126 | Pink urine, beets, and iron deficiency

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Hi there. Welcome to In the Clinic with Camille. My name is Camille Freeman,

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and this podcast is for herbalists and nutritionists who are in clinical practice.

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Today, I want to take you down a little rabbit hole that opened up as I was

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researching for a class I'm teaching.

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As part of the menstrual health intensive that Leanne Mocha and I are right in the middle of,

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I was preparing a class on iron deficiency and iron deficiency anemia,

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two of my very favorite topics because I think they're extremely underexplored

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in clinical practice and so many people have one or both of those conditions

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and are not getting the care that they need.

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So anyway, that's a whole different podcast. But as I was researching for this

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class, I always like to refresh my memory, even though I'm working with this on a regular basis,

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I came across just a little mention of the relationship between iron deficiency and beeturia.

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B-E-E-T-U-R-I-A, meaning your urine turns red or pink after you eat beets.

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And I was like, what? This is so interesting. Maybe I've heard of this in the

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past and I forgot it, but either way, I don't recall ever hearing about this before.

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So I looked into it and I was like, oh, okay, this is very interesting.

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There is a paper that was published in 1963.

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You can read this paper from the British Medical Journal.

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I love reading these papers. As a side note, the papers published in the 50s

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and 60s, if you go and you look at them,

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they're so clear, they're so concise, they're so easy to read,

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and they almost have a conversational tone as opposed to papers that are published,

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these days are extremely academic and very dense and, you know, they're 85 pages long.

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A lot of these papers that are published in the 50s, 60s, and so forth,

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they're just a couple pages. This one's just a few.

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I always find it so interesting to read them. So anyway, I'll link to it if

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you want to check it out yourself. It's open access.

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So anyway, these researchers were trying to figure out what's going on with

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iron deficiency. They were trying to learn more about different groups.

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And they just happened to notice, as they were doing some research,

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that there was this relationship between people who had beechuria and people

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who had iron deficiency.

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And they had thought the initial premise of this paper was that actually it

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might have had something to do with gastrointestinal function.

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So they were trying to tease out.

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What's going on here with GI health and the appearance of beet urea.

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But actually what they realized after running the study for a while was that

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there was this relationship between anemia and iron deficiency anemia and beet urea.

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So then they said they started trying to get more people who had iron deficiency,

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either history or active iron deficiency, to join the study.

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This is very different, very different protocols than we might use today.

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But anyway, so then they tried to kind of beef up the number of people who had

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that particular circumstance in their study.

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And what they wound up finding was that beet urea was relatively common in just

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regular people who didn't have any obvious health history.

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They said about just under 14% of what the quote normal population had beet

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urea with no obvious reason for it.

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But among people who had iron deficiency anemia, almost 50% of them had beech urea.

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And people who had iron deficiency and they had never been treated with oral

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iron, 80% of them had beech urea. So it's so interesting.

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So basically, the takeaway here is that just having your urine turn red or pink

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after you eat beets does not necessarily mean that you have iron deficiency, but it is a potential.

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There is a potential relationship there.

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It might make it more worth looking into just to see, especially if the person

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has any other signs or symptoms that they might have iron deficiency or iron deficiency anemia.

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So I thought that was really interesting. Now, do remember that.

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And different studies find, you know, 2% to 10 or 15% of regular people who

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don't have iron deficiency, etc., have this beach area. So it's not definitive,

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but just an interesting sign.

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So then I was like, huh, I wonder why that is. What could possibly be the relationship

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between having your urine turn pink or red and being iron deficient?

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So I looked into this a little bit, and it turns out this hasn't been explored

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in great detail. It turns out there's other pressing issues to investigate.

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But the working theory right now is that.

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The chemical in beets that pigments, at least is partially responsible for that

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red pigment, is called betanin or betalane.

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You'll see it in different papers.

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Maybe they used to call it one and now it's the other or vice versa.

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I don't know. But normally what happens is before it gets absorbed in the gut, it gets decolorized.

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All right, so what happens is the betonin, the red color in the beets,

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is destroyed by oxidation.

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And one of the things that can

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oxidize that red color is ferric ions from iron that you have ingested.

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There's other things like gastric acid in some cases, some bacteria,

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etc. So that may be why there's this variation in some healthy people.

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But generally speaking, most people, it's going to get decolorized before we

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absorb it into the gut, and therefore it's not going to have the potential to turn the urine red. But.

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When we have iron deficiency, one of the things that happens is that the enterocytes,

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the lining of the gut, they actually pull in iron more aggressively and more rapidly,

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than when we don't have iron deficiency.

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So the body has signals to say, hey, we need more iron, sop up more iron from

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whatever's coming through the gut.

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And what that means is there's less iron available in the lumen of the gut to,

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decolorize this red pigment. and therefore it just stays red.

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You absorb it and it can color your urine. So I thought that was really interesting and,

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they've done some studies showing that when you provide iron to people who have

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this bichuria, a good portion of them, actually the bichuria goes away.

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Again, indicating that it's just a reflection of an iron deficiency state where

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your gut is absorbing more iron than normal.

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So I thought this was really interesting. I'm not sure it's extremely clinically

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relevant, but again, a lot of people don't think to spring for or ask about

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iron deficiency, and it could be just another little indicator that might.

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Be useful to add to your toolbox.

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So anyway, thought I'd pass it along. I'll put some of these studies in the,

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show notes in case you want to check them out for yourself.

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The older one from 1963 is open access. There's a couple others that are not

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open access. If you want them, you're going to have to do some scouting around

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to see if you can find access to those papers. Okay, I hope this was helpful.

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If you want to stay in touch and you are not already on my Practitioner Notes

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newsletter, I would send that out every Thursday. It covers things that we don't

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talk about here in the podcast. I'd love to send it to you.

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You can go to intheclinic.com or camillefreeman.com and sign up in either place,

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and I hope you have an amazing day. Thanks so much for the work that you do.