Can iron deficiency cause vertigo and other balance issues?

Iron Deficiency and Vertigo: The Connection Between Iron Status and Balance

Yes, iron deficiency can cause vertigo and other balance issues, with symptoms improving after iron supplementation. 1

Pathophysiological Mechanisms

Iron deficiency affects the central nervous system in multiple ways that can lead to balance disturbances:

1. Neurological Impact: Iron is essential for brain development and function, particularly in regions involved in balance and coordination 2. Iron deficiency can lead to:

   • Altered neurotransmitter metabolism
   • Impaired myelination
   • Neuroanatomical damage in the hippocampus 3

2. Vestibular System Effects: Iron is required for proper functioning of the vestibular system, which controls balance and spatial orientation.

3. Cognitive Processing: Iron deficiency can impair cognitive processing that supports balance control 3.

Clinical Evidence

A prospective interventional study found that:

• Symptoms of vertigo/dizziness were significantly more common in students with iron deficiency
• Iron supplementation led to a significant reduction in vertigo/dizziness symptoms 1

This provides direct evidence of the relationship between iron status and balance issues.

Spectrum of Balance-Related Symptoms

Iron deficiency can cause several balance-related symptoms:

• Vertigo: True spinning sensation
• Dizziness: General feeling of unsteadiness
• Poor balance: Difficulty maintaining equilibrium
• Lightheadedness: Feeling faint or woozy

These symptoms typically appear alongside other manifestations of iron deficiency such as fatigue, irritability, and decreased exercise tolerance 4.

Diagnosis and Assessment

When evaluating vertigo or balance issues with suspected iron deficiency:

1. Laboratory Testing:

   • Complete blood count (CBC)
   • Iron studies including serum ferritin, transferrin saturation, and serum iron 5
   • Serum ferritin <15 μg/L indicates iron deficiency 5

2. Important Consideration: Balance issues may occur before anemia develops, as iron deficiency affects the brain before affecting hemoglobin production 2.

Treatment Approach

For patients with vertigo/balance issues related to iron deficiency:

1. Oral Iron Supplementation:

   • First-line treatment: 60-120 mg elemental iron daily for 3 months 5
   • Continue treatment for 3 months after hemoglobin normalization to replenish iron stores 5

2. Dietary Recommendations:

   • Include heme iron sources (meat, poultry, fish) which have higher bioavailability
   • Pair non-heme iron sources with vitamin C-rich foods to enhance absorption 5

3. Monitoring:

   • Check iron studies (ferritin, transferrin saturation) after 3 months of therapy
   • Target ferritin >30 μg/L and transferrin saturation >20% 5

Special Considerations

1. Common Pitfall: Stopping treatment too early when symptoms improve but before iron stores are fully replenished, which can lead to symptom recurrence 5.

2. Absorption Issues: Certain foods and medications can inhibit iron absorption:

   • Tea, coffee, calcium supplements
   • Antacids and proton pump inhibitors

3. At-Risk Populations:

   • Women of childbearing age (due to menstrual blood loss) 2
   • Athletes (especially female) 2
   • Individuals with restricted diets (vegetarians/vegans) 5

Clinical Pearls

• Balance issues may be an early sign of iron deficiency, appearing before anemia develops
• Improvement in balance and vertigo symptoms can be expected within weeks of starting iron supplementation 1
• Consider iron deficiency in any patient with unexplained vertigo or balance issues, especially if they have risk factors for iron deficiency
• Iron deficiency can cause neurological symptoms that may not be fully reversible if treatment is delayed, highlighting the importance of early diagnosis and treatment 4, 3