Iron And Mood - The Connection Runs Deep
Note: this article was originally written in June 2022.
Here at Wild Lemon Health, we’re a mental health focused virtual naturopathic clinic based in Sacramento.
Which means that we’re focused on using a wide toolbox for addressing mental well-being, from mindfulness to supplements, to the role of nutrition and exercise.
If you’ve spent any time Googling or reading online, you’ve certainly come across people talking about the mental health benefits of things to get in your diet, like omega-3 fatty acids, folate, vitamin D, or even turmeric.
These are all great and worthy of consideration
But when it comes to natural mental health solutions, there may be a blind spot that’s quite consequential and foundational.
And that thing is iron. In particular iron status.
I’d venture to say that if you’re struggling with your mood, some combination of the following may be part of your symptomatology:
Fatigue and low energy
Low motivation
Trouble sleeping and/or restless legs
Non specific pain
Hair loss
Those symptoms also overlap with iron deficiency (ID) and iron deficiency anemia (IDA).
You’ve likely heard of anemia, so I want to expand on the critical importance of also addressing deficiency.
That’s the state that isn’t quite anemia, but where your body is struggling to meet the demands and requirements for iron and can lead to symptoms.
But, first, let’s take a look at how iron and mood are connected.
The Importance Of Iron For Your Mental Health
It’s estimated that a third of women of reproductive age GLOBALLY are anemic.
That’s an estimated 1.3 billion women who aren’t getting the iron they need to thrive.
And that’s a big deal – iron is critically important at every age.
Iron For Cognitive Development In Children
Iron is particularly important during the major windows of childhood development.
In infants, iron deficiency can lead to changes in behavior that manifest as wariness, lack of positive affect and lack of social engagement.
This, in turn, can look like anxiety or depression as adults (Shah et al, 2021).
A developing baby has a huge need for iron, and newborns who are born deficient experience an effect on their memory, processing and bonding.
RELATED: The Foods That Help Your Brain Grow
Unfortunately, these changes persist even when iron levels are repleted (Georgieff, 2020).
I bring this point up not to fear monger, but to drive home how important iron is.
It’s a public health issue.
It, perhaps, isn’t an exaggeration to say it’s a feminist issue when we consider how the unique risk factor women have for anemia and the deep impact on our sense of well-being deficiency can have.
It’s why we need to be really proactive at assessing and differentiating between repletion, deficiency and anemia.
Iron For Adult Mental Health
As well, we see in adults that iron deficiency increases the risk of mental health challenges.
A 13 year study conducted in Taiwan followed people who had no psychiatric concerns.
The group excluded anyone with anxiety disorders, depression, psychotic disorders, bipolar disorders, sleep disorders, or restless leg syndrome at the start.
At the end of the study, they found that those with iron deficiency were at a 52% increased risk of mental health diagnosis like anxiety, depression, psychotic disorders and sleep disorders (Lee, Chao, Huang, Chen, & Yang, 2020.
Iron Deficiency Is Harmful. Does Iron Supplementing Help?
So if you’re low on iron, it causes mental health issues.
The above studies clearly demonstrate that.
But that doesn’t necessarily mean iron supplementing will help.
Unfortunately, we don’t have a lot of data on this one way or another.
In the Taiwanese study, they did see that those who supplemented with iron had a lower risk of mental health diagnoses.
But they also screened their candidates to make sure anybody who actually did have a mental health disorder wasn’t part of the study.
We don’t have many studies where someone has depression, we give iron, and it improves their condition.
Still, we have to consider this from a pragmatic angle.
There’s a range of symptoms associated with iron deficiency.
Many of these symptoms are associated, directly or indirectly, with mental health issues. Iron has an important role to play in cognitive development and mental health.
Therefore, it’s my belief that iron must be part of the conversation through the lens of whole body mental health.
How Do We Assess For Iron?
Many times in practice, patients will share that their GP ordered a complete blood count (CBC) test, and found their levels were normal.
So if your CBC is normal, that must mean you’re not low in iron, right?
This is where things get juicy: hemoglobin is not enough to check the box that everything is okay with your iron levels.
We know that there’s a step in between where iron is deficient, but not anemic.
And that gray zone of deficiency can often be symptomatic and contribute to you feeling crummy.
However, the current recommendations ask us to go further.
I really think it’s important for you to know this so you can advocate for yourself and work with your practitioner to get a FULL assessment.
There are two other considerations we need to make: ferritin and inflammation.
Ferritin
First, ferritin.
Hemoglobin is not sufficient to rule out deficiency or anemia.
In addition, we need to look at ferritin which is a marker of iron stores.
It’s generally understood that a ferritin level of less than 30 ug/L is iron deficient.
At this point, your body cannot meet iron requirements regardless if you’re anemic or not.
However, interestingly, there’s discussion that any ferritin below 100 ug/L could still be considered deficient.
This is especially true if you have symptoms like anxiety, depression, fatigue, trouble sleeping, exercise intolerance, brittle nails, or restless legs.
In short, you want to work with your practitioner to put your labs in context of your whole health picture.
Inflammation
Second, the role of inflammation.
Ferritin levels rise in the presence of inflammation.
Because ferritin is a storage molecule and it will go up in a chronic inflammatory state, it could obscure what is actually going on iron wise.
So if you have a health disorder associated with inflammation, a high sensitivity C-Reactive Protein (hs-CRP) test may show you have higher ferritin levels.
Disorders that can trigger this include things like:
Rheumatoid arthritis
Depression
Insomnia
Diabetes
Chronic kidney disease
Graves’ disease, a thyroid disorder
And others
So, a ferritin in the range of 30-100 ug/L in the presence of inflammation should prompt follow up testing to totally rule out deficiency.
In other words, if your ferritin is a 70, but there’s inflammation, this could still be considered falsely elevated and you might need to replete iron.
Book Your Appointment With Wild Lemon Health Today
Iron is a complicated mineral.
It can be difficult to get enough through food, even if you’re following a Mediterranean diet.
And because it can actually interfere with the absorption of other vitamins (like calcium, it can be difficult to supplement with.
But it’s critical for your wellbeing.
Here at Wild Lemon Health, we offer naturopathic consultations to residents of California and Oregon.
If you have symptoms and have normal-ish (or abnormal!) labs, I can help clear up your iron status.
From there, we can take a look at how to restore your iron levels, address your symptoms, and keep you healthy and strong.
Book your FREE introductory call with Wild Lemon Health today.
References:
Georgieff, M. K. (2020). Iron deficiency in pregnancy. American Journal of Obstetrics and Gynecology, 223(4), 516–524. https://doi.org/10.1016/j.ajog.2020.03.006Lee, H.-S., Chao, H.-H., Huang,
W.-T., Chen, S. C.-C., & Yang, H.-Y. (2020). Psychiatric disorders risk in patients with iron deficiency anemia and association with iron supplementation medications: a nationwide database analysis. BMC Psychiatry, 20(1), 216. https://doi.org/10.1186/s12888-020-02621-0Shah,
H. E., Bhawnani, N., Ethirajulu, A., Alkasabera, A., Onyali, C. B., Anim-Koranteng, C., & Mostafa, J. A. (2021). Iron Deficiency-Induced Changes in the Hippocampus, Corpus Striatum, and Monoamines Levels That Lead to Anxiety, Depression, Sleep Disorders, and Psychotic Disorders. Cureus, 13(9), e18138. https://doi.org/10.7759/cureus.18138
