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October 1, 2024 18 mins

There’s a common concern I see among those wanting to start a plant-based diet lifestyle. And it’s this. It’s a fear that eating this way will cause them to seriously lack key nutrients, because they’re taking out meats, dairy, eggs and other animal-based foods from their meals. Do you have this fear too?

 

If so, iron might be one of those nutrients you are especially worried about when making this big lifestyle shift. Since meats are a source of iron, it’s natural then to be wondering, “Will eating plant-based make me end up with nutrient deficiencies and get health problems like iron deficiency anemia?”

 

Let’s talk about it. In this episode, we’ll look at the importance of iron for our bodies, how common iron deficiency anemia really is, and what the recent research is showing. That way, we can better answer this question. I’ll meet you on the inside!

 

 

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Episode Transcript

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(00:01):
There's a common concern I see amongthose wanting to start a plant-based
diet lifestyle, and it's this.
It's a fear that eating this waywill cause them to seriously lack
key nutrients, because they're takingout meats, dairy, eggs, and other
plant-based foods from their meals.
Do you have this fear too?

(00:22):
If so, iron might be one of thosenutrients you are especially worried about
when making this big lifestyle shift.
Since meats are a source of iron, it'snatural then to be wondering, will
eating plant-based make me end up withnutrient deficiencies, and get health
problems like iron deficiency anemia?

(00:43):
If you're wondering this, I want to help.
In this episode, let's look at theimportance of iron for our bodies, the
prevalence of iron deficiency anemia,and what recent research is showing
so we can better answer this question.
Ready?
I'll meet you on the inside.

(01:06):
Welcome to the Plant BasedEating Made Easy Podcast.
I'm your host, Anna Tseng, Plant-BasedRegistered Dietitian and Transition Coach.
Hi Friend, do you want to regain yourhealth with plant-based eating but feel
overwhelmed and lost about how to do it?
Do you feel it'll be hard to changeyour meat-heavy diet and impossible

(01:26):
with working, running the home,or chasing after the grandkids?
If so, you're in the right place.
Here you'll find simple strategies,clear nutrition guidance and
practical tips to help you thriveplant-powered with more energy.
So if you're ready to ditch the guessworkand transform your health the stress-free
way, cozy up now with a hot cup of teaor listen while you walk, and let me show

(01:50):
you how doable plant-based eating can be.
Let's do this!
I see many in my community withconcerns about getting adequate
nutrition on a plant-based diet.
They're worried that if they makethis lifestyle shift and don't eat
enough or the right foods, they'llend up with big nutrition problems.

(02:12):
And one common nutrient of concern,aside from protein, is iron.
For example, I remember seeingthis lady share about her biggest
challenge eating plant-based.

She said it was this (02:23):
learning and ensuring I can receive proper nutrition
and be sure my iron levels are sufficient.

Someone else wanted to know (02:32):
do all vegans have low iron levels?
That's a great question.
It speaks to the underlying worrymany have about moving to plant-based
eating and the impact it canhave on their nutritional status.
But there's so much to say onthis subject that I decided to
take this question and address itmore fully in a podcast episode.

(02:56):
So listen in as we unpack this topic.
I hope this episode willbring you much clarity.
First, what is iron andwhy is it important?
In a nutshell, iron is a criticalmineral that our body needs
in order to function well.
In red blood cells, iron forms a keypart of a protein called hemoglobin.

(03:21):
Red blood cells help transfer the freshoxygen we breathe in from our lungs to
other tissues and cells within our bodies.
They then help to transfer the wasteproduct of breathing - carbon dioxide
- back to the lungs to be exhaled out.
Besides this, iron plays manyimportant roles in our body.

(03:43):
It's key to know that there are twolevels of severity with low iron levels.
The first is iron deficiency itself,which is defined as a drop of the
total content of iron in the body.
A more severe situation is iron deficiencyanemia, or IDA, which occurs when the iron

(04:03):
deficiency condition has become severeenough to reduce erythropoiesis, which
is the production of red blood cells.
How common is iron deficiency anemia?
According to the World HealthOrganization, WHO, it is estimated
that about half of the 1.62 billioncases of anemia worldwide are

(04:26):
due to iron deficiency anemia.
In fact, Iron deficiency is seento be the single most prevalent
nutritional deficiency worldwide.
In the United States, it accounts foranemia in about 5 percent of American
women and 2 percent of American men.
So yes, men can get irondeficiency anemia too.

(04:49):
Now let's look at thekey episode question.
Do all vegans or plant-basedeaters have low iron levels?
To answer this question, let's look atwhat some of the recent research says.
In 2022, a systematic reviewof 141 studies was published
in the journal Nutrients.

(05:09):
It looked at the nutrient intake andstatus of adults consuming plant-based
diets compared to meat eaters.
The results?
Out of four iron studies that specificallyassessed iron deficiency, it was found
that the average prevalence of irondeficiency was 15 percent in vegans.
So right there, we see from thisstudy that 85 percent of vegan

(05:33):
participants assessed in the analyzedstudies didn't have iron deficiency.
They had adequate iron levels.
This effectively answers our questionthat not all vegans or plant-based
eaters have low iron levels.
That's reassuring to know.
And in my own experience andfrom interacting with clients

(05:53):
and others in my community, Iknow that to be the case as well.
Now you may be wondering, is there adifference in iron deficiency prevalence
among vegans compared to meat eaters?
And the answer is yes.
There appears to be a slightdifference at this point, though
results vary among different studies.

(06:15):
In the 2022 systematic review I justtouched on, researchers reported
a slightly higher prevalence ofiron deficiency in vegetarians and
vegans, at 11 percent in vegetariansand 15 percent in vegans, compared
to 7 percent in meat eaters.
In 2018, a different study was publishedby Roman Pawlak and colleagues.

(06:40):
It was a review of literature onthe iron status of vegetarian adults
from studies done in 10 countries.
Among six studies in which ferritinlevels among vegetarian and non-vegetarian
participants were reported, five studiesdid report female vegetarians to have
lower serum ferritin values than femaleomnivores, though one study found female

(07:04):
vegans having higher mean ferritinvalues than female non-vegetarians.
But in general, this study found a higherproportion of vegetarians compared to non
vegetarians having iron deficiency anemia.
This was especially true forpremenopausal vegetarian women.
However, another recent studyfound a different result.

(07:28):
In a 2021 study published in the journalBiomolecules, researchers measured
a variety of blood markers for ironstatus in 191 healthy adults residing
in Norway from three diet groups,vegan, vegetarian, and pescatarian.
They found that the median concentrationof blood markers for iron status were

(07:51):
within the normal range for each dietgroup and that there was no significant
difference between the groups.
As a result, researchers stated thattheir data suggests that even on a
vegan diet, it is possible for bothgenders to obtain adequate iron status
as measured by these blood markers.
The use of iron supplementationwas also low in all three groups.

(08:15):
Keep in mind that the results fromthe three studies mentioned here are
associations and not definite causations.
So more studies are definitely neededin this area to determine if eating
plant-based will really cause agreater likelihood of getting iron
deficiency or iron deficiency anemia.

(08:35):
Personally, I feel the juryis still out on this topic and
here are four main reasons why.
First, all researchstudies have limitations.
Since human research studies areoften conducted in the real world,
there will be limitations to how theresearch can be conducted for ethical
reasons, and it will be impossibleto remove all confounding factors.

(09:01):
For example, in the 2022 systematicreview I referred to earlier,
the prevalence level attained wasbased off of only four studies.
There's also no clear indicationof what the participants in the
reviewed studies on a vegan orvegetarian diet actually ate.
However, we do know that theresearchers had excluded overly

(09:24):
restrictive plant-based diets likethe raw food diet and macrobiotic
diet and healthy diets designed tolower non-communicable diseases like
the DASH diet and Mediterranean diet.
To me, this exclusion appears to meanthat even studies with a focus on a
whole food plant-based diet would havebeen excluded, which is unfortunate.

(09:48):
If this is the case, we won't know ifthose eating a whole food plant-based
diet would have better iron biomarkerssince they are eating more nutrient rich
natural whole plant-based foods regularly.
Obviously, food choices can affectiron intake and status, so if the
majority of the participants in thereview ate a junk food vegan diet, with

(10:11):
lots of highly processed commercialvegan products, that would certainly
negatively impact their iron status.
Also, for vegetarians with a diet heavyin dairy products, their iron intakes
can be affected as well, since dairyproducts contain little to no iron.
Second, most people on a vegan orvegetarian diet moved into this way

(10:35):
of eating at some point in their life.
Few people would have started a fullplant-based or vegan diet in late
infancy once they started solids.
Yet, there are no studies so far thathave looked into the prior iron status
of participants before starting a vegandiet, and then tracked them over time

(10:55):
to see the percentage that developiron deficiency or iron deficiency
anemia due to this diet change.
As you can see, this is an importantdetail to know, because it is very
possible, that at baseline, a participantmay have had a low iron level prior
to even starting plant-based eating.

(11:15):
For example, in 2015, a study waspublished in the Journal of the
American Medical Association lookingat the prevalence of iron deficiency
and iron deficiency anemia in USfemales aged 12 to 21 years of age
using National Health and NutritionExamination Survey or NHANES data.

(11:36):
From the data analyzed between 2003 and2020, researchers found that almost 40
percent of females in this age grouphad iron deficiency, and iron deficiency
anemia affected 6%, with variation by theferritin or hemoglobin thresholds used.
Obviously, the majority of these femaleswere on a regular diet, not a vegan diet.

(11:59):
So if low iron levels is so prevalentamong 12- to 21-year-old females in
the United States, it is very likelythat a good number of them already
had existing low iron levels prior tomoving to a vegetarian or vegan diet.
Third, the possible higher prevalenceof iron deficiency seen in the
vegan and vegetarian populationsmay be partly due to a lack of

(12:23):
adequate education and awareness.
The majority of the participants inthese studies analyzed may not be
aware of good iron rich plant-basedsources or of smart strategies
to easily boost iron absorption.
If this knowledge was actually learnedand applied to their way of eating,
then it is possible that their ironintake from foods and biomarker

(12:46):
levels would be changed positively.
Fourth, there could be manyother reasons for iron deficiency
anemia to occur, without itbeing a nutritional intake issue.
I know of one research article thatlisted 20 potential specific causes
of iron deficiency anemia besideshaving a deficient iron intake.

(13:08):
I even came across a 2019 review articleon iron that listed 24 conditions or
situations where iron deficiency andiron deficiency anemia could occur.
Situations that could increase therisk of getting iron deficiency
anemia include times of increasediron requirements such as during
pregnancy, excess blood loss fromheavy menses, gastrointestinal tumors,

(13:34):
use of certain medications, bariatricsurgery, and health conditions such as
chronic kidney disease and inflammatorybowel diseases like celiac disease.
So today we looked at a common questionmany have when starting plant-based
eating, and that is, "Do all vegans orplant-based eaters have low iron levels?"

(13:56):
And I showed you that while a percentageof vegetarians and plant-based eaters
do have iron deficiency and irondeficiency anemia, the majority of those
on a vegan or vegetarian diet don't.
It's clear that not all vegans orplant-based eaters automatically
get low iron levels, andthat's reassuring to know.

(14:16):
We also saw that a percentage ofthose on a regular diet also have iron
deficiency and iron deficiency anemia.
Though there may be a slightly higherprevalence of vegans and vegetarians
having this diagnosis than among meateaters, more studies are definitely
needed to explore this area better.
And I gave you four reasons why I feelthe jury is still out on this topic.

(14:41):
In my opinion, the research literatureI've seen so far isn't answering
my question yet of how a whole foodplant-based diet would impact iron status,
especially if smart strategies are usedto boost iron intake and iron rich foods
are eaten regularly on a plant-based diet.
So in my view, in order to trulydetermine if eating plant-based would

(15:05):
increase one's risk of getting irondeficiency or iron deficiency anemia,
better design studies are needed.
If I could design one, this is whatmy research study would look like.
I would conduct a large-scaleprospective study following
participants over at least 10 years.
At baseline, the participants'past food and diet history and

(15:29):
iron status would be tested.
Then participants would be randomizedto be on either a whole food plant-based
diet with nutrition education on ironsources and strategies to boost iron
absorption, and those on a whole foodplant-based diet who don't receive
this education, plus a third controlgroup who make no diet changes.

(15:50):
All groups will not be supplementingfood intake with iron supplements.
Researchers would then trackparticipants over time to see
changes in food intake using periodicweighed food records and blood iron
biomarker tests to assess iron status.
They will do this while monitoringthe incidence of other factors such

(16:11):
as heavy menses and medical conditionsthat can contribute to low iron
levels occurring in these individuals.
I know that's a lot, buta girl can dream, right?
So what's the takeaway?
Among other things, this discussiontoday brings home to me the point of
how important it is to plan out thefoods we eat on a plant-based diet.

(16:33):
It's not just about avoiding meats andother plant-based products in your meals.
The quality of your plant-baseddiet is also very important, as
well as knowing smart strategies tomaximize nutrition eating this way.
If your plant-based diet is wellthought out, the number of nutrients
you need to be concerned aboutlacking on a plant-based or vegan

(16:55):
diet is actually less than you think.
But it's important to plan yourplant-based diet well, if your
goal is for optimal nutritionlong-term eating this way.
So if you would like support andhelp to plan out your diet transition
so you can truly thrive eatingplant-powered for life, send an email

(17:15):
to me at healthnow@plantnourished.com.
You can also apply for a freeRapid Health Transformation Call
using the links in the show notes.
I'll show you that plant-based eatingcan be simple and doable even with your
current health challenges, and how toget the best nutrition eating this way.
I look forward to connecting with you.

(17:38):
Thank you so much for listening.
If this podcast has inspired,encouraged, or helped you in some
way to transform your health,I would love to hear about it.
Please take 30 seconds to rateand leave a written review on
Apple Podcasts to let me know.
It will encourage me so much tohear how this podcast has positively
impacted and made a differencein your journey towards wellness.

(18:02):
And share about this podcast witha friend or loved one so we can
all thrive in the best health.
Remember, plant-based eatingcan be easy and doable.
See you in the next episode, my Friend.
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