Do vegans get enough iron, or become anaemic?

The objection

“Plant iron is the poorly absorbed kind. Study after study finds vegans with lower iron stores than meat-eaters, and plenty of them, women especially, end up tired and anaemic.”

The answer

The objection is right about absorption and about stores, and only partly right about anaemia. Plants supply non-haem iron, which the body absorbs less readily than the haem iron in meat [2][10]. A 2010 review estimated that people with no iron stores absorb 14 to 18% of the iron in a mixed diet but 5 to 12% of the iron in a vegetarian one [1], and US and Canadian reference values (Institute of Medicine, 2001) set vegetarians’ iron requirement 1.8 times higher than meat-eaters’ for that reason [2]. The NHS gives no separate figure for vegetarians: it advises 8.7 mg a day for men and for women aged 50 and over, and 14.8 mg for women aged 19 to 49, adding that women still having periods after 50 may need the same [3].

The weaker absorption shows up in iron stores. A 2018 meta-analysis of 24 cross-sectional studies found that vegetarians’ serum ferritin, the main blood measure of stored iron, averaged 29.7 µg/L lower than non-vegetarians’, with a bigger gap in men (61.9 µg/L) than in premenopausal women (17.7 µg/L) [4]. A 2021 systematic review by two Unilever scientists, averaging the 17 studies that measured ferritin, found vegans lowest of the three diet groups even though they ate the most iron, and vegetarian women lower still, at 24.3 µg/L [5]. Average intakes in every diet group cleared even the estimated average requirement once it was raised to allow for poorer absorption from plants (14.6 mg a day for women, 10.8 mg for men), though vegetarians fell short of it in 7 of 32 studies [5]. Only three of the ferritin studies compared vegans with meat-eaters directly, and two of them found meat-eaters’ stores significantly higher, a difference more marked in studies that left out people taking supplements [5]. Both reviews rest on comparisons of groups at a single point in time, which can’t fully separate diet from the other ways vegetarians differ from meat-eaters. In the 2021 review’s averages below, iron deficient means ferritin under 15 µg/L, a measure only four of the studies reported [5]. That cut-off is strict: a 2021 British Society of Gastroenterology guideline says ferritin under 15 µg/L is highly specific for iron deficiency, but notes that 45 µg/L has been suggested as the best practical trade-off and that levels under 30 µg/L generally mean low stores, which puts both plant-based averages just above 30 and below 45 [16].

2021 review averages	Meat-eaters	Vegetarians	Vegans
Iron eaten (mg a day)	13.9	15.3	21.0
Ferritin (µg/L)	55.5	33.8	31.3
Iron deficient	7%	11%	15%
Haemoglobin (g/L)	139	140	136
Anaemic	5%	11%	17%

Each row averages a different set of studies, and not every study included vegans, so the rows can’t be read against each other. That is one reason the share anaemic can come out higher than the share iron deficient, and anaemia can also have causes other than a lack of iron [5][11].

Are vegans more likely to be anaemic?

Vegans and vegetarians are more likely to be anaemic than meat-eaters, with the clearest gap in women before the menopause, though most people in these studies were not anaemic. Low stores and anaemia are different things, since anaemia means haemoglobin itself has fallen, below 120 g/L in women and 130 g/L in men as these studies defined it [5][6]. Average haemoglobin barely differed between diets in the 2021 review, but the studies that counted anaemia found it in 17% of vegans and 11% of vegetarians against 5% of meat-eaters [5]. In a 2019 analysis of blood counts taken from 447,726 white British adults in UK Biobank between 2006 and 2010, 12.8% of premenopausal vegetarian women were anaemic against 8.7% of premenopausal women who ate red or processed meat more than three times a week, a gap of about four percentage points [6]. After the menopause the figures were 5.8% against 3.4%, and in men the difference wasn’t statistically significant [6]. That study counted anaemia from any cause, and its 398 vegans were too few to show a clear difference either way. A 2018 review of 13 studies also found iron-deficiency anaemia more common among vegetarians, especially premenopausal women [7]. All of these figures are for adults. In children and teenagers, a 2026 meta-analysis of 59 studies comparing diets, which included 1,289 vegans, found lower ferritin and haemoglobin in vegans than in children who ate meat, and higher odds of iron deficiency and anaemia in vegetarians, though most group averages stayed within children’s normal ranges [17].

Does the body make up for absorbing less?

The body partly makes up for absorbing less plant iron, because it absorbs more iron from food when it needs more [10], and a 2010 review concluded that a person’s iron status generally affects absorption more than the make-up of their diet does [1]. In a 2000 US feeding study, 31 men ate a diet with either high or low iron availability for 12 weeks, and by week 10 their absorption had adapted enough to narrow the difference between the diets from eightfold to fourfold [8]. The men started with healthy iron stores and the adaptation was only partial, so it narrows the gap without closing it.

Vitamin C in the same meal raises absorption of plant iron, strongly in single-meal tests and more modestly across a whole diet, while tea and coffee at mealtimes blunt it [9][10]. When a 2001 study measured how much iron 12 people absorbed from their whole diet over three five-day periods, raising or lowering their vitamin C intake across a range of 51 to 247 mg a day made no significant difference to average absorption [9]. The NHS also suggests that people with iron deficiency anaemia cut down on tea, coffee, milk and foods high in phytic acid, such as wholegrain cereals, because large amounts of them make iron harder to absorb [11]. In practice, squeeze lemon on the lentils and drink the tea between meals.

Which plant foods are high in iron?

Pulses, tofu, nuts, seeds and fortified breakfast cereals are all good plant sources, and gram for gram several of them carry as much iron as beef mince, though less of it is absorbed [1][12]. The BDA notes that all bread sold in the UK other than wholemeal must be fortified with iron, and many breakfast cereals are too, so check the label [10]. In the table, pulses and edamame are shown per 80 g, the NHS adult 5 A Day portion, and dried apricots per 30 g, its portion of dried fruit [13]. Tofu is shown per 100 g and the rest per USDA household measure [12].

Food and portion	Iron per portion (mg)	Iron per 100 g (mg)
Lentils, boiled, 80 g	2.7	3.33
Tofu, firm, calcium-set, 100 g	2.7	2.66
Pumpkin seeds, 28 g (1 oz)	2.5	8.82
Kidney beans, boiled, 80 g	2.4	2.94
Chickpeas, boiled, 80 g	2.3	2.89
Edamame, cooked from frozen, 80 g	1.8	2.27
Tahini, 15 g tablespoon	1.3	8.95
Dried apricots, 30 g	0.8	2.66
Beef mince (85% lean), cooked, 85 g (3 oz)	2.3	2.68
Chicken breast, roasted, 86 g (half a breast)	0.9	1.04

The NHS also lists nuts, soy bean flour and fortified breakfast cereals as good sources [3].

Do vegans need iron supplements?

UK health advice doesn’t tell vegans, or anyone else, to take iron supplements routinely: the NHS says most people can get all the iron they need from a varied and balanced diet, though women who lose a lot of blood in their periods are at higher risk of iron deficiency anaemia and may need them [3]. It suggests speaking to a GP or a registered dietitian for advice, and the BDA notes that UK dietary surveys indicate many women aren’t getting enough iron [3][10]. In pregnancy, the BDA says, a doctor will usually measure iron levels and may recommend a supplement if there’s a risk of anaemia [10]. For anyone who does need tablets, taking them with a meat-free meal doesn’t seem to matter: in a 2025 US randomised trial funded by the National Cattlemen’s Beef Association, 52 women of childbearing age with low iron stores took a 32 mg iron supplement with lunch every day for eight weeks, and their ferritin rose by an average of 10.7 µg/L, with no significant difference between those whose lunch contained beef and those whose lunch contained plant-based meat [18]. The authors concluded that the “meat factor”, the idea that meat helps the body absorb plant iron, made no substantial difference, though the trial was small and short and tested tablets rather than iron in food [18].

Tiredness, shortness of breath, palpitations and paler skin than usual are the common symptoms of iron deficiency anaemia, though tiredness on a new vegan diet has other causes too [11]. A GP will usually start with a full blood count, which shows whether you are anaemic and also checks for other types such as B12 or folate deficiency anaemia, and iron tablets are the usual treatment when the anaemia comes from a lack of iron [11]. The test that shows stored iron is ferritin, which the 2021 British Society of Gastroenterology guideline calls the single most useful marker of iron deficiency anaemia [16]. The authors of the 2018 meta-analysis, noting that high iron stores are themselves a risk factor for some diseases such as type 2 diabetes, advised vegetarians and meat-eaters alike to have their iron status checked regularly [4]. None of this rules a vegan diet out: the Academy of Nutrition and Dietetics’ 2025 position, which covers adults who aren’t pregnant or breastfeeding, holds that appropriately planned vegan diets can be nutritionally adequate [14].

Some cautions apply whatever you eat. If you think you might have iron deficiency anaemia, see a GP, and if the blood test shows anaemia, don’t assume diet is the cause: heavy periods and pregnancy are very common causes, and bleeding in the stomach or gut is another common one [11]. That bleeding can come from anti-inflammatory painkillers such as ibuprofen and aspirin, from ulcers or, less often, from bowel or stomach cancer, which is why a GP who can’t find the reason may test a sample of poo for blood [11]. The NHS says taking 17 mg a day or less of iron supplements is unlikely to cause harm, though a GP may advise a higher dose, and that doses over 20 mg can cause constipation, sickness and stomach pain [3]. Iron tablets can interact with a number of other medicines and supplements, including levothyroxine for an underactive thyroid, some antibiotics, antacids and other indigestion remedies, and calcium, so the NHS advises leaving a gap between iron and any other medicine and asking a pharmacist or doctor how long it should be [19]. If you are on any other treatment, speak to a GP before changing or stopping any medicine. Keep iron tablets out of children’s reach, since an overdose of iron can kill a young child [3][11]. People with haemochromatosis, an inherited iron overload that most often affects people of white northern European background and is particularly common where many people have Celtic roots, as in Ireland, Scotland and Wales, are usually advised to avoid iron and vitamin C supplements and breakfast cereals with added iron [15].