Thursday, January 19, 2012

Iron - The Truth About Iron and Iron Deficiency....

If you’re a vegetarian or a vegan chances are you’ve been asked about Iron. Next to protein and calcium, iron is one of the biggest nutrients that non-vegetarians always seem concerned about. Not for themselves mind you, but for you. How do you get your iron? Where do you get your iron? Aren’t you worried about becoming anemic? These questions get asked over and over again and sometimes they’re coupled with comments such as, "I tried vegetarian for a while but had to stop because I became anemic." or "I had a friend who was vegetarian who had to go back to meat because she was anemic." Statements like these continue to perpetuate the myths that the diet of vegetarians is in some way lacking, difficult to manage, or that vegetarians are simply incapable of receiving proper nutrition through a healthful plant-based diet. All of which are entirely untrue.

I don’t know what it is about our culture but so often it seems that we end up hearing one ‘fact’ from one person, who may or may not have any actual authority on the matter and then stick to it like it’s gospel. Somewhere along the line it seems like we dropped the ball on asking questions and doing research for ourselves. It’s this lack of education that keeps these myths alive. So since I’ve already dispelled the common myths surrounding protein, and calcium I thought it pertinent to do the same for Iron. The information you’ll find in this post I think will be helpful for a wide range of people regardless of your dietary orientation, and you’ll see why in a moment.

Iron of course is one of the essential minerals needed to sustain most of earth’s life forms (both human and non human) and is required for normal human physiology. The majority of iron in the body is found in the hemoglobin, the protein in red blood cells that carries oxygen to your tissues. It’s also essential for regulation of cell growth.

There are two different types of iron problems that effect humans. Iron deficiency - which is described as low iron stores typically measured by a serum ferritin level of less then 18ng/ml (nanograms per milliliter) and Iron Deficiency Anemia. IDA symptoms include pale skin, brittle fingernails, hair loss, fatigue, weakness, difficulty breathing upon exertion, inadequate temperature regulation, and loss of appetite. Many of these are symptoms of other nutritional deficiencies and diseases and therefor only a medical doctor can properly and accurately diagnose IDA.

Iron deficiency is the most common nutrient deficiency Worldwide and in the United States. Iron deficiency effects people of all backgrounds, races, economic status, and dietary choices. Meaning iron deficiency effects vegetarians, vegans and non-vegetarians almost equally. Though people often show ‘concern’ for the iron levels of vegetarians the truth is iron deficiency is not about vegetarians not getting the proper nutrition while non-vegetarians are getting the proper nutrition, it’s a case of everyone needing to make sure they are receiving the proper nutrition from their diet, regardless of their dietary choices. In fact studies have shown that healthful vegetarian - and particularly vegan - diets contain higher or equal amounts of dietary iron then that of non-vegetarians. Why is it that vegetarians/vegans have more iron in their diets then non-vegetarians? The answer is simple, not only does virtually everything a vegetarian eats contain some level of iron but also vegetarians simply consume more fruits and vegetables. Why is this important? Because of vitamin C. Studies show that vegetarians consume up to 50% more vitamin C then non-vegetarians and consuming vitamin C at the same time you are consuming iron rich foods makes the iron more bioavailable to the body.

When it comes to iron there are two types available through our diet. Heme iron which comes from animal products, and nonheme iron which comes both from plants and animal products. While heme iron is considered more easily absorbable, it is not superior. Once the iron has been absorbed into the body and has reached our cells to be used in building hemoglobin and other purposes the body doesn’t care where the iron originated from and whether or not it was heme or nonheme. It’s also important to note that some studies suggest that heme iron from red meat has effects which may increase the likelihood of colorectal cancer. Which brings us to the next point.

While there is such a thing as iron deficiency, there is also such a thing as iron overabundance. Iron you see is tightly regulated by the human body which has no regulated physiological means of excreting excess iron. Excluding incidences of blood loss due to injury or menstruation, the amount of iron lost daily due to mucosal and skin epithelial cells sloughing is very, very small. Large amounts of ingested iron can cause excessive levels of iron in the blood. High blood levels of free ferrous iron react with peroxides to produce free radicals which are highly reactive and can damage DNA, proteins, lipids and other cellular compounds; thus iron toxicity occurs when there is free iron in the cells, which occurs when iron levels exceed the capacity of trasferrin to bind the iron. Damage to the cells of the gastrointestinal tract can also prevent regulation of iron absorption leading to further increases in blood levels.

Iron overload is serious and is particularly damaging to the cells in the heart and liver, as well as the pancreas, and spleen. It can cause significant adverse effects such as various types of cancer, coma, metabolic acidosis, shock, liver failure, coagulopathy, adult repertory disease syndrom, long term organ damage, osteoporosis, diabetes, hyperthyroidism, and death. Excess iron has also been linked to diseases like Parkinson’s, and Alzheimer’s, as it was found that an excess of iron had accumulated in the hippocampus section of the brains of those with Alzheimer’s, and the substantia nigra of patients with Parkinson’s. Iron overload can also accelerate the effects and symptoms of Alzheimer’s, Parkinson’s, MS, and Epilepsy. Not very fun stuff, and while you certainly don’t want to mess around with anemia either, recent studies have shown that low iron stores may not necessarily be a bad thing.

While healthy vegetarians are no more susceptible to iron deficiency then non-vegetarians, it is documented that most adult vegetarians have iron stores that are on the lower end of normal. In addition to not being put at a higher risk for the above mentioned diseases caused by or linked to iron overload, low iron stores are also associated with a higher glucose tolerance which may help prevent diabetes.

Those at the highest risk for iron deficiency (vegetarian or non-vegetarian) are woman of childbearing age (menstruating woman) pregnant or breast feeding woman, children and the elderly. You do not need to worry about iron if you are otherwise healthy and eat a varied vegan or vegetarian diet. Of course if you are worried about iron absorption there are steps you can take to increase the bioavailability of iron in your body. Increase the amount of beans and legumes in your diet, and just as vitamin C helps with iron absorption there are many things that can also inhibit iron absorption. Coffee and tea are two of the biggest culprits as the tannins within them work to block the absorption of iron into the body. It is not recommenced that you drink either of these beverages while eating iron rich meals, particularly if your goal is to increase absorption. Taking calcium supplements with meals can also decrease the amount of iron absorption as well as eating dairy products including eggs, chocolate, and taking Aspirin, and antacids. Drinking alcohol with meals or over abuse of alcohol, narcotics, or prescription medications can all impair iron absorption. It is wise to remove these things from meals, and make sure to eat your iron rich foods with foods rich in vitamin C such as lemon, lime, tomato, oranges etc... Of course if your concerns persist you should have a doctor measure your iron stores, which is a quick and easy thing to do. In fact I recommend having a full blood test done at least once a year just to ensure that you are getting adequate nutrition. That’s what I do, and it gives me peace of mine and the confidence to defend my diet when others may criticize it.

Part of the reason the myths surrounding vegetarianism and iron deficiency continue to persist despite evidence to the contrary is that an overwhelming amount of people self-diagnose themselves as being anemic. All too often when people first transition to a vegetarian diet they automatically assume they’ve become anemic if they begin to feel tired or fatigued. However their feeling tired could be the result of a number of things such as not eating enough calories or protein, eating too many high-sugar foods, or even not getting enough sleep. However rather then dig into the real reasons for why they may be feeling the way they are people tend to jump to what they consider to be the most logical conclusion. Since these myths about iron continue to persist that ‘logical conclusion’ is usually ‘anemia’. Some people may also base this judgment on the suggestion of family or friends who automatically jump to that conclusion as well, without having any of the actual facts. As stated before the only way to know for sure if you have iron deficiency anemia is to be diagnosed by a doctor.

There is some evidence that iron absorption may be more of a problem when a person first becomes vegetarian, because long-term studies of vegetarian woman have not shown high drop off iron rates. Physiologically it makes some sense that the problem would show up right away or not at all for the following reason: The body secretes transferrin into the digestive tract when iron stores are low in order to increase absorption into the blood. If someone has been a meat eater all their life, their body has not had a need to manufacture as much transferrin as they may now need as a vegetarian. This might cause a quick initial drop in iron absorption after first becoming vegetarian. As the person’s body adjusts to the new diet and lifestyle it may become more efficient at producing the appropriate amount of transferrin over time. However if a person becomes anemic or iron deficient right away they will likely quit the diet without giving their body a chance to acclimate to the new lifestyle. More evidence to support this theory is that children who were vegan from birth, and otherwise well-nourished and living in developed countries, are not known to have developed Iron deficiency Anemia. Since vegan infants have no prior history of depending on heme iron, they begin their lives efficiently absorbing nonheme iron and retain this ability throughout life.

If you do become anemic after switching to a vegan or vegetarian diet, this is easy to fix with iron supplements. Of course make sure to get diagnosed by your doctor first, and then talk about supplementation with him/her before self dosing. Your doctor may tell you to start eating meat again if he/she finds you to be anemic, this is a common response when doctors encounter anemic vegetarians yet it is a ridiculous one that doesn’t make any sense. After all iron deficiency and anemia in non-vegetarians is not simply treated by having the meat-eater, ‘eat more meat’ they are treated through iron supplements, and vegetarians or vegans can also be easily treated this way. However it is important to note that unless a deficiency or enhanced need exists, iron should not be supplemented, particularly in males, and postmenopausal woman who are no longer menstruating regularly, as iron is an oxidant and over abundance of it can lead to increased risk for many diseases as well as toxicity as described in the paragraphs above.

As you can see iron deficiency and iron deficiency anemia is not the disastrous and un-treatable boogeyman most people make it out to be. A lot of the fear and hype is overblown, and there is some very good evidence for why a lower (within reason) iron store may be more beneficial then a higher one. To say vegetarians or vegans are more susceptible to iron deficiency or anemia simply because thy don’t eat meat isn’t only ludicrous it’s simply not true. Statements such as those have absolutely no basis in fact, and are built off of propaganda, and myth designed to discredit a vegetarian diet, or to simply justify and excuse a non-vegetarian one. The perpetuation of these inaccuracies not only due us all a disservice but they are particularly harmful to those of us who want to continue on the vegan or vegetarian path for moral, ethical, environmental or health reasons, and are told we should not. All too often otherwise dedicated vegetarians are swayed back to eating meat by these myths, particularly when informed of them by an authority figure, not knowing any better they may feel forced to switch back despite their resistence to do so. This is something I know from personal experience, as it was the reason I shifted back to eating meat after just over a year of vegetarianism when I was in my teens. I also know non-vegetarians are equally plagued by iron deficiency anemia from personal experience as I’ve had two non-vegetarian friends diagnosed as anemic despite their constantly gorging themselves on red meat.

So now that you have all the information you may be wondering what some iron rich foods are. That’s the easy and delicious part! Beans particularly white beans, pinto, soybeans and chickpeas are an excellent source of iron, as are all lentils. Nuts and seeds, particularly pumpkin seeds are a great source of iron, as are whole grains. Especially barley, quinoa, and oatmeal. Blackstrap Molasses also contains a good deal of iron, as do Sea Vegetables (Seaweeds) and tofu. Dried fruits such as apricots, figs and raisons are all excellent sources as well, and of course last but not least greens. Lots and lots of greens such as spinach, Swiss Chard, Kale, Collards, Broccoli, asparagus, green beans, peas, bok choy and Brussels Sprouts. Potatoes and mushrooms are also a decent source of iron. As you can see, given you’re eating a variety of whole plant foods not processed junk your diet should be rich in iron, and of course it’s also an option to buy iron fortified cereals, and non-dairy milks as well. For extra insurance. Don’t ever let anyone tell you, your diet is nutritionally inferior!

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