Red Cell Alert

Judy Adamson

Tired? Vague? Maybe you're anaemic. I report on a syndrome few people recognize.
We've all seen those ads on TV: the ones where women talk about how tired they are, and then you discover that they're all iron deficient.
Given that most people have hectic work, home and social lives, it's easy to blame exhaustion on an over-full schedule. Yet data collected by the Australian Longitudinal Study of Women's Health shows that up to a third of Australian women under 50 have had iron deficiency diagnosed at some stage, so there may well be more to it than just being busy.
But what does it mean to be iron deficient? Are there any clues to alert you to its presence apart from tiredness? Dr James Biggs, an expert in iron metabolism and a part-time lecturer in the faculty of medicine at the University of NSW, says it's perfectly possible to be iron deficient and still have normal levels of hemoglobin. "The majority of iron is in the form of hemoglobin in the blood, but there are also a lot of iron stores in the body, particularly in the liver," he explains.
"A normal person might have as much as 1.5 grams in storage, so when you lose those stores you're said to be iron deficient."
The symptoms of iron deficiency are so general they're difficult for people to recognise, says Dr Greg Anderson, head of the Iron Metabolism Laboratory at the Queensland Institute of Medical Research.
"If you go into the street and ask 100 people if they consistently feel tired, you'll probably find that most will say 'yes'," he says. "This has been shown in a variety of studies. The symptoms are so non-specific that just as many non-iron-deficient people will say they suffer from chronic tiredness as those with iron deficiency."
Iron deficiency can have negative effects on a person's immune system, ability to think clearly, work performance and body temperature. But often these symptoms are attributed to lifestyle issues - working too much, partying too much - so the underlying problem isn't discovered.
Adam Walsh, a dietitian and associate lecturer in the school of exercise and nutrition sciences at Deakin University, says that because the symptoms of iron deficiency appear gradually, people assume they are caused by things such as a decrease in their fitness level or an over-busy life.
"You tend to find that the activities that you may once have accomplished without feeling too exhausted are now becoming quite hard, and that the recovery phase is a lot longer," he says. "Concentration becomes harder. People vague out a little bit - they find that halfway through a
conversation they're very easily distracted. They might also be a bit pale, especially children.
"In extreme cases where people are very, very iron deficient, they might have strange food cravings.
Young children might eat really crunchy things such as sand or dirt or velcro, and it's called pica. As adults we know that we don't eat velcro, but young children are craving iron so much that they're endeavouring to get it from whatever they can - and for whatever reason, it manifests itself as a strange oral fixation with crunchy things."
While iron deficiency (and anaemia) can occur because of a number of chronic illnesses, Walsh says those most likely to be iron deficient are women of child-bearing age, children going through puberty and premature babies. "Women lose quite a great deal of iron through menstruation, and their needs do increase throughout pregnancy, so if they don't watch what's happening there they can become iron deficient or anaemic during pregnancy.
"Also, if you are breastfeeding and your iron stores are low, then certainly a baby will receive low iron through breast milk, but the body will try and give the baby as much as possible, so mothers will suffer with respect to that."
Premature babies can be at risk just because their early birth means iron stores, which mainly accumulate in the third trimester of a pregnancy, are not what they should be, while children going through puberty will need extra iron as part of their rapid growth.
Vegetarians can be anaemic, partly because they're not eating meat, but also because they're not absorbing the iron in plant material efficiently. There are a number of things that can be done to bump up iron levels. For most people, simple dietary interventions, such as increasing the intake of vitamin C, will help the body absorb iron more efficiently. Eating red meat is another option. If iron deficiency is more severe, then iron tablets and other supplements are available.
Biggs also warns that people who are iron deficient should not expect a quick fix. He says doctors can make the mistake of giving only a short burst of treatment and then stopping supplements before the patient's body has had a chance to build up iron stores.
"If it's a woman having fairly heavy periods, for example, within another year or two she'll have iron deficiency anaemia again," he says. Even if you have a good diet, don't think it can't happen to you. Walsh says his own wife became anaemic after giving birth to their baby "and she's married to a dietitian. How good is that?" Losing and finding my pep.
I felt off-colour for about six months. Not sick; just as if my motor was running at 50 per cent. Usually energetic, I struggled to get out of bed. But as I wasn't obviously ill, I thought my lethargy was just lack of motivation.
Anaemia seemed impossible. I had been a robustly healthy vegetarian as a teenager, and now I ate meat as part of a balanced diet. My skin wasn't pasty. My weight was steady. But I did suffer from cripplingly heavy periods.
I finally went to the local clinic for a blood test in August last year, and a few days later the nurse left an urgent message on my phone. Luckily, my problem wasn't life-threatening, but still serious enough to slow me down. My levels of ferritin (the protein that stores iron) were almost
non-existent.
Fortunately, low-iron anaemia is easy to manage. I scheduled in steak time and juggled various supplements, none of which were terribly glamorous. Even fruity flavours can't disguise the taste of liquid iron. The tablets are less intrusive but not as easily absorbed. Both block your digestion. But within weeks, I rediscovered my pep.
[SMH]