Iron Status - Vegan Style

Here's a helpful guest post by Evelyn Pearce on achieving optimal iron status.

Some take homes:

• Vegans can have optimal iron status
• Iron from meat (heme-iron) might be a causative factor in the link between meat and many chronic  diseases
• Being conscious about eating healthy whole plant foods usually means including an iron rich food at each meal
• There are a few little food tricks that can boost iron absorption which might be important for some people... read on to learn more... 

Demystifying Iron: Why Vegans Can Have Optimal Iron Status

A vegan diet offers many health benefits. It is lower in calories and saturated fat, yet high in antioxidants, B vitamins, potassium and fiber, all of which reduces your risk of heart disease. There is also growing evidence that those who avoid or limit their intake of animal produce are less likely to develop diabetes and cancer. As all three medical conditions are highly prevalent in the United States and other industrialized countries, this can only be a good thing. While the advantages of a vegan diet for your health are well recognized, worries relating to potential nutritional deficiencies are one of the barriers standing in the way of more people adopting a completely plant-based diet.  It is true that you can develop particular vitamin and mineral deficiencies on a vegan diet, but equally this can occur if you eat meat or other animal produce. The key is ensuring you include the right balance of foods whichever dietary approach you choose to adopt.

The question of iron

However, when people hear you follow a vegan diet, one of the most common things they assume is that you must be anemic. It’s still a widely held belief that avoiding all animal produce will leave you deficient in iron. As any vegan with a good awareness of nutrition knows – which to be honest is a lot of us – there are a variety of plant sources of iron and obtaining adequate iron through our diet is easily achievable. We just need some forward planning, but then everyone should be putting thought into their meals irrespective of whether they eat meat or not.

Admittedly iron deficiency anemia is a relatively common in America, with figures showing that it affects around 9% of women under 50 years of age. It’s not a pleasant condition; you’re left extremely tired, as your blood is unable to carry sufficient oxygen, which makes even day to day activities difficult. However, research suggests that vegetarians are at no greater risk than non-vegetarians of developing this form of anemia. While less well studied in vegans, the National Institutes of Health doesn’t identify us as an at risk group for iron deficiency anemia. However, it does suggest we may need twice as much iron as meat eaters to prevent deficiency, though more on this point shortly.

Vegan source of iron
When relying solely on plant produce for iron, there are a number of key foods that provide this; though as a matter of following a vegan diet, they are probably included already. Pulses (peas, beans and lentils), wholegrain cereals and those which have been fortified with iron (which many are, so check the label), tofu, green leafy vegetables like kale, spinach and cabbage, dried fruit and seeds are the main providers. We should ideally be including at least one of these foods at each meal and consider the likes of cereal, dried fruit and seeds for snacks.

A matter of absorption
As hinted previously, the iron in plant-based foods is not as well absorbed as that from meat and fish, which is why we need to consume more iron to ensure our bodies receive sufficient. This relates to the fact that the iron present in the two sources is slightly different, with that found in animal produce more readily available to the body. However, we can take steps to increase our uptake of iron from plants.

• It’s well-known that vitamin C increases absorption of iron by converting the iron in plant foods to the more favourable form, so a source of the vitamin should be included with meals. Good sources of vitamin C besides citrus fruits include berries, kiwis, peppers, tomatoes and green vegetables. 
• Meanwhile the tannins and polyphenols found in tea and coffee make it more difficult for the body to take up iron if these are consumed near meal times; try to avoid them for an hour either side of meals to give your body a better chance of iron absorption. 
• Phytates, which are found mainly in pulses and wholegrains, also reduce iron absorption. However, as these foods are also a source of iron, you should not avoid these in your diet, but instead concentrate more on increasing your vitamin C intake and avoiding tea and coffee near meals.

Health benefits of non-heme iron
Obtaining your iron from plant sources (known as non-heme iron) in contrast to that derived from animal flesh (heme iron) could be a healthier option according to research. There is increasing evidence that heme iron encourages production of free radicals - damaging substances that cause injury to cells and are implicated in the development of heart disease and cancer. This may explain why meat eaters have been shown by studies to have a higher risk of heart disease and bowel cancer than those who avoid it. Research also suggests that consuming heme iron increases the risk of developing diabetes; this condition of impaired glucose metabolism is certainly less common amongst vegetarians and vegans. As non-heme iron is less readily absorbed, it is unlikely that iron stores will accumulate; it is these high iron stores which have been linked to increased susceptibility to chronic diseases.

About the author:

Evelyn Pearce is a freelance writer and mother of two, who when not at her keyboard or minding the children, likes to take her German shepherd for a walk in the hills around her home in Red Oak, Iowa.

Why SOME people struggle with a vegan diet

Is a vegan diet for everyone?

If consciously crafted, a vegan diet has profound health advantages and allows us to best care for our environment and live in alignment with our innate compassion. So yes, a type of vegan dietary pattern could be ideal for the vast vast majority of humans. And yet, we can't deny that some people (read: the minority) struggle to make a vegan dietary pattern work for them.

Why do SOME people not thrive on a vegan diet? And what can you do about it.

Frankly, this question hasn't been well researched and is poorly understood. But here are a few hypotheses that are worth considering if you or someone you know is not doing well on a vegan diet.

1. Not Enough Calories

One great advantage of a vegan diet is lower calorie density.  People often lose weight when they go vegan. This is super awesome for the majority of people, but not necessarily for relatively-thin, highly-active young people who are also very health conscious. Chances are these people have less appetite-drive and don't absorb calories as well as others. They probably avoid food when they are anxious/stressed and avoid binging on calorie-rich foods. They tend to choose the least calorically dense foods possible because these are healthier - like raw veggies and brown rice.

For some of these folks, they simply will not always be meeting their caloric/energy needs and they might feel more fatigued then usual overtime. Perhaps this is the brain's way of saying "slow down, there just isn't that much food around to support all this extra activity". They might feel better when they return to eating animal products, simply because they begin eating more calories and have a less restricted diet.

Rather than adding back the animal products, a better solution is do some creative meal planning and figure out ways to add back the missing 500 or so calories. There are lots of ways to do this, from emphasizing fat rich foods (e.g avocado, nuts, seeds, coconut) to making food more dense (e.g. smoothies, dehydrated foods/food bars, nut butters, dried fruit) to even sometimes choosing more processed foods (e.g. white rice) and including more protein-concentrated foods (e.g. seiten).

2. Junk-Food Vegan

On the opposite side of the coin is the junk food vegan that lives off vegan pizza, tofutti, french fries, soda, vegan cupcakes, etc. This we know: just because it's vegan, doesn't mean it's healthy. Believe me, I <3 my vegan junk food on occasion. But the problem here is no different from the standard american diet: you are crowding out the nutritious life-sustaining food and stuffing yourself silly with crap.

3. Social Isolation Syndrome

It amazes me how poorly we appreciate the effects of social isolation. Watch this video to see how physiologically powerful physical and social isolation can be. Being vegan doesn't mean you have to be socially isolated, but for a few it can make them feel more isolated. This is not a recipe for optimum health.

Early adopters have to cope with a little isolation, but one idea how is to cultivate a greater sense of compassion for human-animals who eat other animals. They are just as flawed as you are and there's no reason they can't be your friend, share meals with you, be your lover, etc. In fact, if you really want to influence the world, the more you hang out with these creatures the better. (unless of course you're a miserable conspiracy-lover who refuses to shower and thus has the effect of decreasing the odds that other people will move to a vegan diet. Apologies for the rant.) 

4. It's Not The Food

Food makes a huge impact in health. Ok. But just because you're vegan doesn't mean that really bad stuff can't happen to you. And it doesn't mean that every health problem you have has something to do with your diet.

Genetics, horrific bad luck, mood/psychology, drugs, infections, and many other factors can trump diet. It's always wise to considering whether your diet caused the problem or can contribute to healing it, but you've got to be open to the idea that it might have nothing to do with what you eat.

Also remember that many people became vegan because their health was not optimal to begin with. Those same underlying issues might not go away on a vegan diet, and some might get worse over time.

5. Unmasking Effects & Rare Genetic Disorders

Changing your lifestyle can, in rare cases, unmask hidden problems. For example, fructose malabsorbtion - a not too uncommon issue whereby eating concentrated fruit sugar causes irritable-bowel like symptoms and is associated with depression. If you suddenly start eating fruit-juice sweetened desserts and more fruit and fruit juice, then these symptoms will get worse. The solution is a plant-based diet that favors vegetables over fruit and avoids concentrated fruit sugar and juice and minimizes refined sugars.

Another example is diabetes in a long-time Atkins-style eater. If you eat no carbohydrates but are very overweight and have insulin resistance, switching to a more carb rich plant-based diet may initially make blood sugar control worse.  The answer is weight loss, avoiding processed carb-rich foods, eating only healthy fats, exercise, minimizing/moderating fruit, along with a high-fiber vegan diet.

Finally, there is also at least one type of rare genetic disorder involving carnitine transport which can be mitigated by carnitine-rich foods (i.e. meat). However, this is better treated with high dose carnitine supplements then with meat. Dr. Greger has a great post on this. 

6. Under Supplemented

Yes, it would be ideal if we got all our nutrients from our diet. Frankly, there are just some cases where this is not possible (vitamin D, vitamin B12). And there are some individuals who need higher levels of some nutrients (iron, zinc, omega-3s) because they don't absorb them well for whatever reason. This is true for meat-eaters too.

Sometimes, you've just got to add some supplements to your diet. Some vegans have a ridiculous hang-up about taking an "unnatural" supplement. While I applaud their idealism, they are doing themselves and our movement a huge disservice.

People ask me what I take: Vitamin D 1000 IU to 2000IU with food (most days, but especially in the winter); B12 (I buy a bottle a few times a year to boost my body stores); occasionally I get paranoid and buy a bottle of algae-based DHA/EPA. And I regularly eat some nutritional supplements: flax oil, fortified soy milk, chia seeds, flax meal, hemp seeds, nutritional yeast, marmite (because I was born in South Africa and it's delicious ok!).

At the same time, I'm super skeptical of the functional/orthomolecular medicine folks who advocate massive supplement regiments to cure everything.

7. High-Fiber Exercise-Deficiency

We did not evolve to blog. Or read blogs or work at a desk. Sitting is one of the worst things for your health, and we do it all day. My sense is that our guts function way better when we are regularly active and that exercise becomes even more important when you increase your fiber intake.

A very high-fiber diet with a sedentary high-stress lifestyle can set you up for a lot of bloating and gas pain. The solution is daily movement/exercise and plenty of water.

8. Beat By Cravings

Our understanding of cravings is amateur. Just because your brain craves something doesn't mean you have a deficiency. Craving chocolate does not mean you are magnesium deficient. Craving meat does not mean you are iron deficient and need to go back to killing animals for sustenance.

It's not to say that cravings can't have true information embedded in them, it's just that it's complex. For example, we make psychological associations with food. When we are stressed, we seek comfort, and food is one way to get comfort. Thus when stressed I might crave my comfort food, not because I need the nutrients in the food but because I need to be comforted. Your comfort food is probably different from mine - not because we have different blood types (or other such nonsense) but because of the different exposure to comforting food we had as kids.

Another random psychological nuance: the more one tries to avoid thinking about something, the more likely one is to think about it. If you are obsessed with avoiding meat, you are more likely to think about it and to crave it. We are funny creatures that way.

One last example, dissection lab -- the formaldehyde has been known to illicit cravings for meat. You can imagine how disturbing that is to an unaware vegan med student, on many levels.

Point being -- cravings are complex and often misinterpreted. Take them with a grain of salt. Roll with them and focus your attention elsewhere when the craving defies common sense.

What Else? & What if My Problem isn't on this list?

This is not an exhaustive list, and admittedly it is a list of hypotheses, but chances are the reasons people don't thrive on a vegan diet are fairly small in number and have a feasible solution if there is a will, an understanding and a few good measures of creativity.

Sometimes it can be hard to figure out (or you lack a doctor who can help you figure it out), and sometimes adding back some animal-products seems to make the difference and provide a sense of well-being that was missing. In that case, think of the animal-products as supplements - not to be eaten at every meal, but in the smallest dose possible. You'll still be eating a predominantly plant-based diet and doing a lot for your health and the world.

Vegan must-knows on Vitamin B12

As you are reading these sections please keep in mind that the science of measurement and definitions of normal vs. optimal levels for these substances is still evolving. Plus there is incomplete standardization of these tests in the US - meaning the reference normal range may be different from one lab to the other. But these few paragraphs will give you a good background with which to interpret new discoveries and opinions as they emerge!

Vitamin B12
 
One of my favorites (such a complex and hotly debated vitamin). There are only a few essentials you need to know - but they are important to understand fully. The active forms have a variety of ___-cobalamin names, but you will mostly hear about B12 as "cyanocobalamin". Now we know why we call it B12 for short.

B12 is only made by bacteria and fungi, which explains why we have a hard time finding it in our modern antiseptic foods. Ruminants like cows have b12 because bacteria in their gut make it for them (and thus eating or drinking cows provides b12). Our intestinal bacteria also make B12, BUT these little guys live away from the place in our intestines where we are able to absorb B12...this is why we must eat B12.

Take B12 seriously - B12 deficiency is not rare. A prolonged deficiency of B12 has serious yet reversible effects (such as anemia - low red blood cell levels) and even more serious but irreversible effects (such as subacute degeneration of the dorsal columns - permanent damage to nerves that enable you to feel the floor and stay balanced, which is something I have a hard time doing even with normal dorsal columns).

Low B12 levels are also associated with depression and other neurological conditions.

Here's the good news - B12 is cheap, it has little if any side-effects, you need very little of it (around 2-3 micrograms/day) and you (well your liver) can hoard stores of b12 for one or more years (you'll hear ranges from 1-7 years, but NOTE: you will eventually run out if you don't eat any b12). Your liver, at least, understands how important this vitamin is!
 
Now here's the thing - B12 deficiency is more common than we'd like in both non-vegans and vegans. Why? Because most b12 deficiency is not from eating too little, but rather from being unable to absorb it (for reasons I wont get into here)...This said, vegans do consistently have lower levels of B12 than non-vegans.

So here's what you should do:
 
1/ make sure you have a reliable daily source of b12. These include a multivitamin, B12 supplement or fortified soy or rice milk, fortified cereals and "cliff" bars (or similar).

Yes you might be able to get B12 from a few dietary sources (e.g. Red Star Brand nutritional yeast, marmite). And there are some folks who claim other sources have b12 (traditionally made tempeh, your gut bacteria, blue-green algae, nori, etc.) but it is highly unlikely that these sources provide adequate amounts of B12 for all people. And frankly it is foolish to bet our nerves and blood on it. To complicate matters some of these other "sources" have "inactive" B12 analogues which can compete for absorption in your gut with active B12 thereby worsening your real B12 levels - another reason not to count on these less reliable sources.

I realize some people think there is something "unnatural" and bad about taking supplements, but it is the price we must pay for eating less dirt, feces and insects than our primate ancestors.

2/ being vegan gets you a free b12 level lab test. Actually it may get you as many as you want! This is because doctors are classically conditioned to associate the word vegan with the word b12 deficiency. It's part of the fun training we get. So get your b12 level checked and find out where you stand.

The B12 blood test your doctor will do is not a perfect test (like most tests we use), so the result may need some interpretation. For instance, if it comes back in the upper half of normal (often &gt;400 pg/mL) - rock on, it's normal. Recheck once in about 2 years. And keep eating a reliable daily source as per above. If it comes back "normal" but it's at the very low end (say below 300/350) then you should request a more specific test (e.g. methylmalonic acid and homocysteine) to make sure all is kosher. Talk to your doctor about this. Assuming the confirmation test is normal, you still need to be extra diligent about taking in b12 at least once per day and consider a repeat lab in 3-6 months . If a confirmation test or your initial test comes back "deficient", then you have some important work to do with your doc. (Note: an alternative strategy for a low-normal B12 is aggressive supplementation for a few months and then recheck with the standard test. Also note that labs may use different units such as pmol/L).

Look for updates on the topic of what the optimal b12 range is. If indeed it is optimal to be above 300-350 pg/ml, than that would mean a huge proportion of people around the world have deficient B12 levels. Yes this may seem extreme, but it is not an impossibility in our modern sanitized world - which has eliminated our 'natural' exposure to B12.

B12 Summary - find a daily reliable source, get your B12 level checked - it's simple.

For the clinically/medically minded see this article in the AAFP for a good B12 review.

For a nice informal review of B12 studies relating to vegan diets see this article from the 35th World Vegetarian Congress



As always, this blog does not provide individualized medical advice - for that you should find a good doctor.
If any of the above is unclear, please feel free to post related questions.

The fears of a suspecting vegan. Answered.

Maybe you're a touch freaked out about becoming vegan...about abandoning the dietary staples that billions of dollars in marketing have told you are essential to a happy successful productive and fertile life?

You're asking yourself: "But, where will I get my protein?!!!"

Now, I do believe that you're genuinely concerned about your amino acid pool, though I think what you're really asking is: how easy is it for me to screw this vegan business up and end up a crippled wreck? What do I really need to worry about? And what can I chill out about?

Important questions. Here is my answer:

If you're vegan, there are 5 major concerns you should address:

Pssst. don't tell anyone, but you should concern yourself with these things even if you're not vegan. Oh, and I have a much longer list for non-vegans, but I'll spare you that for now.

From easiest to tackle to hardest:
1. Vitamin B12
2. Vitamin D
3. Omega 3 Fatty Acids
4. Befriending refined Carbs
5. Getting cozy with isolation
 

Notice that protein isn't on this list. But it does get an honorable mention in my rant on carbs...so read on! If I had to list a number 6, it would probably be Iron (mostly for women) and 7 might be getting enough calories (though this would only apply to maybe 10-20% of us at most)...

Update: This blog will provide a BRIEF overview of the above worry list and I will wax philo-medical on each topic in more detail in separate blogs. If you're interested in topics 6 or 7 let me know and I'll happily offer a spiel!

1. Vitamin B12 - the vitamin that makes doctors and scientists alike wave their big wobbly index finger at us crazy vegans. And they are right (but they conveniently forgot to wave it at themselves as well) - you need to hunt out little bits of this vital substance and get your B12 level checked periodically. Read why and how by clicking here.

2. Vitamin D - the sunshine vitamin. Understanding this master vitamin will give you a new found respect for that golden globe that warms our spirits. Vitamin D deficiency runs surprisingly rampant in us northerners and it's so easy to prevent. In the least, take a supplement in the fall and winter. Read why and how by clicking here.

3. Omega-3 - the rarest of the "essential fatty acids". It's the fat you need in your diet for your heart, brain and maybe more. But omega-3s are a little tricky to find in good quantities unless you're a regular fish eater (which I'm guessing you're not). Read why and how to get vegan sources by clicking here.

4. Refined carbs - unlike D, B12, and omega-3s the problem here is that these little devils are just too easy to find and they are awfully tasty. We all (vegan or not) need to crack the whip and get these foods off the everyday menu. But they are everywhere. Like mosquitoes ruining a good sunset picnic. Take a hard look at what you eat and you'll be surprised. Read about your options for switching to whole grains, and why that's important, here.

5. Avoiding isolation - say what?! I don't eat isolation. Thank goodness you don't, because being vegan can be a good recipe for adding isolation into your life.

Let me rewind for a second. I've often asked myself: if eating animal foods is so damn harmful and eating plant foods so protective, why doesn't the medical literature abound with data that blows the efforts of our friendly meat and dairy lobby groups to smithereens? (Don't get me wrong - it does support the benefits of a whole food vegan diet).

Well, one answer (of many) may be that people who choose to buck society and become vegan are different. Maybe (and for good reason) they are more often depressed about the world they see around them. Maybe (and for good reason) they feel different and more isolated from the average Joe or Jane. Maybe there is an unspoken psychological toll that befalls those of use who care deeply about what we eat and what we don't. No, I'm not advocating ignorance - just that as a community we need to start thinking and talking about this. I'll muse on this more, tell you why I think it deserves a place on the top 5 list and offer a few suggestions on the topic if you click here 

The unofficial 6th worry: keeping it in context.

I want to be clear - eating a whole-foods vegan diet is a great way to help maximize your health and make the earth a better place. It's a great way to bring purpose and meaning into your life, to minimize cruelty to animals, to lessen your environmental foot-print and hey, it may even help you stay lean in America.

But let's face it, eating vegan doesn't cure malaria or prevent SUVs from running you over. Being Vegan = one important piece of the puzzle, but it rarely stands alone. There are many other important determinants of health and well-being. But we can muse more on that later.

Oh, and worrying IS bad for you. So take action on these concerns, but don't let them cause undue stress!
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Note: take everything you read on The Internet with a grain of salt. My writings do not constitute individual medical advice - for there is no advice that applies to everyone. These are just my informed opinions and I hope they can provide some guidance in your quest for wellness. In short: Please don't sue me. I'm Canadian.

One final disclaimer: my views do not represent the views of my employers or the academic centers I have been fortunate to attend.

Thanks for reading this. Feel free to comment, or offer suggestions on further blogs...