When you have diabetes, lowering your heart disease risk by watching your blood pressure and weight is critical.

But there’s another risk factor that needs to be on your radar, and it’s a surprising one: your iron level.

Researchers came to this finding after analyzing data from two different studies on heart disease in people with type 2 diabetes, one done in Spain and the other in Scotland—different populations in many ways, including their diets and levels of alcohol consumption. Yet both groups showed the same pattern of increased risk of heart disease when their iron levels were low. In fact, people with diabetes and low iron were 217% more likely to develop heart disease than those with normal levels of iron.

We don’t know whether people with diabetes who increase their iron levels by taking supplements or changing their diets can reduce their risk of heart disease. More research is needed to confirm the link and learn the exact mechanism. But Milton Fabian Suárez-Ortegón, PhD, one of the researchers, said that in the meantime it makes sense for people with diabetes and their doctors to be aware of the finding because, at the very least, an iron deficiency can be a marker of other conditions and can lead to anemia if levels drop extremely low. Remember that simply having diabetes can have as big an impact on your heart and blood vessels as having a heart attack. So, doing everything you can to protect your heart is very important.

PREVENT A DEFICIENCY

All men and postmenopausal women need at least 8 mg of iron a day; all other women need 18 mg. You may be able to get all you need from your diet. Meat, seafood (particularly oysters and mussels), poultry and liver are particularly good sources because they contain both hemeand nonhemeiron (heme is the easier of the two types for the body to absorb). Plant foods, notably cooked spinach, lentils and beans, quinoa, and nuts including hazelnuts pistachios and cashews, deliver a good amount of iron but only the nonheme type. (They have plenty of other nutrients, though, so keep eating them!) In fact, eating a food high in vitamin C or one of the iron-rich meats or seafoods along with these plant-based foods will increase the amount of iron your body extracts. Calcium, on the other hand, can interfere with iron absorption—you can lessen this effect when your meal includes a variety of foods.

Yes, you can get iron from a supplement, but it’s hard to know how much supplemental iron will be safe and effective without results from blood tests. (Too much iron can cause side effects such as an upset stomach and constipation, and can interfere with absorption of medications.) Your best bet is to check with your health care provider before supplementing on your own.

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