Help me decipher IRON test..thanks!!

Hi

I have had an athlete with a recent iron problem. She has been feeling very off in training and racing for about 4 months, and actually ran 3 minutes slower in the 10km than her pb. We should it would be best t get her iron tested. She came back with a ferritin level of 8, but normal iron readings. The doctor started her on ferrogradument c and she has been taking them for about about 3 months.

She has started to ran really well in training again recently, and got tested for iron about 2 weeks ago. Her ferritin was lvl 67. My point here is that ferritin really does impact on performance and I don't give a crap for anybody who says otherwise. If you are running bad, get your ferritin tested. I will say this 100000000 times, it is the cause if it is low. The doctor doesn't want to say this, only sports doctors do, so don't go to your local doctor, go to a sports professional.

The reason why she is not runing to per potential is the ferritin, start plucking steaks and take the iron tablets are prescribed. Wait a month, and she will be good as gold!

Send me an email (click on my screen name) and I'll send you Michael Colgans new article on how to fix low iron in runners, or you can download it on his website colganinstitute.com (which can be a tricky process).

Is she taking in anything when she takes iron? So many things (wheat, caffeine, calcium, etc.) really reduce iron absorption rates when taking near the same time.

You probably already knew this, but take the iron with a vitamin c supplement or source as well. Mixing the liquid iron in some orange juice (without calcium) works well.

Lastly, something else could be causing the issue. Does she have any stomach issues or potential wheat intolerance?

Unknowns here:

Dose of iron supplement

Compliance with supplement

Blood loss (most likely menses but possibly GI - unlikely but possible)

Dietary sources of iron

Changes between the two sets of lab values seem insignificant to me. Hematocrit and hemoglobin can change daily due to hydration, recent viral illness, etc. Her hgb/hct are very good, higher than most female athletes I take care of. Change in ferritin is also trivial.

My guess is she just needs a higher iron dose, for a longer time period, and needs evaluation to see if she is having heavy menstrual blood loss.

Is she taking the liquid iron with a Calcium-fortified OJ? If so, cut out the Calcium. I would also wonder about the timing of the iron supplement, in relation to other foods that may be hindering absorption (~caffeine, grains, dairy, calcium supplement) or not consuming foods with it that help absorption (meat, fruit and veggies, fruit juice).

thanks for the responses....

To answer a few Q's:

Advised to take with OJ.

Iron is in powdered form suggested by the pharmacist because it was fast absorbing. 88mg dose taken 2 time a day. Probably with food but after seeing the latest test results I told her to try it on an empty stomach. Also told her to try doubling the dosage. Don't like giving medical advice but since the hemocrit was so low and dropping I think the risk of getting too much iron anytime soon is pretty nill.

She knows about caffeine hindering absorption. And I mentioned calcium but maybe should re-emphasize that.

Blood loss is low.

I was a little frustrated because the first doctor insisted there wasn't a problem so there was recommended amount of iron supplementation or anything...we just did as much research as we could and the thought we'd supplement for a month and then get retested.

The good news is the second doctor was much better and had more test taken (not sure what for yet) and advised her to see a hematologist.

He also mentioned that he had some old tests that showed her iron was always low....not sure of the numbers yet but it's interesting and may indicate an iron loss source beyond running because she's only been running for a few years and only 40 miles or more the last 3 years or so.

I guess my biggest concern is seeing the ferritin drop 3 pts in a month even after supplementation. Would it be best to just cut mileage sharply for awhile.....right now we were looking at an an April HM but was thinking now to kind of shift focus to June and wait to do any more intense stuff for another 2 months or so.

But what about long runs? Could her 16-18 mile runs be contributing as well...?

Thanks again for your responses..

Am I reading that right that she has a hematocrit of 46%? If so, I fail to see the problem. Seems she is not anemic. If she's tired, it has another cause because you have to be pretty severely anemic for it to cause you to be tired (at least according to my hematologist).

yeah 46%

The way I understand though is that Hg and Hemacrit are the last to drop..and since the ferritin is not only extremely low it dropped %30 in 30 days, and a small drop in Hg as well, I'm concerned and want to fix the problem before it manifests itself in dropped Hg and feeling horrible....

Admittedly I o hemacrit nly have a rough general idea of how all the blood levels are interrelated...but if hemacrit is the real problem (the fire )...then wouldn't a ferritin score dropping from an already very low 11 to an extremely low 8 in a month be a large amount of smoke? Why wait for the hemacrit to drop? I understand that people natural hemacrit levels vary widely...but the cases I always see held out as examples ( J. Cruz etc) it was always in the 20's or so.... isn't it pretty universally accepted that 8 is too low..?

Also, since I don't have a baseline score for her Hg how do we know it hasn't been dropping slowly but steadily for a year? Yeah the drop of .3 in 30 days is probably within the normal fluctuation...but why assume that? Just because her score is in the upper range doesn't mean it couldn't be .6 or .8 below where it would be with sufficient iron? Why give away those 45 seconds in the 5k for free?

Of course the hematologist will help explain a lot...but I'm becoming increasingly aware that you can't always take the first medical opinion as 100% accurate because they are used to dealing with the general public. Another way of looking at this is if a world class runner came in and ran a full out mile in 6 minutes. A medical generalist would look at the charts and deem him fully healthy and in great shape.

Just trying to get as much info as a can from people with experience with runners with low ferritin levels so that I can compare notes with what the doctor says.

Thanks!

From my experience, I would advise taking iron on an empty stomach. I usually feel sick after I do this. Other than that, it sounds like you are doing everything right. I take 65mg of ferrous sulfate 3 times per day and in the past 2 years I've gotten about 2 minutes faster in the 5000m. Good luck!