Ode to Fe

You don't know what you've got until it's gone? Well, maybe. In the case of hemoglobin and running, that cliché is spot on.

Hemoglobin is a protein that is extremely important to running performance. They're the little helpers inside your red blood cells that carry oxygen throughout your body and also take away the carbon dioxide. Iron is a big part of what makes the process work.

Life without enough hemoglobin is tough. Most runs, I felt just drained.  My normal pace was running about a minute and half slower than usual. I felt like I was dragging through my runs. I was breathing harder and felt like my oxygen had just gone missing. My heart was working way too hard (increased heart rate). I had nothing to give. After 3 months of difficult run after difficult run, I went to see the doc. Diagnosis: anemia. For the first time in my life, I was told to take iron supplements. I also had to make sure I was taking my B vitamins and folic acid on a regular basis rather than just whenever I got around to remembering.

Let's face it, new stuff is scary. I started doing what it is that I do when I feel like I might have missed the clue bus. I started researching. Anemia is a symptom of something else gone wrong. Once you are anemic, they are on the search to figure out why you got that way. There are a lot of things that can cause it. Women are more susceptible due to menstruation. Runners are more susceptible. Vegetarians are more susceptible. While I'm not a vegetarian, I cannot eat read meat due to an allergy and haven't had any in almost 7 years. Red meat happens to be our best and most easily absorbed form of iron (heme). Iron from dark leafy greens and veggies is referred to as non-heme and is less easily absorbed by our digestive system. While I am still not 100% certain at this point what led me to my current situation, I have learned some useful tidbits for runners. Here are the cliff notes for your general edification and perhaps increased running performance.

There are over 400 types of anemia which are divided into 3 groups: anemia caused by blood loss, anemia caused by decreased or faulty red blood cell production, and anemia caused by destruction of red blood cells.

Normal Levels of hemoglobin in the blood (source):
Men: 14 - 18 gm/dL
Men after middle age: 12.4 - 14.9 gm/dL
Women: 12 - 16 gm/dL
Women after middle age: 11.7 - 13.8 gm/dL

"...for an endurance athlete, the lower end of normal should be extended by about 1 gram per 100 ml, due to our larger blood volume." - source Pfitz

Lack of iron can lead to anemia but so can lack of folic acid or B12. Iron deficiency is the most common (source).

Within two weeks of taking iron supplements, hemoglobin and hemocrit levels should begin responding to iron supplementation (source). It can take up to 3 months to get iron stores back (source: my doc).

Certain medications / vitamins decrease iron absorption:
Antibiotics
Certain antibiotics including Cipro (source) which I was put on for Peru belly and Penicillin (source) which I was put on for my tooth.
Calcium (source)
This means if you are taking calcium in a multivitamin, you should be taking your iron supplement 1 hour before or 2 hours after your calcium.
Antacids
Some types of antacids can block iron absorption by the body. Pepto-bismol is said to reduce the chance of travelers diarrhea by 65% (source) so I was taking it every day while in Peru. Oops.

Other items of interest:

Vitamin C increases iron non-heme absorption (source). Order the salad with dark leafy greens and mandarin oranges or strawberries.

Training at altitude can lead to iron deficiency as your body tries to increase your red blood cell volume to account for the lack of oxygen (source). If you are coming from somewhere low (say... Ohio), and training somewhere high (say.... the Inca Trail), make sure you get plenty of iron rich foods.

Ferritin is the level of iron stores in your body.  It's important, too.

Having too much iron in your system can cause big problems so you shouldn't be taking iron if you don't need it.

Coffee and tea reduce iron absorption (source). If you like your coffee in the morning, then it isn't a good time to take your iron supplement.

If you don't have insurance or a doctor, you can pay $29 through DirectLabs to get a CBC (complete blood count).

Obviously there is a lot more to anemia than what's above, but I thought this was good info for the runner. It showed me that I still have a lot of good stuff to learn about endurance training and one of God's greatest gifts: the human body. If you are feeling continually run down during your workouts, a blood test might be a good place to start. Your iron level can make a difference in performance (source).

Here are a couple of great blog articles about anemia and running from two top-notch runners:
Lauren Fleshman
Camille Herron