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

• 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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