Doctor's Note

I’ve previously touched on the double-edged iron sword in Risk Associated With Iron Supplements and Phytates for the Prevention of Cancer. It may even help explain Why Was Heart Disease Rare in the Mediterranean?

Those eating plant-based diets get more of most nutrients since whole plant foods are so nutrient dense. See Nutrient-Dense Approach to Weight Management.

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  • Veggie Eric

    Another nail in the coffin for meat… So glad I went WFPB. Best way to start the day is with a Nutritionfacts video! Thanks again Dr G for another awesome vid!

    • HemoDynamic, MD – NF Volunteer

      Best way to start the day is with a Nutritionfacts video!

      I and many others agree whole’food’heartedly!

      • Agreed! I subscribed to Nutritionfacts both in my RSS reader and through email updates just to make sure I never miss an article/video. It’s always been confusing with so many contradictory stories everywhere, but this site goes right to the science and shows the latest research. No opinions, no biases, just science (minus the corporate funded biased junk science). That’s why it has become the most important nutrition resource on the planet.

        As someone with a degree in molecular and cellular biology, I understand the research papers, but, since I no longer work in the field I no longer have access to the research. This site fills that gap, and I am really grateful.

  • Brian Humphrey

    Love it! Another great reason (other than feeling great) to continue to stay plant-strong
    I can remember 10 years ago when I first started to go WFPB reading reports about how people who follow a vegetarian/vegan diet are wholly deficient in iron because plants contain the less absorbable non-heme iron and meat has heme-iron.
    So I made sure I eat iron rich foods with Vitamin C to increase the iron absorption rate. Everytime I to a blood donation my iron levels are great!
    Now I know (thanks to Dr. Greger and staff) that non-heme is preferred by our bodies!
    I wonder if it’s because we eat mostly plants for the during our 2.5+ million year evolutionary ancestry?

  • HemoDynamic, MD – NF Volunteer

    “If blood-based crackers don’t sound appetizing, there’s always cow blood cookies and blood filled biscuits. The filling ends up a dark-colored, chocolate flavored paste with a very pleasant taste. . .”

    I would have never dreamed that someone would concoct such a ‘food’. What a gem of a find in the literature!

    • Plantstrongdoc M.D.

      In Denmark we have something called “blodpølse” (blood sausage – pork and dried pigs blood). I dont know if it exist in other countries – really disgusting! It is sliced and fried (probably in lard) and you serve it with syrup – and you are allegedly supposed to eat it!

      • HemoDynamic, MD – NF Volunteer

        Anything to maximize the use of the by-products from slaughter. Yum?

        • Plantstrongdoc M.D.

          Maybe from the down of times when we were vikings – maybe it was manly to eat back then – in my opinion it is now manly to eat nuts and broccoli!

      • Robert Haile

        The French like it also and my wife ate it as a child.

        • Darryl

          Le Boudin, the march of the Foreign Legion. “Pour les Belges y en a plus.”

          Boudin is a fairly big deal in South Louisana as well, where its mostly rice and spices soaked in blood. Oh look, here’s a Vegetarian Boudin Sausage recipe.

        • Plantstrongdoc M.D.

          Hope she is well! :-)

      • Christian Behrends

        It is called Blutwurst here in Germany.

        • Plantstrongdoc M.D.

          Yikes! It is everywhere!

      • It’s called black pudding in the UK.

        Have a look at the ingredients of the Scottish Haggis lol

      • Eric Van Buggenhaut

        In UK, Ireland and other European countries, black pudding is a pretty popular food.

      • Mery Daae

        “morcilla” in Spain, there’s even a version with rice inside

      • Aldo_49

        Blood sausage is common in European rural areas during Autumne (fall) (local slaughtering season). Has a delicious fine taste. – By the way, some African tribes drink their cows blood (iron, nutrition) without slaughtering them!

    • How about this for an alternative? Betcha can’t do this with blood crackers!

      http://youtu.be/NHqN-Be5nlU

  • Wade Patton

    Dang, now I never get to try the British speciality Blood Pudding. I could, but then why? Also Anthony Bourdain was blown away by a blood-based soup in Thailand (if i recall correctly). It was/is probably much better than the UK stuff anyway (I like Thai HOT) and I would certainly try it if travelling Southeast Asia. That’s why i’ll remain a FLEX-WFPB. “Plant-Based” doesn’t exclude the oddity now and then, so “WFPB” does fit my notions.

    I never thought I’d get this far (in 3 months). Change your mind and the body will follow. Excellent information and research (found here) and results have swayed my eating and food notions dramatically in only a few months. Thanks Dr. Greger.

    I keep recommending and sharing and attempting to discuss these things, but mostly find closed minds and closed ears. Truly SAD.

    Now back to my stone-ground grits with raspberries picked minutes ago.

    • Thea

      Wade: re: “I never thought I’d get this far (in 3 months)….
      and results have swayed my eating and food notions dramatically in only a
      few months.”

      I LOVE stories like yours. I’ve been following your comments and appreciating your enthusiasm and honest reporting. I feel proud to support NutritionFacts when I read stories like yours. Thanks for letting us know how it is going with you. I hope it continues to go well for you for years and years to come.

      • Wade Patton

        Thank you Thea. I actually found Nutritionfacts/Dr. Greger on Youtube as I was looking for dietary issues that could be complicating or enhancing my ADHD. Never did I consider going full-tilt vegan. And I’ll likely never be “absolute” in that regard. Matter o’ fact, my experience with 80/10/10 taught me that I could keep weight off by eating unlimited fruit/veggie calories 5 days per week, then “rewarding” myself on the weekends. I really did enjoy those weekends, but now I don’t have the URGE to consume the meat and junk. Just not interested.

        Also, that way of eating was becoming a chore with the massive amounts of fruit consumed daily. WFPB is much easier in that regard and that fullness lasts longer.

        Tastes and cravings do change and quickly. I whole-heartedly recommend anyone who is interested to try _one day_ at a time. It takes some time to learn how to prepare different foods and keep them interesting at first. Rewards came so quickly for me that it was very easy to continue.

        UNDERSTANDING the science and biology of these diseases of Western eating is always key for me and This site has been instrumental in my catching up with what is KNOWN, but kept hidden and obfuscated by industry and current medical practice.

        The MOST frustrating thing is watching loved ones continue to eat themselves to death. I wish there was some easy way to pique their curiosity. I’ll keep trying, and setting my example. That’s all I got.

        Cheers.

        • Nick Presidente

          I’m in the same boat, went from standard diet to WFPB almost instantly. I started off with a cheat day a week which I would allow cheese, but even thats gone now. I went from reactive eating to spending hours 1-2 days a week to make lunches, breakfast and dinners.
          The videos here really opened my eyes.
          I’m still learning and tweaking, but the all the fake quasi-science the Paleo communities like to push out is hard to get through.

        • Mark Marquette

          We ALL “eat [our]selves to death! No one gets out alive! And, cancer has environmental, but as much or more genetic causes!
          You’re all fooling yourselves! Yeah, you will likely be ‘healtheir”, for a whiel – but NO guarantees!

          • Wade Patton

            I’m not quite sure of your point. I was unhealthy and nearly overweight, now I’m healthy and trim. I prefer healthy and trim. Eating WFPB made that happen without any problems, or counting, or exercise (beyond my normal “high” level of activity). I am not fooling me, I am enjoying much less aches and pains, reversal of GERD and BPE, and better fitting clothing and less load on my feet and ankles. No foolin’ at all.

          • Mark Marquette

            Well, congrats on your success story! Truly. However, I have personally seen numerous people who did not “thrive” as you are.I still maintain that gnetics is a big factor in how your espond or not. I was also being facetious, in that, we all die, and most /many will not make that big a difference by diet. OK, I know I have to temper my statement, but so do you all who think veganism will cure all the world’s ills and create “everlasting life”. Y

  • Joe Caner

    Blood filled chocolate paste creamed cookies? Foodies rejoice!

  • Guest

    An oncologist once gave me heme iron to take, while I am preventing reoccurrences. I asked him if he was sure this was safe. Oh yes!

    I knew better and discontinued it after a few weeks.

  • guest

    Dr. Greger: How do we know that the differences observed are due to the form of iron, not due to other bad stuff in meat, like cholesterol, saturated fats, hormones and antibiotics given to animals, and the nasty compounds formed during cooking? Thanks

    • Joseph Gonzales R.D.

      That’s a good question. My understanding is researchers account for other variables that could interfere with their findings. They may discuss this more in the actual papers. All citations can be found in “sources cited.” You bring up a great point though, as several mechanisms are likely involved. I referenced studies about high heme-iron intake in my review paper on cancer and nutrition showing that many mechanisms are found to contribute to cancer risk: ” Putative mechanisms by which red and processed meat contribute to cancer risk include the abundance of heme iron [43], nitrites [44], heterocyclic amine formation [45], and the over abundance of essential amino acids and other nutrients that promote cell growth [46].”

      • fred

        I’d like your opinion on adding a supplement such as….

        http://www.swansonvitamins.com/swanson-ultra-ajipure-9-essential-aminos-formula-pharmaceutical-grade-60-veg-caps

        in order to obtain basic aminos without added “toxics”…etc?

        Same idea is expounded here…

        http://www.secondopinionnewsletter.com/Health-Alert-Archive/View-Archive/13445/How-to-digest-more-protein-and-build-your-muscles-faster.htm

        So…as one gets older…which is going to kill you first…sarcopenia …falling down and breaking something or cancer? Also it seems cancer typically takes a long time to occur…meaning poor dietary habits from the past are most likely to contribute?

        And…wouldn’t other cancer reducing inputs offset the increased cancer risk from growth promoting aminos?

        • Joseph Gonzales R.D.

          I recommend obtain all essential amino acids from whole foods. Our body is the best biochemist around! When we try to manipulate and manufacture supplements in the laboratory it never turns out as good as nature intended. Should We Take a Multivitamin?. There is a good explanation at the end of the video. Other research has found certain supplements like Lutein pills may actually increase cancer risk. Antioxidant supplements are not an effective replacement for eating real veggies. From the SELECT trial vitamin E was associated with increase prostate cancer risk. Folic acid supplements may also be associated with increased cancer risk. Male smokers supplementing with beta-carotene have been shown experience increased risk of lung cancer and mortality. The only supplements that Dr. Greger mentions in this blog that “with the exception of vitamins D and B12 (Vitamin Supplements Worth Taking), we should strive to get our nutrients from produce, not pills”.

          What may off-set the harmful effects of carcinogens and excess growth promoting amino acids (which I questions are used in the first place?) are antioxidants from food.

          See if any of these links help? Don’t forget helpful links in the Doctor’s Note below each video/blog. Thanks for your questions!

    • It is hard to separate out all the factors and assign relative weights to them. One of the downsides to “reductionistic” science when dealing with complex or adaptive systems such as humans. Dr. Campbell’s second book, Whole, is a good introduction to the limitations of reductionism. Note: I’m not saying reductionistic science isn’t valuable but the limitations need to be understood. As a physician I know which are the best diets to recommend based on various chronic conditions… always starting with a foundation of whole food plant diet without added oils and with adequate Vitamin B=12. It is the diet most consistent with our anatomy and physiology…. hunted gatherers who are hind gut fermenting herbivores. Beyond the basic diet modifications may need to be made to the recommendations based on individual variation and/or the response to the new lifestyle. For instance autoimmune disorders can have plant triggers. So we may never know for sure about all the causative factors but it is fascinating. If you keep tuned in to NutritionFacts.org you will be keeping up with the latest in science.

      • I second the recommendation for Colin Campbell’s book, Whole. It opened my eyes to the limitations of evidence-based decision making for complex systems. The book’s thesis can be applied to any complex system, including the economy, the stock market, the environment and politics.

        • Stewart E.

          Arshad, I think that is an outstanding observation. As an historian and economist I have often been appalled by “explanations” of socio-political phenomena that were reductionist to the extreme and hence explained nothing.

  • robert

    Try blood oranges instead!

  • Acreech

    Interesting that this came up today. I saw this site where someone is selling iron fishes to give to Cambodians so they can get more iron in there meals to help prevent and cure iron def anemia. http://www.luckyironfish.com/

    • Joseph Gonzales R.D.

      I’ve seen this, too! Interesting way to reduce anemia in Cambodia. I would be interested to see any research or follow-up on it’s efficacy. Thanks for sharing the link.

  • Robert Haile

    We must never forget greenhouse gases, excess water consumption, clearing of rainforests, climate change, and cruelty associated with the meat industry.

  • The Vegetarian Site

    Multivitamin/mineral supplements contain non-heme iron, unless they’re specifically made from animals — correct?

    • Joseph Gonzales R.D.

      Yes, that is my understanding. I’ve never seen heme-based iron capsules, but I think they would be labeled as “heme iron polypeptide” or something. Non-heme sources are the common one’s founds in supplements such as ferrous sulfate, ferrous gluconate, ferric citrate, and ferric sulfate. I wouldn’t take any of them unless doctor prescribes.

      • Johanna

        When one gets blood work done, what is the “iron” category? Heme? Non-heme? Both?

        • Joseph Gonzales R.D.

          Both, since the iron lab values are based on your blood’s iron. There are many tests for iron and your doctor will know which one is best.

      • Matthew Smith

        There has not been one fatality due to Iron poisoning in the U.S.A. from vitamins in the past 27 years. (There was an iron fatality not from a nutritional supplement) (Hoffer, Saul, and Foster Niacin: the Real Story, 58 and 64,65) Iron is a pro-oxidant when it is in the belly, but helps the brain and nervous system dramatically. Twenty-three percent of Americans have anemia, and with everyone on low-iron diets, pernicious anemia abounds. wikiplegarized has the signs of anemia: “While it may consist of the triad of paresthesias, sore tongue, and weakness, this is not the chief symptom complex.[6] Common symptoms include anemia,[7] fatigue,[7] depression,[8] low-grade fevers,[6] nausea,[6] gastrointestinal symptoms (heartburn,[6] diarrhea,[8] dyspepsia[8]), weight loss,[6] neuropathic pain, jaundice, glossitis (swollen, red and smooth appearance of the tongue),[9] angular cheilitis (sores at the corner of the mouth),[8] dehydrated/cracked and pale lips and dark circles around the eyes (look of exhaustion),[8] brittle nails,[9] and thinning and early greying of the hair.[9] Because PA may affect the nervous system, symptoms may also include difficulty in proprioception,[10] memory changes,[8] mild cognitive impairment (including difficulty concentrating and sluggish responses, colloquially referred to as brain fog), psychosis, impaired urination,[6] loss of sensation in the feet, unsteady gait,[10] difficulty in walking,[9] muscle weakness[7] and clumsiness.[6] Anemia may cause tachycardia (rapid heartbeat)[6] and cardiac murmurs, along with a yellow waxy pallor,[9] low blood pressure, high blood pressure, and shortness of breath[7] (known as ‘the sighs’). The deficiency also may present with thyroid disorders.[7] In severe cases, the anemia may cause evidence of congestive heart failure.[8]”

        Doesn’t that sound like your silent elder loved one trudging on? Perhaps they should try some soybeans, lentils, spinach, and sesame seeds. .

        http://en.wikipedia.org/wiki/Pernicious_anemia#Signs_and_symptoms

        It is apparent that Americans need to get more anti-oxidants to balance out the composition of Iron, like Vitamin A,C, E, and plant phytocompounds. Unfortunately, we are probably not getting enough of any of them. Did you know that in pernicious anemia, once a global killer, the ultimate cause of death was a B12 deficiency, which Vegans are susceptible to.

        I am happy to know that Vegetarians have less anemia than the rest of the population.

        • Lisa Mair

          There may not have been a fatality due to iron, but there have probably been cases of cancer, heart disease, and stroke associated with oxidative stress of too much heme iron, as the studies in this video allude to.

          • Matthew Smith

            Thank you. I think that separating iron as a nutrient from iron as an ingredient in animal product could change how we see disease. Health professionals know that anemia is a growing concern in America and almost everyone is on a reduced iron diet in an effort to provoke resistance to oxidation. Is everyone more youthful? Maybe, but iron is an important part of the diet and is important for brain health. I think almost everyone would say that they are on a heme-iron reduced diet, meaning everyone is at least trying to eat less meat. Is this a victory for this society, or would you immediately turn around and suggests more soy, seeds, and spinach? With milling and refining, it seems healthy people can be sickened from what is lost from the whole foods plant based diet, including some antioxidants like vitamin C, and E. .

      • tina stamatakis

        interesting find as i’ve got iron deficiency anemia. trying to get enough iron in a vegan diet is proving difficult and am considering going back on the supplements. however i would love some advice if you can spare it!

        • Joseph Gonzales R.D.

          Absolutely! See if this factsheet on Iron and Vegetarian Diets help? Note it doesn’t mention that lentil, garbanzo and kidney beans are even higher than tempeh and edamame. Focus on vitamin C sources to compliment your iron-based foods. Dr. Greger also mentions how to boost mineral absorption. If you drink a lot of tea make sure to add lemon or a vitamin C source. In Dr. Greger’s section on iron he mentions more of the same, “The absorption of plant-based (non-heme) iron can be regulated by the body, though, making dark green leafy veggies and legumes such as lentils preferable sources, especially since food is a package deal.” See if that helps? Don’t forget is all adds up. Molasses is also a good (and tasty) source if you like it. Work with your doctor or a dietitian to help understand the right value of iron you need per day and optimal food sources. Take supplement if your doctor recommends and lab value are not improving. Let me know how it goes. Good luck!

          Joseph

          • tina stamatakis

            thank you so much for replying. sometimes i feel that the traditional methods of treatment don’t have much to offer for people living out of the norm, diet wise and that’s one of the reasons i’m drawn to this site! thanks for the great vids. your dedication is obvious and appreciated more than it’s possible to express in this comments section! cheers to all of you.

    • I’ve found at least one iron supplement that’s made specifically from animals:

      “Proferrin is an iron supplement made up of heme iron polypeptide naturally sourced from bovine hemoglobin.”

      Gross, and now after seeing this video, possibly a health hazard!

  • Jackie

    I am vegan and have never been deferred as a blood donor, donating a couple times a year.

  • fredc

    Another great video. Thank you. It always amazes me how far off base our general public’s nutritional information has gotten over the past several decades. Thanks for helping set the record straight. Next question: how long will it take for this information to reach our elementary and 8th grade health instruction materials?

  • thangkatruck

    What about cooking with cast iron cookware? Is that good iron or bad iron?

    • The Vegetarian Site

      That would be non-heme iron — but too much?? There must be some study somewhere showing how much of that iron is absorbed for a typical stir-fry serving.

      • Wade Patton

        Well now I’m stirred up looking for a better answer and find none.

        Hey researcher/analysts HELLO? I’ve looked up all the other “iron” videos and THIS question comes up in the comments more than once every single time. It tends to be ignored.

        Rural, home-grown, well-watered, non-city/suburban living nutrition issues/questions are generally ignored here. A lot of America does live that way, although we are a certainly a minority (or are we? makes no difference).

        And WHEN I try to do some research i get stonewalled by sites requiring fees/membership to see documents.

        Iron cookware: good? bad? depends upon what you cook in it? Hola?

        I did find one reply to the iron-cookware issue, here, answered by Dr. Joseph Gonzales (thank you):

        http://nutritionfacts.org/video/risk-associated-with-iron-supplements/ (but i’m not a post-menopausal vegan woman).

        And it raises another question question: What sort of iron comes from cookware? It’s not blood/animal, it’s elemental. Can our bodies regulate this sort of iron? The quality of contact between my food and the skillet has changed since I quit using fats and oils-this may be the real crux of the matter.

        side note: as a rural person, I’m continually giving blood to briars, ticks, mosquitoes, and minor lacerations.

      • Daniel Gordon

        Iron in pots has been linked to secondary hemochromatosis in Bantu tribes who use a purley cured form of cast iron to cook with…..

    • Wade Patton

      If cooking with iron was ever going to be a problem for me, it would have shown up by now. I’ve only used iron for dozens of years (and do nearly all of my own cooking), and plan to continue. Love using 100-year old stuff that functions as good today as it did 99 years ago. My saucepans are SS however and do get a larger portion of the work now that I’m not cooking with oils and fats.

      • Lisa Mair

        Although you might not have a clinical sign that you have too much iron, you are increasing your intake of iron, which is a pro oxidant either way, so most likely you are increasing your risk of chronic diseases due to oxidative stress (cancer, heart disease, stroke, etc). I wouldn’t cook with iron pots.

        • Wade Patton

          What I have realized is that not using oil does give a much more exposure than before. I suppose I’ll have to either start using a tiny bit or get coated CI and maybe pick up some more SS stuff. But then now I’m cooking much more in saucepans-rice, beans, ww pasta, oatmeal, grits. I like the good stuff, so it will take a while. Can’t use silly no-stick or lightweight stuff. Plated copper would be snazzy too! Someday.

          Also, the pots were mostly friers. Not needed now. The seven skillets hanging up over the stove will be difficult to wean away from. I’ll have it looked at next time bloodwork is done. Trust me, my cancer and chronic disease rate has fallen very very quickly in recent months, but I do appreciate your concern.

          • Lisa Mair

            I got some Scan Pans – which are titanium and ceramic – totally nonstick and non toxic. I love them!

  • The Vegetarian Site

    Please comment on inhibitors of iron absorption, such as coffee, tea, and chocolate (due to their polyphenol content) and soy (due to phytic acid content). I might be missing some others. How serious an issue?? Thanks.

    • Leslie

      Concerns me also, as vegan diet very high in polyphenols. Wondering if excess polyphenols could also be bad for gut bacteria, as some is good, but modern-day vegan diets can, if desired, go overboard, I think.

  • justme

    I can’t tell you how timely this is for me. My hemoglobin and iron levels are chronically very low and have been for 40 years. Using greens and molasses, I had the problem under control until a recent issue plunged them lower than ever before. My naturopath wanted me to use a standard process iron preparation with pig’s liver. Since the iron problem is very severe, I was almost tempted to take his advice. Now I know I’ll just stick with greens, beans, and molasses. My levels will rise again just like they did before. Thank you so much for this post.

    As a side note: I’m pretty sick of docs, medical and naturopathic, that push meat and animal by products on me as the solution to my blood issues. Don’t they know they are pushing me into something far worse than anemia: cancer and vascular disease aren’t pretty either. I just don’t feel I can trust anyone with my health besides myself. It’s kind of exhausting.

    • The Vegetarian Site

      Have you tried a non-heme iron supplement short term?

      • Noe

        The most comon supplement are heme- iron? My grand murther is taken and she is with anemia and arteriosclerosis . Apart from diet would you recommend to take any supplement ? Seems that her does not absorb I ought iron in general.

        • The Vegetarian Site

          Supplements are non-heme. Probably best to talk to her doctor about iron supplementation.

    • Veganrunner

      Justme there are great plant based iron supplements on the market. Let me know if you want a couple of recommendations. Nothing worse than the fatigue that goes along with low iron.

  • CC

    Any comments on the Lucky Iron Fish? http://www.luckyironfish.com

    • Wade Patton

      My non-clinical response is that we should learn what is causing the deficiency instead of focusing on a band-aid. Then teach Cambodians how to remedy that problem of it is feasible.

      Also, personally-knowing a bit about metallurgy, I’d need to know that the “iron fish” was cast of clean metal. IOW free of contaminants normally found in less-than-aerospace/medical-grade castings. No need to compound the problem.

    • Joseph Gonzales R.D.

      Yes, someone also mentioned this below. You’d be surprised how our site users often have similar important questions and comments. Scrolling thru the threads here can be super valuable! Here is my comment on luckyironfish.

  • Clean Food Sally

    How do we know it is the meat itself and not the hormones/antibiotics and fat content of conventional meat that raise the risks of CHD? I would like to see some studies on organic meats, grass fed etc. to see if their numbers are as bad.

  • disqus_qIVTw7ULtR

    What about the iron that gets into your food from cast iron pots and frying pans?

    • Joseph Gonzales R.D.

      I wrote about cast iron skillets here. See if this link helps? Thanks for your comment!

  • vegank

    I’ve had iron issues since childhood e.g. fatigue and sometimes passing out even-though I ate like others who didn’t have the problem.
    To my pleasant surprise , it all leveled out after going WFPB vegan.
    This was unexpected since I did wonder if the vegan diet would make it worse or not.
    Perhaps due to the fact that I’ve cut out all dairy(which apparently blocks iron absorption), I am absorbing whatever iron I get more efficiently now? The dosage of iron supplement does not need to be as high now.
    I don’t know why but Dr Greger has a real knack of grossing me out (in a good way) the blood cookies did it !
    The vision of it will no doubt stay with me forever.

  • BB

    Am I correct in assuming that non-heme iron comes in a form that allows the body to better regulate the absorption rate of iron according to its needs, whereas heme iron is more penetrative?

    • Wade Patton

      That’s the way I interpret it. Now for someone to clarify the non-food sources of iron. My guess is that anything non-animal will be non-heme (water, cookware, luckyfish, skillet lickin’.) BUT i could be wrong as I was one time before. 8-)

    • Joseph Gonzales R.D.

      Non-heme iron can either be absorbed or not pending the body’s stores. Heme iron is always absorbed. Makes sense to have more non-heme sources based on the literature, but to make sure you obtain enough.

  • cyndishisara

    IMO the reason for heme ‘s toxicity seals the case. That is its effect on our microbiome. Healthy bacteria cannot tolerate heme. I recommend this article.

    “Overcoming the Heme Paradox: Heme Toxicity and Tolerance in Bacterial Pathogens.’ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2981329/

  • Eisblume

    In our holiday home in Sweden we get our water from a well.
    This water contains so much iron that we can smell and see it.
    It has a yellow touch. Do you know if that is heme or non heme iron?

    • Joseph Gonzales R.D.

      Heme refers to blood-based iron. The iron in water is a non-heme source.

      • Eisblume

        Thank you. I’m glad that you told me heme iron is blood-based only. The question had come into my mind, because the odor of the water reminds me of blood and the color is between yellow and red and I wasn’t sure if this could refer to heme also, because the iron from plants doesn’t smell like that and doesn’t have that colour.

  • gardenchild

    how do we post questions on this site?

    • Wade Patton

      Didn’t you just do that? (pardon my literalism)

      Try the “Comment Etiquette” button up top there. I tried to link it but didn’t work out. Multiple things are explained there.

  • gardenchild

    question regarding report on The Safety of Heme vs. Non-heme Iron
    My Ferritin test results are very low ( @ 30), so I am taking iron supplements. Considering the commentary about iron and cancer, I would like to know the related implications of taking iron supplements? My pills are GNC Gentlesorb iron with 18mg daily, ingredients listed as Iron as hydrolyzed Protein Chelate, also moltodextrin, vegetable cellulose capsules,contains soybean.
    thanks

    • Joseph Gonzales R.D.

      I would take them if only your doctor has prescribed. There are ways to boost your stores. We have so much information about iron here on the site! Do you want me to share some links?

  • Cynthia Jaffe

    As an omnivore, my iron count (hematocrit) was generally 34%. Been a vegan for over a year and at my last count a month ago, my hematocrit was 41%! Go plant based iron!

  • Dr G , does ferritin screen for total iron stores, including plant and animal derived? Is there a better parameter to screen for iron deficiency anemia (to better delineate this differently derived iron) in a clinical practice setting? I am wondering because I currently have a patient that was worked-up for fatigue by her internist. She eats a WFPB diet. She was found to have a (normal ) Hgb of 13.1, and a (low) ferritin of 8.0. She is a 22 yo female who has light menses on oral contraceptives. Please advise

    • Jen Drost, PA-C, NF Volunteer

      Hi Dominick, Hope you don’t mind if I jump in? Thought you asked a great question and I’ve done a lot of reading on iron stores. The evidence to date recommends Hemoglobin and Ferritin as reliable initial tests for assessing iron stores (whether the iron is from heme or non-heme sources). She might benefit from input from a Gastroenterologist (GI doc) to rule out malabsorption issues. As explained in this Dr. G. video, more garlic and onion consumption can help, too!

  • E Page

    Our Vegan household has been adding Orgain organic protein powder to our morning coffee & chocolate soy milk. It contains rice protein, pea protein, among others. McDougall said such proteins, including soy isolates, should not be consumed. What does the science say so far?

    • Joseph Gonzales R.D.

      I think any of these isolates and concentrates are unnecessary, as whole foods are preferred. I only recommend these type of proteins if someone cannot eat by mouth or chew food (oncology, malnourished, GI issues, or HIV/AIDS populations). However, if you feel protein is lacking in the diet and whole food sources are not appetizing then finding a rice, hemp, or pea protein (or combo) may be helpful. The problem is there are not many human trials on these isolated proteins. I suggest avoiding whey and soy, as you mentioned. Some studies suggest whey and leucine-rich foods (meat and milk) stimulate the TOR pathway, which Dr. Greger addresses in this video. Whey protein is a highly concentrated source of animal protein, which can stimulate IGF-1 production. Similarly, concentrated/isolated soy protein supplements can also increase IGF-1. Animal proteins are linked to increased risk of bone degeneration and kidney diseases. It may be that the ratio of animal to plant protein intake is more important? In a paper I wrote about cancer prevention, Applying the precautionary principle to nutrition and cancer I reference a study pointed out to me by Dr. David Jenkins about the overabbundance of amino acids (Reference 46). I would also consider the whole diet. DO you get enough fruits and veggies? Are beans, lentils and dried peas eaten regularly? Consider whole grain consumption and if you are obtaining enough? What about exercise, sunshine, and including an array of herbs and spices? If you are doing all of these things and drinking a bit of rice protein in the morning I would see little concern, if any. The question is if it’s even needed? That is up to you! Hope some of these links help thanks for reposting your question.

      • E Page

        As much as we love lentils & peas, we more often than not find ourselves absent of any legume protein at the end of day (or even for the week!) Definitely something to improve upon buy when we are lacking it, is it better to add the fine sized protein molecules or go without adequate protein?

        • Thea

          E Page: To supplement the great info you have already, I thought I would add my thoughts: Why do you think you are not getting adequate protein? It’s great to eat beans. They are very healthy, and I think it’s a good goal to get some every day. But not necessarily for the purposes of getting more protein.

          Are you generally eating whole plant foods? And getting enough calories? Then you are probably getting *plenty* of protein. We have plenty of science to back up this claim. The following page is one of my favorites for summing up the evidence on protein. If you can work your way through the information, I think you will feel a lot better about your protein intake.
          http://michaelbluejay.com/veg/protein.html

          Note: It may be that people older than 65 need a higher percentage of protein in their diet. I don’t find the current evidence compelling on that point. But if so, then I would make a point of eating more beans rather than isolated protein. It just seems like we have plenty of evidence in general that when we eat processed vitamin pills, processed foods, etc, it causes more harm than good. (That’s just my opinion.)

          Hope that helps.

          • E Page

            Thank you, Thea. Interesting article link! I even posted it on Facebook.

          • Thea, you are an angel of this site! I have printed out the Michalebluejay article to hand to people who bug me about protein. It’s not that I am sick of hearing their concern, but I am sick of their not believing my answer. So read, then we can talk if you still have questions. If you need corroboration, see NF!

          • Thea

            Gayle: Thank you for your kind words. Also, I 100% understand and share your excitement. I still remember reading that page for the first time. It really sunk in for me how much I had misunderstood the concept of protein beforehand. Afterwards, I felt so much more empowered about my diet. I refer people to that page all the time, because I think it does a phenomenal job of clearly answering all the common questions/misconceptions/fears about protein. The two bar graphs say as much as all the words on the page I think. So powerful and empowering.
            .
            Glad I could be of help! Thanks for the feedback.

          • Thea

            I meant to also add, re: ” It’s not that I am sick of hearing their concern, but I am sick of their not believing my answer.” That’s so well said. I like how you make that distinction. I share the same frustration, but had not been able to put it into words before. Thank you.

        • Joseph Gonzales R.D.

          I suggest upping the amount of whole foods (beans, legumes, etc. Quinoa and pistachios are another great source of lysine-rich protein. If protein needs are not met throughout day perhaps the added powders can suffice, but keep in mind they lack so many of the healthful antioxidants and fiber found in whole foods.

  • Suzie Kyootie

    “Plant foods contain only non-haem iron, which is found
    naturally in whole grain cerials and breads; dried beans and legumes; dark
    green leafy vegetables; dried fruits; and nuts and seeds.” (At 3:02) It might
    appear more professional if “haem” is spelled correctly: heme.

    • Benjamin VP

      It is spelled properly; “haem” is the British English spelling (see https://en.wikipedia.org/wiki/Heme ), which is closer to the original Greek with its two vowels: αἷμα .

  • Ron Bartels

    I regard this report as junk science.

    Here is why. Range fed meat has both forms of iron. This study is using pen fed, corn fed, and barn fed meats, without disclosing it. That colors the debate quite a bit.

    Similar significant differences between range fed eggs and barn fed eggs. Confined animals, fed processed grain diets to increase body weight at lower costs using high lysine supplements and other Multinational Agri-Business derivatives of stimulating enzymes are destroying our health, in my opinion.

    They bring in vegetables to replace meats in this report and they fail to reveal even the vegetables are grown on mineral starved land with artificial plant foods made from petrochemicals rather than organic supplied nutrients. You should see the difference, by assay, of broccoli grown on worm castings vs, broccoli grown on Miracle Grow. Compare the heme vs non heme differences and report back.

    Until we have a transparent, unbiased assay of the differences to discuss, I regard this report as junk science.

    • Joseph Gonzales R.D.

      Do you know of any studies reporting on organics and veggies grown in richer soil? Please share if they exist! I am afraid until we have more research these peer-reviewed studies (all list under “sources cited”) are the best we have.

  • Ash

    What are the best sources of plant based iron?

    • Thea

      Ash: Here is a quote from “Becoming Vegan, Express Edition”, which is a great reference book for looking up specific nutrients and getting some background on it. The book has more about iron, but this bit starts to address your specific question:

      page 133 errata page: “Our iron intake can quickly add up to recommended levels if we eat an assortment of legumes, nuts, seeds vegetables, whole grains, and dried fruit. We can get 4 to 6 mg of iron from a cup (250 ml) of beans, peas, lentils or oatmeal, a half cup (125 ml) of soybeans or tofu, or a handful of pumpkin seeds. We can get 18 mg form a serving of fortified breakfast cereal. For sweet ways to increase…

      On the other hand, foods rich in vitamin C, such as red peppers and strawberries, or foods high in citric acid, such as citrus fruits, increase the absorption of iron.”

      Note that that first sentence right there is pretty close to Dr. Greger’s overall nutrition recommendations:

      http://nutritionfacts.org/2011/09/12/dr-gregers-2011-optimum-nutrition-recommendations/

  • A dear friend of mine has sickle cell anemia. She was a vegetarian for a few years but than her health got really bad. Fainting a lot and she actually ended up in the hospital once. Her doctors recommended her to start eating meat again. So she did. But she started to feel real bad about eating meat the last few weeks. She wants to be a vegetarian again and if possible even vegan. Is it possible to become vegan when she has this disease? What are things she should eat and what not? What promotes iron uptake? I really want her to succeed, but i dont want her to end up drained of energy or in the hospital again.
    Thanks a lot!

    • Thea

      Joost: I don’t know anything about sickle cell anemia and I’m not in the health care industry. So, take these ideas for whatever they are worth.

      re: “What promotes iron uptake?”
      Eating vitamin C foods (like say lemon, red peppers and strawberries) with food high in iron will increase iron absorption. And eating an assortment of the following foods will help most people meet dietary needs for iron: legumes, nuts, seeds, vegetables, whole grains and dried fruit. At the same time, your friend should probably stay away from foods which might inhibit iron absorption such as tea, coffee and cocoa. (More details can be found in the book Becoming Vegan.)

      You say that your friend’s doctors recommended eating meat again. But it is not clear why. Is it for the iron? If so, then the above recommendations plus some supplementation if needed would be healthier (at least for most healthy people) than eating meat.

      I agree that you have to be careful when someone is sick and has special needs. But as a lay person, I can’t think of a reason to eat meat just for iron. Or for “energy”.

      I too hope your friend is able to be successful. Good luck.

  • A dear friend of mine has sickle cell anemia. She was a vegetarian for a few years but than her health got really bad. Fainting a lot and she actually ended up in the hospital once. Her doctors recommended her to start eating meat again. So she did. But she started to feel real bad about eating meat the last few weeks. She wants to be a vegetarian again and if possible even vegan. Is it possible to become vegan when she has this disease? What are things she should eat and what not? What promotes iron uptake? I really want her to succeed, but i dont want her to end up drained of energy or in the hospital again.
    Thanka a lot!

  • Joost

    A dear friend of mine has sickle cell anemia. She was a vegetarian for a
    few years but than her health got really bad. She fainted a lot and she
    actually ended up in the hospital once. Her doctors recommended her to
    start eating meat again. So she did. But she started to feel real bad
    about eating meat the last few weeks. She wants to be a vegetarian again
    and if possible even vegan. Is it possible to become vegan when she has
    this disease? What are things she should eat and what not? What
    promotes iron uptake? I really want her to succeed, but i dont want her
    to end up drained of energy or in the hospital again.
    Thanks a lot!

  • BonnieM

    Hi. I have been eating a plant-based diet for about 3 years (and for most of my adult life didn’t eat much meat). I have recently received blood results which show normal results for everything (including iron, red cells, haemoglobin, haematocrit, haemolysis index) except low ferritin. My doctor has asked whether I might re-think my vegan diet or take an iron supplement. I ignored the first part and said I would consider the supplement but I’m not convinced I need it. Is it possible to have 13ug/L Ferritin (normal 25-110) and still be healthy? Thanks very much.

    • Thea

      BonnieM: I can’t comment on what would be a safe level of Ferritin or not. But I can say that a well respected and researched book called, Becoming Vegan says, “Many vegetarians have lower levels of stored iron–called serum ferritin–than nonvegetarians. This common situation doesn’t affect how we feel and isn’t an issue as long as you regularly eat food containing iron so that you can replace any iron that you lose.”

      Eating vitamin C foods (like say lemon, red peppers and strawberries) with food high in iron will increase iron absorption. And eating an assortment of the following foods will help most people meet dietary needs for iron: legumes, nuts, seeds, vegetables, whole grains and dried fruit. At the same time, *if* you are worried, you could stay away from foods which might inhibit iron absorption such as tea, coffee and cocoa. (More details can be found in the book Becoming Vegan.)

      Does that help?

  • Laloofah

    Just donated blood on Monday, and all my pre-donation testing numbers were great, from blood pressure and pulse to iron and red cell count. When I politely refused the junk food the canteen was handing out (brought my own organic Honeycrisp apple, yum!) and, when questioned, said I’m vegan, the volunteer running the canteen said I must be doing something right, as most vegetarians and vegans can’t pass the iron levels test. Of course I’m doing something right – I eat a diet that is 100% plants and mostly whole food with no supplements other than B-12 – and have for 15 years.

    • Jason

      Just a heads up, blood test don’t test for iron levels. They test for hemoglobin levels. Low iron levels may lead to low hemogolobin levels but don’t always. I recently got tested for iron and am very low but my hemoglobin is fine. My doctor and I attribute it to being a frequent blood donor. I’ve donated 5 times this year and don’t supplement.

      • Laloofah

        Well, they claimed to test for both… am donating again next month, so will ask about it then. Kudos to you for being such a frequent donor!

        • Jason

          Youre are right I shouldn’t assume all places don’t. The American Red Cross and NY Blood Centers do not test for iron , just hemoglobin . I’m interested to find out if your location does test for iron, please reply in a month after you inquire.

          I found it funny, 2 out of the last 5 donations the person testing my blood asked if I eat a lot of steak since my hemoglobin levels were on the high range of normal. When I tell them I’ve been Vegan for a year and a half they seem amazed.

          Lastly if they do not test your iron it might be a good idea to get iron blood work just to know your levels.

          Red Cross Link about what is tested during a donation, how much iron can be lost per blood donation. How much Iron we can absorb per day, etc

          http://www.redcrossblood.org/learn-about-blood/iron-and-blood-donation/iron-info-all-donors

  • Leslie Stanick

    I had very low iron for many years. Iron supplements weren’t being absorbed, so the doctor started giving me iron injections of dexiron. Now I am wondering about its source. Is this a heme iron? I’m not sure why I never looked it up on line before, I hadn’t thought that it might be an animal-based product. I just read tonight that it can cause cancer, and is not recommended for patients with liver problems.

  • Blaice

    Lentils all day, errday.

  • Chrmngblly

    Well, none of that withstanding, I have HHT and bleed enough internally to need to take iron supplements. None of the 6 or 7 types I have tried agree with my stomach—so they just infuse me with some flavor of iron directly into my veins. I was wondering about trying some brand of heme iron that might digest better and get me out of the hematology infusion bay at the VA. Ideas?

  • vitaminb

    What level of iron intake would you recommend for a 23yo vegan woman?

  • Eric Van Buggenhaut

    Please note the fact that one of the authors of the MJA article you cite here (Iron and vegetarian diets), Angela Saunders has competing interests (as stated at the end of the article) as working for a food company. So much for the un-biased sources.

  • Josh Wooler

    References?

  • I have a question: How come the iron in heme-iron acts as a pro-oxidant, whereas non-heme-iron doesn’t? and what studies prove that?

  • Martin

    there is a lot of iron in lentils

    take some pineapple and/or papaya for desert, in order to have a good digestion of those lentiles, a better cracking of the protein, and a better fermentation of the grains peels

    drink a lemonade during your meal, in order to convert the iron into iron citrate, which will be much better absorved inside your body.

    don’t take coffee or tea in the same meal, because they block iron absortion.

  • SailDog

    Quick question on iron. With perhaps 1 in 6 people in the US having hemochromatosis, a genetic condition that causes excess absorption of iron (just been diagnosed myself), which leads to several chronic conditions (mine is exhibiting as high urate levels and gout), and already a vegan (i.e. no animal products) what are the dietary recommendations (within an already 100% plant based diet) to reduce the impact? It seems the recommended treatment is blood letting, which seems medieval. That said it doesn’t worry me too much. Certainly I prefer that to drugs. With such a high number of sufferers, many of whom will gravitate to this site, maybe Dr Greger could do video on the subject.

  • Louanne

    I would like to add something about animal vs plant iron: From what I read many years ago about heme and non-heme is that if someone overdoses from iron it is the animal iron version because a messenger in our intestines cannot regulate animal iron but can regulate the uptake of plant iron! Just another piece of evidence that we are plant eaters!

  • Doug Schmidt

    We have been eating WFPB/No oil for over 2 years. We cook primarily on cast iron pans. Should we have any concern of consuming too much iron from the pans?

  • Darteous

    Been vegan a couple years and a point that I don’t have a strong response to in arguments is when people say that they got sick, and found that they had trouble with iron and they were told that their body is poorer than normal at absorbing iron because of some blood condition and so have to eat animals. Do you know of a video that addresses this complaint thoroughly? Thank you

    • Thea

      Darteous: I have one person in my life who believes the same thing. I thought I would share some thoughts, though I second your vote for a video or authoritative answer on the topic.
      .
      My 2 cents is: I’m not an expert and I can’t say for sure what these people’s problems are, but it is possible that they have iron issues. There is one poster on this forum who eats whole plant foods and says that she has to take some iron supplements. (Though she’s a runner, so that may explain the situation. See Dr. McDougall’s article below for info about runners and anemia.) The thing to remember is that people on meat diets also get anemia and the answer from doctor’s in those cases is not to eat more meat, but to take a supplement. (At least that’s what I’ve read.) That a doctor would use a different answer for a person trying to eat healthy makes no sense to me. In other words, such a special condition is in no way a license to eat meat as a healthy/necessary choice since you have to consider that food is a package deal and too much negative comes along with anything positive in meat.
      .
      Second, people who describe this problem may not have iron issues at all. We know that doctors don’t know much about nutrition as a group and are likely to be prejudicial against a meat-free diet. Perhaps instead of an iron problem, there was something wrong with the particular vegan diet they chose and/or with their bodies. Here’s what I mean about “something wrong with the particular vegan diet they chose”: If someone tells you that they tried going vegan and it didn’t work, you don’t really know anything about what they ate. All you know is what they *didn’t* eat (meat, diary and eggs). Some people are vegan and eat truly horrendous diets (french fries and coke etc.). In that case, would anyone be surprised that they got sick?
      .
      Here’s what I mean by something wrong with their bodies: Dr. Klaper has a good talk on this subject with a theory that some people may experience this problem because their bodies are literally addicted to meat and animal protein. Such a person’s body may have stopped producing an important substance. You can learn more from this snippet of the talk here: https://www.youtube.com/watch?v=0tJyb1wTxg4 If such a person went cold-turkey on a WFPB diet, they would at first get sick and then later feel better after going back on meat. The situation may have nothing to do with iron at all. And the appropriate solution is not to go back to an unhealthy diet including meat, but to follow Dr. Klaper’s suggestion of weaning themselves off meat slowly (as opposed to going cold turkey).
      .
      Dr. McDougall also has some interesting observations on the topic of anemia: https://www.drmcdougall.com/health/education/health-science/common-health-problems/anemia/
      He writes: “Recent concern has focused on the effect of the fibers in plant foods on mineral absorption. Fibers will bind minerals and decrease absorption. However, to date the concern is merely theoretical, since actual cases of mineral deficiency attributed to presence of fibers are rare to nonexistent. Furthermore, long-term study shows that vegetarians develop no deficiency in iron from their high fiber foods. … “Is the amount of iron in vegetable foods (and the absorption characteristics of iron) adequate to meet the needs of people eating little or no meat?” Many studies have looked at this question and consistently the answer is yes. Hemoglobin levels in vegetarians, which reflect the amount of iron in the blood, are comparable to those in people who eat flesh as a large part of their diet; and anemia has actually been found less commonly among people who eat vegetable based diets.” There’s a ton of really good interesting information on that page. I recommend taking a look.
      .
      My bottom line is: I think it is doubtful that someone has some special condition that requires them to get iron from meat. If someone has a problem where they are losing blood (say runners or some other problem) and they need some help until they stabilize, a supplement would make more sense in the short term than taking the risks of eating meat. I’m not an expert, so take that for what it’s worth. I just thought you might appreciate these thoughts in case you find yourself having conversations with similar people in the future.

  • MikeOnRaw

    Impossible Foods has released their Heme Iron based burger patties. Does this mean that such plant based heme iron foods may have the same risks of a beef patty?
    http://www.mprnews.org/story/2016/06/21/npr-silicon-valley-plant-burger-impossible-foods

  • meah

    how can I go vegan if I have anemia and can not eat all the iron rich foods because I have hyperphosphotemia and hyperkalemia due to type one diabetes and CKD stage 2. I get my energy from doing iceman breathing cold baths and all that is involved Wim Hof method but im still very anemic. Im also on low protein diet. What is the best solution for me . I could be vegan easily but am afraid of messing this u due to the hyperphosphotemia and hyperkalemia

  • Hendrik

    Another mechanism of how a high iron level in the blood can cause inflammatory diseases, is in that it can activate dormant bacteria in the blood, see the link at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4487407/ and https://www.newscientist.com/article/2104864-bacteria-lurking-in-blood-could-be-culprit-in-countless-diseases/

  • John Stump

    I’m hoping you can talk about hemochromatosis, of which I have been dealing with. I’ve had 5 pints of blood taken out of me in the last 6 weeks. My ferritin level went from 519 to 76, but my other blood levels are really low. I’ve been a vegan for 2 years and am wondering how much non heme iron I can eat. It’s recommended to eat 20 MG a day. But would it be best for me to try not to eat the recommended amount of iron a day?