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Fatigue & Anxiety: Double-Check Your Iron.

Updated: Oct 3, 2019

There is almost no element that has such a strong effect on the mind and body as iron. It’s a part of so many pathways that an iron deficient state in the body will cause symptoms including anxiety, panic, depression, and neurological and digestive conditions. But for such an important mineral, the current standard of testing and cutoffs for treatment for women remains behind the times, leaving many to go possibly under-treated.



A better measure for iron


If you’ve gone to the doctor with fatigue, anxiety, or depression, they likely checked your hemoglobin levels to test for iron-deficiency anemia. If your hemoglobin was above a certain cutoff, you weren’t officially anemic, and you may have been told your iron levels are fine. However, studies show that an iron-deficient state that is not quite anemia, but is still low in iron stores can cause significant symptoms. A 2018 case report by hematologist Soppi stated “iron deficiency may be severe despite a normal hemoglobin and full blood count”.


A better measure for detecting an iron-deficient state is the iron storage parameter, serum ferritin. A study by Vaucher et al (2012) showed that women with low ferritin benefitted from iron supplementation in terms of energy levels and anxiety levels, when their hemoglobin was normal.


Updating cutoffs


Even if your ferritin was measured, the current cutoff for what is considered “low” is maybe not up to date with the research: the normal range of ferritin for most labs in Canada spans 5-272μg/L for women, but studies suggest multiple symptoms begin when a woman’s ferritin drops below 50μg/L. Another study states that patients with restless leg syndrome should be treated when their ferritin levels are below 75μg/L. And for patients with severe unexplained fatigue, the aforementioned hematologist Soppi recommends a target ferritin concentration of >100 μg/L.


Statistically, this new consideration of higher cutoff values changes affect a lot of women. The average ferritin level of Canadian women aged 12-19 is 32μg/L, and women aged 20-49 is 41μg/L, both below the new proposed cutoffs for iron support. Despite the regular testing of hemoglobin in regular blood work check ups, the low cutoff values in current practice leave untreated iron deficiency a public health issue in Canada.


If you’ve had your blood work done within the last year, it may be worth another look at your ferritin levels against this new proposed cutoff – especially if you struggle with mental health.


Iron levels and mental health

Iron is a necessary cofactor in the pathways to create neurotransmitters in the brain. Low iron can result in low serotonin, dopamine, and norepinephrine, contributing to symptoms of depression, anxiety, panic, ADHD, insomnia, irritability, poor concentration, addiction predilection, and restlessness.

Source: Kim et al. (2014)

Changes in brain iron status also strongly modify the balance between excitatory and calming brain chemicals Glutamate (excitatory) and GABA (calming), which is why iron is so important for treating anxiety.


A study by Gerlach et al. named iron as a primary target for addressing mental health conditions, stating, “a strong body of evidence demonstrates that altered [levels] of iron modifies emotional behaviors”.


Treatment


With iron having such a dramatic effect on mental health and energy, it’s evidently important to maintain healthy levels. Integrative treatment of low iron levels begins with diet and may include supplementation, along with addressing the main contributors iron deficiency:


  • Low iron intake from the diet (picky eaters, strict vegans and vegetarians)

  • High iron loss (generally through menstrual bleeding, pregnancy, or breastfeeding )

  • Digestion issues causing reduced absorption (eg. celiac disease, h. pylori, or gastric bypass)

  • Competitive foods reducing absorption ( eg. calcium from milk and cheese can interfere with iron absorption)

  • Medications (eg. antacids and proton-pump inhibitors for gastroesophageal reflux disease).


One of the first steps to an integrative approach to mental health is to find and eliminate nutritional deficiencies that contribute to mood and anxiety symptoms. Iron deficiency is both very common and powerfully influential on your mental and physical health. If you struggle with mood, anxiety, or energy levels, consider double-checking your iron and talking to a health care provider about iron supportive treatment.


*It is possible to have too much iron, a condition that is also a health risk, so be sure to test and monitor iron levels with a health care provider.



References


· Cooper, M., Greene-Finestone, L., Lowell, H., Levesque, J., & Robinson, S. (2012). Iron sufficiency of Canadians. Health Rep, 23(4), 41-48

· Gerlach, M., Ben‐Shachar, D., Riederer, P., & Youdim, M. B. H. (1994). Altered brain metabolism of iron as a cause of neurodegenerative diseases?. Journal of neurochemistry, 63(3), 793-807

· Hartfield, D. (2010). Iron deficiency is a public health problem in Canadian infants and children. Paediatrics & child health, 15(6), 347-350

· Kim, J., & Wessling-Resnick, M. (2014). Iron and mechanisms of emotional behavior. The Journal of nutritional biochemistry, 25(11), 1101-1107

· Pamuk, G. E., Uyanik, M. S., Top, M. S., Tapan, U., Ak, R., & Uyanik, V. (2015). Gastrointestinal symptoms are closely associated with depression in iron deficiency anemia: a comparative study. Annals of Saudi Medicine, 35(1), 31-35.

· Soppi, E. T. (2018). Iron deficiency without anemia–a clinical challenge. Clinical case reports, 6(6), 1082

· Statistics Canada 2009 to 2011 Canadian Health Measures Survey: Mean hemoglobin, mean corpuscular volume, and ferritin concentrations, by age group and sex, household population aged 3 to 79, Canada, 2009 to 2011. https://www150.statcan.gc.ca/n1/pub/82-003-x/2012004/article/11742/tbl/tbl1-eng.htm

· Vaucher, P., Druais, P. L., Waldvogel, S., & Favrat, B. (2012). Effect of iron supplementation on fatigue in nonanemic menstruating women with low ferritin: a randomized controlled trial. Cmaj, 184(11), 1247-1254