The Importance of Iron in ADHD: A Functional Psychiatry Perspective

ADHD is one of the most common neurodevelopmental disorders, affecting millions of children and adults worldwide. Depending on the specific subtype, individuals with ADHD can experience challenges with attention and focus, impulsivity, and hyperactivity, which can negatively impact their academic, professional, and personal lives.

Conventional approaches to ADHD treatment focus primarily on psychostimulants and non-stimulant medications. While these medications can be helpful, they often overlook the underlying causes contributing to ADHD symptoms. A functional psychiatry approach, in contrast, is more comprehensive, holistic, and individualized. It looks beyond symptom management to explore root causes, including nutrient deficiencies, one of the most critical being iron.

Iron’s Role in ADHD: Why It Matters

Iron is crucial for brain health, specifically in the production of dopamine, a neurotransmitter that plays a key role in attention, focus, and impulse control (Pino et al., 2017). Low dopamine levels are often implicated in ADHD. Research has found that many individuals with ADHD, especially children, have low iron levels, which can exacerbate cognitive symptoms (Lahat et al., 2011). In fact, a meta-analysis published in Scientific Reports revealed that children with ADHD had significantly lower ferritin levels—an assessment of stored iron—compared to children without ADHD (Tseng et al., 2018) .

In adults, this deficiency can be just as impactful. A study in Sleep found a similar correlation between low iron levels and increased ADHD symptoms in adults, indicating that optimizing iron levels could be an effective strategy across the lifespan (Lopez et al., 2019).

A Functional Approach to Assessing Iron

Often, in conventional medicine, assessment of a patient’s iron status ends with a complete blood count (CBC). In order to fully assess iron status, however, it is critical to look beyond a CBC, which only identifies severe anemia. A more comprehensive evaluation includes a full iron panel, assessing serum iron, total iron-binding capacity (TIBC), iron saturation, and ferritin levels. Ferritin is particularly important because it reflects the body’s stored iron and can be a more sensitive marker of iron deficiency than just looking at serum iron alone (Bouri, 2018).

Optimal ferritin levels for cognitive health typically fall between 50-100 ng/mL. Levels lower than this can contribute to cognitive dysfunction and worsen ADHD symptoms. While ferritin can be a sensitive marker for iron insufficiency, there are times when it is less helpful. Ferritin is a part of the inflammatory process and can be elevated in cases of inflammation, even when iron levels are low (Gulhar et al., 2023). This can mask a deficiency if ferritin is used in isolation. As such, comprehensively assessing iron status requires looking at several biomarkers in context. To that end, other lab signs of iron deficiency include low hemoglobin and hematocrit, low serum iron, low iron saturation, and elevated TIBC.

Iron: The Goldilocks Mineral

Iron deficiency can lead to poor concentration, brain fog, and fatigue—symptoms often experienced by individuals with ADHD. But as with many things, more is not always better. In too large of quantities, iron in the body can oxidize or rust. This iron overload can be just as harmful as deficiency, leading to oxidative stress and inflammation (Puntarulo, 2005). This is why blindly supplementing with iron without proper testing and supervision can be dangerous. Iron levels must be carefully balanced, neither too high nor too low, to optimize brain function and overall health.

Iron-Rich Foods and Supplementation Options

Once iron deficiency is identified, the first step is optimizing dietary intake. Iron comes in two forms: heme and non-heme. Heme iron, found in animal products, is absorbed more easily, while non-heme iron, found in plant-based sources, is less bioavailable but can still be beneficial when paired with vitamin C, vinegar or other food grade acids to enhance absorption.

Iron-rich foods include:

• Heme Iron:
  • Red meat (grass-fed beef, lamb)
  • Poultry (chicken, turkey)
  • Organ meats (liver, kidney)
• Non-Heme Iron:
  • Lentils, beans, chickpeas
  • Spinach and other leafy greens
  • Fortified cereals and quinoa

If diet alone is not enough to correct low iron levels, supplementation may be necessary. The goal is to choose iron supplements that are effective yet gentle on the digestive system. Two common and well-tolerated options include:

• Iron Bisglycinate: A chelated form of iron that is highly absorbable and less likely to cause gastrointestinal distress compared to other forms like ferrous sulfate.
• Heme-Based Iron Supplements: Derived from animal sources, these are often more bioavailable and beneficial for patients who have difficulty absorbing non-heme iron or experience digestive discomfort with plant-based supplements.

Regular monitoring of iron markers, especially ferritin, is essential when supplementing to avoid the risk of iron overload.

Addressing Root Causes: Iron and Beyond

While iron deficiency plays a significant role in ADHD, it’s just one piece of the puzzle. A functional psychiatry approach to ADHD is about treating the whole person, not just the symptoms. Herbal supplements like Bacopa monnieri, Ginkgo biloba, and Rhodiola rosea can certainly aid cognition, but addressing an individual’s nutrient imbalances, inflammation, and lifestyle factors lays the foundation for long-term cognitive health.

Nutrient deficiencies—whether in iron, magnesium, or essential fatty acids—must be identified and corrected as part of a comprehensive ADHD treatment plan. This root-cause approach not only alleviates symptoms but also empowers patients to take control of their mental health in a more sustainable, holistic way.