Making Dietary Choices When You Have Hemochromatosis
In a diet for iron overload, it is important to understand which foods you should pay the most attention.
The two forms of dietary iron are Heme Iron and Non-Heme Iron:
- Heme iron is found only in meat, poultry, seafood, and fish, so heme iron is the type of iron that comes from animal proteins in our diet.
- Non-heme iron, by contrast, is found in plant-based foods like grains, beans, vegetables, fruits, nuts, and seeds. But don’t make the mistake of assuming it’s only in plants. Non-heme iron is also found in animal products such as eggs or milk/dairy and it is also comprises more than half the iron contained in animal meat.
Another way to think about Heme vs Non-Heme is by categories of foods:
- Animal meat is a combination of heme and non-heme.
- Dairy and eggs are non-heme.
- Plant foods are non-heme only.
The way our body absorbs these two types of iron is very different:
Heme iron is more easily absorbed and is therefore a large source of dietary iron for people both with and without hemochromatosis.
Non-heme iron is usually less readily absorbed than heme iron. Especially in people without hemochromatosis, non-heme iron tends not to be a big source of dietary iron. This, of course, is going to be different in those with hemochromatosis, which I will explain more in a minute.
Why does any of this matter?
Our bodies absorb the iron from animal-based protein (heme iron) better than the iron from plant-based protein (non-heme).
This is one reason why a vegetarian (without hemochromatosis) is more at risk to develop iron-deficiency anemia than people who eat meat; the exclusively non-heme iron found in plants just isn’t as available to our bodies as heme iron is. People who eat meat are getting both non-heme and heme iron while vegetarians only get non-heme, even if they include dairy and eggs.
The absorption of non-heme iron in people without hemochromatosis is approximately 5-12% of the iron listed on the nutritional label. This is because during digestion, the body has to alter non-heme iron in order to fully take it in.
Heme iron is a different story. In someone without hemochromatosis, 20-30% of the heme iron they consume is absorbed from a meal.
In hemochromatosis, however, the absorption of heme iron is up to four times greater, meaning 80-100% of heme iron can be absorbed!
The Iron Disorders Institute provides a nice real world example of how this may work. Say you eat a 4 oz hamburger containing 1.2 mg of heme iron. Someone with normal iron absorption might absorb 0.3 mg of heme iron from that burger. But someone with hemochromatosis might absorb the full 1.2 mg. Take that a step further and imagine meal after meal, day after day, year after year. If every hamburger consumed leads to this amount of iron absorption, then it can really add up.
This variation between what a food label states and what our body actually absorbs makes questions like, “How many milligrams of iron should I eat?” such an impossible question to answer. As you’re maybe starting to realize, it’s just not that simple!
How the Type of Iron in Your Food Relates to What to Eat
One study that looked at how the foods we eat with an iron-rich meal impact how our body absorbed the iron discovered that:
Heme iron…is well absorbed and relatively little affected by other foods eaten in the same meal. On the other hand, the absorption of non-heme iron, the major dietary pool, is greatly influenced by meal composition.
Non-heme iron, the iron found in both plant and animal foods, the iron typically viewed as less threatening and less important when it comes to hemochromatosis diet, this very same iron is the one we have the most ability to affect and change by diet.
But when I say affect, I don’t just mean in a good way. The absorption of non-heme iron can be dramatically increased by unknowingly combining it with foods that make its affects WORSE for our situation. For example, certain foods may increase the absorption of non-heme iron from seemingly benign foods such as rice and corn two or threefold- which is the last thing we want.
But on the other hand, that same knowledge can be used to help reduce the iron absorbed from our meals. Knowledge of how food combining impacts non-heme iron absorption is a very powerful tool to have!
In reality, a well-rounded and nutritious diet is likely going to contain both heme and non-heme iron. That’s just a fact, and it’s hard to avoid. Fortunately, many delicious foods and healthful nutrients can be combined to help reduce iron absorption from our meals.
We should be very conscientious to include the nutrients that impair non-heme iron (and one that also impairs heme iron!) absorption as part of our overall diet.
Hemochromatosis Diet Plan
I have spent years researching the most helpful dietary, nutritional, and natural remedies to help assist people with hemochromatosis to eat a healthy and nourishing diet. At first, it seems like there are a lot of “rules” to follow and that eating properly is an overwhelming task. I know, as I’ve been there. What I have sought to do is to create comprehensive, yet practical everyday strategies to simplify the best ways to think about diet for iron overload. As a result, I have written an entire book on a healthy diet plan for hemochromatosis and my wife has written a comprehensive cookbook for hemochromatosis.
These books describe ways to think about heme vs non-heme iron, which special nutrients and foods can protect you, what precautions to take, and which commonly made suggestions may not be the best advice.
Highest Food Sources of Heme Iron
Top 10 Dietary Sources of Heme Iron (Animal-based foods):
|Top 10 Heme Iron Foods||Heme Iron Content (mg per 3 oz serving)|
|3. Chicken Liver||8|
|5. Beef Liver||5.8|
|8. Extra Lean Ground Beef||2.5|
|10. Lamb Chop||2.1|
In a more general sense, the following is a highest-to-lowest list of foods that typically have a high amount of heme iron:
- Beef & chicken liver
- Oysters, clams, mollusks, & mussels
- Canned sardines
- Fish (halibut, haddock, salmon, tuna)
Highest Food Sources of Non-Heme Iron
Top 10 Dietary Sources of Non-Heme Iron (Plant-based foods):
|Top 10 Non-Heme Iron Foods||Serving Size||Non-Heme Iron Content (mg)|
|1. Soybeans (cooked)||1 cup||8.8|
|2. Blackstrap Molasses||2 Tbsp||7.2|
|3. Lentils (cooked)||1 cup||6.6|
|4. Spinach (cooked)||1 cup||6.4|
|5. Tofu||4 ounces||6.4|
|6. Bagel (enriched)||1 medium||6.4|
|7. Chickpeas (cooked)||1 cup||4.7|
|8. Tempeh||1 cup||4.5|
|9. Lima Beans (cooked)||1 cup||4.5|
|10. Black-eyed Peas (cooked)||1 cup||4.3|
In a more general sense, the following is a highest-to-lowest list of foods that typically have a high amount of non-heme iron:
- Spinach (cooked—when RAW, iron is blocked by oxalates!)
- Seeds (pumpkin seeds, sunflower seeds)
- Firm tofu
- Beans & lentils (chickpeas / garbanzo beans, white beans, red kidney beans, soybeans, black beans, lima)
- Fortified breakfast cereals (for example, Total has 18 mg iron per cup)
- Baked potato with skin (without skin, a potato’s iron is minimal)
- Blackstrap molasses
- Prune juice
- Dried fruits (raisins, apricots, etc.)
- Nuts (cashews, almonds, pistachio, etc.)
We all have to eat, and many nutritious foods contain iron in them, therefore it is important to understand heme iron vs non-heme iron so we can make the best choices for our health.
Gain Insight & Learn How to Help Manage Iron Overload
How We Can Help You
Dr. Eric Lewis is a naturopathic physician who also has hereditary hemochromatosis. With his unique perspective of being both a practitioner and a patient, he brings new insight into holistic approaches to iron overload, providing new understanding about the best diet and supplementation strategies to help support health with hemochromatosis.