Iron is one of those nutrients that vegetarians and vegans often get asked about.
Generally speaking, vegetarians and vegans tend to have lower blood iron levels than meat eaters. Low iron levels can cause a hoard of unpleasant symptoms and ultimately lead to poor health.
However, ingesting too much iron may come with its own set of health problems.
This is true for people of all ages, but particularly of concern for children which may experience the negative consequences caused by very low iron or very high iron levels long after these have been brought back to normal.
This article describes the point at which low iron levels become problematic. It will also teach you how to spot low iron levels, how to boost them through plant foods, as well as when to take supplements and when to avoid them.
Why is iron so important?
Iron is a mineral that’s heavily involved in keeping you energized and healthy. Your body uses iron to make red blood cells and DNA as well as carry oxygen through your blood to your various organs (1).
Low iron levels can weaken your immune system, make you feel tired, and cause difficulty concentrating. They may also cause various other unpleasant symptoms including taste changes, hair loss, and headaches (2, 3).
Too little iron may also influence the way in which your child’s brain develops, possibly resulting in attention, learning and social difficulties. Low iron levels may also cause a delayed motor development (2).
What’s particularly worrisome is that some of the negative effects of low iron levels observed in children appear to not be fully reversible, even when iron levels are brought back to normal (2).
Babies and children tend to have higher iron requirements than adults proportional to their body weight. However, their small stomach size can make it difficult for them to get enough of this nutrient (2).
For these reasons, it’s important to consistently offer your child iron rich foods at each eating opportunity. This means both for meals and snacks.
IN SUM – Iron is a mineral that plays many different important functions in the body. Low iron levels can cause health and developmental problems, some of which may not be fully reversible, even when iron levels are brought back to normal.
Do vegetarians or vegans actually need more iron?
You can find iron in foods in two forms; heme iron and non-heme iron. The first is typically found in animal foods whereas the second is found in plant foods (1).
Heme iron tends to be more easily absorbed in our gut than non-heme iron. This is the reason why vegetarians and vegans are often encouraged to eat 1.8 times more iron than meat eaters (2).
Can a vegetarian or vegan diet cause low iron levels?
Aside from a few outliers, studies generally agree that vegetarians and vegans are more likely to have low or critically low blood iron levels than meat eaters, despite ingesting as much or even more iron from their diets (4).
This suggests that those who avoid meat or other animal products may have slightly higher daily iron requirements.
How much more iron do vegetarians and vegans actually need?
This question is tough to answer.
The current dietary reference intake (DRI) for iron was set close to two decades ago. At the time, it experts failed to take into account the fact that people may adapt to their diet.
We now know that vegetarians and vegans may increase their ability to absorb non-heme iron over time. They also appear to gradually lose less iron on a daily basis (5, 6).
This suggests that vegetarians and vegans may not need as much as 1.8 times the current DRI. However, more research is needed to determine exactly how much their daily iron requirements should be.
IN SUM – Plant-based eaters are likely to have slightly higher daily iron requirements than meat eaters. However, the current DRI may be overestimated. More research is needed to determine how much extra iron vegetarians and vegans truly need.
How can vegetarians and vegans get more iron from plant foods?
A well-planned vegan diet can provide you with enough iron to maintain adequate blood iron levels.
Vegan sources of iron
The plant foods richest in iron include tofu, tempeh, natto, beans, lentils, peas, nuts and seeds, whole grains and leafy greens.
The key is to ensure you eat sufficient amounts of iron-rich foods each day. To achieve this, try to include at least one portion of iron-rich foods to each meal and snack.
If you need help with including enough iron in your diet, you can download a free copy of the meal planner below. This planner is what I personally use to ensure that my family gets enough iron each day!
How to improve iron absorption from plant foods
In addition to eating higher amounts of iron-rich plant foods, you can help your body absorb the non-heme iron they contain more easily by:
- Eat them together with vitamin C-rich foods: combining iron-rich plant foods with foods rich in vitamin C may help boost the absorption of non-heme iron by as much as 300% (7).
- Eat them together with protein-rich foods: combining iron-rich plant foods with foods rich in protein may also boost the absorption of non-heme iron (8).
- Soak, sprout or ferment: doing this to beans, lentils, peas and grains may increase your body’s ability to absorb the non-heme iron they contain by up to 30% (9, 10, 11, 12).
- Use cast iron cookware: preparing your meals in cast iron pots and pans may increase the iron content of your meals by as much as 16% (13, 14).
- Avoid tea or coffee: compounds found in tea and coffee can reduce the absorption of iron by as much as 50-90%. Therefore, try avoiding drinking these beverages together with iron-rich meals or snacks (15).
IN SUM – You can boost your iron levels by including at least one portion of iron-rich foods to every meal and snack. Following the tips above to boost your body’s ability to absorb non-heme iron can also help.
How to spot low iron levels
Low iron levels are common, but not always easy to spot.
This is especially true in the early stages, before low iron levels have progressed to iron-deficiency anemia (IDA) – a more serious condition which causes your blood to contain too little healthy, oxygen-carrying red blood cells (2, 3).
Spotting low iron levels early can help you take the measures needed to prevent them from progressing to IDA. In order to effectively do so, it helps to keep the following notions in mind.
Stages of iron deficiency
Low iron levels typically progress to IDA through the following three stages (2):
- Mild iron deficiency. Consists of low iron stores with normal levels of other blood iron indicators. Ferritin values fall between 10-30 mcg/L, while hemoglobin and hematocrit values remain above 12 g/dL and 36-41% respectively.
- Mild functional iron deficiency. Consists of even lower iron stores with normal levels of other indicators. Ferritin levels tend to fall below 10 mcg/L. Hemoglobin remains above 12 g/dL and hematocrit above 36% for women and 41% for men.
- Iron deficiency anemia (IDA). Consists of depleted iron stores with low values of other indicators. Ferritin levels typically fall below 10 mcg/L. Hemoglobin falls below 12 g/dL and hematocrit falls below 36% for women and 41% for men.
Hemoglobin and hematocrit tests are the most commonly used to screen or diagnose low iron levels. However, they cannot be effectively used to identify the earlier stages of iron depletion (2).
Currently, serum ferritin is considered the most efficient and cost-effective way to diagnose the early stages of iron deficiency. Unfortunately, very few medical professionals routinely test people’s ferritin levels, unless you specifically request it.
So if you’re looking to help diagnose the early stages of iron deficiency, make sure to request that your healthcare practitioner test your blood ferritin, in addition to your hemoglobin and hematocrit levels.
Symptoms of iron-deficiency anemia (IDA)
Getting your blood iron levels tested is the most accurate way to rule out low iron levels or IDA. Alternatively, you may also choose to keep an eye out for the following symptoms of iron deficiency: (2, 3).
- lack of energy
- tiredness
- difficulty concentrating
- being sick more often
- shortness of breath
- pale skin
- feeling cold
- headaches
- heart palpitations
- ringing, buzzing or hissing noises inside your ears
- itchiness
- changes in the way food tastes
- difficulty swallowing or a sore tongue
- hair loss
- spoon-shaped nails
- cravings for non-food items such as dirt or ice – also known as pica
- open sores in corners of mouth
- an uncontrollable urge to move your legs – also know as restless leg syndrome
Do keep in mind that these symptoms tend to be most noticeable once low iron levels have already progressed to IDA. So it’s possible to have low iron levels without experiencing any of the above symptoms, especially in the early stages of iron depletion.
Getting your blood iron levels checked regularly, even if you do not experience any of the above symptoms, can be a good way to identify low iron levels early. This gives you the opportunity to treat them before they get a chance to progress to IDA.
Spotting low iron levels early also makes it easier to reverse them by modifying your diet, without necessarily having to resort to taking supplements.
How often should you get your iron levels tested?
If you have no history of low iron levels or IDA, you may choose to get your blood iron levels tested on a yearly basis.
If you’re currently taking iron supplements to treat low iron levels, wait at least 3 months before getting your levels retested.
Your hemoglobin levels may very well improve within the first 4 weeks. However, it can take at least 3 months for any improvement in ferritin levels to become noticeable (16).
Keep in mind that a small percentage of people either fail to respond to oral iron supplements, or are particularly sensitive to their side-effects.
If you’re currently taking supplements to treat an IDA but fail to notice an improvement in symptoms within the first 4-8 weeks of treatment, consider getting your levels rechecked. You may require alternative treatments (16).
Should babies and vegan children get their blood iron levels tested too?
Most babies are born with iron stores large enough to last them approximately for the first six months of life. That said, various factors can influence the size of these stores. This can cause them to become depleted earlier than the 6-month mark (17).
Iron deficiency symptoms can be difficult to spot in babies and it’s currently impossible to guess the size of your baby’s iron stores without getting their blood iron levels tested.
In addition, just as is the case for adults, studies suggest that vegan children tend to have lower iron stores than non-vegan children (18, 19).
Babies and children with low iron levels have an higher risk of delayed motor development (2).
Low iron levels may also negatively impact their brain development and these effects may not be fully reversible, even when iron levels are brought back to normal (2).
Getting your baby’s blood iron levels tested remains the best way to rule out an iron deficiency. Testing may be particularly important for babies which are exclusively breastfed for longer than 6 months of age.
Here’s a more in-depth explanation about everything you need to know about iron for vegetarian or vegan babies.
IN SUM – Spotting low iron levels early can keep an iron deficiency from progressing to IDA. Getting your blood ferritin, blood hemoglobin and hematocrit levels tested are the best way to rule out an iron deficiency, especially in its earlier stages.
Should vegetarians and vegans take iron supplements?
Iron supplements can be very helpful when wanting to reverse low iron levels or treat IDA quickly.
They can be especially helpful if you are prone to low blood iron levels or are unable to maintain good iron levels through your diet alone.
However, unnecessarily taking iron supplements can actually do more harm than good.
For instance, iron supplements can cause digestive problems. They may also lower your body’s ability to absorb other nutrients in your gut (2).
Moreover, ingesting too much iron from supplements may damage your cells. In severe cases, this may cause organ failure, coma or death.
These side-effects have been observed for all age groups, but appear especially fatal in children. This is why you shouldn’t take iron supplements without first speaking to a qualified healthcare provider (2).
If you’re currently taking iron supplements, ask your doctor to check your blood iron levels regularly. Doing so can prevent you from consuming more iron than is truly necessary.
IN SUM – Iron supplements can help quickly increase blood iron levels. Yet, taking them when not truly needed can unnecessarily cause digestive and nutrient absorption issues, cell damage, and in severe cases, even organ failure, coma or death.
Do vegans benefit from having lower iron levels?
While very low iron levels have been linked to a hoard of health problems, too much iron may bring its own set of problems.
For instance, some studies link high iron stores to a higher risk of diseases, such as type 2 diabetes and metabolic syndrome (20, 21, 22, 23, 24).
Metabolic syndrome is a cluster of conditions including obesity, diabetes, and high blood pressure, which, when combined, increase the risk of heart disease and stroke.
These study results are causing some experts to wonder whether the lower blood iron levels observed in vegetarians and vegans may actually offer some protection against these diseases (5).
Some go as far as suggesting that the body’s reduced ability to absorb the non-heme iron found in plants may, in part, explain why plant-based diets are often linked to a lower risk of disease (25).
As a result, some researchers have started recommending increasing the iron content of a person’s diet by eating more iron-rich plant foods rather than animal foods. However, more research is needed before strong recommendations can be made (20).
IN SUM – Vegetarians and vegans tend to have lower blood iron levels than meat eaters. Excessively low iron levels may cause health problems. Slightly lower levels may offer some level of protection against certain diseases, but more research is needed to confirm this.
To sum it all up
Iron is a nutrient important for many bodily functions. Vegetarians and vegans appear more likely to have low blood iron levels or iron deficiency anemia (IDA) than meat eaters.
Slightly lower iron levels may offer you some protection against disease. However, allowing your blood iron levels to drop too low can cause health problems and bring on various unpleasant symptoms.
You can boost your iron levels by including iron-rich plant foods to each meal and snack. Focussing on strategies that help your body absorb iron more easily can also help.
If you are unable to maintain adequate blood iron levels from your diet alone, consider taking a supplement. Just make sure to seek guidance from a qualified healthcare provider in oder to do this safely.