Fibromyalgia, iron and neurotransmitters

Most readers are aware that low iron reduces oxygen delivery to tissues, and this degrades the ability of every cell to produce energy for function. Naturally this can contribute to chronic pain of various kinds. This valuable paper published in the European Journal of Clinical Nutrition about fibromyalgia brings up another important point: low neurotransitters (dopamine, norepinephrine, serotonin) are a contributing cause of the pain and dysfunction of fibromyalgia, and adequate iron is necessary for their production. The authors begin by observing:

"Iron is essential for a number of enzymes involved in neurotransmitter synthesis. Analysis of cerebrospinal fluid in fibromyalgia syndrome (FMS) has shown a reduction in the concentration of biogenic amine metabolites, including dopamine, norepinephrine and serotonin. This study aimed to investigate the association of ferritin with FMS."

To investigate this association serum ferritin, vitamin B12 and folic acid were measured in 46 patients with primary FMS and 46 healthy controls. Their data paints a very interesting picture:

"Binary multiple logistic regression analysis...showed that having a serum ferritin level <50 ng/ml caused a 6.5-fold increased risk for FMS."

Here's what the authors concluded from their findings:

"Our study implicates a possible association between FM and decreased ferritin level, even for ferritin in normal [see note below] ranges. We suggest that iron as a cofactor in serotonin and dopamine production may have a role in the etiology of FMS."

Important: there is earlier research that validates 50 ng/ml as the correct low point for serum ferritin, but many labs have not caught up and still have a report with a reference range for ferritin that is too low. This is a key point in clinical practice.