Dietary Recommendations for Nutrition-Related Anemia

Nutrition-related anemia can occur due to the inadequate intake and malabsorption of certain vitamins and minerals, including iron, vitamin B12, folate, and copper. The most common form of nutrition-related anemia is iron-deficiency anemia, particularly among women of child-bearing age, vegans and vegetarians, and people with malabsorption (e.g., gastric surgery, short bowel syndrome, celiac disease, inflammatory bowel disease flare, long-term use of PPIs, alcoholism). Vegetarians and vegans need 1.8 times more iron than non-vegetarians because our bodies cannot absorb the plant-based form of iron (non-heme iron) as well as it absorbs the animal form of iron (heme iron). This can make eating enough iron a challenge, so you might need to supplement. Keep reading for practical strategies to help improve intake and absorption of iron and other nutrients that can cause anemia.

Daily recommended intakes (DRIs)

*Vegetarians and vegans need 1.8X more iron due to the decreased bioavailability of non-heme iron.

Four Practical Strategies for Iron Deficiency Anemia

1. Vitamin C: Add foods high in vitamin C to iron-rich meals and snacks to increase your body’s absorption of iron (e.g., try tomato sauce with lentils and/or ground meat, enjoy a chili made with meat and kidney beans, squeeze lemon juice on top of fish or chicken, add bell peppers to a stir-fry made with tofu or shrimp).
2. Eat an iron-rich food at each meal and snack (see below): This could include eggs or fortified cereal for breakfast, dried fruit and nuts for a snack, chicken or lentils for lunch, and meat or a tempeh stir-fry with peanut sauce for dinner. Talk to a registered dietitian for individualized tips on how to eat more iron and learn how to fit it into your lifestyle.
3. Avoid coffee and tea with meals: These decrease your body’s ability to absorb iron. Space coffee and tea one hour before or after meals to optimize iron absorption.
4. Consider using a cast-iron pan: Try this when cooking to gradually increase your iron intake.

Food Sources of Iron

Heme

• red meat, fish, and poultry (chicken, turkey); liver is especially high in iron
• seafood: clams, mussels, oysters, scallops, canned sardines, canned shrimp
• egg yolk

Non-Heme

• blackstrap molasses
• dried fruit: figs, apricots, dates, etc.
• nuts and seeds: pumpkin, sunflower, nut butter, etc.
• whole grains: teff, amaranth, sorghum, buckwheat, cornmeal
• legumes: lentils, white beans, kidney beans, lima beans, baked beans, etc.
• fortified cereals (hot and cold)
• tofu, tempeh, edamame, and soybeans
• vegetables: spinach, broccoli, green peas

Food Sources of Vitamin B12

• meat, poultry, fish, seafood, and eggs
• milk and dairy products
• fortified cereals
• nutritional yeast

Food Sources of Folate

• dark green vegetables: spinach, kale, arugula, Swiss chard, broccoli, etc.
• legumes: chickpeas, lentils, kidney beans, etc.
• fortified cereals and flours: bread, bagels, enriched pasta, or egg noodles
• yeast extract spread, such as Vegemite or Marmite®

Anne-Marie Stelluti, RD

Photo: canva.com

• British Columbia Ministry of Health. Iron deficiency – diagnosis and management page. Available at https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/bc-guidelines/iron-deficiency. Accessed 2022-03-4.
• Health Canada. Dietary reference intake tables page. Available at https://www.canada.ca/en/health-canada/services/food-nutrition/healthy-eating/dietary-reference-intakes/tables.html. Accessed 2022-03-4.
• UpToDate®. Diagnostic approach to anemia in adults page. Available at https://www.uptodate.com. Accessed 2022-03-04.
• PEN®. Food sources of Vitamin B12 page. Available at https://www.pennutrition.com. Accessed 2022-03-04.
• PEN®. Food sources of Folate page. Available at https://www.pennutrition.com. Accessed 2022-03-04.