The Brain and Iron Deficiency
Seeing a new patient that comes in feeling off - low energy, not as motivated, a little more anxious or down than usual - that’s not necessarily out of the ordinary; those characteristics are common in people who are struggling with mental health. What is important for our clinic is to be vigilant about the potential causes of those symptoms. While iron deficiency isn’t always the first thing we think about, it is high on the list of items to rule out, and it comes up more often than people expect.
What’s important to understand is that iron isn’t just about energy in a physical way - i.e. feeling “tired”. It’s deeply (and we can’t underscore this enough, deeply) involved in how the brain functions. It plays a vital role in the production of neurotransmitters like dopamine in addition to the commonly understood role in the delivery of oxygen to the brain. All of which affects mood, motivation, and focus. When iron levels are low, people don’t just feel tired—they can feel mentally slowed down. Oftentimes, cognitive performance, specifically the domain of processing speed, is impaired. That’s where you start to see things like brain fog, difficulty concentrating, or just a sense that they’re not as sharp as they usually are. Sometimes it’s subtle, and sometimes it overlaps with what people describe as stress or burnout.
There is an important mood/psychological component that’s easy to miss. Iron is tied to dopamine and other brain chemicals, which means that low levels can show up as low motivation, increased anxiety, or even depressive symptoms. Patients often do not, or cannot connect those dots, so it can go unrecognized for a while. My role, or more broadly, a clinician’s role, is to identify as well as help educate them about the different systems that work together to help us feel like “ourselves”.
If it continues over time, those effects can become more noticeable. You may see more persistent issues with focus, memory, or emotional regulation. It’s not usually dramatic all at once—it’s more of a gradual shift where people feel like they’re not functioning at their baseline.
Finally, low iron levels are very common, particularly in women, and they’re frequently overlooked. Many causal factors are nonspecific and are part of women’s health more broadly, such as their monthly period, pregnancy (as well as postpartum), and even moderate-to-high physical activity (endurance exercise or repetitive impact – sorry runners!) so they get attributed to other things first. What is important is understanding that these can be causal factors, and most women can make small adjustments that are meaningful in order to avoid needing clinical intervention. The best modification is your diet – iron that is easily absorbed is found in everyday proteins such as red meat, chicken (poultry more broadly), and fish. Alternatively, low-dose supplements as a preventative measure or to establish a healthy baseline can be very effective as well.
The upside is that it’s one of the more straightforward things to address once you identify it. When iron levels are brought back into a healthy range, people often notice a real difference—not just physically, but in how clear and steady they feel mentally.