Kelli Talks Iron

During this last year, I’ve spent time gathering more information on my past successes with clients and iron  supplementation, other experts’ opinions, and any further information to form a more aggressive and proactive Iron Supplementation Recommendation for my athletes.

You see, I’ve seen a correlation with low iron (ferritin) status and everything from impaired running performance, chronic colds and sicknesses (even mono), slow recovery, general fatigue, and even changes in moods.

As more endurance athletes train intensely year-round, and don’t take a lot of time for recovery, it’s become more crucial.  And, as there is a direct link between healthy iron stores and athletic performance, it’s become a priority to me to make sure my athlete clients have all the information they need to make a decision regarding iron testing and supplementation.

Background information:

Iron is required by everyone, and is usually found in adequate amounts in the diets of sedentary people.  However, due to extra losses in sweat, red blood cell breakdown, and gastric irritation, the needs are higher in athletes and especially in runners.  Add to this menstruation in females (significant iron losses), and any less-than-optimal daily eating, and you have a recipe for low iron stores.

Overall, it’s estimated that 80% of all female athletes are iron deficient.  And, while they may not have “diagnosed anemia,” iron deficiency is indicated when serum ferritin levels are checked (this is seldom checked in a routine lab work-up or physical).  In my personal experience, virtually all female runners who are not supplementing iron beyond a multivitamin are deficient.  And, while “normal ranges” for serum ferritin may go as low as 10 ng/mL, there is usually a significant improvement in symptoms when this level is brought up to and above 30 ng/mL (optimal levels for athletes may be closer to 50 ng/mL, but this is seldom achieved during training).

For the males, it’s not quite as common to be deficient, but I certainly do still see it.  Male athletes that seldom eat red meat or are vegetarian are at high risk, much like all female athletes.

What’s more, there may be a link between “overuse” injuries and low serum ferritin, as these injuries are simply seen more often in athletes whose levels are low.

Symptoms of low iron status include fatigue, general weakness, a drop in performance, unusual pale skin, irritability, headache, dizziness, shortness of breath, and craving ice or non-food substances.  Of course, these symptoms are somewhat general and many of them can be the results of other deficiencies and dehydration.

All that said, here’s some general recommendations FOR ADULTS on iron supplementation.  Take it as basic information and consult your doctor about your iron needs.  Please also read my disclaimer at the end of this post.

During Training Season:

Females Athletes:

Avid runners, Ultra-distance athletes, avid pregnant athletes (meat eaters):

1) Supplement with 1 multivitamin per day that contains ~18-28 mg iron PLUS 50 mg elemental iron from ferrous sulfate per day (I recommend Slow-Fe, it contains ~50 mg iron per tablet in the form of ferrous sulfate – it’s over-the-counter and easy on the stomach).  Take your multivitamin and iron supplement at different times per day.

2) If you have reason to believe low ferritin has already become a problem, or if you’d just like to get it tested, ask for a serum ferritin test from your doctor.  If levels are below 20 ng/mL, supplement with 2-3 tablets of 50 mg elemental iron each (100 mg total) + multivitamin per day.  If below 10 ng/mL, increase to 3-4 tablets or 50 mg elemental iron (150 mg total) per day.  Some athletes this low have seen faster increases with liquid iron supplement – talk to you doctor as most of them require a subscription.  Consult your doctor about your dosage and make sure to retest as described below.  See testing information and supplement recommendations below.

Avid runners, Ultra-distance athletes, avid pregnant athletes (vegetarians – iron from plant sources is not as well absorbed as meat sources):

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