Do I have to eat meat? Iron problem.

September 23, 2007 6:18 AM

I'm a pseudo vegetarian (I started eating fish about a year ago) of 17+ years and just discovered the root of my recently diagnosed Restless Leg Syndrome. My iron stores are very low. What's next?

After 3 years of searching for the cause to my excessive tiredness, there seems like their might be light at the end of the tunnel. It seems that my extremely low iron stores (serum ferritin level of 13[micro]g/L) is causing RLS, which is causing me to not sleep worth a damn. Anything under 50[micro]g/L is considered an indicator of RLS, and the lower you go, the worse it is likely to be. (though it doesn't always work the other way. Someone with low iron stores doesn't necessarily have RLS)

What concerns me is that I did this to myself. I've been a vegetarian since I was 13 years old, and while I've always watched the iron I'm eating, I'm now discovering that the type of iron consumed is very important, and it sounds like the iron in meat is more bio-available. I just found a study that showed while vegetarians consume about the same (sometimes more) iron than omnivores, they have significantly lower serum ferritin levels on average.

I started eating fish about a year ago because I started to wonder if diet did indeed play a part in whey I was always so tired. I figured fish was the lesser of all evils if I had to consume meat. I didn't know about the RLS or low iron then so I was just really taking a shot in the dark. My sleep doctor just told me that that's really not going to do much, that its the chicken and red meat where I would get the most iron benefit.

So I have to see my GP again, to rule out any other factors that could be causing low iron stores. However, just based on what little research I've done and what my sleep doc said, I'm pretty sure they're going to say diet.

So the question is, can I still abstain from meats other than fish to get through this? Should I? I'm a vegetarian on moral grounds, so I'd really like to stay away from meat.

If it does come down to eating meat, any ideas about "free range" and organic meat as a more ethical choice? Can I trust something if it says free range? And to make matters worse, I can't cook worth a damn, and never really had to cook meat for human consumption before.

posted by [insert clever name here] to health & fitness (39 comments total)

I buy my steak from a local farm. It's grass fed and he butchers and processes it all there. I don't know how much more responsible you can get than that _if_ you are eating meat. Of course I am surrounded by farms where all things you can buy in a grocery store you can get at a farmers market or right at the farm itself. Is this an option where you live?
posted by evilelvis at 6:32 AM on September 23, 2007

Maybe you shouldn't throw in the towel quite yet.

There are dietitians who specialize in the nutritional deficiencies of vegetarians.

There are drugs for RLS.

Finally, there is also an vast and rich literature of how one can embrace the sacrifice, and even physical pain, that can accompany some moral choices. It's the heart of all Eastern and Western monastic traditions.

(All of the above from a non-vegetarian, of course...)
posted by MattD at 6:42 AM on September 23, 2007

I have had the exact same problem-- longtime vegetarian and very low iron stores. I discovered the problem when I stopped being able to run all of a sudden. I would just kick myself and fall over. The doctor told me I had a blood iron level of 11, so even worse than yours. I was able to fix the problem without eating meat. My doctor gave me a prescription iron supplement (a little red pill, although you can get IV iron if you really need it) and I did a two bottle course of floradix on my doctor's advice.
Now I cook on cast iron and do a smaller bottle of Floradix 2-3 times a year or when I start feeling run down. Floradix is really pretty amazing. It tastes like drinking orange juice and licking an iron pole at the same time, it's all vegetarian and plant-derived, and I invariably start feeling better within a week.
You might want to give this a try before you start eating meat. Go through a large bottle (I would do do a dose and a half a day to start and then back down to one per day) and then get your blood retested to see if it has helped. If not, then you can start thinking about eating steak.
posted by ohio at 6:45 AM on September 23, 2007 [3 favorites has favorites]

Look into grass-fed, grass-finished bison. I work for a couple selling at local farmers markets. There are small family farms doing sustainable ag and treating the animals humanely. A lot of vegans, especially pregnant moms, come to us once they find out about us.

"Grass-finished" is the keyword. Ruminant animals need to be fed grass as it is a diet natural to their system. This also means that they were raised on pasture their whole lives. If they are fed corn or grain, even if it is organic, it is a diet that is too rich for their systems. They'll get fatter, cholesterol levels skyrocket and they get sick in the process. That is why feedlot animals nees high levels of antibiotics.



also read Michael Polians "Omnivores Dilemma"
posted by goalyeehah at 6:45 AM on September 23, 2007

Oh-- and Floradix also is a good source of B-12; many symptoms that vegatarians think are caused by low iron are actually B vitamin deficiencies. I don't know if this is true of RLS (your doctor probably woud have said so if it were) but some extra B-12 can't hurt.

And no, I do not work for them or sell their products. I am just a very very happy customer!
posted by ohio at 6:49 AM on September 23, 2007

Get a cast-iron pan and cook everything in it.
posted by bradbane at 6:51 AM on September 23, 2007

Do you eat eggs? When I was young, I had an iron deficiency, and I was given lots of eggs (and probably other things, but I didn't like eggs much as a kid, so I really remember that).

I've had RLS as a medication side effect, I know it's terrible. I hope it goes away fast.
posted by veronitron at 7:01 AM on September 23, 2007

I have had very low iron due to vegetarianism as well. Couldn't donate to the Red Cross for it. On my eighth failed try I vented to the Red Cross attendant, as I was taking a good deal of iron supplements but it wasn't doing anything for my levels. She recommended I try Hema-Plex. It's an iron supplement that has a whole host of other things in it to make the iron more bioavailable. Holy crap. Only a week or two after taking one of the tablets daily my iron was well within the normal ranges. It is about $10 for 30 tablets, but it is well, well worth it and I highly suggest you try it for a month to see if it works for you before giving up on the vegetarianism.

Plus it turns your pee neon, which is pretty cool. I think this is the high amount of vitamin C in it though.
posted by schroedinger at 7:02 AM on September 23, 2007 [1 favorite has favorites]

Also, you might notice Hema-Plex has a crapload of B-12 and other B-vitamins, so it takes care of that too.
posted by schroedinger at 7:03 AM on September 23, 2007

Thanks guys! You've given me a lot of things to talk to the doctor about. It makes me happy that meat may not be my only alternative, at least there are other things to try.

Oh, and I tried drugs for RLS before they came back with the blood test results (Mirapex, for those interested) and it gave me insomnia. Yay!
posted by [insert clever name here] at 7:13 AM on September 23, 2007

I'm not an expert on this, but have you tried the more iron-intensive fish like salmon?

Also - I'm semi-vegan, and I take about 2-3 OTC iron supplements per month. I've also enjoyed beets + oranges (I believe the vitamin C enhances the absorption of the beets' iron) in the past.

Others will say this, and you probably know this already, but when supplementing, be aware that too much iron is really bad, also. Do monitor your iron levels.

Is part of the reason you haven't mentioned supplements yet? Here is a vegan iron supplement. I think I've seen it on the shelf at my local Whole Foods (I use a slow-release brand myself, since apparently too much iron in the stomach at once can be uncomfortable).
posted by amtho at 7:15 AM on September 23, 2007

I think that you can eat meat and still be an ethical person, but there are many very thoughtful vegetarians and vegans who would disagree. I believe that by eating meat primarily from small producers who treat the animals well, don't over-medicate them, and kill them humanely, that my eating meat fits into the ethical boundaries of a decent life. I also try very hard to (almost) never waste any meat. It doesn't bother me to throw out a bunch of moldy carrots, but to me, throwing out meat is saying that the animal died for nothing. If a living creature is going to die for my health and convenience, I will respect that by putting that meat to good use.

I would strongly suggest finding one or two local meat producers, visiting their farms to see the animals and hear them describe how the raise, treat, and kill the animals, and then buying all your meat from those producers. You may pay a lot more per pound than you will at the big grocery store (although sometimes not -- small producers can have good prices sometimes) but you are buying both a guarantee of high quality and of ethical treatment of the animals and the land.

If you are in a town that has a farmer's market, asking around there should find you someone selling beef, lamb, and chicken. In a really rural area, there are always local farmers and 4-H kids advertising meat in the classified section of the local paper. Big cities probably have a specialized butcher offering high-end meat, which will cost you more but have a great selection. And of course you can mail-order it, but I'd buy local if you have that option at all.
posted by Forktine at 7:19 AM on September 23, 2007

Dried beans and dark green leafy vegetables are especially good sources of iron, even better on a per calorie basis than meat. Iron absorption is increased markedly by eating foods containing vitamin C along with foods containing iron. Vegetarians do not have a higher incidence of iron deficiency than do meat eaters.
posted by bunnycup at 7:24 AM on September 23, 2007

I'm not a doctor but I'm going to school to be one. Your GP more than likely has a very minimal amount of credit hours in nutrition, so he/she may be very unhelpful. I would find a dietician/nutritionist that specializes in vegetarian diets.
posted by hammerthyme at 7:25 AM on September 23, 2007

Oops, I didn't answer your questions.

So the question is, can I still abstain from meats other than fish to get through this?

Yes!

Should I? I'm a vegetarian on moral grounds, so I'd really like to stay away from meat.

Yes you should, and stop eating fish. My grandmother told me recently, "If I wanted mercury, I'd drink a thermometer."

If it does come down to eating meat, any ideas about "free range" and organic meat as a more ethical choice? Can I trust something if it says free range? And to make matters worse, I can't cook worth a damn, and never really had to cook meat for human consumption before.

If you're a "vegetarian" for ethical reasons, why would you consider eating any meat at all? The cow's still going to have its throat slit, the chicken is still going to be boiled alive. Your call.

The best part about a vegetable based diet is it's hard to not cook it right. With meat, if you cook it wrong, you can die. See also heart disesase/Alzheimers/diabetes/gout/osteoperosis/etc., etc.
posted by hammerthyme at 7:32 AM on September 23, 2007

If you want to stay veggie, make sure that you have a good vitamin C source with your iron-heavy foods (or supplements). You need about double the RDI for non-heme iron to supply you adequately. Legumes (beans, soy!) will make absorbing iron very difficult.

There exist lots of good iron supplements, but you should be careful and ask your MD about the course of them, because too much can be very toxic. Your body has essentially no way to excrete iron if you get too much. Iron uptake is highly regulated in your gut, so it's important to space supplements out if that's the road you take.

Institute of Medicine. Food and Nutrition Board. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium and Zinc. Washington, DC: National Academy Press, 2001.
posted by a robot made out of meat at 7:33 AM on September 23, 2007

Not much to add to what's been said already, but you should be aware too that caffeine inhibits iron absorption, and that calcium does as well. So those are something to consider if taking both calcium and iron supplements or when picking beverages to go with meals.
posted by Tuwa at 7:58 AM on September 23, 2007

[comment removed - do not turn this into a referendum on vegetariansism v meat eating. thanks]
posted by jessamyn at 8:22 AM on September 23, 2007

bunnycup; the article you site says exactly what the problem is, its not lack of iron, its lack of iron stores. I spent quite a bit of time reading up last night, and there is some link between iron stores and neurology, and they think that's what the cause of this kind of RLS is. That's my layman's explanation, but a google search of RLS and serum ferritin shows up several studies and articles.

Fortunately, as everyone mentioned it sounds like there are some solutions. And one thing I didn't mention, because I didn't think of it until reading it hear, but the doctor said that I'd probably be taking iron along with vit. c.

I probably need to cut out the caffiene too then. Its been a self perpetuating cycle - I get tired, I drink more caffeine. Caffiene makes the rls worse, so I'm even more tired. More caffeine, etc . . . now I wonder if its also piled on complications with iron.

I have been eating salmon, not because of the iron but I guess that is a nice side affect. Though now I wonder what my iron was a year ago before I started eating fish. Yikes! And actually, the long term goal was I was going to try eating fish for a year, see how I felt, and if it didn't seem to be helping, remove it from my diet again. I may still go that route, but on a different time table. And in the meantime, treat myself to more salmon.
posted by [insert clever name here] at 8:50 AM on September 23, 2007

I'm sorry, ICNH, I guess I don't understand your question. I believed you were looking to avoid eating meat to increase your iron, and proposed vegetarian sources for Iron.
posted by bunnycup at 8:56 AM on September 23, 2007

Biologically useful sources of iron, yes. If my body can't use it, its not going to do me much good.
posted by [insert clever name here] at 8:59 AM on September 23, 2007

My understanding is that grass fed meat is by far better for your health (and the environment etc...), but that if you're coming from iron depletion that food sources are not sufficient. High quality bio-available iron supplementation (with vit. C to increase absorbsion) is the only way to go. MD would have to be a very very rare bird to know the answers to these issues, and even many nutritionists don't know much about these complex issues. A Naturopath would.

IMO, the food based approaches above are good and should be used, but are not sufficient until you're back in the normal iron range and then are just maintaining levels.
posted by kch at 9:04 AM on September 23, 2007

Hmm, well it says: Non-heme iron, 60 percent of the iron in animal tissue and all the iron in plants (fruits, vegetables, grains, nuts) is less well absorbed. Vegan diets only contain non-heme iron. Because of this, iron recommendations are higher for vegetarians (including vegans) than for non-vegetarians.

I think, and of course you need to make your own best health decisions within your own comfort levels, that it's simply saying you have to eat more of it to get the same absorption. But you have information you're happy with now, so all is well! Good luck!
posted by bunnycup at 9:05 AM on September 23, 2007

When I was a wee nipper in the 80s, there was this commercial on tv with some then-famous tennis player with an accent, maybe a South African accent. All I remember was her playing tennis and narrating something about "Geritol, for iron-poor blood" which, in her accent sounded like "Geritol, foh ion-poh blod."

So there you go. That'll be $200. Please pay the receptionist.
posted by kookoobirdz at 9:15 AM on September 23, 2007

A vegetarian or vegan diet is not by definition lower in iron than an omnivore diet. Because many people eat such an unhealthy diet, meat is an easy source of iron. If you eat a really healthy diet, with a variety of green vegetables and pulses every day, and enough fruit and other vegetables, so you get the vitamin-c iron combo that makes the iron much more bio-available, iron is not a problem. The fact that plant-iron is less bio available is a good thing. Many diseases are related to too much iron in our western diet, and that is solely due to the heme iron that is found in meat.

The type of iron is not a problem, IF you get enough, and if you also have an otherwise healthy diet and body. I agree that a supplement is wise to get your body healthy, but after that, it is very possible to get enough iron on a vegetarian diet. Studies that say that on average vegetarians have lower levels of nutrient X are useless to you as an individual if you know your diet is nothing like the diet of the general population.

There will always be people and doctors who tell you miracle recoveries after they started eating meat again, and I do believe those stories, but they'll never know what would have happened if they had started to eat a really healthy vegetarian diet instead.

Don't self-diagnose because of what you read on the internet, and know that most doctors don't know anything about nutrition.
posted by davar at 9:42 AM on September 23, 2007

Peanuts have significant amounts of iron. Start using natural peanut butter (the stuff that's just ground peanuts, it's more liquid-y and better for you) as a dip for vegetables (it is The Yum with baby carrots) or just in pb&j sandwiches.

Oatmeal also has iron in it, believe it or not. I'm not sure if you have to have the old-fashioned type rather than the quick oats.
posted by joannemerriam at 10:04 AM on September 23, 2007

Malt-O-Meal has insane amounts of iron.
posted by peep at 12:38 PM on September 23, 2007

Iron in vegetables is proportional to the iron in the soil in which the plants are grown. So no wonder so many vegetarians now have low iron problems given the current agri-business practices of maximizing yields and profits at the expense of nutrition! Eventually society will demand change, but in the meantime I think you'll want to have supplements on hand.

Switching to meat seems rather drastic to me. You can switch to organic vegetables to see if that helps, take supplements as suggested above or just grow some leafy greens in a garden of your own fertilized with some iron-rich mulch.
posted by TeatimeGrommit at 12:56 PM on September 23, 2007

I've had both your problems, though for different reasons. I've had restless leg syndrome linked due to an iron deficiency but it's because I donate blood every eight weeks and exercise very intensely.

My doctor recommended first trying over the counter iron supplements, and the cheap ones with ferrous sulfate are just fine. My RLS disappeared within a couple of days.
posted by substrate at 1:10 PM on September 23, 2007

Tea can inhibit iron absorption.
posted by spork at 3:06 PM on September 23, 2007

Ditto what spork said. Do you drink a lot of tea (hot or iced)? There is something in tea that inhibits iron absorption. (I work at a blood bank and my boss said that down here in the South, where iced tea is practically a way of life, we have a higher rate of deferral for low iron than in the rest of the US.) If you are a tea fiend, try drinking it at other times than meal time.
posted by radioamy at 3:57 PM on September 23, 2007

With all due respect, I believe that different people absorb iron at different rates. A friend of mine-- a Pole who eats meat, spinach and leafy greens with abandon-- still has RLS. Metabolisms very between individuals.

That's no reason not to try an iron pan, or different supplements. Just keep in mind that you might need medical help.
posted by gesamtkunstwerk at 4:06 PM on September 23, 2007

I have RLS (and have had for 10+ years). I also eat meat daily, and often every meal. I also love leafy veggies (esp. spinach) and fruits.

Unless I am completely unable to absorb iron from food, there is no way my RLS is connected to my iron levels.

However, I just started taking Requip for it and it worked wonders. I'm no doctor and won't recommend it for anyone else, but I can just say it works very well for me, at the minimum dose, as prescribed by a doctor.
posted by Kickstart70 at 5:12 PM on September 23, 2007

I was going to say something about bioavailability, about humanely-farmed meat animals, and about iron metabolism, but Forktine and the best answers you marked have said it very eloquently already.

So I'll confine myself to noting that RLS is a multifactorial condition and it has recently (as in, the last couple of weeks) been shown that most cases of it have a strong genetic contribution. For this reason, rather than beating yourself up about the RLS you've "given yourself" by your carefully considered life choices, I would recommend that instead you focus on thinking about ways to live more healthily with the genes that you have. I agree that the ways to do this would include bioavailable iron supplementation and possibly considering eating a certain amount of meat if that can be ethically acceptable to you.
posted by ikkyu2 at 10:12 PM on September 23, 2007 [1 favorite has favorites]

I also wouldn't recommend taking Requip for RLS associated with iron deficiency. In general I would recommend correcting the iron deficiency first before considering other treatments. For your own case, consult a doc, of course.
posted by ikkyu2 at 10:13 PM on September 23, 2007

Oysters. Delicious, sustainable, irony oysters. Smoked in cans, cheap as dirt, delicious with pasta or on crackers or blended with any number of creamy things to make a spread. 10% RDA per ounce. Sardines are 5%. Compare with Tuna's 1%.
posted by Ambrosia Voyeur at 11:50 PM on September 23, 2007

Iron in vegetables is proportional to the iron in the soil in which the plants are grown. So no wonder so many vegetarians now have low iron problems given the current agri-business practices of maximizing yields and profits at the expense of nutrition!

Small nitpick: iron in vegetables may be proportional to the amount of available iron in the soil. Iron in soil becomes less available to some plants due to high pH. This is the most frequent cause of iron chlorosis in plants- iron tends to remain in soils, but be unavailable to plants unless the pH is lowered. I'm not sure that is correct to say that plants are now less nutritious due to unsustainable farming methods- no grower sells yellow (chlorotic) spinach, therefore the plant is getting enough iron for it's needs. I'm pro-organic in the sense that proper organic soil management is good for soil-plants-organisms in a wholistic sense, but a healthy plant is a healthy plant whether or not it is healthy due to conventional or organic methods. Healthy soils and ecosystems are another thing altogether.
posted by oneirodynia at 1:31 PM on September 24, 2007

Wow, what I wrote is kind of a mess (that's what I get for trying to say complicated things while talking on the phone). It's true that generally speaking organic food has more nutrients than conventionally grown food. I'm not sure it's correct to attribute vegetarians' health to this- spinach still has a lot of iron if it's a healthy plant, though less grown conventionally versus organically.
posted by oneirodynia at 1:55 PM on September 24, 2007

Sorry, a little late back to my own thread.
Kickstart70, low iron stores isn't the only cause of RLS, its just one of the more common ones. Its the first thing my sleep doctor wanted tested, and the only reason I even tried a medication for it is he thought it would be a good idea to try while waiting for the results.
posted by [insert clever name here] at 5:18 AM on September 27, 2007