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
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
Wang, Y., Adekolurejo, O. O., Wang, B., McDermott, K., Do, T., Marshall, L. J., & Boesch, C. (2024). Bioavailability and excretion profile of betacyanins - Variability and correlations between different excretion routes. Food Chemistry, 437(Pt 1), 137663. https://doi.org/10.1016/j.foodchem.2023.137663
Watson, W. C., Luke, R. G., & Inall, J. A. (1963). Beeturia: Its incidence and a clue to its mechanism. British Medical Journal, 2(5363), 971–973. https://doi.org/10.1136/bmj.2.5363.971
Wiczkowski, W., Romaszko, E., Szawara-Nowak, D., & Piskula, M. K. (2018). The impact of the matrix of red beet products and interindividual variability on betacyanins bioavailability in humans. Food Research International, 108, 530–538. https://doi.org/10.1016/j.foodres.2018.04.004
Menstrual Health Intensive - my class with Liane Moccia, in case you're interested!
The 1963 paper is open access; the others may take some scouting to find full text.
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