Low Ferritin and Anemia

Audio Transcript

Claire: Hello Runners Connect fans. Today’s question is another nutrition question and it’s from Jackie.

Jackie: Hi, my name is Jackie.

Early this winter, I noticed that I was increasingly tired and my run seemed to be a real struggle, but I thought it was my mental game and I was just pushing through.

I visited my doctor and she ended up taking my blood and determined I was anemic.

My ferritin level was at 5.1. I began taking iron supplements three times a day, and slow down on running for three weeks.

My ferratin level came up to 13. I then began running more and when I had my levels checked this week, they were basically quickly climbing.

I was up last at one point, so I guess my question is, what should I do from this point? I still want to train and obviously I love running, but how can I get my iron levels up? Thanks.

Claire: I can relate to your question Jackie, as I have suffered from anemia before. I have to pay careful attention to my diet, and I know where you’re coming from.

Let’s first of all go over the role of iron and why it’s important for life and especially for athletes.

What iron does, is, it’s a micro nutrient that transports oxygen and helps produce energy. It’s absolutely critical for life and for exercise performance.

Athletes, and in particular female athletes, are at a higher risk because we lose iron, not only through exercise but also through menstruation.

Treatment for a deficiency of iron includes oral supplements, injections, IV infusions and dietary modifications. With the more pharmaceutical options, there are side effects; constipation, nausea, iron overload. Starting with your diet is definitely preferred.

Let’s talk about some definitions here. What exactly is anemia?

Anemia is low hemoglobin or low red blood cell count. It’s common in athletes and scientists aren’t exactly sure why.

Part of it is because athletes have a lower red blood cell count concentration in their blood and that’s because of the beneficial adaptations from exercise.

When you exercise a lot and you become very fit, there’s an expansion in your blood volume and so that means there are fewer red blood cells in your blood.

It’s because your blood is expanding, you’re bringing more oxygen to your muscles, so that’s a good adaptation.

When you take one sample of the blood, it’s going to have fewer red blood cells than if you had more concentrated blood.

That’s called pseudo anemia and scientists don’t think that that’s actually a problem, but your blood is going to look a lot different from somebody who is sedentary.

An iron deficiency is really the first stage of anemia, and that is characterized by low ferratin.

Ferratin is how we measure how iron is stored in the body. It’s more common in athletes as well, but only a small number of athletes have both anemia and low ferratin, so it sounds like you are definitely falling into this category.

How do you increase your iron?

Studies using dietary iron treatments are pretty rare. A lot of these studies that are out there look at supplementing through pill form, IV or muscular injections. It’s harder to exactly figure out how effective diet is but definitely that’s the low hanging fruit, so you want to try to work on your diet first.

Unfortunately, it’s much harder to dig yourself out of an iron depleted state without some kind of pharmaceutical treatment.

It sounds like you have both anemia and low ferratin, so what is normal? An average man should have somewhere between 12 and 300 nanograms per milliliter, and women should have an average ferratin level of 12 to 150 nanograms per milliliter.

If you think about those numbers, that’s a huge range, so obviously some people are on the low end and some people are on the high end and more is not necessarily better; it’s just individual.

At about 13 nanograms per milliliter, your doctor may think that you’re on the low end of normal.

You’re an athlete, so 13 is still pretty low and you’re not going to be able to perform to your potential without getting that number up.

You need to feel better and you need to perform well, so you really are going to have to boost that quite a bit. Most trainers and coaches want to see that number get to about 20 to 70 nanograms per milliliter, but again everyone is different and you need to see what works for you to feel better.

One question that you brought up is, should you stop running?

That’s really hard to say, that you should stop running.

Regular exercise is so important for every function of the human body and it makes little sense to tell you to stop.

Yes, you lose iron while running and sweating, but this is true for all sports and it’s a myth that low iron only affects runners.

It’s been shown that sports that rely more on mixed sources of energy supply, that is mixing ng aerobic and anaerobic are more at risk than endurance runners or sprinters.

Sports like rowing, volleyball, soccer and certain track and field events, are actually harder on our iron stores than just running.

You may have heard that when we run, the foot strike will crush some of our red blood cells and that will in effect change our iron stores, but actually swimmers get affected by low iron too and they don’t have any impact.

It’s not true that it only affects runners; it affects all athletes and science is not clear on what’s going there.

What I would recommend for you Jackie, is it sounds like you have a harder case than most. I would recommend talking to your doctor about potentially getting an injection, either inter muscular injection or get an IV infusion.

If she is not used to treating athletes, you might want to get a second opinion from a medical doctor.

I am not a medical doctor of course, but it would be smart to get somebody who is used to working with athletes, because this is not a rare occurrence to have such low ferratin levels.

Many elite runners have talked about how an iron infusion has helped them get to a baseline quickly. They have been successfully able to maintain their iron levels with diet after they’ve dug themselves out of the hole with a medical grade iron injection or infusion.

Full disclosure here: I’m a vegan athlete and I do very well on a diet with occasional supplementation, but I get my iron and ferratin levels checked.

By the way, you have to ask for your ferratin levels to get checked.

It doesn’t just come back in a normal blood work, so you have to specifically ask for ferratin levels.

I am going to talk about all kinds of different diets that can help you with increasing iron.

I pay a lot of attention to my iron levels simply because I don’t eat meat, so I can tell you first hand that it is possible to eat an iron rich diet without meat.

Obviously, red meat, sea food, clams and liver are all animal sources that are very high in iron.

Some plant-based sources are green leafy vegetables, whole grains, beans, fortified cereals like grape nuts or total dried apricots.

One of my favorites is black strap molasses.

I make an alternative hot chocolate with black strap molasses and it’s delicious. That’s something I like to have at night, and it helps me with iron and magnesium levels, so that’s a smaller addition that you might want to make that would help.

Some other dietary things that help absorb iron; vitamin C seems to work with iron to help you absorb it better.

An example of a great iron meal would be a nice spinach salad with a lemon vinaigrette, or go ahead and have your grape nuts for breakfast, but have a glass of orange juice with it.

Although there are some things that are going to inhibit iron absorption, like coffee, tea, and calcium. So that breakfast with grape nuts and orange juice, well you can’t really have the milk and the coffee with it, so you kind of have to figure that out and try to take your calcium rich foods at a different time.

Another thing that seems to help, although there isn’t a lot of science that backs it up, but it does seem to help to do most of your cooking in cast iron pans.

It’s said that the iron from the cast iron pans gets absorbed into your food, and that helps you increase your level a little bit as well.

Ultimately, if you are still tired, and your performance is off, that means that you need to get more iron, and if you are doing everything you can, as far as supplementing three times a day and making sure you eat enough calories, make sure that you have a iron rich diet.

If you are doing all of those things right, you need to talk to a doctor about getting some more intensive dose because something is off there and it’s not just your running that seems to be the problem.

What you have is common and can be treated. It looks like you need to get a little bit more help from your doctor in solving this problem.

I hope that helps answer your question Jackie. Thanks for sending it in.

That’s it for me for the week.

I’ve had another great week of answering your questions so don’t forget to send in yours at runnersconnect.net/daily.

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Thanks for listening and have a great run today.