126 | Pink urine, beets, and iron deficiency

0:00 Hi there. Welcome to In the Clinic with Camille. My name is Camille Freeman, and this podcast is for herbalists and nutritionists who are in clinical practice. Today, I want to take you down a little rabbit hole that opened up as I was researching for a class I'm teaching. As part of the menstrual health intensive that Leanne Mocha and I are right in the middle of, I was preparing a class on iron deficiency and iron deficiency anemia, two of my very favorite topics because I think they're extremely underexplored in clinical practice and so many people have one or both of those conditions and are not getting the care that they need. So anyway, that's a whole different podcast. But as I was researching for this class, I always like to refresh my memory, even though I'm working with this on a regular basis, I came across just a little mention of the relationship between iron deficiency and beeturia.

0:57 B-E-E-T-U-R-I-A, meaning your urine turns red or pink after you eat beets. And I was like, what? This is so interesting. Maybe I've heard of this in the past and I forgot it, but either way, I don't recall ever hearing about this before. So I looked into it and I was like, oh, okay, this is very interesting. There is a paper that was published in 1963. You can read this paper from the British Medical Journal. I love reading these papers. As a side note, the papers published in the 50s and 60s, if you go and you look at them, they're so clear, they're so concise, they're so easy to read, and they almost have a conversational tone as opposed to papers that are published, these days are extremely academic and very dense and, you know, they're 85 pages long.

1:50 A lot of these papers that are published in the 50s, 60s, and so forth, they're just a couple pages. This one's just a few. I always find it so interesting to read them. So anyway, I'll link to it if you want to check it out yourself. It's open access. So anyway, these researchers were trying to figure out what's going on with iron deficiency. They were trying to learn more about different groups. And they just happened to notice, as they were doing some research, that there was this relationship between people who had beechuria and people who had iron deficiency. And they had thought the initial premise of this paper was that actually it might have had something to do with gastrointestinal function. So they were trying to tease out.

2:32 What's going on here with GI health and the appearance of beet urea. But actually what they realized after running the study for a while was that there was this relationship between anemia and iron deficiency anemia and beet urea. So then they said they started trying to get more people who had iron deficiency, either history or active iron deficiency, to join the study. This is very different, very different protocols than we might use today. But anyway, so then they tried to kind of beef up the number of people who had that particular circumstance in their study. And what they wound up finding was that beet urea was relatively common in just regular people who didn't have any obvious health history.

3:13 They said about just under 14% of what the quote normal population had beet urea with no obvious reason for it. But among people who had iron deficiency anemia, almost 50% of them had beech urea. And people who had iron deficiency and they had never been treated with oral iron, 80% of them had beech urea. So it's so interesting. So basically, the takeaway here is that just having your urine turn red or pink after you eat beets does not necessarily mean that you have iron deficiency, but it is a potential.

3:55 There is a potential relationship there. It might make it more worth looking into just to see, especially if the person has any other signs or symptoms that they might have iron deficiency or iron deficiency anemia. So I thought that was really interesting. Now, do remember that. And different studies find, you know, 2% to 10 or 15% of regular people who don't have iron deficiency, etc., have this beach area. So it's not definitive, but just an interesting sign. So then I was like, huh, I wonder why that is. What could possibly be the relationship between having your urine turn pink or red and being iron deficient? So I looked into this a little bit, and it turns out this hasn't been explored in great detail. It turns out there's other pressing issues to investigate.

4:41 But the working theory right now is that. The chemical in beets that pigments, at least is partially responsible for that red pigment, is called betanin or betalane. You'll see it in different papers. Maybe they used to call it one and now it's the other or vice versa. I don't know. But normally what happens is before it gets absorbed in the gut, it gets decolorized. All right, so what happens is the betonin, the red color in the beets, is destroyed by oxidation. And one of the things that can oxidize that red color is ferric ions from iron that you have ingested.

5:26 There's other things like gastric acid in some cases, some bacteria, etc. So that may be why there's this variation in some healthy people. But generally speaking, most people, it's going to get decolorized before we absorb it into the gut, and therefore it's not going to have the potential to turn the urine red. But. When we have iron deficiency, one of the things that happens is that the enterocytes, the lining of the gut, they actually pull in iron more aggressively and more rapidly, than when we don't have iron deficiency. So the body has signals to say, hey, we need more iron, sop up more iron from whatever's coming through the gut.

6:07 And what that means is there's less iron available in the lumen of the gut to, decolorize this red pigment. and therefore it just stays red. You absorb it and it can color your urine. So I thought that was really interesting and, they've done some studies showing that when you provide iron to people who have this bichuria, a good portion of them, actually the bichuria goes away. Again, indicating that it's just a reflection of an iron deficiency state where your gut is absorbing more iron than normal. So I thought this was really interesting. I'm not sure it's extremely clinically relevant, but again, a lot of people don't think to spring for or ask about iron deficiency, and it could be just another little indicator that might.

6:57 Be useful to add to your toolbox. So anyway, thought I'd pass it along. I'll put some of these studies in the, show notes in case you want to check them out for yourself. The older one from 1963 is open access. There's a couple others that are not open access. If you want them, you're going to have to do some scouting around to see if you can find access to those papers. Okay, I hope this was helpful. If you want to stay in touch and you are not already on my Practitioner Notes newsletter, I would send that out every Thursday. It covers things that we don't talk about here in the podcast. I'd love to send it to you. You can go to intheclinic.com or camillefreeman.com and sign up in either place, and I hope you have an amazing day. Thanks so much for the work that you do.