Iron deficiency

Iron is very much related to depression. People with low levels in their bodies are more likely to develop this disease. And since determining the causes of deficiency and possible treatment is not a simple matter, and doctors often do not want or do not have funds for proper diagnosis, I decided to describe this issue in detail, such a description will be useful not only for people suffering from depression.

First of all, do NOT test for iron levels. Such a test does not shows anything. The level of this element in blood yes, decreases with anemia, but not only. You can die of iron poisoning and have low levels in your blood, you can have extreme anemia and the iron result is perfect. Doctors often order this in order to save money, but it is done at the cost of patients’ health. The level of ferritin should be checked. And here is an important information, any inflammation can artificially raise the result. Even worse, it will be elevated even months after the infection is cured. Similarly, heavy physical training or really hard work even a few days earlier will cause the test to be falsified. But this only applies to overestimation, not underestimation. If the test shows a very low value, you are definitely deficient.

But that’s not all, you should also do a blood count. In principle, we should be interested in only two indicators: MCV and HCT. The rest is too complicated to discuss on a single web page. I will outline some of the most common interpretations below. I emphasize, the most common, because the same result can mean several different things, everything cannot be described. Proper interpretation should be done by your doctor.

HCT (hematocrit) corresponds to the amount of blood we have. If its level falls below 40 (below 44 for men), we can talk about the beginning of anemia, but in fact only serious drops below 34 (37 for men) can fall under anemia, which is a deficiency of blood in the body, and not (as it is sometimes misunderstood) iron. Smaller fluctuations sometimes come from other causes.

niedobór żelaza a depresja
„3ds max Red Blood Cell Render” by kingdesmond1337 is licensed with CC BY-NC-SA 2.0.

MCV (mean corpuscular volume), on the other hand, is a quick and inexpensive indicator of the cause of anemia. I’ll maybe break down some basic combinations of these values and what they MAY (but don’t necessarily) mean, of course only with actual anemia, i.e. low HCT.

Low ferritin, low HCT, low MCV: iron deficiency.

High ferritin, low HCT, low MCV: infection, DO NOT give iron as it can even kill the patient, this is a basic mistake often made by doctors.

Any ferritin level, low HCT, high (above normal) MCV: anemia due to B12 or folic acid deficiency.

Very high ferritin levels, many times above normal: hemochromatosis, a genetic disorder in which iron accumulates in the body, may be suspected.

Finally, of course, you may wonder why someone has a high MCV with other indicators in the normal range, then you can look at B12 levels (MCV will rise before anemia appears), thyroid or liver.

Iron deficiency is most often due to dietary errors, but there are a number of causes that are not so innocent and require further diagnosis.

Women often lose this element due to heavy monthly bleeding. If such occur for many years, the body gradually loses iron, the deficiency worsens. Then the cause of these bleedings should be determined and stopped, this is a task for a gynecologist.

One of the reasons is bleeding from the gastrointestinal tract. Sometimes their cause is quite trivial, like hemorrhoids, sometimes dangerous, even life-threatening. Twofold test for occult blood in stool should dispel doubts, it should be done by everyone who has iron deficiency without clear and distinct reason (for example, does not give honorary blood). Such test can save life. Again, this element is often omitted in diagnostics.

There are a number of disorders in which effective absorption in the intestines is not possible, be it because of weak hydrochloric acid in the stomach, with villous atrophy (gluten intolerance), or even because of parasitic diseases. It is then good to find the cause, as it is often more dangerous than the deficiency itself.

The last possible cause is cancer; some tumors “eat” this element and supplementation may accelerate the development of the disease. Unfortunately, there is no simple and clear test here to rule out these conditions and you either have to count on luck or spend a small fortune on troublesome and usually completely unnecessary tests.

Only when we have all these tests done: ferritin level, HCT, MCV, only when we have tests done for fecal occult blood, only then can we reach for a supplement. Of course, if ferritin is low, it’s always a deficiency of this element in the body, so even if, for example, MCV comes out high and it turns out to be a B12 deficiency, iron should be supplemented. Additional tests serve simply to detect other diseases, cost very little (both are in the basic morphology) and sometimes even save lives.

People with depression – and not only them – should aim for ferritin levels above 50 ng/mL, because only such a level in the body guarantees full health. This means that you should take supplements even if you are not anemic or feeling unwell. For example, only levels above 70 ng/ml allow hair follicles to regenerate, invaluable information for women who are looking for reasons of excessive hair loss.

There is no point in using high doses; in studies they have been shown to be just as effective as low doses of a few hundred percent of the requirement. The body simply will not assimilate more, at most it will be flooded with them and poisoned. If, despite taking supplements, there is no improvement in results, the blame usually lies not with a too low dose, but for example with sipping tablets with tea or with digestive diseases. Everyone reacts a bit differently to tablets, some people have very big stomach problems after them, severe pain or vomiting, then you can look for another form, such as glyconate, citrate or fumarate. Also, ferritin levels will not increase if you lack the vitamins and minerals necessary to make it from iron.

I don’t know why, but quite a few people believe that drinking “nettle tea” will cure the deficiency. Nothing could be further from the truth. It contains literally trace amounts of the element we are interested in. Yes, it is quite healthy, but for other reasons. It contains valuable silicon and a number of trace elements that can improve the results of therapy, because the body may need them to assimilate iron itself. Absolutely not enough as a single therapy. Similarly, substances like spirulina or inventions like parsley cocktails will not suffice. Many years of deep deficiency can be cured ONLY by large doses of supplements.

Finally, a few words about dietary causes of deficiency, or “after all, I ate healthy!”. It is blocked by calcium, so combining foods with a high content of iron with e.g. dairy products will make the body unable to assimilate iron. Another very common mistake is drinking tea or coffee with such meals, both of which can block absorption almost completely. A number of other deficiencies can prevent the body from assimilating this element, but this is already too extensive topic. You should simply eat a reasonably varied meal and some sort of strong multivitamin during treatment.

Some research.

Women with low ferritin levels were almost twice as likely to be depressed:

Iron supplementation was an effective treatment for postpartum depression: