Serum Ferritin is 1430 ng/ml - Going to have to give tons of blood, who wants to guess what it'll do to my ability to run?

Not uncommon to be put on epo when doing this. Will you be?

That sucks. I hope you are able to manage it properly. The liver is not something to screw around with.

At this point I don’t know. Would be a funny TUE to pursue just to frame it on my wall as a joke if it went there.

In all seriousness the rate of reduction will be limited by my rate of red blood cell reproduction. I expect the impact of this will probably stimulate the hell out of my natural epo production. Will be interesting to see what my hematocrit does when frequent donations cease.

Don’t take supplements without getting tested first!! I’m a vegan and everybody was telling me to take B12. Got a blood test and my B12 was actually on the higher end. And maybe OP did get tested, I just see this a lot especially with iron-ppl just taking it without knowing if they are actually deficient.

This exactly. This is the main point of this post. I think NOP has popularized fairly large iron dosing because typically runners have deficiency issues...but this is dangerous if you don’t know your accumulation and disposal rates as well as your starting point.

Maybe for most folks it wouldn’t be a big deal, but for some of us it is and it’s going to be a pain in the ass for me to deal with.

psychlown wrote:

This exactly. This is the main point of this post. I think NOP has popularized fairly large iron dosing because typically runners have deficiency issues...but this is dangerous if you don’t know your accumulation and disposal rates as well as your starting point.

Maybe for most folks it wouldn’t be a big deal, but for some of us it is and it’s going to be a pain in the ass for me to deal with.

When did NOP popularize large iron doses?

To the OP-

The level won’t drop just from avoiding foods with iron in it for a while? Maybe not fast enough to avoid liver damage, but that many pints of blood seem extreme.

It's strange that each pint of blood reduces ferritin by just 30 ng/ml or that you'd need to donate 45 pints given that you likely only have about 12 pints or thereabouts in you. Getting down to 75ng/ml isn't necessary either. Even being around 300 isn't dangerous at all. It's more than you need, but dramatically better than being over 1000 ng/ml.

Could someone explain how removing ~10% of this person's blood is only going to reduce their ferritin by 2%?

Ferritin level in your blood serum is not the total amount of ferritin in your body. It is in correlation with stored ferritin in the liver so if you measure it, it is a good marker for your overall iron stores.

If you donate 10% of your blood, you have to take into account not only the 10 % of serum ferritin which is removed, but also the hemoglobin which is removed and has to be reproduced, and then new ferritin from the liver is released into the blood serum again. So the calculation is not that simple.

Simple explanation:

Not all the iron in your body is in your blood, so if you remove 10 % of your blood, you remove much less than 10 % of your total iron.

Concentric Hero - Eccentric Zero wrote:

It's strange that each pint of blood reduces ferritin by just 30 ng/ml or that you'd need to donate 45 pints given that you likely only have about 12 pints or thereabouts in you. Getting down to 75ng/ml isn't necessary either. Even being around 300 isn't dangerous at all. It's more than you need, but dramatically better than being over 1000 ng/ml.

Could someone explain how removing ~10% of this person's blood is only going to reduce their ferritin by 2%?

Responding to this one...someone else explained why ferritin only goes down about 30 ng/ml per donation. I tried to spreadsheet it b/c I'm a chemical engineer and quickly realized there are simply too many variables for me to do that and my job at the same time. I'm still going to analyze the data but in a more empirical way and less first principles way.

You're right that for health getting down to 75 ng/ml isn't necessary for health. The concern is that as I've been identified as having a genetic propensity for accumulating iron if i go down to just 300 then i'll be back at levels that could require treatment more quickly. This is not to say that if I'm 24 weeks out from my key race and i'm at 300 I may work with my doctor to see if we can back off on the treatment to balance typical treatment w/ quality of life.

Responding to ThatAverageRunner. For a normal person just eating low iron foods for a bit would reduce levels eventually. But because it appears I have a genetic propensity for accumulating iron it doesn't seem like that would necessarily do it. Of course I did take supplements and even double (even if it wasn't a "high" dose) for a bit, and I'm hopeful that it turns out that was the reason for my trouble and my levels trend down more quickly than they expect...but at this point that's just optimism, not educated optimism.

As far as the NOP comment I made, I probably shouldn't have. I had heard from runner friends that this was occuring. I think some of it was born out by the fancy bears info dump, but I don't know if there's a good source of information confirming this. I'll revise my above statement to "I learned some of my faster friends were having to take a lot of iron to avoid being anemic and anecdotally I thought I'd heard this was common among elites".

I should note just as general information that I read that turmeric chelates iron in blood. Chelation as I understand it is chemical binding of metals such that they can be excreted. As such I've begun both taking 2000 mg of turmeric orally/day and I'm applying turmeric essential oils to my skin once per day to try to accelerate removal of the free iron in my body.

Hoping to get in for first blood donation today, but if I can't I'm getting up to 14000 feet while it's still fun!

Partridge wrote:

Ferritin level in your blood serum is not the total amount of ferritin in your body. It is in correlation with stored ferritin in the liver so if you measure it, it is a good marker for your overall iron stores.

If you donate 10% of your blood, you have to take into account not only the 10 % of serum ferritin which is removed, but also the hemoglobin which is removed and has to be reproduced, and then new ferritin from the liver is released into the blood serum again. So the calculation is not that simple.

Duh, of course this makes sense. Thank you.

I'm a hobby jogger, slighly slower than you and I had to go through a similar thing a few years ago. I went for phlebotomy once a week for about a year and now go just once every 3 months. I think it might slow you down somewhat, but I didn't really feel that much effect from it. The biggest difference is the day of phlebotomy and the day after. You get winded a little easier, but I kept running through it all. They'll do a quick check of your red blood cells, etc before each phlebotomy. You can look at those to see what your cell count, hemoglobin levels, and hematocrit are. This will give you some indication of how you are affected by the phlebotomies.

Bleeder wrote:

I'm a hobby jogger, slighly slower than you and I had to go through a similar thing a few years ago. I went for phlebotomy once a week for about a year and now go just once every 3 months. I think it might slow you down somewhat, but I didn't really feel that much effect from it. The biggest difference is the day of phlebotomy and the day after. You get winded a little easier, but I kept running through it all. They'll do a quick check of your red blood cells, etc before each phlebotomy. You can look at those to see what your cell count, hemoglobin levels, and hematocrit are. This will give you some indication of how you are affected by the phlebotomies.

Thanks for this response, this is encouraging to hear and really helpful! Any advice from your experience?

psychlown wrote:

Bleeder wrote:

I'm a hobby jogger, slighly slower than you and I had to go through a similar thing a few years ago. I went for phlebotomy once a week for about a year and now go just once every 3 months. I think it might slow you down somewhat, but I didn't really feel that much effect from it. The biggest difference is the day of phlebotomy and the day after. You get winded a little easier, but I kept running through it all. They'll do a quick check of your red blood cells, etc before each phlebotomy. You can look at those to see what your cell count, hemoglobin levels, and hematocrit are. This will give you some indication of how you are affected by the phlebotomies.

Thanks for this response, this is encouraging to hear and really helpful! Any advice from your experience?

The main thing is to keep hydrated and eat before each phlebotomy so you don't get light-headed. Drink a lot of fluids after to regain blood volume. The biggest issue that bothered me was the constant big needles in the arm. Hopefully you have accessible veins in each arm - I would alternate arms each week because they would get sore from the needle pokes.

Just a quick update:

First scheduled donation was last friday (9/20). I went for a run before the donation, thought of it as a last hurrah for a while to run with my full engine. Did ~2 hours on trails in the heat, didn't really feel it on the up but crushed the down. Went and got lunch and then went to donate.

The donation was pretty painless. They test your hemoglobin before the test and I was at 17.4 (compared to 16.8 in my previous bloodwork). My hematocrit a corresponding 52.4 vs 48.4 the week before. I realized in the moment that if i want to get "bang for my buck" with these donations it would be beneficial to get dehydrated within reason before the donation, as my blood will be more RBC rich and I'll eliminate more iron per donation this way. Of course this is only if I do not have issues w/ the donations when doing it this way. For the first one it worked out fine.

I went running the next morning at 6am, so ~14 hours after donation. I just did a few easy miles. I felt a little sluggish, but that could easily have been from the hard effort the day before and a decently hard effort 2 days before. Nothing exciting really and no conclusions that I could draw.

Yesterday I decided that I'd like to get a real idea of how much I am diminished because of the blood donation and I did an honest effort up a ~7-8 minute climb that I do often enough to know what I am capable of on it. It's 0.4 miles at 25% average grade on a pretty rough trail. Outside of one outlier effort I ran equal to my best time. This was pretty surprising and really encouraging for me.

So now I want to try to understand this outcome.

Am I not RBC limited when doing an effort like this? (I should note I did it 2 more times feeling as strong as if not stronger than normal during a total of 1 hour of running)

Did I replenish my RBCs so quickly it was a non-factor?

Was there a disbenefit to the high iron such that even though my RBCs are lower I still performed better?

I go in for another blood test today, so hopefully I'll be able to figure out the RBC regeneration factor in these questions.

Probably have my next donation later this week. Will keep journalling this here for my purposes and anyone else who cares.

Didn't note my donation was 500 ml.

I’ll buy it from you.