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

Oh dear, these results don't look good at all.

How about you listen to her doctor?

This is my two cents as a collegiate coach who has dealt with this issue time and time again.

As a young female endurance athlete, she should be consuming red meat. I know that it may be against her beliefs, but it is incredibly hard for young vegetarians to get their ferritin above 30 without eating red meat. Once her menstrual cycle begins you will see that number get into single digits and you will see a drop in performance. People on here can tell me I am wrong, but I have seen it over and over.

Taking an iron supplement daily is a great idea. I tell my runners to alternate days between a pill and liquid to make sure one is getting absorbed. Sometimes either supplement can cause some gastrointestinal issues, but if you take a low dose you won't have that issue. You need to take vitamin C daily with iron supplementation and non-heme foods. You should also plan on cooking with an iron skillet as much as possible.

She should not raise her mileage until you know that her ferritin can be held constant at above 30. Pool running, core and weights are much better for young female runners than a bunch of mileage. Speed and strength should be trained at that age before endurance anyway.

Joe Vigil has a great DVD available on blood iron chemistry. It was part of the 2011 National Distance Running Summit DVD set.

Hope that helps some.

She should eat more red meat.

you're a piece of work wrote:

How about you listen to her doctor?

A good starting point. Of course they'll say yes and have her in their office every two weeks for the rest of her life for a blood test.

Ferritin? I don't even know what the hell that is? Are we supposed to be worried about it? Must be the new gluten-free. The latest craze that doesn't mean shit.

"She is also a longtime vegetarian, near vegan, as is my wife"

Here is the problem. Get a big slab of grass-fed lean beef, cook it rare, and go to town. Life is too short.

Omg her test results are the same as the world class Kenyans.

I'd suggest that you Google "vegetarianism for teenagers".

http://www.vrg.org/nutrition/teennutrition.htm

"Iron requirements of teenagers are relatively high. By eating a varied diet, a vegetarian can meet his or her iron needs, while avoiding the excess fat and cholesterol found in red meats such as beef or pork. To increase the amount of iron absorbed from a meal, eat a food containing vitamin C as part of the meal. Citrus fruits and juices (for example, orange juice), tomatoes, and broccoli are all good sources of vitamin C. Foods which are high in iron include broccoli, raisins, watermelon, spinach, black-eyed peas, blackstrap molasses, chickpeas, and pinto beans."

Thanks for your thoughtful response (also to Randy Oldman and the other helpful posters). Though I realize that there there is dispute about whether her level is a problem right now, I'm particularly focused on the issue you raised about the ferritin levels potentially dropping from here as she matures and increases training over the next few years. Part of the reason I posted (besides the fact that I don't want to be too cavalier about putting my kid on supplements) is that I wasn't sure if there's any reason to be more cautious with a pre-teen, but she is as tall as her mother and nearly 13, so I guess some cautious supplementation is probably a good start. I saw the presentation where David Costill recommended 1mg iron for each kg of body weight, so I may start there. That's substantially less than some of the dosages I've seen recommended and may not be enough, but we can always retest in a few months and see where we're at. But if you or others have any suggestions on dosage, I'm all ears. I'll also see if I can get her to re-start eating red meat :-) But a small amount once or twice per week may not be enough to be meaningful on this issue.

You are raising a resentful, hateful person. You are the reason there should be laws prohibiting certain people from procreating.

Concerned Dad wrote:

Thanks for your thoughtful response (also to Randy Oldman and the other helpful posters). Though I realize that there there is dispute about whether her level is a problem right now, I'm particularly focused on the issue you raised about the ferritin levels potentially dropping from here as she matures and increases training over the next few years.

Ignore all those replies. Her diet is similar to mine (vegetarian, "almost vegan"), and her results are eerily similar as well. Ferritin of 11 (after a week of supplementing), hemoglobin 14.5 (fine but some say under 14 is anemic), bad vitamin D, surprisingly good B12, pretty good in everything else. Even this level has made me very tired, have lots of trouble focusing, and out of breath frequently. Other runners who were at this level have stated dramatic performance increases. I am still working on getting my ferritin levels back up, hopefully without eating meat because it gives me stomach aches and I felt much better when I stopped eating it.

Sir, As a coach, I have worked with a few ladies, her age..on to win nationals USATF. Working with little ladies her age is really tough. I mean with the nutrition and problems that arose that dozens of Doctors could not and still can't figure out. IMHO, I would seek the best professional opinions in the country. Figure this out and protect her, just as your child. Screw running, maybe for now. These next future years she needs to have a handle on everything. You don't need any weird physical problems poping up that became more extreme due to mileage. Ive seen this and could not stop the parents. Only keep her best health in mind..all about her, if that means shutting down the running so be it. Good Luck, and make her healthy and strong!

Thanks, Hardloper and armored. This thread runs true to form for letsrun: about 1/3 sincere responses and 2/3 not. We're not going to do anything too radical, but a ferritin level of 12 does seem like it should at least be monitored and nudged up. To armored's point, if this were to turn into a serious medical issue, which I don't think it is given that all the levels are within the references ranges and blessed by the doctor, we wouldn't hesitate to drop running. But we'll keep doing our research and seek out advice (not just from letsrun).

Ignore all those replies. Her diet is similar to mine (vegetarian, "almost vegan"), and her results are eerily similar as well. Ferritin of 11 (after a week of supplementing), hemoglobin 14.5 (fine but some say under 14 is anemic), bad vitamin D, surprisingly good B12, pretty good in everything else. Even this level has made me very tired, have lots of trouble focusing, and out of breath frequently. Other runners who were at this level have stated dramatic performance increases. I am still working on getting my ferritin levels back up, hopefully without eating meat because it gives me stomach aches and I felt much better when I stopped eating it.[/quote]

This is my two cents as a collegiate coach who has dealt with this issue time and time again.

As a young female endurance athlete, she should be consuming red meat. I know that it may be against her beliefs, but it is incredibly hard for young vegetarians to get their ferritin above 30 without eating red meat. Once her menstrual cycle begins you will see that number get into single digits and you will see a drop in performance. People on here can tell me I am wrong, but I have seen it over and over.

Taking an iron supplement daily is a great idea. I tell my runners to alternate days between a pill and liquid to make sure one is getting absorbed. Sometimes either supplement can cause some gastrointestinal issues, but if you take a low dose you won't have that issue. You need to take vitamin C daily with iron supplementation and non-heme foods. You should also plan on cooking with an iron skillet as much as possible.

She should not raise her mileage until you know that her ferritin can be held constant at above 30. Pool running, core and weights are much better for young female runners than a bunch of mileage. Speed and strength should be trained at that age before endurance anyway.

Joe Vigil has a great DVD available on blood iron chemistry. It was part of the 2011 National Distance Running Summit DVD set.

Hope that helps some.[/quote]

I agree with all of this, except the part about it being "incredibly hard for young vegetarians to get their ferritin above 30 without eating red meat". I am a female, 22, and have been vegan for 12yrs. I'm a 32.30/15.30 runner training 100mi p/wk. I have never had low iron (ferritin) levels. My range has always been between 60-100. Right now its at 88. So don't persuaded into believing that you can't have normal iron levels being vegan or vegetarian. It is imperative to have a well planned diet incorporating iron as much as possible.

I was a teen vegetarian and by my mid-20's I was a wreck. Ferritin of 11 (22=anemia for male). Believe it or not, fat and cholesterol (as well as other nutrients found in good concentration in healthy meats) are among the building blocks of life, especially for young athletes. Consider her long-term health and turn to grass-fed beef and other animal sources of nutrition. Decades later she will thank you.

A little of this wrote:

I was a teen vegetarian and by my mid-20's I was a wreck. Ferritin of 11 (22=anemia for male). Believe it or not, fat and cholesterol (as well as other nutrients found in good concentration in healthy meats) are among the building blocks of life, especially for young athletes. Consider her long-term health and turn to grass-fed beef and other animal sources of nutrition. Decades later she will thank you.

why grass-fed vs corn-fed?

I agree with all of this, except the part about it being "incredibly hard for young vegetarians to get their ferritin above 30 without eating red meat". I am a female, 22, and have been vegan for 12yrs. I'm a 32.30/15.30 runner training 100mi p/wk. I have never had low iron (ferritin) levels. My range has always been between 60-100. Right now its at 88. So don't persuaded into believing that you can't have normal iron levels being vegan or vegetarian. It is imperative to have a well planned diet incorporating iron as much as possible.[/quote]

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

Normally, on running performance related questions I would take a runners word over that of a physician.

That said, when it comes to blood, I side with the doctor. Physicians are very well trained in heme because it is a common thing to deal with every day, while the nuances of exercise physiology are really not relevant to the every day practice of medicine.

The results are fine. They are more than fine. Don't try messing around with anything, use the iron skillet, and if she starts feeling way more fatigued and tired than her normal baseline, wait a few days and if she is still feeling that way go check see the doctor. Anyone who tells you otherwise is running wild with a tiny bit of knowledge.