Understanding Iron Deficiency: Implications and Solutions
- mark
- Jul 24
- 4 min read
Updated: Oct 21
Iron deficiency is a common concern I see in my practice. It can affect your energy, mood and overall wellbeing with many people unaware of the various effects of iron deficiency or the different types of iron found in our diets.
In Chinese medicine, there is a phrase, ben and biao, meaning root and branch. To make the branch healthy, one must treat the root.
In healthcare, addressing the root cause leads to the best outcomes.
The Impact of Low Iron on Mental Health
Hormones often get the blame when teenagers experience mood issues. However, iron deficiency is incredibly common, especially among adolescent females.
Dr. Emi Khoo, a gastroenterologist and clinical researcher at Brisbane’s Mater Hospital, emphasises that iron is crucial for brain health and function and mental health. Adolescent females may be particularly at risk of iron deficiency as they begin menstruation.
Iron's Role in Brain Health
Evidence has accumulated over the last two decades, showing that iron impacts more than just oxygen transport, cellular respiration, and metabolism. Dr. Khoo explains that iron is also required for behavioral organization. A deficiency in iron can lead to poor brain myelination.
“Such changes not only produce deficits in memory and learning capacity, but they also affect motor skills and emotional and psychological well-being,” Dr. Khoo states.
Low iron can also lead to anxiety, depression, and mood instability, negatively affecting cognition.
Has been reported to cause behavioral and developmental symptoms because it affects transmitter production like serotonin, noradrenaline, and dopamine. All this activity in neurons can affect brain function and cognitive learning in school.” Dr Khoo.
Affect energy metabolism, muscle function, sleep, fatigue levels, and the immune system, leading to poor energy levels and fatigue. This can impact academic performance, exercise, extracurricular activities, and, importantly, quality of life and psychological health.
Testing for Iron Deficiency
If iron deficiency is suspected, baseline iron studies and a full blood count (especially hemoglobin level) are recommended with serum ferritin the most useful measure because it indicates how much iron is stored in our organs.
Finding the Underlying Cause of Iron Deficiency
Heavy menstruation and poor nutrition are the two most common causes of iron deficiency in teenagers. “We know that young people like fast food which obviously doesn’t contain much nutrition,” restrictive eating disorders such as anorexia nervosa or bulimia.
Interestingly, iron deficiency can occur when a person starts eating better because they need more iron to build their blood volume as they gain weight.
Key Factors to Assess for Iron Deficiency
The cause of iron deficiency must be assessed for:
Poor dietary intake
Malabsorption
Iron-losing pathology
High iron consumption
Factors impacting absorption, such as coeliac disease or diarrhea
Previous gastric surgery
Are they losing iron from somewhere?
Heavy menstrual bleeding
Gastric ulcer/angiectasia
Rectal bleeding
Chronic infection
Inflammation or any diseases or malignancy that requires more iron than usual
Dr. Khoo recommends an endoscopy, even for those with heavy menstrual periods, especially if they also have concurrent gut issues or rectal bleeding.
“In the past, we tended to ignore rectal bleeding in the young population, assuming it was related to hemorrhoidal bleeding. However, we are seeing more and more colorectal cancer in the young age group lately. So, there’s no harm in getting it checked out earlier than later.”
Treatment Options for Iron Deficiency
The treatment choice for teenagers depends on the severity of the deficiency and any other comorbidities. Generally, oral supplements are the first-line treatment, particularly formulations that contain vitamin C, as it helps with iron absorption.
The timing of taking oral iron supplements is crucial. Tea, coffee, and caffeine-containing energy drinks can inhibit iron uptake by 50 to 80%.
They can also diminish the uptake from food when consumed together.
Abdominal discomfort and constipation are common side effects of oral supplements. In such cases, intravenous iron should be considered or for those with mild deficieny cases, she tends to recommend an iron-rich diet over supplements.
IV iron supplements may be necessary in severe cases where ferritin is almost undetectable or if there are underlying medical conditions such as chronic kidney disease or inflammatory bowel conditions.
Special Considerations for Young Athletes
Athletes, particularly female athletes participating in endurance sports, have high rates of compromised iron status. This is due to heightened iron loss through menstruation and exercise-induced mechanisms associated with endurance activity.
For female athletes, iron-rich diets that include meat, poultry, seafood, whole grains, seeds, and legumes are recommended over supplements. This is because they are better tolerated and absorbed by the body.
“In the past, we would suggest oral supplements for iron deficiency, but this approach has lately been criticized due to the side effects associated with supplements.”
Girls who engage in a lot of sports, particularly endurance sports, may need regular monitoring of their iron levels through blood tests. If levels are close to borderline, Dr. Khoo recommends an iron-rich diet and a referral to a dietitian.
Understanding Dietary Iron Types.
Note that there are two types of dietary iron: haem and non-haem. Haem iron is found only in animal flesh, such as meat, poultry, and seafood.
Plant foods contain only non-haem iron, which is found naturally in iron-fortified whole grain cereals, breads, cashew nuts, seeds, beans, dark leafy vegetables, legumes, and dried fruit.
Haem iron is better absorbed by the body than non-haem iron. Click the button for a list of iron-rich foods.
Vegetarians and vegans are at risk of iron deficiency if they don’t consume well-planned meals with a wide variety of plant foods, including vitamin C, which assists in iron absorption.
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