As a physician in Egypt, Wael M.Y. Mohamed kept seeing the same case over and over again: bright children from poor families, unable to concentrate in school. With more than 51 percent of children in Egypt suffering from anemia, Mohamed suspected the culprit was iron deficiency.
"For a variety of reasons, including diet and possibly even genetics, iron deficiency is a big problem in young people in Sahara and North Africa," says Byron C. Jones, PhD, a professor of Biobehavorial Health and Pharmacology at Penn State, and Mohamed's adviser. "It can produce lifelong problems with cognitive development, as well as lead to problems with motor skills, attention and behavior."
Poor, uneducated Egyptian parents often don't know about the importance of iron and can't afford fresh vegetables and supplements anyway, Mohamed says. Even if he could send children home with bags of spinach, it probably wouldn't help — dietary iron doesn't shore up cognitive deficits once they've developed, research shows.
Seven years into his career as a physician, Mohamed felt that he had more questions than answers for his patients. That drove him, in August 2006, to leave the rural family compound he'd lived in all his life to study neuroscience at Penn State University. A $250,000 scholarship from the Egyptian Ministry of Health paid his way and allowed him to bring his wife and two sons.
"My government has invested a lot of money in me to find a solution for the prevention and treatment of early iron deficiency," he says. "I don't want to let them down."
Brain and Behavior
During his first year at Penn State, Mohamed often felt he was on the verge of failing in his quest. While other students in his program spoke the language of polypeptides and could identify organelles on sight, the 28-year-old physician had never taken a single biology course.
"In our medical school, we did not pay attention to molecular and cellular issues of the diseases," he says.
Essentially, Mohamed was starting from scratch, and sometimes he worried he wasn't up to the challenge.
"After getting a C+ in one of my courses, I was so upset and depressed," he recalls. He took a walk around campus to clear his head, and came up with a confidence-boosting mantra. "I said to myself, 'Go east, go west, Wael is the best.'"
It's served him well. Since those early struggles, Mohamed has published nine studies, earning first author credit on four. For example, in one study, published in 2010 in Behavioral Brain Research, Mohamed and his colleagues found that early iron deficiency does cause ADHD-like symptoms in rats. In the study, they split 92 rats into two groups — with half nursed by anemic mothers, and the other half nursed by healthy mothers. Upon weaning, both groups of rats ate an iron-rich diet. However, once they had matured, the rats that had been deprived of iron as infants were slower to learn a variety of discrimination tasks.
The rats had the most trouble with a test where researchers presented them with two dishes, one with cat litter and the other with mulch. If the rats dug into the cat litter, they'd find a Honey Nut Cheerio, but if they dug into the mulch, they got nothing. Easy enough. The complicating factor, however, was the introduction of a mint or strawberry smell. The smell was randomly assigned — it didn't give the rats any clue as to which dish contained Cheerios. The iron-deprived rats, however, couldn't tune out this irrelevant information, and 85 percent of them failed to choose correctly in six consecutive trials, compared with just 23 percent of the control group.
"As with iron-deprived children, these iron-deprived rats are bright, but they just can't seem to focus," says Mohamed.
Then, the researchers gave the animals varying doses of generic Ritalin, and found that a small dose helped the iron-deprived rats succeed at the discrimination tasks, while larger doses only made them hyperactive. The control group's performance was unaffected by the drug.
The findings suggest that, as Mohamed suspected, Ritalin may help Egypt's iron-deprived children better concentrate in school. Egyptian physicians, however, are hesitant to prescribe Ritalin for fear it may predispose children to cocaine addiction, Mohamed says. Preliminary data Mohamed has collected suggests that early iron deficiency and ADHD itself, rather than Ritalin, may make children more vulnerable to cocaine use. However, other researchers have had contrasting results.
"For now, I'll lean toward behavioral treatments," he says. Encouraging children with ADHD to take breaks during their homework sessions, for instance, and asking teachers to add periods of physical activity into their lesson plans, seems to work wonders, he adds.
Of course, the best solution for early childhood iron deficiency is to educate parents about the importance of the nutrient for growing brains, and to make leafy green vegetables or supplements more affordable. That will require Egypt's government to work toward decreasing poverty and improving its education system, says Mohamed, who hopes that the recent overthrow of Egyptian President Hosni Mubarak might herald such changes.
While solving the scourge of iron deficiency remains Mohamed's primary goal, he also hopes to help modernize Egyptian universities and build a thriving psychology or neuroscience department of his own. Specifically, Mohamed wants to develop a graduate program to train Egyptian psychologists in Western techniques, but allows them to apply them flexibly to people whose religious or cultural beliefs are quite different from Americans'.
For instance, some parents Mohamed has encountered believed that their inattentive children were a curse from God, or the result of possession by evil spirits. Mohamed tried to get them to see their children's problems as the result of physical processes, though he never undermined or argued with parents' deeply held religious beliefs. "In Egypt and many Muslim countries, we psychologists must work together with religious leaders," he says.
First, however, Mohamed must finish his PhD. He successfully defended his dissertation in October and is planning a monthlong trip to Egypt — his first time home in more than five years.
"The first thing I will do when I get home," he says, "is kiss my mother."