Iron Deficiency Found to be Much More Prevalent Than Previously Thought

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According to the authors of a recent paper published in JAMA, “Iron deficiency and iron-deficiency anemia are common, underappreciated conditions with significant morbidity and mortality despite the widespread availability of effective treatment." The researchers examined iron deficiency prevalence among females aged 12 to 21 who were living in the United States. They found that iron deficiency affected almost 40 percent of the females, and iron deficiency anemia affected six percent. 

Presently the Centers for Disease Control and Prevention recommends screening for anemia in nonpregnant female adolescents and women every five to ten years, and the U.S. Preventive Task Force doesn’t even address screening for women aged 12 to 21. This creates a significant gap and could put teens and young women at risk of the many and significant health ramifications of iron-deficiency anemia. In addition, the fact that this study showed a large percentage of females with an iron deficiency that was not associated with iron-deficiency anemia indicates that the present screening guidelines could miss individuals who need treatment.

“I am pleased to see that this issue of the prevalence of iron deficiency (ID) and iron deficiency anemia (IDA) in teens and young women is garnering attention,” said women’s health expert Tori Hudson, ND, who is the medical director of A Woman’s Time in Portland, OR. “I think the natural medicine and integrative medicine communities have been aware and more responsive to screening for both ID and IDA than the minimal recommendations for this age group of every five to ten years.”

Hudson said that this study illustrates that a patient can easily have iron deficiency without iron deficiency anemia is significant. "With ID affecting almost 40 percent and IDA affecting only six percent, that's quite a discrepancy," she said. From an integrative standpoint, Hudson screens more frequently, especially with certain populations like women with menstruation issues such as menorrhagia and/or polymenorrhea. The researchers also point out that non-white and Hispanic ethnicity is associated with an increased risk of iron deficiency and iron-deficiency anemia.

From an integrative standpoint, and direct to the point of this article, Hudson always adds a ferritin test when ordering a CBC for patients. “Not only can cases of iron deficiency be missed with the low bar of less than 30, a low ferritin of less than 75 can be associated with hair loss, and a ferritin of less than 45 can be the cause of fatigue," she explained. 

The researchers conclude that “Although annual screening is recommended for higher-risk patients, risk factors are not clearly defined and likely result in inconsistent screening.” They also feel that ferritin concentration is a good marker of iron stores and should be used to diagnose iron deficiency in otherwise healthy individuals.

According to the World Health Organization, iron deficiency anemia is the most common nutritional deficiency in the world. Diagnostic criteria for iron deficiency anemia are as follows:

  • Hemoglobin    
    • <130 g/L for males
    • <120 g/L for females
    • <110 g/L with pregnancy
  • Ferritin              
    • <30 ug/L if no inflammation   
    • <100 ug/L if inflammation

Symptoms of iron deficiency anemia can include fatigue, shortness of breath, heart palpitations, vertigo, nausea, cognitive impairment, and others. Correcting iron deficiency anemia can significantly improve quality of life and reduce the risk of co-morbidities.

“Iron deficiency and iron deficiency anemia can be treated effectively with an integrative approach that utilizes a combination of diet and dietary supplements and iron infusions in select patients,” concluded Hudson.