The Importance of Iron

[Ryan]

In response to a tweet I made about iron, Andrew shared this blog post about iron with Hillrunner.com on Twitter. Lots of good information in there and in the linked articles.

Iron is a big deal for me personally. With a history of iron deficiency that predates my running, I have a personal stake in this, especially when studying iron in runners and realize that distance running, especially at high volumes, is yet another risk factor for iron deficiency. Many runners, even those with no pre-running history of iron deficiency such as mine, have iron deficiency issues. Often these issues go undiagnosed.

By the way, I have been posting a lot of links from Twitter recently that I haven't had a chance to post here or on Facebook. If you want to see more links like this one or, for example, a retweet I made this morning titled "The Body is not a Machine", check out Hillrunner.com on Twitter and, if you have an account, follow Hillrunner.com.

[Andrew A.]

Right, looking at the Fitzgerald article on the topic that you retweeted, I noticed that it glossed over or completely missed some important facets of the topic.  Similar criticisms of Fitzgerald's work that I have found in the past.  While certainly not an expert by any means, I am fortunate to have worked with some internal sports medicine doctors who helped to increase my knowledge of the topic even further.  As noted in the article, the gut poses a significant barrier to absorption, even in the absence of substances that further hinder absorption of iron such as calcium, caffeine, NSAIDs, and carbonated beverages.  If one supplements perhaps three times daily with vitamin C (aids absorption) using an iron supplement that contains 26 mg of iron per dose (as in Blood Builder, my iron supplement of choice) then one is really absorbing about 11.7 mg of iron, at best, on a daily basis from the supplement.  In some patients, due to unchecked chronically low levels and/or poor individual absorption rate via the gut and/or high individual daily loss of iron, intravenous iron turns out to be the best route to raising ferritin concentration when supplementing orally 2-3 times per day orally (accompanied by vitamin C) on an empty gut is clearly ineffective in increasing ferritin level.  Also note that not all intravenous iron is the same, the stuff that most hospitals use is low grade and can have some bad side-effects.

Incidentally, while facebook does have some nice features that twitter does not, overall I am liking twitter better than facebook.

[Andrew A.]

More http://runningtimes.com/Article.aspx?ArticleID=20675

[Ryan]

Great article. The description of the symptoms is pretty much spot on with what I would describe from the end of my experience with running through iron deficiency. I knew I was more fit but somewhat suddenly, paces that had been easy were somewhat hard. What would be a tempo run was a race effort. I ran somewhere near 27 flat in an 8K in mid-season. By the end of the season, I was struggling to stay under 29 minutes.

A few things I would stress from the article:

If you think you might have iron issues, push as hard as necessary for a ferritin test. When I went to the doctor, he insisted on only testing my hemoglobin level. When that came back fine, the doctor said I just needed to rest. It wasn't until I actually found some research that said, in runners, ferritin levels can be low while hemoglobin levels still register as normal that he agreed to the ferritin test. Finally, I got my ferritin level tested and it came back that I was borderline anemic.

The higher the volume of training, the more a runner relies on oxygen transport to the muscles. This means that elite runners tend to have greater issues with iron deficiency anemia.

Actually, I'd chalk it up to footstrike hemolysis. The higher the volume of training, the more significant an effect this is going to have. The result is the same, though. The higher your volume, the more careful you have to be about this.

Finally, something that can't be stressed enough. Don't self-diagnose. Don't self-treat with supplements. If you're going to supplement, you need to do so under medical guidance and supervision. Overdosing on iron can be deadly.

[Andrew A.]

Yet, as you imply, most (conventional) medical professionals have no idea what is appropriate (let alone optimal) for athletic performance.  Armed with enough information, one could conceivably successfully couple quarterly ferritin testing with modest supplementation, if the numbers in the result are in the range that indicate supplementation would help.  Too many seem intimidated by or disinterested in learning about the health of their bodies and taking more direct responsibility over it.  One would have to be foolishly reckless to overdose on iron.

[sneeka]

I had a really weird thing happen with my ferratin levels this year. For years and years I struggled to keep it barely above 30 by taking supplements. Earlier this year I went to a naturopath and she examined my bloodwork. She put me on two supplements to get more B vitamins, and to get my white blood cell count higher. Now my ferratin is above 50 and I'm able to take fewer iron supplements because apparently the iron is being absorbed from my diet more too. (I'm vegetarian, by the way.) When I saw the result I was shocked because I assumed I could never move it that much. I'm a pretty big fan of my ND now.

[Ryan]

Andrew, I didn't mean to suggest that you should blindly believe your doctor, just that you should get regular tests done to ensure you aren't on a path toward overdosing if you're going to supplement. It may be hard to overdose but, given the severity of the consequences, it's worth getting the relatively pain free tests done to ensure you don't.

Sneeka, that's interesting. I'll have to look into this B vitamin supplementation idea. Have you done any research or asked questions about why you would see the results you have? If so, I'd love to hear about what you have found out.

[sneeka]

Ryan, Sorry, I have no clue why it is helping me absorb more iron. I'm going on blind faith in this woman for now, but every time I see her I learn a bit more about how my body is responding, and apparently she seems to know what she's talking about. I'm not this way with drug prescriptions, but with supplements I'm willing to try it and see what happens. There are so many though, it's good to have some guidance, plus guaranteed good quality supps that she has (which haven't been more $ than I see at the drug store).
 
Also, re-reading what I wrote, it isn't clear that I meant I'm on B's plus another immune booster type supplement. I'm not sure which is helping, or maybe both. I got the impression from her that she feels the B's were a big deal for me.
 
It's an ongoing process, as my hemoglobin is lagging a bit. Her thought now is that B12 is really hard to absorb so I'm on one that absorbs under the tongue instead of in the gut. We'll see what the blood says in a few months.

[runner1]

Interesting topic. I had a blood test done yesterday for my TSH to  see where I am at with my thyroid issues and I asked to have my ferritin checked also. It is at 49 with the normal range being 20(?) to 424(?). I am at the low end and am wondering if this could be a factor in how I feel. I am a picky eater and do not like any veggies(I know,I know I should, but I don't) Also with our five kids and busy schedule our dinners are not the greatest either at times. Where should it be for runners/active people. My TSH is actually leveling out and running is feeling normal again but I do find myself dragging and have a ways to go yet. Let me have a proud father moment here...my oldest (a freshmen) decided to run cross country, after years of playing soccer, the day before practice started. He recently ran 17:55 and was second man on varsity and has been in the low 18's in the other meets. His coach asked me to help out but my son will not let me. I guess it would be embarrassing to him. I guess I am not as cool as I think I am. I do remember being that age and not wanting your parents around though. So I declined.

[Andrew A.]

"The normal range for serum ferritin levels depends on whom you talk to. I have read everything from 50-150 nanograms per milliliter (ng/ml) to 10-300 ng/ml."

[Ryan]

Sneeka, interesting. I've not heard of any such thing but it's obviously working for you, which is the most important thing. I'll have to see if I can find some information on this, it sounds very interesting to me.

Runner1, I've seen similar things to what Andrew posted. I was in the low 20s when I was told I was borderline anemic and it was amazing how quickly after beginning supplementation things began turning around for me. Within a week, I could notice a difference. Within a month, I was back to normal. It's been like pulling teeth trying to get my numbers recently so I gave up. I'm feeling good and I'm told they are within a healthy range. At one point, though, my numbers were climbing toward 100.

Finally, congrats to you and your son. You must be one proud parent to have a son who is doing so well.

[Andrew A.]

I'm a pretty big fan of my ND now.

+1

I work with NDs (who are also athletes, themselves) and they have helped to broaden my knowledge so much.