorption is more sensitive to the iron status of individuals, it is still much more poorly absorbed overall relative to heme iron, which is why the authors of the article (and most dieticians) recommend heme iron because it is better able to prevent anemia. 

          For the person who is worried about chickpeas and omega-6 fatty acids, lentils are an even better source of non-heme iron. But really that concern over omega-6 is misplaced. As long as you avoid high omega-6 oils, the consumption of nuts and seeds will not be a problem and they have been shown so consistently to have positive health effects. Just throw in some flax seeds to balance things out.

          • BPCveg

            If possible, please provide some reputable sources to support your claims.

          • Gale

            Hi Kate,

            Ok. As I understand it we have a system that is great at regulating non-heme iron or heme iron. (when ferritin levels are around 60 the uptake stops) However with some people their regulatory system doesn’t work properly. They either absorb too much iron which is stored in different organs (damaging) or not enough is absorbed and then tend towards anemia.

            I think the main point Dr. Greger is trying to make is that taking iron supplements can cause oxidative stress and should be done only as a last resort.

            I couldn’t find any research articles that stated that the absorption of heme iron was not regulated as well. It appears we have an amazing system if it is working properly.

  • Rose

    It is possible that the oxidative effects associated with a higher intake of meat are increased when the meat source itself has been fattened on a corn/grain-based diet high in Omega 6 rather than a natural grass based diet higher in Omega 3s, and has less to do with excess non-heme iron than excess commercially-raised meat.

  • Jans Louis

    Just for everybody’s information concerning the absorption of heme iron.
    http://www.ncbi.nlm.nih.gov/pubmed/9756117 analyses also demonstrated an effective control of iron absorption preventing development of iron overload in otherwise healthy subjects even if the diet is fortified with iron and even if meat intake is high.
    http://www.ncbi.nlm.nih.gov/pubmed/8557018
    The powerful control of iron absorption implies that dietary iron overload cannot develop in normal subjects, even with diets having high iron content or high bioavailabilityhttp://www.ncbi.nlm.nih.gov/pubmed/9250114Iron absorption from the whole diet, which contained a highly bioavailable form of iron, was measured for 5 d in 31 health men, including 12 blood donors. Nonheme iron in all meals was labeled with an extrinsic, inorganic radioiron tracer added in amounts to ensure uniform specific activity in all meals. Heme iron was labeled similarly by using hemoglobin biosynthetically labeled with another radioiron tracer. There was a good inverse relation between total absorption and concentration of serum ferritin up to approximately 60 micrograms/L. In subjects with serum ferritin > 60 micrograms/L there was no relation to iron absorption. At this serum ferritin concentration, absorption decreased to a level just sufficient to cover basal iron losses, implying that at a serum ferritin concentration > or = 60 micrograms/L no further accumulation of iron stores will occur by dietary iron absorption. The findings thus suggest that in normal subjects there is no risk of developing iron overload by iron absorption from the diet even if the diet is fortified. Similar findings were made previously in two studies in women, both of which indicated an effective control of absorption. At the same serum ferritin concentration the absorption per kilogram body weight was the same in men and women served identical diets with a high iron bioavailability. These new observations strongly suggest that translation of serum ferritin concentration into amounts of stored iron should be made with caution and that in subjects with high serum ferritin concentrations, other causes than increased iron stores should be considered. There was effective control of both heme- and nonheme-iron absorption but their relations to iron status were different.

    • Jans Louis

      Bad copy and paste on the last link it seems, sorry: http://www.ncbi.nlm.nih.gov/pubmed/9250114

  • http://profile.yahoo.com/KUSZH4JCJXBWTORBG5T2XTQ5RI Massimo

     Dr. Greger,
    I would very much like to get a definitive (?) word about the absorption of non-heme iron ins omnivorous vs. vegetarians. The only clear statement I have found so far is in an article by C. Kies and L. Mc Endree, titled “Vegetarianism and the Bioavailability of Iron” published in 1982 by ACS (American Chemical Society) in the proceedings of the symposium “Bioavailabilty of Iron”, ed. by C. Kies, ISBN-10: 0841207461, ISBN-13: 978-0841207462. There, I found the statement that vegetarians absorb non-heme iron more efficiently then flesh eaters. It looks like our body boosts the absorption of non-heme iron when it cannot rely on heme iron, while if the latter is present, then it becomes “lazy” at non-heme iron.
    Are you aware of any later studies on this subject?

  • BPCveg

    jhnycmltly,

    Thanks for the abstract, though preferably it would be a peer-reviewed journal article, which is typically a more rigorously performed study.

    I think that the conclusion of this abstract, namely, “unlike nonheme iron, heme iron absorption is not substantially reduced as iron stores increase”, seems at first glance to be consistent with Dr. Greger’s message. However, they do not associate this reduced absorption with iron overload, as implied by Dr. Greger.

    In fact, the peer reviewed articles sent by Jans argue the opposite that:

    “… in normal subjects there is no risk of developing iron overload by iron absorption from the diet even if the diet is fortified.”

    I am still unconvinced that meat-eaters are prone to iron-overload.

    • Gale

      We agree with you. May this topic RIP.

    • jhnycmltly

      Quote: they do not provide evidence that meat consumption leads to iron overload,

      Answer: The body has no way to excrete the iron once it is absorbed.
      “Iron differs from other minerals because iron balance in the human body is regulated by absorption only because there is no physiologic mechanism for excretion”
      Heme iron , as evidenced , is absorbed all the time and you do not believe , “unconvinced” , that heme-iron leads to iron excess.
      “unlike nonheme iron, heme iron absorption is not substantially reduced as iron stores increase”
      You should maybe stay out of medicine.

  • jhnycmltly

    “The observed differences in estimated body iron stores in Greenlanders from the three residential areas can be explained by differences in the dietary intake of haem iron”
    http://www.ncbi.nlm.nih.gov/pubmed/11168519

    • jhnycmltly

      A curious thing about that study. Other researchers went back years later and found those people who DID have the highest iron stores ? they NOW had diabetes.
      “Prevalence of iron load highest in Uummannaq (men, 32.1%; women, 21.1%).”
      “The prevalence of diabetes in Unmmannaq was higher than that in the towns of Nuuk and Qasigiannguit”
      http://tinyurl.com/3xkawm

      http://care.diabetesjournals.org/content/25/10/1766.full.pdf

      Which means , “the dietary intake of haem iron” , predicted the development of diabetes because the FIRST researchers explained the high iron due to meat eating / haem iron.

  • Carlos169

    This seems to be interesting coming from the meat science journal:
    Denis E. Corpet, Red meat and colon cancer: Should we become vegetarians, or can we make meat safer?, Meat Science, Volume 89, Issue 3, November 2011, Pages 310-316, ISSN 0309-1740, 10.1016/j.meatsci.2011.04.009.
    (http://www.sciencedirect.com/science/article/pii/S0309174011001458)

  • BPCveg

    Good find, Carlos.

    Just read the full article, available freely: http://hal.archives-ouvertes.fr/docs/00/59/29/66/PDF/Corpet-meat-cancer-veg-safer-Meat-Sci-2011-Author-version-2011.pdf

    The conclusion made me chuckle:

    ” Our experimental studies in rats provide direct evidence that red meat and processed meat can increase colon carcinogenesis. They also strongly support the hypothesis that heme iron is the major cause of cancer promotion by red meat. Based on works by other researchers, our results add some evidence to two pathways linking dietary heme iron and cancer promotion. Lastly, we are suggesting several ways to prevent the toxic effect of meat, either by increasing the calcium load of the meal, by changing the meat processing, or by choosing new additives. Full demonstration of mechanisms and of chemopreventive substances has not yet been given, but we expect that these studies will lead to a reduction of the risk of colorectal cancer without losing the nutritional benefit and the pleasure of eating meat.”

    I guess we shouldn’t be surprised by the spin they add in the final sentence given the journal’s title. ;)

  • Ellen M Helms

    I understand this is not the forum for a medical diagnosis so I’m just sharing what I was told after various blood tests and “events.”  I’ve had intestinal bleeding four times in the past four years.  Of course, after the bleeding, I became anemic (after two “events”, I needed a blood transfusion).  The follow-up blood tests revealed that my body does not absorb nor store iron well and I was told to take “chronic iron” as my gastroenterologist put.  (all the tests showed no abnormal growths, tumor or anything threatening, though two tests revealed a large blood vessel on the wall of the lower intestine but then after an enteroscopy, there were no large blood vessel found.)  

    I’ve been plant strong for three weeks, with occasional cheese when eating out with friends (that will now stop because my weight loss, 15 pounds so far, may have reached a plateau).  My plan is to have my blood tested again in another month or so to see where my iron levels are, as well as cholesterol.  I’ve also never felt better!!

    My question is about the iron absorption, storing issue…wondering if I should continue taking “chronic iron”.  I appreciate the video on iron being a double-edge sword but I’d like to have more information; what other links should I check out?

    Many thanks for sharing such important information!!

  • Beck

    What information is out there about taking Iron Infusion for anemia.  Does Iron Infusion cause the same risks such as Parkinsons, oxidative stress?

  • Jan P. de Baat Doelman

    What to do when serum iron is far too high and ferritin level far too low?

  • LynnCS

    Glad I had some smart docs when I went through my time of iron deficienanemia, after not getting help from several others. I didn’t understand about the ‘stores.’ I apparently had had a bleeding ulcer which went undiagnosed (a not so smart doc) when I had a lot of gastric symptoms. (to those who are given a diagnosis of GERD…follow your instinct and get a second opinion.) Anyway, the iron thing….I also was diagnosed with a VERY low thyroid. I was eventually put on a triple dose, 180 mgs of Armour Thyroid along with some other supplements and a liquid iron. It was quite a crash. As time went on I was told to stop the iron, that I checked ok and the ‘stores’ issue was explained. I also started to complain of heart palpitations and the thyroid was lowered, and lowered, and lowered. At some point, I couldn’t get the Armour thyroid any more and I just put off getting another product. A couple years later, it happened again. Sleep disorders, cold to the bone, hair falling out, etc. Just felt horrible! This time I checked out ok for both the iron and the TSH. Changed docs again to an ‘alternative’ doc and was getting a more reasonable discussion of the tests. He found it beneficial to prescribe a single dose of the Armour again. ( it had become available again.) There was some suspicion of Hashimoto’s. I wasn’t tested for it because the single dose of Armour and a single cup of coffee (I use the Folger’s singles to limit what I make) in the morning seems to have turned around the ADD, depression/anxiety and sleep problems. Go figure! Don’t know it this makes any sense to anyone but, I am told that the coffee acts as an upper to excite the brain’s centers that in turn put out the necessary chemicals which affect these chronic disabling issues. I have been on Cymbalta for several years after trying several antidepressants/antianxiety meds that made things worse. I was ready to give up and die. Oh, BTW. I was taking it for terrible Fibromialgia too.

    I took up a raw vegan diet and now not as perfectly raw but definitely vegan. High quality/very low fat. (Your videos and articles help) I feel better than I have for a long, long time. Maybe ever. I don’t want to rock the boat but am getting heart palpitations again. I’ve had all available heart checkups and no serious problems found. I can try taking a little less coffee. I have also been using some ‘herbal’ supplements like Ashwaganda, Astragalus, Holy Basil, Reishi Mushroom, and Ho Sho Wu. I also include some Ceylon Cinnamon which helps with blood sugar balance. My BSugar tests are ok, but helps the cold feeling. I also notice, or think I do, that the palpitations are better when I add some vegan protein powder to my green drink.

    I guess that’s a lot of info. I’M confused, so anyone reading this will be too, I’m sure.

    I’m not trying to get any kind of diagnoses here, but you asked about questions, so my question is….

    Do you see anything glaring here that would tell you I’m doing something right or wrong?

    Thanks for all you do. I read most of your posts and certainly go to your site first when I need to look up some info. Lynn

  • Changeisgood

    Dr. Gregor, What are your thoughts and conclusions about the use of Iron infusion? if one’s iron level at 5. It looks almost impossible to get irons levels high enough, quick enough, without Iron infusion. Sincerely, sleepy in Seattle.

    • http://www.DonForresterMD.com/ Don Forrester MD

      If you have a low iron level the most important thing is to find out why. Dietary, menstrual blood loss and losing blood in gastrointestinal tract from a variety of conditions (e.g. ulcers, tumors). Once the underlying cause is determined and treated there are several ways to replenish depleted iron stores and iron levels. In over 30 years of practice I never saw a case where a patient that needed iron infusions even injectable iron can cause problems. I favor gradual resolution through oral supplementation. You need to work with your physicians as each case is individual. If your physician recommends either infusion or intramuscular injection I would have them back up there recommendations with scientific studies as well as full disclosure of the alternatives such as oral therapy. You need to work with your physicians over time as each patients situation is unique.

  • Disa

    Dear Dr Greger. Thank you for providing us with this fantastic source of nutritional information. I just have one question about iron supplements. Are iron supplements coming from a non-animal source also harmful? I’m taking supplements specialized for vegetarians/vegans (containing B12, Iron, Calcium, Zink, among other) so they don’t contain any blood heme. Should I still be cautious about the iron supplement?

    Background: I’m vegan now and I’ve had a tendency to become anemic since high school (when I had an omnivorous diet), so I think that it would be good for me to eat iron supplements.

    • http://www.DonForresterMD.com/ Don Forrester MD

      There is no need to take iron supplements unless you have diagnosed iron deficiency. The same can be said for Calcium and Zinc. Neal Barnard’s new book, Power Foods for the Brain, reviews the risks of exposure to excess metals such as copper, zinc and iron and Alzheimer’s disease…. just another reason to avoid all supplements except vitamin b12 unless diagnosed with deficiency. You need to remember that about 5% of folks are outside the normal range on blood tests normally.

  • http://www.facebook.com/darryl.roy.752 Darryl Roy

    There is one way to reduce excess iron in healthy adults: blood donation.

    Possible association of a reduction in cardiovascular events with blood donation.
    DG Meyers et al. Heart. 1997

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC484902/pdf/heart00009-0106.pdf

    Donation of blood is associated with reduced risk of myocardial infarction the Kuopio Ischaemic Heart Disease Risk Factor study
    JT Salonen et al. American journal of Epidemiology. 1998

    http://aje.oxfordjournals.org/content/148/5/445.full.pdf

    Blood Donations and Risk of Coronary Heart Disease in Men. A Ascherio et al. Circulation. 2001

    http://circ.ahajournals.org/content/103/1/52.full

    Decreased cancer risk after iron reduction in patients with peripheral arterial disease
    LR Zacharskie et al. J. National Cancer Institute. 2008

    http://jnci.oxfordjournals.org/content/100/14/996.long

  • Rob

    Dr. Greger,

    Any plant friendly ways for increasing ferritin? There seems to be a lot of information about boosting iron levels, but what about ferritin?

  • Pattypoo

    Maybe soon write helpful tips for women with too much iron. Especially spinach and kale lovers
    like myself.

  • james

    What about someone newly starting a vegan diet?(been vegan for about a week now) There is absolutely no way to reduce any excess iron? I am a male, and I am considering donating blood, just in case there is a problem, as there might be. Not even over time? that is amazing and disturbing, as sooo many people think that getting iron from meat is so important. I was taught that…but I am like now wait a second….

  • beccasfriend

    What can a new vegan do to rid oneself of excess iron. I don’t know if I have any, but it seems like that I might. I am thinking of donating blood if I can, otherwise what else might I do? if my body has excess, will my new vegan diet help my body to NOT absorb any new iron, until the levels drop? how long does this take to happen, if ever?

  • Jo

    Hello Dr. Greger. I recently came across articles and interviews by
    Dr. Neal Bernard stating that one should eliminate cast iron cookware
    among other things to help prevent Alzheimer’s.

    As a
    premenopausal, 20-year vegan/once-time vegetarian, I’ve constantly
    battled anemia and low iron levels, so I supplement with iron tablets
    and have considered trying my hand at cast iron again to increase my
    levels. I eat dark green leafys almost every day.

    Should vegan
    and vegetarian women and men really cut out cooking with cast iron for
    Alzheimer’s prevention? Do Bernard’s findings even relate to
    vegans/vegetarians, or does it primarily relate to omnivores? And do you
    suggest getting iron levels tested if we still believe in using the
    cookware?

    Thank you in advance!

  • Catherine

    Dr. Greger, do you know of any research concerning blood concentration of iron in people who cook with cast iron? Do you cook with cast iron?

  • Adrienne

    I am wondering if studies have shown whether cooking with cast iron pans leads to higher blood levels of iron. I see plenty of comments saying that cast iron adds iron to food (eg, http://whatscookingamerica.net/Information/IronCastIron.htm provides food by food analysis) but nothing showing that there is an actual effect in blood levels.

  • Tiago Cartageno

    Hello Dr Greger,
    I´m taking the Vega One supplement from Sequel Naturals and in the label it says it contains the iron pyrophosphate ( 9 mg per scoop ). Is this heme or non-heme iron? Is it healthy for consuming? Thanks for your time.

    • Tommasina

      Vega One is a vegan company, so the iron they are using should be plant-based and therefore non-heme. According to Dr. Greger’s above video, plant-based iron seems to be preferable to animal-based iron sources, but he recommends getting tested for anemia before taking an iron supplement. Hope that’s helpful :)

      • Tiago Cartageno

        Thanks for answering ;)

  • Gabriella

    Dr. Greger, I’ve been following a 100% whole foods plant-based diet for years now and also exclusively eat certified organic foods. About 8-10 months ago I got some blood tests that showed I was Iron deficient (I strongly believe that this is because I had just returned from a long trip during which I had little to no access to iron-rich plant foods). My doctor insisted that I take iron supplements and I refused, saying that I could replenish my iron levels through a concerted effort to maintain a high dietary intake of plant-based iron. More recent blood tests show that my levels are up but I am still iron depleted. Do you think I will be able to restore my levels over time through diet alone? My doctor says I wont (but of course I don’t just blindly follow her instructions).

  • Becky Sue Cook

    I have Crohn’s disease and don’t absorb most vitamins from food or supplements. I was in the hospital and the doctors were ready to give me a transfusion because my levels were dangerously low. I opted to take an iron supplement but not the normal ferrous sulfate that is prescribed. I chose Garden of Life RAW Iron. (plant based) I am happy to report that it has raised my levels and I am almost normal. I like it because it does not cause the upset that ferrous sulfate does.

    • Tania

      That sounds great Becky! I’ll look them up. How much did you take daily and for how long before blood levels looked good?

  • Tania

    I have been vegan for almost 19 years, prior to that I was vegetarian from birth (a third generation vegetarian). For at least 10 years my ferritin (storage form of iron I am told by GPs) has been at the very lowest end of the range and more recently dipping below it. I have always been reluctant to use supplements, preferring to get what I need from the food I eat since this is the most bioavailable and safe. However my food is mostly not organic and also my digestion has been poor, so dietary sources don’t seem to be adequate.

    What I am wanting to know, is it actually “normal”/ healthy for vegans to have low ferritin? After all aren’t the accepted “normal ranges” based on omnivores? I have never been diagnosed with anaemia, but do suffer from Chronic Fatigue Syndrome for the last 9 years and most GPs and alternative health practitioners say I need to get my ferritin levels right up and I may feel improvement in many of my symptoms?

    I have not known what to do and have never had the courage to take high amounts of or consistent supplements. I have gone through bottles of Floradix, a liquid iron supplement, taking usually a maximum of 20mg per day and then once the bottle is used up leave it for a while. But the health professionals are suggesting much higher amounts, in the range of 100mg per day.

    What is your view on this? Thanks.

    • http://www.DonForresterMD.com/ Don Forrester MD

      In my experience and supported in the literature ferritin levels do run lower in patients on a plant based diet. Another blood check which can be done is Fe, TIBC, %saturated to help sort things out. I have two other comments the first is the issue you touched on… normal levels for tests are dependent on the reference population and the second is that their is a normal distribution within reference populations and by definition normal is defined as where 95% of the population falls. This means that you can expect 1 out of 20 values to be outside normal range but normal. I find it helpful in some patients to look at their values over time. This can be particularly helpful in diagnosing or not over diagnosing some disorders such as low thyroid or low iron. It can also be helpful in that it can avoid labeling a patient with a disorder they don’t have. If you have taken iron supplements and your values and more important your symptoms haven’t improved then that would make it more likely that your low ferritin level is normal for you. It is also why you need to work with your physicians to help sort these things out. Finally excess iron in the body is not helpful. Reading Neal Barnard’s most recent book, Power Foods for the Brain, discusses the factors associated with dementia… iron is one of the metals along with zinc, copper and aluminum which have been implicated. Good luck.

      • Tania

        Thanks for your response. Other markers such as Serum Iron, Transferrin, Transferrin Saturation as well as Serum Ferritin are usually all tested at the same time and they were OK until this last test where even the Saturation has dropped to 15% (normal range 13-45). So I guess it’s not looking too good. Those of the more holistic practitioners like to see levels of ferritin at around 100 ug/ L (normal range 15 – 165). Mine is 18. To bring levels up to this recommendation would require high doses, probably over an extended period and I was afraid of doing this? Unless I got it up to the levels they want to see, I guess we can’t tell for sure if the low levels are affecting me or not?

        • Veganrunner

          Hi Tania,
          There are some really good plant based iron sources out there. I also have a very low ferritin level (13) and I have been working to improve it. I can get it up to 30 if I am diligent with supplementation. You should take your doctors advise. You have Chronic Fatigue Syndrome and you might just feel better. I know I do when my levels are up. BTY I was low even when eating meat daily.

          I don’t believe we are the population they are talking about regarding too much iron–we don’t absorb enough.

          • Tania

            Thank you for sharing your experience. I am glad to know you do feel a difference when your levels are higher…. I do realise it is largely the meat-eating population that needs to take heed, but I think it also needs consideration when advised to supplement significantly and regularly…Not meaning to sound arrogant in any way, but I always consider my doctor’s advice before taking action on it. Their knowledge of true nutrition is limited…What my main query was, was whether lower ferritin stores as evident in vegans is actually what is truly normal and healthy?

          • Veganrunner

            Well you could always make the determination of whether your iron stores are normal for you based on your signs and symptoms:

            Anemia symptoms vary depending on the cause of your anemia but may include:

            Fatigue
            Pale skin
            A fast or irregular heartbeat
            Shortness of breath
            Chest pain
            Dizziness
            Cognitive problems
            Cold hands and feet
            Headache

          • Tania

            Good point. An awful lot of them apply.

          • Veganrunner

            And I would add hair loss. My hair and eyebrows thin.

            For me personally as well as patients, friends I have spoken too the feeling of being anemic is stifling. Going up stairs become an issue.

            If you feel fine then your low iron stores are normal for you.

          • Tania

            My hair loss IS a problem…Wonder how much I should supplement daily? Have had up to 20mg per day, but levels have still gone down. I wasn’t confident to take higher doses.

          • Veganrunner

            What did your doctor say? 20 mg 3 times per day? It can upset your stomach but I don’t have that problem with the plant based supplement.

          • Tania

            He suggested an injection ages ago, but I declined. Another doctor I saw, who has more of an interest in functional medicine gave me some tablets to trial and I think the dose was about 100mg, but I forget. I didn’t take them because they were synthetic and had folic acid in them as well (which is a synthetic form of folate that is not recommended) and I prefer to take food source supplements. Besides they were tablets and I don’t seem to break down tablets very well, and prefer liquid iron supplements….So I have found some more suitable forms but am probably not taking a high enough dose. At one time I tried to take 20mg twice a day but it messes with my digestion which is already sluggish anyway, so I went back down to 20mg per day.

          • Veganrunner

            Yes i also take the liquid plant based. I end up with indigestion if I take too much. All I can tell you is as a runner I would never consider walking around low. (even with supplementation I have never had a level above 30) 20 mg isn’t enough for me. It doesn’t budge my ferritin levels. And if I don’t take a supplement it is low whether I am vegan or not. I eat high iron foods. Maybe one day things will change but right now I need to supplement.

        • http://www.DonForresterMD.com/ Don Forrester MD

          I’m not a fan of treating numbers in isolation. There are some videos which show you can enhance iron absorption by eating garlic and onion see… http://nutritionfacts.org/video/new-mineral-absorption-enhancers-found/. If you feel better with higher iron with supplementation as Veganrunner mentioned than I would favor its use. You need to work with your physicians and make a decision that is best for you. In dealing with complex systems like human metabolism there probably isn’t a “right” answer. Good luck.

          • Tania

            I’ll take a look at those videos and eat more garlic and onion. True, there isn’t a “one size fits all” prescription. Thanks everyone for your assistance.

  • cascada

    I believe that donating blood has health benefits. Is there any evidence to this effect?

  • Tiago Cartageno

    Hi Doctor, what kind of Iron is the one you mentioned when you talked about the supplements? If we take non-heme iron supplements there’s no risk right? Because our body can regulate it.
    Thanks for your time!