What to Eat When You Have Hemochromatosis

Dietary Recommendations for Better Management

In This Article

Hemochromatosis is a metabolic disorder caused by a gene mutation. It results in the body, overloading on iron; when left untreated, the condition can cause severe damage to the organs and joints. There is more than one type of hemochromatosis. Type 1—referred to as HHC or classic hemochromatosis—is the number one cause of iron overload. In HHC, people absorb extra iron from the diet.

The hemochromatosis diet enables a person with hemochromatosis to avoid foods that are very high in iron, as well as avoiding those that increase the absorption of iron. The diet consists of foods that will provide enough protein and other nutrients—including an adequate supply of iron—without overloading the body with too much iron.

Benefits

Iron is referred to as an essential nutrient because the body cannot make it; it must be obtained from food. A normal adult requires approximately 1.8 milligrams (mg) of iron per day (women need slightly more than men). In normal adults, only around 10 to 30% of the iron that is ingested gets absorbed. But in people with hemochromatosis, a hormone (called hepcidin) secreted by the liver, malfunctions, causing the body to absorb more iron than it requires.

In fact, hemochromatosis can result in a person absorbing as much as four times the normal amount of iron. So much so, that the body has trouble ridding itself of extra iron and much of it builds up in the joints, pituitary gland, organs, (such as the liver, heart and pancreas). Over time, if the iron is not removed it can damage organs or even cause death.

There have been many studies to identify which foods increase the body's absorption of iron, and which ones decrease it.

Types of Iron

Before learning about the hemochromatosis diet, it’s important to understand that there are two types of iron consumed by humans. These include heme and non-heme iron. Animals and humans use iron to make heme, which is the part of the oxygen-carrying hemoglobin in red blood cells.

The type of iron that is the easiest to absorb is heme iron. Heme iron comes from red meat (including venison, lamb, buffalo, and beef). Heme iron also comes from fish; meat and fish offer both heme iron and non-heme iron. When it comes to fish, the type that offers the highest amount of heme iron is bluefin tuna (note that the deeper the pigment of meat, the higher the iron content). Non-heme iron comes from vegetable sources as well as from fruits and grains.

How it Works

The hemochromatosis diet aims to help balance iron levels while promoting disease prevention, by preventing too much iron overload in the body. The diet consists of fresh fruits and vegetables, whole grains, adequate protein, and a limited amount of animal fats, sugars, and dairy. Whole foods are encouraged whenever possible. Protein sources that are limited in the hemochromatosis diet include those that are high in heme iron (such as red meat).

Duration

Those diagnosed with hemochromatosis should adhere to the diet for as long as it is ordered by their health care provider. Frequent lab work is required to ensure that iron levels are within normal limits. If a person with hemochromatosis develops anemia (low iron level) the diet may be temporarily put on hold until the iron levels rise.

Some symptoms of anemia can mimic those of hemochromatosis; always consult with your health care provider and be prepared for frequent lab tests to ensure adequate iron levels. Never make diet changes without consulting with a health care provider (such as a nurse, dietitian, or physician).

What to Eat

The hemochromatosis diet consists of consuming foods that are low in iron levels and those that help lower the amount of iron that is absorbed by the body.

Compliant Foods

  • Foods high in calcium

  • Yogurt

  • Cheese

  • Canned salmon, cold water salmon, tuna, sardines

  • Chicken, turkey

  • Eggs

  • Deli meat

  • Nuts (like almonds, walnuts, and pecans)

  • Beans (and other high fiber foods)

  • Tofu

  • Whole grains

  • Broccoli

  • Spinach

  • Figs

  • Rhubarb

  • Apples and other non-citrus fruit

  • Avocado

  • Olive oil

  • Black tea

  • Coffee

  • Cocoa

Non-Compliant Foods

  • More than limited amounts of red meat such as beef, lamb, venison, or elk

  • More than imited amounts of citrus fruits (high in ascorbic acid, which increases the absorption of iron in the body)

  • Animal fat

  • Alcohol (which may enhance the absorption of iron)

  • Foods with additive iron compounds (called EDTA+fe and Ferrochel)

Foods That Decrease the Absorption of Iron

These foods can be used in a diet to manage hemochromatosis by decreasing the absorption of iron.

Eggs: Eggs have a phosphoprotein called phosvitin, which binds with iron; phosvitin is thought to be the mechanism that accounts for the low bioavailability of iron from egg yolks. Several studies have shown that eggs can reduce iron absorption significantly.

Calcium: Calcium is a nutrient thought to influence the absorption rate of iron. Human studies have found that calcium supplements (as well as calcium from milk and dairy products) can inhibit (slow) the absorption of iron. Calcium supplements, given in small doses (of 50 mg or less) were not found to have an impact on iron absorption, but when very large doses of calcium supplements (300 to 600 mg) were administered, inhibition of the absorption rate of heme iron was similar to that of non-heme iron. (Note that a cup of milk contains about 300 mg of calcium.) To summarize, large doses of calcium significantly decreased the rate of iron absorption. But, one study discovered that the effect of calcium on iron absorption may only last for a short duration and may fluctuate in time.

Other substances that decrease the absorption of iron include:

Oxalates are compounds from oxalic acid, such as those found in spinach, kale, beets, nuts, chocolate, tea, wheat bran, rhubarb and strawberries and herbs like oregano, basil and parsley. They are thought to lower the absorption of non-heme iron. While spinach is thought of as being high in iron, it also has oxalates which are compounds thought to slow the absorption of the iron.

Phytate is a compound derived from soy protein and fiber, which is found in foods such as walnuts, almonds, dried beans, lentils, cereals, and whole grains.

Tannins, found in black tea, inhibit iron absorption.

Polyphenols, phenolic compounds, and phenolic acid (compounds found in coffee, cocoa, peppermint, apples, and some herbs) are a major inhibitor of iron absorption.

“Swedish cocoa and certain teas demonstrate the most powerful iron absorption inhibiting capabilities, in some cases up to 90%. Coffee is high in tannin and chlorogenic acid; one cup of certain types of coffee can inhibit iron absorption by as much as 60%,” according to the Iron Disorders Institute.

Foods That Increase the Absorption of Iron

While addressing iron overload, consider the evidence for foods that might increase your absorption of iron.

Beta-carotene: Beta-carotene (a class of pigments that give color to plants) helps the body produce vitamin A. In studies, vitamin A was not a major influencing factor in the absorption of iron, but beta-carotene was. Some studies had mixed results, finding that beta-carotene did, in fact, increase the absorption of iron in some study subjects (from Venezuela) but not in those from Sweden or Switzerland. The study authors wrote, “Differences in vitamin A status of the subjects may be a possible explanation for the contradictory findings.”

Foods high in beta-carotene include bright colored foods such as carrots, sweet potatoes, dark leafy greens, cantaloupe, beets, turnip greens, corn, red grapes, prunes, yellow squash, apricots, red and yellow peppers and more. Most experts do not recommend avoiding these fruits and vegetables.

Vitamin C (abscorbic acid): Vitamin C has been found to be one of the most impactful enhancers of non-heme iron absorption. Taking 100 mg of ascorbic acid (vitamin C) supplements resulted in a fourfold increase in the amount of iron absorbed from a meal. In another study, vegetarians with anemia in India were given vitamin C supplements comprised of 100 mg for 2 months, there was a dramatic improvement in the study subjects’ iron levels.

Limit supplements of vitamin C to 200 mg per dose because vitamin C enhances iron absorption (always consult with your health care provider before taking vitamin C or any other type of supplement).

Additional dietary factors that enhance non-heme iron absorption include alcohol.

Sugar and foods containing high levels of sugar (such as processed foods, cereal, fruits high in sugar and blackstrap molasses) should be avoided because these foods are known to boost iron absorption.

Cooking Tips

People with hemochromatosis should not slow cook food in an iron (cast iron) skillet. Some of the iron in iron skillets gets absorbed into the food, particularly when cooking in the skillet for a long duration. Studies have shown that acidic foods (such as tomato sauce) that were water-based, when cooked in an iron skillet, increased the amount of iron in the food/tomato sauce as well as in the study participants.

Modifications

Overall, the hemochromatosis diet is a healthy eating plan. It does not require any modifications for those who have disorders such as cardiac (heart) disease, diabetes (other than the usual interventions such as eating moderate portions at regular mealtimes) or even for vegetarians or vegans. In fact, those who don’t eat meat tend to naturally have lower iron levels as well as a low incidence of hemochromatosis, according to Vegan Health.org.

Considerations

Miscellaneous considerations for people on the hemochromatosis diet include:

  • Eat plenty of fiber-rich meals (fiber is known to impede iron absorption).
  • Drink black tea with meals; this is recommended because the tannins in black tea help lower iron absorption.
  • Maintain close medical supervision, making sure to have frequent lab work to ensure iron levels are within normal limits (because iron levels can drop as a result of a long-term diet restricting iron intake)

Dietary Restrictions

People with hereditary hemochromatosis should avoid raw shellfish because it can contain a type of bacteria—called Vibrio vulnificus—which is known to be fatal in those with high iron levels.

Tobacco products and smoking cessation gums and patches may increase iron levels in the blood; smoking and the use of nicotine-containing products should be avoided.

A Word From Verywell

Although there have been studies showing that foods such as those containing beta carotene may increase iron absorption, most experts advise that people with hemochromatosis should eat plenty of fresh fruits and vegetables which contain a high level of fiber and antioxidants—inhibiting free radical production. Excess iron in the body causes an overproduction of free radicals, which in turn, causes injury to the body’s organs.

Foods such as spinach are thought to be high in iron and although many people assume spinach is high in iron and should be avoided, it contains oxalates which impair absorption of the iron contained in spinach. Most fresh fruits and vegetables are allowed on the hemochromatosis diet, because they have non-heme iron, which is not well absorbed by the body.

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Article Sources

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