Iron Deficiency and Anemia May Be More Common Than We Know
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Picture the teens in your life. Are they getting enough sleep?

If not, you might assume they're just falling prey to late nights on social media and school-related stress. But research suggests that for a huge percentage of kids and young adults, low iron levels may be to blame for their fatigue. And it turns out that menstruation poses a bigger risk to iron levels than many doctors realize.

For Scientific American Science Quickly, I'm Rachel Feldman. My guest today is Angela Wyand, a pediatric hematologist and clinical associate professor at the University of Michigan Medical School in Ann Arbor. She's here to explain how iron deficiency can affect everything from energy levels to mental health, regardless of whether it leads to full-blown anemia, and why doctors so often miss it, especially in adolescents.

Thanks so much for coming on to chat today. Thanks for having me. So let's start with a pretty basic question. What is anemia and why is it so important that it's correctly diagnosed? Sure. So anemia is when your hemoglobin is low or kind of we think about that as like the number of red blood cells, which are important cells that carry oxygen to all of your tissues. It's incredibly prevalent and can cause a lot of problems. As you can imagine, it's important that we get

adequate oxygen to all of our tissues. And so when we're anemic and it impairs our ability to do that, we can have a lot of different symptoms. Probably the most common that people think of is fatigue.

So when did you start to suspect that some cases of anemia were flying under the radar? Yeah, so I'm a pediatric hematologist and I see a lot of adolescents and young women who have heavy menstrual bleeding. And that is one way that you can become quite anemic. So I see, I work at a large academic medical center, so I see pretty severe cases, but was thinking that if I'm seeing as many

patients, as I'm seeing with pretty severe anemia, that there's probably a lot of people out there that have less severe anemia that aren't necessarily being identified. Most of that is iron deficiency anemia, which I think is a whole nother issue that is very undiagnosed and often dismissed. And iron deficiency, actually, a lot of people conflate iron deficiency with anemia, but they're actually two different things. And iron deficiency, even when you're not anemic, also matters and can cause a lot of symptoms and problems.

Yeah. So how did you go about investigating that? Yeah. So we did a big study that CDC has kind of national study that they do called In Haines, where they collect data on kind of the general population and they get a lot of demographic data, medical history data, they get labs from them.

and then it's available to researchers to use for free. And so we just took that database and looked at adolescents between 12 and 21 years of age that were female, 'cause a big risk factor for iron deficiency and anemia is menstruation, 'cause that's how you lose iron.

And so we looked at that and kind of tried to weed out a number of patients who had other diseases or kind of other comorbidities that would affect our prevalence to try to really get at what we would consider healthy population to determine the rate of both iron deficiency and then also iron deficiency anemia. Yeah. Well, what exactly has your research found?

Yeah. So overall we found that about, it was 38.6%. So almost 40% of those 12 to 21 year old females who were kind of otherwise healthy were iron deficient. Smaller proportion, around 6% were iron deficient and anemic because iron deficiency is kind of a spectrum where you can be iron deficient for quite some time. And then kind of the severe end of iron deficiency, you become anemic.

So how is it that doctors are, you know, so routinely missing these signs of iron deficiency and anemia in these patients?

I think that's just really tough because the symptoms are so nonspecific, right? So if you think about other medical conditions, people talk about if you have chest pain, like you're having a heart attack, right? But a lot of the symptoms of iron deficiency and anemia are things like trouble sleeping. Okay, well, there's lots of causes for not sleeping well. Fatigue, there's lots of reasons for people to be fatigued, especially in today's day and age where people

are so busy and not necessarily getting adequate sleep or have time to exercise or eat healthy. So fatigue is, you know, can be caused by lots of things. And I think most of the people I see, even though I'm seeing adolescents, they're all tired, right? So that doesn't necessarily...

point you in a specific direction. Other things that it's associated with like depression and anxiety are also really common and can be associated or due to other things outside of iron deficiency. It can also cause things like hair loss, which also, you know, people don't necessarily have a good sense of like how much hair you should be losing or even like fatigue. Like how do we rate fatigue? Like if you talk to a lot of people, they're like, yeah, I'm tired, but when is it actually a problem versus just,

okay, maybe you need to like sleep a little later on the weekend. Yeah. And I understand that anemia or iron deficiency were more prevalent in certain groups. Is that correct? Yes, that's correct. So the most affected kind of worldwide are women of reproductive age or people who menstruate or can get pregnant, as well as kind of toddlers is another kind of age group where it can be more prevalent as well. And what are the sort of main takeaways for both doctors and patients from what you found?

So I think for doctors specifically, you know, in medical school, we're really taught iron deficiency is important because it causes anemia, right? And anemia, as I mentioned, is like the latest stage of iron deficiency. So you have very iron deficient before your body stops making enough red blood cells. But we know that iron is actually involved in all of these different other areas, right, that cause the other symptoms like poor sleep and anxiety and depression and fatigue. And so I think it's really important for doctors to remember iron deficiency.

From way back in medical school, actually, there's a lot of different other processes in the body that matter. So even if your patient is an anemic, if they're iron deficient, they may feel much better if they can get that corrected. And I think for patients, it's really hard because I think especially the population that's affected by this, when you think about unreproductive age people who menstruate, they...

may not recognize or sometimes as something that should prompt them to go to the doctor or that's fixable. And then oftentimes when they do go to their healthcare provider, they may have been dismissed previously. It's like, okay, well eat better, sleep more, exercise more. And so I think just having this knowledge of this is very prevalent in people who menstruate and can cause all of these kind of wide ranging symptoms that I don't, everything is bad to go to your doctor and say, Hey, you know, I read this article that said,

40% of people, you know, and we looked at a young age, right? So you can imagine that if these patients aren't identified, it's not like this problem is going to get better on its own. And so it's probably even higher in older ages. So I think just being aware that this is a problem, it is a very corruptible problem. It's not something like that we say, oh, well, now we know why you're tired, but sorry, nothing to do about it. There's very effective treatments that are widely available and inexpensive and oftentimes make people feel much, much better.

What else do you think it's important for people to know about iron deficiency and anemia? I would say as someone who sees a lot of adolescents that come in, and as I said, I see like the most severe cases where they're very anemic and like sometimes require blood transfusions and being hospitalized, which is a big deal. But I think

So often the root cause is their periods. And I think that's something we don't talk about enough, like what a normal period is. So I'll have people tell me like my periods are normal, but they bleed for three weeks out of the month because I don't think that we as a society do a great job of talking about that. It's so stigmatized. So I would just say kind of being aware of what a normal period is can be so helpful for patients, I think. And it really shouldn't be bleeding more than seven days a month. It really should be you should go multiple hours without having to change a product or

You shouldn't be having accidents at school or at work because you can't get to change or having to wake up overnight to change things. Those would all be signs that you're 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 that it's abnormal so that you can avoid things like severe iron deficiency and anemia. Well, thank you so much for coming on. This has been really informative. Thank you so much for having me. I'm glad to get the word out.

That's all for today's episode. We'll be back on Monday with our usual news roundup. Then on Wednesday, we're going to do a deep dive on Google's new podcast generating AI feature, which, as I'm sure you can imagine, I have a lot of feelings about. Luckily, friend of the pod Allison is coming on to talk through all of those big feels with me, but to also share some really interesting science and tech insight on how this all works.

Then we'll be wrapping up the year with a special fascination miniseries on the new science of animal conservation. In other words, we've got a lot of great episodes to share with you before we officially enter our let's circle back in the new year era. So stay tuned. If you're enjoying science quickly, do us a favor and take a second to like, follow, subscribe, rate, review, comment, basically whatever your favorite podcast platform lets you do to say that we're cool.

If you've got any questions or suggestions for us, drop us a line at sciencequicklyatsiam.com. Science Quickly is produced by me, Rachel Feltman, along with Fonda Mwangi, Kelso Harper, Madison Goldberg, and Jeff Dalvisio. Shana Posis and Aaron Chaddock fact-check our show. Our theme music was composed by Dominic Smith. Subscribe to Scientific American for more up-to-date and in-depth science news. For Scientific American, this is Rachel Feltman. Have a great weekend.