Should You Reduce Your Iron Intake?

Beef steakIron has an unequivocally positive reputation among the general public. After all, pregnant women use it to construct tiny humans, tiny humans use it to become slightly larger, more functional humans, and our cells require it to grow. And in many developing countries, iron deficiency is a real issue. Too little iron can have disastrous effects on cognition, growth, and overall physical robustness. Even adult women who aren’t building tiny humans inside their wombs may run low on iron due to menstrual cycle blood loss. Ask the average person and you’ll hear “the more iron, the better.” Consequently, many countries mandate iron fortification of wheat flour; in the US, we fortify pretty much everything with the stuff because it’s just so, so good for us. Is it true, though?

Not necessarily.

There’s another side to iron. Its inherent proclivity for electron exchange can create free radicals that damage DNA, cells, and blood lipids. Observational studies link iron intake and stored iron to diseases and disease states like type 2 diabetes, heart disease, insulin resistance, inflammation, Alzheimer’s disease, hypertension, fatty liver, hypothyroidism, arthritis, and cancer. The list of disease states connected to excess body stores of iron is impressive and, frankly, daunting. You name it, it’s probably linked to excess iron levels. A huge post on the link between iron fortification and obesity went up at Free the Animal earlier this year. Heck, one researcher even thinks the iron content of tobacco smoke may be responsible for its negative health effects.

Does that mean iron causes these diseases and we should all stop eating red meat forever? No. There’s more to the story, of course, and observational studies can’t prove anything, but the breadth of connections should give you pause.

First, though, figure out if iron is a problem for you. Pregnant women, women who still menstruate, tots, babes, teens, tykes, kids: don’t worry about iron. Don’t stress. Eat and be merry.

Men, particularly those of you getting up in the years? Post-menopausal women? Get your ferritin levels tested. Ignore the suggested normal range, which for men is a massive 18-270 and for women is 18-160. What, are we supposed to believe that a ferritin level of 25 is just as normal as one of 240? Nonsense. There’s a lot of room for things to go wrong there.

A 40-60 range might be ideal, as drops in insulin sensitivity have been seen at slightly higher levels, but don’t quote me on that. The true ideal, if it exists, is likely going to be very personalized. In general, lower is better, as long as you’re not feeling any negative effects (fatigue, hair falling out, poor gym performance, etc).

Although we have mechanisms in place for regulation of iron absorption—and there are many ways we can actively change how much iron we absorb—men of any age and post-menopausal women have no mechanisms to shed excess iron. It can be done, but you have to be proactive and, most importantly, aware of the issue. Your body isn’t going to handle it for you.

So how can we handle things? We can regulate iron levels by altering how we absorb it and taking extra-physiological steps to excrete it. We can also mitigate any negative effects of ingested iron.

Eat a diet rich in polyphenols, flavanols, phytonutrients, and other plant-derived antioxidant compounds. Many of these phytonutrients inhibit iron absorption, and some of the ones we eat show up in our LDL particles where they exert protective effects against oxidants like iron. I’m talking about curcumin (from turmeric), quercetin (from apples, onions, and many other plant foods), grapes—the colorful spices and herbs and plants.

Drink coffee and/or tea with your meals. Coffee inhibits iron absorption (and instant coffee seems to be the most effective!). So does tea, both black and green. Maybe that’s partially why coffee is constantly associated with lower rates of mortality from all causes.

Eat dairy after meals. Dairy, especially the calcium it contains, is a potent inhibitor of iron absorption. More than that, calcium reduces any carcinogenic interactions between heme iron and colonic cells. That’s right; the majority of the animal studies purporting to show a link between red meat/heme intake and colorectal cancer use low-calcium diets or else the cancer won’t “take.” Scared of dairy? Most people can tolerate some form of high-quality dairy, whether it’s kefir, yogurt, hard cheese, or raw milk.

Avoid eating red meat with iron-fortified food. Not only are the two types of iron additive, but they may synergize as heme iron actively increases absorption of non-heme iron.

If you’re going to drink alcohol, make it red wine and lean toward lower-alcohol wines. Its polyphenols inhibit iron absorption, while straight ethanol enhances iron absorption.

Drink mineral water with your meals. High-calcium mineral water can both inhibit iron absorption and reduce the carcinogenicity of heme in the colon.

Train regularly. Intense exercise reduces iron stores. This is a problem for chronic exercises, particularly young women at risk for full-blown iron deficiency anemia, but it can be a helpful strategy for moderate iron reduction and may even explain some of the benefits seen with regular training.

Avoid isolated sources of omega-6 PUFAs. The proposed mechanism mediating the relationship between heme intake and colorectal cancer is heme’s oxidative effect on fatty acids. Which fats are subject to peroxidation, though? PUFAs. In one studyfeeding heme iron to rats promoted colon cancer only when fed alongside high-PUFA safflower oil. Feeding MUFA-rich and far more oxidatively-stable olive oil alongside the heme prevented the colon carcinogenesis. In another paper, only mice consuming fish oil-based and safflower oil-based diets exhibited carcinogenic fecal peroxides after eating heme iron; a coconut oil-based group of mice had no negative reaction to heme.

I suspect the association between colon cancer risk and heme iron intake is largely mediated by PUFA intake. Among a cohort of US nurses, high heme intake had moderate links to colon cancer. Among a cohort of Swedish women, the association was far weaker. US intake of PUFA is on the high side, with around 7% of calories coming from PUFA (mostly vegetable oil). Swedish intake of PUFA is under 5% of calories, with a greater proportion coming from fish.

Does this mean you have to ditch all PUFAs? Of course not. Nuts and seeds are good and contain inhibitors of iron absorption that balance out the interaction between the PUFAs and heme iron; refined soybean oil and corn oil just PUFA and little else. If you’re eating lots of polyunsaturated fats with your meat, if you’re cooking your meat in bad oils, or you’re eating meat that’s been cooked in refined high-PUFA seed oils (like most prepared and restaurant food), iron may cause problems.

Give blood (if you’re not already giving it unwillingly). Blood donation, or phlebotomy, is the most effective way to reduce iron stores and tends to increase insulin sensitivity. In insulin resistant men with fatty liver, blood donation normalized insulin sensitivity and liver enzymes.  In meat eaters, blood donation reduced ferritin levels to match those of lacto-ovo-vegetarians and improved insulin sensitivity. One study even tested the effect of randomized phlebotomy on cancer incidence. After four and a half years, those subjects placed in the phlebotomy group lived longer, had less cancer, and had lower ferritin levels than the subjects who didn’t donate blood.

Blood donation is the biggest take home from the entire post, if you ask me. You don’t have to adopt an entire new way of eating. You don’t have to take a bunch of supplements. You just go down to the clinic and give some blood. It’s good for you and good for people who need your blood. If you’ve got a husband or family member who refuses to adopt a Primal way of eating, just convince him to give blood. It might really help.

Even though they’re the ones likely to benefit most from it, people with hypertension or type 2 diabetes are usually barred from giving blood. That’s unfortunate and misguided, as little to no evidence exists those groups are any likelier to have adverse reactions to blood donation. I’m not sure what avenue exists for them.

Summing Up

The idea of iron being wholly “bad” doesn’t jibe for me. High-heme red meat intake has trended downward and low-heme poultry has trended up, particularly in the US, yet the metabolic disorders and diseases associated with excess iron are progressing. In the context of a diet rich in refined PUFA oils and iron-fortified cereal grain products and deficient in colorful and phytonutrient-rich fruits, vegetables, chocolate, coffee, and tea with healthy full-fat dairy? Yeah, I can see heme iron adding to the issue.

But rather than give up a nutrient-dense food like red meat (and liver), you can get the best of both worlds by employing the strategies described in this post.

What about you? Ever had your ferritin levels tested? Do you (perhaps unwittingly) use any of the methods described above? Do you give blood? Will you?

Thanks for reading, everyone. Take care and be sure to leave your thoughts below.

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TAGS:  men's health

About the Author

Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/paleo, keto, and Whole30-friendly kitchen staples.

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65 thoughts on “Should You Reduce Your Iron Intake?”

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  1. Great post, Mark, and a subject I’ve been hoping you’d cover for a while now. Through blood donations every 4-6 months over the last 3 years or so, I’ve successfully lowered my ferritin level from >100 all the way down to 28.

    Iron panel numbers still confuse the heck out of me. I’d still like to know why ferritin can be on the normal/low range, while TIBC/UIBC can show elevated iron levels. Is ferritin still the best overall indicator of bodily iron stores?

    1. Ferritin is a proxy for iron levels. It is a protein the body makes to sequester iron. But the body will often crank up ferritin for other reasons, for example an infection or injury. This is to mop up loose iron in the later case, and deny iron to invading germs in the former case.

  2. Wow this is all new territory for me, Mark, so thank you for that!

  3. One option that may or may not be available for those ineligible to give blood for various reasons – there may be laboratories nearby that allow blood donations for research purposes. (Usually researching how to better preserve donated blood)

    1. That’s interesting, blood donation is no longer an option for me due to a previous illness.

      I’ll investigate that idea further, thanks.

  4. “A 40-60 range might be ideal, as drops in insulin sensitivity have been seen at slightly higher levels, but don’t quote me on that.” -Mark Sisson

    Sorry, I had to…

  5. “I’m not sure what avenue exists for them.” – Blood letting, anyone?

    1. mmm I was just wondering if that’s why leaches had been useful in days gone by, perhaps they were lowering the iron levels.

    2. “I’m not sure what avenue exists for them.”
      – A match with Holly Holm

  6. “Give blood.”

    Reminds me of a joke I heard in college. The Rugby team encouraged folks to “Donate blood… Play Rugby”. Hey, it just occurred to me that Rugby is Primal play, so folks can kill two birds with one stone, as it were.

  7. Sorry but what kind of units does Mark mean? I got my bloods back and my serum iron is 8.0 umol/L – marked with red pen as low by my doc ( reference range is between 10.6-28.3 umon/L apparently )

    1. I’ve done a lot of reading on iron testing and studies, and as far as I understand iron panels, serum iron is just one of several readings that attempt to iron in the body.

      Serum iron measures current iron in the bloodstream, while serum ferritin is the major iron storage protein in the body and that test usually provides a more accurate measure of body stores of iron. Full iron panels also include TIBC/UIBC (iron binding capacity; low numbers = higher iron and vice versa) and transferrin saturation (the ratio of serum iron and total iron-binding capacity, multiplied by 100).

      Many believe serum ferritin is the best single value for identifying possible iron deficiency or overload, but a full iron panel provides a better snapshot of bodily iron stores. I usually test mine once every year or two and order my test rec through directlabs (about $65 for the full panel).

  8. People who are otherwise barred from donating blood can get a prescription for a “therapeutic phlebotomy”

  9. I personally think iron linked to all those diseases is more coincidental than a cause.

    When you look at the richest sources of iron, you’ll see one of them is whole grains and fortified cereals, something the general population probably consumes a lot of. Especially if you tried to follow the guide lines of a lower fat higher carb diet.

    I’m more inclined to think that someone who consumes a lot of grains (which usually is also inundated with sugar), will have such diseases like fatty liver, diabetes, Cancer, hypertension etc.. I personally have been at Paleo for 2 years and have consumed a lot of foods (minus the grains and beans) that are high on the iron list, and my iron levels have never been in excess.

    Things like fatty liver is linked directly to fructose. Certain types of cancer is believed to be linked to fructose. Hypertension is linked directly to excess carbs as the volume of water your body stores causes the blood pressure to go up, hence why doctors falsely prescribe lower sodium as it indirectly lowers blood pressure by reducing the amount of water your body stores.

    1. You may want to re-think your position on iron. Clinical trials have shown improvements in fasting glucose and insulin sensitivity after lowering iron by phlebotomy. Sometimes, improvements were even seen in men with normal iron after a single blood donation.

      The FeAST trail showed dramatic reductions in heart disease and cancer in the iron lowering group as conpared to the controls, and in that study, the target ferritin numbers weren’t even reached.

      Of course, all of the problems with hemochromatosis come from excess iron, and de-ironing a patient reverses many of their problems.

      And blood donors tend to be healthier and live longer than non-blood donors as well.

      Lastly, I will point out that Dr. Facchini got great results in kidney patients using a high protein, low iron diet high in phenols, tannins and phytate, which means it was high in things like whole grains and soy. Although I don’t eat whole grains and soy myself, his diet was very effective, and even helped some of his patients avoid or delay dialysis.

    2. While I agree with you on the account of over consuming grains and the health issues associated, there is lots of evidence out there on iron causing or contributing to a host of health issues and diseases—there are some great books and articles out there on the dangers of too much iron in the body. The short of it: it’s not just coincidence. Check out some of the stuff by Anthony Colpo (forewarning, he’s a bit wacky and often vulgar, but it’s all based on actual science). His book “The Great Cholesterol Con” talks a lot about iron and it’s damaging effect on the body.

      1. How are you guys so sure about that?

        You do realize that our ancestors would have probably had higher than average iron in their diets relative to what we have today but remained virtually disease free.

        Remember, or you may have not known, all those diseases Mark described only became more prevalent in the population once Britain removed tariffs on sugar over a century ago. Once that happened, refined flour and grains became more of a staple in the diet That has been well documented by the groups both for and against sugar.

        Knowing that, how exactly did iron suddenly emerge into the picture when sugar became more readily available in the population? I’m not saying you guys are wrong, but this seems more of a case of correlation is not causation. If we look back at history when these diseases when these diseases took off so to speak, it would seem iron had absolutely nothing to do with it.

        Now perhaps iron may amplify the problem, that is a good possibility, but one of the causes of them, I find that hard to believe considering there are populations today that are virtually disease free and will have a high iron diet.

        1. Many studies (clinical, not just epidemiological) have shown correlation between high iron and metabolic disease, and not only that, reduction techniques have been successful in reversing damage caused by iron including lowering insulin resistance and increasing glucose tolerance.

          But to answer your question, yes, it’s not really known exactly why our bodies (especially men) are unable to properly dispose/regulate excess iron, especially in current day. Some theorize genetic mutations and other factors. And yes, inflammatory diet changes (grains, etc) possibly play a role. Though eliminating grains and other potential sources of dietary inflammation don’t help reduce iron stores (I’m a good example of that). The only way to reduce iron substantially is through donating or losing blood, and in my opinion, it’s important to spread this message because 1. regulating iron can reverse health issues, and 2. donating blood is one of the best things you can do for others in need. It’s a win-win!

          Chris Kresser also has a two or three great posts talking about exactly this, and he’s collaborated with Colpo on treating his patients with iron overload (almost 30% of the patients he sees!).

        2. “You do realize that our ancestors would have probably had higher than average iron in their diets relative to what we have today but remained virtually disease free.”

          Amanda, this just isn’t true. According to the USDA, Americans are eating about 10mg more iron per day than they were just 50 years ago. Some of this increase is due to people eating more food in general, but the main reason is iron fortification of flour, and supplemental iron in vitamins. This likely means that, over the past 40 years, Americans have been consuming the highest iron intakes in all of history.

          There are other factors as well. Some iron is lost through sweat during physical activity, so becoming more sedentary has likely led to higher body iron as well.

          Next, there is helminths. That’s right, intestinal worms! They are pretty much ubiqitous in primitive populations, and they feed on the host’s blood. That’s more natural iron reduction that pretty much all humans had up until about 200 years ago that we don’t have in modern society.

          And don’t forget about bloodletting! It was the go to medical treatment for pretty much any disease for thousands of years pretty much everywhere in the world. It hasn’t been really popular since the 1880s, though.

          Lot’s of traditional diets were also rich in iron inhibitors, which may have prevented some iron absorption as well.

          As for sugar coming into the picture, one of things that sugar does? Enhances the absorption of iron. It also used to be boiled in cast iron pots.

        3. Also, my favorite iron example in food-

          A cup and a half of Total Cereal contains 200 calories and 36mg of iron.

          To get that same amount of iron from beef liver, you would have to eat 21oz, which is 1,037 calories.

          How many people in history have eaten over a pound of liver for breakfast every day?

        4. From what I understand (and I’m in no way an expert), traditional meals our ancestors ate that were high in iron were typically accompanied by ingredients or paired with dishes that naturally inhibit iron absorption. It’s been awhile since I researched it. Also, the US and many other countries fortify flour with iron. You can’t convince me that the iron shavings or whatever they use to fortify cereals and flour are any good for you. Also, I recall there have been studies where iron fortification programs and high fruitcose corn syrup were shown to be synergenic in creating obesity. I don’t remember why I began researching Iron, but I think it was after reading a weekend love link in MDA; there must have been a really compelling article a few months ago that got me digging on the subject.

        5. Our ancestors would have had internal parasites and blood-drawing ticks, fleas and lice to contend with, and I don’t think anyone’s ready to go THAT primal!

          But these can make a serious difference – “A study of 986 indigenous women in Bolivia indicated a lifetime of Ascaris lumbricoides, a type of roundworm, infection led to an extra two children.

          Researchers, writing in the journal Science, suggest the worm is altering the immune system to make it easier to become pregnant.” BBC news yesterday.

          Hookworms meanwhile were found to have a strong negative effect on female fertility – so don’t rule our ancestor’s little “passengers” out as huge players.

  10. You hit close to home!

    I’m overall very healthy if not for my high ferritin levels (389~290) which is compounded by low hemoglobin; in short I’m anemic. All due to lack in a particular enzyme (g6spd Deficiency which destroy red blood cells known as hemolysis ) and if only I was screened earlier and forewarn to stay clear of certain foods.

    You provided awesome tips but can you make additional suggestion other then reducing stress – a tough one? Donating blood was ruled out on account of being anemic…. Thanks!

    1. One thing I would investigate if I were you is your B vitamin levels. When I was lowering iron by phlebotomy, my hemoglobin levels were getting pretty low. A B complex and Life Extension’s Two Per Day helped them shoot right back up. There’s lots of anemias that can happen in the face of high iron. The ones caused by lack of B Vitamins are some of the most common, and most easily fixed.

      1. Thanks for your input but phlebotomy isn’t a viable treatment for someone with high iron levels and low hemoglobin at the same time. Besides, g6spd (inherently genetic)isn’t curable one activated, but perhaps manageable. On the other hand, I am naturally protected against Malaria 🙂 I am however, taking B-50 and some of the supplements in Life Extension’s separately. Vitamin C for instance isn’t recommended.

  11. My ferritin levels are much too high. 300+ I believe. I’m 33, male. Obese with hypertension. No diabetes… yet. I had heard before about giving blood, this confirms it. Is hypertension a problem because it can be unhealthy/dangerous for me to give blood, or because they won’t allow me to give blood if I divulge my condition? I also wanted to ask, is there a ballpark on how often one should give blood in a case like this? I’m sure the best route is to give blood and keep retesting my ferritin levels, but are we most likely talking weekly? Monthly? Quarterly? Thanks!

    1. In the donation centers I’ve gone to, they have never asked about high blood pressure, but they do take your blood pressure before you can donate. It was slightly elevated when I first started, but I’ve never been denied as a donor. I’m sure there is some sort of cutoff, but low blood pressure is probably a bigger reason for rejecting donors than high blood pressure.

      I would try to donate as soon as possible, because legally, you can only donate every two months unless you have a prescription. Then again, donation centers don’t share records, soooooo……………….

    2. The American Red Cross website says that their cut-off for donation is 180/100 and meds are ok. Most places won’t let you give blood more often than every 8 weeks and from the studies I remember reading about, that’s plenty to make an impact, but less frequently was also helpful.

  12. Iron for senior citizens – I am 70 years old. I have read that senior citizens need about 8 mg of iron per day. I added up what I am getting in food and it’s a little less than that on an average day.

    the Centrum Silver multi-vitamin that I take has 8 mg of iron in it, so I only take it every other day. I alternate it with a multi-vitamin that has no iron.

    Thoughts? I guess I need to have my blood levels checked. Do I just ask for a “ferritin level” check?


    1. The American Red Cross will allow you to donate whole blood every 56 days.

  13. I’ve donated whole blood since 19 every 10-12 weeks with minor breaks for the 2 kids. Usually sailed close to the lower Hb limit tho’ that no longer happens since menopause. Sent away to see the GP once or twice for blood tests. He was very supportive of people donating blood frequently, got the message about “rusty iron” often in his training days he told me. My low BP is often remarked on at interview and is probably the reason I expect to feel weary for an hour or so after.

  14. How does cast iron skillets play into this? Does that increase dietary iron?

  15. “Even though they’re the ones likely to benefit most from it, people with hypertension or type 2 diabetes are usually barred from giving blood. That’s unfortunate and misguided, as little to no evidence exists those groups are any likelier to have adverse reactions to blood donation. I’m not sure what avenue exists for them.”

    I’m not sure how it works everywhere, but the American Red Cross website has a long page on eligibility re: health status, and they say that high blood pressure meds are not a problem, though they want your BP under 180/100 on the day you donate, and for diabetics, as long as their blood sugar is controlled, they’re fine to donate too.

    I’d assumed various heart meds made one ineligible to give blood but after reading Mark’s write-up, I really wanted to go and check and was surprised at how relatively few meds are prohibited.

  16. I just signed up to donate blood, for the first time in years. Thanks for the motivation!

    1. Me too! I just went in yesterday (Friday the 20th) and let them bleed me. It was a cakewalk except I feel a bit tired today.

  17. I guess I’ll answer the question at the end of the post…

    Yes, I have checked my ferritin levels along with iron markers. Initially, ferritin was high, I believe 440. I began donating blood and also used some other iron reduction techniques (IP6, shifting protein away from meat a bit and toward dairy and eggs). It took about 8 months to get it to that 40-60 range. Last time I checked it, ferritin was 28.

    I believe I have more energy and better mood since getting de-ironed. I also eat a lot more carbs now. Never seem to get a carb crash, either.

    One thing I noticed while getting de-ironed was a reversal of some gray hairs. I was still eating copper rich foods like oysters and liver, and I’ve heard that iron can affect copper metabolism, so maybe, MAYBE, blood donation can reverse graying of hair.

    I plan to be a blood donor for the rest of my life. I’m O negative, CMV negative, so hospitals love my blood. I’m also a carrier of two of the hemochromatosis genes, so I also plan on monitoring iron for life.

    1. Now you have my attention. I started turning gray at age 26. Any way to reverse this process without ridiculous dyes is of interest to me. I’m too young for this crap.

  18. I get that iron fortification can be a problem and with lowering iron levels is important.

    But you have got to be kidding with the phlebotomy, blood-letting, leaches….C’MON JERRY BLOOD LETTING? WHAT’S THE DEAL!

    1. The idea that bloodletting could be theraputically useful is almost as crazy as the idea that Saturated Fat doesn’t cause heart disease.

  19. Fabulous article, thankyou. Unfortunately, I’m on the other side where my ferritin levels are too low. Even after a year of Paleo, and then taking iron supplements every day for two months, still too low. I really notice it in my energy levels. If I forget to take that supplement for a couple of days running, fatigue will set in. Energy levels will bounce back to normal within two days of supplements. But will I give up coffee? No way, man. Soooo not ready!

    The information about blood donors lit up my ‘interesting’ receptors. My man has a work collegue whose capacity for sugar intake exceeds anyone I’ve ever known. Here in Italy, they like a ‘Caffè Corretto’, which is an espresso ‘corrected’ with liquor. This fellow tops up his espresso with Sambucca and THEN adds two sugars. His sugar hits start at breakfast and continue way into the night. Does he have insulin sensitivity? I don’t know, He’s skinny as a rake, athletic as a monkey and strong as an ox. He also gives blood regularly.

  20. I come from a family that passes along hemochromatosis and I’ve had the genetic testing done. I only have one mutated chromosome (which means I don’t have it). My uncle wasn’t so lucky. The health effects of too much iron are devastating, and the literature about that is significant. It is not coincidental; it is a cause. And it takes decades to reveal itself. The treatment is blood letting, and far more often than every 60-90 days. All men should give blood, period. And the fact that this is so little known, even by people who take their health seriously, like the readers of MDA, is, unfortunate. Thanks for getting this article out.

  21. I’d like to personally thank Chris, John, Rose, RobbyJ, plus any others who donate, or plan to donate, blood. Setting aside the possible health benefits of donating regularly, you are saving lives every time you do this. Even if your donation doesn’t make the difference between life or death for someone, it’s still immensely helpful.

    I used to donate regularly, but I lost the ability to do so after I became ill and encountered severe anemia. I was just dragging through my days until my oncologist prescribed a blood donation for me. It just made such a huge difference, and I am forever grateful to the folks who can and do donate blood.

    So please, if you can, donate blood a couple of times a year. It makes all the difference.

  22. Hi Mark. I’m curious. You say: …men of any age and post-menopausal women have no mechanisms to shed excess iron.

    You go on to clarify that we indeed do have mechanisms to shed iron. As a marathon runner and coach, I’m sure you’ve seen your share of low ferritin levels.

    What caught my eye in that statement is the word “excess.” If someone is eating primal or paleo, how is it possible for them to accumulate iron to the point of excess? Our ancestors have had rather long periods lasting thousands of years where we they were practically obligate carnivores, our diets predominantly coming from red meat (and it’s heme content). Despite exposure to iron of a greater magnetude than we would today (especially if eating primal or paleo), there are no indications that our ancestered suffered from any disease “associated” with iron overload during those extended periods. It seems to me that our bodies have a mechanism in place to control the bioavailablity of heme iron, just as it has a mechanism to control the bioavailability of ingested cholesterol. If you eat primally is it really necessary to even be concerned with iron ingestion? After all, if someone is primal, they’ll be eating most of the things you suggest they eat to shed non-existant “excess” iron, no? 🙂

    1. “If someone is eating primal or paleo, how is it possible for them to accumulate iron to the point of excess?”

      Easy. They could have the hemochromatosis genes (I carry two of them). Or maybe they eat a lot of meat and cook in cast iron. Or maybe they pop Vitamin C near meals. Or drink a lot of alcohol. Or pop an iron containing multi. Or maybe they were iron loaded from years of being sedentary and eating the SAD.

      And again, I will point out there is NO EVIDENCE that our ancestors were eating more iron that we do today, and in fact, quite a bit to suggest that we eat more iron today. The USDA documents that people are eating about 10mg more iron today than just 40 years ago, most of that being due to supplements and fortification, which grok certainly didn’t have to deal with.

      Breakfast cereals like Total and Special K have 10 times the iron content per gram than beef liver.

      Also, grok likely had helminths, that kept his iron stores low, since they feed on the hosts blood.

      Anyway, whatever groks iron intake and ferritin levels were are somewhat irrelevant. There’s lots of observational evidence that blood donors live longer and are healthier, and clinical trials indeed show that lowering iron stores has a multitude of health benefits. That trumps everything.

      1. John, it appears you misunderstood my post. I was talking about the 99.9% of us who don’t suffer from an iron overload disorder. As well, I was talking about people eating primal, which would eliminate all those who eat Total or Special K, or need vitamin C supplementation, etc. If you aren’t familiar, eating primal means you don’t eat that crap or need to pop pills.

        Cast iron pans and helminthes may affect body burden of iron, but at this point it is too theoretical. And likely minor.

        For your information, there is ample evidence our ancestors ingested heme iron (reread my post) in excess, by a large margin, of what people consume today as they were practically carnivorous for large chuncks of history (ice ages, for example). And their is no evidence they suffered from, well, anything (other than high infant mortality).

        It’s also well known, at least to physiologists, that the body burden of iron is controlled via heme iron, the predominant form of iron in the primal diet. The body has ways to regulate the bioavailability of heme iron based on need.

        My point is–not so subtlely, this time–eating primal is preventative of developing iron overload. I thought Mark could have spun this theme–eating primal–rather than ways of ways to get rid of nonexistent iron overload in primal eating folks.

        If you choose to respond to this comment, I would appreciate it if you read it carefully and stayed on subject.

        1. Heme iron, contained in animal foods has high potential of adsorption, near 100% however your gut limits adsorption to a few mg per day. The excess will pass through with the stool. Therefore you can eat large volumes of red meat and not have iron overload. Non-heme iron though poorly adsorbed, does not have a limiting mechanism, probably because humans were not exposed to large doses of non-heme iron in the past so this would be a useless adaptation.

          Even though it is possible that our ancestors consumed more iron, it would have been in the form of heme iron. Non-heme iron in the form of supplements and fortification of foods dominates our consumption today.

          Your body sheds approximately 2 to 3 mg of iron per day through sweat and loss of hair and skin which is also the maximum adsorption quantity of heme iron. Therefore if you eat animal products, you naturally replace lost iron. Iron deficiency anemia is caused by people who do not have access to enough animal foods, esp children and pregnant women. The fortification of flour was intended to reach these populations. Since adsorption of non-heme iron is low, fortified flour is intentionally spiked with extremely high levels of non-heme iron. Far higher than any naturally occurring food. The intention being to replace the animal products that people were not getting. Also note that vitamin C, HFCS, alcohol, and PUFA does increase the adsorption of non-heme iron and may effect heme iron also. Therefore a SAD diet will likely cause a massive increase in daily iron adsorption over a primal or even a traditional US (pre WWII) diet. (There are also other huge issues with fortified flour besides the iron, too lengthy to detail here but just keep in mind.)

          I find it highly plausible that it’s the exposure to extreme levels of non-heme iron that is the problem, not naturally occurring iron. It is also possible that iron exposure has damaged your metabolism so even someone who has eaten primal for several years may have residual problems stemming from their earlier SAD that is not yet resolved, since excretion of iron is very slow.

          I think the apparent success or popularity of vegetarian diets today is because the removal of meat helps abate metabolic issues from mineral and vitamin imbalances since you are removing nutritionally dense sources of food and thus minimizing the problem nutrients. Gluten free diets work in the opposite mechanism, they remove most of the fortified foods. Note that as the GF fad has taken off, food MFGs have started fortifying the nutritionally bankrupt GF foods to make them appear to by healthy and the diet has simultaneously become less effective.

          The best approach is a primal approach to diet with a balance of natural nutrients. It is just important to know the dangers of excess iron in fortified foods as an underlying cause of disease to protect yourself from exposure to them.

        2. There is no “reply” button below Chris D’s response, so I’ll say what I have to say here. Thanks, Chris D, for putting in the time and explaining so succinctly the real concern with iron. Cheers to you.

        3. “My point is–not so subtlely, this time–eating primal is preventative of developing iron overload.”

          Well, it certainly wasn’t in my case. My serum ferritin was at 444 after two years of eating paleo/primal. That is out of range high. I don’t know what it was before, but eating a paleo diet certainly didn’t lower my iron stores into the normal range. And I’m guessing it helped push the number up.

          Chris Kresser would likely also disagree with your point. He’s a big promoter of paleo who sees a lot of patients in his practice (at one time he estimated about 30%) who have iron overload. This was often after implementing a paleo diet.

          If you know of any studies tracking iron makers of people eating a paleo diet, I would be curious to see them! To my knowledge, it’s never been studied. Dr. Fachinni actually did create a diet to protect against excess iron, and did measure the effects on total body iron. It’s titled “A Low-Iron-Available, Polyphenol-Enriched, Carbohydrate-Restricted Diet to Slow Progression of Diabetic Nephropathy.” His results showed that his diet lowered ferritin from an average of 328 to 35 over 3 years.

          I’ll also point out that many people don’t know if they have high iron until they get an iron panel or do the genetic test. Hemochromatosis is most frequently diagnosed at DEATH.

          And helminths will lower body iron since they feed on the hosts blood, and that is NOT theoretical. Dr. Fachinni mentions this in his book “The Iron Factor of Aging.”

          As for your “proof” that that our ancestors ingested heme iron in excess, I’d like to see what group of our ancestors you are referring to, and how the levels of heme and non-heme iron compare to current USDA estimates of Americans intake. I didn’t see any iron intake estimates in for any population in either of your comments. (By the way, the USDA estimates that Americans currently eat about 23mg of iron a day).

          I would suggest you watch Chris Kresser’s excellent presentation “Iron Behaving Badly,” or read “Exposing the Hidden Dangers of Iron” by Weingberg and Garrison before you suggest that iron overload is “nonexistent” for primal eating folks.

    2. The normal body has no ACTIVE means of ELIMINATING iron. There is a steady passive loss of a few mg a day. It does have an active means of regulating the ABSORPTION of iron, and this regulation is broken in hemochromatosis suffers (i.e. the digestive input gate is stuck open all the time). The gate could also be bypassed if you have a leaky gut.

  23. Don’t know if I have ever had my ferritin levels checked. I’ve had my haemoglobin levels checked which are in the normal range. I drink tea with my breakfast and with my evening meal. I also no longer take multi vitamins. I do take Vitamin C once a day. I’m over 70 and don’t think in the UK you can donate blood once over 70 unless you have been donating for years.

  24. No problem Stipetic, all the more reason not to eat processed foods esp fortified white flour and never take multi vitamins. Excess iron gets safely stored in the protein molecule ferratin. The bodies ability to produce ferratin is however limited so that large loads of excess iron is in a free state and can directly cause oxidation damage. Non-heme iron in supplements and fortified foods are often non-charged (silver iron) or reduced (blue iron) states that are very susceptible to oxidation. So if you happen to eat fortified foods for a social occasion like birthday cake, follow Mark’s advice. Another likely consideration for primal folks is that ferratin is stored in fat cells once lean tissues are saturated. If you have excess iron from your days of eating SAD, you will not be able to lose fat cells used to store the ferratin until there is an iron deficit. Your body will behave as if those fat cells can not be accessed for stored energy, because they literally can’t since there is no where for the iron to go. Therefore if you suspect iron overload, you may want to limit your consumption of high iron foods and consume them with iron inhibitors when you do. If you have stubborn fat deposits that just won’t go away no matter how much dieting and exercise you do, you may want to consider having your iron levels checked.

  25. Dear Mr. John (reply button not activated). I never said eating primal is preventative of iron overload out of the context of ancestral diets. My point is that prior to food fortification, heme iron dominated iron intakes and that is by itself limiting to the extent that lost iron is replaced by eating animal foods, and heme iron has adsorption limits on quantity. If you already have iron overload, eating primal will not lower your iron as it is not an iron reducing diet, it is an iron balanced diet. I provided no proof that our ancestors ate more iron, just reasoned that if they did, they would have been protected because they did not consume large quantities of non heme iron. Can you dispute that? If you have elevated iron like I do, it is from non heme iron from fortified foods eating a misguided SAD. I’m not sure what you are arguing. We all know excess iron is bad, lowing iron is troublesome, and most diets are not designed to lower iron. Even if you have hemochromotosis, eating primal should not exacerbate your condition further, unlike most diets, as Mark recommends eating a wide variety of plants and animals and not focusing on eating a high red meat diet to the exclusion of other important sources of nutrition.

  26. I have been diagnosed with high ferritin levels following blood tests. I suffer from tiredness, loss of libido, depression, joint problems. I am post menopausal so do not have a monthly blood loss. Tests for hemochromatosis were negative. It appears the excess iron in my body is due to high intakes of red meat, a daily multi vitamin and mineral supplement and a daily high vitamin c supplement which aids iron absorption. I also have evidence of fatty liver disease, my doctor says the two are linked as excess iron is not excreted but stored in major organs particularly the liver, but also the heart. The only way to reduce my iron levels is weekly blood letting(phlebotomy) for several months which will reduce the levels of iron. I rarely eat fortified bread or cereals for other reasons but had never considered the iron content in them. I have now been given up red meat until my levels are lower and will continue to avoid bread and cereals. I live in the UK where flour is fortified but understand that in other countries like France it is not fortified. Maybe explains why I could eat bread on the continent but at home it made me ill. I had wrongly put this down to gluten intolerance . The tests for which came up negative tests at the same time highlighted my high ferritin levels!

  27. The area Mark didn’t touch on was the impact of blood donation on aerobic performance.

    Does donating highly trained blood provide an iron benefit and a fitness negative if done too frequently?

  28. After 3 years on Paleo my dr found my ferritin levels too high.
    I was taking quercitin regularly but stopped 2 years ago. Will restart
    I will try other suggestions too.
    See dr next week.

    Actually saw an osteopath for one year lasy year and gained 10 pounds. Helped with absorption but also I guess with iron absorption too?


  29. I’ve had high levels of ferritin for years but no doctor has done anything about it. My most recent blood work showed my levels at 700! My NP is alarmed and is sending me for a liver U/S and referring me to a hematologist. Liver enzymes are normal. Iron levels are normal. But I had Hep-A 20 years ago and wonder if that has anything to do with it.

    I eat just about everything you recommend except for red wine because I don’t like it. I hate coffee but have learned a few tricks to make it palatable but the caffeine does drive up my Blood Pressure.

  30. Mas, segundo li, quase 90% da ferritina elevada se deve a inflamção, etc, ou seja, nada ver com excesso de ferro, conquanto a saturação da transferina esteja normal.
    No meu caso, ferritina 350, mas ST normal