Previously published in ESPN Rise
Last year I wrote a series of articles on young runners who struggle in training and racing with low iron issues. I discussed a specific low iron issue that seems to plague young female and some male endurance athletes called a low ferritin. Ferritin is a protein stored iron that when it is low affects the oxygen uptake system. Young runners who suffer from this can perform beautifully in practice but struggle in the later parts of their race. I received hundreds of emails from many families who shared their tremendous stories about their athlete’s struggles and how these articles have helped them. I learned a lot not just from my own research, but also from the countless stories that came out of those articles. But, I also want to follow up on taking TOO MUCH IRON and not retesting. To help me with this I have invited Amy Baltes, a registered dietitian, who has helped many of my athletes and is co-writing this article with me.
(Janet Leet Writes ) Low Iron storage (ferritin) can be a big problem for the endurance athlete. I had many campers (at the SUB5 Girls Running Camp) this year leave camp and get tested during their high school and middle school back to school physicals. Several of them wrote back with Ferritin iron levels numbers as low as 6 and as high as 217, both are terrible. These athletes can be struggling greatly in their performances. And YES the 217 is terrible too. Too little iron and too much iron can cause fatigue in an athlete. It is a struggle not only for the athlete but for the coach who is baffled as to why she is not performing.
One struggle is getting some medical doctors to order the right tests and read the results. I have had to send some of my private clients into walk-in clinics to get the proper testing done because their own Pediatrician does not think it is necessary. Some doctors just want to order a finger prick test that only shows the iron in the blood and not the stored iron (ferritin). The iron in the blood can test normal but the stored iron can be too low or too high. The other problem is the charts the doctors use. I do not blame the doctors, I blame the wide range on the tests that those charts show. One of the charts I found on line suggests that the ferritin levels need to be between 12 – 300 ng/ml for men and 12 – 150 ng/ml for women. The range needs to be 40 - 70 for most runners. This number can be lower for some and higher for others. Finding your number takes time and lots of follow up testing.
Another problem is that many doctors will just call you with results and say they are fine and that all the blood work came back great. The athlete does not ask what those numbers are and so she walk away with no understanding. Look at that range and educate yourself on what range you should be in. Work with a nutritionist or medical professional who can help guide you on this subject. Athletes, parents, and coaches please ask for the results and get a copy for your records. I have had doctors tell my clients they are fine with a 4ng/ml and even a 120 ng/ml. Athletes, parents and coaches, get the results and have a good nutritionist or medical person help guide you through this.
There is another side of Iron; too much is not good either. Iron can be a toxic substance and can cause other problems if taken in high dosages. It is CRITICAL that the proper testing and FOLLOW-UP be done. I use to recommend my athletes to take much higher dosages of 2 to even 3 irons a day but now I am backing away from that. I try to put them with a nutritionist who can get them to the right levels a lot safer and healthier. The iron used for each athlete is specific and individual. If you find you or your athlete is suffering from a low iron, it is critical that you not only get on an iron supplement but you get on the right one. I also want to warn you that supplements alone are NOT THE ANSWER. (AMY BALTES writes ): Iron is very hard on the stomach and can cause cramping and constipation and can interfere with the absorption of many other key vitamins such as the B’s, D and so much more. In addition, there is a huge variety of Iron supplements to choose from. Looking for the one that is the best for you is tricky. I like ferrous succinate as it is a much easier on the digestive system with a higher absorption rate. I also like multi spectrum supplements that contain more than just Iron and are whole food based. But all this also depends on what your numbers are, how the athlete is feeling, and any digestive issues the athlete may have, which is super common I might add. If starting on an iron program a retest really needs to be done after 6 weeks and then every 3 months.
What is so imperative is that you really delve into what you are trying to accomplish, which is optimal athletic performance over a long period of time. The question remains: what numbers do we have to look at and what is safe and effective? In the long run our objective is to make more blood to circulate in the system in addition reduce oxidation and inflammation. You have to remember that numbers are markers and averages. So what works for one runner is not optimal for other runners. In addition large doses of Iron are VERY toxic and can cause long term problems if not monitored correctly, so that you can find the right mix for each athlete.
I don’t want you to get hung up on the numbers but how the athlete feels. If you don’t feel right and your running is sub-par there are several things that you should look at: Hydration, diet and low ferritin levels. It is important to look at all three components and it may take several changes to accomplish the ultimate goal.
Nutrition is very complex and the important part to remember is that there is a synergy to food, and that while Iron is important and a number to gage it does not work by itself. Iron needs B vitamins, vitamin C, phytonutrients, water, proteins and so much more to help build more blood and increase oxygenation to the muscle. Coaches, doctors and nutritionist have different opinions on how it should be dealt with, when in reality each runner is different and there is not one size fits all way to deal with it. Over time if your diet is filled with toxic foods, limited in fruits, veggies and a lacking in natural iron sources it will start to break down and fight back.
There are a million products out there that are designed to enhance performance and improve muscle recovery. Many times these are quick fixes and can in the long term make things so much worse. That is why it is very important to work with a competent medical professional to help you develop an optimal program that works for each athlete individually. They can help create a diet and supplementation program that works for them.
(Janet Leet Writes ): This past year I have decided to move my family onto a product called Juice Plus. I was concerned that my own children were not getting the proper amount of fruits and vegetables. Amy Baltes recommended it to me. After several months I noticed that my son, who had a low ferritin issue, is no longer fatigued during workouts and races. His coloring is better and his fitness level continues to improve and is better than ever before. My daughter, who has always struggled staying healthy during the school year, has yet to get a virus. As for myself, I have not been sick, my hair is getting thicker, and I now sleep through the night. My husband, who was not a believer, took himself off but after seeing what our son is doing he is now back on. If you want to review a short video on it click on this link and go to the video www.runsub5juiceplus.com. What I like about this product is that once the athlete has reached their optimal iron levels Juice Plus can maintain it. Juice Plus is simply fruits and vegetables in a capsule. You can take the whole bottle and not go toxic.
(AMY BALTES writes ) All in all this article is ambiguous because there are so many factors that play a role in optimal performance for an athlete including: Iron stores, hydration, nutrition, sleep, stress reduction and so much more. There needs to be a foundation of and core belief of what nutrition is and how it can affect an athlete’s performance. I have been using Juice plus as a foundation for the last three years and what I love about it is backed by science! All the research can be can accessed on www.runsub5juiceplus.com . I have been taking it and recommending it for over 3 years and the results have been awesome. Ferritin and Iron stores are a key piece of the puzzle and needed information to help so many athletes. Please make sure you look at all aspects to include this in a safe and effective way to improve long term health and wellbeing of so many runners.
Amy Baltes RD, LDN, HFI and Janet Leet