ADHD and Iron Deficiencyby Anthony Kane, MD
About 8% of children, ages 4 years and under, are deficient in iron. Between
ages of 5 and 12, percentage rises to 13%, and then settles back to 8% in people above age of 15. Anemia is best-known repercussion of iron deficiency. However, even minor deficiencies in iron may weaken immune system, affect thyroid, and impair general physical performance. Iron deficiency has also been implicated in a number of psychiatric and neurological conditions, including learning disabilities and ADHD.
Iron is a co-enzyme in anabolism of catecholamines. That means it is essential for creation of certain neurotransmitters. It helps to regulate activity of neurotransmitter dopamine, which probably accounts for association of iron deficiency with neurological problems. It makes sense that supplementing ADHD children, who have some level of iron deficiency, might have some effect on their ADHD. However, what makes sense in theory, does not always work in practice. Unfortunately, there have been very few studies done testing effects of iron supplementation on ADHD.
One study, done in Israel, evaluated 14 ADHD boys for effect of short-term iron administration on behavior. Each boy received iron daily for 30 days. Both parents and teachers assessed behavior of children. The parents found significant improvement in behavior of children. However, teachers noticed no improvement.
In a second study, 33 iron-deficient, but otherwise normal, children were given an iron supplement. The children became less hyperactive. This study suggests that iron deficiency may cause hyperactive behavior in some children and that hyperactive behavior is reversible when deficiency is treated.
A third study tested affects of iron supplementation on a group of teen-aged high school girls who were determined to be iron deficient. At end of 8-week study, researchers found that girls who received iron supplementation performed better on verbal learning and memory tests than those who did not.
This is about all evidence we have. It’s not a lot and it’s not very impressive. None of studies were double-blind studies, which means we cannot really rely on them all that much.
If this were only consideration, I would say you should definitely try to treat your child for iron deficiency. The reason is that hyperactive children are more likely to be iron deficient than other children. Also, there is a possibility that your child has a higher than average iron requirement. That means that he might test normal on all iron blood tests and still be iron deficient because he requires more than average amount of iron.
So why not just give your child iron supplements and see what happens? Because iron functions in body like a two edged sword.
Iron exists in body in two chemical forms. There is ferrous form, where iron atom will bond to two electrons and ferric form where atom will bond to three electrons. Iron can go back and forth between these two forms. This is property of iron that allows it to play a role in carrying oxygen as part of hemoglobin. However, it also makes iron an active player in oxidation-reduction reactions. What that means is that iron has ability to act like a free radical and cause significant damage to tissues. Whenever iron is not bound to hemoglobin or to some other carrier protein, it travels around body as free iron and can cause damage anywhere it goes. To further exacerbate problem, excess iron is not eliminated well by body. Most of iron in body gets recycled. Therefore, not only is excess iron toxic, but also once you have excess iron in your body, it is going to stick around for a long time. High amounts of iron have been found in brains of people with Parkinson’s disease. It is very likely that excess iron can aggravate, if not cause, other neurological problems as well.
