What to Eat When You Have Hemochromatosis

Dietary Recommendations for Better Management

Hemochromatosis is a genetic disorder that causes an excessive build-up of iron in the body. If left untreated, it can cause severe organ and joint damage and even death.

The hemochromatosis diet enables a person with hemochromatosis to avoid foods that are high in iron as well as those that can increase the absorption of iron. The diet consists of foods that will provide ample protein and other nutrients to maintain optimal health without overloading the body with iron.

Purpose of the Hemochromatosis Diet

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

In normal adults, only around 10% to 30% of the iron that a person eats gets absorbed in the gut. In people with hemochromatosis, a hormone called hepcidin increases the absorption by as much as 400%, leading to iron overload and iron toxicity.

The hemochromatosis diet is used to decrease the intake of heme iron, 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 found in vegetables, fruits, and grains. These foods are considered more beneficial than not. Instead, foods that can increase the absorption of non-heme iron may be limited or avoided.

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, an adequate intake of protein, and a limited amount of red meat, citrus fruits, sugars, and dairy. Whole foods are encouraged whenever possible.

Principles of a Hemochromatosis Diet

While there are no formal guidelines for the hemochromatosis diet, there are guiding principles, namely:

  • The reduction in red meat consumption
  • The avoidance of animal fat and sugar
  • Limitation of vitamin C from all sources
  • The moderate use of alcohol
  • Increased intake of whole grains, rice, and beans
  • The consumption of tea and coffee
  • High intake of fresh fruits and vegetables

By working with a doctor and dietitian, you can formulate how much red meat you can consume on a weekly basis and find alternative sources of protein. The same applies to vitamin C and other dietary nutrients so that a healthy, balanced diet can be maintained irrespective of the iron intake.

Duration

People with hemochromatosis can adhere to the hemochromatosis diet over the long term under the care of a physician. Frequent lab work is required to ensure that iron levels are within normal limits.

Dietary adjustments may be needed if the levels either get too high or too low. If left unmonitored, a hemochromatosis diet can cause iron levels to drop excessively, leading to iron-deficiency anemia and the temporary cessation of the diet.

Because symptoms of anemia can mimic those of hemochromatosis, it's important to see your doctor if you experience extreme fatigue or weakness while on the hemochromatosis diet. Only a blood test can reveal if your iron levels are too high or low.

Never make dietary changes without first consulting your health care 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.

Compliant Foods
  • Yogurt

  • Cheese

  • Poultry

  • Fish (including canned rish)

  • Eggs

  • Nuts and seeds

  • Beans and legumes

  • Tofu

  • Whole grains

  • Broccoli

  • Spinach

  • Figs

  • Rhubarb

  • Apples

  • Avocado

  • Olive oil

  • Black tea

  • Coffee

  • Cocoa

Non-Compliant Foods
  • More than limited amount of red meat

  • More than limited amount of citrus fruits

  • Animal fat

  • Alcohol

  • Sugars

  • Food additives with ferric EDTA or chelated iron

People with hereditary hemochromatosis should also avoid raw shellfish 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 that 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 found in spinach, kale, beets, nuts, chocolate, tea, wheat bran, rhubarb, and strawberries 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 found in walnuts, almonds, dried beans, lentils, cereals, and whole grains also impedes heme iron absorption.
  • Polyphenols: These plant-based chemicals found in coffee, cocoa, peppermint, and apples are a major inhibitor of heme iron absorption.
  • Tannins: These organic compounds found in black tea, grapes, barley, cranberries, and dried fruits bind to iron and aid in its clearance from the body.

Swedish cocoa and leaf teas able to inhibit iron absorption by as much as 90%. One cup of coffee, which is high in tannin and chlorogenic acid, can inhibit absorption by up to 60%.

Foods That Increase Iron Absorption

Red meats are not the only foods to be concerned about when embarking on a hemochromatosis diet. 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 by 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 found in brightly colored foods such as carrots, sweet potatoes, beets, and red and yellow peppers are also thought to promote iron absorption. Even so, their nutritional benefits outweigh the potential risks, and 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 and can even get a metallic taste.

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 doctor 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 doctor or certified dietitian.

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