Help, my top HS girl has anemia, 2 weeks to State

Tell her to lose weight.

if she wants, let her run... wrote:

OP, I'm not sure why everyone is jumping all over you, especially with regard to her "long term health". Since she is now supplementing with iron, I'm not aware of any health "risk" for her running in her condition. Sure, she probably won't run fast and it may slow down her body's recovery, but that's not the same thing as risking her long term health. And I think you already said in your original post that the doctor said it was ok to run??

If she is feeling at all better, she should certainly be free to run at the state meet. It should be her call, and maybe the decision that you mentioned to be announced and drop out was hers, and that's fine. But I wouldn't pressure her into that or any other decision. Good luck

Hematocrit is the amount of red blood cells in the blood, 34% for a women is right at the cusp of full-blown anemia. Serum Ferritin is the primary indicator of iron stores in your body, and a low number indicates the body's ability to produce more red blood cells is very limited. For an endurance athlete a healthy ballpark minimum for men is about 30ng and for women 25ng. While there is a decent variance on what an individual can fully function on, 12ng should be considered an absolute minimum that any athlete can adequately function at. 5ng is off the charts awful. For some perspective, i think the high end of safe serum ferritin levels is about 200ng, above which you may begin to suffer from metal poisoning symptoms.

So a young women with a Hematocrit level of 34% is technically suffering from Anemia. Her Iron stores are so low they must go up significantly before her body can adequately produce red blood cells to get out of the anemic condition. Hard training, particularly impact training such as running, has been shown to burn through red blood cells faster than normal. So not only can she not effectively produce new red blood cells due to lack or stored iron, she is churning through the more limited supply even faster by continuing to train.

As for health concerns, low red blood cell counts means oxygen is not being transported throughout the body at a normal rate, leaving the body more vulnerable to infections and fighting off illness. It also makes a person feel continuously short of breath, and can lead to fainting during hard exercise or during quick changes in blood pressure, like what happens when you stand up...

Longer term, Anemia can lead to even more serious issues such as an enlarged heart, arrhythmia conditions, and even heart failure.

So yeah, moving past the part where a runner in this state is going to have very poor performances, and is just slowing their ability to return to a healthy state and effective training, those are the risks.

Same exact scenario as OP here. I coach an elite female with low ferritin and textbook signs of iron deficiency.

Low molecular weight IV iron appears totally safe. Does anyone know how long it takes to kick in? Postseason starting soon but we have almost 6 weeks until NB outdoor. Like OP I will leave the medical decision making to the kid, her parents, and her doctor.

Out of pure curiosity though, I I am looking for data points of HS girls who have had IV or taken the liquid with OJ... specifically how long before the kid felt back to her old self? I want to be prepared if they ask my opinion on whether to shut down or go for glory.

I am wondering also about the best form of iron to take under these circumstances as well. Advice from other coaches I have talked to (collegiate and top HS coaches) was to take liquid iron. However, I talked to a chiropractor the other day who works with a lot of endurance athletes and he said to take Heme iron, specifically Proferrin ES. Much more expensive, but he said many runners start feeling better in a week to 10 days. Any thoughts on this?

I doubt anyone with full blown anemia will feel like themselves in 6 weeks let alone at their peak physical shape. A good ballpark estimate is an increase in hemoglobin of 1g/dL per month. I had severe IDA (~8 Hemoglobin and ~28% Hematocrit at it's worse) and it took a good year for me to feel like myself and probably another 6 months to feel like I was in any kind of shape.

Another one wrote:

Same exact scenario as OP here. I coach an elite female with low ferritin and textbook signs of iron deficiency.

Low molecular weight IV iron appears totally safe. Does anyone know how long it takes to kick in? Postseason starting soon but we have almost 6 weeks until NB outdoor. Like OP I will leave the medical decision making to the kid, her parents, and her doctor.

Out of pure curiosity though, I I am looking for data points of HS girls who have had IV or taken the liquid with OJ... specifically how long before the kid felt back to her old self? I want to be prepared if they ask my opinion on whether to shut down or go for glory.

From what I've heard and learned through my daughter, who was truly anemic, (ferritin

Holy crapola wrote:

From what I've heard and learned through my daughter, who was truly anemic, (ferritin

No clue what happened to the rest of my reply, but here goes...

If you're truly anemic, meaning low ferritin, low HGB, low hematocrit, no matter how you replenish the iron (IV will yield a quick increase in numbers but the old, small RBCs are still in the bloodstream for 120 days)... truly anemic athletes will start feeling mildly better in a few weeks, but it often takes a good 4-6 months to be racing at peak ability. My daughter had a ferritin of

I don't know why my messages are all cut off.

Proferrin ES is good stuff but pricey. Ugh.

Medical advice from idiots? It boggles the mind

Holy crapola wrote:

I don't know why my messages are all cut off.

Proferrin ES is good stuff but pricey. Ugh.

Parents are idiots wrote:

Medical advice from idiots? It boggles the mind

Holy crapola wrote:

I don't know why my messages are all cut off.

Proferrin ES is good stuff but pricey. Ugh.

What the hell is wrong with you? I worked with a hematologist. You have no idea what you're talking about so STFU.

1. CHECK FOR CELIAC DISEASE

2. Regardless of results of 1. Supplement with 210mg ferrous fumarate once daily.

Shouldn't need to alter training much at all on 210mg.

seenitallbefore wrote:

1. CHECK FOR CELIAC DISEASE

2. Regardless of results of 1. Supplement with 210mg ferrous fumarate once daily.

Shouldn't need to alter training much at all on 210mg.

Yes, my daughter is gluten intolerant and once she went off of gluten, she absorbed iron. Our hematologist worked with us on figuring out how to replenish iron after discovering the intolerance. That part of my message was cut off. Good advice.

Holy crapola wrote:

seenitallbefore wrote:

1. CHECK FOR CELIAC DISEASE

2. Regardless of results of 1. Supplement with 210mg ferrous fumarate once daily.

Shouldn't need to alter training much at all on 210mg.

Yes, my daughter is gluten intolerant and once she went off of gluten, she absorbed iron. Our hematologist worked with us on figuring out how to replenish iron after discovering the intolerance. That part of my message was cut off. Good advice.

Amazing how no one ever checks for it when anemia or low ferritin is found. It should be routine.

Curious about the sudden down-turn in Hemoglobin/Ferritin:

Was there a sudden and dramatic increase in mileage? March hemolysis is responsible for many runners developing low iron stores (often without overt anemia).

Was there a dramatic change in diet? Or, more concerning, did she lose much weight?

I would argue that there are many good doctors out there and many awful ones. For athletes, it behooves you to see a physician who specializes in athletes as it is just simply not routine medicine. For older athletes, the difference becomes even more stark when discussing cardiovascular issues. Then, I would essentially NEVER recommend a cardiovascular evaluation by anyone other than a sports cardiologist.

I hope your runner is well and on the road to recovery.

physician wrote:

Curious about the sudden down-turn in Hemoglobin/Ferritin:

Was there a sudden and dramatic increase in mileage? March hemolysis is responsible for many runners developing low iron stores (often without overt anemia).

Was there a dramatic change in diet? Or, more concerning, did she lose much weight?

I would argue that there are many good doctors out there and many awful ones. For athletes, it behooves you to see a physician who specializes in athletes as it is just simply not routine medicine. For older athletes, the difference becomes even more stark when discussing cardiovascular issues. Then, I would essentially NEVER recommend a cardiovascular evaluation by anyone other than a sports cardiologist.

I hope your runner is well and on the road to recovery.

There are only a few reasons for low ferritin.

1. Heavy bleeding (obviously more common in women)

2. Poor diet (which would lead to levels not recovering from training)

3. Malbsorption (such as Celiac disease)

1. Sounds as if there was no history to support this, though severity is often misrepresented

2. Definitely a concern...I'm not sure we talked enough about diet and disordered eating

3. Malabsorption was discussed

This list misses several other causes:

4. Exercise related gastrointestinal bleeding (idiopathic) - would require additional testing and a nuanced understanding of fecal blood testing

5. "March" hemolysis (as previously mentioned) - very common and underdiagnosed in high mileage athletes

6. Atheletics related Cytokine-driven anemia does not fit because it should behave like anemia of chronic inflammation and increase ferritin.

Holy crapola wrote:

I don't know why my messages are all cut off.

Don't try to use the less than symbol. It thinks you're trying to do HTML or something (I'm not a programmer... I just know to avoid that).

zzzz wrote:

Holy crapola wrote:

I don't know why my messages are all cut off.

Don't try to use the less than symbol. It thinks you're trying to do HTML or something (I'm not a programmer... I just know to avoid that).

https://www.khronos.org/collada/wiki/Help:Using_greater-than_and_less-than_symbols_and_HTML_in_wiki_articles

I had no idea! Thanks for the tip. :)

physician wrote:

1. Sounds as if there was no history to support this, though severity is often misrepresented

2. Definitely a concern...I'm not sure we talked enough about diet and disordered eating

3. Malabsorption was discussed

This list misses several other causes:

4. Exercise related gastrointestinal bleeding (idiopathic) - would require additional testing and a nuanced understanding of fecal blood testing

5. "March" hemolysis (as previously mentioned) - very common and underdiagnosed in high mileage athletes

6. Atheletics related Cytokine-driven anemia does not fit because it should behave like anemia of chronic inflammation and increase ferritin.

In regards to #4 outlined - I would be curious if the athlete had been taking a lot of NSAIDS, maybe reason for GI bleed? Sure it could be other factors but certainly worth exploring...

Also, on your point #5 add disrupted menstrual cycle for females and lack of iron rich foods (how many teenage/young adults) like green leafy vegetables or steak/liver?