As exam season approaches, students across the country prepare for one of their most challenging academic periods. Research reveals a critical yet overlooked element affecting student performance: low iron stores and anaemia and their profound impact on cognitive function and stress management, especially amongst school-going teens.

As part of the “Iron It Out” awareness campaign currently being rolled out across Cape Town schools, Cape Town Infusion Centre’s Sister Karin Davidson, the Infusion Room’s Sister Pippa Hime and dietitian Kath Megaw are highlighting the symptoms of low iron stores and/or anaemia and offering practical advice on how to combat and manage this common condition.

Midsection portrait of a student girl sitting in a bench while eating healthy salad with pasta in a glass lunch box

The global iron pandemic: One in four people globally may be experiencing the effects of anaemia during their most critical learning years, according to a 2021 study published in the medical journal, The Lancet. The World Health Organisation reports that the impact is particularly severe across African nations where an estimated 103 million children are affected by anaemia. In addition, in sub-Saharan Africa, the prevalence of anaemia has risen to 41.5% amongst non-pregnant women.

Iron deficiency and exam stress: The physiological impact of iron deficiency creates a perfect storm for academic underperformance amongst school-going children. Several factors compound exam stress: sleep deprivation during intensive study periods, poor nutrition as students prioritise study time over balanced meals, increased caffeine consumption which interferes with iron absorption, heightened anxiety about academic performance, and social isolation reducing support systems. Iron deficiency compounds each of these stressors through direct neurological pathways:

Cognitive impact: Low iron stores with or without anaemia can cause a decrease in attention span and cognitive processing, poorer sensory perception functions and decreased emotional regulation. “The most common symptom is fatigue, but difficulty concentrating and mental fog are symptoms we see often in our practice,” says Sister Davidson.

Teenage girl wearing eyeglasses sitting at desk in classroom in high school. Female student smiling while studying in classroom.

Anxiety connection: There is a direct link between low iron stores/anaemia and increased anxiety levels. Iron plays a crucial role in producing neurotransmitters like serotonin and dopamine, which regulate mood.

“Since launching the “Iron It Out” campaign two months ago, every time we pose our questions about symptoms, we see a sea of hands raised – up to 50% of our audience,” says Sister Davidson, whose work encourages advocacy from teens to their parents, teachers and caregivers.

• Physical symptoms include: Persistent fatigue and weakness, shortness of breath during normal activities, poor sleep, cold hands and feet, brittle nails and/or hair loss, and pica (unusual cravings for non-food items).
• Cognitive and emotional symptoms include: Brain fog, difficulty concentrating, poor memory retention, increased anxiety and irritability, and feeling overwhelmed by previously manageable tasks.

Expert nutritional advice for high-stress periods

Kath Megaw, registered dietitian and founder of the paediatric practice, Nutripaeds, emphasises the necessity for robust nutritional support during exams. “Having a stress-responsive nutrition strategy is as crucial to preparing for exams as revision,” she says.

Key strategies include:

1. Stress-relieving foods: Pair iron-rich foods like meat, fish, poultry, lentils and spinach with vitamin C sources to boost absorption. Include magnesium-rich foods like nuts, seeds, and dark leafy greens to ease muscle tension and improve sleep quality.
2. Smart meal timing: Start the day with protein, iron and slow-release carbohydrates. Plan small, regular meals every three to four hours to keep blood sugar steady. Choose light, nourishing options for late-night study sessions.
3. Iron-rich foods for busy students: Boiled eggs with fruit, wholegrain wraps with chicken and spinach, lentil soup, trail mix with nuts and seeds, and smoothies with banana, nut butter and spinach.

Supplementation and treatment: Both Sister Davidson and Megaw agree that iron supplements and infusions can be life-changing when administered after conclusive blood tests. “Medical grade iron infusions effectively treat anaemia, while low iron stores can be corrected using supplementation once levels are above a certain threshold,” says Sister Davidson.

Oral Iron supplementation tips:

• Take on an empty stomach with water or orange juice.
• Avoid taking with tea, coffee, or high-calcium foods such as dairy, as these block absorption.
• Combine iron-rich foods with stress-calming nutrients and steady meal timing.

“Our work advocates for patients to be aware of the value of healthy iron stores, to act when intervention is needed, and to maintain optimal levels thereafter, for both everyday life and during times of increased stress,” concludes Sister Davidson.