I agree with the authors here. As a hematologist, I often see the end result of missing the “borderline” patient, and I do think our ferritin cutoffs are often too conservative. Doing more in medicine is not always better, and iron deficiency still needs to be diagnosed thoughtfully.
But this is a cheap blood test, and treatment is safe, effective, and available over the counter. Waiting for patients to become symptomatic or anemic before acting is reactive medicine. Avoiding morbidity by recognizing early iron deficiency will ultimately save the system $ as well.
Given the difficulty measuring “brain fog”, fatigue etc even a RCT of screening would be difficult to perform. I find it hard to believe that the high percentages of iron deficiency cited above are clinically meaningful. Reminds me of recent “data” suggesting that more people have pre- diabetes, anxiety, ADD, spectrum disorders etc.
Before I start treating asx low ferritin I would need several concordant RCT justifying same.
Putting pregnancy aside as situation that warrants special consideration, is there really enough evidence to support a causal connection between low ferritin and symptoms like pica, restless legs syndrome, and “brain fog?” A recommendation for universal Iron repletion in all instances of depleted iron stores predicated on a bio-plausible hypothesis (the role of iron in mitochondrial energy metabolism, skeletal and cardiac muscle function, neurotransmitter production, and immune regulation) in the absence or RTCs sounds similar to recommending estrogen replacement therapy to improve cardiovascular outcomes in all post-menopausal women.
Is there a reason that, despite wealth and access to cheap meat that has never been seen in history, that so many women are iron deficient? Pregnancy is a very normal event, and I would have thought the human race would have died out quickly if our ancestors had anaemic mothers and low IQ. It seems odd that this is such a problem in a rich western society.
“Opening a rich vein” is an interesting word choice here. Much appreciated.
I agree with the authors here. As a hematologist, I often see the end result of missing the “borderline” patient, and I do think our ferritin cutoffs are often too conservative. Doing more in medicine is not always better, and iron deficiency still needs to be diagnosed thoughtfully.
But this is a cheap blood test, and treatment is safe, effective, and available over the counter. Waiting for patients to become symptomatic or anemic before acting is reactive medicine. Avoiding morbidity by recognizing early iron deficiency will ultimately save the system $ as well.
Given the difficulty measuring “brain fog”, fatigue etc even a RCT of screening would be difficult to perform. I find it hard to believe that the high percentages of iron deficiency cited above are clinically meaningful. Reminds me of recent “data” suggesting that more people have pre- diabetes, anxiety, ADD, spectrum disorders etc.
Before I start treating asx low ferritin I would need several concordant RCT justifying same.
Putting pregnancy aside as situation that warrants special consideration, is there really enough evidence to support a causal connection between low ferritin and symptoms like pica, restless legs syndrome, and “brain fog?” A recommendation for universal Iron repletion in all instances of depleted iron stores predicated on a bio-plausible hypothesis (the role of iron in mitochondrial energy metabolism, skeletal and cardiac muscle function, neurotransmitter production, and immune regulation) in the absence or RTCs sounds similar to recommending estrogen replacement therapy to improve cardiovascular outcomes in all post-menopausal women.
Is there a reason that, despite wealth and access to cheap meat that has never been seen in history, that so many women are iron deficient? Pregnancy is a very normal event, and I would have thought the human race would have died out quickly if our ancestors had anaemic mothers and low IQ. It seems odd that this is such a problem in a rich western society.