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):

1) Supplement with 1 multivitamin per day that contains ~18-28 mg iron PLUS 50-100 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 tablets of 50 mg elemental iron each (100 mg total) + multivitamin per day.  If below 10 ng/mL, increase to 3 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.

Male Athletes:

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

1) Supplement with 1 multivitamin per day that contains ~18-28 mg iron 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 tablets of 50 mg elemental iron each (100 mg total) + multivitamin per day.  If below 10 ng/mL, increase to 3 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 (vegetarians – iron from plant sources is not as well absorbed as meat sources):

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 tablets of 50 mg elemental iron each (100 mg total) + multivitamin per day.  If below 10 ng/mL, increase to 3 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.

Any athlete that suspects low-iron:

1) You can start by supplementing 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.  Make an appointment with your doctor and get your serum ferritin tested.

Supplementation recommendations:

1) If low ferritin status is confirmed (below 30 ng/mL), take supplemental iron as indicated above.  Usually, for sedentary adult, therapeutic iron supplementation is ~50-60 mg elemental iron 2-3 times/day (so 100-180 mg elemental per day). However, for an athlete, I recommend a slightly higher dose to cover daily needs + a therapeutic amount to get stores back to normal.  In this age group, runners need ~20 mg elemental iron more than sedentary counterparts – so approximately 120-200 mg elemental iron per day split into 2-3 doses/day. You can get iron through a prescription or over the counter. Over the counter, products that are “slow-release” like Slow-Fe work well.  Each tablet is ~50 mg elemental iron.  In addition to the recommended amount of tablets per day, continue to take your multivitamin.

2) Further Supplementation Tips:

• Take each supplement tablet at different times of day.  It’s fine to combine one with your multivitamin.
• Take with a small amount of juice, 1-2 oz. (100% vitamin C).
• Remember that many antacids can decrease iron absorption, as can soy protein, coffee, tea, eggs, whole-grain cereals and breads, and spinach. Iron absorption also can be reduced by high doses of calcium, zinc, manganese, magnesium or copper. When consuming one of these foods or high-dose mineral supplements, wait 1 to 2 hours to take your iron supplement.

Nutrition Tips:

1) Include 4-6 ounces of red meat in meals at least 2-3 times per week.  Add a vitamin C source to the meat after it’s cooked, such as spaghetti sauce or tomatoes, lime juice in Mexican foods, or lemon juice.

2) Use cast-iron cookware whenever possible to increase iron in foods.

3) Unfortunately, for athletes, I don’t count on vegetarian sources of iron to provide much help – the oxalates and fiber in these foods bind the iron in the gut, making it much more difficult to absorb.

Side Effects:

Typical side effects are gastrointestinal changes – usually constipation.  If you experience any constipation from iron, discontinue use and consult your doctor.

Testing Information:

In addition to, or in place of hemoglobin and hematocrit, ask for a serum ferritin test.  Normal ranges are:

Females: serum ferritin: 12-150 ng/mL; hematocrit: 36-46%

Males: serum ferritin: 12-300 ng/mL; hematocrit: 41-53%

Avid Athletes – Serum ferritin should be 30 ng/mL or above.

Then, ask to get serum ferritin levels rechecked after 2 months of supplementation to make sure the dosage and plan is working to increase serum ferritin.  Adequate iron replacement has typically occurred when the serum ferritin level reaches 30-50 ng/mL for athletes

Resources:

http://www.anemia.org/professionals/feature-articles/content.php?contentid=306&sectionid=15

http://www.trackandfieldnews.com/hs/coachscorner/20051215.html

Fuel Your Adventure.  Nourish Your Body.

DISCLAIMER: The techniques, ideas and suggestions in this document are not intended as a substitute for proper medical advice.  Always consult your physician or health care professional before starting any new eating program, supplement, food or drink – particularly if you are pregnant, breastfeeding, elderly, or if you have any chronic or recurring medical conditions.  Any application of the techniques, ideas, and suggestions in this document is at the reader’s sole discretion and risk.  The author makes no guarantees or warranties of any kind in regard to the content of this document including, but not limited to, any implied warranties of merchantability to any person or entity for any errors contained in this document or for any special, incidental, or consequential damage caused directly or indirectly by the information contained within.

Tags: cycling nutrition, Iron deficiency