Patients who switch to a whole food plant-based eating pattern (WFPBD) generally have an uneventful transition, but may present with dizziness and lightheadedness. Research demonstrates that anemia is no more common when transitioning to a WFPBD than in the normal population, but Iron deficiency is possible in the context of a transition to a whole food plant-based diet resulting in either microcytic or normocytic anemia. All six pillars of lifestyle medicine; diet, activity, sleep, stress, social engagement, and risky substances, can affect absorption of Iron and are discussed. This paper discusses how the use of lifestyle modifications can potentiate iron supplementation, or replace the need for it altogether, to reverse anemia.
DeMaeyerEAdiels-TegmanM. The prevalence of anemia in the world. World Health Stat Q. 1985;38:302-316.
2.
MedawarEHuhnSVillringerAWitteA. The effects of plant-based diets on the body and the brain: a systematic review. Transl Psychiatry. 2019;9:226.
3.
CraigW. Health effects of vegan diets. Am J Clin Nutrition. 2009;89(5):1627S-1633S.
4.
Waldvogel-AbramowskiSWaeberGGassnerCBuserAFreyBMFavratBTissotJD. Physiology of iron metabolism. Transfus Med Hemother. 2014;41(3):213-221. doi: 10.1159/000362888.
5.
Al HasanSMHassanMSahaS, et al.Dietary phytate intake inhibits the bioavailability of iron and calcium in the diets of pregnant women in rural Bangladesh: a cross-sectional study. BMC Nutr. 2016;2:24. doi:10.1186/s40795-016-0064-8.
6.
PawlakRBergerJHinesI. Iron status of vegetarian adults: a review of literature. Am J Lifestyle Med. 2016;12(6):486-498. doi:10.1177/1559827616682933.
7.
Institute of Medicine. Dietary reference intakes for vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc. http://www.nap.edu/download.php?record_id=10026. Accessed April 15, 2016.
8.
HoJChanALauKChanH. Iron deficiency as a common treatable cause of chronic normocytic anemia. Blood. 2014;124(21):4032.
9.
McMackenMShahS. A plant-based diet for the prevention and treatment of type 2 diabetes. J Geriatr Cardiol. 2017;15(5):342-354.
10.
GardnerCCoulstonAChatterjeeLRigbyASpillerGFarquharJ. The effect of a plant-based diet on plasma lipids in hypercholesterolemic adults; a randomized trial. Ann of Int Med. 2005;142(9):725-733.
11.
SharpP. Intestinal iron absorption: regulation by dietary and systemic factors. Intl J for Vit and Nut Res. 2013;80(45):231-242.
McCormickRMorettiDMcKayA, et al.The impact of morning versus afternoon exercise on iron absorption in athletes. Med Sci in Sport & Exer. 2019;51(10):2147-2155.
14.
TeucherOCori. Enhancers of iron absorption: ascorbic acid and other organic acids. Intl J Vit Nut Res. 2013;74(6). doi:10.1024/0300-9831.74.6.403.
15.
DamianMVulturarRLoginCDamianLChisABojanA. Anemia in sports: a narrative review. Life. 2021;11(9):987.
16.
HoppeMHulthénLHallbergL. The importance of bioavailability of dietary iron in relation to the expected effect from iron fortification. Eur J Clin Nutr. 2008;62:761-769.
17.
GibsonRSHeathALMSzymlek-GayEA. Is iron and zinc nutrition a concern for vegetarian infants and young children in industrialized countries?Am J Clin Nutr. 2014;100:459S-468S.
18.
SandbergAS. The effect of food processing on phytate hydrolysis and availability of iron and zinc. Adv Exp Med Biol. 1991;289:499-508. doi:10.1007/978-1-4899-2626-5_33.
19.
HurrelRF. Phytic acid degradation as a means of improving iron absorption. Int J Vitam Nutr Res. 2013;74:445-452. doi:10.1024/0300-9831.74.6.445.
20.
BadenhorstCEDawsonBCoxGRLaarakkersCMSwinkelsDWPeelingP. Acute dietary carbohydrate manipulation and the subsequent inflammatory and hepcidin responses to exercise. Eur J Appl Physiol. 2015;115:2521-2530.
21.
RusuIGVodnarDCPopCR, et al.Iron supplementation influence on the gut microbiota and probiotic intake effect in iron deficiency—a literature-based review. Nutrients. 2020;12:1993.
22.
McKayAKAPeelingPPyneDB, et al.Six days of low carbohydrate, not energy availability, alters the iron and immune response to exercise in elite athletes. Med Sci Sports Exerc. 2021. published ahead of print.
23.
BrittenhamG. Short-term periods of strenuous physical activity lower iron absorption. Am J Clin Nut. 2021;113(2):261-262.
24.
Skarpańska-StejnbornABastaPTrzeciakJ, et al.Effect of intense physical exercise on hepcidin levels and selected parameters of iron metabolism in rowing athletes. Eur J Appl Physiol. 2015;115:345-351. doi:10.1007/s00421-014-3018-3.
25.
SchumacherYOSchmidAKönigD, et al.Effects of exercise on soluble transferrin receptor and other variables of the iron statusBritish. J Sports Med. 2002;36:195-199.
26.
NewlinMKWilliamsSMcNamaraTTjalsmaHSwinkelsDWHaymesEM. The effects of acute exercise bouts on hepcidin in women. Int J Sport Nutr Exerc Metabol. 2012;22:79-88.
27.
ConderheidSTussing-HumphreysLParkC, et al.A systematic review and meta-analysis on the effects of probiotic species on iron absorption and iron status. Nutrients. 2019;11(12):2938.
28.
ChenJShenHChenC, et al.The effect of psychological stress on iron absorption in rats. BMC Gastroenterol. 2009;9:83.
29.
PeelingPDawsonBGoodmanC, et al.Effects of exercise on hepcidin response and iron metabolism during recovery. Int J Sport Nutr Exerc Metabol. 2009;19:583-597.
30.
StephenHennigarHatch-McChesneyAAllenJCarriganCMurphyNKarlJP, et al.Declines in dietary iron absorption following simulated military operations are exacerbated by energy deficit. Curr Dev Nutr. 2020;4(Supplement_2):1807. doi:10.1093/cdn/nzaa067_034.
31.
StoffelNStoffelZBrittenhamGMorettiDZimmermannM. Iron absorption from supplements is greater with alternate day than with consecutive day dosing in iron-deficient anemic women. Haematologica. 2020;105(5):1232-1239.
32.
RidefeltPLarssonARehmanJAxelssonJ. Influences of sleep and the circadian rhythm on iron-status indices. Clin Biochem. 2010;43(16-17):1323-1328. doi:10.1016/j.clinbiochem.2010.08.023.
33.
KuhnEBrodanVBrodannovaMFried-mannB. Influence of sleep deprivation on iron metabolism. Nature. 1967.
34.
DuanePRajaKSimpsonRPetersT. Intestinal iron absorption in chronic alcoholics. Alcohol Alcohol. 1992;27(5):539-544.
35.
HosseiniSZabihiAEbrahimiSAmiriSKheirkhahFBijaniA. The prevalence of anemia and its association with depressive symptoms among older adults in north of Iran. J Res Health Sci. 2018;18(4):e00431.
36.
CarterRJacobsonJBurdenMArmony-SivanRDodgeNAngelilliM, et al.Iron deficiency anemia and cognitive function in infancy. Pediatrics. 2010;126(2):e427-e434.
37.
LozoffB, Early iron deficiency has brain and behavior effects consistent with dopaminergic dysfunction. J Nutr. 2011;141(4):740S-746S. doi: 10.3945/jn.110.131169.
38.
BernerAKamalMBenerHZBhugraD. Higher prevalence of iron deficiency as strong predictor of attention deficit hyperactivity disorder in children. Afric J Online. 2014;4(3). Special Issue.
39.
ArayaRDunstanFPlayleRThomasHPalmerSLewisG. Perceptions of social capital and the built environment and mental health. Soc Sci Med. 2006;62:3072-3083.
