Anorexia and Iron

Iron supplementation has improved the health of some anorexics, but don’t go popping pills without medical supervision. The relationship between anorexia and iron is complex, and unsupervised supplementation can be highly toxic.

According to wholehealthmd, iron is an essential element which helps the blood and muscles supply oxygen to the body. The site notes that iron is abundant in hemoglobin, an oxygen-carrying pigment in red blood cells, and in myoglobin, an oxygen-rich substance found in muscle tissue.

Wholehealthmd lists several other benefits of iron: it plays an important role in maintaining energy levels, clarity of thought, and immune function. The site notes U.S. government figures showing that females, in particular, are often iron-deficient. These statistics indicate that 9 percent of adolescent girls and 11 percent of women under age 50 have low levels of iron. Wholehealthmd notes that iron reserves can be depleted by the following: pregnancy; rapid growth during childhood; dieting, especially of the vegetarian kind; heavy exercise; and menstruation. Compulsive dieting and exercise are two common symptoms of anorexia nervosa.

Eating disorders specialist Barton, J. Blinder, M.D., observes that “chlorosis,” a term used by 18th and 19th century physicians to describe an illness among young women, “may have been in some instances a form of anorexia nervosa accompanied by anemia (iron deficiency), restrictive eating habits, and psychological disturbances.” The relationship between iron deficiency and anorexia nervosa was recently described by Susan M. Ferron, M.D. in a letter to the editor published in the American Journal of Psychiatry (156:801, May 1999).

Dr. Ferron described the case of a 16 year-old girl hospitalized with anorexia nervosa and iron deficiency anemia. According to Dr. Ferron, the cause of the low iron count was unknown.

The girl’s doctors knew that she exercised compulsively, but did not realize that she also ran in place for two hours every night. She had concealed this behavior by performing it in her bathroom or bedroom where nobody could see her.

Once discovered, the girl’s running was stopped. To enforce this restriction, hospital personnel closely monitored her. After “iron supplementation and an improved diet,” her anemia disappeared.

Dr. Ferron’s letter suggests that the key to the patient’s condition was a combination of compulsive exercising and poor diet, and that iron deficiency did not play a direct, if any, role in causing the anemia. She cautioned that “the anemia of anorexia nervosa is usually…without iron deficiency,” and that the physical activities of anorexics with iron deficiency anemia or gastrointestinal bleeding should be closely studied prior to treatment.

Though poorly understood, iron does seem to be involved in appetite regulation, which could have implications for sufferers of anorexia nervosa and other eating disorders. Dr. Blinder describes cases of iron deficiency in patients with pica, an illness in which people compulsively eat indigestible objects such as hair or matches. According to Blinder, research has linked low iron levels with decreased dopamine receptors in the brain “and consequent reduction of several CNS [central nervous system] dopamine driven behaviors.” Dopamine is a chemical which helps transmit nerve impulses. Although anorexia nervosa is not pica, the research suggests that iron can influence dietary behavior.

Wholehealthmd stresses that you should only take iron supplements if your doctor says you need them, and after he or she performs the necessary blood tests. The site also stresses the need for regular follow-ups. According to wholehealthmd, excess iron increases the risk of colon cancer and heart disease. The site notes that the recommended daily allowance (RDA) of iron for women over age 50 is 10 mg. The RDA for women under 50 is 15 mg, and, for pregnant women, it’s 30 mg. In addition, wholehealthmd says that, to prevent an overdose, non-anemics should make sure their multivitamins do not contain iron. The site also emphasizes that iron supplements should be kept away from young children. As few as five high-potency iron pills can kill them.

The Canadian Pediatric Society (CPS) notes that iron deficiency is associated with anorexia in infants and very young children. However, as Dr. Blinder points out, anorexia in babies and anorexia nervosa much later in life are very different. According to Blinder, anorexia in the very young tends to be a short-term condition related to anxiety in a particular developmental stage, while an eating disorder such as anorexia nervosa is a long-term condition with deeply ingrained psychological patterns and consquent medical complications.