Heads up! I’m NOT a doctor or nutritionist. I’m not giving you any medical advice or dietary recommendations here. Check with your doctor before you make any changes to your lifestyle, diet, or supplement regimen.
When you have hemochromatosis, you depend on two things to stay healthy and to keep your iron-levels normal.
The first is phlebotomy, aka bloodletting.
Bloodletting is the best way (that we currently know of) to remove iron from the body.
The second is diet.
The less iron you eat, the less time you'll spend at the doctor's office. As well as saving you from extra phlebotomies, a healthy, anti-inflammatory, and low-iron diet creates positive results for your liver, heart, and pancreas - three of the organs most affected by iron overload. All three of these organs can become damaged and diseased if you don't choose what you eat carefully.
Unfortunately for anyone with hemochromatosis, a good ol' standard American diet consisting of foods like cereal, orange juice, toast, muffins, burgers, potatoes, spaghetti, calamari, steak, and beer, could steer you toward some dangerous side effects of hemochromatosis such as diabetes, arthritis, or cancer.
So, how do you master the hemochromatosis diet?
You'll need to take into consideration...
- your current iron levels:
- serum iron
- ferritin
- transferrin
- total iron binding capacity/unbound iron binding capacity
- how fast you tend to absorb iron:
- this usually comes down to your genes...
- do you have two copies of C282Y? (you tend to absorb iron fastest)
- or do you have different mutations? (usually not quite as fast)
- this usually comes down to your genes...
- how healthy your joints, organs, and body systems are:
- do you have diabetes already?
- are you liver enzymes off?
- do you have other health issues?
These factors will determine just how strict you need to be with your diet.
Your iron levels might be doing great so you can bend the rules.
Or, your iron levels might be higher than you want, so it's time to get out the pen and paper. Take notes and tape them to your cupboard!
Here's a list of foods that anyone and everyone with hemochromatosis needs to be careful consuming.
Some of the foods on this list simply need to be eaten at a different time than when you consume foods with iron. Other foods on this list are best just left alone.
And, of course, always check with your doctor before making any changes to your diet.
1. iron supplements
You might think this is a no-brainer. Even though it's obvious, it's easy to forget to check your current supplement list! Perhaps you've been taking the same vitamins for years and it hasn't even crossed your mind to look at the nutritional labels since the time you got diagnosed with hemochromatosis. If you take vitamins or supplements, re-read your labels to make sure they don't contain iron!
One of the most important supplements to check is your daily multivitamin.
For men, this generally isn't a problem. Usually, men's multivitamins don't contain any iron.
However, if you're a woman, go find your multivitamin bottle and give the label a good scan! Multivitamins targeted at women ages 18 to 40 almost always contain iron. Fortunately, if you still want to take a multivitamin to get all your other daily nutrients, the ones for women in their 40s, 50s, and older are normally iron free.
SUMMARY
Check your vitamins and supplements to make sure they're iron-free. Find alternatives if needed.
2. iron-fortified/iron-enriched foods
Whenever possible, avoid foods that have iron added to them. Food manufacturers add iron to foods either through fortification or enrichment.
The difference?
Fortified foods have extra nutrients added. These nutrients don't occur naturally in the original food (or they occur in very small amounts). The food is boosted up with extra stuff to make it more nutritious than it would be on its own.
For example, if you go check out the cereal aisle in the grocery store, you'll notice plenty of fortified cereals. You'll know they're fortified when you read the ingredient list and you see that vitamins and minerals have been added. Looking at the ingredient list for Malt-O-Meal cereal, we can see that it's been fortified with calcium, iron, several B vitamins, and folic acid.
If you see any of the following words - iron, ferric, ferris, fe, or words that contain the letters "fe" like Ferrochel - then you know the food has iron added to it.
Fortified foods are different from enriched foods . Enriched foods lose their naturally occurring nutrients during the manufacturing process so the food manufacturer replaces those nutrients. Sometimes, even if the nutrients aren't lost, the food manufacturer simply wants to add more of the naturally occurring nutrients into the food. Breads, flours, and pastas are often enriched with iron. For example, if you read the ingredient list on a loaf of bread you're buying, you might see the words "enriched flour." This means iron has been added to the flour along with a handful of other vitamins and minerals.
Either way, avoiding foods that have iron added into them (whether through enrichment or fortification) is ideal.
SUMMARY
Iron enrichment/fortification is common in a lot of packaged and pre-made foods. Always check the label to see if iron has been added! Make sure you're eating non-enriched/non-fortified.
3. alcohol
Straight up, here's what you need to know: Alcohol enhances the absorption of iron in anyone with hemochromatosis.
Alcohol also increases the body's iron storage - so anytime you drink, not only do you absorb more iron, but you store more iron away as well.
Studies show that people with hemochromatosis who drink the equivalent of 60 g of alcohol per day (that's equivalent to two and a half glasses of wine, or about three beers) are 9 times more likely to develop cirrhosis of the liver than those who drink less.
9 times!
And yes, there are benefits to drinking one glass of red wine daily. Red wine is different than other types of alcohol. That's because the tannins in wine actually block iron absorption (a little bit).
But any amount over one glass can do more damage than good.
Alcohol creates free radicals that damage cells, cause inflammation, and stop our organs from working properly. This free radical damage leads to liver disease and even cancer. The National Cancer Institute has actually identified alcohol as a carcinogen.
Too much iron also causes free radicals and is also a cause of cancer.
Don't increase your chances two-fold by having iron overload AND being boozy.
SUMMARY
Steer clear of alcohol. If you're going to drink, choose red wine - and drink moderately.
4. raw seafood and shellfish
I choose to stay away from eating fish and seafood for a number of reasons, but if you do eat seafood, then you should know this:
Raw seafood contains a dangerous type of bacteria called Vibrio Vulnificus. It's a type of bacteria that multiplies and flourishes in an "iron rich environment" so a person with hemochromatosis is pretty close to its dream destination.
If this bacteria finds its way into your bloodstream, it can cause serious and deadly infection with a 50% mortality rate in people with hemochromatosis. That's why the doctors advise anyone with hemochromatosis to stay away from raw seafood and shellfish.
Next time you and your friends go out to eat, steer clear of the sushi restaurant or oyster bar.
SUMMARY
No raw seafood or shellfish unless you want to risk contracting the Vibrio vulnificus infection which has a 50% mortality rate in people with hemochromatosis.
5. meat
Meat is the only food that contains the type of iron known as heme iron.
Heme iron is much easier for your body to absorb than its counterpart non-heme iron. Unlike "normal" people who absorb 15-35% of heme iron, people with hemochromatosis absorb 80-100% of heme iron, according to Dr. Eric Lewis and The Iron Disorders Institute.
Meat is made up of about half heme iron and half non-heme iron, whereas plant-based foods are made up of only non-heme iron.
What does that mean for you?
Anytime you eat meat you'll absorb more iron than if you ate the same amount of iron from plant-based foods.
Another downside of eating meat is the "Animal Protein Factor," also called the MFP factor (MFP stands for Meat-Fish-Poultry).
Animal protein from meat, fish, and poultry triggers your body to absorb more iron - including more non-heme iron from plants - than it normally would.
Imagine making yourself a vegetarian soup vs. meat soup.
VEGETARIAN
As someone with hemochromatosis, you'll absorb around 20-30% of the non-heme iron from the veggies, and the rest will pass through.
MEAT
You'll absorb 80-100% of the heme iron in the meat. Because of the "Animal Protein Factor," you'll end up absorbing more than the usual 20-30% of non-heme iron that's also found in the meat, as well as more non-heme iron from the veggies than you'd absorb from the vegetarian soup.
On top of the obvious drawback of causing you to absorb more iron, heme iron creates inflammation in the body and is linked to cancer.
According to Dr. Michelle McMacken, "heme iron is a prooxidant molecule that can form carcinogens and cause DNA damage, oxidative stress, & inflammation."
In a study of more than 500,000 adults, heme iron was linked to death from 9 different causes.
SUMMARY
A person with hemochromatosis absorbs a lot more heme iron from meat (80-100%) than non-heme iron from plant-based foods (20-30%). Heme iron in meat is tied to inflammation, cancer, and death. Meat also prompts your body to take in extra iron from other foods because of the Animal Protein Factor.
6. animal fat
According to the Iron Disorders Institute and The Haemochromatosis Society, animal fat in combination with iron creates free radicals, which damage our bodies and our DNA, leading to damaged tissues, organs, and diseases like diabetes and cancer.
For example, eating a piece of steak may trigger a chain reaction creating free radical damage because of the highly absorbable iron in the red meat paired with the fat found in the meat.
Another example is eating iron-rich food with butter. The high iron content in the food combined with the animal fat in butter may create an environment where free radicals can multiply and cause damage to your body.
What about fats like oils? Aren't those healthy?
Certain oils like extra virgin olive oil, coconut oil, avocado oil, walnut oil, and flaxseed oil can be healthy because they contain antioxidants, polyphenols, and other nutrients that are actually beneficial for hemochromatosis.
But only if you're eating high quality oils. Unfortunately, many oils sitting on grocery store shelves have been processed in a way that they lose their nutrients, and may even be completely rancid. If an oil is rancid, it will cause free radical damage in your body. Make sure you buy from reputable brands, and look for certifications that show the company is held up to standards!
SUMMARY
Free radical damage is one of the most common side effects of hemochromatosis, so you have to be extra careful to avoid it. One of the ways you can do that is to avoid animal fat. Instead, try to eat high quality oils.
7. fructose
Too much sugar in ANYBODY can lead to inflammation, premature aging, and a weakened immune system, not to mention bloating and a belly. Sugar is a big factor in causing heart and liver disease.
People with hemochromatosis are already at risk for all of these things, especially heart and liver disease, so sugar only makes things worse!
One type of sugar in particular can lead to even bigger problems for people with hemochromatosis - fructose. Fructose is linked to higher iron stores.
In one study, people who took an iron supplement in combination with fructose had up to three times higher iron stores than those who took the same supplement without fructose, according to the Iron Disorders Institute.
Fructose actually changes the structure of iron molecules, making them more bioavailable, meaning they're easier to absorb.
Where is fructose most commonly found?
FRUIT
This doesn't mean you shouldn't eat fruit! Fruit is an important part of your diet - loaded with antioxidants, polyphenols, and nutrients that are beneficial for hemochromatosis and incredibly important for living a long and healthy life. The trick is to avoid eating too much fruit (and fruit juices) when you're also eating foods high in iron. You can also incorporate more low-fructose fruits into your diet - like bananas and blueberries.
HIGH FRUCTOSE CORN SYRUP
You've probably heard of high fructose corn syrup, commonly used in foods like sodas, candy, sweetened yogurt, muffins, cookies, frozen dinners, granola bars, bread, breakfast cereal, energy drinks, ice cream, and lots of sauces and condiments. Read your food labels since anything containing this ingredient can have concentrated levels of fructose and "up" your iron stores. High fructose corn syrup only has negative health consequences. It's a contributing factor to both diabetes and fatty liver disease, and researchers think it has played a significant part in creating the obesity epidemic. Avoid high fructose corn syrup as much as possible.
TABLE SUGAR (also called sucrose)
Regular old table sugar also contains fructose (it's made up of a combination of glucose and fructose). Check the ingredient list when you buy pre-packaged foods to see if there's added sugar, cut down on sugary foods, and resist the temptation to add sugar into your home cooked meals and baked goods.
Wondering what to use instead of sugar?
There are some great sweetener alternatives that are low in fructose and also low in iron, so try choosing one of these the next time you want to sweeten your coffee or bake cookies.
- Stevia (no fructose at all!)
- Monk fruit extract (no fructose at all!)
- Brown rice syrup (no fructose at all!)
- Yacon syrup and yacon powder (just a little bit of fructose)
- Maple syrup (does contain fructose but less than most sweeteners)
- Coconut sugar (does contain fructose but less than most sweeteners)
If you want to learn more about the best and worst sweeteners for hemochromatosis, read this.
SUMMARY
Fructose increases iron absorption. Stay away from high fructose corn syrup and table sugar. Continue to eat fruit but try to time it right. Don't eat too much fruit at the same time that you're also eating an iron-rich meal, and opt for low-fructose fruits like bananas and blueberries when possible. Try using sweetener alternatives that are fructose-free or low fructose, such as stevia, monk fruit extract, yacon, brown rice syrup, maple syrup, and coconut sugar.
READ THIS BEFORE YOU CONTINUE...
Before we go any further into this list, I want to point out that #1-#7 above are foods I recommend minimizing or even cutting out of your diet completely (with the exception of fruit - see #7).
Going forward with this list, #8-#12 below are all healthy foods that are important for a balanced diet. The below foods are not to be avoided! However, because they help your body absorb iron, they're best eaten away from iron-rich meals. Now, take a moment to breathe because you don't need to be perfect at this. You're going to combine these foods with iron because it's inevitable.
Just having the knowledge and awareness of these foods will allow you to make small changes and swaps so you can start to feel more in control of your iron intake!
8. carotenoids
Carotenoids are pigments that give plants vibrant colors ranging from yellow to orange to red.
We all need carotenoids - their health benefits range from enabling our bodies to produce vitamin A to improving your lung health to preventing cognitive decline. Carotenoids are also antioxidants, which fight off disease, heal damage to organs, and slow down the aging process.
Amazing, right?
But.....do your best to get your carotenoids AWAY from iron ingestion.
Why?
Carotenoids enhances iron absorption "significantly," according to the Iron Disorders Institute.
Here's a list of foods high in carotenoids that you'll want to watch out for.
- Sweet potato
- Carrot
- Butternut squash
- Red bell pepper
- Tomato
- Apricot
- Nectarine
- Orange
- Cantaloupe
- Grapefruit
- Watermelon
REAL LIFE EXAMPLE: When you make your morning bowl of oatmeal, instead of topping it off with apricots, opt for blueberries to help minimize your iron absorption from the oats. Hold off on the apricots and instead eat them a few hours later as a light snack.
SUMMARY
You NEED carotenoids. Among their many health benefits, they fight disease and help your body make vitamin A. However, because carotenoids increase iron absorption, whenever possible, avoid eating carotenoids with iron-rich meals.
9. vitamin c
Unless you never get sick, you're probably well-aware of vitamin C's renown for boosting the immune system. Products like Emergen-C and Airborne are popular vitamin C supplements you'll find in any grocery store or pharmacy for this very reason.
Vitamin C is a multi-tasker, actually doing much more than preventing you from getting sick. It heals wounds, helps create collagen, and maintains your bones and teeth. It's an incredibly important nutrient. In fact, vitamin C deficiency is what caused "scurvy" in the old days - with symptoms like weakness, skin problems, and gum problems.
While vitamin C is crucial to a healthy diet, on the flip side, it also enhances the absorption of iron. When possible, avoid consuming vitamin C at the same time that you're also eating foods that are high in iron.
According to the Iron Disorders Institute, when someone pairs their meal with 100 milligrams of vitamin C (the equivalent of one large orange) they absorb 4.14 times more iron from their food.
Foods that are high in vitamin C include...
- Green and red peppers
- Broccoli
- Kiwi
- Guava
- Papaya
- Strawberries
- Pineapple
- Tomato
- Citrus fruits (lemon, lime, orange, grapefruit)
REAL LIFE EXAMPLE: Next time you snack on hummus or dip, use celery sticks and cucumbers (both low in vitamin C) for dipping instead of high-vitamin C veggies like bell peppers or broccoli. This will help you minimize your iron absorption from the dip.
You also need to watch out for ascorbic acid on food labels - ascorbic acid a different name for vitamin C. Ascorbic acid often sneaks into foods you might not think twice about, like teas and bottled beverages. Double check the ingredient list on your pre-packaged foods.
SUMMARY
Vitamin C is beneficial for your entire body - it promotes a healthy immune system, strong bones and teeth, and clear skin. However, vitamin C also increases iron absorption when you pair it with your meals. Your goal is to avoid combining large doses of vitamin C with iron-rich food. Start to notice combinations of vitamin C and iron in your meals so you can make small changes here and there. Pay attention to your food labels - "ascorbic acid" is the same thing as vitamin C.
10. acidic foods
The acid in foods like vinegar, soy sauce, tomato paste, and orange juice frees up iron bound in food and allows it to be absorbed better by your body. While this is great for anyone looking to boost their iron levels, it's not what you're aiming for if you have hemochromatosis.
Acidic foods aren't necessarily bad for you. In fact, many acidic foods have a lot of good stuff going for them.
For example, vinegar can kill harmful bacteria, lower cholesterol, balance blood sugar, and improve heart health. Oranges and tomatoes also provide beneficial nutrients!
However, you need to become aware of when you're eating acidic foods and if you're pairing them with a lot of iron.
REAL LIFE EXAMPLE #1: Do you love ketchup? (I sure do). Did you know that one of the main ingredients in ketchup is vinegar? The tomato paste in vinegar is also highly acidic. That means when you slather ketchup all over your veggie burger, you'll be absorbing more iron than you would without the ketchup. While you don't necessarily need to stop using ketchup (in small amounts), it's important to factor this into your daily iron intake.
REAL LIFE EXAMPLE #2: How often do you use a vinaigrette dressing on your salads? Just knowing that vinegar will allow your body to absorb more iron from your green salad is good knowledge to have! You don't need to stop using vinaigrettes, but try pairing them with lower-iron greens such as romaine or red leaf lettuce.
REAL LIFE EXAMPLE #3: A lot of people love a glass of orange juice in the morning with their breakfast. Because orange juice will make you absorb more iron from your meal, swap it out for black tea or coffee. Both black tea and coffee have been proven to actually block iron absorption, making them ideal choices for your morning beverage.
SUMMARY
You shouldn't have to give up acidic foods, especially because some have really wonderful health benefits! But take a moment to think of when and how you're using acidic foods so you can become more conscious of your iron absorption, and make small changes as needed.
11. fermented foods
Fermented foods are back in vogue! From kombucha to kimchi to DIY pickling kits, fermentation is a popular trend and for good reason...
Fermented foods create the good bacteria that strengthen your gut microbiome. That's important because researchers now think of your gut as your "second brain." Studies have demonstrated links between gut health and your immune system, mood, mental health, autoimmune diseases, endocrine disorders, skin conditions, and even cancer.
Timing with fermented foods is EVERYTHING for a person with hemochromatosis. Because fermented foods increase iron absorption, it's best to eat fermented foods at a time when you're not also eating iron-rich foods.
Here are some common fermented foods that may increase your iron absorption:
- Sauerkraut
- Kimchi
- Pickled vegetables
- Kombucha
- Vinegar
- Some types of soy sauce
- Miso
- Tempeh
This doesn't mean you can't eat these foods. You just need to be careful about when you're eating them and what you're pairing them with.
REAL LIFE EXAMPLE: Because soy sauce will make you absorb more iron from your meal, the next time you cook up a stir-fry dish, choose low-iron veggies to mix in with your soy sauce. Shiitake mushrooms and green cabbage are both great low-iron options.
SUMMARY
Fermented foods support your gut health by providing the necessary probiotics to create a strong and diverse gut microbiome. However, because fermented foods increase your iron absorption rate, pair them with low-iron foods.
FINAL THOUGHTS
After reading this post, your brain might be spinning, and you could be thinking that the hemochromatosis diet seems impossible!
Don't worry, it's going to be okay!
A low-iron but still nutritious diet is hard to figure out. Almost every food on the planet contains iron, and there are tons of different factors that impact how well you absorb the iron in your food. At the end of the day, iron is impossible to avoid.
Keep in mind, it's better to get a healthy diet with diverse foods that have a range of colors and a variety of vitamins and minerals than to be so obsessed with avoiding iron that you deprive yourself of other important nutrients. And don't forget, you actually NEED a little bit of iron to survive, so try not to think of iron as your enemy!
The info above is intended to empower you so you know more about hemochromatosis and can make consciously informed decisions about what you're eating.*
That's essentially why I started this blog. Knowing what to eat for hemochromatosis is confusing, and I wanted a place to document what I found out. I'm still learning - so if you have any info you'd like to share or if you know something more than me, please send it my way!
And, if you're looking for tricks and tools to lower your iron absorption, check out some of my other blog posts like this one on milk thistle and this one on vervain.
*Check with your doctor before you change your diet!
The views expressed in this post are for informational purposes only. This post is not, nor is it intended to be, a substitute for professional, medical, or nutritional advice, diagnosis, or treatment, and should never be relied upon for professional, medical or nutritional advice, diagnosis, or treatment.
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