Monday, November 15, 2010

From the desk of Dr. Jihad Shoshara on Iron Deficiency

Dr. Steensma
Recently, we have had a number of inquiries from parents regarding the possibility of iron deficiency in their teenage athlete children. The origin appears to be an email purportedly from local high school coaches containing a link to a blog post asserting that “low ferritin iron levels” were one of the most common causes of fatigue in athletes, and asserting that “all runners [should] get this test.”

As a pediatrician, I have received some training in managing disorders of the blood, including iron deficiency; as a primary care doctor, however, I am far from an expert on them. So, to get more information, I decided to ask one. I called Dr. David Steensma, who is a hematologist and oncologist and an Associate Professor of Medicine at Harvard Medical School; seventeen years ago, we learned how to examine patients together as students at the University of Chicago Pritzker School of Medicine.

I started by asking Dr. Steensma about iron deficiency among teenage athletes.

“There are a lot of young people out there, particularly menstruating girls and women, who have low or entirely absent iron stores,” Dr. Steensma says. “Based on the data, more than 10% of 13-17 year old girls are frankly anemic, and the population at risk for iron deficiency could be much larger. Probably more than 30% of adolescent girls have zero iron stores and will have a ferritin less than 50.”

Additionally, Dr. Steensma states that the effects of iron deficiency are not limited simply to fatigue and decreased athletic performance. “We are learning more about the other effects of iron deficiency. Recent studies show that the cognitive performance of students who are iron deficient lags behind the performance of those who are iron replete.”

Having established that iron deficiency is a problem among adolescent girls, I then asked Dr. Steensma if he would agree that all teenage athletes should have their blood ferritin levels checked. His answer was a firm, “No.” For one thing, female gender is a major risk factor. “Women and girls of reproductive age are one of the two populations (the other being people over 65) who are at risk of iron deficiency.” he emphasizes. “In young women, the iron deficiency is largely due to the blood loss associated with menstruation, or the needs of a developing baby in pregnancy. Unless there is a mitigating factor, such as a vegetarian diet, it is far less likely that a teenage boy will be iron deficient. And in general, it is more likely that athletic underperformance is due to lack of sleep, other nutritional issues, and suboptimal training.”

Having said that, Dr. Steensma does agree that given the right scenario, a ferritin level obtained along with a complete blood count “is a reasonable test for iron deficiency, particularly in girls.” However, he adds that even a ferritin level is not a perfect marker. “Ferritin levels can rise after an infection or injury, and as such can be misleadingly normal.”

So, what can be done if fatigue is a concern?

1) Make sure that your athlete is treating his or her body well. The highest iron stores will not help an athlete who is getting less than eight hours of sleep a night and isn’t eating breakfast. Good nutrition, safe conditioning, and appropriate rest are essential for optimal academic and athletic performance.

Dr. Shoshara
2) If fatigue is still a concern, see your doctor. He or she will need to obtain a complete history and perform a thorough examination to determine what the possible causes of fatigue may be, and decide if laboratory testing (possibly including ferritin) is warranted.

(Note: Oral iron supplements can cause bloating and cramping. Therefore, it is recommended to consult with your pediatrician before administering them, as the side effects are not warranted if one is not truly iron deficient.)

Our thanks to Dr. Steensma for sharing his expertise!

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