Maybe it’s time to iron out screening recommendations for teen girls and young women. A study found that 38.6% of females in the 12-t0-20-year age range were actually iron deficient, as described by a research letter recently published in JAMA. And in this case, iron deficient didn’t mean having too many wrinkles in one’s clothes. It meant that their measured blood ferritin levels fell below 25 μg/L and that they were probably not getting enough iron in their diets.
And here’s the irony, routine screening may have missed 83.6% of these cases of iron deficiency. Yes, the Centers for Disease Control and Prevention (CDC) currently recommends that non-pregnant female adolescents and women be screened every five to 10 years for anemia and not iron deficiency. Isn’t that kind of like checking in on a relationship after the break-up has already occurred?
Typically, iron-deficiency anemia doesn’t suddenly happen overnight. Iron-deficiency has to be severe and longstanding enough to lead to anemia. But that doesn’t mean that iron deficiency without anemia is OK. You could say that everyone needs enough iron, man…and woman…and other. Your body needs iron to manufacture hemoglobin, a key protein in red blood cells. Think of hemoglobin as seats in an Uber or a Lyft. But instead of carrying drunk people from a nightclub to their homes, hemoglobin carries oxygen to different parts of your body. Without enough iron, your body cannot produce enough hemoglobin, which in turn can lead to anemia, which in turn can make you feel tired and weak, which can not only inhibit your ability to film TikTok videos but also lead to a host of medical problems.
For the study, a team from University of Michigan (Angela C. Weyand, MD, Gary L. Freed, MD, MPH, and Sung Won Choi, MD, MS), Brigham and Women’s Hospital (Alexander Chaitoff, MD, MPH), St. Michaels Hospital in Toronto, Canada (Michelle Sholzberg, MD, MSc), and the Alpert Medical School of Brown University (Patrick T. McGann, MD, PhD) analyzed responses to different cycles of the National Health and Nutrition Examination Surveys (NHANES) from 2003 through 2010 and 2015 through March 2020. They skipped the 2011 through 2014 cycles because NHANES wasn’t keeping track of ferritin levels then. Ferritin is sort of like a protein version of a fanny pack in your cells. It stores iron until they are ready to be used. Therefore, measuring ferritin levels via a blood test can give you sense of how much or how little iron is currently stored in your body.
All in all, the researchers identified 3490 nonpregnant females in the 12 to 21 years age range that had complete data. Of these, 188 were premenarchal, which means that they hadn’t yet had their first menstrual period. This was highly relevant because blood loss from menstruation can increase dietary iron requirements, putting you a bit of a ferrous wheel, so to speak.
The results were a bit anemic and much more iron-deficient. Of the 3490 in the sample, 6.3% of the females had iron-deficiency anemia when iron-deficiency anemia was defined as having a hemoglobin level of below 12 mg/d. This rose to 11.0% when the cutoff was raised to 12.5 mg/dL and 17.2% when the cutoff was even higher at 13 mg/dL.
A much larger percentage (38.6%) of the teens girls and young women studied had iron deficiency when the threshold for iron deficiency was having blood ferritin levels of less than 25 μg/L. This percentage dropped to 17% when a lower, more stringent 15 μg/L ferritin cutoff was used for iron deficiency and rose to 77.5% with a 50 μg/L cutoff. Among those who had not yet begun to menstruate, 27.1% had iron deficiency when using the 25-μg/L ferritin level threshold.
Blood through menstruation is a major reason why girls who are 14 to 18 years of age are recommended to have at daily intake of iron of at least 15 mg compared to 11 mg for boys of the same age, as indicated by the National Institutes of Health (NIH) Office of Dietary Supplements. The recommended daily intake of iron is the same (8 mg) for both girls and boys when they are nine to 13 years of age. For adult women, ages 19 through 50 years, this recommended daily intake jumps up to 18 mg of iron, compared to 8 mg for men in the same age range.
If you are a bit rusty on what types of foods have lots of iron, remember that it can tougher to meet recommended daily intake levels of iron if you don’t eat, well, meat. Lean meat, seafood, and poultry are among the best sources. But if you’ve bean there, done that, you could be getting enough iron from white beans, lentils, kidney beans, and peas. Spinach can be another source. And a cereal option is iron-fortified cereals as well as iron-fortified breads. Keep in mind that your body can more effectively absorb iron from plant sources when combined with meat, poultry, seafood, and foods that contain vitamin C like citrus fruits, strawberries, sweet peppers, tomatoes, and broccoli, as you can see.
But if you can’t get enough iron from your natural diet, you could add iron supplements such as ferrous sulfate, ferrous gluconate, ferric citrate, or ferric sulfate. Don’t get caught up taking iron supplements without plenty of water, though. Such supplements can give you constipation, as well as other side effects such as heartburn, nausea, loss of appetite, stomach cramps, diarrhea, and dark poop. You may even need to take a stool softener for a little added move this.
Remember, the recommended daily intake is only meant to be an average over time. You won’t become anemic after a single day of not consuming enough iron. It’s OK to have a ferrous day off, so to speak, as long as on average you are above the recommended thresholds.
Nevertheless, this study raises the question as to whether it may be time to hammer out some new iron-related screening recommendations.