The 20 Ultimate Strategies To Prevent Iron Deficiency And Overload
Coffee? Grains? Milk? You can see them all in the picture above. All of these foods have very specific effects on how iron is absorbed in your body, especially if you combine them with other high heme-rion foods such as meats.
This blog post makes up the last part of my 5-instlalment series on iron and human health. In this blog post I give you 20 different strategies to manage your iron deficiency or iron overload - i.e., your iron status.
The topics of the earlier installments were:
Below you find 20 different strategies to manage your iron status once and for all:
Twenty Strategies To Manage Iron Absorption And Iron Status
The next step is to give you 20 different strategies with which you can manage your own iron status.
Disclaimer: you do not have to implement all these strategies.
Instead, implementing just one or two strategies (such as donating blood or ingesting calcium with your meals) can already dramatically influence the iron levels in your body. The more strategies you implement though, the greater the effect on your iron status.
So let's begin:
1. Make sure your gut functions well.
Remember that the gut, specifically the small intestine, is the main place where iron from your food is absorbed?[23; 24; 25]
Also recall that I've previously mentioned that gut disorders such as gluten intolerance or "inflammatory bowel disease" lower iron absorption in the gut.
While the topic of healing your gut is enormously complex, and cannot be treated in this blog post, if you do have gut issues I highly recommend experimenting with different diets.
Examples are a diet higher in vegetables and tubers (insofar these foods do not trigger you), or a diet that's very low in fiber (such as the carnivore diet).
Suffice it to say that gut problems are problematic and can cause iron deficiency. The simplest way to test whether you've got gut problems is to check whether you've got consistent and firm stools, and whether you're having stomach pain or indigestion...
Then there's a related strategy:
2. Ensure you've got adequate stomach acid.
This one's really simple:
You need sufficient stomach acid to properly absorb iron from food.[367; 368] In fact, taking prescription drugs that reduce stomach acid can lower the absorption of iron by a tremendous 30%.
A 30% loss can lead to a deficiency over time...
And surprise, surprise:
Lots of people in modern society also have low stomach acid levels. Yes: contrary to popular belief, low rather than high stomach acid is dangerous.
A condition called "gastric acid reflux", for instance, in which stomach acid enters your throat is most often caused by insufficient stomach acid levels.
Infections to the stomach, such as "Helicobacter pylori", may also decrease the iron you absorb from a meal.[369; 370; 371; 372]
Solution:
Adding some betaine HCL to your meals is a simple test to diagnose whether stomach acid is an issue. Betaine HCL increases stomach acid. If you feel very warm after a meal when taking betaine HCL, it's a sign your stomach acid was low initially, and that food breakdown has improved.
That's it...
Let's now consider the most important variable for your iron absorption:
3. Know your genetics.
While in my blog about the carnivore diet I've claimed that an all-meat diet may be perfect for eliminating food sensitivities, iron is a possible downside of such a diet.[108]
Let's say you're exclusively consuming meat without the addition of any plant foods. Depending on you activity level, you'll need 2-8 pounds per day of (red) meat per day, which massively increases your iron intake.
Remember that meat contains 50% heme iron, which puts you at an even higher risk for an overload.
A conservative estimate is that 1% of the world's population has a genetic predisposition to iron overload, called "hereditary hemochromatosis" which comes down to 70 million people.[251]
Caucasians actually have a 5-fold increased risk for getting hereditary hemochromatosis. Men are also at greater risk because they don't have periods.
Because a wide array of genetics variations can cause hemochromatosis, up to 1 in 9 people may be at risk in more Northern countries - you thus need testing...
The way to find out whether you're at risk for iron overload is to do a DNA test, such as at 23andme.com or Ancestry DNA.
Make sure to protect your privacy and use all confidentiality options you have been given by law.
For example, if you use the saliva test at 23andme, it's possible to opt for the complete destruction of your sample if you wish to do so. That option does not mandate them to delete your data (based on the sample), but still, you can anonymously process a testing kit to counter data buildup on you as a person.
You can then take the raw data of the test and put it through an online analyzer. The 23andme also gives you basic information about iron overload or deficiency, but does not allow you to manually analyse the data.
So let's consider the relationship between iron and your DNA, and why your DNA can be a problem in relation to iron.
Genetics 101: some parts of that DNA can "mutate". A "mutation" simply signifies a permanent DNA change. Changes in your DNA can be beneficial or detrimental - which option is the case often depends on circumstances.
Many processes in your body can be altered as a result of a mutation. Due to mutations you can have changes in your sleep pattern, for example, or your risk for nervous system diseases, your musical abilities and...: your iron storage.
Let's explore my claim that changes in DNA can be both beneficial and detrimental.
50,000 years ago, when your ancestors may have lost more blood than people today on a consistent basis, and were infected with more parasites, a DNA mutation that increased iron storage could be very beneficial.
In the modern world those same DNA mutation can be detrimental, because you don't lose blood on a monthly basis while hunting and you're probably not infected with (many) parasites either.
So let's consider how DNA exactly affects how your body handles iron - I'm mainly going to cover the basics:
The HFE gene is most important. You can have a "C282Y" mutation in that gene, which causes changes in hepcidin levels. I've mentioned hepcidin earlier.[397; 398]
To be more precise, hepcidin levels are very low when you've got that mutation, which causes the body to accumulate more iron.
There's nothing you can do about that mutation, except use the strategies in this section to manage your iron status. With that mutation, the same meal will make you absorb much more iron than a person who does not have that mutation, all other variables being equal.
There's more:
The TFRC gene contains the "TfR1" and "TfR2" proteins which influence transferrin in your body - it's also possible to have mutations in that gene.[399; 400; 401; 402; 403]
Remember that transferrin is bound to iron in the blood.
Mutations in these genes can also cause iron overload.
Thirdly, the H63D gene is also associated with iron overload.[479; 480; 481] I recommend checking these genes when you're putting your genetic data through an online analyzer.
Lastly, the S65C is probably also responsible for iron overload, although it's not as dangerous as the previously stated mutations.[482; 483; 484; 485; 486] In other words, mutations in the H63D gene is generally less problematic than the C282Y gene.
Advanced explanation:: other important mutations may also exist, such as hepcidin antimicrobial peptide (HAMP), which also plays a role in hemochromatosis type 2 (in addition to the HFE2 gene).[404; 405; 406] The other side of the medallion are G6PD mutations, which can cause low iron levels due to red blood cells disintegrations.[407; 408]
Bottom line: your genetics can make an incredible difference in how your body handles iron.
If you're of European descent, or have a history of heart disease or diabetes in your family, I highly recommend testing your genetic predisposition for iron accumulation.
4. Donate blood to lower your iron intake if necessary.[103; 104; 105; 106; 107]
Blood donations are really an amazing strategy if you've accumulated excess iron.
There's a large variance in how often you need to donate blood: if you have a tendency to accumulate too much iron (and thus tend to have very high ferritin levels) you may need to donate blood up to multiple times per year.
If you're managing your iron intake very well, however, with the other strategies in this blog post, then you'll be at much less risk for an iron overload - even if you're genetically predisposed.
Blood donations are thus not always necessary, even though it's the quickest way to lower your iron levels.
Be careful with donating blood too frequently: many frequent blood donors eventually become iron deficient - especially if you don't have a predisposition for iron overload. Up to 50% of men who frequently donate have iron deficiencies, and 66% of women.[109; 110; 111; 115; 116]
The following logical inference should thus be common sense: the more often you donate, the higher your risk for iron deficiency. Most blood donors do so multiple times pear year, as 70-90% of donated blood originates from repeat donors.
If you're not genetically prone to accumulate iron over time, then you'll need about 1 milligram of additional iron per day for every 500 milliliters of blood that you donate during a year.
Every 500 milliliters of blood you donate lower your ferritin levels by about 30 nanograms per milliliter.
So what if you want to donate blood, but don't want to end up deficienct?
In that case, follow these guidelines:
Most men can retain adequate iron stores with 2-3 donations of 500 milliliters of blood per year. If you're a woman, that number comes down to 1 and maybe 2 with a great diet. More frequently donating a smaller amount of blood may also be a good solution for women--donating too much blood at once can put you in a deficiency quickly as a woman.
The bottom line is that blood donations are the perfect method to lower iron stores (such as ferritin) that are too high. I do recommend relying on lab tests when opting to donate more frequently, however.
5. Understand how blood transfusions can cause iron overload.[99; 100; 101; 102]
The reason blood transfusions cause iron overload is that you'll habitually receive new blood that contains lots of iron.
To be exact, half a gram (500 milligrams) of iron can be found in 1 liter of blood. Remember that pregnant females - who are the group with the highest iron needs - only need 27 milligrams of iron a day. Adult males only need 8 milligrams.
With a 500 milliliter blood transfusion you'll thus ingest a whopping ~10-30 times your daily requirement. Of course, the dosage of the blood transfusion (i.e., the milliliters of received blood) may be lower, but with a quarter of a liter you'll still end up with 5-15 times your daily iron needs.
These transfusions are mostly dangerous if you're reliant on them due to health conditions, specifically red blood cell transfusions that contain the iron itself.
I'm not going into too much detail regarding this strategy, as its only applicable to a very small group of people.
Nevertheless, I did want to mention blood transfusions to make sure you'll look into this topic if this info applies to you.
Moving on:
6. Consider the role of plant compounds such as "phytate", "tannins" and "polyphenols".
Phytic acid is a compound found in differing amounts in plant foods. The role of phytic acid is to prevent plants from being eaten by animals. Phytic acid binds to minerals such as iron or zinc in foods, thereby lowering the amount of minerals you absorb.
From all plant compounds, phytic acid is one of the most problematic in inhibiting iron absorption.
Seeds, nuts, grains, and legumes contain high levels of phytic acid. To reduce the phytic acid content of such plant foods, you'll need to soak, ferment, germinate, and/or cook them.
So how does that process work?
Let me give an example:
To properly absorb the minerals in nuts, it's best to soak nuts for 8-12 hours overnight in salt. Make sure the nuts are fully submerged in water. Drain the nuts the next morning. Subsequently place the nuts in a dehydrator to reduce their moisture.
Only after completing that process will you absorb all nutrients. I know the process is time consuming, of course, but treating nuts in somewhat larger batches will save you time.
To fully understand how to soak, sprout, germinate, ferment, and cook plant foods, I highly recommend the Nourishing Traditions book by Sally Fallon.
Example why treating most plants matters: without preparation, you only absorb 1% of the iron in legumes - which can be a benefit or a downside, depending on your iron status.[487] Most vegetables, moreover, only require cooking.
If you remove all phytic acid from grains or legumes, the amount of iron that's absorbed can increase up to 12-fold.[42] Overall, the average absorption increase due to proper plant food preparation is located around 3-10 fold range.[44; 45; 48; 49; 53; 54; 55]
Adding some vitamin C to your meals, through either vegetables or fruit consumption, also decreases phytic acid's effect.[44; 61]
The upside?
If you frequently consume plants that contain phytic acid, your body slightly gets used to the effects and increase its iron absorption somewhat.[46] Don't rely on that process though, as you're still taking a risk deficiency relying on mostly phytate-rich foods.
Many people who rely on phytase-rich foods have nutritional deficiencies.
And there's more to consider in the area of plant compounds:
Tannins, secondly, also lower iron absorption.[57; 373; 374; 375]
Tannins are yet another antinutrient that has close ties to iron absorption inhibition. Only plants contain tannins. While tannins are usually subsumed under the polyphenol category (which I'll consider soon), I'd still like to treat tannins in detail here.
Whether you tolerate tannins partially depends on your genetic code - for that reason some people do really well on plant foods, while others do better on plenty of animal foods.
Berries, tea, and coffee and red wine all contain lots of tannins - tannins give red wine that astringent taste. Tannin levels are lower in fruit juice because these compounds are generally removed so that a sweeter product is created.
Fresh fruits thus contain more tannins than juice.
Berries, several grains, grapes, legumes, beans, and several vegetables such as squash contain higher levels of tannins. Chewing really well on tannin-rich foods may reduce their impact on iron absorption, as compounds in the saliva inhibit the effects of tannins.
Polyphenols, thirdy, should also be taken into account. Polyphenols are also exclusively found in plants.[45; 50]
Don't get me wrong...
if you can tolerate them, polyphenols can be amazing for your health. Fortunately, most people can tolerate polyphenols.
Foods that contain many polyphenols, such as chocolate, coffee, or tea, can lower the iron content you get from a meal.[56; 57; 58; 72]
Example:
One cup of coffee contains about 200 milligrams of polyphenols.[59] When you consume 100-400 milligrams of polyphenols with a meal - which can be accomplished by consuming 2 cups of coffee - iron absorption is decreased with a whopping 50-80%.[60]
Adding coffee (or better yet: coffee with chocolate) to a meal can thus dramatically lower iron uptake.
Would polyphenols thus be an important variable to take into account? You bet!
Lastly, curcumin also reduces iron accumulation all by itself:[466; 467; 468]
Use that food streategically...
So what's the catch? Should you always maximally avoid tannins, phytic acid, and other plant compounds to increase iron consumption?
Of course not...
In fact, including minimally processed plants may be used as a strategy to decrease iron absorption if necessary. Again, increasing or decreasing your absorption thus depends on the context...
There's even evidence that including plant foods directly protect against the damage of iron overload. Many of the compounds discussed before can act as antioxidant in your body if you tolerate them, bringing a net-positive health benefit.
Let's move on to the next iron-inhibiting compound:
7. Mind your calcium intake.[62; 63; 64; 65; 66; 67; 68; 69; 70; 71]
Yes, that's right.
Just drinking one glass of milk with your meat already decreases iron absorption.
As you know right now that you may be much more susceptible to having problems with iron absorption due to your genetics, calcium's role can be both a blessing or a curse.
To be clear, you don't have to drink milk to get calcium. Small bones in found in fish are another great source, as are properly prepared (sea)vegetables and nuts. If all of these foods are not an option to you, I recommend getting a calcium supplement.
One problem with using calcium may be that it only acts for a very short period of time, and that your body gets used to the iron-inhibiting effect. Calcium may also mostly have an effect if your calcium intake is already low.
Non-heme iron may not be affected, so that calcium inhibits absorption more from seafood and meat than from plant foods.
(The topics of calcium and blood transfusions make me think of the Maasai tribe in Africa, who drink cow's blood as part of rituals. Fortunately, they often mix the blood with milk. How's that for intuition?)
Next, another variable:
8. Take your vitamin C intake into account.[73; 74; 75; 76; 77; 78; 79; 80]
Remember I mentioned vitamin C before, in the context of inhibiting phytic acid's effect on lowering iron absorption.
Vitamin C may have an additional effect though, in helping to convert iron from one type into another (Fe3+ to Fe2+). Moreover, vitamin C also increases ferritin level and helps iron stay in the cells - all these effects lower your overall iron requirement.
Why consider vitamin C?
Simple:
Lots of people take vitamin C supplements to prevent a cold or boost their immune system. Independent of whether that strategy is successful for preventing disease, vitamin C supplementation can increase the amount of iron you absorb from a meal an extreme 2-3 fold.
That's right, 2-3 fold...
If you're thus not aware of the effect vitamin C is having, then you might end up with much higher levels than you'd presuppose.
Additionally, there's an elephant in the room: vitamin C is added as a preservative to many foods.
Just a little vitamin C already increases iron absorption. Some foods that contain naturally high levels of highly absorbable iron, such as meat, also contain vitamin C as a preservative.
Usually that vitamin C is listed on a product description under the name "ascorbic acid"
That's double trouble...
As a side note: in the last few years it's become more probable that higher levels of vitamin A increase iron absorption as well.[123; 124; 125; 126]
Interesting...
Hopping on to some minerals:
9. Watch your copper, zinc, and manganese intake, which can all interfere with iron absorption.[81; 82; 83; 84; 85; 86; 87; 88; 89; 90]
These ones are simple...
Let's start with zinc:
Foods highest in zinc content include shellfish, meat, dairy, and eggs. Some plants contain high levels of zinc as well, but that zinc is less well absorbed if plants than zinc sourced from animal foods.
Fortunately, high iron and zinc foods mostly overlap in nature. That means that in most cases, you won't end up with an iron deficiency if you're eating zinc-rich foods.
So what's the exception to that rule?
Easy: if you take zinc supplements, you're at greater risk for having iron deficiencies. Zinc and iron depend on a similar process in the liver for their absorption, and taking high zinc doses can displace iron.
The reverse is also true: taking iron supplements can cause zinc deficiency...
Zinc and iron also co-depend on each other, on the other hand, so that a zinc deficiency can make you end up with a iron deficiency as well.[82; 88] If you're deficient in zinc, you thus thus have to test your iron levels also.
If your zinc comes from supplements (chemically known as "inorganic zinc"), then the iron-inhibiting effects are the strongest.[86] Non-heme iron absorption is most affected.
Secondly, you may think: "how about coppper?"[93; 94; 95; 96; 97; 98]
Same story, although somewhat different.
With lower copper levels, you can end with lower iron levels as well.[93; 96] Copper is needed to properly absorb iron (remember the ceruloplasmin I mentioned earlier?)
Oysters, liver, leafy vegetables, lobster, cacao products, and mushrooms are great copper sources.
High levels of copper, hence an excess, will also decrease iron absorption. Overall, you'll thus need to find a golden mean between a copper deficiency and overload.
The case of manganese, lastly, is really special: manganese directly counteracts the effect of iron.[442; 444; 445; 446]
Beans, legumes, nuts, most whole grains, leafy vegetables, and cacao are great sources of manganese.
If you include manganese-rich foods into a meal, iron absorption will probably be slightly lower. The fact that manganese-rich foods counteract iron absorption may be one reason why vegetarians and vegans are at greater risk for iron deficiency...
Lastly, other minerals such as lead (commonly known as heavy metals) also gives you problems with iron absorption.[91; 92]
While I'm not treating these minerals in this blog post, you may keep them in the back of your head for reference.
Bottom line: some minerals you consume can affect iron consumption, but you should mostly be worried if you're supplementing with zinc and/or copper.
10. Animal protein may increase iron absorption all by itself.
Yes, next to heme iron, animal protein also increases iron absorption.[39; 40; 41; 47; 49] Non-heme iron specifically increases most in retention.
Implications?
Sure...
Example:
Let's say you're eating a meal of rice and beans. Adding some animal protein then helps your body absorb the iron from those plant foods, through a mechanism that is irreducible to the addition of heme iron in the meal.
Other compounds in animal foods except protein may also play a role in increasing absorption.
One reason meat has an iron-absorption-increasing effect may be that meat increases stomach acid production. Increased stomach acid results in more iron from other foods being absorbed.
Caveat: there's some conflicting evidence on the role of protein and iron absorption.[51]
Moving on:
11. Watch your wine intake
Wine is a special case: when wine that's high in polyphenols is consumed with meals, iron absorption decreases.[379; 380; 381] Red wine contains about 10 times as many polyphenols as white wine.
If you're drinking wine in the absence of food, however, the effect is very different. In that instance, wine increases your iron stores. The reason is that wine contains some iron by itself, and with the absence of food, that iron is a net-positive contribution to your iron status.
Another caveat: the evidence on the effects of alcohol in the wine itself are somewhat conflicting right now. Alcohol may increase absorption, while polyphenols have the opposite effect.
12. Lower ferritin with sunlight or infrared.
Although this strategy is more speculative, there is some proof that sunlight and infrared light can lower your overall ferritin levels.[344; 345; 346; 347]
Let's first recap:
Remember that sunlight consists of 1) ultraviolet light (which can give you sunburns); 2) visible light (the colors of the rainbow), and 3) infrared light (that feels as heat on your body. Ultraviolet and infrared light are invisible to the human eye.
The light spectrum...
While that relationship may seem far out, let me explain. Hemoglobin contains an iron chemical in the middle. That iron reacts to sunlight.
High ferritin levels may be a response to having low infared and ultraviolet light in your environment, in the sense that the body compensates for lower light levels by increasing ferritin. Why? Well, when you move into the sun, blood actually transfers to your skin.
That blood is "irradiated" with ultraviolet and infrared light, in which sunlight reacts to the iron in your blood.
Many people may thus have an iron overload because they're simply not spending much time outside in the sun.
Sweating, moreover, also causes you to lose some iron through the skin all by itself.[443]
What's fascinating is that some people have experienced lower ferritin levels after integrating infrared saunas into their lives. I'd love to see people testing their ferritin levels before integrating more sunlight into their lives, to observe what happens.
For nerds: higher ferritin status - although this is speculation not verified by empirical evidence - may thus be an adaptive response increase irradiation exposure to sunlight.[488]
13. Mind your environmental iron exposure.
Yes, really:
Some occupations naturally put you at risk for iron overload.[382; 383] If you're an electrical worker or work in the metal industry it's therefore very important to use lab tests.
Don't guess what your iron status is...
Metal dust is one example of environmental iron exposure that's dangerous. That metal dust can simply be viewed as a form of "air pollution" - I've written extensively about air pollution.
The lungs are one of the best mechanisms to absorb substances - that's why people smoke marijuana instead of eating it. If you inhale iron, that iron may directly end up in your bloodstream, causing damage everywhere.
Other environmental sources of iron exposure also exist, such as cookware. When cooking in iron, a small amount of the mineral can leach into your food every day. Over time you can end up with an overload with that method.
Cooking in iron pans can add a tremendous 30-500% additional iron to your meals compared to what you'd normally consume. Liquids such as sauces are especially dangerous, as the leaching percentages end up on the higher range of the previous percentages..[489]
Let's now return to an "old acquaintance":
14. Keep parasites into account
Parasite infections have been truly underappreciated as a source of iron deficiency. In fact, the more parasites are contained in your body (such as hookworms), the lower your iron stores become.
While the topic of treating parasite infections is far too complex to consider in this blog post, suffice it to say that improving general health is the most important strategy to get parasite infections under control.
What's fascinating is that our ancestors - at least, primates - are almost universally affected by parasites. 85% of chimpanzees have a parasite infection.[384] Another study found 65% of chimps affected by parasites, and 85% of gorillas.[385]
In developing nations, people have parasite infections as frequently as 4-90%, a number that averages around 20-40%. That number is much higher in poorer countries.[409; 410; 411; 412; 413; 414]
(Just be happy that I'm not including a picture of parasites.)
Let's move to another danger:
15. Avoid soy
Soy is always a great food to avoid, as there's almost no upside to consuming most forms of soy (except, perhaps, natto).
One detriment of soy is that it decreases iron absorption. Soy is often consumed by vegetarians and vegans, and should thus be carefully considered if you're on a diet that's already low in absorbable iron content.
Despite the high amount of antinutrients contained in soy, such as "phytic acid", soy also independently decreases iron absorption. In other words, even if you fully remove the phytic acid from soy, iron absorption will still be inhibited.
16. Fructose
Fructose is a carbohydrate that's found mainly in fruit and honey. Fructose may increase iron absorption, although conflicting evidence exists. Animal studies demonstrate an increase in iron uptake exists, while human studies show no effect.[386; 387]
Fructose is thus probably a net-contributor to your status, and will not lead to deficiency. Fruits which contain both high levels of vitamin C as well as fructose can thus skyrocket your iron uptake...
17. Organic acids
Lactic acid and citric acid - added to food supply - are examples of organic acids.[74; 388; 389; 390]
Some substances in nature naturally contain compounds such as lactic acid or citric acid. Citric acid is found oranges, for example, while lactic acid is found in fermented milk products.
Consuming these products increases iron absorption. When you add a product high in lactic acid to a meal of maize, for example, iron absorption doubles.
It's precisely problematic that these foods are added to the food supply, because you can end up with much higher iron absorption levels than you'd initially assume.
Citric acid, for example, is sometimes used as a meat preservative. The iron in meat already absorbs enormously well, and adding citric acid bolsters that process.
Is some vitamin C (ascorbic acid) that's added to the mix as a preservative? That's double trouble.
Next:
18: Young women: mind your monthly cycles and contraceptives
I've exhaustively treated this option above, but just wanted to include this info as it's an essential strategy. Bottom line: If you're menstruating, then you're losing more iron - up to double the amount of adult men.
Let's make some calculations:
Women lose about 60-100 milliliters of blood during their period. Over the course of a year, that number roughly equals two blood donations of 500 milliliters. 500 milliliters blood contain 250 milligrams of iron, so women lose an additional 500 milligrams of iron on a yearly basis if they're menstruating.
Bring on that steak...
Some counterarguments exist though, claiming that menstruation barely increases iron losses. Please read that counterargument as well if you're a young woman.
Caveat:
Some contraceptives such as the pill lower the amount of blood loss women have on a monthly basis. In that case, your period will thus have less of an effect on iron stores.
In poorer countries, where you're already at greater risk for developing iron deficiency anemia, contraceptives can exacerbate that problem (although the benefits of contraceptives still massively outweigh the downside risks in most cases).[391; 392]
Beware...
Almost done:
19. Watch the alcohol intake
Yes, I know I've talked about red wine, which is a special case. Alcohol in general, such as beer, is very different from wine when looking at iron absorption levels.[393; 394; 395]
In some cases, drinking alcohol actually increases your body's iron stores - if alcohol is rich in organic acids. Drinking alcohol with meals that contain plant foods as opposed to outside meals can thus have totally different effects.
Alcoholics generally have increased iron stores because of continually drinking without eating, while storing the small amounts of iron contained through alcoholic beverages.
20. Future possibility: use prescription drugs to regulate your iron status
This strategy is somewhat more speculative, but bear with me:
Since some time, a class of prescription drugs called "hepcidin agonists" have entered the research domain.[376; 377; 378] By targeting hepcidin, you can control how much iron is stored in the body.
Hepcidin agonists stimulate hepcidin levels, which lower iron levels--hepcidin antagonists accomplish the opposite.
Unfortunately, the hepcidin agonists and antagonists prescription drugs are still in the research phase and have not entered the market yet.
Prescription drugs should also be your last resort, however, as blood donation and especially dietary changes are generally much healthier methods than using prescription medicine (and are understood in terms of their side-effects).
Bonus: Circadian Rhythm
BONUS strategy (because you've been reading all the way up until here): realize that your 24-hour day and night rhythm has a massive impact on your iron status.[501; 502; 503]
This link has only been discovered since a few years, but has been backed up by evidence.
The gist is that disruptions in your day and night rhythm can alter the iron status of your body. Iron status - just as as fat loss, cogntive function, or sleep - is thus disrupted by circadian mismatches.
For more background on that tip, read my blog post about blocking blue and green light at night. In that blog post I demonstrate that blue and green light - from television screens, smartophones, and artificial light - disrupts your brain's melatonin production, which in turn decreases sleep quality.
Another speculated - but probable mechanism - is that blue light also affects iron levels through skin exposure. It's thus recommended if you spend lots of time under artificial light, not only to wear blue blockers but also to cover up your skin.
That mismatch in your day and night rhythm may create changes down the line in your ferritin or transferrin status. Fixing an overload issue may thus involve blocking blue and green light and getting sufficient sunlight during the day.
In essence: there is reason to believe that the artificial light in your environment affects the iron in your blood and skin.
How to apply these strategies
So that's it: twenty strategies + 1 bonus tip to manage your iron status.
But you may think: "how to apply these strategies?"
Well, the first step is to become more aware of what you're doing to increase or decrease iron levels. The second step is to know your iron status through lab tests, then change your behavior accordingly.
Caveat: there's no mathematical formula I can give you to on how to apply these strategies. The interaction between the several strategies is so complex that it's hard to gauge the results without extensive lab testing.
Of course, you know that your iron levels will be higher if you add orange juice to a meal (which contains citric acid, fructose, and vitamin C, which all increase iron absorption).
I thus recommend to use common sense. If you're genetically predisposed to iron overload, you probably have to use more of the strategies to balance your intake - the same is true if you're a vegan.
If your lab tests turn out optimal, proceed as you've always been doing.
Let me give you some examples:
- If you're a vegan and eating meals with soy, polyphenols, tannins, and phytic acid, add vitamin C to plant foods that are rich in non-heme iron, and consume calcium rich foods and coffee outside your iron-rich meals
- If you're deficient, then eating liver with orange juice may be the quickest way to skyrocket your levels once again.
Very simple...
Next, a more controversial topic:
Iron Supplements: Angel Or Devil?
Let's look at the role of supplementation in preventing iron deficiencies.
The only reason to ever take iron supplements is if your low iron levels have been established through lab tests. And even then, I'm going to argue that taking supplements shouldn't be your first option.
Why?
Let me tell you:
Iron supplements have downsides that iron-rich foods don't have - which is analogous to iron-fortified foods.
If you supplement with high doses of iron, it's easy to get other minerals such as copper or zinc out of whack. And getting the dosage exactly right, specifically in relation to other minerals, is difficult to do without lab tests.
Another problem is that iron supplements cause direct side-effects. These side-effects include diarrhea, nausea, irritation of the gut, and constipation.[497; 498; 499] And no: these side effects don't just occur when you take too high a dosage--side effects occur at recommended dosages...
Insane but true...
To avoid these side-effects, take iron supplements with a meal and drink enough water to prevent constipation.
The upside?
Sure:
Iron supplementation have been proven two work to restore your iron status after blood donations, for example.[112; 113; 114]
Of course, you only need supplementation if you're deficient after a donation. High quality foods to replenish iron stores have not been tested in large scale scientific studies yet, although a better effect than supplementation may reasonably be expected.
Warning: at higher dosages, iron supplements can cause bleeding, organ failure, and eventually coma. Thus keep iron supplements away from children. If children pop a few iron pills during "play", the end result can be fatal.
So what's the solution?
Well, if you don't want to supplement, I recommend you do this instead:
Your best option is to use iron-rich whole foods to increase your stores.
Again: liver, oysters, and lobster come to mind - find the list of optimal choices in th eprevious installment
There's a "but" though:
In some instances, iron supplements are necessary, specifically intravenous supplements.
"Intravenous" (IV) means that the supplement is directly put into your bloodstream. The reason IV supplements are sometimes necessary is because some people cannot properly digest iron from food or supplements.
If you've got gut problems, for example, then an IV might be your perfect solution. In "inflammatory bowel disease", which I've talked about earlier, iron supplements may actually aggravate the problem.[117; 119; 122]
If you've got gut problems that are so incapacitating that you can no longer digest iron, then please seek help from a medical professional.
In other cases, there's another short-cut (click the picture to view the product):
Liver extract
I only recommend using that liver extract only if you do not eat beef liver every week. If you already consume beef liver, which is very high in iron (23 milligrams per 100 grams (3.4 ounces) of product), then you don't need this product.
Beef liver is also very high in copper, and consuming too much of the stuff is counterproductive, as you'll end with a copper overdose.
Next, there's beef spleen extract (click the picture to view the product):
Beef Spleen
Keep in mind that beef spleen is extremely rich in iron. Twelve capsules of Ancestral Supplements beef spleen (pictured above) yields 2.5 milligrams of heme iron.
If you take twelve capsules with iron absorption enhancers described in section eight, you're almost certainly golden (unless you've got gut problems, for example. You can use lemon or lime juice (for both citric acid and vitamin C), for instance, with 6-12 capsules of beef spleen, so that all these 2.5 milligrams are maximally absorbed.
For overall health benefits (if you don't yet eat liver), then I recommend using beef liver over beef spleen. If maximum iron absorption is your goal, take the spleen.
Using canned oysters is a last (but amazing) alternative:
Buying fresh oysters is better of course...
Now, again, I generally do not recommend supplementing with iron--getting your iron though the food supplements listed above is your best bet. Getting your iron through whole foods is even better...
If you do decide to take supplements anyway, which I can understand in some situations, so that you may as well take the best.
Quick joke: "I don't always supplement with iron, but when I do, I use Ancestral Supplements".
Ancestral Supplements is the company I've listed above, that sells the Beef liver and spleen.
Why that specific company?
Well, their products are sourced from cows that grow up on grass, and keep eating grass until they're slaughtered. These cows are also not exposed to GMO foods, pesticides or hormones. And lastly, the supplements are 3rd party tested for purity, and don't contain fillers.
Doesn't get better than that...
That's it, all you need to know about this amazing mineral. So by the way, congratulations, you're now an expert on iron.
Let's conclude...
Finishing Thoughts: Iron's Role In Health Remains Underappreciated
The case study of iron demonstrates that health is not as simple as many people would believe it is.
Health is much more than "eating less and exercising more", or "calories in, calories out". While the latter statement may be true, it's also completely nonsensical.
Why?
Well, "calories in, calories out" is per definition true from a thermodynamics perspective, but the statement is strongly misleading in the sense that the total calories burned by a human being can alter over time.
The effect of a mineral such as iron is a great example of that principle. Why? Well, iron is very central to your body's energy production.
Too little iron, and your basic metabolism is not going to be what it should be. In other words, you're burning fewer calories and producing less energy when you're anemic. Every process in your body is affected when your metabolism slows down.
In that case the statement "calories in, calories out" still holds true, but is also still highly misleading and dangerous, because it implies youjust need to watch the calories they eat and burn off more calories if you're overweight.
The true reason for being overweight in that case might be an iron deficiency, which is causing a slowdown in metabolic rate.
The final message of this blog post is that you should care about your iron status if you want to optimize your health.
No excuse...
Both a deficiency and overload are highly problematic, and slowly ruin your life.
Taking care of that problem can make you feel on top of the world, just like you (probably) did in your 20s. And fortunately, iron status problems are very easy to fix in 99% of cases.
The bright side of my message is that you're in full control.
You deserve the best. Get your iron status fixed today.
Don't guess.
Don't go through life blindfolded.
So in the end, the question of "iron, angel or demon", can be answered with "both"! You choose...
Items Mentioned
This is a post by Bart Wolbers. Bart finished degrees in Physical Therapy (B), Philosophy (BA and MA), Philosophy of Science and Technology (MS - with distinction), and Clinical Health Science (MS), and is currently a health consultant at Alexfergus.com.
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