The Safety of Heme vs. Non-Heme Iron

The Safety of Heme vs. Non-Heme Iron
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Heme iron, the type found predominantly in blood and muscle, is absorbed better than the non-heme iron that predominates in plants, but may increase the risk of cancer, stroke, heart disease, and metabolic syndrome.

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It is commonly thought that those who eat plant-based diets may be more prone to iron deficiency, but it turns out that they’re no more likely to suffer from iron deficiency anemia than anybody else. This may be because not only do those eating meat-free diets tend to get more fiber, and magnesium, and vitamins like A, C, and E; they also get more iron. But the iron found in plants is non-heme iron. Those eating meat-free diets don’t get any of the heme iron found in blood and muscle, which may be a good thing. The avoidance of heme iron may be one of the key elements of plant-based protection against metabolic syndrome, and may also be beneficial in lowering heart disease risk.

The link between iron intake and coronary heart disease has been contentiously debated, but the inconsistency of the evidence may be because the majority of total dietary iron comes mostly from plants and so total iron intake is associated with lower heart disease risk. But if you just look at iron intake from meat, it’s associated with significantly higher risk for heart disease. This is thought to be because iron can act as a pro-oxidant contributing to the development of atherosclerosis by oxidizing cholesterol with free radicals. The risk has been quantified as a 27% increase in coronary heart disease risk for every one milligram of heme iron consumed daily.

The same has been found for stroke risk. The studies on iron intake and stroke have had conflicting results, but that may be because they had never separated out heme from non-heme iron, until this study, which found that the intake of heme iron–but not non-heme iron–was associated with an increased risk of stroke, as well as diabetes. Higher heme iron (animal iron) intake was significantly associated with greater risk for type 2 diabetes, but not total or non-heme iron (plant iron); 16% increase in risk for every daily milligram of heme iron consumed. And the same for cancer, with up to 12% increased risk for every milligram of daily heme iron exposure. In fact, you can actually tell how much meat someone is eating by looking at their tumors. To characterize the mechanisms underlying meat-related lung cancer development, they asked lung cancer patients how much meat they ate, and examined the gene expression patterns in their tumors, and identified a signature pattern of heme-related gene expression. Though they just looked at lung cancer, they expect these meat-related gene expression changes may occur in other cancers as well.

We do need to get enough iron. Only about 3% of premenopausal white women have iron deficiency anemia these days, but the rates are worse in African- and Mexican-Americans. Taking our leading killers into account—heart disease, cancer, diabetes—the healthiest source of iron appears to be non-heme iron, found naturally in abundance in whole grains, beans, split peas, chickpeas, and lentils, dark green leafy vegetables, dried fruits, and nuts and seeds. But how much money can be made on beans? So the industry came up with a blood-based crispbread, made out of rye and cattle and pig blood–one of the most concentrated sources of heme iron, about two thirds more than chicken blood. 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; dark-colored because spray-dried pig blood can have a darkening effect on the food product’s color. But the worry is not the color or taste; it’s the heme iron, which, because of its potential cancer risk, is not considered safe to add to foods intended for the general population.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

Images thanks to JD Hancock via Flickr

It is commonly thought that those who eat plant-based diets may be more prone to iron deficiency, but it turns out that they’re no more likely to suffer from iron deficiency anemia than anybody else. This may be because not only do those eating meat-free diets tend to get more fiber, and magnesium, and vitamins like A, C, and E; they also get more iron. But the iron found in plants is non-heme iron. Those eating meat-free diets don’t get any of the heme iron found in blood and muscle, which may be a good thing. The avoidance of heme iron may be one of the key elements of plant-based protection against metabolic syndrome, and may also be beneficial in lowering heart disease risk.

The link between iron intake and coronary heart disease has been contentiously debated, but the inconsistency of the evidence may be because the majority of total dietary iron comes mostly from plants and so total iron intake is associated with lower heart disease risk. But if you just look at iron intake from meat, it’s associated with significantly higher risk for heart disease. This is thought to be because iron can act as a pro-oxidant contributing to the development of atherosclerosis by oxidizing cholesterol with free radicals. The risk has been quantified as a 27% increase in coronary heart disease risk for every one milligram of heme iron consumed daily.

The same has been found for stroke risk. The studies on iron intake and stroke have had conflicting results, but that may be because they had never separated out heme from non-heme iron, until this study, which found that the intake of heme iron–but not non-heme iron–was associated with an increased risk of stroke, as well as diabetes. Higher heme iron (animal iron) intake was significantly associated with greater risk for type 2 diabetes, but not total or non-heme iron (plant iron); 16% increase in risk for every daily milligram of heme iron consumed. And the same for cancer, with up to 12% increased risk for every milligram of daily heme iron exposure. In fact, you can actually tell how much meat someone is eating by looking at their tumors. To characterize the mechanisms underlying meat-related lung cancer development, they asked lung cancer patients how much meat they ate, and examined the gene expression patterns in their tumors, and identified a signature pattern of heme-related gene expression. Though they just looked at lung cancer, they expect these meat-related gene expression changes may occur in other cancers as well.

We do need to get enough iron. Only about 3% of premenopausal white women have iron deficiency anemia these days, but the rates are worse in African- and Mexican-Americans. Taking our leading killers into account—heart disease, cancer, diabetes—the healthiest source of iron appears to be non-heme iron, found naturally in abundance in whole grains, beans, split peas, chickpeas, and lentils, dark green leafy vegetables, dried fruits, and nuts and seeds. But how much money can be made on beans? So the industry came up with a blood-based crispbread, made out of rye and cattle and pig blood–one of the most concentrated sources of heme iron, about two thirds more than chicken blood. 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; dark-colored because spray-dried pig blood can have a darkening effect on the food product’s color. But the worry is not the color or taste; it’s the heme iron, which, because of its potential cancer risk, is not considered safe to add to foods intended for the general population.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

Images thanks to JD Hancock via Flickr

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.

If you haven’t yet, you can subscribe to my videos for free by clicking here.

184 responses to “The Safety of Heme vs. Non-Heme Iron

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  1. 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!




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

      I and many others agree whole’food’heartedly!




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      1. 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.




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  2. 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?




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  3. “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!




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    1. 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!




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        1. 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!




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        1. “krvavica” in Slovenia and it is filled with either rice or buckwheat. used to be my favorite before I went to WFPB … clearly, I was unaware of the risks and to me, meat was never that appealing …




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      1. 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!




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        1. The tribe best known for drinking their cattle’s blood is the nomadic Maasai tribe. The best chemistry tutor I ever had was a Maasai from Kenya (his family had abandoned the nomadic life and settled there). He told me consuming blood in various forms was no more remarkable to the Maasai than, say, eating hen eggs is to Americans. I kept trying to convince him as to the virtues of a plant-based diet, perhaps because of some subconscious symbolism in my mind. He is a full Ph. D, a professor I think, in Minnesota last I heard.




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    2. As a young man who lifted weights rather intensively I sought any source of protein; we were told heavy protein intake was the secret of the Russians who dominated strength events in the Olympics. So, at lunch time, I’d pick up some blood and tongue sausage from the little gourmet shot near my work and then head over to the YMCA. It wasn’t terrible, but I don’t think I could have dealt with the gelatinous quality of the congealed blood without the more appetizing chunks of tongue.

      I think the blood and tongue sausage came from a German source, but it was hardly more off-putting than many of the foods we routinely ate when I was growing up on our Tennessee farm, things like cow stomachs (tripe), pork brains and pigs’ feet. I didn’t become a vegetarian because I was squeamish.




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  4. 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.




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    1. 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.




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      1. 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.




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        1. 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.




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          1. No. There’s pseudo-science being pushed from all sides, this one included.

            Don’t make the mistake your side is right and everyone else’s isn’t. Reality is more nuanced than that.




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        2. 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!




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          1. 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.




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            1. 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




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    2. I’m not one to demand religious purity from vegans. Do the best you can, for then animals and for yourself, and if an occasional transgression is necessary to help you stick with it, no judgment on my part. Two NEAR vegans do more good than one total vegan, I suspect, though the pure vegans are important in demonstrating that humans don’t really need ANY meat. Stick with it!




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  5. 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.




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  6. 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




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    1. 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].”




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      1. 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?




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        1. 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!




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    2. 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.




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      1. 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.




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        1. 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.




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    1. 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.




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




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




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    1. 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.




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        1. 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.




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      1. 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.




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        1. 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.




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          1. 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. .




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      2. 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!




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        1. 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




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          1. 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.




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    2. 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!




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  9. 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?




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    1. 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.




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      1. 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.




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




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    2. 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.




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      1. 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.




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        1. 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.




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  10. 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.




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    1. 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.




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  11. 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.




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      1. 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.




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    1. 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.




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    1. 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.




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    2. 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.




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  12. 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.




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    1. Good question. Dr. Forrester and I address this in response to a similar question here. There is one study that found less multi-drug resistant bacteria contamination on organic chicken, compared with conventional chicken, but the difference was not huge. I do not think many studies separate organic meat from conventional. If someone has some links or papers please share! Interestingly, a new study finds consumption of organic meat does not diminish the carcinogenic potential associated with the intake of persistent organic pollutants (POPs)”. See if these links help? Thanks, Clean Food Sally.




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  13. 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.




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  14. 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?




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    1. 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-)




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    2. 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.




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  15. 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?




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      1. 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.




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    1. 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.




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  16. 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




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    1. 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?




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  17. 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!




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  18. 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




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    1. 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!




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  19. 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?




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    1. 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.




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      1. 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?




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        1. 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.




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          1. 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!




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            1. 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.




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            2. 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.




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        2. 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.




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  20. “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.




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  21. 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.




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    1. 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.




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    1. 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/




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  22. 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!




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    1. 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.




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  23. 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!




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  24. 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!




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  25. 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.




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    1. 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?




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  26. 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.




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    1. 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.




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        1. 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




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  27. 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.




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  28. 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?




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  29. 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.




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  30. 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.




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  31. 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.




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  32. 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!




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  33. 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?




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  34. 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




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    1. 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.




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  35. 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




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  36. 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?




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    1. Hi John- Here’s a nice one pager on diet and hemochromotosis (sorry if you know all of this info already). hemochromotosis and diet Even though non-heme iron is not as well absorbed as heme iron, it is still absorbed and used efficiently by the body (see other videos on this site about iron). It’s probably best to try and stick close to your providers recommendations with perhaps very small changes over time to see how your body reacts. Good luck!




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  37. What about Impossible Meats’ new Impossible Burger? They claim it’s the “heme” in the burger that gives it its meaty taste. The ingredients list cites “leghemoglobin (heme protein)” as an ingredient. Is this the same as the harmful “heme iron” discussed in this video?




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    1. Hello – I am a plant based dietitian located in Scottsdale, Arizona. I help Dr. Greger as a moderator on NutritionFacts. You pose such an interesting question – just this weekend, I was learning about the Good Food Institute and their interest in supporting organizations and entrepreneurs that are working to come to market with meat like non meat food. They have a repository of scientific information on their site: check http://www.gfi.org/resources for a listing of their resources. There are people involved with animal welfare involved in GFI, but the question you pose is really important!! Thanks for your question.




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      1. This is a great topic as I’ve eaten this burger and was wondering the same thing! I reached out to Impossible Meat and they’ve discovered how to take heme from plants and produce it using fermentation — similar to the method that’s been used to make Belgian beer. Yet, i’m still confused whether its good for consumption? is heme extracted from plants the same as heme iron? Would Dr. Greger have any thoughts on this?




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  38. I don’t know chemistry well, so maybe my question and assumptions are totally without merit, but if I understand the biology correctly – Plants uptake Fe2+ (heme iron) and convert it to Fe3+ (non-heme iron) which is better for humans. I’m also wondering if and how these forms of Fe interact with nitric oxide and maybe even sulfur, and what benefits are found in the availability of these chemical reactions. I think I’m beginning to see a very complex relationships, but without a good chemistry background I might be asking silly questions. Am I even close to putting it together?.




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  39. Dear Dr Greger We have been following the WFPB diet for 5 years now but we are struggling with low iron levels. My low levels can be explained by anaemia of chronic disease (psoriatic arthritis which I am trying to treat through a combination of diet and drugs). However my husband and children (12 & 10) have now had abnormal blood tests on their anaemia profile. I’m just waiting to find out exactly which results were abnormal. Unfortunately our GPs response will probably be “just eat some meat” which I’m not prepared to do. My children probably eat 90% plant based as I cannot control all of their intake as none of our extended family or friends eat this way. Do you have any resources that could help me with this issue? Any suggestions? I have looked up the top iron rich plant foods and will add more of these into our diet but I thought we were eating enough already. Could low iron be genetic? Any other factors? The kids aren’t having any caffeine and virtually no dairy to limit absorption. Vitamin C would be in every meal in either fruit or salad.




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    1. Natasha: I sent your post to our medical moderators in the hopes that they will have some ideas for you. We get too many questions to answer them all, but at least your post is in the pile.
      .
      I’m not an expert, but in the meantime, I thought I would share some thoughts resources for you on this topic. First, the following quote from well respected Jack Norris RD makes a lot of sense to me: “”If your iron stores are too low, your doctor might suggest eating meat or taking an iron supplement. Anemia in meat-eaters is normally treated with large doses of supplemental iron, not with eating more meat. Similarly, vegetarians with anemia do not need to start eating meat but can also be treated with supplemental iron and vitamin C. If your doctor insists that you eat meat, you might want to show him or her this article.” http://www.veganhealth.org/articles/iron (first pointed out to me from “b00mer”) The entire article from Jack Norris is worth reading.
      .
      WFPBrunner, a knowledgeable participant on this site, once told me that she takes the GAIA (sp?) brand. Something you might look into as I think she did a lot of research.
      .
      Also, I highly recommend the following article from Dr. McDougall: https://www.drmcdougall.com/health/education/health-science/common-health-problems/anemia/ One of Dr. McDougall’s main points is that the cause of anemia should be determined first as then you will know how best to move forward to treat the problem. That just makes so much sense.
      .
      I hope this helps.




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        1. Hello Diane,

          I am a plant based dietitian nutritionist based in Scottsdale, Arizona helping Dr. Greger as a medical moderator. I looked at the Lucky Fish, and based on the information that is on the website, I would be uncomfortable recommending it to anyone. I like to use and recommend things that pass the “science” test, not just representations on websites which cannot be verified. Third Party studies, done and published in evidence based, peer reviewed journals, is my test.

          It is critical that you identify the cause and type of the iron deficiency that you have. Knowing that your iron levels are “low” is not enough. There are different types of low iron with different treatments. Eating red meat is not a treatment for iron deficiency; taking iron supplements (the right kind) is.

          Using an iron additive in the form of iron in your cooking pot will deliver a non standardized, possibly unsafe dose. Using reputable supplements as well as eating Vitamin C rich foods at the same time (which increases absorption) is the way to go, under MD supervision.

          Too much iron is a very bad thing. Iron overload caused by supplementing without supervision or the genetic condition hemochromatosis can result in excess iron being deposited into the body’s organ system, including pancreas, liver, and even heart. Consequences of too much iron in the body can include Type II Diabetes, Cardiovascular Disease, and Cirrhosis of the Liver, just to name three very serious conditions. Muscle aches and pains, lethargy, and fatigue are physical symptoms that may be connected to iron overload.

          Putting things into perspective, the body is adept at balancing iron levels through a well balanced plant based diet that includes a large amount of iron rich plant based food sources. If you don’t respond from diet, knowing the type of iron deficiency you have is the next step. Supplementing with a high quality medical grade supplement, NOT eating red meat, is the next step.

          Good luck, and thanks for your question.




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    2. Hi, Natasha. I am Christine, a NF volunteer moderator. It does appear that some people absorb iron better than others, so low iron may be subject to genetic influences. If you have not already seen this video, it may be of interest to you:
      http://nutritionfacts.org/video/risk-associated-with-iron-supplements/
      I understand that you do not want to “just eat some meat,” and the difference in the way heme iron is used by the human body is a good reason to avoid it. If supplementation is needed in your case, there are some good, plant-based supplements available. I hope that helps!




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    1. HI Andrew Nig …. I’m going to assume that means you’re getting about 40 mg of iron per day? The NIH (National Institute of Health) states that “Adults with normal intestinal function have very little risk of iron overload from dietary sources of iron [2]”; the toxicity concerns are with iron supplements. On the other hand, Dr.G. as you likely know, has many videos on health concerns with heme (meat) iron but not non-heme iron. It sounds to me like you must be eating a very healthy diet with lots of legumes, nuts, seeds, soy etc to be getting that level of iron. Enjoy!




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      1. Thank you for your reply. And you’re correct, my diet is 100% whole foods and 90% raw. I track everything I eat on CRON-O-Meter and virtually all vitamins, minerals, proteins and fats I consume are over 200% of RDA. The only minerals I can’t seem to get enough are Zinc and calcium.




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  40. I spoke with one of the top iron scientists in the world. He thinks that the heme vs. non-heme iron has the same risk, normally, but that a plant based diet naturally slows the bodily uptake of iron because the plant compounds contain natural chelation agents. Or the heme-iron consumption normally means more meat which has lots of other bad things associated with it; endotoxemia, inflammation causing mechanisms, effects on TOR, etc.




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  41. Hello

    I have a friend who was vegan but decided to eat red meat again on their doctor’s advice because they became severely anaemic, apparently down to their inability to absorb non-heme iron. This was after trying substances that increase the bioavalibilty of iron for absorption.

    Can you tell me more about this? Is this a condition that affects many people? Should people be advised to switch back to red meat in this scenario?




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  42. Hello,
    I had a question. I had been suffering from gastritis for last last 4 months. Was on strict diet and medication during that time. Now I am off of all medication. At the start of my gastritis my D and B12 was low so I started taking those supplements. At that time my total iron was 46 and Ferritin 39. Now after 4 months, my recent blood work shows my Ferritin is down to 22 and total iron is 127. Was asked to take iron supplements. But I am worried it might flare my gastritis again. Dr. Greger, whats your opinion on it? Any specific type of supplement you recommend?

    Thanks!




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  43. Reshma,

    Your diet, not described, could be a potential cause of your gastritis and disturbed iron and B12 levels. I would ask that you see your physician and consider a course of HCL caps with meals and determine if your absorption is the cause, along with some supplementation of both iron and the B-12. Additionally, I would be curious about your protein intake. In regards to the iron…..I would avoid the iron sulfate and take a chelated form, such as iron bisglycinate to minimize the potential of upsetting your gastritis. Also, consider a much more accurate testing of the B-12 using the MMA test.(https://labtestsonline.org/understanding/analytes/mma/tab/test) . Have your physician also ask questions regarding the timing of your gastritis symptoms and any correlation with various foods. As a simple test, you might find that using some diluted vinegar, before a meal, helpful to avoid gastritis. See (http://nutritionfacts.org/video/optimal-vinegar-dose/) And yes there are supplements such as DGL (http://www.huffingtonpost.com/julie-chen-md/dgl-supplements_b_2976260.html)…. however fixing the problem is the best approach. Dr. Alan Kadish moderator for Dr. Greger




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    1. Thanks Dr. Kadish for a quick reply! I am a vegetarian since 30 years and mostly follow whole plant based diet. My protein mainly comes from lentils. The only thing I think about that happened before gastritis was I was trying to loose weight and hence having irregular meals ( skipping dinners). Dont know if that could have caused it. Would this gentle iron work? https://www.amazon.com/Solgar-Vegetable-Capsules-Promotes-production/dp/B00013Z0QA/ref=sr_1_4_a_it?ie=UTF8&qid=1488739108&sr=8-4&keywords=iron%2Bbisglycinate&th=1

      Also, I am curious. Does B12 supplementation increase your total iron levels? In the last 4 months I only took Vitamin D and B12 supplements. In that time frame, my total iron increased from 46 to 127 and ferritin dropped from 39 to 22. Wondering if its just a coincidence or there is some relation between B12 supplementation and iron.

      Thanks!




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  44. Hi Dr. Greger,
    I have a question about possibly taking too much non-heme/plant iron.
    My husband likes to put a teaspoon of beet powder in his smoothy every day.
    I’m not sure how much iron is in one teaspoon, but in can not take it. He says that he has no problem with it at all.
    Could too much beet powder be a bad thing?

    Love your work!
    Thanks!
    Karin




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    1. Hey Karin, too much of *anything *has the potential to be a bad thing!
      Natural products are no exception. I don’t believe there is much research to support a negative effect of beet powder on chronic medical conditions.
      Iron however is known to be poorly absorbed, non-heme (plant source) iron even more so, and unless your husband has a condition that causes excess iron accumulation (hemochromatosis) I don’t think there is a need for concern.




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  45. Hi Dr Greger,
    Thank you for everything you do. I have a question regarding iron: I’ve known to be iron deficient for almost 20 years and my hematologist suspects I was probably deficient even in my teenage years (over 30 years ago). i’ve taken supplements, have gone for regular iron infusions at the hospital for over 2yrs (ferritin was around 300 back then, now it’s back down to 15 or so and still going down into anemic zone). Nothing has been working thus far and no illness has been diagnosed.
    So as you can imagine I’ve been following your posts on iron with great attention. In order to boost both ferritin and hemoglobin levels, what can be done apart from the usual consumption of iron rich foods eaten alongside iron absorption promoting foods? Could wheatgrass be an option to fortify the blood and increase iron absorption?




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  46. Hi. I’m a 57-year-old male in good health and became a vegan after coming across “How Not To Die” and researching plant-based lifestyles pretty thoroughly. I’m close to ideal on Dr. Michael Greger’s suggestion list, and follow the “Daily Dozen” tips. Also, no added salt or sugar in my diet.
    I had a blood test last week, though, and it showed my hemoglobin levels are down to the point where I should be considered anemic – except that I have no signs of anemia: no fatigue (exercise regularly), not pale, have a good appetite and usually on the go.
    Also, there are differences between the lab results and the estimate OneBlood (which is what the Red Cross is here in Florida) uses when you donate blood, using that little device on your thumb.
    From my last lab results in 09/2016 till last week:
    • Hemoglobin has fallen a bit, from 11.8 to 10.6, even though I eat a lot of spinach (smoothies!) and beans and a couple of figs regularly.
    • The B12 levels are high at 1301; according to the reference sheet from Quest Diagnostics, the range should be 200 – 1100). So, doesn’t appear to be B12-related anemia.
    • Don’t have any symptoms associated with anemia, such as fatigue – if anything, I feel more energetic than I used to, and I was no slouch earlier either.
    • I donate blood regularly, and the OneBlood hemoglobin count in Feb. was 14.1 and yesterday was 13.1. Don’t know how to reconcile the differences between the lab results and the OneBlood estimate.
    I have a doctor’s appointment next week, so may learn more about this issue. He ordered some extra lab work when I told him I’d become vegan. The other numbers, in case they make sense to others on this board:
    Hematocrit 34.0 (reference range 38.5 – 50.0)
    MCV 70.7 (ref. range 80.0 – 100.00
    MCH 22.5 (ref. range 27.0 – 33.0)
    Red blood count 4.81 (ref. 4.2 – 5.80
    White blood count 4.0 (ref. 3.8 – 10.8)
    Would greatly appreciate it if anyone can offer thoughts/ideas/suggestions to take up with my doc next week. He’s pretty encouraging of healthy lifestyles and cutting down on meat/salt/sugar, so I look forward to a good discussion with him




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    1. Hi Sal- I’m Dr Anderson, a volunteer with Dr Greger. Don’t worry about having B12 levels higher than the range. Agree that you clearly don’t have B12 deficiency. In B12 deficient anemia, the MCV (size of red blood cells) would be high. On the other hand, red cell size is small in iron deficiency. Your cells are normal in size.

      I’m guessing your doc has ordered iron studies. The ferritin level is a measure of iron stores. The ferritin level in plant based eaters is lower than in meat eaters, and this alone doesn’t mean a person is iron deficient. Very low level of ferritin is consistent with iron deficiency. The iron level and TIBC levels also help determine the presence of iron deficiency. Some folks also have an inability to absorb iron from the diet; this occur when they have a low level of “intrinsic factor.”

      The OrSense (the thingy used by OneBlood) device looks at the color of the blood through your finger to estimate the hemoglobin. The measurement in a blood test is a direct hemoglobin measurement, so more accurate. The hematocrit is a calculation rather than a direct measurement.

      Your doctor will be able to go over with you whether you appear to be iron deficient or not and how to treat that if needed. Best luck!




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      1. Dr. Anderson, many thanks for your response.
        Will check with my doctor about the ferritin test.
        My wife wonders if I should cut back on the blood donations (5 times last year; twice so far this year). Will ask my doc about that as well.




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  47. Can you explain how vegetarians/vegans get more total iron than those who eat meat? Meat contains both heme and non-heme iron. So if a meat eater were to just be eating meat all day, or a combination of meat and other plant-based foods; wouldn’t they in turn always be consuming more? Especially if we want to talk the amount of iron that is absorbed (since non-heme iron is less readily available for absorption compared to heme).




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  48. emjfish, that is an excellent question since many people believe that meats are the “best” source of iron. After looking up some nutrition labels, here is what I found. A serving of dark meat chicken (dark meat has more iron than white meat) has 249 calories and 1.9 grams of iron (10% DV). http://nutritiondata.self.com/facts/poultry-products/759/2 A serving of black beans has 227 calories and 3.6 grams of iron (20% DV). http://nutritiondata.self.com/facts/legumes-and-legume-products/4284/2 As you can see, the black beans have less total calories and more iron. So if a person is doing a healthy plant-based diet and eating the same number of calories as a person on a meat-based diet, it is very possible to consume more iron. Additionally, non-heme iron is only absorbed when needed, while heme iron is absorbed whether your body needs it or not. This is why heme iron leads to increased heart disease and is a pro-oxidant as stated in the video.




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    1. Thanks for the response Stephanie! So does the DV not account for what is actually absorbed in the body? Because as we know heme and non heme iron are absorbed different (where heme iron is more readily absorbed) and therefore the two (meat vs bean) should not be treated as equal. Using your example, say I have two servings of dark meat chicken and still only 1 serving of beans: While yes they both may equate to 3.6 grams of total iron my body is going to absorb more of the 3.6 grams iron from the chicken than it would from the beans (again, due to the heme iron found in the chicken).




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  49. Hey, My friends mum was told by her doctor that her body has trouble converting non-heme iron to heme iron for her body to use and have been told to eat red meat. They both have had iron infusions because they have both gotten to a low point with their iron. Is there a way to get them plant based?




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    1. Nicole, It is always challenging to speak with a friend with advice that seems contradictory to what the friend’s health care professional is advising. I would encourage your friend to learn more (without contradicting her dr’s advice) then she could ask her doctor alternate plant-based approaches while minimizing or eliminating meat. There are some wise comments about how to promote plant-based nutrition for those who have iron deficiencies. Have you looked at these (Scroll above). If you already have reviewed these, and your friend then states she has thoroughly explored this with her dr (possibly asking for consultation with a knowledgeable dietitian?) and is confident in her dr’s approach, then I’d say you have done what you could. You certainly can continue to encourage following more plant based nutrition, even if the meat issue remains.




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  50. It is the Impossible Burger, not Beyond Meat, that includes “plant heme.” Beyond Meat uses beet juice as a coloring to make it look like meat. My guess is that the Impossible Burger is so new, and so limited in availability, that this is not an issue for most people yet. The “plant heme” included in the Impossible Burger is most likely Leghemoglobin, described as “A hemoglobin-like oxygen-binding hemeprotein present in the nitrogen-fixing root nodules of leguminous plants. The red pigment has a molecular weight approximately 1/4 that of hemoglobin and has been suggested to act as an oxido-reduction catalyst in symbiotic nitrogen fixation,” in the NIH MeSH database. The health effects of human consumption of this pigment do not appear to have been specifically tested. More on the ingredients in these burgers may be found here:
    https://www.impossiblefoods.com/faq/
    Both products are processed foods made with a lot of fat and sodium, and are not whole plant foods. They may be okay for an occasional treat for those without serious health problems, but should probably not be eaten too often. I hope that helps!




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  51. I am thinking about using Sabja seeds (Basil seeds) in my drinks, but was concerned about the iron content. I put it into cronometer and it is 499% of the daily iron requirement per hundred grams. Do I still need to be concerned about the amount I consume since non-heme iron is only absorbed when needed?




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  52. Contrary to the apparent concern of iron deficiency for vegetarians, I have found with my WFPB consumption that I have frequently budded up against (or surpassed) my upper daily limit of Iron intake. A single cup of Grape Nuts is bears over 32mg of iron, which based on my age and gender is less than 13mg away from the upper daily limit. Yet, from what I can tell, there is no discrimination between heme/nonheme sources for that UDL. Based on your video, it would seem that restriction is due to the type of iron, and less about Iron in general. I’m curious to know the foundation of that UDL assumption… any insight?




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  53. Hi, can you please let me know what is the ideal level of ferritin. It does say online between 10-120 ng/ml which is such a huge gap. My level is actually 26ng/ml but do experience tiredness and slightly too much hair shedding. I did try to increase my iron by vegan food but the level doesn’t really change. Do you advise iron infusion/injection? Thanks!!




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  54. Dr. Greger,

    Now that we know how iron can be harmful, would you please consider providing some information on how to best supplement when iron deficient. There is a lot of conflicting info out there, controversy with spinach and iron absorption, etc… I’ve been vegan for two years but my iron anemia has been exacerbated. Just trying to figure out how to cope best.




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    1. Sorry, not Dr. Greger here, just a moderator,

      it’s always important to consult the treatment of iron deficiency with your doctor. There are many different causes of iron deficiency. But is always very important to take vitamin C with iron to improve absorbtion. Slow-release iron supplements may be a good choice.




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  55. I recall when I first learned of heme and non-heme iron the latter was described as less nutritious as it was not as readily utilized by the human body, yet another warning to foolish vegans. I accepted that as one of the rare cases in which animal sources were superior, but simply figured I’d have to eat a few more leafy greens to compensate. Later I learned that the greater bioavailability of heme iron was a bug, not a feature.




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