What to Eat When You Have Iron Deficiency Anemia

Dietary Recommendations for Better Management

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Dark green leafy vegetables are a good source of iron. Martin Barraud/ GettyImages

Anemia is a medical term that means your body doesn’t have enough red blood cells. One of the most common types of anemia is caused by iron deficiency, which may happen if you don't get enough iron from the food you eat or if your body can't absorb it well. The anemia diet focuses on foods that can help correct and prevent iron deficiency while avoiding those that can inhibit iron absorption.

The recommended iron intake for most adults is 7-18 grams per day. If you follow a plant-based diet, have certain health conditions, or are pregnant, you may need to adjust your iron intake. 

Benefits

If you're anemic because of an iron deficiency, your doctor will likely have you start by making changes to your diet. Research has shown diet can be an effective route to manage iron deficiency anemia.

Your doctor may encourage you to try the anemia diet before other treatments, as it often helps a mild deficiency and doesn't have the side effects of oral iron supplements.

Eating more iron-rich foods is a good starting point even if you developed iron deficiency anemia for reasons aside from your eating habits. It may not be the only factor contributing to anemia, but your diet is one you can have some control over by choosing foods that are good sources of iron and avoiding those that inhibit iron absorption.

How It Works

There are two different types of iron. If you're following an anemia diet, you will need a mix of different foods to get adequate amounts of both types. Red meat is a rich source of heme iron. Non-heme iron is found in plants. While you need both, your body tends to have an easier time absorbing heme iron.

An anemia diet focuses on iron-rich foods as well as those that are good sources of other nutrients, including vitamin C, vitamin B12, and folic acid, that help your body absorb iron. It also discourages the consumption of some foods and beverages that impede iron absorption.

Eating an anemia diet can help correct a mild iron deficiency, but you may need to take an oral iron supplement as well. If these interventions are not enough, your doctor may recommend additional treatment.

While you can purchase many supplements over-the-counter or as part of a multivitamin preparation, talk to your doctor before you start taking iron pills.

Duration

Anemia can be a short-term problem that happens if your body is under stress from an illness, injury, or surgery. Your doctor may advise you to eat more iron-rich foods and/or take a supplement but not recommend any other treatment.

Once your levels are back to normal, you may not have to eat as much iron-rich food or keep taking iron supplements. However, if your doctor thinks you're at risk for becoming anemic again, they may tell you to stick to the changes you've made to your diet or continue to take supplements even after your iron levels improve.

Chronic anemia usually means you have to make permanent dietary changes to keep your iron levels up. Your doctor may recommend you eat red meat a few times a week or take an oral iron supplement every day as part of your normal routine.

If your body is destroying red blood cells, cannot absorb the iron from food, or is not storing iron, your doctor may prescribe other treatments. If you have a critically low level of iron, such as after an injury or surgery that caused a lot of bleeding, you may need a blood transfusion to restore it.

Once the medical crisis has passed, if your body is still unable to maintain normal iron levels—even with oral supplements and dietary changes—you may need to receive regular intravenous (IV) iron infusions.  

What to Eat

Iron is naturally present in some foods, such as red meat. Other types of food have iron added to them when they are manufactured. In the United States, about half of the iron people get from their diet comes from iron-fortified foods.

As you’re planning your meals, you can choose from a mix of naturally iron-rich options as well as iron-fortified grains, such as cereal. 

Compliant Foods

  • Beef

  • Liver

  • Tuna

  • Poultry

  • Sardines

  • Pork

  • Kidney beans, lentils

  • Oysters

  • Cashews, pistachios

  • Chickpeas

  • Sweet potato

  • Tofu, soybeans

  • Raisins, dried fruit

  • Dark leafy greens

  • Tomatoes

  • Citrus fruits

  • Bok choy

  • Bell peppers

  • Pumpkin or pumpkin seeds (pepitas)

  • Iron-fortified bread, flour, cereal, and pasta

  • Black-strap molasses

Non-Compliant Foods

  • Coffee

  • Tea

  • Wine

  • Herbs and spices

  • Milk, yogurt, cheese

  • Eggs

  • Peppermint

  • Apples

  • Walnuts

  • Almonds

  • Rhubarb

  • Wheat/gluten

  • Brown rice

  • Barley, rye, oats

  • Peanuts

  • Parsley

  • Chocolate/cocoa

  • Raspberries

  • Sesame

  • Blueberries

  • Blackberries

  • Soda

Fruits and vegetables: Dark leafy greens—such as spinach, Swiss chard, and kale—are natural sources of non-heme iron, as are peas, string beans, Brussels sprouts, and sweet potatoes. Figs, dates, and raisins are a good source of iron, as are other dried fruits like apricots. In addition, some options—especially citrus—are particularly in vitamin C, which can help lessen the negative effects of phytates—compounds that reduce iron absorption.

Grains: Whole grain bread, cereal, and pasta are high in phytates, which can inhibit iron absorption. However, these foods (and the flour used to make them) are often fortified with iron. 

Dairy: In general, dairy products aren’t naturally good sources of iron, though milk is often fortified. If you eat a diet high in calcium, it may affect your body’s ability to absorb iron. (This is especially true for infants and young children, who may drink a lot of cow's milk.)

However, your body does need some calcium for several critical functions, including bone health. Your doctor may tell you to avoid eating cheese or yogurt, as well as drinking milk, with your iron supplement or as part of an iron-rich meal.

Proteins: Meat (especially beef, veal, and liver) can provide heme iron in your diet. If you follow a pescatarian diet many types of seafood and shellfish are good sources of iron, especially oysters, tuna, and sardines. If you do not eat animal products, soybeans and tofu can be iron-rich protein sources for plant-based diets. 

Nuts, beans, and legumes are high in phytates, but these foods are also good sources of folate, which can improve iron absorption. Pistachios are an iron-rich snack that isn't as high in calories as other nuts. While eggs are a good source of protein and do contain some iron, they also can inhibit iron absorption—especially when the yoke is included.

Dessert: Maple syrup, honey, corn syrup, and black-strap molasses are sweet iron sources that can be used for baking. Adding dark chocolate, dried fruits, raisins, or nuts to cookies or cakes can add a little iron as well. 

Beverages: Coffee, tea, and wine contain polyphenols, which can inhibit iron absorption. You may want to limit your intake of these drinks altogether, or at least avoid having these beverages with an iron-rich meal.

Recommended Timing

The anemia diet doesn't call for following a specific schedule or number of meals. Rather, it's important to consider when you eat certain foods, as some combinations can impact iron absorption—for better or for worse.

For example, one study looked at individual meals to assess iron absorption when different foods were combined. The study showed the body can absorb 2.5 times more non-heme iron from a meal when it also has heme-containing meat.

The same study also found that the body’s ability to absorb iron may be reduced by half when the meal contains 165 milligrams of calcium (about as much as a slice of cheese). That said, other researchers looked at many different studies that took place over a long period of time and didn’t find that calcium had a major impact on iron absorption.

Beverages that contain polyphenols or tannins, such as coffee and tea, may make it harder for your body to absorb iron if you drink them at the same time as you eat. The effect may be lessened by having these beverages between meals instead of with them.

Certain medications can make it harder for your body to absorb iron, while others may become less effective when they interact with the mineral. Follow your doctor's instructions as to when to take any drugs you've been prescribed when following an anemia diet. For example, you may be told to wait at least two hours after eating an iron-rich meal to take your thyroid medication.

Cooking Tips

Because of the risk of impacting iron absorption when combining certain foods, you need to take care when planning and preparing meals. For example, if a non-compliant food is part of a recipe, consider ingredient alternatives.

Rethink pairings, too. For example, to promote better iron absorption, try topping a salad with sliced steak, which may help your body fully absorb the iron found in spinach. If you’re having iron-fortified cereal for breakfast, avoid drinking your morning coffee or tea while you’re eating.

These tips may boost the iron content of your meal:

  • Choose cookware wisely: Some research has shown that cooking meat or vegetables in a cast iron skillet can help boost its iron content.
  • Reduce cooking time: To the extent you're able (without compromising food safety), aim to cook food for as short a time as possible to maintain its nutritional benefits.
  • Add citrus: Citric acid can boost your body's iron uptake. Try drizzling a little lemon juice on your grilled fish before digging in.

Modifications 

While red meat is a good source of iron, if you have certain health conditions or risks factors you may not want to eat it every day. Ask your doctor how many times a week you should aim to include meat in your diet. 

If you are limiting dairy products to improve your body’s absorption of iron, you may be at risk for developing low levels of calcium. Your doctor may want to test your bone mass (density) if you are at increased risk for developing osteoporosis

Considerations

Changing how you eat can affect other areas of your life. Before you get started, you’ll want to think about how the changes you’re making to your diet and lifestyle may affect (or be affected by) your day to day routine at school or work and at home. 

For example, if you do the food shopping and prepare meals for your family, you’ll want to think about how these responsibilities might influence the changes you make (and the other way around!). 

General Nutrition

If you need to add more iron-rich foods to your diet, you will likely be eating the kinds of foods that will provide more overall nutrition. Not only are leafy greens a rich source of iron, but they’re also packed with vitamins K and A, potassium, and fiber. 

Red meat is a rich source of iron and protein, but it can also be a high cholesterol choice. In moderation, lean cuts of beef can be an important part of an anemia diet, especially if you use low-fat cooking methods and limit salty extras like steak sauce.

Safety

If you’re consuming too much iron, either through diet, supplements, or both, you may be at risk for iron overload. Rarely, an overdose of oral iron supplements has lead to toxicity. This is more likely to occur if children eat iron pills meant for adults. If you take iron supplements, make sure they are safely stored out of reach. 

Your body can also have too much iron due to a medical condition. In hereditary hemochromatosis, genetic changes cause your body to be unable to regulate how much iron is in your blood.

It's also possible for a person to have another form of the condition, secondary or acquired hemochromatosis, if they take high doses of iron, have alcoholic liver disease, or receive multiple blood transfusions.

If you have too much iron in your body, your doctor may want you to periodically have blood taken (therapeutic phlebotomy). However, this treatment is mostly used for people who experience iron overload as a result of hemochromatosis or another medical condition.

While you’re taking iron or vitamin supplements, alert your doctor if you experience any signs or symptoms of iron overload or hemochromatosis, such as:

  • Joint pain
  • Chronic fatigue
  • Bronze-colored skin
  • Erectile dysfunction and infertility

Flexibility

When you’re shopping and cooking for yourself, you can make sure to add more iron-rich foods to your diet. As long as you know which foods are good sources of iron, you can also keep up your iron-boosting habits when dining out.

These days, most restaurants are accommodating when it comes to adjusting dishes for dietary reasons, so ask about suitable substitutions if necessary. You can also consider creating your own iron-packed meal by ordering several items a la carte, rather than an off-the-menu dish.

Dietary Restrictions

If you eat a special diet to manage a health condition, you may need to make adjustments if you are iron deficient. Certain medical conditions that affect your body’s ability to absorb nutrients, such as inflammatory bowel disease, can lead to iron deficiency. 

If you need to avoid specific food allergens (like gluten if you have Celiac disease), eating a limited diet can make it harder for you to get all the nutrition you need. You may find it helpful to work with a registered dietician or nutritionist to identify your nutritional needs are and create meal plans that will meet them. 

If you are deficient in iron but are unable to make changes to your diet, your doctor may prescribe supplements for you instead.

Support and Community

It’s important to have social support whenever you’re making changes, especially if they involve your diet and lifestyle. If you have iron deficiency anemia, you may be changing how you eat and receiving other treatment, especially if you have an underlying medical condition. 

Talking to others who are familiar with the experience can be helpful, especially if you are feeling frustrated or need more ideas for how to follow an anemia diet.

Look for in-person or online support groups, especially those run by and for patients who have the same medical condition you do. You might also find networks to join on social media. 

A Word From Verywell

If you are anemic due to iron deficiency, you may need to make changes to your diet. Eating more iron-rich foods or limiting foods that can inhibit iron absorption are two strategies your doctor may suggest. You may need to take iron supplements or supplement other vitamins and minerals that help your body use iron, such as folic acid, vitamin B12, and vitamin C.

If you have certain medical conditions or risk factors, such as being pregnant, menstruating regularly, eating a vegan or vegetarian diet, or have Celiac disease, you may be more likely to become anemic. If your anemia is severe or doesn’t respond to changes in your diet, you may need to have a blood transfusion or receive infusions of iron to restore your body’s levels to normal.

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