According to the World Health Organization (WHO), iron deficiency is considered the number one nutritional disorder in the world . And it is that iron is essential for our body as it participates in many metabolic processes, especially in the formation of hemoglobin (Hb) contained in red blood cells.
In the words of Salvador Tranche, president of the Spanish Society of Family and Community Medicine (Semfyc) : “Hemoglobin is the main responsible for transporting oxygen to tissues and is also essential for DNA synthesis, cellular respiration and for that key metabolic reactions are carried out, as well as for an adequate functioning of the immune system ”, hence the importance of iron, whose deficiency also causes anemia to appear , a disease that affects more than 30 percent of the world's population.
If we focus on knowing what the appropriate levels are, and although they vary depending on the laboratory, Tranche specifies that normal levels of iron in blood serum , that is, circulating iron, range between 50 and 150 mg / dl . “But we are also interested in knowing what the iron stores are, that is, ferritin, which is the main iron storage protein, with normal concentrations ranging from 15 to 300 ng / mL. In the absence of inflammation, it is the test that best correlates with iron deposits (1 ng / mL = 8 mg of iron) ”, adds the president of Semfyc.
نقص الحديد عند الاطفال
Iron deficiency and anemia occur mainly in women . The causes are various, as specified by Guadalupe Blay, head of Endocrinology and Nutrition at the Spanish Society of General and Family Physicians (SEMG) , and they range from a poor diet (following a very strict vegetarian diet, not consuming red meat, drinking a lot of tea or a lot of fiber ), taking medicines that prevent its absorption , being pregnant or having insufficient absorption of iron , which is mainly due to having intestinal surgery or diseases of the intestine, such as Crohn's disease or celiac disease, according to Blay.
The president of Semfyc adds that the normal Western diet contains about 15-20 mg of iron, of which 1 to 2 mg are absorbed daily. “ Foods rich in iron are oysters, clams, legumes, meat, fish, eggs… In addition to the fact that the foods are rich in iron, it is important that the absorption that can be achieved is good and thus can range from 1-5 percent of vegetables and 20-30 percent of meat and fish ”, he specifies, and emphasizes that in developed countries the food factor is exceptional as a cause of anemia, except in those who follow strict vegetarian diets.
However, the main cause of iron deficiency and anemia is blood loss . " In developed countries it is mainly due to menstrual loss in premenopausal women and digestive bleeding in men and postmenopausal women," adds Tranche.
Both agree that if the causes of blood loss are gynecological or related exclusively to women, menstruation, childbirth or increased iron needs during pregnancy are usually the main reasons.
Regarding digestive bleeding, they indicate that it may be due to a bleeding ulcer, a polyp in the colon or colon cancer , esophagitis or taking anti-inflammatory drugs, among others.
Finally, sports overexertion can also be a cause of this decrease in iron levels.
For WHO, iron deficiency and anemia reduce the work capacity of people, and even entire populations, entailing serious economic consequences and hampering the development of countries.
If we focus on the general symptoms that each person can notice, Blay describes that fatigue, asthenia, tachycardia, feeling of shortness of breath, paleness, chest pain, cramps and hypotension can appear.
"In general, at the individual level, the most common symptoms are fatigue, weakness and exercise intolerance . The most common is that the person has mucotaneous paleness (of the conjunctiva, face and palms of the hands). If the anemia is moderate-severe, there may be hair loss, brittle nails, sweating, swelling of the tongue, lesions on the lips, irritability, decreased concentration, sleep disorders, respiratory distress and general deterioration ", adds the president of Semfyc.
Because the symptoms are common to many other diseases, people do not usually consult a doctor until several suddenly occur, so Tranche recommends that you should go to the doctor before very heavy or frequent menstruations, or in the presence of tiredness with no apparent explanation . "Since we have commented that the most common cause in men and postmenopausal women is digestive bleeding, you should consult if you have abdominal pain, burning or stomach pain, if you regularly take anti-inflammatories or if you have very dark (blackish) stools", he adds .
Many of the symptoms of iron deficiency are themselves the consequence, but if we dig deeper we see that in general our body's immunity decreases, as Blay points out. In women and children the consequences of a lack of iron and / or anemia have a great impact on their lives.
The main complications involved are unsatisfactory pregnancy outcomes , physical and cognitive development problems, increased risk of morbidity in children, and reduced labor productivity in adults.
“Anemia in developing countries may be responsible for 20 percent of all maternal deaths and multiple complications during pregnancy, including an increased risk of stunting, blindness, serious illness, decreased cognitive performance, defects spinal and cerebral. Anemia in pregnancy also increases the risk of miscarriage, stillbirth and low birth weight thus increasing the risk of infant mortality , as well as complications in childbirth causing hemorrhages that correspond to an increased risk of depression and maternal mortality ”, he points out. Tranche.
First, the doctor must diagnose if there is anemia through a simple blood test (hemogram). The next step is to look for the cause of the anemia.
"In addition to treating the cause, iron must be provided since there is a deficit of it," says Tranche. “ No food contains a sufficient concentration of iron, so it is necessary to indicate pharmacological treatment with any of the many preparations on the market . This treatment should be maintained for up to three months after normalizing the values ”.
Regarding food , the president of Semfyc specifies that for it to be adequate and varied, it must include meat, fish, eggs, legumes, etc., avoiding strict vegetarian diets . "It is also necessary to carry out preventive treatment in those known situations that are accompanied by absorption difficulties, such as in patients with hemodialysis, stomach surgery or malabsorption problems, or those with increased losses as occurs in cases of very abundant menstruation" .
It is also important "to carry out the treatment properly, as for example in the case of ferrous sulfate, where it should be taken on an empty stomach with vitamin C (orange juice) to facilitate its absorption and for 3 more months after reaching normal values" , concludes.