My pre-teen daughter is healthy but ferritin is only 12 -- should we supplement?

Concerned Dad,

It sounds like you want what's best for your daughter, including taking her to the doctor & posting on letsrun/trying to get more information.

If you're concerned about raising her iron levels, could you possibly find a vegetarian dietician in your area to work with your daughter AND your entire family to create a vegetarian meal system to aid in her health? (You want to make sure your daughter is NOT a "junk food vegetarian.")

The above two posters give you perspectives on the issue. (The first, by the way, sounds A LOT like FSU coach Karen Harvey. I've seen her speak a couple of times & the language/word choices sounds EXACTLY like her.) The second gives ancedotal evidence that running & vegetarianism can, in fact, work hand-in-hand.

I suspect having a good (vegetarian) meal plan can allow your daughter success with her morality (i.e. vegetarianism) AND with her running.

Good luck!

Veggie Coach[/quote]

what does morality have to do with being vegetarian? Are you saying it's immoral to eat meat?

Indoor? wrote:

Most Doctors don't have a clue about blood.

Right, but the slack jaw morons on LRC do!

OP, can you add molasses to her diet?

I hate to say this but vegetarianism or veganism in teenage girls, at a time when they're growing, can often lead to it being hard to fulfill their energy requirements and can also lead to eating disorders (energy deficit can be a trigger in susceptible people). It must be hard for her to go out with her friends and at times she might have to miss things out because of the near veganism.

I can see you're not vegetarian so I'm pretty sure it may have not come from you, but teenage girls are the one group of people I'd be very wary of near veganism in. Good luck with it all.

My ferritin level has averaged around 20, this definitely affects my running. I have taken iron supplements and vitamin C for up to six weeks at a time and also included blackstrap molasses in my diet. This has raised my ferritin level to 55-70. Hope this helps.

Here are some articles that talk about low iron in runners.

http://www.trackandfieldnews.com/hs/coachscorner/20051215.html

http://runningtimes.com/Article.aspx?ArticleID=4009

http://www.running.net/read_feature/low-iron-may-have-you-feeling-fatigued

I am not Coach Harvey, but I am a male who has had to learn a great deal about iron issues over the past decade.

I never said it was impossible to be vegetarian and have high ferritin levels, just hard and I should have included "for some people". Some people have the ability to absorb more iron through non-heme sources than others. I have worked with a vegetarian ultra-marathoner. She did not run super high mileage, but would usually do 18-25 mile long runs every other week. She was also a nutritionist who knew what to eat and when to eat it. I also worked with a 3k-5k runner who ran 55-70 miles per week that was a vegetarian who had a ferritin of 3-10. She was a nutrition major and knew a great deal about her diet. When she started eating red meat again, she got back up to 30-40 and dropped over 1:30 minutes off her 5k. Just like in training, everyone is going to be a little different.

When looking at the absorption of heme vs. non-heme, there really is a big different. You usually absorb between 10-30% of heme iron compared to 2-10% of non-heme iron. When eating non-heme iron you also need to stay away from certain foods and minerals. These would include, calcium, magnesium, caffeine, bran and antacids. I also tell my runners to take a multi-vitamin at completely different times from when they take an iron supplement or are eating there pre-determined "heavy" iron meal.

Going back to the original subject, look at what her ferritin is right now, 12. That is without menses and high mileage, so think about what is going to happen in 1-2 years. I think it is great that you are a father who is figuring this out about her before she starts losing 30 mL of blood everyday during her cycle. That is around 0.5-0.6 mg of iron per day.

It would be a very smart idea, as previously mentioned, to find a good nutritionist. You should also plan on getting blood work done 3-4 times a year to find an average ferritin number, along with wbc, hemeglobin, hemocrit ect.

Your daughter's hct and hgb look solid, so there may not be an iron problem.

I'm a hematologist with a 13-yo daughter.

Your daughter is not anemic (hgb of 14 is verý good for a young girl). She is hypoferritinemic, which can lead to anemia.

You are right in everything you say. You know the cause (her diet; maybe periods?). You should treat with an iron supplement and monitor ferritin. What supplement? Whatever your daughter can handle. Iron will give her abdominal cramping and constipation to some degree, so that's the limiting factor for most. There is no other side effect, so you can't take too much of it.

You may not want to hear this, but if she is losing blood (ie. iron) from heavy periods, she should consider going on a birth control pill. It's never a bad idea for a teenage girl anyway.

Overall, this is not serious. It's a pre-problem and it seems like you can nip it in the bud.

I have to disagree with the idea of birth control for everyone. Birth control can effect a women's testosterone and estrogen levels to the point that they are not getting recovered from even regular running sessions. Again, everyone is different but this can happen.

Eat red meat. Get it locally from farmers or hunt so that it isn't contaminated with chemicals and is treated humanely.

I'd be much more worried about the crazy dad and the doctor quacks.

Leave the poor girl alone and allow her to be healthy.

J.R. wrote:

I'd be much more worried about the crazy dad and the doctor quacks.

Leave the poor girl alone and allow her to be healthy.

The doctors are right, the LetsRun quacks are not. Low ferritin WILL make you tired, and if she's only 12 she probably doesn't even realize it as that is all she remembers.

You are right. Birth control is not for everyone. However, if a female athlete is getting anemic from heavy periods (and some women just have super heavy periods), then a trial of birth control pills (or local hormonal regulation with a Mirena IUD or Nuva Ring) are good options.

The "patient" in this setting is not even anemic, of course. She could very well be fine, even if she didn't take iron supplements.

Concerned Dad wrote:I would be grateful for feedback on my 12-year old daughter's low ferritin level and whether we should do something to boost it. I realize that there's controversy surrounding whether low ferritin is a problem (for performance or in general) if she is not anemic...

you really need to get a bit more clued up/realistic

she is doing helluva lot of physical work at young age & therefore her nutrional requirements are going to be helluva lot more than gameboy-kid

as a vegetarian this makes life hard

running can reduce blood cells thru traumatic haemolysis, which is no problem for someone with mixed diet, but with lowish ferritin, she has no Fe reserve to manufacture more RBC as demanded

this means she is vulnerable to go from normal haemoglobin to anaemic very rapidly

especially since she will start menarche soon enough

she will get into trouble then not just with running/training but "always tired"

put her on standard ferrous sulphate 200mg/day ( 1 tablet ) which is standard prophylactic dose which i put virtually every pregnant woman who walks thru my door on

( just watch out for tummy cramps/constipation, but it is a vitamin/mineral so it's not "bad medicine" ) & i'm told vitamin C helps absorption ( orange juice ) although i haven't looked that up

she may need to go onto 2 tablets/day at some point when getting older/more mileage/menses established

stop puussyfooting around :

if you brought her to my Practice & having an interest in sports, i'd put her immediately on prophylaxis dose of ferrous sulphate or fumarate or if digestive side-effects, one of the modified-release tabs which seem to be better tolerated

look :

this is an ( almost ) mandatory vitamin/mineral for any aspiring athlete NOT heroin !!!

As a female runner I had a ferritin level of 2 when I was 15 and felt super tired, didn't perform well in the classroom, and very bad on the track. All of this while eating quality red meat at least three times a week since my dad had a farm with grass feed cattle. I supplemented two or three times a day with 50mg and I felt significantly better within a few weeks.

From my point of view nutrition can help increase the iron level, but it never workout out for me. The doctors told me my body just simple doesn't absorb iron through my digestive system.

Since then I have been low a lot and actually got iron transfusions this summer after being down to 14 again which gave me a boost into the 60s. 3 months and a great XC season later I was back to lower than 10 and got transfusions again.

My advice would be to monitor it closely and supplement unless she has problems digesting the pills. If you only pursue to change her regular diet you will have to get her tested a few times the next months to make sure she responds to it. Ultimately transfusions are from my point the best option cause it is almost instant help.

what does morality have to do with being vegetarian? Are you saying it's immoral to eat meat?[/quote]

Yes. That is exactly what I am saying. For some vegetarians--myself included--it is, in fact, immoral & inhumane to eat meat.

Thanks, everyone, for some really good feedback. Though I get that it's possible that there is nothing wrong with her results, from everything I've read (both here and elsewhere) I'm convinced that at best she's at risk of a problem and at worst it's already a problem. So what's the amount of supplementation that everyone would suggest? David Martin (sorry, I said David Costill before) recommends 1mg elemental iron for every 1kg of body weight. Does that sound right? That would be something like 40mg per day for her. That's consistent with what Ventolin just recommended as I understand 200mg of ferrous sulfate contains 40mg of elemental iron, but it's much lower than dosages I've seen mentioned on other threads. I'd like to use a chewable, iron amino acid chelate as it seems to be easy on the stomach and well-absorbed, but let me know if there's any reason to use something else. To cover all bases, we will run all of this past her GP, but I think it's an easier discussion if I present him a proposed supplementation and re-testing plan and ask for his feedback rather than just asking for his recommendation (given that he already said everything was fine).Re vegetarian/vegan diet, my wife and I did a lot of research over the past few years on a balanced diet and have tried to ensure sufficient protein, B12, calcium, etc, but we admittedly didn't focus on iron since we figured that, with relatively low mileage and pre-menses, iron wouldn't be an issue. That's why we waited until now to test for it. But my daughter reluctantly says she's open to including some red meat in her diet. We'll see...but figure that supplementation is probably going to be a good place to start. We also broke out the cast iron skillet yesterday that hadn't been used in years. :-)

Michigan Man wrote:

You are right in everything you say. You know the cause (her diet; maybe periods?). You should treat with an iron supplement and monitor ferritin. What supplement? Whatever your daughter can handle.

ventolin^3 wrote:

put her on standard ferrous sulphate 200mg/day ( 1 tablet ) which is standard prophylactic dose which i put virtually every pregnant woman who walks thru my door on

( just watch out for tummy cramps/constipation, but it is a vitamin/mineral so it's not "bad medicine" ) & i'm told vitamin C helps absorption ( orange juice ) although i haven't looked that up

she may need to go onto 2 tablets/day at some point when getting older/more mileage/menses established

no offence

but i'd kick you out after 8'30 so i have 1'30 to type & ring buzzer

no offense

he knows sh!t about sports or what a young athlete needs

you need full level + of iron & vitamin D ( usually sunlight ) + calcium ( dairy )

Bigfoot is pretty much a vegetarian & he has been just fine at 10 foot/1500 pounds chomping on Forest + odd chipmunks

poor research

Fe/Vit D/Calcium/Vit Bs

are most important for youngster

Iron most important, because it gives the strength to hunt the next 3

( my primitive evolutionary belief )

testing offers nothing

get her ferritin upto middle at worst

she's huge gal ( already wife's height )

she needs :

augmentation

NOT

starvation

i have been a vegan for 80%++ of my life with odd exceptions

it does not stop me from taking vitamins

the B vitamins really do help becoming less dumber

the Fe/Vit D/Ca really do help becoming less weaker

"less" is important consideration...

No offense taken, ventolin. I agree with most of what you said. Maybe we didn't focus enough on the iron intake, but she gets tons of iron through beans, broccoli, edamame, etc. Still, it turns out not to have been enough (probably due to issues of non-heme absorption plus the presence of phytates), and that's on us. Or, as IronChick said, maybe my daughter has a particularly difficult time absorbing iron from these sources. Either way, we're focused on it now. Re running this by the GP, I'll still be interested in hearing his opinion and, frankly, it'll be easiest for us to use his office for future blood tests. I doubt he'll say no, and we won't just drop the matter in the unlikely event that he does.

ventolin^3 wrote:

no offense

he [GP] knows sh!t about sports or what a young athlete needs

you need full level + of iron & vitamin D ( usually sunlight ) + calcium ( dairy )

...

poor research

Fe/Vit D/Calcium/Vit Bs

are most important for youngster

Iron most important, because it gives the strength to hunt the next 3

( my primitive evolutionary belief )