causes the body to absorb too much iron from foods.
To minimize the symptoms and reduce the risk of complications, people can follow a
hemochromatotis diet.
1Dietary factors
2What to eat
3What to avoid
4Effects of diet
5Other treatments
6FAQs
7Summary
1Dietary factors
The goal of treating hemochromatosis is to reduce the amount of iron in the body to normal levels.
As well as eating only foods that are low in iron, there are other factors to consider. For example, some dietary components affect how much iron the body absorbs.
Examples include:
- Iron type: Heme iron is easier for the body to absorb than nonheme iron. Plant-based foods contain only nonheme iron, whereas meat, poultry, fish, and seafood contain both heme and nonheme iron.
- Vitamin C: This vitamin enhances nonheme iron absorption.
- Calcium: This mineral can reduce iron absorption.
- Phytates, tannins, and polyphenols:These dietary components limit the absorption of nonheme iron.
In addition to dietary changes, doctors can treat hemochromatosis with medication and therapeutic phlebotomy, a treatment that removes blood from the body.
2What to eat
Currently, the American College of Gastroenterology (ACG) and the European Association for the Study of the Liver (EASL)offer guidelines for the hemochromatosis diet. While there are some conflicting recommendations, the guidelines largely offer similar suggestions.
Fruits and vegetables
Fruits and vegetables are an important part of any healthful diet. They are rich in vitamins and minerals that are vital for the body to function properly. A 2021 overview advises people with hemochromatosis to consume as much fruit and vegetables as they can.
Some fruits and vegetables, including spinach, mushrooms, and olives, are high in nonheme iron. However, as nonheme iron is harder for the body to absorb, they are less likely to affect iron levels significantly.
Many fruits and vegetables also contain substances that reduce iron absorption.
Some examples include:
- spinach
- kale
- rhubarb
- strawberries
- beetroot
- leafy greens
- edamame beans
Certain proteins
Lean protein is an essential part of a healthful, balanced diet, but many sources of lean protein contain iron.
Preferable sources of protein on a hemochromatosis diet include:
- lean white meat, such as poultry
- fish
- eggs
Additionally, soy proteins, such as tofu, tempeh, soybeans, soy milk, and edamame beans can help to inhibit iron absorption.
Wholegrains
Wholegrains contain phytates, which can make it difficult for the body to absorb iron. A 2021 narrative review advises that people should consider non-sourdough, yeast-fermented bread with at least 50% whole grain to help slow the absorption of iron.
It is advisable to avoid sourdough bread, as the bacteria that ferments it produces lactic acid, which can enhance iron absorption.
Tea and coffee
Tea and coffee contain tannins, which are types of polyphenol plant compounds.
The tannins in tea and coffee may reduce iron absorption. Drinking these beverages is another way for people with hemochromatosis to manage their iron levels.
Calcium-rich foods
Calcium can inhibit the absorption of both nonheme and heme iron.
Examples of calcium-rich foods include:
- yogurt
- milk
- cheese
- tofu
- green leafy vegetables, such as broccoli
3What to avoid
Doctors generally advise people with hemochromatosis to avoid iron-fortified foods and supplements. Other foods to consider avoiding
Red meat
Most red meats, including beef, lamb, and venison. Chicken and pork contain lower amounts of heme. As heme iron is easy for the body to absorb, people with hemochromatosis may wish to avoid most red meat.
If a person wishes to consume read meat, they can pair it with foods that reduce iron absorption.
Raw shellfish
Shellfish, such as mussels, oysters, and clams, sometimes contain Vibrio vulnificus bacteria. These bacteria can cause a serious infection called vibriosis.
People with hemochromatosis are more susceptible to vibriosis infection. Therefore, it is important to cook any shellfish thoroughly to kill the bacteria. People can also reduce their risk of infection by discarding any raw shellfish that have open shells and avoiding eating any shellfish that remain unopened after cooking.
Vitamin C
Vitamin C increases the absorption of nonheme iron. Due to this, people with hemochromatosis should avoid vitamin C supplements.
The amount of vitamin C in fruits and vegetables is generally too low to have a significant effect on iron absorption. These foods also contain a variety of other nutrients that are important in a healthful diet.
However, eating foods or drinking beverages high in vitamin C alongside iron-rich foods may enhance iron absorption. For this reason, pairing iron-rich foods with vitamin C-rich foods may not be the best choice for those with hemochromatosis.
Fortified foods and iron supplements
Fortified and enriched foods contain added vitamins and minerals that aim to improve nutrition. For example, many cereal products are fortified with calcium, vitamin D, and iron. Similarly, iron supplements aim to increase a person’s iron intake.
As such, it is advisable for people with hemochromatosis to avoid iron-fortified foods or supplements containing iron.
Alcohol
Consuming alcohol can promote the absorption of iron. Additionally, digesting alcohol causes the body to produce substances that damage the liver.
As such, a doctor may suggest
to a person with hemochromatosis that they limit their alcohol intake.
4Does diet have much effect on this condition?
Diet can affect iron absorption, but whether it has much of an effect on hemochromatosis is unclear.
According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), dietary changes have only a small effect on iron levels compared with standard treatments for hemochromatosis. Although dietary changes may help reduce iron levels in small amounts, they are not nearly as effective as medications or phlebotomy. However, it is advisable for a person with hemochromatosis to consult a dietician.
Additionally, the Centers for Disease Control and Prevention (CDC)
suggest that people with hemochromatosis should avoid:
- iron supplements
- vitamin C supplements
- raw shellfish
- high alcohol use
Managing Genetic Hemochromatosis:
An Overview of Dietary Measures, Which May Reduce Intestinal Iron
Genetic hemochromatosis causes iron overload by excess absorption of dietary iron, due to a decreased expression of hepcidin.
The objective was to elaborate dietary recommendations that can reduce intestinal iron absorption in hemochromatosis patients, based on our present knowledge of the iron contained in nutrients and the mechanisms of iron uptake.
This is a narrative review.
Literature search in PubMed and Google Scholar of papers dealing with iron absorption from the diet was conducted.
Most important proposed dietary recommendations are:
1) Choose a varied vegetarian, semi-vegetarian or flexitarian diet. A “veggie-lacto-ovo-poultry-pescetarian” diet seems optimal. Avoid iron enriched foods and iron supplements.
2) Eat many vegetables and fruits, at least 600 g per day.
Choose protein rich pulses and legumes (e.g., kidney- and soya beans). Fresh fruits should be eaten between meals.
3) Abstain from red meat from mammals and choose the lean, white meat from poultry. Avoid processed meat, offal and blood containing foods.
Eat no more than 200 g meat from poultry per week.
Choose fish, eggs, vegetables and protein rich legumes the other days.
Eat fish two to four times a week as main course, 350 – 500 g fish per week, of which half should be fat fish.
4) Choose whole grain products in cereals and bread.
Avoid iron enriched grains.
Choose non-sourdough, yeast-fermented bread with at least 50% whole grain.
5) Choose vegetable oils, and low-fat dairy products.
6) Eat less sugar and salt.
Choose whole foods and foods with minimal processing and none or little added sugar or salt.
7) Quench your thirst in water.
Drink green- or black tea, coffee, or low-fat milk with the meals, alternatively water or non-alcoholic beer.
Fruit juices must be consumed between meals.
Abstain from alcoholic beverages.
Drink soft drinks, non-alcoholic beer, or non-alcoholic wine instead.
These advices are close to the official Danish dietary recommendations in 2021.
In the management of hemochromatosis,
dietary modifications that
lower iron intake and decrease iron bioavailability may provide additional measures to reduce iron uptake from the foods and reduce the number of phlebotomies.
5Other treatment options
Treatment for hemochromatosis usually involves:
Phlebotomy
Doctors remove excess iron by drawing about 1 pint of blood at a time. They will regularly order blood tests to check iron levels.
Chelation therapy
Chelation therapy removes iron using pills or injections. These treatments are necessary for people who are unable to undergo blood removal due to conditions such as anemia or heart problems.
Chelation therapies are less effective than phlebotomy in removing iron.
5Frequently asked questions
Some FAQs about the hemochromatosis diet may include:
What foods should you avoid if you have hemochromatosis?
People with hemochromatosis should try to limit iron-fortified or iron-rich foods, such as red meat. It may also be helpful to avoid pairing these foods with sources rich in vitamin C, such as citrus fruits. This is because vitamin C can increase iron absorption.
However, it is important to note that diet only has a small effect on iron levels in comparison to the medical treatments for hemochromatosis.
Is chicken bad for hemochromatosis?
Many protein sources may also contain iron. Despite this, people following the hemochromatosis diet do not need to avoid animal protein. However, it is advisable to opt for lean animal proteins that contain lower amount of iron, such as chicken.
Can you eat cheese if you have hemochromatosis?
Calcium-rich foods, such as cheese, can help to inhibit the absorption of iron. As such, it can be helpful for those following a hemochromatosis diet to include foods such as cheese.
What foods lower your iron levels?
Foods that can reduce the body’s ability to absorb iron include soy proteins, such as tofu, beverages containing tannins, such as tea and coffee, wholegrain fibers, such as bran, and calcium-rich foods, such as cheese.
6Summary
Hemochromatosis causes people to absorb too much iron from foods.
The goal of treating hemochromatosis is to remove excess iron from the blood through phlebotomy or chelation therapy. Avoiding vitamin C supplements, raw shellfish, and high alcohol use may also be helpful.
Eating foods that are lower in iron or reduce iron absorption may also help keep iron levels within normal limits. However, reducing dietary iron is not as effective as other hemochromatosis treatments.
