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The best diet for hemochromatosis

If you have iron overload, you don’t have to completely cut it out of your diet. Here’s where to start.
Sara Lindberg
By | Updated on Aug. 7, 2024 Medically reviewed by Jesse P. Houghton, MD, FACG & Chad Shaffer, MD
A bag of groceries- hemochromatosis diet

Key takeaways

  • Hemochromatosis, a condition of iron overload, can be managed through regular medical visits, treatments like chelation agents and phlebotomy, and dietary adjustments without completely eliminating iron from the diet.

  • Dietary strategies for managing hemochromatosis include decreasing consumption of red meat, drinking tannin-containing beverages (such as tea) to reduce iron absorption, avoiding supplements with iron or vitamin C, and choosing foods that naturally inhibit iron absorption, such as berries, plums, sweet cherries, apples, artichokes, chicory, and red onions.

  • Foods recommended for a hemochromatosis diet are fruits, vegetables, lean proteins, legumes, grains, nuts, seeds, eggs, coffee, tea, and dairy.

  • Foods to limit or avoid in a hemochromatosis diet include vitamin C-rich foods, red meat in excess, raw fish and shellfish, alcoholic beverages, sugar, iron-fortified foods, and beta-carotene-rich foods, as they can increase iron absorption or pose additional health risks.

In this article:

Hemochromatosis, aka iron overload, is a serious condition that affects more than one million people in the United States. The good news? Regular visits with your healthcare provider, treatments like chelation agents and phlebotomy, and following a hemochromatosis diet to decrease your iron intake can help keep iron levels in check. Great foods to incorporate include eggs, dairy products, fruits, vegetables, whole grains, and legumes.

What is hemochromatosis?

There are two types of hemochromatosis: primary and secondary. Primary hemochromatosis is an inherited condition that causes the body to absorb too much iron. Most people absorb about 1 milligram of iron per day, which gives the body what it needs. However, people with hemochromatosis absorb about two to four times that amount, leading to a buildup of iron in the blood. 

Secondary hemochromatosis can be caused by a number of different mechanisms. Examples include the consumption of too much iron from food or supplements or treatments like multiple blood transfusions.  

When iron levels get too high, excess iron can find its way into vital organs like the pancreas, liver, and heart, explains Marvin Singh, MD, a triple-board certified gastroenterologist and founder of Precisione Clinic. This can cause long-term damage and lead to life-threatening conditions. 

Dr. Singh says treatment for hemochromatosis usually involves phlebotomy, which helps keep iron levels lower in the bloodstream. Dietary modifications may also help manage iron levels. However, he does point out that dietary therapy or restrictions are not a replacement for standard therapies in this condition. 

How a hemochromatosis diet works

A hemochromatosis diet will include foods to eat and ones to limit. This type of eating plan can be followed long-term under the guidance of a health professional. Following the principles of a healthy diet for hemochromatosis will help you lower your intake of heme iron (found in animal sources) as well as understanding which other foods affect the absorption of iron. You may also try to lower iron levels through medication, supplements, and other lifestyle modifications. When following a hemochromatosis diet, you will: 

  • Decrease your consumption of red meat, which is high in heme iron
  • Drink tannin-containing coffee and tea with meals to decrease the absorption of iron
  • Consider eating eggs, fiber, and supplemental calcium to inhibit the absorption of iron
  • Limit your consumption of sugary foods and drinks which enhance the absorption of iron
  • Avoid taking any iron supplements, vitamin C supplements, or multivitamins containing iron, which increase iron absorption
  • Avoid undercooked and raw shellfish, which can contain a bacteria, vibrio vulnificus, that is more virulent in a high iron environment and can be fatal
  • Eat fruits, vegetables, nuts, grains, rice, and beans, because even though they contain non-heme iron (found only in plant sources), non-heme iron is more difficult to absorb than heme iron
  • Don’t drink alcohol, as it can heighten the risk of liver damage with hemochromatosis
  • Avoid using iron cookware based on the transfer of iron to food cooked within it 

6 foods to eat when following a hemochromatosis diet 

To help reduce the occurrence of iron overload/hemochromatosis and prevent long-term organ damage, Trista Best, RD, says it’s best to eat foods relatively low in iron. 

The good news is following a hemochromatosis diet does not mean eliminating all sources of iron. “Plant food sources that contain iron have a form of iron called non-heme iron, while animal sources of iron are known as heme iron,” says Best. Non-heme iron is not as easily absorbed as heme iron. So, it’s not always necessary to avoid vegetables that are high in iron. “Eggs, grain, and legumes contain non-heme iron as well and can allow the individual to consume iron with less risk of hemochromatosis,” says Best. 

With that in mind, here are some foods to include in a hemochromatosis diet:

1. Fruits and vegetables

Green leafy vegetables and brightly colored fruits are packed full of antioxidants, which inhibit free radical production. Although spinach is known for its iron content, it contains oxalates, which impair non-heme iron absorption. Other sources of oxalates include kale, rhubarb, and strawberries. 

Berries, plums, sweet cherries, apples, artichokes, chicory, and red onions contain polyphenols, which have been shown to inhibit heme iron absorption. Plus, fruit and vegetables contain non-heme iron, which is not absorbed well. 

2. Lean protein

Lean proteins like chicken, white meat turkey, cod, mackerel, and salmon are lower in iron than red meat and should be the focus when including heme protein sources in the diet. 

3. Legumes, grains, nuts, seeds, and beans

Whole grains, legumes, seeds, beans, and some nuts contain phytates or phytic acid, which can decrease the absorption of iron. They’re also high in fiber, which impairs the absorption of non-heme iron.

4. Eggs

Phosvitin, a phosphoprotein in egg yolks, binds to iron and helps limit the amount of iron the body absorbs. 

5. Coffee and tea 

Tea drinkers consume an organic compound called tannins, which are commonly found in coffee and tea. According to a 2017 study review published in Current Developments in Nutrition, tannin consumption may impair iron bioavailability. 

RELATED: Health benefits of coffee

6. Dairy foods

Dairy foods like milk, cheese, and yogurt are low in iron. They can also decrease the iron absorption in pills and foods taken at the same time. 

7 foods to limit in a hemochromatosis diet

A low-iron diet for hemochromatosis requires avoiding foods that are rich sources of heme iron, which is more easily absorbed by the body. Eliminating or reducing food and drinks high in iron is one way to avoid foods that can make hemochromatosis worse. 

Here are some foods and beverages to avoid or reduce in a low-iron diet for hemochromatosis: 

1. Vitamin C-rich foods

Dr. Singh recommends avoiding food and drinks with high amounts of vitamin C because vitamin C can increase iron absorption, which can worsen the iron burden and hemochromatosis status. 

2. Red meat in excess

Best says animal sources of protein, like beef, contain heme iron, which is more easily absorbed by the body. Small amounts of red meat may be acceptable as part of a hemochromatosis diet, but it should be discussed with a healthcare provider or registered dietitian. 

3. Raw fish and shellfish

Raw fish and shellfish—especially oysters—may contain vibrio vulnificus, a bacterium found in warm saltwater. This bacteria can cause the illness vibriosis. While anyone can get sick from vibriosis, people with iron overload disease, and especially those with liver involvement, are more likely to get an infection or have complications. Symptoms to be aware of include fever, chills, diarrhea, nausea, vomiting, or a skin infection that appears red and warm.

4. Alcoholic beverages

Dr. Singh says alcohol could potentially cause injury to the liver in those people with hemochromatosis, so avoiding or limiting it is best. That said, anyone with cirrhosis from hemochromatosis should stop drinking alcohol completely.

5. Sugar 

Food and beverages high in certain sugars can increase the absorption of non-heme iron by approximately 300%, according to a 2013 study. More specifically, the study found that high fructose corn syrup, which is the major source of fructose in a Western diet, was the main culprit. Sucrose and glucose did not appear to increase the absorption of dietary iron.

6. Iron-fortified foods

Many foods, like breakfast cereal, are fortified with iron. Eating iron-rich fortified foods can contribute to the effects caused by too much iron in the body. 

7. Beta-carotene

Present in foods like beets, apricots, carrots, and sweet potatoes, beta-carotene increases the absorption of iron and can even diminish the iron-inhibiting effects of tannins when taken at the same time. That’s why it’s best not to supplement with the carotenoid. 

Is fasting good for hemochromatosis? 

Intermittent fasting is a popular method of eating that restricts food and drink to certain times of the day or days of the week. More specifically, it requires alternating between periods of eating and periods of fasting. 

There are various intermittent fasting methods, each style boasting benefits related to certain health conditions. However, research on the benefits and risks of fasting and hemochromatosis is limited. 

Dr. Singh is not aware of any recent study on the role of intermittent fasting in hereditary hemochromatosis. Still, he does point out that if fasting causes one to eat less iron-rich foods, it could be a potential adjunctive measure to management. However, he would not rely on it as a primary means of therapy. 

One 2014 study published in Eating and Weight Disorders looked at the impact short-term fasting had on iron metabolism in relation to well-being and depression symptoms in 46 healthy women. 

While not a study designed to test iron levels and metabolism in people with hemochromatosis, the results showed that restricting food for a one- to two-day timeframe every eight days for a period of 48 days significantly decreased iron concentrations in hair and serum. The study also found a decrease in ferritin levels, hemoglobin, hematocrit, red blood cells, and total iron-binding capacity. 

How to lower iron levels in other ways

A low-iron diet for hemochromatosis may be recommended by your healthcare provider. However, dietary changes are often not enough to bring iron levels down to the normal range in patients with hemochromatosis. According to the American College of Gastroenterology, other non-dietary treatments for hemochromatosis include: 

  • Therapeutic phlebotomy
  • Iron chelation

Therapeutic phlebotomy

Therapeutic phlebotomy—a procedure that removes blood and iron from the body—is the most common treatment for hemochromatosis. During this procedure, a healthcare provider inserts a needle into a vein and drains a small amount of blood. The blood flows through an airtight tube into a sterile bag. 

The goal of therapeutic phlebotomy is to reduce the ferritin (a protein that stores iron in your body) levels in your blood to 50-150 mcg/L. This will secondarily decrease tissue iron stores to normal levels and hence decrease the effects of iron overload in the body (improve fatigue and skin bronzing complications, reduce abdominal pain, and improve cardiac functioning and diabetes control). 

Iron chelation 

Medications like chelating agents are commonly prescribed to help lower iron levels in people with secondary hemochromatosis. Chelating agents bind to iron in your body, thus allowing it to pass from the body into the stool or urine before it can be deposited in our vital organs. This is used for people who can’t have therapeutic phlebotomy. Common chelating agents for hemochromatosis include Desferal (deferoxamine), Jadenu (deferasirox), and Ferriprox (deferiprone). These medications may be given orally in pill or liquid form or through an intravenous (IV) infusion.

Supplements

Research on the beneficial role dietary supplements play in managing hemochromatosis is lacking. However, avoiding supplements containing iron or vitamin C is recommended since they can increase the amount of iron the body absorbs. 

In addition, some studies show that both calcium and zinc supplementation may decrease iron absorption; however, the results on body iron levels seem to be minor.

When to see your healthcare provider

Symptoms that may require a healthcare provider’s visit include: 

  • Fatigue
  • Weakness
  • Abdominal pain
  • Joint pain, especially in knees and hands
  • Decrease in sex drive
  • Gray, metallic, or bronze skin coloring 

Dr. Singh says anyone with hereditary hemochromatosis should be under the care of a healthcare provider, even if treatment is not necessary at the moment, if for no other reason than periodic observation. 

“Early diagnosis and management can help prevent excessive iron deposition in various organs and can reduce the risk of things like liver cirrhosis, joint issues, heart failure, diabetes, and impotence, among others,” Dr. Singh says. Once these problems arise, reversing them might be more challenging. 

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