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Is low iron getting you down?

Micronutrients in Mental Health Series I

The role of optimal nutrition in depression, and a number of other mental health conditions, is often overlooked, but plays a critical role in health and well-being. Iron deficiency, even without being diagnosed with anemia, can lead to low energy, fatigue and depression.  Many of my patients who have been told that they are not anemic (i.e. their iron status are fine according to conventional medicine) have low iron stores on testing and experience improvements in mood, motivation, energy and the ability to get out of bed in the morning, have stamina with exercising and stay warmer when iron is given supplementally.

Iron deficiency is one of the most common nutrient deficiencies worldwide. Iron deficiency and anemia caused by iron deficiency affects at least 9-20% of adult women and over 2 percent of adult men in the United States1.  Iron deficiency in adults is generally due to poor dietary intake.  Allergy-free diets in which food fortification is absent (gluten-free grains are often not fortified with iron) can contribute to decreased intakes of iron.  Vegan, vegetarian and raw foods diets often result in decreased intake of iron. Poor dietary planning (diets with little variety and high in processed foods) can also contribute to poor iron status.

Menstruating, pregnant and lactating women are particularly at risk of iron deficiency. Women using an Intrauterine Device (IUD) for contraception tend to lose more blood (and thus more iron) in menstruation ( whereas women using the contraceptive pill tend to lose less blood (and thus less iron)). Women following vegetarian or vegan diets should be especially careful as vegetarian sources of iron are often less absorbable and may not be sufficient to maintain iron stores. Individuals who donate blood regularly are also at risk of iron deficiency.

Iron deficiency is the most common cause of anemia. The term anemia refers to blood that is deficient in hemoglobin (the oxygen-carrying portion of the red blood cells). When there is insufficient hemoglobin in the red blood cells, there is insufficient delivery of oxygen to the body’s tissues, resulting in fatigue, weakness, lack of motivation, difficulty getting out of bed, shortness of breath, palpitations, pale skin and nail beds, restless legs, decreased cold tolerance (due to a secondary deficiency of thyroid hormone), abnormal menstrual bleeding, vague gastrointestinal complaints (changes in appetite, flatulence, belching, nausea and constipation or diarrhea), impaired immune system function and decreased productivity and work capacity.

Iron is a critical part of the hemoglobin molecule and is also an integral part of enzymes involved in energy production and metabolism– which means that even low iron stores can result in symptoms – long before frank anemia would be diagnosed. I see this often in patients complaining of low energy, a lack of motivation and symptoms of dysthymia or depression.

If you suspect that you may have low iron stores or anemia, laboratory tests and supplementation (under the guidance of a medical provider) is indicated. Iron supplementation is not safe for individuals with iron storage disorders such as hemosiderosis (a relatively common and often silent disorder) and is not safe in excess (where it will act as a pro-oxidant).  The best indicator of iron stores (in most cases) is serum ferritin. {Hemoglobin and Hematocrit levels will often be in the normal laboratory ranges even when iron stores have become significantly depleted.}

For those needing to increase iron in the diet, it is available both from plants (non-heme form) and from animals (heme form)- see the table below. Absorption of iron is higher for heme vs non-heme iron – though even a little heme iron can enhance non-heme absorption (this is referred to as the MFP factor – Meat, Fish & Poultry factor). Consuming iron-rich foods with vitamin C greatly enhances iron absorption.  When low iron stores or anemia is discovered, highly absorbable forms of iron are often advised, in conjunction with vitamin C, and iron rich herbs such as Yellow Dock root, Dandelion root and Nettle tops.  Iron in supplemental form can be constipating so being able to give lower doses of highly absorbable forms formulated with other nutrients and herbs can be helpful. Tea (black, green and white) can reduce iron absorption by up to 50%, so is best consumed away from iron-rich foods and supplemental iron. Supplemental calcium is also best given away from iron-rich foods or supplemental iron as it can significantly decrease the absorption of iron.  Phytates in the fiber or bran component of wheat, rice, nuts and corn can significantly decrease iron absorption. (Adding vitamin C or meat to a meal where phytates are present helps to minimize this phenomenon.) Finally, cooking in cast iron pots and pans can contribute a significant amount of iron.

Iron Requirements-RDA Image

Iron Sources 2,3, 4

Iron in Foods Table Image

Iron is used homeopathically in the remedy ‘Ferrum metallicum’. Prepared as a homeopathic remedy, iron’s more subtle qualities emerge, aiding someone who seems a little under the weather, depressed or despondent and pessimistic. Weepiness and irritability can often be seen. Anxiety about one’s family is often present.  A desire for solitude – even avoiding the sight of intimate friends and family is characteristic of those needing Ferrum metallicum homeopathically. There is a tendency to being chilly and faintness with exertion is seen. Knowing iron’s involvement in energy production, many of these symptoms make sense…they are a defense/preserver of the little energy that one does have.  

The homeopathic picture of Ferrum metallicum also includes an oversensitivity to pain and an intolerance to being contradicted. This intolerance is quite notable, for upon being contradicted, someone needing Ferrum metallicum may fly into a rage! Allergies to many substances can be seen in those needing Ferrum. And changes in appetite and poor digestion are often seen as well.

When working with those affected by low energy, depression and irritability, low iron stores and anemia need to be ruled out. Addressing such imbalances is best done over time with the guidance of a skilled healthcare practitioner and careful monitoring of symptoms and laboratory values. Optimal iron levels are so important to mental and physical health– so be sure that you have the levels that you need to function at your best!

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  1. Killip, S., Bennett, J.M. & Chamber, M.D. (2007). Iron Deficiency Anemia. Am Fam Physician, 75 (5), 671-678.
  1. Grosvenor, M.B. & Smolin, L.A. (2012). Visualizing Nutrition. Everyday Choices (2nd). Hoboken, NJ: John Wiley & Sons, Inc., 289.
  1. Marz, R.B. (1999). Medical Nutrition from Marz. (2nd). Portland, OR: Omni-Press, 117.
  1. NIH Office of Dietary Supplements. (2015, Nov. 24). Iron. Dietary Supplement Fact Sheet. Retrieved from 








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