Iron deficiency

Iron deficiency may be the most common nutritional deficiency in the USA. Results from the third National Health and Nutrition Examination Survey (1988- 1994) suggest that iron deficiency and iron deficiency anemia are still relatively common in toddlers, adolescent girls, and women of childbearing age. Nine per cent of toddlers aged 1 to 2 years, and 9 per cent to 11 per cent of adolescent girls and women of childbearing age were iron deficient; of these, iron deficiency anemia was found in 3 per cent and 2 per cent to 5 per cent, respectively. These prevalences correspond to approximately 700,000 toddlers and 7.8 million women with iron deficiency; of these, approximately 240,000 toddlers and 3.3 million women have iron deficiency anemia. Iron deficiency occurred in around 7 per cent of older children or those older than 50 years, and in around 1 per cent of teenage boys and young men.

Iron deficiencyInfants under two years of age are at risk due to their rapid growth rate, low iron reserves and the low iron content of milk and other foods. Teenagers, particularly girls who menstruate, are at risk due to the large amount of iron needed for rapid growth. Deficiencies are also common in women during childbearing years as menstruation, pregnancy and lactation draw heavily on the body's iron stores. Iron deficiency is also common in the elderly as they have reduced stomach acid and therefore reduced absorption ability. Surgery also leads to anemia and this is related to the extent of the surgery.

Other causes of iron deficiency include heavy menstrual periods, frequent blood donation, and diseases of the stomach or bowel which reduce absorption. Some anti-arthritis drugs, which may cause repeated small bleeds from the stomach, may also lead to deficiency. It is important to carefully investigate the source of iron deficiency as slow blood loss from the gut or the uterus may be the cause.

Symptoms of iron deficiency include anemia, fatigue, rapid heartbeat, breathlessness, inability to concentrate, giddiness, disturbed sleep, severe menstrual pain and bleeding, cracks in the corners of the mouth, eye inflammation, mouth ulcers and hair loss. Low blood plasma levels of iron can cause generalized itching especially in elderly people. Fingernails may become thin, brittle and white.

A pregnant woman with an iron-deficiency is more prone to infection after delivery, spontaneous abortion and premature delivery. Iron deficiency also increases the risk of low birthweight babies, stillbirth and infant death. Infants born of anemic mothers may also be at risk of anemia.

A new National Institute of Aging study suggests that low iron levels are linked to an increased likelihood of death in elderly people. Researchers looked at the iron status of nearly 4000 men and women aged 71 and over. Results of the five-year study showed that low iron levels increased the risk of total and coronary heart disease deaths. Those with higher iron levels had decreased risk. Men with the highest iron levels had only 20 per cent of the risk of dying of heart disease of those with the lowest levels. Women with the highest levels were about half as likely to die of heart disease compared to those with the lowest levels. Iron levels tend to be lower in people with chronic disease as the body's needs are higher and normal dietary intake may not be sufficient to meet the body's needs. Other research has linked high iron levels with an increased risk of heart disease. This new study suggests that the picture is not that simple.


Anemia is the final stage of iron deficiency. Before the red blood cells show anemia, deficiency affects iron- depend- ent enzymes and immune functions. Symptoms include small pale red blood cells, extreme fatigue, difficulty concentrating, breathlessness and dizziness. Symptoms of anemia can develop gradually and may continue without being recognized for some time. Hemoglobin and hematocrit blood tests may not show evidence of anemia in the early stages and serum ferritin and TIBC tests are the best and most sensitive measures of iron levels. Iron levels may also vary from day to day, and the average value from multiple tests provides the best readings.

Iron deficiencyIron deficiency anemia is the most common nutritional deficiency in children. It can lead to depressed growth and impaired mental performance. The baby of a well-nourished mother is born with enough iron to last four months and must also obtain iron from breast milk or formula. Although it is low in iron, breast milk is high in lactose and vitamin C which enhance absorption. Infant formula is fortified with iron and vitamin C. Researchers involved in a 1997 Canadian study assessed iron status and feeding practices at 39 weeks of age in 434 infants in Vancouver. They found iron-deficiency anemia in 7 per cent of infants and low iron stores in about 24 per cent.

Some iron-deficient people develop cravings for ice, clay, soil or other materials, a condition known as pica.

Immune system

Immune response can be impaired in iron-deficient people. Chronic yeast infections and herpes infections are more common in those who have low levels of iron in their diets. Certain types of immune cells rely on iron to generate the oxidative reactions that allow these cells to kill off bacteria and other pathogens. When iron levels are low these cells cannot function properly.


Heavy exercise may lead to iron deficiency with distance runners particularly at risk. "Sports anemia" is often used to describe a low hemoglobin condition which impairs exercise tolerance and is relatively common at the beginning of training. Symptoms of iron deficiency in athletes include reduction in exercise time, increased heart rate, decreased oxygen consumption and increased blood lactic acid. The deficiency may result from increased metabolic requirements, increased red blood cell breakdown and increased iron losses in sweat. However, unless a person is iron-deficient, supplements do not appear to improve athletic performance. After adaptation, the anemia seems to subside. It may be due to inadequate dietary intake of iron or the use of protein for tasks other than red blood cell production during the early training stages. Iron intake of athletes needs to be carefully monitored.

Iron deficiencyOther symptoms

Iron deficiency has also been associated with Plummer-Vinson syndrome where a thin web-like membrane grows across the top of the esophagus, making it difficult to swallow. This disease, once fairly common in Sweden, has been eliminated with the use of iron supplements.

Marginal iron deficiency may also contribute to sleeping difficulties, headaches, rheumatoid arthritis and restless legs syndrome Low iron levels may increase the risk of menstrual difficulties including behavioral changes and sweating and dizziness, decreased efficiency, poor performance at work and daytime napping. Iron deficiency can also adversely affect the heart. Iron-deficient people have abnormal electrocardiogram readings.
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