IRON – IF YOU ARE LOW, YOUR BRAIN CAN NOT HEAL

FACTS:

1. SEPTEMBER 26, 2012 American Regent, Inc. announced that Venofer® (iron sucrose injection, USP) was approved for Pediatric patients. Venofer®, the #1 IV iron in the United States, is approved for adults and children ages 2 years and older. The science for this approval was completed years ago and after review, the FDA approved the use of Venofer down to the age of 2.
2. The cost of treatment for these malnourished children pales in comparison to the cost of the delay in cognitive development for them.
3. I am a primary care physician who served the underserved population in the state of South Dakota. I found rewarding relationships with the adolescent patients who suffered consequences and circumstances that shuffle them into facilities I served such as Juvenile Detention Centers, chemical dependency programs and shelter care. I performed the screening physicals for this cohort of adolescents. The time the adolescent spent within these facilities was unpredictable. This fact greatly impacted my decisions about the care of these young minds.

BRAINS NEED IRON

The impact of low iron can be directly correlated to the quality of life and the brain development of adolescents.  This also impacts the repair of injuries in the adult brain. Intravenous iron utilizes as an upfront therapy, produces faster and less expensive clinical outcomes with a powerful positive impact.

Recent research indicates that that untreated low iron can lead to stunted brain development, as well as correlation to mental health concerns (i.e. depression, anxiety). Low iron is predominantly found in communities with low economic and generational poverty. These communities are duly burdened with low access to healthcare. In South Dakota, only eleven of sixty-six counties have primary healthcare. South Dakota also has four of the nation’s poorest counties.  IV iron provides the fastest, most effective way to return these children to their communities with the best chance for maintaining improvements.  

These interviews provide more complete coverage of this story: KETOWOMAN WITH DAISY BRACKENHALL.  Daisy has interviewed me several times.  These 2 interviews are the beggining of our friendship and teamwork.

PART 1 EPISODE 46 

PART 2  EPISODE 47

• iTunes – Audio

I screened for iron deficiency if the adolescent has one of the following concerns:

• a failed literacy screening questionnaire
• a recent decline in their math performance in school
• a failed screening questionnaire for depression
• behavior issues of impulsivity to the point of judicial intervention
• severe fatigue
• a poor concentration that affects their performance during my exam or the interview
• restlessness of their legs or kicking during sleep

I specifically look at their iron storage evaluation as opposed to looking at the hemoglobin or hematocrit. This is a very important distinction in the robust bone marrow activity of the adolescent.

This clientele had several of the risk factors that predict low iron. Lab results substantiated that inquiry.

Replacement of their severe deficiency in such limited time challenged the medical team. If the deficiency is not mended by the time they left our shelter-care, the replacement will simply not happen. This bold statement is not an opinion. Please find references below that lend expert discovery and strategies to diagnosing and replacing iron. The strategy of oral iron replacement fails universally when compliance cannot be mandated for the nine to twelve months that is needed to bridge the deficit. The homes and lives that landed these adolescents in my care rarely have the stability within the home to mandate such compliance for a medication that causes constipation and nausea.

Why is iron important to the human body?

Iron is a mineral used by the body to make hemoglobin. Hemoglobin is the main protein in red blood cells, which carry oxygen through your blood to all the cells in your body. Hemoglobin is what makes red blood cells red. Iron is needed not only for blood but also for brains. Neurotransmitters, the chemicals in the brain that carry messages from one nerve to another, require sufficient iron to function properly.

If you have enough iron in your system, your muscles and bodily systems will function as well as your level of physical fitness allows. Sufficient amounts of iron in the body can help eliminate fatigue and muscle weakness. Iron also benefits the immune system, thus people who consume enough iron tend to have better overall health.

What is iron deficiency?

Iron deficiency is a condition in which there is a lower than normal level of iron in the blood. If left untreated, iron deficiency can lead to anemia, a condition in which there are low hemoglobin levels in the blood. Hemoglobin is the part of the red blood cell that carries oxygen throughout the body. Iron is necessary for the bone marrow to produce adequate levels of hemoglobin and, therefore, healthy red blood cells.

With insufficient iron, and therefore not enough hemoglobin, red blood cells become small and pale and don’t carry enough oxygen. Hemoglobin carries oxygen throughout the body, so without iron, the tissues, muscles, and other systems do not receive adequate oxygen, and thus cannot function properly. This leads to fatigue and poor health. You may have heard the phrase “tired blood.” This really means blood that is low in iron and that can’t carry enough oxygen to vital organs and muscles. “Tired blood” results in a tired body.

An iron deficiency can also cause shortness of breath, inability to perform physical tasks well, poor attention, and other learning problems. A person with an iron deficiency may have a tired mind as well as a tired body.

Why is it important for children to have their iron levels checked?

1. Low iron stores have been linked to reduced cognitive (IQ), psychomotor (brain-body) and behavioral (social) function in children
2. Children with low iron stores have been shown to have higher rates of anxiety, depression, attention problems, and hyperactivity.
3. Children with low iron stores early in life tend to have poorer cognitive and motor skills and poorer school performance than their healthier peers, particularly in math and reading.
4. Low iron stores have been linked to a variety of conditions including ADHD, dyslexia, restless leg syndrome, Tourette’s syndrome, sleep disturbances, lead toxicity, and increased rates of drug abuse.

Why should iron deficiency be treated?

Iron supplements can increase your child’s energy levels and his or her ability to learn.

1. Improving iron stores in children with low iron has been shown to increase verbal learning, memory, and cognitive function.

2. Improving iron stores in children with low iron may improve symptoms of Attention Deficit Hyperactivity Disorder.

3. Improving iron stores in children with ADHD who are taking medications to treat this condition may improve the effectiveness of these medications or reduce the necessary dose of medication needed to effectively control ADHD symptoms.

4. Treating children for iron deficiency is safe, effective, and inexpensive.

Children between six months and fifteen years of age should have a ferritin level above 50 micrograms per liter.  When the ferritin level is below 30, the child has had low iron levels for a significant amount of time. More aggressive treatment is required. The use of injectable IV iron sucrose is recommended.

References:

1. Ragab, Mahmoud, and Ragab. Maintenance Intravenous Iron Sucrose Therapy in Children Under Regular Hemodialysis, J. Med. Sci., 7 (7): 1112-1116, 1st October, 2007.
2. Intravenous low molecular weight iron dextran in children with iron deficiency anemia unresponsive to oral iron.
3. Anbu, A et al Low incidence of adverse events following 90-minute and 3-minute infusions of intravenous iron sucrose in children on erythropoietin.Acta Paediatrica 2005; 94: 1738-1741.
4. Hulin, S et al. Post-hemodilution anemia in pediatric cardiac surgery: benefit of intravenous iron therapy. Annales Francaises d’Anesthesie et de Reanimation 2005.
5. Safety and efficacy of intravenous iron therapy in reducing requirement for allogeneic blood transfusion: systematic review and meta-analysis of randomised clinical trials
6. Intravenous iron sucrose for children with iron deficiency anemia: a single institution study
7. Michaud, L et al. Tolerance and efficacy of intravenous iron saccharate for iron deficiency anemia in children and adolescents receiving long-term parenteral nutrition. Clinical Nutrition 2002; 21(5): 403-407.
8. Surico, G et al. Parenteral iron supplementation for the treatment of iron deficiency anemia in children. Ann Hematol 2002; 81:154-157.
9. Meyer MP, et al. A comparison of oral and intravenous iron supplementation in preterm infants receiving recombinant erythropoietin. J. Pediatr 1996; 129:258-63.
10. Martini A, et al. Intravenous iron therapy for severe anemia in systemic-onset juvenile chronic arthritis. The Lancet 1994; 344:1052-54.
11. A review of studies on the effect of iron deficiency on cognitive development in children. Grantham-McGregor S, Ani C. J Nutr. 2001 Feb;131(2S-2):649S-666S; discussion 666S-668S. Review.
12. Benton D, Roberts G. Effects of vitamin and mineral supplementation intelligence of a sample of school-children. Lancet 1988; i: 140-43.
13. Iron Status in Toddlerhood Predicts Sensitivity to Psychostimulants in Children.Turner CA, Xie D, Zimmerman BM, Calarge CA. The University of Iowa Carver College of Medicine. J Atten Disord. 2010 Oct 26.
14. Juneja M, Jain R, Singh V, Mallika V.Department of Pediatrics, Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi 110 002, India. [email protected] Indian Pediatr. 2010 Nov 7;47(11):955-8. Epub 2010 Mar 
15. http://www.ehow.com/how-does_4564496_iron-help-body.html
16.  http://www.venofer.com/pdfs/Patient_Brochure.pdf
17. http://www.askdrsears.com/topics/family-nutrition/iron/why-do-you-need-iron
18. http://www.webmd.com/a-to-z-guides/ferritin?page=2