Archive for the ‘Iron & Anemia’ Category
Ins & Outs of Iron Supplements
Over the years I have tried countless different types of iron supplements in multiple forms. There are liquids, capsules, tablets, and soft gels. Iron is available over the counter, by Rx, in natural food stores, and at your local big box grocer. They are not, however, all created equal.
As a general rule, I avoid tablets whenever possible. They are the hardest of the forms to digest and often leave me with stomach pain. I also figure that the less my body has to work to break the product down, the more potent it will be. I’m not saying that the liquids won’t give you a stomachache! Many of them surely will, but depending on the type of iron it contains- you are probably absorbing more of it.
(For me, liquid ferrous sulphate is like taking a black enema in a bottle- sorry to be graphic.)
Here are the best Iron Supps I’ve taken (and I still have a cabinet full of others!):
1) Floradix- This stuff is expensive, especially when you consider how much elemental iron you are getting per serving. However, it works great if you are not terribly low and don’t mind the cost. They even have a version gluten and yeast free version called Floravital. Gentle enough to be taken after meals, this was my old standby in college.
2) SSS Iron Tonic- Another liquid. I ordered a few bottles along with the liquid B-complex. I was attracted by the claims that it works better than injections. It surely did work for me, right away I felt my iron come up and noticed a difference on runs within a week and a half. It did, however, give me a very constant stomachache for the month that I took it. Although there are no gluten containing ingredients on the label, the manufacturer cannot confirm that it is GF…. which was enough for me to stop taking it.
3) Hema-plex- I know, this is a tablet… but it is a good one. There are tons of beneficial ingredients packed into this little pill. It includes other blood builders such as beets and greens, as well as vitamins that enhance iron’s absorption. Another plus is that one tablet has 85 mg of iron as an amino acid chelate! Hemaplex is also wheat and yeast free, but they do not say gluten free. The ingredient in question for me is the barley grass juice, while I know that it shouldn’t contain gluten… if the grass had sprouted before it was juiced…. then there is a small chance. Uggh. Click here for a link to purchase.
4) Gentle Iron- This bottle was actually the first iron supplement that I ever purchased. I was in college and severely anemic… I couldn’t keep my eyes open in class and thought I had mono. Looking back, I’m sure it was the celiac disease, because I went through six-week stretch of everything running straight through me. Ironically, I started to cut out anything with fiber, fruit, then veggies, then nuts, and finally I was down to plain bagels. And nothing helped! I even had to go to the doctor for stool samples! (they told me I must have had a food born bacteria, but that it had worked its way out). Needless to say my track season was literally in the toilet that year. Anyways- As much as I’ve strayed, I keep coming back to this old standby. It is even Gluten-Free. Unfortunately each pill is only 25 mg…. but true to its name, it is truly the most gentle.
If you don’t have a sensitive stomach, then you can go the cheap route and get a ferrous sulfate liquid or the super cheap route and get ferrous sulfate tablets. Again, you should see faster results with the liquid, but it might also be harsher on your stomach. If the cheap iron tablets are a bit much for you, there’s always the extended release option too.
How to take Iron:
My stomach is so sensitive that I only take mine at night before bed. I left my dinner digest a little first, just because I think the less you have in your stomach the better it is absorbed.
Take the iron with Vitamin C. Try it with OJ or an Emergen-C. If you take a liquid iron, you can even make a little cocktail. 
Take your iron with a B-complex vitamin and make sure it contains plenty of B12.
Do not take other minerals with your iron! Minerals, especially calcium and zinc can block iron absorption. You’ll also probably hinder the absorption of the other minerals as well. Make sure your OJ isn’t fortified with calcium. Save that one for breakfast only.
Do not take iron with coffee, tea or soy milk. Caffeine is another substance that seems to hinder iron absorption. The same has been found with the tannins in tea (black and green, not herbal), and soy protein. Try not to consume any of these substances within 2-3 hours of taking your iron pill. This is also true with absorbing the iron from food- try not to drink caffeinated beverages or teas (herbals are OK) with meals.
Better get to the afternoon run. Cheers!
Signs of Iron Deficiency
Common Signs of Iron Deficiency:
- tiredness when running (hills are really hard!)
- sleeping a lot and still feeling tired
- muscle burning (especially quads)
- elevated heart rate
- reduced tolerance to cold weather
- apathy (lack of enthusiasm for running or anything else)
- shortness of breath
- frequent infections and colds
- irritability
- headaches
- poor concentration
- clumsiness
- bruising easily
- craving of non-food items (like ice)
Sound familiar? Consider getting tested. If your training has increased, ask about upping your dosage if you already take iron.
Running Into the Ground: Iron Basics
Reasons Why Runners are Often Low in Iron:
1. Foot Strike Hemolysis—red blood cells are destroyed by runners’ feet pounding on the ground. You literally squish them as you strike the ground. This loss can be even more intense at altitude.
2. Sweat & Urine—small amounts of iron are lost in sweat and urine and these amounts can add up over time and worsen in hot weather.
3. GI & Menstrual Bleeding—small amounts of iron are lost due to bleeding in the gastrointestinal tract that is common with intense training/racing, while larger amounts can be lost through a regular menstrual cycle. If your cycle is causing you to lose more significant amounts of blood due to an extended length, heavier flow or increased frequency, you should report this to your doctor so that she can try to find the cause.
4. Low Iron Intake—runners who follow the traditional high-carb/low-fat endurance diet often do not consume much red meat, which is the best absorbed source of dietary iron. Many runners also tend to under eat in an effort to maintain an artificially lower weight. There is evidence that this type of calorie restriction lowers metabolic functioning and over the long term may lead to a sluggish thyroid or hypothyroidism.
Key terms:
Hematocrit— the percentage of red blood cells in the blood
Ferritin— the body’s stored iron (primarily in bone marrow, liver, and spleen)
Iron-Deficiency Anemia—clinically low hemoglobin or hematocrit levels
(B12 deficiency can cause another type of anemia, more common in vegetarians than meat eaters because B12 is difficult to get from a vegan diet)
Iron Depletion—low ferritin levels (for running purposes 30)
What exactly is ferritin again?
For one thing, different people seem to require different levels to feel good. One athlete may perform best as long as her ferritin is over 40, while another may require double. When fine-tuning for performance enhancement, it is best to track ferritin levels over time, that way you can get a baseline level of what might be normal for you. Unfortunately, few people think to go in for blood tests when they are feeling fine. Some sports medicine docs and coaches like an athlete’s ferritin to be above 100. It is commonly accepted in the running community that a score under 30 means you should be pumping some iron into your system, in whatever form necessary.
Serious female runners should have their iron levels checked a minimum of twice (preferably four times) per year. Competitive male runners should be tested annually, and those with a history of iron depletion (or vegetarians) should be tested at least twice per year. To ensure consistent results, always have your blood tested before running (i.e., when you are well-hydrated), because dehydration will make your iron levels appear higher than they are. Again, the major iron status tests of interest to runners are: hemoglobin, hematocrit, red blood cells and ferritin. And, depending on how savvy your doc is, you may have to specifically request the ferritin to be checked. Unfortunately, it is still not a commonly performed test by many family practitioners.
More on iron supps and common signs of deficiency in another post.
Stoking the Fire…. Iron Scores
Today I got the results from the team blood test we had on Wednesday.
Drum roll please…..Ferritin is 16!*
Because low iron is so prevalent in distance runners, (why? see my post entitled Running Into the Ground) we screen our athletes twice a year with blood work from the health center. The woman who stuck me with the needle asked me what year I was when I got on the table. She was embarrassed when I told her my age and that I’m a coach. At least she complemented my veins.
Unfortunately, I couldn’t wait that long to get tested. At the end of June I began a pretty steep decline. I went from feeling somewhat decent on runs, to starting to get tired, to having an allergy induced asthma attack while running on Wildwood. That hasn’t happened to me in a few years- and it has only happened 4 or 5 times in my life. I do know from experience (and the allergist) that it is brought on by exposure to the allergen AND severe fatigue. Since the allergy tests revealed that I am basically allergic to Oregon, or at least all of its trees and grasses, I knew that fatigue was the main culprit.
The heat over the fourth of July in Ashland only made me feel worse, so I emailed my Endo in Houston to ask for some blood work. I was overdue in checking my thyroid’s status anyways. The only red flag from the results was, of course, my iron. Ferritin was 6. Again. Again! I thought the gluten-free diet was supposed to be helping, but apparently my intestines are still not in shape.
So it has been 5 or 6 weeks of stomachaches now. 5 or 6 weeks of reading gluten-free forums and message boards in search of some kind of help from the celiac community about how to overcome the chronic anemia. I have known about my iron issues since college. I was even sidelined my sophomore track season with chronic anemia. At least now the malabsorption problems have been somewhat explained. (i.e. in people with celiac, gluten destroys the microvilli which line the intestine to aid in capturing nutrients).
I’m trying to figure out how to go about getting a drip or even injections, but I am without insurance…. so who knows. I am just anxious to get rid of the stomach pain and GI problems again. I can only liken it to eating a steaming bowel of hot buckwheat**….EVERYDAY!!!
* The level of ferritin in your blood is a measure of your body’s iron stores. Ferritin is a protein containing iron stored in your bone marrow and liver. My highest recorded ferritin has been 18, the lowest was 5. Under 30 is a red flag. Ideally, much higher is better for performance.
**I actually did this by accident 3 weeks into my gf life- thought it was the cream o’rice cereal. Paid for dearly for it for three days afterwards.
