Plant Based Nutrition – Will I Get Anemic?

As a personal trainer I’ve talked with many people and even seen clients struggle with iron-deficiency anemia after adopting a plant based diet. I’ve even had people describe to me how much better they felt eating this way until the issue of anemia arose and they were ‘forced’ to return to red meat. This can be really frustrating for these individuals, and certainly frustrates me upon hearing it – especially when their doctor’s only recommendations tend to be eating more red meat, or taking an iron supplement!

I try to steer anyone who asks about plant-based sources of iron towards the most iron dense foods (my favorite: beans & greens!), but to go into a little more detail here I referenced two of my favorite nutrition books: Nutrition Guide for Clinicians and The Complete Idiot’s Guide to Plant-Based Nutrition. Here’s the gist:

Iron-deficiency anemia occurs when the body’s stores of iron in the liver become depleted, and it no longer has enough iron to make all the red blood cells it needs for optimal oxygen distribution. Some common symptoms of anemia are fatigue, shortness of breath, and frequent bruising. 

Anemia has a whole array of origins, only one of which is nutritional deficiency. The most common cause is actually menstruation in women (women of childbearing age have the highest rate of anemia), as this monthly loss of blood leads to depleted iron stores over time. Pregnancy also greatly increases the risk of anemia, as a woman’s iron needs roughly double during the term. Rapid growth, such as in infants and children, also increases the need for iron and the subsequent risk of deficiency. Other less common causes of anemia are problems that cause internal bleeding such as ulcers and cancers of the colon and esophagus. 

Iron is one of those nutrients many people tend to think only exists in animal products (like vitamin B12, Calcium, and protein), but like these other nutrients, this is far from the case! Many plant foods are great sources of iron, especially leafy green vegetables and legumes (beans & greens)! There is also iron in whole grains, and many grain products are fortified with iron as well.  The iron present in animal products is called heme iron (meaning it is in the same form as in our bodies, because it is in the tissue and residual blood of the animal being eaten) which is absorbed at a flat rate of about 25%. Iron from plant-foods is called non-heme iron, and can be absorbed at a wide variety of rates depending on the needs of your body and conditions with which it is eaten. If you are in need of iron and eat iron containing foods (beans & greens!) along with foods that promote iron absorption, such as fruit, you will have an excellent rate of absorption. 

The take home message on iron/anemia:

Great sources of iron

  • Beans, lentils, and legumes
  • Dark leafy green vegetables
  • Dried fruit (dates, prunes, raisins)
  • Artichokes
  • Potatoes
  • Oats
  • Barbells and Dumbbells! 🙂


Nutrients that improve iron absorption

  • Vitamin C and organic acids (found in fruits and vegetables, citrus, and vinegar)
  • Vitamin A and Carrotenoids (found in brightly colored fruits and vegetables)


Foods that reduce iron absorption

  • Dairy Products (milk, cream, yogurt, cheese, etc)
  • Eggs
  • Tea, coffee and cocoa (when consumed with the iron-containing meal)


An Iron-packed and highly absorbable meal example: Salad! Spinach with raisins, tomatoes, mandarin oranges, chickpeas, shredded carrot, and a vinaigrette dressing. Mmmmmm….


31 thoughts on “Plant Based Nutrition – Will I Get Anemic?”

  1. I have had low ferritin and iron levels for years. Even before going vegan. I had my period for a year which finally made me go to the doctor. Turned out to be hypothyroidism. It can cause ongoing heavy periods. I eventually was put on brand name synthroid and my tsh levels normalized. Recently they went up for the first time in years and my synthroid dose was increased. Periods were lasting a long time and I was getting them frequently. I have also been completely wiped out and fatigued. I’ve been taking high dose iron supplements for several months and my anemia got worse (probably from my cycle). I recently had two iron infusions and feel so much better. I’ve been mostly vegan for several years and more recently gluten free. Admittedly I struggle with compulsion issues so I can’t honestly say I’ve been complete vegan and gluten free. I now take adderall for ADD and that has helped greatly with compulsion issues!! It’s pretty rare I break down anymore. I went gluten free beside I was having all kinds of weird symptoms. Bone pain mostly. When I went GF the pain went away. I think my iron issues are from not absorbing nutrients due to having a crappy diet (even when I thought I was eating well) most of my life. Obviously my thyroid doesn’t help when it’s not working. But my tsh has been “normal” for me (anywhere from .5 to 1.5 I feel good – over 2 and I start to have major symptoms). I’ve not been able to get my ferritin over 23 and that has been going on for years and years before thyroid problems and before going vegan. I truly think all the processed foods and animal products as well as gluten sensitivities (also have soy corn and dairy sensitivities) are the root of the problem. So if someone is suffering from anemia and heavy periods – get thyroid checked (mine was over 3.5 at diagnosis and I had several symptoms – some labs don’t count that as hypo I was lucky mine did – anything over 2.5 was abnormal – since I was diagnosed they have gone back to the .5ish to 5.5 range so I feel fortunate mine was caught at all. And remember it could be a side effect from years of a poor diet as well as gluten and processed junk. My doctor said they like to see a ferritin over 70 at least – I will be getting mine checked again soon. I still feel tired since the infusions – especially right before my period – but I feel 1000000 percent better than I did before – with that and my increased thyroid dose.

  2. I’m looking for information on tackling anemia with a 100% plant-based approach ..perhaps you can provide your resources on this topic. A relative has been fighting anemia for over a year now. He had significant ongoing internal blood loss and the source could not be identified. He was hospitalized and they ran tests after test. The blood loss dissipated for a while but surfaces periodically so he is constantly fighting anemia. His doctor tells him to eat beef a couple times a week. His wife is an excellent, healthy cook and provides tons of plant-based options daily but the beef regime continues. 🙁
    I know you can’t provide specific medical advice and your article is informative but this individual is an 86 year old engineer…fact driven, headstrong and won’t take info unless he recognizes and respects the sources. Thanks so much

    1. Yikes! Thanks for reaching out Sharon. I would definitely call either the True North Health Clinic if you’re near the west coast or the Barnard Medical Center if you’re near the east coast. Both are excellent facilities that use preventative medicine and a plant-based nutrition approach. I hope he finds a healthy solution!

  3. I’m vegan now for 2 months, I eat everything, greens, beans, lentils, chickpeas, oatmeal, fruits, seeds, nuts, tofu, seitan, brown rice, whole wheat pasta,… A week ago I noticed quite severe breathing problems after eating a meal with tofu and mixed nuts, almost astma attack like. sometimes I feel really gassy and bloated, I ingest close to 90 grams of fiber a day. The past week I couldn’t sleep, I fell asleep around 6 o’clock in the morning, while going to bed at 23 o’clock, it’s mainly shortness of breath, constantly gasping for air, and my blood pressure is really low. It really bothers me, since I really like the diet and lifestyle. When I was omnivor I had severe artritis symptoms in my feet, they went away completely on the vegan diet. So for me it’s really fucked up, it’s like choosing between breathing problems or artritis :/.

    1. Hi Will. I’m very sorry to hear that. It sounds like you have a specific and potentially dangerous food allergy. We recommend having a consultation with a medical practice that understands plant-based nutrition such as the True North clinic or PCRM’s facility in Washington DC.

  4. Hey guys ;). Well i made the switch from lacto-ovo vegetarian to vegan now (2mths ago)and still feeling great. I knew i would. Still enjoying weights and have my 1st ever marathon in 2wks – wish me luck *i’ll need iron for that haha 🙂

  5. Anemia is the most common disorder of the blood. The several kinds of anemia are produced by a variety of underlying causes. It can be classified in a variety of ways, based on the morphology of RBCs, underlying etiologic mechanisms, and discernible clinical spectra, to mention a few. The three main classes include excessive blood loss (acutely such as a hemorrhage or chronically through low-volume loss), excessive blood cell destruction (hemolysis) or deficient red blood cell production (ineffective hematopoiesis).’`^^

    See you in a bit

  6. Hi. Everyone was telling me my iron levels were gunna be too low. I ate lacto ovo vegetarian for 11months (limited dairy and eggs) but could still do a 31km 3/4 marathon and still keep up my weight training. Felt great. Yet I had unhealthy people eating whatever they wanted telling me this haha. I did slip up and reintroduce meat/anything i wanted diet for only 4months but didnt feel the move was what i deeply believed in and wanted. Im now back to pescatarian at least but im talking 1x per week eating fish not 3 serves a day etc. The switch to vegetarian I think will be one over a period of time. Cheers,

  7. My girlfriend and I follow plant-based diet. She suffered from low blood-iron for a long time, but, when last tested, was told that her levels are too high! Because of all the broccoli she eats. She actually has to cut down lol

  8. generic “cheerios” and “frosted wheat” also high in iron. Vitamin C helps absorb iron but must be consumed in the same meal as the high iron foods. Potassium can help reduce the amount of iron excreted in urine, and copper helps the body utilize iron. Sesame seeds are high in copper. IMO, a breakfast of high iron cereal, a glass of calcium & vitamin D fortified OJ with two tbsp. of utritional yeast, and a banana will start your day of good.

      1. Thanks Taylor for the link! i kept thinking all day what is the B12 food? my friend and i were discussing this and he continued to say ‘no non-animal can provide B12’ THANKS for this!

  9. What about vitamin B12? It is said to be a real tough obstacle for those who wish to live based on plants only. And, somehow, personally, I don’t like the idea of ‘supplements’.

    1. Interestingly, B12 is not naturally present in animal flesh. Farm animals are injected with B12 supplements and are in turn eaten by people, so your choice is really between supplementing first or second hand.

      This blog post has some details and an amusing perspective, too.

  10. After 2 years of 80/10/10 raw vegan diet I have sever iron deficiency that is causing me heart problems. I guess the diet is not working for everyone. And yes, I did everything by the book. I am aloso deficient in B12 and my HDL is way too low. I am changing my diet.

    1. I understand your frustration.

      I believe that our ancestors, (and monkeys) ate far more leafy greens than us, making the bulk of the diet, which are super rich in iron and other minerals/vitamins/amino acids.

      Therefore, 80/10/10 can be dangerous if you ‘only’ eat fruit and include ‘small’ amount of leafy greens.

      I would recommend you add red split lentils to your diet.. Super high in minerals/vitamins/protein and easy to digest. As its not easy, or affordable in the 21st century to eat so many greens.

      Also, be careful not to pay too much attention to the ‘standard’ deficiency ‘levels’ as in a nutritionally distorted, sick world, the ‘norm’ in regards to minerals in the blood is quite often not a true guide to health…

    2. I have the same problem! I Was veg for 6 years on and off vegan for 1 year. I started having all sorts of health problems. I used Vega sport for a good year and noticed a tremendous change in my body. But still with blood tests my iron, HDL and B12 were still very low. I even started losing hair and sleep :(…I have changed my diet but with a conscious outlook.

  11. Adding lemon to dark leafy greens helps to make the iron more bio-available in the body. Also, don’t forget beets. I’d recommend juicing the dark leafy greens with the lemon & a half a beet..awesome way to get your iron! 🙂

  12. Great post. Many people asked about iron deficiency , and they are vegan or want to go vegan. They only believe that red meat is the only source of iron and they want to take different supplement. But the true is that all the nutrition is lies in the nature and we should eat more and more vegetables to get planet in a shape.

  13. Great post!! I am a new vegan but I am low in iron. This is a great list of foods that I now know I need to increase (because I’m not going back to eating animals). Thank you so much!

  14. I love the “so if you don’t eat meat, how do you get everything you need in your diet?” attitude.

    It’s so weird. I mean how can you ask someone who eats healthy food all day long how they get their nutrition. I am 32 and have a 6 pack and no fat and I sit at a computer most of the day. I don’t work out, although I do alot of walking.

    Most of these people think that fast food is an ‘ok’ filler if you “have to eat”. It’s amazing how they have no idea at all about nutrition.

    They think nutrition-devoid meat is good for you. Meat takes forever to break down and increases the PH of your entire digestive system, thus destroying valuable nutrients in a acid bath.

    Why because it has protein? Animal protein. They have no idea that animal proteins, fats and toxins are not good for you. When you eat the factory farmed animal, who spent its life sick and pumped full of drugs to keep it alive, you in turn get all those toxins in your body. The average North American consumes over 130 grams of protein a day. That’s multiple times the natural amount of protein that your body is developed to consume, requiring additional work by the kidneys to expel.

  15. Great article. My daughter and I are both vegetarians (more vegan everday). We both just had our blood work done and the results are excellent. So many people ask me everyday (where do you get your protein, iron etc.). After cooking with lots of fresh fruits, vegetables, grains, beans, seeds etc. it is not difficult to get all the vitamins and minerals you need each day to thrive. Thanks for posting your article and your blog.

      1. Wait a couple of years after…what? I’ve already been vegan for 12 years and Derek has been vegan for 5 and we both have always tested with excellent iron levels – I even had above average iron levels while pregnant. Additionally, your results reflect your current diet…it doesn’t take years for your diet to influence your iron levels.

  16. Black strap Molasses also has a lot of Iron. That is why licorice made with it is my “not so guilty” treat.

  17. Great post. My wife and I were just discussing this. Plant based living has actually improved her monthly flow situation. They used to be very heavy :/ The Drs used to warn her of borderline anemia. I’ll be sharing this article with her 🙂

  18. You got me for one second with the “barbells and dumbbells” as a source of iron. Good info. I have very high body fat but normal weight probably needing to hit the iron. I just tried a green shake to day with Kale and banana as the base. It was really delicious.

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