126 | Pink urine, beets, and iron deficiency

While prepping a class on iron deficiency for the Menstrual Health Intensive that Liane Moccia and I are currently teaching, I stumbled into a rabbit hole: a 1963 BMJ paper linking beeturia - pink or red urine after eating beets - to iron deficiency. Physiology nerds, check out this episode for a quick overview of why iron deficiency might cause red or pink urine in some cases, and why it's more of a clue and less of a clear diagnostic sign.

What I Cover

Beeturia basics

A 1963 study in BMJ that identified the relationship between beeturia and iron deficiency

The working theory about why iron deficiency might cause red or pink urine

Why beeturia isn't diagnostic on its own, but might be worth noticing alongside other signs and symptoms

Key Takeaways

Red or pink urine after eating beets does not mean you (or your client) have iron deficiency - it shows up in roughly 2-15% of "normal" people without ID/IDA

Beeturia is more common in iron deficiency, especially when untreated

The likely mechanism is an "iron hunger": the gut absorbs iron faster, so less is left in the lumen to oxidize and decolorize betanin before it's absorbed

Links and Resources Mentioned

Oski, F. A. (1993). Iron deficiency in infancy and childhood. New England Journal of Medicine, 329(3), 190–193. https://doi.org/10.1056/NEJM199307153290308