ADHD and Iron Deficiency
About 8% of children, ages 4 years and under, are deficient in iron. Between the
ages of 5 and 12, the percentage rises to 13%, and then settles back to 8% in
people above the age of 15. Anemia is the best-known repercussion of iron
deficiency. However, even minor deficiencies in iron may weaken the immune
system, affect the 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 the anabolism of catecholamines. That means it is
essential for the creation of certain neurotransmitters. It helps to regulate
the activity of the neurotransmitter dopamine, which probably accounts for the
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
the effects of iron supplementation on ADHD.
One study, done in Israel, evaluated 14 ADHD boys for the effect of short-term
iron administration on behavior. Each boy received iron daily for 30 days. Both
parents and teachers assessed the behavior of the children. The parents found
significant improvement in the behavior of the children. However, the 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 the deficiency is treated.
A third study tested the affects of iron supplementation on a group of teen-aged
high school girls who were determined to be iron deficient. At the end of the
8-week study, the 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 the evidence we have. It's not a lot and it's not very
impressive. None of the studies were double-blind studies, which means we cannot
really rely on them all that much.
If this were the 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 the iron blood tests and still be iron
deficient because he requires more than the average amount of iron.
So why not just give your child iron supplements and see what happens? Because
iron functions in the body like a two edged sword.
Iron exists in the body in two chemical forms. There is the ferrous form, where
the iron atom will bond to two electrons and the ferric form where the atom will
bond to three electrons. Iron can go back and forth between these two forms.
This is the 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 the 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
the body as free iron and can cause damage anywhere it goes. To further
exacerbate the problem, excess iron is not eliminated well by the body. Most of
the iron in the 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 the brains of people with
Parkinson's disease. It is very likely that excess iron can aggravate, if not
cause, other neurological problems as well.
With that in mind we have to approach iron supplementation with caution. My
feeling is that if your child turns out to be one of the 8-13% that is deficient
in iron, it is worth giving iron supplements. I doubt that it will help much
with his ADHD, but it should help with his general health. This advice applies
to your non-ADHD children, also.
How should you test iron deficiency? The hemoglobin and hematocrit counts that
come as part of the standard complete blood count (CBC) are good for diagnosing
anemia. They do not really give you accurate information about the body's iron
status. The best test for iron status is the serum ferritin test, which measures
how much iron is stored in your body. It will be low if you are deficient and
high if you are overloaded.
If you find your child has an iron deficiency problem, there are several
approaches to treat it. Probably the safest is by giving him more
iron-containing foods. You can serve him red meat several times a week. Liver is
an excellent source, if you can get him to eat it. You can enhance dietary
absorption by supplementing with vitamin A (about 10,000 IU) and vitamin C
(about 500mg) with the meals.
The most likely the reason that your child is deficient is because he is a poor
eater; so, dietary intervention may not be practical. A second and far inferior
source of iron is through supplements. The primary difficulty of iron
supplements is that they do not get into the body. Fortifying foods with iron in
general does not work. Many foods bind iron and, as a result, the iron is
excreted rather than absorbed. The best form of supplemental iron is Ferrochel.
Ferrochel is an amino acid chelated iron, which is highly bio-available and is
not affected by foods that bind iron.
Most iron supplements have a ten percent absorption rate. That means if you take
10 mg of the supplement, your body absorbs 1 mg. Ferrochel is different.
Ferrochel has a 75% absorption rate. That means 1.5 mg of Ferrochel provides
more iron to your body than 10 mg of other supplements.
That is an interesting fact, but it is not why I am recommending it. The more
important property of Ferrochel is that since it is already amino acid bound, it
does not become free iron in the body. That means it does not have the dangers
and side effects of other iron supplements. The FDA has given Ferrochel the
designation of GRAS, (generally regarded as safe). No other iron supplement has
this designation.
The take home message is that iron deficiency may be the cause of hyperactivity
in some children. It is worth your while to have your child tested. If for some
reason you suspect your child is iron deficient, the best approach is to
increase your child's iron intake through his diet. If that doesn't work and you
need to use supplements, the best supplemental iron is Ferrochel.
Anthony Kane, MD is a physician, an international lecturer, and director of
special education. He is the author of a book, numerous articles, and a number
of online programs dealing with ADHD (addadhdadvances.com/childyoulove.html)
treatment, ODD, parenting issues (addadhdadvances.com/betterbehavior.html), and
education. You may visit his website at http://addadhdadvances.com. To sign up
for the free ADD ADHD Advances online journal send a blank email to: subscribe@addadhdadvances.com?subject=subscribeartcity
akane@addadhdadvances.com
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