Introduction

I reckon I'd be a millionaire if I were to count up all the times I've been asked where I get my iron from and then given a dollar for each time. I think that this question has been asked a lot of times.

 Where can you get iron from on a vegan or plant-based diet, and how much iron do you need? What do you do if you get low readings, and what is a low reading? What should you be looking out for? When should you take a transfusion? Should you take supplements? All these questions will be answered in this podcast. Yay!

This is episode number 11 and I'll be talking about what foods to eat, what foods to avoid for malabsorption and all the rest of it. 

What is iron?

Iron is a super important mineral that our body needs. It is more common to know that we need iron these days. I didn’t know about it when I was growing up.

We need iron;

for creating healthy red blood cells

to carry oxygen to our lungs and the rest of our body. 

to grow and maintain healthy muscles

for bone marrow production

for organ function

Types of tests for iron 

There are two types of tests 

Serum level testing

Ferritin level testing for iron 

Serum is the liquid that remains after the removal of the clotting element in blood cells. This test is measured in micrograms per decilitre (ug/dl) or sometimes it's measured in grams per decilitre (g/dl)

Ferritin is a protein that stores iron inside your cells. Our body stores ferritin for later use and it is concentrated in the liver, other organs and the immune system cells. When the body is using iron from the blood, it will release ferritin into your bloodstream. Ferritin levels reflect the amount of iron stored in your body. 

Results of serum level testing

Normal iron range for serum iron levels in 

women is 60 - 140 micrograms per decilitre or 6 - 14 grams per decilitre

men it's 75 - 150 micrograms per decilitre or 7.5 - 15 grams per decilitre. 

If this is at the lower range of normal which is 60 ug/dl, you definitely need to be looking at your iron and boosting your iron levels. 

On occasion, pathologists will do a serum test for transferrin, transferrin can bind in the blood and this is measured in micrograms as well. The normal range is  250 - 450 ug/dl 

Note to not confuse these readings with each other.

Results of ferritin level testing

The normal reading for ferritin levels is 

women 14.7 - 205.1 nanograms/millilitre

men 30.3 - 565.7 nanograms/millilitre

For ferritin levels, even as low as 12 nanograms, you can fix this with diet. 

If your levels are at the lower range of the normal results, your doctor will probably suggest that you get a transfusion. If you know you can’t be diligent with your iron intake from food and you may have a malabsorption issue, then you may want to get the transfusion.

However, a few doctors have told me they recommend transfusions because they don’t trust their patients will go and eat iron rich foods and they also admit they don’t know how to direct them in this as they don’t have nutrition training.

Depending on your test results instead of a transfusion or supplements you can be super diligent with your iron intake and increase your levels yourself.

Symptoms of low iron

skin paler than normal

extreme tiredness,

weakness

dizziness

short of breath 

rapid heartbeat (tachycardia)

The symptoms for high iron, funnily enough are the same as they are for low iron, but you'll also have painful joints, heart issues, weight loss, abdominal pain, loss of body hair, and lack of sex drive. 

Causes of low iron

heavy periods

pregnancy

malabsorption 

blood loss

Causes for high iron 

hemochromatosis, where your body cannot use up the iron and it keeps storing too much iron

alcohol use disorder

autoimmune disease

obesity

hypothyroidism

 liver disease.

How to increase iron intake

There are three things that you can do to increase your iron. 

a) Diet

You can fix low iron with diet by adding more iron rich foods and possibly using cast iron cookware and iron fish. 

b)    Eat foods rich in vitamin C

You also need to look at adding more vitamin C foods when eating iron, especially if you're on a plant-based diet or you're transitioning to a plant-based diet. 

c)  Find out why your body isn’t absorbing iron

Diet

You need to be diligent at adding iron-rich foods into every single meal. For people on a vegan/plant based diet, it is recommended that a daily intake of iron on a plant-based diet is 14.4 micrograms to 34 micrograms, depending on if you're menstruating or pregnant.

Some examples of what this would look like. 

>  Having herbs like thyme, parsley or oregano in two of your meals, or dandelion in one of the meals, or alfalfa in one of the meals. Including herbs in every meal you eat.

> If you don't feel like herbs at breakfast, you could have spirulina or microalgae in your smoothies. On the lean side, herbs are going to give you 18 micrograms a day if eating them in every meal. Not if you just put two little sprigs of parsley, you've got to put quite a bit in, between 10 – 20 g of herbs each meal.

> The protein that has iron in it is tofu, tempeh, black eyed beans and chickpeas. You'll get around six to seven micrograms per meal. If you're having one of those in two meals in the day, it's going to give you up to 14 micrograms.

> Add seeds and nuts for more iron

> Eat dark chocolate 

> Make a tahini dressing 

> Add lots of pepitas or pepita sprinkle 

> Add cooked spinach or leafy greens and peas 

> If you're super low you can take two tablespoons of molasses a day. Take that with tahini and put that in biscuits, make molasses tahini biscuits. 

> Add a spoonful of dulse or seaweed flakes to at least two of the meals. Drink beetroot juice, prune juice, eat quinoa instead of rice. If you're super diligent you will get enough iron from food.

A few doctors have told me that they prescribe an iron infusion because they just can't trust people are going to get enough iron rich foods each day. Mostly people don’t do this because they don’t know what foods are rich in iron, so those suggestions listed should help, as should the list I have in my 'Healthy You on a plant-based diet' free e-book.

Eat foods rich in vitamin C

We need to be eating vitamin C rich food along side iron rich food on a plant-based diet. Plant-based food contains non-heme iron, which will only convert in the body if it is eaten alongside foods high in vitamin C. 

Meat contains heme iron. Heme iron is more absorbable than non-heme iron. However when you eat non-heme iron foods with vitamin C rich foods it becomes absorbable. 

Examples of food high in vitamin C 

parsley

citrus

red capsicums

blackcurrants

potatoes

Brussels

broccoli

berries

watercress

jalapeno

red cabbage

cauliflower

broccoli

kiwi fruit 

they are just some of the amazing foods rich in vitamin C and they're yummy 

Ways to support your body's absorption of iron

You may be diligently eating all the iron-rich foods and supplementing them with vitamin C, yet your iron readings are  you have a malabsorption issue.

What causes malabsorption

gut issues can cause malabsorption 

all the following can cause malabsorption and gut issues 

dairy

smoking 

red wine 

caffeine – coffee and tea

oxalates and phytic acid 

excessive exercise 

The biggest thing I found that people struggle with when they're low in iron is they don't want to give up caffeine. I understand it; I was a coffee addict for a seriously long time. I only had one a day but I was addicted and it was something I looked forward to every single day. 

However, I didn't have low iron. I think if I had low iron I would have quit coffee a lot earlier than I did. If you do give up coffee, you need to wean yourself off. Give it a 3 month trial or even a 6 month trial and see how your iron readings are. Do all the other things mentioned above, eating iron rich foods and vitamin C rich foods.

Excessive exercise particularly running and dancing, where the pounding of the heels in the body can cause malabsorption of iron. If you're exercising a lot, then you really do need to increase your intake of dietary iron and vitamin C and definitely stay away from those foods that cause malabsorption.

Oxalates and phytic acid can inhibit the absorption of iron, so you don't want to be eating raw leafy greens. What happens with oxalates and phytic acid is, they will bind to the mineral and then the body won't absorb the mineral and they will just be taken out of the body. So to remove these naturally formed chemicals, you need to soak lentils and cook them with boiling water. Listen to episode number nine and get the free download, the free resource on how to cook beans and legumes. 

Soak 

whole grains 

quinoa

millet

buckwheat

almonds

cashews 

seeds

legumes and beans

And always eat cooked or even just wilted leafy greens, like I said before, not raw,  because that will get rid of the oxalates. Doing all those things will definitely help you in assisting your body to absorb iron.

I hope that's been useful. 

Summary, it's easy to get iron through diet. You just do need to be diligent and you do need to know what foods are going to give you the iron. 

Should you take supplements?

If you're really depleted, you definitely have to take supplements. If you're really depleted and your doctor's telling you you've got to get a transfusion then you do have to get a transfusion, but you need to avoid that by making sure that your levels of ferritin do not go below 12 and that your serum levels do not go below 60. So just really keep eating those iron and vitamin C rich foods and ditch the foods that cause malabsorption, soak grains and legumes and cook leafy greens.

Recipe 

Quinoa tempeh herb salad with tahini dressing

½ cup soaked quinoa (overnight in fridge if weather is hot)

½ block soy tempeh cubed

2 cups of washed herbs -e.g. parsley, oregano, watercress, dandelion leaves

½ head of broccoli cut into florets

1 small red capsicum

Tahini sauce 

1/3 cup tahini

up to a 1/3 cup water to thin the tahini

juice 1 large lemon 

salt and pepper and you can add ¼ tsp tumeric

1.    Cook the quinoa and broccoli in plenty of boiling water for five minutes or when the white tail pops out on the quinoa.  (Alternatively you can steam the broccoli).

2.    Cook the tempeh cubes in a frying pan with a splash of olive oil.

3.    Wilt the dandelion leaves and oregano in the frying pan, chop the rest of the herbs small. 

4.    Slice the capsicum thin.

5.    Mix the cooked quinoa, tempeh, herbs, broccoli and capsicum gently.

6.    Make the tahini sauce by mixing all the ingredients in a bowl. 

FCT (fun cooking tip)

Something else that you can consider when cooking your food is cast iron cookware and even buying a lucky iron fish which is made out of cast iron. I don't know if you know where the lucky iron fish came from. Lucky iron fish was an idea developed in Cambodia. They were a population very low in iron and somebody, some amazing person, created a lucky fish made out of iron and promoted it over in Cambodia for people to start putting in their cooking pots when they were cooking. So you can just add the lucky iron fish into whatever you're cooking. I've never worked with a lucky iron fish and I don't work with cast iron cookware but I've never been low in iron, so that could be something to consider. Cast iron cookware is quite easy to cook with if you know how and it's often the choice of most people when they come to cookware.

Have a wonderful time eating sensational food, iron rich food and until next time I will say bye bye bye.