Are you a vegetarian or vegan who is concerned about low iron or anemia? You are not alone! Many people who follow a vegetarian diet or vegan lifestyle wonder if they are getting enough iron or if they are putting themselves at risk for anemia. Here I'll share some info about low iron and anemia, what you can do to ensure you are getting enough iron, and what my experience has been with anemia.

Anemia Explained

The National Institutes of Health reports that anemia is a condition in which your blood has a lower-than-normal amount of red blood cells or hemoglobin. If you have anemia, your body is not getting enough oxygen-rich blood, which can lead to you feeling tired, weak, short of breath, and you may experience headaches, tingling in the hands, feel colder than usual, and you may have an irregular heartbeat. It can be a sign of a serious condition, or it could be a sign that you are not consuming enough iron, or that you are not absorbing enough iron. 

According to the Centers for Disease Control and Prevention, there are around 2.8 million people per year who visit the doctor due to anemia. It's a condition that also kills over 5,000 people per year in the US alone. Globally, the World Health Organization reports that around 1.62 billion people have anemia, or roughly 25% of the world's population. Clearly, anemia is an issue that many people around the world are touched by.

How We Get Iron

We get our iron from what we consume. There are two kinds of iron to know about, which are heme and non-heme. Heme iron is that which comes from animals. It's easily absorbed and largely in abundance when eating meat. Non-heme iron is the iron that comes from plant-based foods, and it is not as easily absorbed. This leaves many people wondering if vegetarians and vegans are more at risk for anemia than their meat eating counterparts.  There has been some research conducted on this issue, including: 

• Research published in the May 2018 issue of the journal Critical Reviews in Food Science and  Nutrition, where they concluded that "vegetarians are more likely to have lower iron stores compared with non-vegetarians."
• Research published in the February 2019 issue of the journal Nutrition Research and Practice, where they concluded that anemia was a public health problem among female vegetarians in their study. Their study of 177 vegetarian women found that 28% of them were anemic.
• Research in The Medical Journal of Australia advises that vegetarians who eat a varied and well balanced diet are not at any greater risk of iron deficiency anemia than non-vegetarians.
• Research in the American Journal of Clinical Nutrition advises that although the iron stores of vegetarians may be reduced, the incidence of iron-deficiency anemia in vegetarians is not significantly different from that in omnivores.
• Research in the journal Nutrients, reported that their study showed iron deficiency was frequent in vegetarian/vegan women (although not in men). 

There is information on both sides, with research showing that vegetarians and vegans may have lower iron stores, but not necessarily be anemic. Vegetarians and vegans may be more at risk for anemia, but they are not the only groups of people who are at a higher risk for it. According to the American Society of Hematology (hematology specializes in the blood), others who are at a higher risk of anemia include menstruating women, women who are pregnant or breastfeeding, those who have undergone major surgery, people with gastrointestinal diseases, those who have had gastric bypass, and children who drink at 16 ounces of cow's milk per day (cow's milk inhibits iron absorption).

How do you know if you are anemic?

You will need to have a blood test conducted in order to determine if you are anemic. You may experience some symptoms of anemia that bring the issue to your attention, such as being tired, having no energy, being pale, rapid heartbeat, craving ice, brittle hair, etc. A quick way to see if you may be anemic, is to gently pull down your lower eyelid and see what the color is on the inside (the side against your eye). Those who do not have anemia usually have a bright pinkish/red look, while those who are anemic won't have that, it may be pale for them. This is not a definitive test,  however, so it is best to go have a blood test taken if you suspect you may have anemia. It can be a serious situation, so it is not something to overlook and not take action about.

How to Increase Iron Intake as a Vegetarian or Vegan

Vegetarians and vegans can get iron from eating such foods as leafy greens, dried fruits, legumes, iron enriched pasta, rice, and bread, chia seeds, quinoa, nuts, potatoes, oatmeal, flax seed, tofu, etc. Plus, it is good to consume vitamin C with your iron, as it helps with increasing absorption. Foods high in vitamin C include citrus foods, berries, pineapple, bell peppers, etc. You can also boost your iron intake by using a cast iron pot/pan to do your cooking. Iron absorption is also increased by consuming vitamin around the same time. It's also important to know that there are things that can inhibit your iron intake, such as drinking tea around your meals. Tea can drastically reduce the amount of iron that your body absorbs from your food, therefore you should avoid drinking it with your meals. Try to drink it at least an hour before or after your meals.

You can also take an iron supplement, but if you do please check with a medical professional regarding how much to take. Addressing your anemia also depends on what is causing it. It can be caused by loss of blood inside the body, heavy periods, nutritional deficiencies, B12 deficiency, and more. If you are not sure what is causing your low iron or anemia you should consult with a medical professional who can help you find the cause and help you treat it. It is important to know the reason for your anemia in order to properly address it.

My Experience Being Anemic as a Vegetarian / Vegan

I've been vegetarian (primarily vegan) since October 1995. I've battled anemia issues my whole life. I know it's not because of my diet, because two of my sisters (who are meat eaters) also battle anemia. Several years back, I was diagnosed with having Crohn's Disease, which is a disease that leads to poor iron absorption. So no matter how well I do with eating a lot of iron-rich foods, my body has a difficult time absorbing it. Add to that my addiction to drinking tea and it's a mess. 

Back about six months ago, I could tell that something was wrong with my iron. While I battle anemia on and off forever, it seemed it must be really low. I was extremely tired every day, very cold, tingling in my hands, and my blood pressure was going up. Plus, I'm a runner and  I noticed my pace had gotten about 2 minutes slower per mile, for no apparent reason. I literally could not run faster, even when I tried. I just didn't have it in me. And it made sense, because if you are anemic your body isn't getting the oxygen needs for you to maintain your faster pace. (I also learned that you lose iron through sweat, and I sweat a lot when I run - and I run three days per week).

Because I battle anemia on and off, I have my blood tested here and there on my own to keep an eye on it. I order my own blood tests through a place like HealthLabs.com or PersonalLabs.com. It's simple, because you don't need to see a doctor. You order and pay for your test on your own, go to a local lab to have the blood drawn, and usually the next day the results are available online. Simple, affordable, and I don't have to go to a doctor to have the test. Better yet, invest in a home hemoglobin meter! 

In August 2018, my hemoglobin was at 11.4. Not bad at all for me. It was on the low end of normal, but I was feeling fine and it had been staying around that level for well over a year. I had been taking an iron tablet, but I'm not always good with keeping up with it, because it makes me sick to my stomach. Then I began feeling anemia symptoms and went for another test in April 2019. I was shocked to see my hemoglobin had dropped to 8.6. I immediately started watching when I drink my tea and made sure to take that iron tablet daily, even though it made me feel sick. I tried to include more iron-rich foods. I bought an iron skillet. 

I went back to re-test five weeks later. My hemoglobin had only went up to 9.1. It went up a little, but wasn't going up fast enough. I began researching if there was a better option than taking the iron tablets I was taking. I found that the best absorbed are chewables and liquids (although the liquid stains your teeth), followed by softgels, then tablets. I was taking the source that was the least absorbed! 

I remembered that my neighbor had battled anemia about a year prior. I texted her to see what she was taking and if it helped. She highly recommended Hema-Plex chewables. I immediately placed an order for them and started taking them. Now, I will tell you that they taste horrible. Like grabbing a metal bar and licking it. But I needed something that works, so I took them daily. Right after swallowing them I would drink water or grab a bite of something to get the taste out of my mouth. I loved the fact that they did not make me sick. I felt fine taking them every day! 

I went back to re-test after taking the Hema-Plex for five weeks. My hemoglobin had went up to 10.8 in that time. Yay! I continue taking them today, which has been another month. I haven't re-tested again yet, but I feel confident that they are working. For me, what worked to bring up my hemoglobin was taking Hema-Plex chewables each day, not drinking tea around my meals, and continuing the other things I do of trying to eat foods with iron. I realize that having Crohn's Disease my body doesn't do a great job of absorbing the iron I consume, so I'm happy to have found Hema-Plex and that it's working. My neighbor does not have Crohn's, by the way. My husband, who eats the same diet, does not have any issues with anemia, by the way. 

The bottom line is that being a vegetarian or vegan doesn't automatically mean you are going to be anemic, but if you are are also a menstruating female, have a gastrointestinal disease, or some other condition, you may be at a higher risk. Or if you are a vegetarian or vegan who doesn't consume enough plant-based iron-rich foods you could be at risk for anemia. If you are experiencing anemia symptoms, it's a good idea to get tested and take action to bring it up if you iron/hemoglobin level is too low. One of my sisters who had anemia found out she had internal bleeding, which was causing the problem. If you have anemia you need to know what is causing it so that it can be addressed.

Update October 2020: I have since purchased a home hemoglobin meter, which you can read about here.