1. Iron deficiency

Iron is an essential compound of hemoglobin that is involved in the blood transport of oxygen from the lungs to tissues and organs.

Although the body has reserves in iron, a deficiency in iron supply through diet depletes these reserves resulting in anemia [2].

Anemia is due to the incapacity of the body, and specifically the bone marrow, to produce enough hemoglobin for red blood cells transport of oxygen, resulting in microcytic and hypochromic anemia.

• What Causes Iron Deficiency?

Blood Loss

Rapid blood loss through injury, surgery, or childbirth, significantly depletes iron reserves as new blood, and therefore, new hemoglobin is required to compensate for the blood loss.

Chronic blood loss can also be a result of nosebleeds, hemorrhoids, ulcers, menstruation, intestinal cancers.

It is estimated that iron deficiency anemia affects more than 1.2 billion individuals worldwide [3].

Enteropathies

Any alterations of the function of the intestines such as inflammation (Enteritis), can results in the malabsorption of nutrients, including iron.

• Iron Rich Food

To prevent iron deficiency, there are foods that are rich in iron including dark-green leafy vegetables, nuts and seeds, meat, fish, tofu, eggs, brown rice, and dried fruit. Dietary iron supplements are also commercially available.

2. Zinc deficiency

Zinc is an essential factor for many enzymatic reactions and is involved in the synthesis of nucleic acid synthesis (DNA and RNA).

It is also necessary for the growth and maintenance of healthy hair and skin.

Zinc deficiency results in slower growth and development of infants and children, loss of appetite, hair loss, loss of smell, altered immune response, and delayed wound healing.

• What Causes Zinc Deficiency?

In addition to dietary causes, alcoholism, exercise, and diarrhea have been associated with zinc deficiency.

It can also be caused by a rare hereditary disorder known as acrodermatitis enteropathica that affects the mucosal membrane of the intestine.

• Zinc Rich Food

To prevent zinc deficiency, there are foods that are rich in iron such as oysters, beef, lobster, pork, cereals, crab, chicken, pumpkin seeds, baked beans, dairy products (milk, yogurt, cheese), cashews, chickpeas, and oatmeal. Dietary zinc supplements are also commercially available.

3. Iodine deficiency

Iodine is essential for the synthesis of the thyroid hormones, thyroxine (T4) and triiodothyronine (T3), which are necessary for growth, cellular metabolism, and for the regulation of body temperature. 

Iodine deficiency results in reduced production of T3 and T4 resulting in a condition known as hypothyroidism characterized by an enlargement of the thyroid gland and the appearance of goiter.

Hypothyroidism leads to symptoms such as impaired mental function, hoarse voice, tiredness, dry skin, a gain of weight, aches, and intolerance to cold.

• What Causes Iodine Deficiency?

Insufficient Intake of Iodized Salt, veganism (e.g., no dairy products and eggs), pregnancy, living in regions that have low iodine soils can all contribute to iodine deficiency.

• Iodine Rich Food

To prevent iodine deficiency, there are foods that are rich in iodine such as seaweed, bread, cod, oysters, dairy products (milk, yogurt, and cheese), eggs, shrimps, and tuna.

4. Calcium deficiency

Calcium is essential for the contraction of muscles, the formation of bones and teeth, the regulation of cardiac rhythm, coagulation, neurotransmission, and several metabolic and enzymatic reactions.

The most known effect of calcium deficiency is osteoporosis associated with the reduction of bone strength.

• What Causes Calcium Deficiency?

Lactose intolerance individuals can result in decreased consumption of dairy products that are rich in calcium. In post-menopausal women, the decrease in estrogen level reduces the absorption of calcium and increases its mobilization from the bones and its elimination through urine.

• Calcium Rich Food

To prevent calcium deficiency, there are foods that are rich in calcium such as dairy products (milk, yogurt, cottage cheese, mozzarella), Tofu, soymilk, sardines, salmon, soybeans, spinach, turnip greens, kale, and beans 

5. Magnesium deficiency

Magnesium is necessary for the function of the nervous system and muscles and is involved in the production of energy (ATP).

It is also involved in the regulation of blood glucose, blood pressure, and the metabolism of calcium and potassium.

Deficiency in magnesium can lead to tiredness, loss of appetite, nausea, and vomiting.

A severe deficiency manifests with cramps, numbness, seizures, and cardiovascular symptoms. If intreated magnesium deficiency can cause hypocalcemia and chondrocalcinosis.

• What Causes Magnesium Deficiency?

Magnesium deficiency can be due to chronic alcoholism, gastrointestinal diseases (e.g., malabsorption), poorly controlled diabetes, and certain types of medications such as antibiotics, diuretics, chemotherapeutic agents, and proton-pump inhibitors [3].

• Magnesium Rich Food

To prevent magnesium deficiency, there are foods that are rich in magnesium including green leafy vegetables, such as spinach, nuts, seeds (chia and pumpkin seeds), legumes, and whole grains. Dietary magnesium supplements are also commercially available.

6. Selenium deficiency

Selenium is essential for the metabolism of thyroid hormones, DNA synthesis, protection from infection and oxidative damage (antioxidant), and for reproduction.

Selenium deficiency leads to the development of a viral disease in children and young women, known as Keshan disease, that is characterized by cardiomyopathy [4].

A combination between selenium deficiency and iodine deficiency can cause goiter and hypothyroidism.

• What Causes Selenium Deficiency?

Selenium deficiency mostly affects people living in selenium-deficient regions and people who are under kidney dialysis.

• Selenium Rich Food

To prevent selenium deficiency, there are foods that are rich in magnesium include such as Brazil nuts, organ meats, and seafood.

7. Fluoride deficiency

Fluoride is naturally found in the body as calcium fluoride and is required for new bone formation and for preventing teeth decay.

Fluoride deficiency can lead to tooth decay and fracture of bones.

• What Causes Fluoride Deficiency?

Although fluoride is sufficiently available through food products made with fluoridated tap water and fluoridated tap water, adequate intake of fluoride can reduce teeth decay (caries) and bone fractures.

• Fluoride Rich Food

Foods that are rich in fluoride include black tea, raisins, wine, fluoridated water, lamb, and carrots.

Conclusion

Iron, calcium, zinc, iodine, magnesium, selenium, and fluoride are essential for the function of the bones, muscles, heart, and brain. They are also involved in vital metabolic reactions as coenzymes. Any deficiency in one of these minerals can have severe health consequences such as diseases that affect both adults and developing embryos.

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• Omega-3
• B Vitamins
• Amino Acids
• Essential Minerals
• Vitamin D
• Plant-Based Antioxidants
• Probiotics and Prebiotics

1. Omega3

1.1. What Are Omega3 Fatty Acids Good For?

Omega-3 fatty acids are essential for the metabolism of lipid in our body and that can only be provided by the diet.

Omega-3 fatty acids are not a single entity, but they are divided into docosahexaenoic acid (DHA), linolenic acid (ALA), and eicosapentaenoic acid (EPA) [1].

• Docosahexaenoic Acid (DHA)

Docosahexaenoic Acid (DHA) is the principal constituent of the plasma membrane of neurons found in the brain and cerebral cortex. It is also found in the retina and skin.

• Eicosapentaenoic Acid (EPA)

Eicosapentaenoic Acid (EPA) is essential for the synthesis of the vasodilator, anticoagulant, and inflammatory hormone, Prostaglandin (PG).

Eicosapentaenoic Acid (EPA) is also essential critical for the synthesis of the pro-coagulation and thrombosis factor, thromboxane, and the inflammation mediators, leukotrienes.

• Linolenic Acid (ALA)

Linolenic Acid (ALA) is involved in the regulation of blood lipids and endothelial (Vessels) function. It has also significant anti-inflammatory and anti-thrombotic effects.

1.2. Why Are Omega 3 fatty Acids Good for Mental Health?

Several studies reported that the reduction in intake of Omega 3 fatty Acids results in mood disorders [2].

Major depression and schizophrenia were also associated with reduced consumption of fish and omega 3 fatty acids [2].

The severity of depression was linked with the reduction of omega 3 fatty acids concentrations in the blood.

When comparing with healthy individuals, patients with schizophrenia had significantly lower levels of EPA and DHA.

1.3 Which Food Contains More Omega-3?

Foods that are rich in Docosahexaenoic Acid (DHA) and Eicosapentaenoic Acid (EPA) include fatty fish such as salmon, tuna, herring, mackerel, sardine, and fish oils, while flaxseed, chia, walnuts, hemp, and vegetable oils are rich in Linolenic Acid (ALA).

2. B Vitamins

2.1. What Are B Vitamins Good For?

Through their co-enzymatic (help other enzymes) activities, B vitamins are essential players in the cell metabolism of sugars, amino acids, and lipids. They are also involved in the synthesis of neurotransmitters necessary for the nervous system functions.

2.2. Why Are B Vitamins Good for Mental Health?

Alterations in the activity of neurotransmitters have been associated with changes in mood, depression, bipolar disorder, schizophrenia, and obsessive-compulsive disorder (OCD). B vitamins are essential for the synthesis of several neurotransmitters and in the conductance (transmission) of nerve impulses [3] [4].

• Vitamin B1 (Thiamine)

Through its activity as a coenzyme, vitamin B1 (Thiamine) is involved in the synthesis of the neurotransmitters, GABA, Acetylcholine, and glutamate.

• Vitamin B6 (Pyridoxine)

Through its activity as a coenzyme, vitamin B6 (pyridoxine) is involved in the synthesis of neurotransmitters, dopamine, histamine, serotonin, norepinephrine, and GABA.

• Vitamin B9 (Folate, Folic Acid)

Folate has several roles in the nervous system:

– Increases the level of the neurotransmitter, serotonin, by reducing the breakdown of tryptophan which is an essential amino acid involved in the synthesis of serotonin.

–  Through its activity as a coenzyme, folate contributes to the synthesis of the monoamine neurotransmitters, serotonin, norepinephrine, and dopamine.

– Contributes to the synthesis of compounds necessary for the energy metabolism of the brain.

• Vitamin B12 (Cobalamin)

Vitamin B12 (cobalamin) has also several roles in the nervous system:

– Through its activity as a coenzyme, vitamin B12 (cobalamin) contributes to the synthesis of the monoamine neurotransmitters, serotonin, norepinephrine, and dopamine.

– It is involved in the maintenance of myelin sheets that envelop neurons and which are involved in the transmission of nerve impulses.

– Helps the activity of folate.

2.3. Which Food Contains More B Vitamins?

• Vitamin B1 (Thiamine) is naturally present in food such as whole grains, legumes, and fish.

• Vitamin B6 (Pyridoxine) is mainly found in meat products such as Beef, pork, and fish.

• Vitamin B9 (Folate) is found in many types of food; however, due to its instability (e.g., high heat cooking), it is being added to several food sources as a fortifier to prevent a vitamin B9 deficiency.

• Vitamin B12 (Cobalamin) is naturally present in foods such as meat, liver, milk, clams, fortified breakfast cereals, and eggs.

3- Amino Acids

3.1. What Are Amino Acids Good For?

Amino acids are the building blocks of proteins that are essential for life. Proteins are a vital part of building cells, tissues, and organs. They are also critical for their functions as all physiological processes of the cells require proteins.

3.2. Why Are Amino Acids Good for Mental Health?

Amino acids play a critical role in the function of the nervous system and in mental health. The amino acid glutamate is a neurotransmitter, while other amino acids are necessary for the synthesis of several neurotransmitters.

• The neurotransmitters dopamine, norepinephrine, and epinephrine are made from the amino acid, Tyrosine, that is also made from phenylalanine.
• The neurotransmitter serotonin is made from tryptophan

3.3. Which Food Contains More Amino Acids?

Foods that are rich in amino acids include meats, eggs, and milk, and other dairy products.

4- Essential Minerals

4.1. What Are Essential Minerals Good For?

Essential minerals are essential for life through their role in the production of energy, bone formation, nucleic acid synthesis (DNA and RNA), hemoglobin synthesis, and metabolism of the cells.

4.2. Why Are Essential Minerals Good for Mental Health?

• Zinc

Zinc is involved in the regulation of gene expression and protein synthesis. As a cofactor for many enzymes, zinc is involved in several metabolic reactions.

 Zinc intake has been associated with a reduced incidence of depression [5]. Zinc deficiency is also involved in learning impairment and olfactory dysfunction [6].

• Iron

Iron is essential for the production of energy (ATP) in the brain. As a coenzyme, Iron is involved in the synthesis of the neurotransmitters, serotonin, dopamine, norepinephrine, and epinephrine [4].

• Magnesium

Magnesium is involved in several mental health disorders, including anxiety, depression, and migraine.

Magnesium has an essential role in neurotransmission and neuromuscular transduction through its protective function against excitotoxicity (excessive transmission by neurotransmitters) [7].

4.3. Which Food Contains More Essential Minerals?

• Foods that are rich in Zinc include oysters, beef, lobster, pork, cereals, crab, chicken, pumpkin seeds, baked beans, dairy products (milk, yogurt, cheese), cashews, chickpeas, and oatmeal.

• Foods that are rich in Iron include dark-green leafy vegetables, nuts and seeds, meat, fish, tofu, eggs, brown rice, and dried fruit.

• Foods that are rich in Magnesium include green leafy vegetables, such as spinach, nuts, seeds (chia and pumpkin seeds), legumes, and whole grains

5. Vitamin D

5.1. What Is Vitamin D Good For?

Vitamin D is involved in the intestinal absorption of magnesium, phosphate, and calcium necessary for calcium homeostasis and bone metabolism.

5.2. Why Is Vitamin D Good for Mental Health?

A study reported the involvement of vitamin D in schizophrenia associated with low levels of maternal vitamin D during pregnancy [8].

Another study reported an association between low levels of vitamin D and depression [9].

5.3. Which Food Contains More Vitamin D?

Vitamin D is naturally found in many foods such as beef liver, cod liver oil, eggs, salmon, tuna, mackerel, and sardines.

6. Plant-Based Antioxidants

6.1. What Are Plant-Based Antioxidants Good For?

Plant-Based Antioxidants prevent oxidative stress damage to cells that can lead to their death. They perform this action by neutralizing free radicals.

6.2. Why Are Plant-Based Antioxidants Good for Mental Health?

Unbalance in plant-based antioxidants such flavones, polyphenols, flavonoids, phytoestrogens, and catechins, has been shown to promote anxiety and depression.

Plant-based antioxidants prevent anxiety and depression through their role in reducing the inflammation of brain cells and restoring balance to neurotransmitters [10].

6.3. Which Food Contains More Plant-Based Antioxidants?

Foods that are rich in plant-based antioxidants include oilseeds, legumes, tree nuts, plants of the Lamiaceae family, tea and coffee, cereals, fruits, and berries.

7. Probiotics and Prebiotics

7.1. What Are Probiotics and Prebiotics Good For?

Probiotics are the gut’s most known “good bacteria” that are Lactobacillus and Bifidobacterium. These bacteria help other gut bacteria by providing them with nutrients that are commonly known as prebiotics [11].

The most common prebiotics are fructooligosaccharides, galactooligosaccharides, and trans-galactooligosaccharides, but other prebiotics plays important roles in health and aging such as insulin enriched-oligofructose, lactulose, and oligofructose.

7.2. Why Are Probiotics and Prebiotics Good for Mental Health?

The administration of prebiotics such as non-starch polysaccharides was shown to improve the performance of working and recognition memory and cognitive functions [16][17].

 Another prebiotic known as insulin enriched-oligofructose enhances mood and immediate memory [18].

Lactulose was also shown to improve cognitive function and health-related quality of life [19].

7.3. Which Food Contains More Probiotics and Prebiotics?

Probiotics are found in yogurt, lactobacillus milk, some cheeses such as Gouda, cheddar, cottage cheese, and mozzarella, pickles, sauerkraut, kefir, kimchi, tempeh, kombucha, and miso.

Prebiotics are found in carrots, quinoa, radishes, onions, chicory roots, konjac roots, oats, yams, garlic, barley, wheat bran, berries, apples, asparagus, bananas, leeks, chia seeds, flax seeds, cocoa, coconut, jicama root, and dandelion greens.

Conclusion

Although sometimes we are not aware of the importance of the food we consume, consuming the right nutrients such as omega 3 fatty acids, B vitamins, plant-based antioxidants, probiotics and prebiotics, essential minerals, vitamin D, and amino acids can make a big difference in preventing or reducing mental health issues.

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Iron is the main component of hemoglobin which plays an essential role in oxygen transport by red blood cells, and therefore, the lack of a physiological amount of iron affects the oxygen-carrying capacity of the blood, leading to tissue hypoxia (deprivation of oxygen supply) [2]. 

What Are the Causes of Iron Deficiency Anemia in the Elderly?

Any disorder, condition, diet, or medication that limits the supply or absorption of iron will restrict the amount of hemoglobin available to transport oxygen; thus, leading to iron deficiency anemia.

1- Stomach ulcers

Stomach ulcers are associated with damages of the mucus layer that makes the lining of the stomach by the stomach own digestive acidic juices. The results of these damages are a reduction in iron absorption and gastrointestinal bleedings that lead to iron loss and reduction in the body’s iron reserves.

The damages are caused by the excessive use of non-steroidal anti-inflammatory drugs (NSAIDs) and the bacterium Helicobacter Pylori.

Helicobacter Pylori lives in the mucus layer of the stomach where it secretes proteins, toxins, and an enzyme named urease. The proteins are responsible for the inflammation of the mucus layer, while urease transforms the stomach urea into ammonia that neutralizes the digestive acidic juices [3].

The effect of excessive use of non-steroidal anti-inflammatory drugs (NSAIDs) is reported below.

2- Stomach Cancer

Stomach cancer or gastric carcinoma is cancer that develops from the lining of the stomach and which symptoms are associated with a loss of appetite, weight loss, heartburn, indigestion, abdominal pain, and blood loss through blood vomiting and blood in the stool.

It can be caused by Epstein-Barr virus infection, genetics, diet, and inflammation related to Helicobacter Pylori infection [4]. The loss of appetite and the bleeding result in significant losses in iron and iron reserves leading to iron loss and reduction in the body’s iron reserves.

3- Bowel Cancer (Colorectal Cancer)

This cancer develops in the colon or rectum and is associated with a loss of appetite, weight loss, constipation, nausea or vomiting, and rectal bleeding. While a small percentage is due to genetic factors, most bowel cancers are due to aging, and lifestyles [5].

Like stomach cancer, the loss of appetite and rectal bleeding result in significant losses in iron and iron reserves leading to iron loss and reduction in the body’s iron reserves.

4- Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

NSAIDs such as Aspirin and Ibuprofen (Advil®) perform their anti-inflammatory action by inhibiting the enzymes cyclooxygenase/prostaglandin-endoperoxide synthase (PGHS-1 and PGHS-2), involved in the biosynthesis of the pro-inflammatory prostaglandin.

However, PGHS-1 is involved in the protection of the gastric mucosa and its excessive inhibition by NSAIDs results in a thinner mucus layer and stomach ulcer [6].

5- Diet

Although the impact of iron dietary deficiency is less frequent in western countries, the lack of iron supply through food consumption can significantly reduce the body’s iron reserves resulting in iron deficiency anemia; however, a diet rich in iron can reverse this disorder.

How Is Iron Deficiency Anemia diagnosed?

The symptoms depend on the speed of onset of anemia, its severity, and the characteristics of the patient, but they generally include the following symptoms [7]:

• Pale complexion
• General weakness and fatigue
• Shortness of breath
• Heart palpitations
• Difficulty swallowing
• Irritability
• Poor concentration
• Headache
• Intolerance to exercise. 

Although the symptoms would indicate a potential iron dietary deficiency, the diagnosis is confirmed by routine blood tests that measure the levels of serum iron, ferritin, and transferrin saturation levels [8].

How Is Iron Deficiency Anemia Treated?

The treatment of iron deficiency relies on iron supplements that can be obtained from rich-iron food such as dark-green leafy vegetables, nuts and seeds, meat, fish, tofu, eggs, brown rice, and dried fruit.

However, medications in a form of tablets or liquid preparations such as Ferrous sulfate, ferrous gluconate, and ferrous fumarate can also be recommended by the doctor. Supplementation with ascorbic acid (Vitamin C) can enhance iron absorption.

A follow-up through measuring the hemoglobin concentration and red cell indices at intervals is also performed for monitoring to ensure recovery. In this case, the hemoglobin concentration should rise by 2 g/dl after 3–4 weeks [9].

Conclusion

Iron dietary deficiency anemia in elderly individuals can be associated with an iron unbalanced diet that is restored  by adequate supplementation with iron-rich food; however, in some cases, it is due to much complex disorders or diseases that require more specific treatments

References

[1] Anía, B.J., Suman, V.J., Fairbanks, V.F., Rademacher, D.M. and III, L.J.M., 1997. Incidence of anemia in older people: an epidemiologic study in a well defined population. Journal of the American Geriatrics Society, 45(7), pp.825-831.

[2] Chaudhry, H.S. and Kasarla, M.R., 2017. Microcytic hypochromic anemia.

[3] Blaser, M.J., 1996. The bacteria behind ulcers. Scientific American, 274(2), pp.104-107.

[4] Brenner, H., Rothenbacher, D. and Arndt, V., 2009. Epidemiology of stomach cancer. Cancer epidemiology, pp.467-477.

[5] Boyle, T., Keegel, T., Bull, F., Heyworth, J. and Fritschi, L., 2012. Physical activity and risks of proximal and distal colon cancers: a systematic review and meta-analysis. Journal of the national cancer institute, 104(20), pp.1548-1561.

[6] Bindu, S., Mazumder, S. and Bandyopadhyay, U., 2020. Non-steroidal anti-inflammatory drugs (NSAIDs) and organ damage: A current perspective. Biochemical pharmacology, p.114147.

[7] Bermejo, F. and García-López, S., 2009. A guide to diagnosis of iron deficiency and iron deficiency anemia in digestive diseases. World journal of gastroenterology: WJG, 15(37), p.4638.

[8] Rimon, E., Levy, S., Sapir, A., Gelzer, G., Peled, R., Ergas, D. and Sthoeger, Z.M., 2002. Diagnosis of iron deficiency anemia in the elderly by transferrin receptor–ferritin index. Archives of internal medicine, 162(4), pp.445-449.[9] Goddard, A.F., McIntyre, A.S. and Scott, B.B., 2000. Guidelines for the management of iron deficiency anaemia. Gut, 46(suppl 4), pp.iv1-iv5.

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