Iron deficiency is the most common nutrient deficiency in the U.S. Worldwide, it’s the most prevalent nutritional deficiency. Worldwide, the groups that are most susceptible are women who menstruate (that is, women of childbearing age), pregnant and lactating women, teenagers, and children aged 6 months to 4 years. This is true for vegetarians and non-vegetarians. I repeat: This is true for vegetarians and non-vegetarians. We all need iron - boys and girls, men and women, vegetarians, vegans, and non-vegetarians - but there is a big difference between saying we need iron and saying we need meat. We need iron, but we don’t need meat.

INCREASING ABSORPTION
Studies show very little difference in the incidence of iron deficiency between vegetarians and non-vegetarians in developed countries. In fact, the amount of iron in vegetarian, and particularly vegan, diets tends to be higher than or at least equal to, that in nonvegetarians diets. Why? Because vegetarians and vegans tend to eat more fruits and vegetables; vegetarians get about 50% more vitamin C than nonvegetarians. For vegans, it’s even higher. And why is vitamin C important?

It’s important because vitamin C increases our ability to absorb iron; in other words, it increases the iron’s bioavailability. Intake/consumption is one thing, and healthful, whole-foods plant-based diets are fantastic in that aspect. But absorption is another thing altogether. There are two different types of iron in foods: heme iron and nonheme iron. Heme iron is found in animal products; nonheme iron is found in both plant foods and animal products.

Dietary factors influence the body’s ability to absorb nonheme iron. After being absorbed and reaching our cells to be used for building hemoglobin and other purposes, our body doesn’t care whether the iron was originally heme or nonheme. This is important to know. When people say, "our bodies need heme iron from meat," it’s not true. The human body needs to absorb iron, but it doesn’t care where it comes from in the end. So, if dietary factors influence our body’s ability to absorb nonheme iron, it’s these dietary factors we want to increase. And what are these factors?

Eating vitamin C-rich foods at the same time we eat iron-rich foods is one of the best things we can do. In one study, vegetarian children with iron deficiency anemia in India were given 100 mg of vitamin C at both lunch and dinner for 60 days. They saw a drastic improvement in their anemia with most making a full recovery. Vitamin C is found in citrus fruits and juices (oranges, grapefruit, etc.), strawberries, kiwi, papaya, green leafy vegetables (broccoli, kale, collards, swiss chard, Brussels sprouts), bell peppers (yellow, red, and green), and cauliflower. And if you cook citrus-based foods, such as tomato-based pasta sauce or sweet and sour sauce with lemon juice, in cast iron cookware, that also increases the iron’s bioavailability.

THINGS THAT DECREASE ABSORPTION
Now, just as there are things we want to do to increase absorption, there are things we want to do to avoid DECREASING absorption. When we consume calcium supplements, coffee, or tea at the same time we eat iron-rich foods, we inhibit iron absorption. So, just avoid these things when eating iron-rich foods. I have a great love (READ: obsession) of green tea, but I don’t drink it at meals. The bioavailability of iron can be reduced by up to 60% by the tannins in black or green teas when consumed at the same time as iron sources.

Also, there are some foods that are high in iron but also high in oxalates, which prevent absorption. These iron- and oxalate-high foods include spinach, swiss chard, beet greens, and rhubarb. It doesn’t mean these aren’t good foods to eat; it just means if you are looking to increase your iron intake, don’t look to these as iron sources.

Finally, the other thing to consider is that vegans have a considerable advantage in the iron department because they don’t eat dairy. Cow’s milk – either the liquid stuff or products made from it – is a poor source of iron. It displaces iron-rich foods from the diet, and the presence of cow’s milk or dairy-based cheese in the diet has been shown to decrease the absorption of iron from a meal by as much as 50%.

IRON-RICH FOODS
How much iron do we need to consume and what are the foods that are particularly high in iron? There are some variations for babies, toddlers, and seniors, but the daily recommendation is essentially 10 mg for adult men and 15 mg for menstruating women. Neither should exceed 45 mg/day. There’s no shortage of iron in plant foods, but some are higher than others:

*2 1/2 cups of cooked mushrooms contain 6.4 mg.
*3 1/2 cups of raw broccoli contains 3.1 mg of iron.
*3/4 cup of cooked green beans (or yellow beans) contains 3.7 mg.
*1/3 cup soybeans contains 3.0 mg.
*1/2 cup lentils contains 3.0 mg.
*1/2 cup of cooked quinoa has 2.5 mg.
*Firm tofu is pretty high (though brands vary, so check the label). Generally ½ cup contains 7.2 mg.
*Just 2 tablespoons of pumpkin seeds contain 2.8 mg.
*12 dried apricot halves contain 2.0 mg.
*And of course, blackstrap molasses has 7.4 mg per 2 tablespoons.

Then there are the fortified foods, including many different cereals as well as various veggie burgers and veggie dogs. For instance,

*2 of Yves’ brand soy dogs contain 4.7 mg.
*1 of Yves’ burgers is also 4.7.

(You can also find a comprehensive chart in the book, Becoming Vegan, the basis for much of my information in this article, or just do a search online to find a chart on iron-rich plant foods.)

WHAT TO DO IF YOUR IRON STORES ARE LOW?
I’ve heard of people who claimed to become anemic after becoming vegetarian. Most of these cases tend to be self-diagnosed; they never had their iron levels checked or had a doctor diagnose them. They just assumed they were anemic because they were tired. Now, they could be tired for a number of reasons, such as not eating enough calories, eating too many high-sugar foods, and possibly not getting enough sleep. This doesn’t mean that iron deficiency is not real for some people, but if you’re concerned, check with your doctor and get your iron tested.

But first understand a few things about what your iron status means. There are three stages, essentially, of actual iron deficiency. The first is just iron depletion – it means your stores are low, but it doesn’t affect how you feel. The second is iron deficiency, and you may feel tired and a sensitivity to cold. The third is iron deficiency anemia, where your total blood hemoglobin is below the normal range. You are likely to feel exhaustion, irritability, lethargy, and headaches. Your skin may also appear pale. If you are suffering from the symptoms of iron deficiency, just have your doctor measure your iron status. If your doctor thinks your iron stores are too low, he or she may suggest that you eat meat (which is unnecessary) or that you take an iron supplement (which should do the trick). Anyway, if your doctors find that your stores are low, first you might just try – as suggested by Jack Norris, R.D. – taking a 100 mg vitamin C tablet with two meals a day for 60 days, and refraining from tea and coffee during meals. If this doesn’t work, consult your doctor about iron supplementation – which is what they would do for non-vegetarians anyway. They would add supplements for those who really needed it. Norris emphasizes this point: "anemia in meat-eaters is normally treated with large doses of supplemental iron, not with eating more meat. Similarly, vegetarians with Iron Deficiency Anemia do not need to start eating meat but can also be treated with supplemental iron."

It’s important to keep in mind that though there is little difference in the incidence of iron deficiency between vegetarians and nonvegetarians, vegans and vegetarians do often have iron stores on the low end of the normal range. BUT this doesn’t seem to pose a problem. For those in generally good health and with abundant food available, iron stores at the low end of the normal range is just not a problem.

In fact, there are a few potential upsides:

1. Low iron stores are associated with higher glucose tolerance and therefore could prevent diabetes.
2. High iron stores have been linked to cancer because of increased evidence of free radical damage. Having lower iron stores seems to protect cells from free radical damage.

So, consuming too much iron, particularly if you’re taking a lot of it in supplement form, can be a problem. Multivitamins should be considered insurance – not a substitute for a healthful diet, and you may have noticed that some multivitamins contain iron and some do not. According to the recommendations from doctors and nutritionists, I don’t take iron as a supplement. I get a more than adequate amount from my diet, so my multivitamin is iron-free.

EAT WHOLE FOODS
As always, when I talk about a vegan diet, I’m talking about a healthful vegan diet – one that is rich in vegetables and fruits, not junk food. Eat lots of iron-rich food, and there’s plenty of it available on a plant-based diet.

One more note about your blood. Give it away! Donating blood is one of the easiest ways to help people. For those of us who are candidates, there’s no reason we shouldn’t give blood every two months. Many blood centers – I know this is the case in California – simply do not have enough blood in the time of an emergency. And giving blood when an emergency hits doesn’t account for the 72 hours it takes to test and prepare the blood, so do consider donating.

For more on iron, visit Vegan Health, or pick up a copy of Becoming Vegan: The Complete Guide to Adopting a Healthy Plant-Based Diet. My information for this article came from both these sources.