Adventures with Iron Deficiency, Part 3

(Once more for those in the back -- I AM NOT A DOCTOR OR NUTRITIONIST. I basically just read the internet. Below is what worked for me, but that doesn't mean everyone should do it, and you should definitely *definitely* not start taking an iron supplement without having your levels checked because you CAN get iron poisoning, and some people have a condition that keeps their iron levels abnormally high. Just sayin'.)

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We've been talking iron deficiency (not the same thing as anemia) this week on the blog. You might want to catch up on Part 1 & Part 2 before dividing into Part 3, in which we talk about how I ultimately fixed my low ferritin issues.

Adventures with Iron Deficiency, Part 1

Adventures with Iron Deficiency, Part 2

When we left off, I'd just learned about a month before the Boston Marathon that my ferritin was at 13 ng/mL. Normal for sedentary couch potato pre-menopausal women is 12-300 ng/mL, but female athletes training a lot--particularly runners--generally need to be around 30 ng/mL at a bare minimum and many feel weak and exhausted unless they're closer to 45 or 60.

I'd also learned that raising low ferritin numbers often requires getting 60-180 mg of iron a day (four to 12 times the couch potato recommendation of 15 mg per day) and I'd been eating more like 22 mg. And, also, that it's virtually impossible to consume this much iron through food alone. Ergo, supplements.

There used to be this idea that liquid iron was the most effective way to supplement and that the pills didn't work as well, but in my research I learned that there is no scientific evidence for that and although some people feel like the liquid works better, scientific studies showed that people get the same results regardless of which they used. The liquid tastes bad, stains your teeth, & is a pain to take & a pain to travel with, so most people these days opt for the pills.

There are some important things to know about taking an iron supplement, most of which (again) I learned from John Davis's extremely rigorous & informative article on the subject.

• Read the label. You want a pill with around 65 mg of elemental iron, but it's easy to get confused when you pick up a bottle and see that it contains, say, 325 mg of ferrous sulfate. That's not how much iron is in it; it's how much of the iron-containing compound is in it. Check the back for the number called "elemental iron."
  
• Avoid the ones with a slow-release coating. Iron supplements can cause GI issues and this is designed to help prevent that. However, there's also some evidence that it interferes with absorbing the iron, and you don't want that.
• Always take them with vitamin C. The vast majority of iron pills are non-heme (plant source) iron, meaning you only absorb 2-20% of it. Vitamin C increases iron uptake so it's a good idea to add ~100 mg or so with the iron. (Don't overdo it with the Vitamin C, though; as Davis points out, too much Vitamin C can interfere with training adaptations.)
• Take them on an empty stomach if you can. There are a lot of minerals and other chemicals in food that interfere with iron uptake, so it's just easier if you avoid taking them with any food at all.

What I did:

• I got this bottle at Walgreens & the pills are 65mg elemental iron. I took one first thing in the morning and one right before bed. (Right before bed maybe wasn't great timing since I was doing evening workouts, so in the future I think I'd do it right after.)
• For the Vitamin C you can do orange juice, tomatoes, blueberries, strawberries, etc., or you can just take a pill, or part of one. (Most Vitamin C pills contain more than any human possibly needs or can physically process.) I just did 1/4 of a 500mg vitamin C pill with each iron pill.
• Don't be shocked if you have some GI issues, at least at first. It's super common and I found it was true for me in the first week or so. BUT THEN, it did get better, so there's that.

I took the iron pills through Boston & then stopped. Right before we left I had my levels tested again, and tada! My ferritin was up to 45 ng/mL. Not bad!

One last note about ferritin levels--It's not really a *great* idea to base any decisions about supplementing on one single blood test number. It turns out the numbers actually vary a LOT from day to day, and can spike if you've been sick. The main way that it's useful is to have it tested regularly, and to keep some sort of record of how you were feeling when your number was a particular thing. Some people feel great at 30 ng/mL; others feel like shit unless they're closer to 90. The thing is to figure out your particular pattern and where you need to be to feel good. I definitely started to feel better around 40/45 both times, so that's good info for me.

Some people recommended getting tested at the beginning & end of each big training cycle or season (so, 2-3 times per year?) but it just depends on how much it's an issue for you. Also if your doctor/insurance will okay it.

(That said, in his article, John Davis recommended a few services that do private blood work for individuals at reasonable rates, if that's a thing that's important to you. I am always very cautious of getting & interpreting blood work without a doctor, but with running & ferritin in particular, I feel like I have a solid enough understanding of my body & what has worked for me in the past that I'd consider it.)

These last few weeks as I've been relaxing and recovering from Boston/Big Sur, I haven't been taking iron, but I think I'll probably go back to taking it twice a day once I start training again (probably one in the morning on an empty stomach and then one immediately after my afternoon/evening run, an hour or two before eating). I'll be interested to see if maybe starting iron from the beginning of the training cycle will help me avoid that awful sleep deprived/low blood sugar feeling as I start to build up mileage. I don't really feel the need to get my ferritin tested again right now, but it might be interesting to do it again, say, after RNRSJ. We'll see how things go.