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Iron deficiency is a common concern when you have Crohn’s disease, a form of inflammatory bowel disease (IBD). In fact, one research review found that about 25 percent of people with the condition had iron-deficiency anemia, a blood disorder caused by lack of iron that can lead to symptoms like fatigue.
This can happen for a variety of reasons in Crohn’s. “Chronic inflammation can cause ulcers that bleed, resulting in blood loss, and it can also reduce absorption of iron,” says Neha D. Shah, RD, of the Colitis and Crohn’s Disease Center at the University of California, San Francisco, and owner of Neha Shah Nutrition, a private practice where she works with IBD clients. In addition, symptoms like abdominal pain or diarrhea, as well as a restricted diet, can make it tough to get enough iron through food, she says.
There are two main forms of iron present in food: heme and nonheme. Plant foods contain nonheme iron, while meat, poultry, and seafood contain both types.Your body absorbs heme iron more easily than non-heme iron. But you can improve nonheme iron absorption by combining nonheme food sources with those rich in vitamin C, such as fruits and veggies.
Shah recommends making sure that you get both heme and nonheme iron. “Many individuals with Crohn’s already have food restrictions in place, and it’s important to maintain variety. Including a mix of both helps meet iron needs while respecting individual dietary preferences and tolerances,” she says.
Red meat is an obvious choice for many looking to increase their iron stores, but “usually people do not need a reminder to consume it; they need permission to explore other iron-rich foods that are also microbiome health–promoting,” says Stacey Collins, RDN, who specializes in IBD nutrition in Denver.
To help keep your levels of the mineral high, here are seven foods to include in your diet — both plant- and animal-based — that are rich in iron.
1. Poultry
Chicken and turkey are typically leaner than red meat, and the lower fat content makes these sources of iron easier to digest for people with Crohn’s, says Collins. Dark meat is about twice as high in iron compared with white meat, giving you more bang for your buck when trying to maximize iron intake. One catch: Dark meat is significantly higher in fat than white, but leaving off the skin will reduce the fat content by about one-third.
2. Sardines
Sardines are a fatty fish that are also a good source of iron. Plus, sardines are also rich in omega-3 fatty acids, which have anti-inflammatory properties, says Collins. They are, however, high in sodium. So make sure to take that into account on days you eat them.
A great thing about sardines is that they’re easily found canned in the grocery store. This often makes them an affordable source of fish that’s easy to keep on hand at home.
3. Lentils
Lentils are packed with iron, as well as gut-friendly nutrients like fiber.
That can be an especially powerful nutrient combo: Iron intake lowers the risk of deficiency, while research suggests that fiber can help control inflammation and help maintain remission in Crohn’s.
One caveat: If you’re in an active flare, go for lentil soup over regular cooked lentils, Collins says. The softer texture will be easier to digest, she says. One cup of lentil soup provides about 3.5 milligrams (mg) of iron, plus some vitamin C.
4. Chickpeas
Like lentils, chickpeas are legumes that are packed with both iron and fiber. One cup of canned chickpeas is an excellent source of iron. Collins recommends switching to hummus for a softer, easier-to-digest texture when in a flare. Remember to pair this one with vitamin C; lemon juice pairs nicely with chickpeas, for instance.
5. Pasta
An iron-rich grain option for people with Crohn’s is enriched pasta that’s been fortified with nutrients. “Pastas are usually quite tolerable and easy to make,” says Collins. Stick with white pastas rather than whole grain versions if you’re in an active flare, as these are lower in fiber.If you’re in remission, you may be able to tolerate whole grain versions, which have more iron.
6. Tuna
Canned or fresh tuna is a solid seafood choice when you’re aiming to get more iron. If you’re trying to maximize your iron intake, choose canned tuna over fresh. Canned tuna has more iron, though both are good choices. Tuna is also a good source of anti-inflammatory omega-3 fatty acids.
7. Cashews
Nuts and seeds, including cashews, are also plant-based sources of nonheme iron. A handful of cashews can make a great snack full of healthy fats and fiber. Pair them with fruit, and you’ve got a good source of vitamin C, too.
During a flare, nuts and seeds are best when broken down into a smoother consistency, says Collins. She recommends eating nut and seed butters over whole nuts and seeds during times of active inflammation. When you’re in remission, you can go back to having whole nuts if you tolerate them.
The best sources of iron will differ, depending on whether you’re in an active flare or remission; the table below can help you choose. If you’re in an active flare, try to choose foods designated as having a “high” level of gut-friendliness, which are easier to digest. If you’re in remission, choose any foods listed, unless your doctor or a registered dietitian tells you otherwise.
As mentioned before, it’s a good idea to pair the plant-based iron sources below — such as beans, spinach, or tofu — with a source of vitamin C, like a squeeze of lemon or a fruit or vegetable that’s rich in the nutrient. This helps maximize the amount of iron your body absorbs.
For reference, the federal government’s recommended amount for iron is 18 mg daily for premenopausal women and 8 mg for all other adults.