When you should (and shouldn't) be recommending iron supplements

Perhaps the most frustrating type of patient who comes through your practice door is the one with a seemingly vague set of symptoms.

They may complain of feeling run down and tired, even though they seem to be getting an adequate amount of sleep each night. They may also say that they have difficulty concentrating on tasks. Of course, if you run a complete blood count (CBC) and notice that your patient’s hemoglobin (red blood cells) are abnormally low, you will know that their symptoms are all a result of anemia.²

There are a number of medical issues that can cause anemia, including chronic lead poisoning, vitamin B12 deficiency, and sickle cell anemia.¹

However, iron deficiency is, by far, the most common cause for anemia throughout the world. In the United States alone, approximately 10 million people have some form of anemia, of which half are a result of a lack of iron.¹

It should be rather self-evident that the easiest way to prevent this form of anemia is iron supplementation, although caution must be taken not to raise iron levels too high, as that may cause other health issues. Below are some of the more common instances in which you should recommend that your patients might benefit from iron supplementation.

Signs of iron deficiency

You can usually spot the symptoms of iron deficiency reasonably quickly. There is a general cluster of symptoms, including:

Fatigue and loss of energy
Very fast heart beat, particularly with exercise
Shortness of breath and headache, particularly with exercise
Difficulty concentrating
Dizziness
Pale skin
Leg cramps
Insomnia

Iron deficiency during pregnancy

A 2013 meta-analysis combined the results from 21 smaller studies (which included a combined total of 5,490 women) to look for common data regarding the advisability of daily versus intermittent iron supplementation for pregnant women.³ This type of study is done in order to strengthen the overall findings by extrapolating from patterns of similar findings.

The researchers found that, although both daily and intermittent iron supplementation were equally effective in reducing anemia, intermittent supplementation reduced the risks of overly high hemoglobin levels in the second and third trimesters of pregnancy.³ The researchers concluded that intermittent supplementation may be a good choice for women who have no other risk factors associated with their pregnancy.

Iron deficiency and attention deficit and hyperactivity disorder in children

In a 2014 article published in the Annals of Medical and Health Sciences Research, researchers looked at the medical records for 630 children between the ages of 5 and 18 with a diagnosis of attention deficit and hyperactivity disorder (ADHD).⁴ These children were compared to a matched control group of 630 children within the same age range who did not have ADHD.

Data regarding the children’s health status was examined, including serum iron, ferritin, and vitamin D levels. The researchers found that those children who had received a formal diagnosis of ADHD also were more likely to have vitamin D deficiency and low serum iron and ferritin levels.⁴ The practical take home for you is that you might consider suggesting that your pediatric patients who have ADHD could benefit from iron and vitamin D deficiency.

Given the widespread prevalence of iron deficiency anemia, combined with its diffuse symptoms, it may be prudent to include checking hemoglobin levels as a part of every first office visit for your new patients. If the levels are indeed high, iron supplementation is an easy, effective way to manage their anemia.

References

Miller J. (2013). Iron deficiency anemia: A common and curable disease. Cold Spring Harbor Perspectives in Medicine, 3(7), 10.1101/cshperspect.a011866 a011866.

Injeyan HS, Gotlib AC, Crawford JP. (1997). The clinical laboratory in chiropractic practice: What tests to order and why? Journal of the Canadian Chiropractic Association, 41(4), 221-230.

Peña-Rosas JP, De-Regil LM, Gomez Malave H, et al. (2013). Intermittent oral iron supplementation during pregnancy. Cochrane Database System Review (10), CD009997.

Bener A, Kamal M, Bener H, Bhugra D. (2014). Higher prevalence of iron deficiency as strong predictor of attention deficit hyperactivity disorder in children. Annals of Medical and Health Sciences Research, 4(Suppl 3), S291-S297.