What to Eat When You Have Iron Deficiency Anemia

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 to 18 grams (g) 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 healthcare provider will likely have you start by making changes to your diet. Research has shown that diet can be an effective route to manage iron deficiency anemia.

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

Eating more iron-rich foods (and avoiding those that inhibit iron absorption) 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 your anemia, it is one you can have some control over.

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.

Duration

Anemia can be a short-term problem that happens if your body is under stress from an illness, injury, or surgery. Your healthcare provider may advise that you 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 be able to go back to your normal way of eating. However, if your healthcare provider thinks you're at risk for becoming anemic again, they may tell you to stick to the diet changes you've made 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 healthcare provider 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.

There are some cases, however, when diet (and supplementation) is not enough. If your iron level is critically low (e.g., after an injury resulting in substantial blood loss) or you cannot absorb/store iron from food, your healthcare provider may prescribe other treatments including a blood transfusion or regular intravenous (IV) iron infusions.  

What to Eat

Iron is naturally present in some foods, such as red meat. Others have iron added to them when they are manufactured. In fact, 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. 

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 high in vitamin C, which can help lessen the negative effects of phytates—compounds that reduce iron absorption.

Grains: Whole grain breads, cereals, and pastas are high in phytates. 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 healthcare provider 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. 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 yolk 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 them 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 includes 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 (mg) 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.

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 healthcare provider 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 healthcare provider may want to test your bone mass (density) if you are at increased risk for developing osteoporosis. 

Considerations

Modifying how you eat can affect other areas of your life and other aspects of your health.

General Nutrition

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

On the other hand, 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 led to toxicity. However, this is more likely to occur if children swallow 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 hereditary hemochromatosis. This involves genetic changes that cause your body to be unable to regulate how much iron is in your blood. While you may start an anemia diet because your iron levels are too low, hereditary hemochromatosis can cause your levels to then become too high.

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.

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

• Joint pain
• Chronic fatigue
• Bronze-colored skin
• Erectile dysfunction
• Fertility issues

Flexibility

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 à 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 dietitian to identify what your nutritional needs are and create meal plans that will meet them. 

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 healthcare provider 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.