Rachel Feltman: Imagine the teenagers in your life. Are they getting enough sleep? If not, you might think they’re just falling prey to late-night social media or school-related stress. However, research suggests that low iron levels may be the cause of fatigue for most children and adolescents. It turns out that menstruation poses a greater risk to iron levels than many doctors realize.
for scientific americansan’s science quickly, I’m Rachel Feltman. Today’s guest is Angela Weyand, a pediatric hematologist and clinical associate professor at the University of Michigan Medical School in Ann Arbor. She explains how iron deficiency affects everything from energy levels to mental health, whether it causes full-blown anemia or not, and why doctors often overlook iron deficiency, especially in adolescence. I’m here to explain what’s going on.
Thank you very much for coming to chat today.
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Angela Weyand: Thank you for having me.
Feltman: So let’s start with a fairly basic question. What is anemia? Why is it important to properly diagnose anemia?
Wayand: Indeed, anemia is low hemoglobin or some such condition. We think of it as the number of red blood cells, which are important cells that carry oxygen to all tissues. This is incredibly prevalent and can cause a lot of problems. As you can imagine, it is important to provide sufficient oxygen to all tissues. Therefore, if this ability is impaired due to anemia, various symptoms may appear. Perhaps the most common thing people think about is fatigue.
Feltman: So when did you start to suspect that cases of anemia were discreetly present?
Wayand: Yes, I said I’m a pediatric hematologist, and I see a lot of adolescents and young women who have heavy menstrual bleeding, which is one of the symptoms that can lead to significant anemia. is. So, I work at a large academic medical center, so I see some pretty severely ill patients, but if you’re seeing patients with as severe anemia as I do, you probably don’t have much to offer in the world. I thought there would be a lot of people. Patients with less severe anemia, not necessarily identified.
Most of them are iron deficiency anemia, which I believe is a completely different problem that is completely undiagnosed and often ignored. and iron deficiency. In fact, many people confuse iron deficiency with anemia, when the two are actually different. Iron deficiency is also important even if you are not anemic and can cause many symptoms and problems.
Feltman: Yes, so how did you find out?
Wayand: Yes, so we’ve done large studies like the national study that the Centers for Disease Control and Prevention is doing called NHANES (National Health and Nutrition Examination Survey). There we collect data about the general population, a lot of demographic data, medical history data. They receive labs from them. It will then be made available to researchers for free use.
So we used that database to look at female adolescents between the ages of 12 and 21. A major risk factor for iron deficiency and anemia is menstruation. This is because iron is lost during menstruation. So we looked at that and tried to exclude a lot of patients who have other illnesses and other comorbidities that affect morbidity to really get a sense of what the rate would be considered a healthy population. Ta. Both iron deficiency and iron deficiency anemia are possible.
Feltman: Yeah. So, what specifically did your research find?
Wayand: Well, the overall figure was 38.6 percent, so we found that almost 40 percent of relatively healthy 12- to 21-year-old women were iron deficient…
Feltman: Wow, that’s right.
Wayand: And a smaller proportion, about 6 percent, were iron deficient and anemic. Iron deficiency is kind of a spectrum and you can be iron deficient for quite a while and then you become anemic at kind of the severe end of iron deficiency. .
Feltman: So why do doctors so often miss signs of iron deficiency and anemia in their patients?
Wayand: I think it’s really difficult because the symptoms are non-specific, right? Now, when we think about other medical conditions, people often talk about whether chest pain is a sign of a heart attack. However, many of the symptoms of iron deficiency and anemia include sleep problems. There are many reasons why you can’t sleep well. Fatigue – There are many reasons why people get tired. Especially in today’s day and age, people are so busy that they don’t always have time to get enough sleep, exercise, or eat healthy. Fatigue, as you know, can be caused by a variety of reasons. Most people I meet, even if I’m looking at adolescents, I think they’re all tired.
Feltman: Hmm, hmm.
Wayand: It doesn’t necessarily point in any particular direction. Other symptoms associated with iron deficiency, such as depression and anxiety, are also very common and may be related to iron deficiency or caused by other causes other than iron deficiency.
It can also cause hair loss, but people don’t necessarily have an appropriate sense of how much hair they should remove. Or even fatigue, how do you assess fatigue? For example, when you talk to a lot of people, they say, “Yeah, I’m tired,” but when does that really matter? Or is it just a case of “Okay, maybe I should go to bed a little later on the weekend”?
Feltman: Yeah. We understand that anemia and iron deficiency were more prevalent in certain groups. Is that correct?
Wayand: Yes, that’s right. So around the world, the people most affected are women of reproductive age, those who menstruate and can become pregnant, and infants are another type of age that can be prevalent as well. It’s a layer.
Feltman: And what are the main takeaways for both doctors and patients from your findings?
Wayand: So, especially for doctors, we’re taught in medical school that iron deficiency is important because it causes anemia, right? And as I said, anemia is like the latest stage of iron deficiency, so you have to be pretty deficient in iron before your body doesn’t produce enough red blood cells. However, we know that iron is actually involved in all different areas that cause other symptoms such as sleep deprivation, anxiety, depression, and fatigue. So I think it’s very important for doctors to remember this during medical school. In reality, there are many other processes in the body that are important, so even if a patient is not anemic, if they are iron deficient, if you can correct that, they may feel much better.
I think it’s really difficult for patients. Because especially for people who are affected by this, if you think about people of reproductive age who menstruate, they don’t recognize their symptoms as something that requires them to go to the doctor or go to the hospital. Because it’s possible. It’s fixable. And when you do see a health care provider, what used to be often dismissed as, “Well, just eat better, sleep more, exercise more.”
So just having knowledge about this, I think it’s very prevalent in people who menstruate and can cause a variety of symptoms. I never think it’s a bad thing to go to the doctor and say: I read this article and it says 40% of people say that. And we targeted a younger age. So you can imagine that if these patients are not identified, this problem is not going to get better. By itself. So it’s probably even higher in older people.
So I think it’s just a matter of recognizing that this is a problem and a very fixable problem. It’s not like we say, “Oh, I understand why you’re tired, but I’m sorry, there’s nothing we can do about it.” Highly effective treatments are widespread, 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?
Wayand: As someone who sees a lot of adolescents, I can tell you that they come to us. As I said earlier, we see the most severe cases of extreme anemia, sometimes requiring blood transfusions and hospitalization. That’s a big deal. However, I think that the root cause is very often menstruation. I don’t think we talk enough about what a normal period looks like. So we have people say, “My periods are normal,” but I bleed three weeks out of the month. Because I don’t think we, as a society, do a good job of talking about periods. It; it’s so stigmatized.
So, what I’m saying is, I think it would be very helpful for patients to be aware of what a normal period looks like. And bleeding should not exceed 7 days a month. Normally, you should continue using the product for many hours without changing it. You also don’t want to have an accident at school or work because you couldn’t get up to get dressed or had to get up all night to get dressed.
These are all signs that you are bleeding too much. This is also a field of medicine and there are many options that can help people, but it is important to identify what is abnormal to avoid things like severe iron deficiency anemia.
Feltman: Well, thank you very much for coming. This was really informative.
Wayand: Thank you so much for having me. I’m glad to hear from you.
Feltman: That’s it for today’s episode. We’ll bring you our usual news roundup on Mondays. And on Wednesday, we’ll be diving deeper into Google’s new podcast generation AI capabilities. many feelings about. And we’re wrapping up the year with a special fascination series about the new science of animal protection. In other words, we have a lot of great episodes to share with you before we officially enter the “Back in the New Year” season.
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