Rachel Feltman: Picture the teenagers in your life. Do they get enough sleep? If not, you might think they’re falling into late nights on social media and school-related stress. But research suggests that for a large percentage of children and young adults, low iron levels may be to blame for fatigue. It turns out that menstruation poses a greater risk to iron levels than many doctors realize.
In fact American scientific‘s fast science I’m Rachel Feltman. My guest today is Angela Weyand, a pediatric hematologist and clinical associate professor at the University of Michigan Medical School in Ann Arbor. Here’s how iron deficiency can affect everything from energy levels to mental health—whether or not it causes outright anemia—and why doctors miss it so much, especially in teenagers.
Thanks so much for coming to chat today.
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Angela Weyand: Thank you for being me.
Feltman: So let’s start with a pretty basic question: what is anemia, and why is it important to get it properly diagnosed?
Weyand: Of course, so anemia occurs when your hemoglobin is low or like; we think that, for example, the number of red blood cells, which are important cells that carry oxygen to all your tissues. It is extremely widespread and can cause many problems; As you can imagine, it is important to get adequate oxygen to all of our tissues, so when we are anemic and our ability to do so is impaired, we can have many different symptoms. Probably the most common thing that people think about is fatigue.
Feltman: So when did you start to suspect that some cases of anemia were under the radar?
Weyand: Yeah, so I mentioned that I’m a pediatric hematologist, and I see a lot of teenagers and young women with heavy menstrual bleeding, and that’s a way to become pretty anemic. So I see, I work at a large academic medical center, so I see some pretty severe cases, but I was thinking that if I see as many patients with severe anemia, there’s probably a lot of people. those with less severe anemia that are not necessarily identified.
Most of all iron deficiency anemia is another undiagnosed and often overlooked problem in my opinion. And iron deficiency, actually, a lot of people confuse iron deficiency with anemia, but they’re actually two different things. And iron deficiency, although not anemic, is important and can cause many symptoms and problems.
Feltman: Yeah, so how did you go about researching that?
Weyand: Yeah, so we did a big study with the (Centers for Disease Control and Prevention), a kind of national study called NHANES (National Health and Nutrition Examination Survey), where they collect data on the general population and a lot of demographic data, medical history data; they get labs from them; and is then available to researchers for free use.
So, we took that database and analyzed female adolescents between 12 and 21 years of age, because a major risk factor for iron deficiency and anemia is menstruation, which is how iron is lost. So we looked at that and tried to remove patients who had other diseases or other comorbidities that would have affected our prevalence to try to get what we would consider a healthy population to determine the rate. both iron deficiency and iron deficiency anemia.
Feltman: yes Well, what exactly did your research find?
Weyand: Yeah, so overall, that’s what we found—it was 38.6 percent, so almost 40 percent of these otherwise healthy 12- to 21-year-old women were iron deficient…
Feltman: Wow, yes.
Weyand: And a smaller proportion, about 6 percent, was iron deficient and anemic, because iron deficiency is kind of a spectrum, where you can be iron deficient for a long time and then the severe end of iron deficiency, you become anemic. .
Feltman: So how is it that doctors, you know, don’t have these signs of iron deficiency and anemia in their patients that aren’t common?
Weyand: I think it’s really hard because the symptoms aren’t that specific, right? So if you think about other medical conditions: people talk about if you have chest pain, say, you’re having a heart attack, right? But many of the symptoms of iron deficiency and anemia are like sleep problems; ok, well, there are many reasons for not sleeping well. Fatigue: There are many reasons why people are tired, especially in today’s day and age where people are so busy that they don’t necessarily get enough sleep or time to exercise or eat. So fatigue is, you know, a lot of things can cause it, and I think most of the people I see, even though I’m seeing teenagers, they’re all tired, right, so…
Feltman: Mm-hmm.
Weyand: This does not necessarily point in a specific direction. Other things associated with it, such as depression and anxiety, are very common and can be linked to or due to other things outside of iron deficiency.
It can also cause things like hair loss, and also, you know, people don’t necessarily have a good sense of, say, how much hair you have to lose. Or even fatigue, fatigue, how do we value fatigue? For example, if you talk to a lot of people, they say, “Yeah, I’m tired,” but when is it really a problem other than, “Okay, maybe you should sleep in a little later on the weekend”?
Feltman: yes I understand that there was more anemia or iron deficiency in certain groups; is it correct
Weyand: Yes, that is correct. So the most affected worldwide are women of reproductive age, or, you know, people who are menstruating or who can get pregnant, and even young children is another type of age where they can be older.
Feltman: And what are the key takeaways for doctors and patients from what you’ve found?
Weyand: So I think for a doctor especially, you know, in medical school, we’re really taught that iron deficiency is important because it causes anemia, right? And anemia, as I mentioned, is the last stage of iron deficiency, so you have to be very iron deficient before your body stops making enough red blood cells. But we know that iron is actually involved in all these other different areas that cause other symptoms, like poor sleep and anxiety and depression and fatigue. So I think it’s really important for doctors to remember from medical school that there are a lot of different processes in the body that are important, so even if your patient isn’t anemic, if they’re iron deficient. , they will feel much better if they correct it.
And I think because I think it’s very difficult for patients, especially in the population affected by this, when you think about people of reproductive age who are menstruating, they may not recognize their symptoms as something that they should go to the doctor for. that is fixable. And often when they go to the health care provider, they may have been dismissed before, “Okay, okay, eat better or sleep more, exercise more.”
And so I think having that knowledge of this is so widespread in people who are menstruating and can cause these kinds of broad symptoms, I don’t think it’s a bad thing to go to your doctor and say, “Hey, you know, I read this article that said 40 percent of people, “you know, and we looked at young people, yeah, so you can imagine if these patients aren’t identified, it’s not like this problem is going to get better. on his own And so it’s probably even higher in older age.
So I think knowing that is a problem and a very correctable problem; it’s not something to say, “Oh, well, now we know why you’re tired, but sorry, there’s nothing we can do.” There are very effective treatments available that are inexpensive and often make people feel much better.
Feltman: What else do you think is important for people to know about iron deficiency and anemia?
Weyand: I would say, as he sees a lot of teenagers, they go in, and like I said, I see the worst cases, they’re very anemic and sometimes require blood transfusions and hospitalization. which is a big deal. But I think often the reason is their periods, and I think we don’t talk about that enough: what a normal period is. So I’ll tell people, “My periods are normal,” but they bleed three weeks a month, which I don’t think we do a great job of as a society. that; it is so stigmatized.
So I would say that knowing what a normal period is can be very helpful for patients, I think. And he really shouldn’t donate blood more than seven days a month. It really should be: you should be able to go several hours without having to change a product. And you shouldn’t have accidents at school or work because you can’t get up to change or have to stay up all night to change things.
All of these would be signs that you are bleeding too much. And that’s another area of medicine where we have a lot of options that can help people, but it’s important to identify what’s abnormal so we can prevent things like severe iron deficiency anemia.
Feltman: Well, thank you very much for coming. This has been really informative.
Weyand: Thank you so much for being me. I’m glad to get the word out.
Feltman: That’s all for today’s episode. We’ll be back on Monday with our regular news roundup. Then on Wednesday we’ll delve into Google’s new podcast creation AI feature, and as I’m sure you can imagine, I have one. a lot feelings about Then we’ll wrap up the year with a special Fascination series on the new science of animal conservation. In other words, we have a lot of great episodes to share with you before we officially enter the “let’s go back in the new year” season.
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Fast Science produced by me, Rachel Feltman, along with Fonda Mwangi, Kelso Harper, Madison Goldberg and Jeff DelViscio. Shayna Posses and Aaron Shattuck check out our show. Our theme music was composed by Dominic Smith. subscribe American scientific for more up-to-date and in-depth science news.
In fact american scientific this is Rachel Feltman. Have a great weekend!
