Iron Depletion in Endurance Athletes

Posted in: Training articles

Most endurance athletes understand, at least in part, anemia and its detrimental effects on athletic performance.  Likewise, most trips to the doctor’s office for routine physicals or the common cold involve getting blood drawn for basic lab work known as a CBC.  A basic CBC will indicate if a person is anemic, or if they have low hemoglobin and/or hematocrit.  However, I have learned that as endurance athletes, or what most average people would probably referred to as “extreme athletes,” we must have more than a basic understanding of the CBC and classic anemia.  In fact, our athletic performance and improvement, and more importantly our overall health and quality of life, depend upon it.

What I have discovered is that one does not have to be anemic in order to have their athletic performance, and quality of life, decrease.  Iron depletion, or low stores of iron in the body, can have the same effect as full blown anemia on a person’s well-being.  I think this is especially true for athletes when you consider the demands placed upon the body – in my opinion, the consequences of even slight deficiencies can be magnified due the extraordinary demands we put on our bodies.

Additionally, iron depletion can often be a precursor to the more serious condition of anemia – in other words, iron depletion when left undiscovered and untreated will often lead to full blown anemia.  What is so unfortunate in my opinion is that most general practitioners will not test a person for low iron stores; therefore, most people won’t know they are low on stores until the problem is exacerbated into anemia.  This is especially unfortunate since the low iron stores are common among endurance athletes, and even more prevalent among female athletes.

In my research, I have found scientific evidence that athletes with low ferritin levels often have twice or as many as three times the number of overuse injuries as their peers with healthy levels.  In addition, research shows that performance often declines or plateaus with low ferritin levels.  Ferritin, or iron stores, is used by the body to build new red blood cells; and red blood cells carry oxygen to your working muscles.  Red blood cell counts in the body affect hemoglobin and hematocrit levels in your body; and low ferritin often leads to lower hemoglobin and hematocrit (H&H) levels.  Even if H&H levels are within the “normal” limits on a routine CBC, that doesn’t mean that these levels shouldn’t naturally be higher in your body.  Your body wants to operate at its natural balance point, and if that point is 14.0 for Hemoglobin, why would you want to settle for 12.5.  I can assure you that you will feel much better at 14.0 than 12.5, even though both are within “normal” limits.  Don’t wait until you are below the normal limits to check to make sure your system is in balance.  Be proactive!

Personally, I had no idea that I suffered from iron depletion issues until my coach forced me to demand a complete iron profile from my physician.  My performance had plateaued, I routinely became ill, and I had very frequent overuse injuries or aches/pains.  By the time I gave in and listened, I was full blown anemic.  For me, treatment wasn’t easy as my body didn’t respond well to the typical supplements.  It has taken the good part of a year to get my iron stores to return to normal; and ultimately, my physician had to refer me to a hematologist (a medical doctor specializing in blood disorders – most of the time these physicians are oncologists as well).  I have discovered along this journey that my body has a hard time storing iron from my diet, and even through over-the-counter iron supplements.  I tell my personal story here because now that I am recovered for the most part, I cannot believe how much better I feel in general.  In reality, I had no idea how bad I felt and how tired I was before because I can’t ever remember feeling any different.  Even as a teenager, I was tired and injured and my performance in sports would yo-yo back and forth as my energy levels fluctuated on a routine basis.  I thought it was normal, but it is NOT.  And I now know what a healthy person is supposed to feel like.

I urge all athletes, and parents of student athletes, to ask for iron profiles once or twice per year at a minimum.  You must be educated and take responsibility for your health.  I learned this lesson much later in life than I wish I had.  I have been an athlete, a serious athlete, for two decades and just had my first iron profile about one year ago.  I was a three season varsity athlete at an NCAA Division I school and never had this lab work done!  So, please I urge all athletes out there to educate yourselves and take charge of your own well-being.


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