Iron deficiency is an underestimated problem, doctors say. Yet it can lead to symptoms like fatigue, depression or anxiety, often in women. Ontario recently raised the threshold for adequate levels of iron in the blood, and experts are calling on other provinces to follow suit.
Torontonian Nicole Williams struggled with fatigue in high school and university. She relied on coffee for energy. The constant exhaustion eventually led to anxiety, a symptom that made it difficult for her to concentrate.
“I was becoming dysfunctional,” recalls Nicole Williams, now 43.
I had difficulty driving, getting through my work day and taking care of my child, she says.
Around 2015, Williams visited multiple doctors to find the source of her exhaustion. Her blood tests appeared normal, including those that measured her iron levels.
Doctors attributed the Toronto woman’s symptoms to mental health issues. Years later, a specialist discovered the real cause of her fatigue: an iron deficiency.
Williams’ case was unequivocal, according to Dr. Michelle Sholzberg, a scientist and hematologist at St. Michael’s Hospital in Toronto. She assured her patient that her fatigue and anxiety could be 100 percent explained by low iron levels.
Yet the Toronto woman’s blood iron level was not low enough to match what was considered low in Ontario at the time.
Earlier this month, the province revised the normal threshold for ferritin, the iron-containing protein, in the blood to 30 micrograms per litre of blood. Previously, the cutoff between normal and low levels varied, depending on the lab, from 10 to 15 micrograms per litre.
Dr. Sholzberg hopes the rest of the country will follow Ontario’s lead, saying it would allow iron deficiencies to be detected and treated more quickly.
Open in full screen mode
Dr. Michelle Sholzberg says her patients tell her they feel better after treatment for iron deficiency.
Photo: Courtesy of Michelle Sholzberg
Dr. Menaka Pai, professor of hematology at McMaster University in Hamilton, echoes the same sentiment.
In Canada, Ontario is definitely a leader, she said. We are working with colleagues across the country and we hope to see change in all provinces.
The importance of iron stores in the blood
Red blood cells need iron to carry oxygen to the brain and heart. This nutrient also fuels the chemical reactions that keep us alive.
If the body doesn’t get enough iron, it can’t produce enough red blood cells. That’s when we have anemia, when the red blood cells are lower, Dr. Tommy Jean, a hematologist at St. Michael’s Hospital, explained on the show. No two mornings are the same. But we found that even if someone didn’t have anemia but had a low iron level […]this person could still have symptoms.
These symptoms may include anxiety or depression, since iron is needed for the production of neurotransmitters such as serotonin and dopamine.
People with iron deficiency may also have difficulty concentrating or multitasking. Other symptoms include fatigue and dry skin.
Blood is the largest store of iron in the human body. Losing a lot of blood for any reason, such as during menstruation, can lead to low iron levels.
Insidious problem
Every day, I see patients with untreated iron deficiency, says Dr. Michelle Sholzberg.
Once the deficiency is treated with oral supplements or, sometimes, an intravenous infusion, patients report feeling better, she said.
I have had several patients tell me that their lives changed, that they felt like superheroes, that they could focus again and that they could get through a day without feeling exhausted.
A quote from Dr. Michelle Sholzberg, hematologist at St. Michael’s Hospital in Toronto
Dr. Malcolm Munro, a Canadian-trained obstetrician-gynecologist now at the University of California, Los Angeles School of Medicine, says half of menstruating women in North America would be considered iron deficient under Ontario’s new thresholds.
It’s a major and insidious problem, he said.
The extent of the problem is minimized because it is normalized not only by society and family but also by doctors, he adds.
Dr. Munro is hopeful that other Canadian provinces and American hospitals could follow Ontario’s lead.
A certain resistance
However, the idea of testing people who appear healthy for iron deficiency meets with resistance.
Last month, the U.S. Preventive Services Task Force (New Window) (USPSTF) concluded that there is not enough evidence to test and treat the iron levels of pregnant people who have no symptoms of deficiency.
Dr Amy Cantor, who led the US study, says the lack of standardised thresholds for iron levels makes it difficult to build a case for change.
Open in full screen mode
Blood iron stores say a lot about the body’s balance, says Dr. Menaka Pai.
Photo: Courtesy of Menaka Pai
Iron deficiency can be treated with oral tablets. Most patients tolerate the medication well, says Dr. Menaka Pai. However, some have side effects such as constipation.
If medications don’t work, intravenous iron infusions are also an option, which is more expensive.
As for heavy bleeding during some people’s periods, it can be controlled with certain forms of birth control, with or without hormones, according to Dr. Pai.
Toronto resident Nicole Williams says she is happy with her treatment for iron deficiency. She says she now has the energy to run with her child and work full time.
She hopes the Ontario government’s new guidelines can help other women in her situation.
According to a report by Amina Zafar, CBC
