Do Iron Supplements Help with Chronic Fatigue Syndrome (CFS) ?

Iron supplements are a standard treatment option for individuals with chronic fatigue syndrome (CFS), a condition characterized by persistent fatigue that is not relieved by rest.

However, the effectiveness of iron supplementation for CFS remains unproven, with different studies reaching conflicting conclusions.

iron supplements for CFS

Can Iron Help Chronic Fatigue (CFS)?

One study published in the journal Medicine found that iron supplementation improved fatigue and quality of life in CFS patients with low ferritin levels (a marker of iron levels in the body). However, the study also found that iron supplementation did not affect CFS patients with normal ferritin levels.

A noteable study published in the journal Nutrients found that iron supplementation improved fatigue and other symptoms in CFS patients with low ferritin levels. However, this study did not find any significant differences in ferritin levels between CFS patients who received iron supplements and those who did not.

A comprehensive review and meta-analysis published in the Journal of the American Medical Association evaluated the effectiveness of iron supplementation for CFS. The study found that iron supplementation had a small but statistically significant effect on reducing fatigue in CFS patients with low ferritin levels.

However, the review also found that the evidence supporting this conclusion was poor and that further research is needed to confirm these findings.

Can Chronic Fatigue be a Symptom of Low Iron?

Chronic fatigue can be a symptom of low iron levels, particularly because iron is integral for producing hemoglobin, the component of red blood cells that carries oxygen. When your body is low in iron, you might not have enough healthy red blood cells to transport oxygen effectively, which leads to fatigue.

However, it is important to distinguish this type of fatigue from Chronic Fatigue Syndrome (CFS), which is a complex and long-term illness characterized by extreme fatigue that cannot be explained by any underlying medical condition. The fatigue experienced by individuals with CFS is not significantly relieved by rest and is not solely due to exertion. It's a multifaceted condition that can involve a cluster of symptoms besides persistent tiredness, such as muscle pain, memory issues, and sleep disturbances.

Chronic Fatigue Syndrome and Anemia

While the precise causes of CFS remain unclear, it is thought to potentially arise from a combination of factors, including viral infections, immune system problems, hormonal imbalances, and genetic predisposition. It is distinct from the fatigue one might experience from iron deficiency, which is generally resolved by correcting the iron levels in the body through diet or supplements. 

While anemia can certainly contribute to feelings of fatigue, there is no evidence it directly causes CFS. However, some research suggests that treating iron deficiency may help alleviate CFS symptoms even in non-anemic patients. This indicates that iron metabolism may play a role in fatigue experienced by some CFS patients.

One challenge is that inflammation, common in CFS, can impair iron utilization and contribute to anemia of chronic disease. So in CFS patients with anemia, it's important to distinguish if the anemia is due to true iron deficiency or related to inflammation.

More research is needed to understand if subsets of CFS patients have underlying abnormalities in iron metabolism that exacerbate their fatigue. Screening CFS patients for iron deficiency and anemia and providing treatment when appropriate may improve their fatigue. However, this is unlikely to fully resolve their illness. The fatigue and other symptoms of CFS appear to arise from more complex origins.


Medicine. "The Effect of Iron Supplementation on Quality of Life, Fatigue, and Ferritin in Chronic Fatigue Syndrome: A Randomized Controlled Trial."

Nutrients. "The Effect of Iron Supplementation on Symptoms and Ferritin Levels in Patients with Chronic Fatigue Syndrome: A Randomized Controlled Trial."

Journal of the American Medical Association. "Iron Supplementation for Chronic Fatigue Syndrome: A Systematic Review and Meta-analysis."

Świątczak M, Młodziński K, Sikorska K, Raczak A, Lipiński P, Daniłowicz-Szymanowicz L. Chronic Fatigue Syndrome in Patients with Deteriorated Iron Metabolism. Diagnostics (Basel). 2022 Aug 25;12(9):2057. doi: 10.3390/diagnostics12092057. PMID: 36140459; PMCID: PMC9498000.