What to Eat When You Have Hemochromatosis

Hemochromatosis is a genetic disorder that causes too much iron to build up in your body. If it is not properly treated, it can cause severe organ and joint damage and even death.

For most people with hereditary hemochromatosis, adopting a special diet isn't necessary. The American Academy of Family Physicians doesn't currently recommend dietary management of the condition. However, you may want to ask your healthcare provider if the hemochromatosis diet could be right for you.

The hemochromatosis diet restricts foods that are high in iron. It also limits foods that can increase the absorption of iron. When you follow this diet, it's also important to eat foods that provide protein and other nutrients.

This article looks at the hemochromatosis diet, what you should and shouldn't eat on it, and what healthcare providers and scientists say about dietary management of this genetic condition.

Purpose of the Hemochromatosis Diet

Iron is considered an essential nutrient. This is because the body cannot make it. Instead, it must be obtained from food. 

Normally, only around 10% to 13% of the iron that a person eats gets absorbed in the gut. In people with hemochromatosis, however, a hormone called hepcidin is inhibited. This causes as much as a 400% increase in iron absorption. This increase can cause iron overload and toxicity.

The hemochromatosis diet is used to decrease the intake of heme iron. Heme iron is the type of iron most easily absorbed in the gut. Prime sources include red meats and organ meats. Less focus is placed on reducing the intake of non-heme iron. This type of iron is found in more beneficial foods like vegetables, fruits, and grains. Instead, the diet limits or forbids foods that increase the absorption of non-heme iron.

How the Diet Works

The hemochromatosis diet is intended to meet the unique nutritional needs of a person with hemochromatosis. The diet consists of fresh fruits, vegetables, whole grains, and protein from sources that are low in iron. It limits red meat, citrus fruits, sugars, and dairy. Whole foods are encouraged whenever possible.

Work with your healthcare provider and dietitian to determine how much red meat you can eat on a weekly basis. You will also need to find alternative sources of protein.

Vitamin C has been shown to promote iron absorption in the body. For this reason, foods high in vitamin C should be excluded from your diet. Again, your healthcare provider or dietitian can work with you to find foods that can replace other nutrients that you may not get enough of after adopting this diet.

Duration

If you have hemochromatosis, you can adhere to this diet over the long term under the care of a healthcare provider. You will need frequent lab work to ensure your iron levels are within normal limits.

Dietary adjustments may be needed if your levels get too high or too low. Left unmonitored, a hemochromatosis diet can cause iron levels to drop excessively, leading to iron-deficiency anemia. If this happens, you'll need to temporarily stop following the diet.

Because symptoms of anemia can mimic those of hemochromatosis, it's important to see your healthcare provider if you experience these symptoms while on this diet:

• Extreme fatigue
• Weakness

Only a blood test can reveal if your iron levels are too high or low.

Never make dietary changes without first consulting your healthcare provider.

What to Eat

There are foods on the hemochromatosis diet you can eat and others that need to be avoided or limited. Non-compliant foods are those that either deliver too much iron or increase the absorption on heme and/or non-heme iron.

People with hereditary hemochromatosis should also avoid raw shellfish. This is because it contains a type of bacteria called Vibrio vulnificus that is known to be fatal in those with high iron levels.

Foods That Decrease Iron Absorption

There are foods in the hemochromatosis diet that are beneficial because they impede the absorption of iron in the gut. A typical meal would include more of the foods rich in the following compounds:

• Calcium: Calcium found in milk, green leafy vegetables, soy, and oily fish are thought to slow the absorption of iron in the gut. However, it is only at higher doses (around 300 to 600 milligrams) that these foods appear to have a chelating (clearing) effect.
• Phosvitin: Eggs contain a protein called phosvitin. This protein binds to iron and helps clear it from the body. Even though egg yolks are rich in iron, phosvitin helps limit the amount of iron the body absorbs from them.
• Oxalates: These plant-based compounds are found in spinach, kale, beets, nuts, chocolate, tea, wheat bran, rhubarb, and strawberries. They are thought to lower the absorption of non-heme iron. Even though spinach is rich in iron, oxalates appear to limit their absorption.
• Phytate: This stored form of phosphorus is found in walnuts, almonds, dried beans, lentils, cereals, and whole grains. It also impedes heme iron absorption.
• Polyphenols: These plant-based chemicals are found in coffee, cocoa, peppermint, and apples. They are major inhibitors of heme iron absorption.
• Tannins: These organic compounds are found in black tea, grapes, barley, cranberries, and dried fruits. They bind to iron and aid in its clearance from the body.

Foods That Increase Iron Absorption

Red meats are not the only foods to be concerned about. Some otherwise nutritious foods can enhance the absorption and promote iron overload. These include:

• Citrus: Vitamin C is one of the most potent enhancers of non-heme iron absorption. An intake of 100 milligrams (equivalent to two 8-ounce glasses of orange juice) can increase iron absorption fourfold. In addition to citrus, other rich sources of vitamin C include tomatoes, guavas, and red peppers.
• Alcohol: Non-heme iron absorption increases by around 10% when alcohol is added to a meal. Wine and hard liquor appear to have the same effect.
• Sugar: Sugar and foods high in sugars, including high-fructose corn syrup, can boost non-heme iron absorption by as much as 300%.

Beta-carotene is found in brightly colored foods such as carrots, sweet potatoes, beets, and red and yellow peppers. It is also thought to promote iron absorption. Even so, the nutritional benefits of these foods outweigh the potential risks. This is why foods rich in beta-carotene are not excluded from the hemochromatosis diet.

Other Considerations

People with hemochromatosis should not slow cook food in cast iron because some of the iron from pots and skillets can be transferred to food, especially in slow-cooked foods. Tomatoes especially are prone to iron absorption when cooked in cast iron. They can even get a metallic taste.

What the Research Says

There isn't much evidence to support dietary modification for people with hemochromatosis. The iron in iron-fortified foods is considered to have poor bioavailability. This means your body doesn't readily absorb it. And although red meat does contain significant amounts of iron, people with hemochromatosis who adopt vegetarian diets don't seem to have lower iron stores. 

The American Academy of Family Physicians recommends limiting your alcohol intake if you have hereditary hemochromatosis. Beyond this, it doesn't recommend making changes to your diet.

Whatever you decide to do, it is important to first consult your healthcare provider or a dietitian. They can help you decide if a hemochromatosis diet is right for you, and what the best way to follow it might be.

Summary

The hemochromatosis diet focuses on limiting the consumption of foods that are high in heme-iron, such as red meat. Foods that contain non-heme iron can still be eaten, but you should also limit your consumption of foods that help your body absorb iron, such as those rich in vitamin C. Foods that decrease iron absorption, such as coffee and black tea, are encouraged on a hemochromatosis diet.

The American Academy of Family Physicians doesn't currently recommend adopting a hemochromatosis diet. This is because there isn't much evidence that it is beneficial. Either way, make sure to consult a dietitian or your healthcare provider before you make any changes to your diet.

A Word From Verywell

The hemochromatosis diet is neither intended for weight loss nor to be used unsupervised. It requires the regular input of your healthcare provider with routine blood tests to check your iron levels. It should not be used during pregnancy or in anyone who doesn't have hemochromatosis.

If you have other chronic health conditions, like diabetes or heart disease, further adjustments will need to be made to the diet under the direction of a healthcare provider or certified dietitian.