Iron and Inattention

Iron and Inattention

Low iron levels worsen inattention. Inattentive ADHD can be worsened by having low iron levels even if you iron levels are not low enough to cause anemia. This is one of many medical issues surrounding the symptoms of ADHD Inattentive that give me a huge headache.

Serum Ferritin is a measure of how much iron you have stored in your body. A child or adult may have low serum ferritin levels and have symptoms of inattention but they will never get a serum ferritin test because this test is never done except when there is a case of suspected anemia.

A study published in the December, 2010 Journal of Child and Adolescent Psychopharmocology found that children with low ferritin levels had increased inattention, hyperactivity/impulsivity and total ADHD scores. These researchers found that the amount of inattentive ADHD behavior and total ADHD behavior could be predicted by the level of blood ferritin. The authors of this study reported that, "Serum ferritin was inversely correlated with baseline inattention, hyperactivity/impulsivity, and total ADHD symptom scores." The lower the ferritin level was, the more severe the ADHD symptoms.

Several other studies have also shown that low serum ferritin worsens the symptoms of ADHD. The problem and the headache is that no one routinely measures serum ferritin and unless you have signs of anemia you will never have a serum ferritin blood study.

It is even more complicated because iron is not one of these vitamins that you should take 'Willy nilly' and iron vitamin over dose is a real problem especially in children. Unlike some water soluble vitamins that you could take until the cows came home and no harm would come of it, over dosing on iron is a potentially fatal mistake.

The answer is to make sure that your diet and the diet of your children is filled with iron rich foods such as fortified cereals, fortified bread, and other fortified products (the labels will state that the food is fortified) and to consume at least three servings on an iron rich food such as:

Iron fortified food help Inattention

  • Lean red meats, including beef, pork, lamb 
  • Seafood, such as oysters, clams, tuna, salmon, and shrimp, etc. 
  • Beans, including kidney, lima, navy, black, pinto, soy beans, and lentils 
  • Iron fortified whole grains, including cereals, breads, rice, and pasta 
  • Greens, including collard greens, kale, mustard greens, spinach, and turnip greens 
  • Tofu 
Iron and ferritin deficiency can be caused by diets that are: 

  • High in Milk Products (children who consume lots of milk get full on milk and then do not eat iron rich food) 
  • Low vitamin C diets (Vitamins C helps the body absorb iron) 
  • Vegetarians (It is harder for the body to absorb non-meat sources of iron) 

The best way to insure that Inattentive ADHD symptoms are not being worsened by low ferritin levels is to increase your dietary intake of spinach, lean meats and other iron rich foods. Make sure to take your "one a day' vitamin so that your body has plenty of Vitamin C on board to aid with absorption. Your doctor may never offer to test your ferritin level but if your diet is adequate, he/she may not need to.

World J Biol Psychiatry. 2011 May 17. [Epub ahead of print]
Brain iron levels in attention-deficit/hyperactivity disorder: A pilot MRI study.
Cortese S, Azoulay R, Castellanos FX, Chalard F, Lecendreux M, Chechin D, Delorme R, Sebag G, Sbarbati A,Mouren MC, Bernardina BD, Konofal E.


  1. I didn't realize that a vegetarian diet could impact iron levels. It seems like there are still many foods that vegetarians can eat, like beans, spinach, and tofu, that will still deliver the needed iron.

  2. Thanks for your comment. Yes that is, unfortunately, one of the concerns with vegetarian diets.

  3. Great post. Iron deficiency runs in my family, as does ADHD... plenty of food for thought here!

  4. Iron is very important, but it's also important, as you pointed out, to make sure that you don't go overboard with iron supplements! It can cause serious liver issues. Any pharmacist, or hopefully your doctor, can make sure that you're buying the right supplement levels for you and your children.

  5. I haven't found doctors or dieticians much help on supplement levels. There seems to be much ignorance even amongst medics. You can give serum ferritin tested privately - I did in the UK when our GP refused to give one to my Asperger's son. (It was below the range.) Worth doing. My son is vegetarian and milk drinking, so at obvious risk. He would also probably be diag. as ADHD inattentive in the States, and I suspect has low brain iron anyway (he has Restless Leg Syndrome, which autopsy studies show is linked strongly to low brain iron - that's iron in the fluid in the brain, not the level of iron in the blood, these are two different fluids). This could perhaps have been caused by immediate cord-clamping - he had a slightly premature birth and there was a crash team in the room, and I understand that in those circs immediate cord clamping is normal. Not that I could see from my end.
    There is very little evidence on how to raise brain iron, or even if it is possible or desirable.

    Some things which inhibit absorption of iron supps - phytic acid, found in beans, grains and rice. So the iron supplements in branded cereals won't absorb well because of the milk in the bowl AND the grains in the cereal and the rice.
    Polyphenols found in some vegetables, coffee, tea, wines and spices can reduce absorption of supplementary iron. So if you have your breakfast cereal with tea or coffee you're absorbing even less of the added iron in that cereal.
    Soy reduces iron absorption.
    Lead, obviously.
    Heliobacteer pylori is assoc with iron def. anemia.
    Celiac disease is assoc with low iron - no one knows yet whether gluten sensitivity will turn out to have the same effect but I'm betting it will.

    Vitamin A def can make iron deficiency worth. So a cod liver oil pill might help with the iron.
    Vitamin D def has been associated with low iron in some studies.

    Vit C helps, so eat meat with some fruit or fruit based sauce, or orange juice.

    So give the most easily absorbed iron supps (check on PubMed) with vitamin C and don.t give them at meal times. Don't imagine that because you are giving 100 per cent of the RDA for a child that it is all being absorbed. The body only absorbs 15 per cent of the iron which is digested. That's why you need to keep testing iron and ferritin levels if you see a problem. (And if you have a needle sensitive child, how hard is that?)

    And remember if your child has any kind of inflammation or infection the body will reduce its absorption of iron in order to fight off the invader - a chronic minor infection can lead to a relatively high serum ferritin level, which might give you false reasssurance that all is OK on the iron front when it isn't. You will have to track down and cure the inflammation or the infection (so tthat's easy!) before the body will start absorbing properly again.

    It is difficult. But it is maybe crucial.


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