NEW RESEARCH: Anaemia – how does your diet or monthly cycle put you at risk?

Qualified Nutritionist (BSc, MSc, RNutr)
Ask Emma

31 July 2019

Anaemia – what puts us at risk?

It's readily assumed that women may be more at risk of iron deficiency anaemia when compared to men, which this new research also suggests, however, which other factors can have a part to play? This brand new study investigates some other contributing factors including:

  1. Gender
  2. Being vegetarian or vegan
  3. Menstrual blood loss
  4. Hormonal contraceptive use
  5. Supplement use
  6. Body composition and physical activity

In light of the research, I explore these themes in more detail and offer some top tips for helping to overcome the subsequent risk of anaemia.

1. Gender

This study found that men were generally iron sufficient compared to their female counterparts, who were most at risk of experiencing iron depletion or iron deficiency anaemia.1

As the men were also following similar dietary patterns (i.e. being vegetarian or vegan), this suggests that gender-specific differences such as monthly period symptoms, may have more of an influence, over dietary factors.

My take home message:

Unfortunately it seems that vegetarian or vegan women may be are more at risk of anaemia than men. However, that's not to say there's nothing that can be done!

Later we look at how understanding your cycle, tailoring your diet, using supplements or moving more, could all potentially help to protect against anaemia.

2. Being vegetarian or vegan

As the study only involved vegetarians and vegans, unfortunately there was no control group to compare to – a control group would show how protective a diet including meat, in comparison, could be when it comes to anaemia. Although, research has suggested that vegetarians or vegans following a healthy, plant-based diet may be at no greater risk of anaemia that their meat-eating counterparts.2

However, the results from this latest study, does suggest there may be some crucial differences between men and women. Whilst men, with the absence of monthly periods, seemed to be protected from anaemia even whilst following a vegetarian or vegan regime (none were considered anaemic and only 13% were considered iron deficient), 78% of the female subjects were considered deficient in iron or anaemic.

Interestingly, there is a theory that vegans may be better off in terms of their iron status when compared to vegetarians. One theory is that dairy may actually inhibit the absorption of iron, to some degree.1 However, in this study no significant differences were found between the iron status of the vegetarian and vegan groups, although the vegetarian group were considered to have a relatively 'low consumption' of dairy products.

One other significant dietary pattern worth noting here was in the most iron deficient group. They were found to not only have the biggest consumption of vitamin C rich foods such as peas, (which is a positive for iron absorption) but also the largest intake of pasta which can be considered as an iron inhibitor.1 Therefore, these effects may have somewhat cancelled each other out and ultimately didn't help to protect against iron deficiency.

My take home message:

If you're following a veggie or vegan regime, it's not to say that you're inevitably going to end up iron deficient, there is some hope!

Firstly, men seemed to be more protected to start with, but for women, there seems to be some additional, contributing factors to contend with, including monthly cycles.

However, following a healthy diet, rich in fresh foods, is an important protective measure you can take. Including lots of vitamin C-rich sources of food in your diet, such as citrus fruits, bell peppers and leafy greens can all help to support the proper absorption of iron.

Meanwhile, watching your diet isn't too heavy in certain foods, including grains or beans which are rich in phytates, or dairy products high in calcium, can help to ensure the absorption of iron from your food isn't blocked.

3. Menstrual blood loss

Unsurprisingly, menstrual blood loss seemed to be one of the biggest risk factors in terms of iron status. This seems to make women, on the whole, more at risk of iron deficiency than men, but our monthly cycles may also explain the individual differences women experience.

Although the results from this trial were not statistically significant in this area, we can still detect patterns, which can then influence areas of further research.

Some of the results were as follows: the number of days of bleeding was higher in those who were anaemic at 5.4 days, versus 4.4 days, on average, for the women who were considered iron sufficient. Heavy bleeding days were also highest in the anaemic group at 2.8 days versus 1.9 days in the iron sufficient group.

My take home message:

Bleeding for longer or heavier, may put you more at risk of anaemia – no surprises there! Whilst taking an iron supplement may be a good tactic, as we'll explore later, understanding your cycle and taking steps to balance hormones can also prove really helpful.

If your periods are on the heavier side, perhaps come more frequently than every 28 days on average, plus you suffer at the hands of any other symptoms of PMS, then an extract of Agnus castus may help to manage some of your symptoms over time.

My Top Tip:

If you need a little extra help to deal with painful periods then you may find Agnus castus useful. Take 15-20 drops in a little water twice daily.  

"Top-notch quality, this stuff is a life saver!"


Read what other women are saying about Agnus castus.

4. Hormonal contraceptive use

Whilst the numbers were smaller in the iron deficiency anaemia group at only 5 people, none of those were found to be on hormonal contraceptives. In contrast, over a third of the iron sufficient group were on hormonal contraceptives including the pill or the vaginal ring.

Although these results again, weren't hugely significant, it does give us some reason to believe that hormonal contraceptives may actually be protective against anaemia, perhaps as they help to keep more erratic, and/or heavy cycles in check.

My take home message:

Whilst hormonal contraceptives aren't often our go-to recommendation, there is some reason to believe that regulating our hormones more deliberately can have its benefits. However, we also have herbs which can help with this and are often associated with fewer side effects.

If you aren't quite sure where to start in terms of balancing your hormones (although my video blog on this topic may help), you can contact me directly at for some tailored advice.

5. Supplement use

Interestingly, in this study iron supplementation was more apparent in the most at risk groups - that was those with the lowest iron status.1 Whilst this is good, and suggests a greater awareness of the potential risk of iron deficiency anaemia for those who are more vulnerable, it does also create a slight cause for concern, in that these people may be struggling to turn this around and manage the deficiency effectively.

Although this study doesn't go into this in detail, it is worth noting that the wide array of the different iron supplements available could be having some influence. Certain forms of iron may be more bio-available in the body, or better tolerated in terms of the side effects experienced, which could influence compliance.

However, the authors did suggest that iron supplements may not need to be recommended to vegetarians routinely, and we should stick to recommending this nutrient to only those who are more at risk of deficiencies.

My take home message:

Unless your doctor has confirmed you're anaemic, an iron supplement may not be necessary, but it is something to be aware of and check regularly, especially if you have heavier periods which it seems, can put women more at risk.

6. Body composition and physical activity

Although there were no significant statistical differences between the iron status of groups with differing physical activity levels and/or body compositions, there were certainly some trends worth noting. Interestingly, the highest proportion of active subjects was observed in the iron-sufficient group, whilst the iron deficiency anaemia group were found to be the least active.1

These results are preliminary and the direction of this relationship wasn't well understood. It could suggest that being more active could help to protect against anaemia, or it could simply mean when someone is anaemic they are less likely to keep active as a result of some of the associated symptoms including tiredness or fatigue.

In line with this, the study also showed that those iron sufficient versus those iron deficient did have some significant differences in body composition, including having more body muscle and a higher bone mass, which could also have links to the amount of activity these subjects were doing.

My take home message:

Whilst we aren't sure of the direct of the causality, it seems that being more physically active and having a larger proportion of lean body mass (muscle) may be more favourable and help protect against anaemia.



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