Iron/Ferritin/Anemia

[Camille Herron]

I was reading Nate Pennington's blog, in which he mentioned getting his ferritin tested and finding out it was low. Ferritin = stored iron.... your body uses it, as needed, to make red blood cells to carry oxygen. I honestly believe having low, or even "normal", ferritin is limiting A LOT of runners/marathoners from reaching their full potential. It can't be emphasized enough how it important it is for serious runners to get enough iron, whether through diet (RED meat, green veggies, black beans) and/or supplement, when you're bumping up the mileage/training load (and possibly doing so at high altitude, where the body has an even greater demand for it). The more depleted your ferritin becomes, the greater the risk for being diagnosed with anemia.

I would encourage everyone who is serious about their running to get their ferritin tested. What your numbers should be probably depends on the individual, and possibly your training load and where you live (which is going to affect the turnover of ferritin). My husband is a collegiate coach (2:18+ marathon best), and he prefers his guys to have a number over 50, and preferably 60-70. If they're below 50, they start taking the liquid iron + OJ (how much depends on how low they are). They get their blood tested every ~4 months to keep their ferritin in check. I've read that Jack Daniels had an Olympic 800m runner with a ferritin always below 30 (but the training for the 800 is a far cry from the demands for the marathon!). Personally, I felt like crap with a ferritin of 41, while putting in 100-130 mpw at high altitude last summer (and this is despite eating lots of red meat and taking an iron pill 2x/week). Once I started taking the liquid iron in OJ EVERY DAY, it was remarkable how much better I felt.... AND to see my times start to drop dramatically in workouts and races (~7 PRs last year). I've continued taking the liquid iron + OJ every day and my times continue to improve (~4 new PRs this spring). Last time I got my ferritin tested it was 78, so 78 (for me) = "feel good". Not only should you know your ferritin when you "feel bad" (why wait until you feel bad?!), but you should know it when you "feel good" (~what's right for you).

I just wanted to get this out there cause I believe it's a real problem that isn't being taken serious enough. I agree with Nate that if you want to get the most out of your body, you need to "be healthy".... and being healthy as a distance runner isn't the same as being "normal" for a sedentary person! There's a gazillion articles on this topic:

This guy says you have to be on supplements to have a ferritin above 50: http://www.trackandfieldnews.com/hs/coachscorner/20051215.html

http://www.runnersweb.com/running/rw_news_frameset.html?http://www.runnersweb.com/running/news/rw_news_20050817_PPO_Iron_Deficiency.html

http://www.pfitzinger.com/labreports/iron.shtml

[Camille Herron]

Hi Marco, sorry for not getting back to you any sooner! I've always heard liquid iron is the best because it's more easily and quickly absorbed (liquid vs. solid). Dr. David Martin at Georgia State says because iron is absorbed in the first part of the small intestines, breakdown of iron pills does not occur quick enough to ensure absorption. Thus, he believes liquid iron (ferrous sulfate elixir, ferrous is the absorbable form) is optimal.

[Marco Dozzi]

One more question, Camille (or anyone else): why liquid iron instead of pills? Is it just a matter of getting MORE iron, or does it have more to do with the absorbing process?

[Marco Dozzi]

Great response; thanks. I'll see what I can get at the doc's office, and will post again if I have any further questions/comments.

[Camille Herron]

The tests I get done are the Comprehensive Metabolic Profile, ferritin, TSH (thyroid), and CBC with Differential (looks at RBCs/morphology and immune cells). They don't draw very much blood (but it's not a finger prick!)-- not enough to affect how you feel. The ferritin will specifically tell you your iron status (even the low end of "normal" may not be good for you). If anything looks funny with the Red Blood Cells (~RBC count, hematocrit, hemoglobin, mean corpuscle volume, red cell distribution width), you may want to get further tests to see if you have a B vitamin deficiency (which is also under-recognized in distance runners, ~B vitamins needed/used for aerobic metabolism).

I work in a foods and nutrition lab and some of the grad students told me ferritin has a short half-life, meaning it has a rapid turnover. So I would imagine the "hit" to ferritin stores is pretty significant following a long, hard session or a period of hard training, and also that there is a huge need to refill those stores soon to feel normal again. Since I started taking the liquid iron + OJ every day (and I take it right after my longer run for the day), I'm assuming it's helped keep my ferritin stores more stable because I feel like I recover better/not dragging so much after really long, hard runs. So it would make sense that overtraining is linked to iron status.

[Marco Dozzi]

Hey guys, I'm going to be training at high altitude starting a month from now, so I'm going to take Camille's advice and get my iron tested in case I need to correct for any possible deficiencies before I get up there. My question is: is ferritin the only thing that needs to be checked with iron-related blood-work? I thought I'd heard there are other things related to iron levels one can or should get checked. (Also, can I do this just by getting a pinprick on the finger? I hate those I.V. blood tests.)

Also, I was wondering if over-training can itself cause low iron levels. Occasionally I will feel like crap for a few days at a time, to the point that it seems to be more than just fatigue from a workout or a couple of days of long/hard running, and I was wondering if this could be related to my iron levels dropping from the over-training (making the existing problem worse).

[Nate Pennington]

Thanks Camille. I will certainly order Dr. Wilber's book. He has tested me at the OTC and is a great guy. I did not know he had a book. He is the authority on athletic testing and will certainly add it to my collection. Thanks and your dead on in regards to ferritin levels. I will write more later today in regards to that.

Best Wishes,
Nate

[Camille Herron]

Sure, I want to help. I'd recommend the book "Altitude Training and Athletic Performance" by Randall Wilber (Chief Physiologist at the OT Center in Colorado Springs). It's the most thorough and practical book out there on high altitude training. He recommends getting your ferritin tested at least a month prior to going to high altitude and correcting for any deficiency. As I mentioned, red meat + an iron supplement (2x/week) wasn't enough for me (as I found out after a month of being there!).

[2012 OTM]

Thanks for this. I have two female athletes, one who will be going to altitude for a month for the first time, and I have been thinking about having her take an iron supplement. Now I will definitely have her get checked and supplement!