Always pale and constantly tired

Jonas complains: «I'm really too tired for training today.» The mother of the tall 13-year-old has been hearing this sentence more and more often recently. She is worried. Because Jonas is normally very active and can't be stopped from playing football. «Jonas has an iron deficiency,» the paediatrician concludes after a thorough examination. Excessive amounts of iced tea and milk drinks have slowed down Jonas' iron absorption.

The body loses small amounts of blood every day

Iron is a vital trace element that the body needs above all for haematopoiesis and the transport of oxygen from the air we breathe to the organs. Iron is also involved in certain enzyme functions in the body. «As the body cannot produce iron itself, the trace element must be ingested regularly through food,» explains Markus Schmugge, senior physician and paediatric haemato-oncologist at the University Children's Hospital Zurich.

«Most of the iron in the body is contained in haemoglobin, the red blood pigment, and in myoglobin, the red muscle pigment.» For «bad» times, the body also stores a small amount of iron in the liver, spleen and bone marrow, where it is bound to the protein complex ferritin. The body loses small amounts of iron every day through dead cells, faeces, urine and bleeding. However, a balanced diet normally compensates for this loss.

Teenagers are particularly at risk

However, the need for iron is increased during periods of strong growth such as puberty. In addition to growth in length, boys' muscles and blood volume also increase within a short period of time. Girls lose additional iron with the onset of menstruation.

Adolescents are therefore particularly at risk of slipping into an iron deficiency. Especially if they eat fast food or try one-sided diets. "Longer flake diets, for example, can depress the iron balance," emphasises Schmugge. "As the phytic acid contained in cereals hinders iron absorption in the intestine."

Iron contained in plants is less easily utilised by the body than iron from animal food sources.

Markus Schmugge, senior physician at the University Children's Hospital Zurich

Vegetarian and especially vegan diets can also favour iron deficiency. "This is because iron contained in plants is less easily utilised by the body than iron from animal food sources," says the Zurich haematologist. "You should also be aware that intolerances such as coeliac disease can cause iron deficiency."

Various illnesses such as stomach ulcers with hidden gastrointestinal bleeding, chronic inflammatory bowel disease or parasite infestation can also be behind the deficiency. Iron deficiency always develops gradually. "If an imbalance occurs, the body first draws on its iron stores," explains Schmugge. "If the values here fall below a certain level, we speak of a latent iron deficiency."

An article on vegan nutrition for young people:

Typical signs include tiredness, reduced stamina and concentration problems. Of course, these symptoms can also have numerous other causes in adolescents. "But if even favourite hobbies are neglected for a long time, parents should take notice," advises the haematologist.

If the reserves are exhausted and the iron supply continues to fail, iron deficiency anaemia develops. "The red blood cells are now smaller than normal and contain less haemoglobin," explains Schmugge. "As a result, the body's cells are increasingly poorly supplied with iron." This form of iron deficiency is less common. In addition to loss of performance and pallor, there is now also a risk of hair loss, torn corners of the mouth - possibly also shortness of breath and increased susceptibility to infections.

An analysis of data from the 2011 KiGGS study, a study on the health of children and adolescents in Germany, also showed poorer school performance in anaemic children compared to healthy children. Finally, a functional iron deficiency is present when anaemia occurs even though the iron stores are well filled. "In this case, the body is unable to utilise the available iron," emphasises the expert in blood disorders. "This is usually caused by chronic illnesses such as rheumatism or intestinal diseases."

Eliminating the causes of iron deficiency

In order to correctly diagnose the extent and form of iron deficiency, many different factors need to be taken into account. "During the patient consultation, the exact symptoms, nutritional situation and any pre-existing conditions are asked about," says Schmugge. "During the subsequent blood test, all changes in the blood count are analysed. The ferritin value as a measure of the level of iron stores is just one of many parameters."

Foods such as red wine, black tea or dairy products bind iron in the intestine and inhibit iron absorption.

The first step in treating iron deficiency is to eliminate the causes. "If there are pre-existing conditions, these must be treated professionally," emphasises the iron deficiency expert. "More often, however, nutritional errors are the root of the problem."

It is important to know that the body can only actually utilise around 10 percent of the iron from food. Iron-rich foods should therefore be actively included in the diet, especially during periods of increased iron requirements.

Avoid iron robbers in your diet

Liver and red meat are particularly good sources of iron. "The iron they contain is in a trivalent form known as haem iron and can be utilised particularly well by the body," emphasises Markus Schmugge. "But plant-based foods such as soya, millet, beans and oatmeal also contain a lot of iron." However, the bivalent iron from plants is much harder for the body to absorb. "Vitamin C can help here, as it promotes the absorption of iron into the body," recommends the Zurich paediatrician.

"Iron-rich foods should therefore be combined with orange juice or red peppers." Some foods, on the other hand, bind iron in the intestine and thus inhibit iron absorption. "These include tannins, especially in black tea or red wine, large protein molecules in cow's milk and dairy products or oxalic acid in spinach and rhubarb," says Schmugge. "Such iron thieves should therefore not be consumed together with iron donors if possible."

Iron for swallowing or by infusion

"For the treatment of children and adolescents, we prefer iron supplements that are swallowed daily over several weeks," says the paediatrician. "This form of iron therapy is a little tedious, but never dangerous." However, annoying side effects such as flatulence and constipation can occur. "I therefore advise you to drink plenty of fluids when taking it," says Markus Schmugge.

"Alternatively, if side effects occur, you can switch to other preparations such as capsules or syrup in a lower dosage, which are better tolerated." If it is not possible to absorb iron via the intestines or if there is a particularly severe form of iron deficiency anaemia, iron therapy can also be given by infusion.

"An iron infusion should always be the exception for minors and should be supervised by a paediatrician who specialises in this if possible," emphasises the haematologist. "This is because administering large amounts of iron directly into the blood works much faster than tablets or drops, but in rare cases it can also lead to severe allergic reactions or iron overload."

An iron infusion should always be the exception for minors.

Markus Schmugge

In contrast, therapy methods from the field of complementary medicine promise little to no side effects. They can be used for mild forms of iron deficiency or as an adjunct to conventional therapy.

"Unlike in conventional medicine, the missing iron is not replaced here, but rather the body is stimulated to better utilise the iron provided," explains Renato Kaiser, physician and board member of the Swiss Association of Naturopaths (NVS). "Phytotherapeutically, you can drink teas or juices made from the leaves of haematopoietic plants such as dandelion, nettle or berries."

Certain substances contained in it can help to improve iron absorption. "In spagyric medicine, the three-month intake of specially prepared iron drops in the morning and copper drops in the evening is recommended as iron therapy," explains Kaiser. "In homeopathy, Ferrum phosphoricum D12 is a classic remedy for iron deficiency."

Compulsory health insurance for iron infusions on the brink

In Switzerland, iron infusions for the treatment of "early-stage iron deficiency (IDS)" have been covered by basic insurance for over 20 years. According to the Swiss Iron Health Organisation (SIHO), IDI is present when symptoms of iron deficiency occur and the ferritin value as a measure of the storage iron level is below 50 ng/ml.

The World Health Organisation (WHO), on the other hand, only sees a need for action if the value is below 15 ng/ml. As doubts and criticism have recently arisen, particularly from insurers, about the sense of the rapidly increasing number of iron infusions, the Federal Office of Public Health is currently having iron infusion therapy comprehensively reviewed. As a result, the assumption of costs could be reorganised.