When a patient walks into a clinic describing low mood or feeling stressed, the initial clinical thought often leans toward depression or burnout. However, it is frequently worth considering a much more common biological factor: iron deficiency.
In Canada, iron deficiency affects over 2 million people. While anyone can suffer from it, the condition is far more common among women of reproductive age, who are twice as likely to be deficient than men.
Why the risk is higher in women
For most of their lives, women are at a significantly higher risk for iron deficiency than men. The biological math is straightforward: monthly menstrual blood loss, coupled with the high iron demands of pregnancy and lactation, means women are roughly twice as likely to be anemic as men.
It’s not just about blood loss, though. Lifestyle factors, such as vegetarian or vegan diets, and absorption issues from conditions like IBD or Celiac disease, can push iron stores even lower.
The “sneaky” symptoms
Iron deficiency is often a clinical “chameleon.” Because its symptoms are vague and slow-moving, it often hides in plain sight:
- Mental health: Low mood, irritability, and anxiety are frequent early signs.
- Physical toll: Fatigue, low exercise tolerance, leg cramps, and “brain fog.”
- Aesthetic clues: Brittle nails, dry skin, and hair loss.
The overlap with depression is significant. Research shows that adults with iron-deficiency anemia are nearly twice as likely to screen positive for depression. If we aren’t including iron stores in our differential diagnosis, we risk treating a mineral deficiency with a psychiatric medication.
Who should get tested?
While we don’t need to screen everyone, certain “buckets” of patients should trigger an automatic workup:
- Women’s health: Heavy menstrual bleeding, pregnancy, or those who are lactating.
- Surgical prep: Anyone undergoing major surgery (especially gynecological).
- Absorption issues: Patients with IBD, Celiac, or a history of bariatric surgery.
- Chronic conditions: Patients with heart failure or kidney disease where iron status directly impacts prognosis.
So, what are the solutions?
The first line of defense is oral iron, but the biggest hurdle is tolerability. Many patients stop their treatment because of GI side effects like nausea, reflux, and constipation.
Clinician Tips for Success:
- Iron requires an acidic environment to be absorbed effectively. While traditional iron salts are often taken with Vitamin C or orange juice to help, newer formulations simplify this.
- Ferrous ascorbate provides iron and vitamin C in a single molecule, so there is no need to take vitamin C or orange juice separately to increase iron absorption.
- For patients who struggle with side effects, taking iron every second day can actually improve efficacy by reducing “hepcidin blocks” and making the therapy easier to tolerate.
Want to learn more?
Identifying the right patient and the right formulation can drastically improve your patient’s quality of life.
Checking out this free, 15-minute course designed to give you a quick, expert update. “Optimizing Oral Iron Therapy: Practical Insights for Clinicians” features Dr. Christine Palmay and Dr. Michelle Jacobson sharing evidence-based strategies to manage deficiency effectively and improve patient adherence.