Adventures with Iron Deficiency, Part 2

(Once again: I am not a doctor, nutritionist, dietitian, coach, etc. and have absolutely no formal training whatsoever in medicine, diet, sports training, etc. and probably no one should listen to me about anything. Everything I know, I've learned from reading or talking either to people who ARE experts or other female runners who have had similar experiences. This entire blog is just Some Lady Rambling on the Internet and if you are getting your medical and/or training advice from me something in your life has gone very, very wrong; please go pay an actual expert actual money.)

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So, last time we were talking about iron deficiency--what it is, and why runners (especially female runners) might care. You can read Part 1 where I discuss my first experience dealing with iron deficiency & some things I learned about it here.

All caught up? Excellent!

Fast forward to about a month before the Boston Marathon. In my first couple months of training I felt amazingly good--workouts were easy, and I had no trouble hitting the mileage. After that (as you know if you've been following along), I had some injuries and got really sick one week, so I would never in a million years have thought that I was training hard enough to mess with my iron levels.

Still, I kept getting that same feeling I remembered from when I was training for Eugene; just exhausted all the time, hitting workout paces starting to feel way, way too hard (and for the first time I can ever remember, sometimes actually impossible), and that sleep-deprived/low-blood-sugar, knock-me-over-with-a-feather feeling while running, even just on short easy runs.

For a while I was chocking it up to stress, losing fitness from all the missed miles, and maybe just getting old. But chatting about it with Don one day, he was like, "When was the last time you had all your blood work checked? Could it be iron or thyroid or something?"

I had just had my thyroid levels checked recently [I have hypothyroidism] because I was starting to have some of the symptoms I associate with low thyroid levels (mainly feeling tired and really cold all the time) and they had been normal. But then I started thinking about the iron question because it can have some of the same symptoms. (Low ferritin is also often associated with hypothyroidsim.)

"Surely I'm not training that hard?" I thought. But, I mean, I was still doing a lot more than nothing, so maybe it was possible?

I started looking into the diet part of it just out of curiosity, which I'd never done before. Like, how much iron was I actually getting, relative to how much I needed as a female distance runner?

First, if you're just a normal, not-that-active, pre-menopausal lady, supposedly you need something like 15-18mg per day on average, just to stay in that "normal" 12-300 ng/mL range.

Here's what I was eating in a typical day:

• Breakfast: 3 eggs with spinach & peppers + Greek yogurt with granola, coconut, & almonds - 4 mg
• Lunch: 1/2 green salad with chicken & beans + 1/2 turkey sandwich on wheat with veggies & goat cheese - 5 mg
• Mid-afternoon snack: same as lunch - 5 mg
• Dinner: Dinner varies a lot, but let's be REALLY OPTIMISTIC & say I was eating a really super iron rich dinner, like a hamburger or lamb curry plus a salad or some other vegetable - 7mg

  Total: ~21 mg

So, like. Pretty decent, right?

Sure, if you're just a normal, lightly active lady, but if I was feeling so terrible with my ferritin at 17, I wasn't convinced just a few more grams above the normal recommendation was going to cut it for me.

Given that I'd had low ferritin before, I decided to just ask my doctor for a blood test & see what it said. Lo and behold, my ferritin as of late March was 13 ng/mL--even worse than the last time. Like, sure, in the technically "normal" range for couch potatoes, but just barely. And most definitely not cutting it for someone training for a marathon. Most coaches and others who work with female runners seem to view 30 ng/mL as the bare minimum, with most women feeling and performing better in the 45 ng/mL range, so I decided to shoot for that.

I found the John Davis article I've been referencing when I started looking into how to improve my low ferritin. Eating hamburgers non-stop had gotten me to 37 before, but just pounding red meat didn't seem like perhaps the most optimal route out there health- or environment-wise.

From the article:

"Alleyne, Horn, and Miller recommend a dose of 150-200 mg of elemental iron per day. Though this paper concerns iron deficiency with anemia, that range is a good starting place for runners with low ferritin.

In a 1989 paper in the Journal of Pediatrics, researchers in Wisconsin reported that a dosage of 60 mg of elemental iron per day was able to prevent iron deficiency in 65% of female cross country runners, but the remaining 35% needed a dosage of 180 mg per day.

Notably, they also found that dietary counseling failed to increase dietary iron intake in any meaningful way. This suggests that most iron-deficient athletes can't recover simply through dietary interventions—a supplement is the best way to go."

Yeah; I was getting 21 mg per day, on a good day. Clearly, not gonna cut it.

And, I totally get that just telling women to eat more iron rich foods like x/y/z didn't work. Because here is what no one tells you about iron: Almost NOTHING is rich in it, besides red meat and liver. There are listicles about "iron rich foods" but they're all lies; there are foods that have MORE iron in them than others, but that's really a matter of "some trace amounts of iron" vs. "basically no iron at all."

You thought spinach was rich in iron? HAHAHAHA. Oh, young padawan. Your spinach salad with 1-2 cups of the stuff nets you .8-1.6mg. Good luck getting to 60 or 100 or 180 mg with that.

Even worse, plant iron sources are what is called non-heme iron, which means it's less bioavailable and you absorb even less of it. You absorb 15-35% of heme iron, but only 2-20% of non-heme. (I'm not dissing on vegetables or vegetarians--just lamenting the nutrition facts.)

Even worse, calcium significantly decreases iron absorption as well. You thought you'd have a nice hamburger with cheese? Congratulations! You just decreased the amount of iron you get from that burger by 50-60%. Well done.

You know what else interferes with iron absorption? Eggs, phosphorus, tannins & polyphenols (found in coffee, tea, & wine), zinc, calcium, magnesium, and copper. So even consuming 21 mg of iron per day, who knows how much of it was actually working its way into my body.

So, yeah; it seemed that in order to have any hope of raising my iron to useful levels, I was going to need to take some kind of supplement.

Part 3: How I Fixed My Ferritin Levels