By: Coach Kate Van Buskirk
What is Iron Deficiency?
There are two prevalent forms of iron deficiency: iron deficiency anemia, and iron deficiency non-anemia. Anemia occurs when your body doesn’t have enough iron to produce hemoglobin. Hemoglobin is the part of red blood cell that carries oxygenated blood throughout your body. If you don’t have enough iron in your system your body can’t produce enough hemoglobin, and iron deficiency anemia may eventually develop. Iron deficiency non-anemia occurs when hemoglobin levels are sufficient, but ferritin levels are low.
What to Look For
Symptoms of iron deficiency/anemia often include (but are not limited to):
- Extreme fatigue
- Pale skin
- Shortness of breath
- Cold hands/feet
- Lack of motivation
- Brittle nails
- Fast heartbeat
- Restless leg syndrome
What Causes it
There are four main causes of iron deficiency:
- Blood loss
- Iron-deficient diets
- Iron absorption issues
So obviously, one of the four causes listed above is easy to fairly immediately rule out; if you are pregnant, congratulations! If not, lets talk about what else might be leading to low iron, and how to deal with each cause.
2. Blood Loss
One of the realities for female athletes is that even those of us who have light or intermittent periods are still losing a decent amount of iron through menses; those with heavier and regular periods are losing even more. Many of my female runner friends have experimented with contraceptive pills to regulate their periods or decrease their monthly blood loss, with varying results. I personally wanted to try an approach that involved as little hormone adjustment as possible, and was encouraged by both my family physician and my sports med doc to consider an INTRAUTERINE DEVICE. I opted for the MIRENA, a non-copper, low-dose localized progesterone device inserted in the uterus by an MD. Most women experience lighter and shorter periods with the Mirena, which means less monthly blood loss and subsequently less iron loss. *Learn more about the Mirena HERE.
In October 2012 I opted for the Mirena, a “levonorgestrel-releasing system placed in your uterus to prevent pregnancy for up to 5 years…and also treats heavy periods”. The Mirena releases a low-dose of progestin locally into the uterus; it is estrogen-free, is non-systemic (ie; it is local to the uterus and therefore only a very small amount of the hormone enters your blood stream) and can be reversed by removal at any time. It is available by prescription only, and unless you have medical coverage, it is a fairly big chunk o’ change up front: the Mirena put me back about $400. However, it is effective for up to 5 years so over the long run its much more affordable.
My experience with the Mirena has been overall positive, although the first 3 months or so came with their challenges: a lot of discomfort (bad cramping after hard runs/workouts and following intercourse), intermittent bleeding between periods, and increased cramping during periods. To be honest, it wasn’t great. But these side effects are normal and settled down significantly about 3 months in. Since then, I have noticed a major decrease in blood loss and cramping; I actually stopped getting a period altogether for 3 months during the racing season, and when menstruation resumed this fall it has consisted of very light, short periods.
3. Iron-Deficient Diet
This is one of the most obvious and talked-about reasons for low iron. In my case, it was especially pertinent. I was a VEGETARIAN for 15 years, from age 10 to 25, and didn’t eat any meat or fish during this time. I have always supplemented with various iron pills and ate iron-rich foods (cereals, green leafy veggies, pumpkin seeds, etc) and was able to keep my ferritin levels acceptably stable throughout university. However, I always knew there would likely come a time in my athletic career when I would need to reconsider my vegetarian lifestyle. When my ferritin levels dropped below 20 a few years ago and I couldn’t elevate them on my own, I decided to slowly reintroduce MEAT AND FISH into my diet. I didn’t experience any major digestive issues as I started eating animal products again, and for the past year I have maintained a diet that includes RED MEAT at least 2 times per week, and fish once every 1-2 weeks. I had a tough time coming to terms with becoming a meat-eater because my choice to be vegetarian was based on a lot of issues that I felt (and continue to feel) very strongly about: inhumane raising and slaughter practices, deforestation for grazing land, hormone-laden meat, overconsumption of animal products in the developed world, etc. But I am trying to remain mindful of these and be a conscientious and responsible consumer.
I also learned a lot more about SUPPLEMENTATION. Based on my research and information from my various doc’s, here’s what I’ve discovered: There are 3 main types of iron supplements: FERROUS GLUCONATE, FERROUS SULFATE, FERROUS FUMARATE. For years I was using a ferrous sulphate supplement, but recently learned that ferrous fumarate contains the highest percentage of elemental iron: 1 gram of ferrous gluconate = 120mg of elemental iron (12% iron), 1 gram of ferrous sulfate = 200mg elemental iron (20% iron), and 1 gram of ferrous fumarate = 330 mg elemental iron (33% iron). It can also be one of the hardest types on the gut. I started taking EURO-FER, which is the generic–and much less expensive–version of PALAFER (both available over the counter at Shopper’s Drug Mart in Ontario), 200mg/day (2x100mg) on an empty stomach, one tablet right before bed and one in the middle of the night when I invariably wake up to go to the bathroom. I didn’t notice any stomach discomfort but did see positive jumps in my blood ferritin levels. The other supplement that I take is PROFERRIN, a synthetic HEME IRON supplement. Heme iron is only found naturally in red meat, and even if you are a meat-eater, it is good to supplement with a heme tablet on days that you don’t consume animal products.
4. Iron Absorption Issues
Finally, even if you are ingesting an adequate amount of iron through diet (meat and plant products and supplementation) there are a variety of reasons why your body may not be properly absorbing this iron. Here are a few culprits from my case:
COFFEE: I love coffee, but have had to be really mindful of my consumption. Caffein inhibits iron absorption the gut, so reducing your coffee intake, especially within a few hours of taking your supplements or eating red meat will help a lot.
CALCIUM: Similar to caffein, calcium inhibits iron absorption. If you take a daily calcium supplement, make sure that you don’t take it within several hours of your iron. Also, avoid dairy products around the time you ingest iron.
STRENUOUS EXERCISE: Anytime you work your body to the point of lactic acid accumulation, you are exposing your gut to increased levels of inflammation which in turn reduce your body’s ability to absorb nutrients to their greatest potential. I try to time my iron supplementation to be as far away from hard workout sessions as possible. I also try to eat red meat on non-workout days, since on recovery days your gut will be less inflamed and will therefore be more likely to utilize and absorb the iron.
In addition to avoiding certain foods/exercise at the time of iron intake, you can boost your gut’s absorption potential by combining your supplementation with VITAMIN C, which promotes iron absorption I try to take my iron tablets with a glass of orange juice or a vit. C supplement.
Another avenue I explored was UREA BREATH TEST to check for the presence of the H. PYLORI bacteria *learn more about this here: http://www.cbc.ca/news/technology/diagnosing-stomach-problems-check-your-breath-1.851635
Please note: this information is based entirely on my own research, personal experiences, and advice from my physicians and team staff. I am not an MD, nor an expert on iron issues for runners. However, I hope you all found this information as useful as I did.
You have one life to live. Run for your life.
Mayo Clinic: http://www.mayoclinic.org/diseases-conditions/iron-deficiency-anemia/basics/symptoms/con-20019327
About Pace & Mind
Pace & Mind is an advanced coaching service for runners. We offer advanced and highly customized 5k, 10k, half-marathon and marathon coaching for runners to improve their performance both on and off the road. Our coaching is based on the principles founded by Head Coach and Co-founder Rejean Chiasson, a Canadian marathon champion, 4x half-marathon medalist and Brooks Elite Ambassador. He is supported by our Online Run Coach, Kate Van Buskirk, an internationally accomplished track and field athlete, bronze medalist at the 2014 Commonwealth Games and Brooks Elite Ambassador. Unlike traditional ‘cookie-cutter’ or ‘clinic’ approaches to coaching, our Coaches first assesses, then customizes each runner’s training program based on:
INDIVIDUALITY * PROGRESSION * RECOVERY * MOTIVATION * COMMITMENT * COMMUNITY
Coaching programs are powered by TrainingPeaks software to ensure data accuracy. No runner’s program is the same and it constantly changes season by season, cycle by cycle. Our Coaches review your plan in detail each week, then adjust based on your progression and listens to you in terms of changes in nutrition, mental state and cross training efforts. Each runner also receives a cross-training plan and a racing singlet as part of the program.
You have one life to live. Run for your life.