Iron Deficiency Anaemia

More nonsensical and inaccurate claims have been made about this condition than any other. So successful have they been that it has almost entered the public’s consciousness that to avoid iron deficiency you must eat meat. It’s simply not true. Vegetarian diets which include vegetables, legumes, fruits and grains provide all the iron necessary (85, 86, 87, 88, 89, 90).

Iron deficiency is, however, the biggest nutritional problem facing the world and the WHO estimates that 750 million people have it – most of them women and most of child-bearing age. The real causes of iron deficiency are poor iron absorption and blood loss – not just diet (91).

All the main health advisory bodies – ADA, BMA, WHO, PCRM – agree that iron deficiency anaemia is no more common in vegetarians than it is amongst meat eaters. However, that doesn’t alter the fact that it is a problem for many women and all should ensure they have good sources of iron in their diet, particularly during and shortly after their periods. Iron-rich foods in a vegetarian diet include pulses, dark green leafy vegetables, wholegrains and dried fruits.

A criticism sometimes levelled at vegetarian diets is that plant-based iron (non-haem) is poorly absorbed by the body. It may be more slowly absorbed but studies show that vegetarians have high intakes of iron and their haemoglobin levels (iron-rich red blood cells) are normal (92). Plant foods rich in vitamin C help absorption and vegetarians tend to eat more of these vital fresh fruit and vegetables. Iron intakes are particularly high in vegetarians and vegans whose staple food is wholemeal bread (93), so this is another reason for sticking to whole products rather than eating processed, denatured, mass-produced foods.

So misguided have been the concerns over iron deficiency that they have diverted public attention away from the problems of iron overload, more common and possibly more dangerous (94). If you have too much iron in your diet, the body has no way of getting rid of it. The only control over it is how slowly or quickly it is absorbed from the intestines into the blood (95, 96).

Haem iron (from meat) is absorbed quickly and easily, whether the body needs it or not. This encourages iron overload. Non-haem iron (from plants) is absorbed more slowly (97) as the body needs it. Meat-based (haem) iron has been linked with heart disease (98, 99) and high iron stores have been linked with some cancers (100, 101, 102) and poor responses to infection (103, 104).

In a study of 33,883 meat eaters, 18,840 vegetarians and 2,956 vegans in the UK, vegans were found to have the highest daily intake of iron (147).