Introduction to Iron Deficiency
While I’m no expert in the area of iron deficiency, I felt this was an important topic to discuss in relation to dystonia. Through my own experience and research, I came to the realization that iron deficiency can severely impact cellular activity, energy levels and brain function, including mood, motivation and memory. Yet it is often overlooked by the majority of doctors, unless it has progressed to the point of anemia.
The Hidden Impact of Iron Deficiency on Dystonia
The incidence of iron deficiency in dystonia is unknown. And unfortunately, research exploring the connection between iron levels and dystonia and/or stress is limited and contradictory. However, there is research showing an association between iron deficiency and psychiatric conditions. Additionally, it is evident that the effects of stress on the body (ie. appetite, digestion, microbiome, hormones, neurotransmitters) can affect iron availability. In turn, low iron levels may adversely affect many of the above body systems and functions.
We will first take a look at the function of iron within the body and dietary iron requirements. Next, we will explore ferritin – what it is, its relationship with iron, optimal levels, and symptoms of ferritin/iron deficiency. After that we will find out more about factors that contribute to iron deficiency, and finally we will focus on substances that increase and decrease iron absorption. Iron requires a very delicate balance in order for the body and all its systems to function optimally, so ideally a deficiency should be acted upon before it progresses to anemia.
What is Iron and What is its Role?
Iron is an essential mineral with many important functions in the body. Iron is most widely known as being part of the hemoglobin molecule, which carries oxygen from the lungs throughout the body via the red blood cells – 60% of the body’s iron is attached to hemoglobin. Myoglobin is another oxygen binding protein that stores oxygen in muscles cells – 15% of the body’s iron is bound to myoglobin. This explains why fatigue, shortness of breath, and exercise intolerance are common symptoms of iron deficiency.
Iron is involved in immune cell production and ensuring an adequate immune response through various complex mechanisms. Iron is also required for the formation and activity of enzymes, cellular function, and energy production.
In the brain, iron is needed for oxygen transport, DNA synthesis, formation of myelin, and production of neurotransmitters, such as serotonin and dopamine. Thus, it is not surprising that iron deficiency (low ferritin) has been associated with depression, anxiety, and schizophrenia, as well as sleep disorders and fatigue. There is even emerging evidence that iron deficiency may be a factor in dysautonomia and have an effect on neuroplasticity.
Please note that Excess iron has also been associated with neurodegenerative disorders, and some symptoms of high iron can mimic those of iron deficiency, so it is imperative to confirm an iron deficiency prior to following these recommendations.
Iron impacts numerous other systems and functions within the body, including hormones (thyroid and reproductive); and research is beginning to uncover a correlation between iron deficiency and blood sugar levels.
Serum iron measures the iron in your blood, but is not an accurate measure of iron stores. Various other tests are part of iron studies commonly ordered by doctors, although despite its importance, a ferritin level will often need to be specifically requested.
Dietary iron requirements:
Men age 19 and up: 8 mg
Women age 19 – 50: 18 mg (27 mg during pregnancy) Women age 51 and up: 8 mg
Iron is tightly regulated and is recycled by the body. The amount of iron circulating in the average person is 1 – 3 grams. From our daily food intake, we absorb approximately 1 – 2 mg per day, and we lose around 1 mg per day through sloughing of skin and mucosal cells; although menstruating women lose closer to 2 mg per day.
Iron Deficiency and Dystonia –Understanding Ferritin and Its Importance
What is Ferritin?
Ferritin is a protein made in the body that stores iron for future use – 25% of the body’s iron is stored attached to ferritin. A low ferritin level may be an early sign that iron levels are becoming depleted. Unfortunately, a low ferritin level with no other evidence of disease isn’t often given the attention it deserves, even though the World Health Organization (WHO) recommends that “ferritin is a good marker of iron stores and should be used to diagnose iron deficiency in otherwise apparently healthy individuals.”
Iron deficiency is most often associated with anemia. Anemia occurs when iron stores become depleted to the point where there aren’t enough healthy red blood cells or hemoglobin to carry oxygen to the tissues. However, research indicates symptoms of iron deficiency often occur when ferritin is low, even before anemia is present, and outlines the benefits of early treatment. Even with normal red blood cell production, low iron stores affect the body’s ability to replenish losses and support proper function.
Optimal ferritin levels:
The optimal ferritin level may differ between individuals. Depending on the laboratory test performed, the “normal” range is ~ 20 – 200 ug/L. The World Health Organization ferritin recommendations state that a ferritin level below 15 ug/L in apparently healthy adults is the cut- off for defining iron deficiency. It recommends that in adults with infection or inflammation, a ferritin level below 70 ug/L be used to indicate iron deficiency, as ferritin levels tend to be elevated in these conditions.
From a functional medicine perspective, a ferritin level in the low end of the normal range is not anywhere near sufficient to support normal bodily functions. Some functional medicine practitioners suggest an optimal range between 50 – 100 ug/L for women and 75 – 150 ug/L for men. In the presence of inflammation or infection, the suggested goal is closer to the higher end of this range. Of course, in any case, ferritin levels must be interpreted on an individual basis by your doctor or health care practitioner in relation to iron levels, inflammatory markers, symptoms, and medical history.
Symptoms of low ferritin/iron deficiency:
Since iron has such a wide array of functions in the body, a lack of iron can lead to a multitude of symptoms. Aside from anemia, it is common for iron to be overlooked as a factor in many of these symptoms and conditions. Yet without replenishing iron stores, other treatments may not be effective.
Symptoms associated with iron deficiency may include the following, although some symptoms become more prominent with the progression to anemia:
o Anemia
o Unexplained fatigue
o Hair loss
o Depression/anxiety
o Attention issues
o Restless leg syndrome
o Dizziness
o Chronic headaches
o Unexplained weakness
o Dry skin
o Ringing in the ears
o Irritability
o Sleep disturbance
o Leg pains
o Shortness of breath
o Tachycardia/palpitations
o Rapid breathing on exertion
o Reduced exercise tolerance
o Infections
o Poor cognitive functions
o Poor memory
o Lack of motivation
o Absentmindedness
o Sores at corner of mouth
o Brittle or damaged nails
Factors Influencing Iron Absorption and the Importance of Managing Iron Levels
Iron deficiency can occur due to:
- Inadequate dietary intake
- Impaired absorption – low stomach acid; intestinal permeability
- Increased requirement for iron – rapid growth, pregnancy, menstruation
- Intense workouts/sports
- Chronic inflammation – celiac disease, autoimmunity
- Excess blood loss – infections, injury, ulcers, polyps, hemorrhoids, cancer
Factors that may contribute to iron deficiency
There are two types of iron found in foods – heme iron, found in animal products; and non-heme iron from plant sources.
Heme iron (animals) is much better absorbed (absorption rate ~ 15 – 35%) and less affected by other dietary factors. Some of the highest amounts can be found in clams, liver, oysters, mussels and venison, which have significantly more iron than red meat.
Non-Heme iron (plants) can be more difficult to utilize in boosting iron levels (absorption rate ~ 2 – 10%). Absorption may be inhibited to some extent by other dietary compounds such as calcium, eggs, oxalic acid, polyphenols, and phytic acid. Many plant-based foods are fortified with iron; however, these tend to be processed foods. Plant sources of iron include legumes, dark leafy green vegetables, pumpkin seeds, and baked potatoes.
Low stomach acid can substantially reduce iron absorption, since adequate stomach acid is necessary to ensure plant-based iron is in the proper form to be absorbed. Low stomach acid also affects absorption of cofactors needed for iron absorption, such as folate and B12. Heme iron is more efficiently absorbed and less affected by stomach acid.
Hepcidin, a hormone secreted by the liver, plays a central role in maintaining homeostasis (balance) of iron levels. It controls the absorption, storage, and utilization of iron. Chronic inflammation or dysbiosis stimulates release of hepcidin to reduce transport of iron. This is one of the body’s strategies it uses to stop pathogen growth, since pathogens also require iron for energy. When hepcidin is lowered, iron absorption increases.
Gut health and a balanced microbiome are critical to proper regulation of iron levels. Good bacteria play a role in digestion and absorption of nutrients; they help maintain the gut lining thereby reducing intestinal permeability (leaky gut), and they protect against pathogens. Chronic inflammation is closely related to dysbiosis. Prebiotic fibres (which feed the good bacteria) may also enhance absorption of iron.
Iron Deficiency and Dystonia – Substances That Reduce Iron Absorption
Calcium has the potential to inhibit both heme and non-heme iron absorption; although, the impact of calcium on iron deficiency is still under investigation and may be dose-dependent. Regardless, calcium-rich foods do not have to be avoided, but it is suggested to take calcium supplements separately from iron-rich foods or iron supplements.
Eggs can significantly impair the absorption of iron, and the iron content of eggs themselves has limited availability since it is tightly bound to protein. The best way to benefit from the nutrients found in eggs is to consume them separately from iron-rich foods.
Oxalic Acid (found in spinach, beets, nuts, chocolate, tea, rhubarb, parsley) may reduce the absorption of non-heme iron. However, this seems to be a very controversial topic with no conclusive evidence. Some oxalates are excellent sources of iron as well as other nutrients, so the best option may be to consume in moderation in rotation with lower oxalate foods.
Polyphenols (found in cocoa, coffee, black tea, green tea, herbs, walnuts, apples, and berries) inhibit non-heme iron from plant foods. Since polyphenols also have many health benefits and are excellent sources of antioxidants, it is not recommended to avoid all of these foods. Consume away from iron-rich meals or ensure intake of Vitamin C rich foods with polyphenols in order to counteract the inhibitory effect on iron.
Phytic Acid (found in soy protein, nuts, fiber, legumes, whole grains, and some vegetables) can reduce iron absorption by 50-60%. Proper preparation of these foods such as soaking, sprouting or fermenting significantly reduces phytate content. Similar to polyphenols, they can be eaten separately from iron-rich meals or consumed with Vitamin C rich foods to counteract the negative effects.
Substances That Increase Iron Absorption
Vitamin C (ascorbic acid) has been shown to increase both heme and non-heme iron absorption by up to 4 – 6 times, depending on the amount consumed. It is more effective when taken with a meal, and can potentially counteract the negative effects of polyphenols and phytic acid consumed in that meal.
Beta-carotene significantly increases iron absorption; it can also protect against the inhibitory effects of polyphenols and phytic acid. Carrots are an excellent source of beta-carotene.
Heme iron (ie. Meat, fish and poultry) enhances the absorption of iron from non-heme iron foods (plant-based foods or eggs) when eaten at the same meal.
Cast iron – Cooking in a cast iron pan adds “non-heme” iron. The amount of additional iron added by cooking in cast iron increased with acidity, moisture, and cooking time.
Overall, a nutrient-dense diet is essential in order to support the body in the presence of iron
deficiency. Chances are, it’s likely not the only nutrient that is deficient. Adequate absorption of
other nutrients is necessary to produce hemoglobin and to support the body systems affected by
iron deficiency and dystonia.
In many cases, it may not be possible to boost iron levels sufficiently with food alone. Please discuss any questions you may have regarding iron supplements with your health care practitioner.
Conclusion: The Vital Role of Iron in Health and Dystonia Management
Understanding the multifaceted role of iron within the body highlights its significance not only in maintaining general health but also in the context of neurological conditions like dystonia. With the complexity of iron absorption and the subtlety of its deficiency symptoms, it becomes clear that proactive management and individualized care are crucial. By acknowledging the intricate relationship between iron levels and dystonia, individuals and healthcare providers can better navigate the path to optimal health and improved quality of life. Whether through dietary adjustments or supplementation, addressing iron deficiency is a key step in supporting both physical and neurological well-being.
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