Updated September 16, 2024 (Previous version January 5, 2021)
If you are experiencing anxiety, depression, ADHD, apathy, or Restless Leg Syndrome (RLS), it is critical to have your iron levels evaluated! Low levels of iron is a common factor that may be a cause. In this article, we share insight into how iron deficiency is linked to emotional health and a range of other symptoms including RLS. If you or someone you know suffers from any of these often debilitating conditions, please share this article with them. Iron deficiency is a common problem which frequently goes unrecognized.
I have noticed an increasing number of patients struggling with depression, anxiety, and other mood problems over my 30+ years of practice as a physician. Mood disorders are on the rise in all age groups, with a recent survey of teenagers in the United States revealing that 36% of girls and 14% of boys experience depression at some point during their teenage years.[1] Girls are 2 times more likely to become depressed than boys, particularly after beginning menstruation at puberty.
When I treat patients with mood disorders, I search for any underlying medical or nutritional causes. One nutritional deficiency that often contributes to mood disorders is iron deficiency. When I saw that girls are more likely to become depressed than boys and that there is a spike after beginning menstruation (a time when iron is lost in the blood), I couldn’t help but wonder lack of iron might play a role for some of these teenage girls.
Another growing group of patients that I have seen become iron-deficient and depressed are patients who are taking acid-blocking medications. Acid blockers, like Prilosec and Nexium, reduce stomach acid to treat symptoms of reflux and heartburn. The problem is that stomach acid is required for the proper absorption of iron from food. Ongoing use of these medications can lead to iron deficiency and a cascade of symptoms to follow.[2]
Strict vegetarians are also at risk of iron deficiency. Iron is obtained from food sources, such as meat, poultry, seafood, lentils, beans, spinach, and sesame seeds.
Another group at risk is those who donate blood frequently.
Let’s take a step back. What exactly does iron have to do with mood and depression?
Iron and Depression
Iron is a vital mineral that plays a role in every cell of the body.
Iron is a component of the hemoglobin protein in red blood cells, which carries oxygen throughout the body.
When there is a lack of iron in the body, red blood cells may become small, and less oxygen circulates to body tissues—a condition called iron-deficient anemia. Common symptoms of iron-deficient anemia include lack of energy, dizziness or lightheadedness, and pale skin.
It is important to note you can be Iron deficient and not be anemic. This common, underdiagnosed condition is discovered by checking a ferritin level. Ask your healthcare professional to routinely check the ferritin level as part of your annual blood panel. Note: on the flipside, hemochromatosis (iron overload), can be diagnosed by discovering an elevated iron.
Fun fact: A unique symptom of iron deficiency is a craving for ice. There is a medical term for craving ice: pagophagia. If you crave ice, you may want to have your iron levels checked.
How does low iron contribute to mood disorders?
Iron deficiency can contribute to mood disorders because of its relationship with dopamine—one of the neurotransmitters in the brain that keeps us happy. It is the "feel good" neurotransmitter. Iron is required for the production of dopamine in the brain.[3] Our bodies use tyrosine from protein-rich foods to produce dopamine, but this only happens in the presence of iron.[4] A lack of dopamine can lead to depression, anxiety, and even movement disorders like restless leg syndrome.[5] Think of it like this:
Symptoms of Dopamine Deficiency
- Fatigue / Apathy
- Anxiety / Depression
- Poor Concentration
- Restless Leg Syndrome
Testing for Iron Deficiency
Routine blood tests measure the number, size, and shape of red blood cells as well as the amount of hemoglobin in the blood. These measurements give insight into iron status, but they do not reliably detect iron deficiency in all patients.[6] The most reliable way to test for body stores of iron is to test ferritin. Ferritin is the body’s storage form of iron and the most reliable test for iron deficiency.
A Case Example
I had a young woman come to see me with heart palpitations. Her palpitations had begun after taking a medication to treat restless leg syndrome. We know that restless leg syndrome can be associated with low iron levels. Sure enough, her ferritin level was low. It turns out that her iron level was low because she was taking an acid-blocking medication to treat her heartburn.
Here we have a woman experiencing a side effect of a medication, which she is taking to treat the side effect of another medication. How could we turn this around? We needed to get to the root cause of the original symptom: heartburn.
We discovered that her heartburn was a reaction she was having to gluten.
We did a trial of a gluten-free diet and started her on a protocol to heal her digestive system. The heartburn went away. We gave her a natural iron supplement, which corrected the iron deficiency. As her iron levels returned to normal, her dopamine levels rose, and her symptoms of anxiety and restless leg syndrome improved.
Mood disorders can affect friendships, performance, and even lead to suicide attempts. If the answer might be as simple as correcting iron deficiency, then why not explore that possibility? The next time you have your blood checked ask to have the ferritin level checked if not done previously. Ask to test your ferritin levels and screen for any other underlying medical causes. The treatment is simple - search for the underlying cause of the iron deficiency and restore iron levels to normal with supplementation.
Supplements
I recommend Xymogen® Iron Glycinate™. This form of iron has high bioavailability, lower toxicity, and fewer food interactions.*
References:
- Breslau J, Gilman SE, Stein BD, Ruder T, Gmelin T, Miller E. Sex differences in recent first-onset depression in an epidemiological sample of adolescents. Transl Psychiatry. 2017;7(5).
- Hashimoto R, Matsuda T, Chonan A. Iron-deficiency anemia caused by a proton pump inhibitor. Intern Med. 2014;53(20):2297-2299.
- Youdim MB, Ben-Shachar D, Ashkenazi R, Yehuda S. Brain iron and dopamine receptor function. Adv Biochem Psychopharmacol. 1983;37309-321.
- Unger EL, Bianco LE, Jones BC, Allen RP, Earley CJ. Low brain iron effects and reversibility on striatal dopamine dynamics. Exp Neurol. 2014;261462-468.
- Allen RP. Restless Leg Syndrome/Willis-Ekbom Disease Pathophysiology. Sleep Med Clin. 2015;10(3):207-14, xi.
- Johnson S, Lang A, Sturm M, O’Brien SH. Iron Deficiency without Anemia: A Common Yet Under- Recognized Diagnosis in Young Women with Heavy Menstrual Bleeding. J Pediatr Adolesc Gynecol. 2016;29(6):628-631.
*These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.