Iron Supplementation for runners

The greatest loss of iron for distance runners is through footstrike hemolysis (loss of oxygenated red blood cells, see Journal of Applied Physiology article here ). If you’re putting in a lot of miles, that means more potential footstrike hemolysis and a greater need for iron to make new red blood cells (RBCs). Could shoe cushioning (or no shoes) have an impact on iron status? That would make for an interesting research study! My experience is the lighter the shoe (or no shoe!), the lighter your step (and potentially less iron loss? Who knows!). Does surface matter? Probably not, considering there’s no difference in impact force going from one surface to another– you simply change your “muscle tuning” so there’s no variation in impact force. Other losses come through the GI tract, sweat, and menstruation with women. Compound this with living and training at high altitude, where you have a greater need for making RBCs (and thus oxygen), and iron becomes incredibly important.

Being a bigtime red meat eater, I always assumed I was getting enough iron through my diet. I would also take an iron pill with OJ once a week, usually after my long runs. I always assumed my “tiredness” and “leg soreness” was simply a product of the high mileage and marathon training. I had also been through a few stressful years of grad school, so I assumed my underperforming was due to that.

It wasn’t until I went to train in Alamosa, CO in the summer of 2008 that I realized something wasn’t right. Knowing there was a greater need for iron at high altitude, I had upped my iron-supplementation regimen beforehand to ~3 iron pills a week, plus eating lots of red meat. When I got there, I continued this regimen. After a month in Alamosa, and a few headscratching performances, I realized I needed to get my ferritin checked to know what’s going on. While not extremely low compared to what you normally hear about with other runners, it was at the low end of “normal” (41). I purchased some liquid iron from Walmart (ferrous sulfate elixir, Qualitest brand, brown bottle with yellow label) and started taking it daily. Within a week, I felt ridiculously amazing, dropping 10 seconds per mile off of mile repeats. I also ran a 10K PR in Colorado Springs…. at 6,000ft. elevation!!! I continued to run one PR after another going into the fall. I knew I was onto something big…. something I had overlooked for YEARS of high mileage training!

I can’t stress enough to other runners the importance of iron! Ferritin is the storage protein for iron that is used, as needed, to make new RBCs, which contain hemoglobin that carries oxygen. It acts as an indirect serum marker of “stored iron”. Given the great demand by distance runners, ferritin can become depleted quite rapidly. If there isn’t enough of it, the body shuts off making red blood cells/hemoglobin, and anemia will follow. Thus, ferritin is the “gold standard” for early detection of iron depletion. If you only look at RBCs/hemoglobin/hematocrit, those things are affected later, and you may not detect the early signs of iron depletion (~low ferritin). Beside being used to make RBCs, iron is also directly used to make enzymes needed for aerobic metabolism.

Ok, so here’s the scoop: we/doctors/coaches are so used to hearing of runners with a ferritin of “0-30″ that we almost think it’s “normal”! People, this is NOT normal, if you want to perform at your best! Even being at the low end of the ”normal” range for ferritin, 30-50, is likely not enough! That might be ok if you’re a sedentary person, but not for those pounding out 50-140+ miles per week! Given the high turnover rate, your ferritin needs to be MUCH HIGHER, or your RBCs/hemoglobin (carries the oxygen) will become depleted, leading to anemia. According to this Review article on iron supplementation in distance runners, you need to get your ferritin above 60. As mentioned in the article (and also this article ), you essentially have to supplement, somewhat, to maintain your ferritin this high. Most elite distance runners and their coaches know about this– that’s probably one reason why they are elite (and others are not). Unfortunately, not as many college/high school/sub-elites/doctors know about this.

If you don’t want to go through the time-wait/hassle of seeing a doctor to get your ferritin checked, you can do it through Health Check USA ($40, they’ll email you a form you take to your nearest clinic, a phlebotomist will do a small blood draw, and they’ll post the results online within 1-2 days). The research article I posted says to get your ferritin checked 2-3 times per year, ~in between seasons. If you begin closely monitoring your ferritin, you can get a general idea of what it is when you either feel good or feel bad– of course, it’s most important to know what it is when you feel good! Your ferritin may also be highly dependent on the individual– for example, I’ve been steady between 70-92 each time I’ve had my ferritin tested the past 2+ years. Some people may have no problem getting >100, while others have a hard time getting above the 30-50 range (but still feel fine, or at least think they do!). The higher you can get it, up to a certain point…. the better you’ll feel and perform. There may be great individual variance on what is ideal to feel at your best.

How much/what type of iron you need to take may depend on the individual (stomach sensitivity), where you’re located (sea level or high altitude), and what your ferritin value is. There are all sorts of recommendations (see previous research article, Iron supplementation process, plus David Martin’s talk ), whether taking 1-2 pills/day or 1-3 tsp/day for a few months (mixed in non-Calcium OJ/fruit juice)– if your ferritin value is lower, you’d want to take more to get it up more quickly. You also want to time it so that you’re not taking it with anything that will hinder absorption (see Pete Pfitzinger’s article), like Calcium and tea (~tannins hinder absorption). Meat (the “meat factor”– contains more readily absorbed heme iron), Vit. C., and a cast-iron skillet will enhance absorption– this is important, since iron is poorly absorbed. If you’re a vegetarian (and runner), getting enough iron and absorbing it is a real issue.

My personal experience (through trial and error) is that when I go to high altitude to train, I need to take liquid iron (1 1/2 tsp) in OJ every day. When I’m at sea level, I only have to take it 3-4 times per week (plus a meat-rich diet). I usually try to take it after my second run for the day and before dinner (a meat-rich meal). At one time I was taking the liquid iron in OJ every day at sea level, and I begin to experience GI problems and symptoms of tiredness/leg soreness (which actually closely mirrored anemia symptoms). I backed off, and have found that I feel fine taking it only 3-4 times a week. When you supplement with iron, you should definitely keep tabs on your ferritin value. Over time, you’ll figure out how much you personally need to take to “feel good”. Not only has iron supplementation helped me to feel better and perform better, but also to stay healthier, in terms of musculoskeletal health and also immune health. I haven’t had a cold in 3 years (although I still get hay fever when the seasons change).

Most people/dieticians/physicians are highly concerned about developing an iron toxicity with iron supplementation. Given the high prevalence of anemia amongst runners (and the physiological impact of what we do!), I don’t see iron toxicity ever being an issue. We have such a high need and high turnover of ferritin/RBCs that it doesn’t seem possible, unless you’re doing something crazy with the iron supplementation or have the genetic condition called hemochromatosis. Even moreso, women putting in high mileage esp. have a higher need for iron due to our monthly blood loss. Compound this with a vegetarian diet…. and well, the odds are very good you will start to have issues with anemia!

So take it for what it’s worth…. if you’re serious about your running, you should take your iron status seriously!

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Comments

  1. Another great post, jam packed with highly important information for female runners! Ironically enough I stumbled upon my iron issues by accident. I had surgery a while back and while that the surgery went really well I wound up getting one of those nasty hospital infections. Long story short I became so severely anemic I had to have 3 blood transfusions! I found out after the fact that even prior (years!) to surgery I was borderline anemic but no one mentioned it! After the transfusions I felt amazing – it was like night and day. I was sent home with iron pills and afterwards once my doctor saw iron had been an ongoing issue for me before surgery he told me to stay on them as long as I remain as active as I am now. After the fact, all those times I felt so run down and worn out make much more sense – now that I supplement daily, I no longer feel anywhere near as exhausted as I sometimes used to.

  2. Whoa, what a way to figure it out! Glad you got it sorted! Isn’t it a remarkable difference?!

  3. Sorry if I use a lot of big words! My hubby tells me that all the time, esp. when I was in grad school and reading lots of Biochem….. big words flowing out, lol. I have to remember that lay people may be reading this!

  4. You’re a highly intelligent lady which gives you the right to use all the big words you want!

    Man-o-man. Really & truly – the difference has been night and day. I’m no where near your caliber but with my triathlon training (half ironman) I easily put in 16-18 hours of swimming, biking, running and weight training at the height of my training and it used to wear down on me heavily. I mean you expect to ‘feel’ hard workouts and what have you, but in the past I would wake up feeling like I needed to be scraped off the floor on many days. That never happens anymore, not even as my training has become more intense and competitive. If only I knew then what I know now….

    • Ahahaa, thanks! That makes me feel better about the big words. :)

      That is truly amazing how much work you put into Triathlons! Wow. Well glad I did a post about it– I knew this was a big issue, but your story (and the difference in how you feel/perform) further reinforces the importance of it! And yep, I feel like I had several wasted years. If only I knew then what I know now! Never assume you’re ‘ok’, because you eat lots of meat!

  5. my last check was 19.5 not good. That went down from 34 it went up while I was injured and not running. I am taking supplements but I have GI issues I wish could get consistent but it is so darn hard to remember to take and then not take it with things that interfere with absorption. I am getting mine rechecked next week I hope for an improvement geez I would like to see what I would feel like with a 50 or 60

  6. Claudia Becque says:

    Hey! I love your blogs!! Thanks for all the great info! Nice job on all of your races…..so impressive.
    So ever since I moved to Cali, I have had a hard time finding the Qualitest. I was using it back in Chicago when you told me about it last year. Do you know if I can get it online? I tried googling it, but had no luck.
    See you soon!!
    Claud

    • Great, glad you like it and hope it’s helpful! Yep, I’m on a roll (and a marathon winning streak!).

      Have you checked with Walmart and CVS? I’ve bought it from CVS as well, but it’s usually pricier ($9?). I’ve tried Googling it online, and all these weird pharmacy websites pop-up. I would check with a pharmacist at CVS (if you haven’t already).

  7. Camille – this was a very intresting article and makes a lot of sense. I’m hardly in your category of a runner, but am in the 50 MPW range now and planning to increase. As a result of your article, I bought a multi vitamin that has 100% of the daily requirement of IRON…and started taking it.. Of course I dont know if my levels might be down but they surely could be because I dont eat much meat and do run 50 MPW. I’m just about due a dr appt and check up, and they’ll do blood work so I’ll find out what my ferritinm levels really are. This was a good heads up.

    I enjoy your blog and ‘tidbits’ of wisdom. Not many elites pass on information as freely as you do and I have picked up a few good pointers from you. I’ll never make elite status (SUCKS to get OLD), but I can definitely go beyond “hobby jogger”

    • Yeaaa, excellent John! A good multivitamin is a great starting point. Always, it’s most important to have a good diet first, and any supplements are secondary to your needs (ex. I also take Calcium and Vit. D supplements, since I’m lactose intolerant). Besides getting your blood tested, the biggest factor is how you feel and perform.

      My reason for creating my website was to candidly share what I’ve learned so it may help others. So far, I’ve gotten a lot of positive feedback! If I can significantly impact someone’s life for the better, that means more to me than any personal achievement. :-)

  8. Dean Gartland says:

    What section of Walmart do they carry this?

    • You have to ask the pharmacist for it– they may have to order it. Sometimes I’ve had trouble getting it at Walmart (I could get it in Alamosa, but in W. Lafayette I have to get it at CVS pharmacy).

  9. thanks too from me Camille – this has reinforced what I have felt for some time. I am a keen amatuer runner and have been suffering from low iron off and off for some time. I finally went to my GP 3 years ago as so fatigued and calf cramps when running – discovered that Hb was less than 10 and Ferritin was 3! Was on iron tabs for 3 months – made a huge difference. Was advised to stop them once my Hb climbed back to 15 (I was taking meds to supposedly lessen heavy menstruation as that was undelying cause). Have been having the occasional blood test from my GP who has assured me that my Hb is perfectly fine but I have been finding running harder and harder ( thought it was my age – 44years old) to discover that my ferritin levels have been steadily dropping. Doctors were not concerned as they were happy with Hb. Now Ferritin is 8 ( Hb 13) and have been advised to recommence iron tablets. Has made a difference in less than 3 weeks! Amazing!

    • Wow, that’s great you figured it out Liz, and are thriving from supplementation! Yeaaa!!! It’s miraculous the difference it makes! Keep it up, and watch your running take off! Good luck. :)

  10. hey, nice article. I would like to ask what in your opinion the optimal hemoglobin and hematocrit levels would be.
    I managed to get my ferritin from 6 to 96 in 2.5months of iron supplementing but hemoglobin only climbed up to 13.3 (it was 12.1 before supplementing) and hematocrit is at 39% now. is that good enough or not?
    thanks!

    • Thanks! I think some of the links in the article have the info on hemoglobin and hematocrit– it’s different for men and women, 12-16 for women and 14-18 for men on the hemoglobin and 37-47% for hematocrit. I’m guessing your iron stores will become “replete” more quickly, but it takes longer to get the hemoglobin and hematocrit back up.

      http://www.pfitzinger.com/labreports/iron.shtml

      http://www.runnersweb.com/running/rw_news_frameset.html?http://www.runnersweb.com/running/news/rw_news_20050817_PPO_Iron_Deficiency.html

      • thanks for the reply!

        what I really was asking about is what hemoglobin/hematocrit levels are optimal for running. I forgot to say in my previous post that I was interested in terms of running.

        the thing is, interestingly enough, I read everywhere that hemoglobin recovers first and then iron stores take a substantially longer time to refill.

        after doing the iron supplementing, I had two blood tests in total and hemoglobin didn’t move up from 13.3, it stayed at 13.3, but ferritin did improve even further, it went from 96 to 102. (yes I know I said 96 in my first posting but I had another test later. and yes, I kept taking iron, though in a lower dosage than before the first test.)

        so it looks like that hemoglobin won’t change for me any more unless there is some way to get it to move up more without altitude training…

        but if you think 13.3 is optimal for running then let me know..I’m female.

        I’m only asking because to me it seems to be still a bit on the lower end of the range – because, as you said the range is 12-16.

        hope I was able to make my question clearer this time. thanks again!

        oh and I have another question out of curiosity – what is your hemoglobin/hematocrit level like before altitude training and after it?

        • Ferritin becomes repleted first, before the hematological parameters go up. You have to have iron to make the RBCs, so it will use the stored iron, as needed, to make the RBCs. That’s why ferritin is the “gold standard” for early detection of anemia– it will go down (with depletion) and raise up (with repletion) first, while there is a delay in the loss/making of RBCs. You have to be in a fairly depleted iron state, to see hemoglobin/hematocrit below the normal ranges.

          I’m not aware of an “ideal runner’s range” for hemoglobin/hematocrit. As long as you’re within the normal range and you have enough stored iron, your body is functioning as it’s intended. There may be an “ideal range”, FOR YOU, that stays fairly stable (and same applies to ferritin). If you get your blood tested every few months, you may start to recognize trends and what’s normal for you. Plasma volume could be higher and fluctuate, due to hydration/exercise– that will definitely impact hemoglobin/hematocrit values (hemoglobin = g/deciliter). Ferritin can also be higher because of overtraining/stress/inflammation.

          According to the Runnersweb link I provided above, a research study found that with iron supplementation, ferritin/VO2 max/performance improved, while there weren’t any significant changes in the hematological parameters. Besides being used to make RBCs, iron is also directly used for aerobic metabolism. Given this, what really matters is how you feel and perform.

          I don’t have my paperwork available at the moment to give exact numbers (we just moved and everything is in storage), but I believe I’ve only had my ferritin tested with pre- and post-high altitude. From what I vaguely remember, when I’ve gotten full bloodwork at sea level, my hemoglobin has always been around 13-14 and low 40s with hematocrit. I had my VO2 max tested about 5 1/2 years ago (67.5– pretty good for a lady!)– I want to say my hemoglobin was around 13 and hematocrit around 40. I’ll get the paperwork out when we move into our new home.

          I think you’re fine! No worries! Best wishes with your training and racing! :) Camille

  11. thanks! for me hemoglobin went up first and then ferritin; hemoglobin stopped increasing at one point so that was why I was wondering. I’ll be curious to see your data whenever you can get to it! :)

    • From what you described, your ferritin skyrocketed from 6 to 96 in 2.5 months (and a little higher in a later test), while your hemoglobin went from 12.1 to 13.3 and stabilized. There isn’t much difference between 96 vs. 102 and not any reason to freak out for not seeing a corresponding increase in your hemoglobin. This confirms what I said, that your body FIRST rapidly replenishes ferritin (6 to 96 is HUGE– good for you!), while there isn’t much jump or change in the hemoglobin value. Your body definitely has enough iron, and it will make what it functionally needs for RBCs. I wouldn’t worry about the 13.3 value with no change– as long as you feel fine, that’s what matters.

      • @Camille: Hey I’m getting back to your reply only now.

        Since then (summer 2011) the ferritin decreased from 102 to I don’t know where exactly (I’ve seen it at 30-ish and 70-ish too) but hemoglobin stabilized at 13.6. I guess that’s just how it is for me :) I’m still taking some iron every day, and I take double the amount if I have a run that day (I don’t run daily yet, just 5 times a week).

        I would say it was a lot of jump in hemoglobin to go from 12.1 to 13.3, though… Maybe a little misunderstanding here! Basically, the data is, 12.1 hemoglobin I had with the ferritin of 6. Then I had 13.3 hemoglobin and 96 ferritin a couple of months later. then 13.3 hemoglobin and 102 ferritin. (Not a lot of time difference between these two tests though.) So, to me that’s a jump in hemoglobin too. It wouldn’t make sense for hemoglobin to NOT go up over a couple of months of iron supplementing (if supplementing is done properly) as basically all the old blood cells die off and get replaced gradually with new ones within that time frame.

        By the way I looked at a few comments here and I’d like to say this to everyone with iron deficiency as a suggestion: don’t use just that floradix thing to replete the iron. Floradix has relatively little iron in it, you need a BIG LOAD of iron daily for the first few months to do the iron repleting job right and fast. My recommendation anyway. Sure you can do it over a few years with products similar to floradix if you have the time to wait for the results.

        If someone has issues with going to the toilet with a large dose, I recommend trying extra fiber, but do not take it along with iron or the iron absorbtion may suffer, IIRC. That fiber trick worked wonders for me… :) Tbh, maybe my GI system got used to the iron after a few days because I got lazy on eating fiber and I was still fine! So who knows.

        Another question. In the post I see: “At one time I was taking the liquid iron in OJ every day at sea level, and I begin to experience GI problems and symptoms of tiredness/leg soreness (which actually closely mirrored anemia symptoms). I backed off, and have found that I feel fine taking it only 3-4 times a week.” — I don’t understand this part, why would taking more iron interfere with your running? Can you please explain this as it makes no sense to me. Thanks!

        Another note but that’s just nitpicking really, it’s interesting you’ve been in Alamosa for about a month and then taking iron for a week before your performance got better. I recall (maybe it was in your articles or somewhere else) that it takes a few weeks at altitude to get the improvements out of it. You were just around that point by then. Afaik one week of taking iron doesn’t do much yet, at least this is what I was told. Though who knows, maybe it did do a lot. I’m not debating the point of taking iron, I’m doing it myself :) Just it’s sometimes hard to determine real cause and effect unless doing real scientific experiments while excluding all the other factors… seems nearly impossible with running :o At least not over a short time frame. That’s a bit annoying to me, but it’s interesting still, heh.

        • note, “BIG LOAD” just means what the doctor recommends, do not by any chance start taking iron in a totally crazy way… in general 100-300mg of iron a day is great until the hemoglobin and ferritin are back to normal.

  12. Julie Crossley says:

    I totally tanked in a marathon on Oct 1st where I was going for subthree (heartrate out of control, muscle cramps where I usually don’t get cramps). I trained hard all summer, probably overtrained (under recovered) running three other marathons before then since June 2011 and averaging 65-70 miles a week. Last Sept. 2010 I had a ferritin level of 5!!!! yup 5. I read that performance decreases when it goes under 20. My dr. was very concerned and I had to get 4 IV transfusions of Iron Dextrose. I felt so good afterward that I never followed up until this past summer I started noticing the symptoms sneak up on me but I thought “I could overcome this” , no big deal. Wow was I wrong. I was in complete oxygen deprivation by mile 18, more sore than any of my training runs and running slower by then (coming in to the half at 1:31). I am 42 and had 3 periods in six weeks, the last one ending the week before the marathon. I felt completely wiped out before the race even started. My dr. is getting me all checked out again. As I am very sure my ferritin never even came close to what you suggest on your site even after transfusions. I took my supplement (floradix, liquid iron) randomly so I was not the best patient. But now I will be seeing again the same performance issues striking me. I also only eat red meat once every two weeks or so. Going to change that as well. By the way I was able to run the marathon in 3:08 but it was painful. More painful then my 3:09 four months before on a more difficult course. So YES get your ferritin level checked. IT IS SO IMPORTANT in every aspect of your body functioning well.

    • Hi Julie! Wow, you’ve got a lot going on, between all the marathons and your health issues. My best advice is to work with a doctor and a dietician who understand female runners. It sounds like you’re all over the place, not just an iron issue, and that’s obviously going to throw your body out of whack. Good luck getting everything sorted, and most importantly…. let your body recover and relax! It needs it. :-)

  13. Hi Camille, fascinating reading! I have a question regarding the haemolysis issue. Where does the iron go since you aren’t losing blood externally? I would have thought the body would be able to reabsorb and reuse the heme and its associated iron. Is it all filtered out renally? In which case have there been studies that have looked at urinary iron loss in athletes?

    • Hi Janene, this is a good question. The body is good at “recycling” iron. One of the articles I shared (http://jap.physiology.org/content/94/1/38.full.pdf+html) states this on page 41 (and keep reading into 42),
      “Although most iron is salvaged from senescent or
      damaged RBC and reutilized under normal conditions
      (6), these conservation mechanisms may fail when subjected
      to the stress of intensive training. For example,
      should blood haptoglobin stores be overwhelmed or
      incompletely replenished during the recovery period,
      excess hemoglobin will be excreted or broken down.
      Although a single hemolytic episode is unlikely to
      cause iron loss of clinical significance (20), daily or
      twice-daily hemolytic episodes during hard training
      may have a cumulative effect that might be significant;
      athletes such as marathoners with high training volumes
      would be particularly at high risk. Several studies
      have indicated that distance runners have compromised
      iron stores (4, 8, 14, 22).

      In terms of “excretion”, guessing it could be fecal or urinary. This may be “too much information”, but when I supplement with iron, what my body doesn’t need/use “appears” to be lost through feces. You could probably do a search on PubMed and find articles looking at urinary iron loss in athletes. Considering that distance runners tend to have compromised iron stores (as mentioned above), it sounds like more iron is excreted rather than recycled.

      • Dear Camille,

        Thanks for your comprehensive reply and also for stopping by my blog :). Yes as you indicated, it does get so much more complicated when you factor in heavy training. I haven’t been able to do much mileage at all for quite some time, so would expect my body to be dealing with its iron issues a lot better than it is. It will be interesting to see if normal tissue iron levels override the fatigue that has plagued my attempt to get back to distance running for the last 10 months or so! Thanks again :).

  14. Great post Camille! Would you consider doing a similar post on the acceptable levels of testosterone for male endurance runners? Especially concerned about the 50+ age group. Thanks and best of luck at the Trials! :-)

    • Hi Dean! Thanks! I’m not really familiar with testosterone levels and if there’s a difference for male endurance runners (and with aging), but that would be an interesting topic to research.

  15. Wow Camille thank you so very much for this post! It makes so much sense now. I just ran Boston last Monday (Set a 10 min PR finishing in 3:22) and after the race a friend of mine suggested I start an iron supplement. I am not an elite runner (just ran my very first 5k 18mo ago) and did not understand why I would need this. Now it all makes so much sense!! I don’t eat much red meat and should probably get my levels checked. I started running high mileage before Boston peaking at 80 mpw and I live in Utah so very high altitude. Anyway I’m sure you don’t care about all of the details but I am so glad I found this post it is so incredibly helpful.

    • runcamille says:

      Hi Rachelle! Wow, congratulations on PRing in such extreme conditions! Someone else messaged me and said they PRed as well. That’s amazing! I’m willing to bet you have a lot of untapped potential. I have a friend who went from 4+ hours in her first marathon…. and has gotten down to 2:37! Don’t give up bettering yourself and reaching for the sky.

      Definitely, you should be aware of your iron status. You’ve got a lot of risk factors for having low iron. That’s great you PRed, but you may still be running with less than an ideal iron status. It can make a remarkable difference! Personally, I went for years, thinking it was normal to feel tired all the time with marathon training. It was like “flipping a switch” when I went on the iron (instantly dropping time in workouts and races). Go get your ferritin checked, whether by a doctor or going through something like ~healthcheckusa.com .

      Also, if you have any issues with your menstrual cycle (since you’re running more mileage), that should be a red flag that you need to eat more. This is really important! I would say to watch out for other abnormal “signs”– ~fatigue, tiredness, muscle soreness, etc.. You really have to tune into your body and be aware when it doesn’t feel right. This is really key to getting better and staying healthy.

      Best wishes and hope you’re treating yourself for your hard work and success! Congratulations and keep the momentum going! :)

  16. HI – I’m slightly confused. In this extremely helpful write-up, when you refer to “ferritin”, are you referring to “iron” on the CBC (normal range between 40-175 UG/DL) or “serum ferritin” (normal range 10-154 ng/ml)

    • runcamille says:

      Ferritin = serum ferritin. It’s usually a separate test you have to request, beyond the CBC test.

  17. I just ordered a tent Camille. I think your tips about iron will prove useful and perhaps I’ll start loading my system before exposure.

    • runcamille says:

      Hi Mark! That’s great– glad my post is helpful too on the iron! I actually haven’t used my tent since we moved to Okla. last summer. I figured out that I’m claustrophobic! So I’m thinking about selling my tent. Shoot me a message though if you have questions, and also your experience with it after a few months. I think you have to figure out the ideal altitude for you– be somewhat ‘stressed’ but not overly stressed. You also have to figure out the ideal routine of use– when to use it…. when to back off. I put a fan in there to circulate the air, and you also need to make sure you’re hydrating really well.

  18. I was so excited to see this article! I was tested last week and found out I have a ferritin level of 10.7. Given my low level, do you have any suggestions on how much to take in supplements? I took a few days off but started running easy again. Once I start taking the supplements, is it ok to start training and racing again? How long will it take for those supplements to make me feel better (given I feel pretty crappy right now)? Any guidance would be greatly appreciated!

    • runcamille says:

      Hi Eva! That’s really good you figured out your Ferritin. Based on my husband’s practical experience as a college coach, he says to take liquid ferrous sulfate elixir, 1 tablespoon twice a day for 2 weeks in OJ (morning, night). Then cut back to 1 tablespoon/day for 2 weeks at night. Go get your ferritin checked again in a month, and see if it’s improved. If it has, than you can cut back to 1-2 teaspoons/day. Do that for a few months. You want to get up to at least 50, and preferably 60-70 (or higher).

      Probably each person is different on when you’ll start feeling again. Each person might have a different “threshold” they need to be at to feel good. Personally, I felt good within a week of starting supplementation, but my ferritin was quite a bit higher than yours. Let your body and how you feel be the guide. It may be that longterm, you need to supplement to some degree to keep your ferritin up and feeling/performing at your best.

      Best wishes!

      • Thank you SO MUCH Camille! I am so grateful for your guidance!!

        For those looking to buy the elixir, I found it on amazon.com:

        http://www.amazon.com/Ferrous-Sulfate-Elixir-supplements-Efficient/dp/B000GCS7WK/ref=sr_1_1?ie=UTF8&qid=1342635535&sr=8-1&keywords=ferrous+sulfate+elixir

      • Are these dosages safe for an 18-year-old girl 5’5 110 lbs?

        • runcamille says:

          Hi Jona! I recommend reading the linked articles I shared (Iron Supplementation Process, Dave Martin’s talk). Your age/weight/height doesn’t dictate how much iron you should take– it’s your ferritin level, which you need to get tested. The lower this is, the more you need to supplement with.

          • Thank you for your reply Camille. It is actually my daughter, and we have had her tested. Ferritin is 10.6 on a scale where acceptable is 6.8 – 151. She is taking ferrous sulfate 325 mg with 65 mg elemental iron, twice a day with a glass of OJ and a vitamin C pill. The problem is I am doing this without medical advice, because I can’t locate a doctor who specializes in runners or even athletes, outside of orthopedic! Her senior track season gets underway in three weeks, with the first race coming in about 6 weeks. I am hoping ot have her levels much improved by then.

            I wanted to try the ferrous elixir, but I read it can discolor your teeth! Thoughts?

          • I can help with this one– yes, unfortunately the elixir stains your teeth. I developed pretty sizeable gray stains on my two front teeth but my dentist was able to to polish them off. He suggested drinking the orange juice and elixir through a straw and immediately brushing my teeth after.

          • runcamille says:

            Thanks for chiming in Eva! Just saw your message, after I commented. Spot on with the drinking through a straw!

          • Thanks Eva!

          • runcamille says:

            Ahhh, Ok! A ferritin of 10 is definitely low! She should aim to get above 50– can’t go by the “normal range” because distance runners need to be much higher to account for the high turnover rate. I asked my husband what he does with his college athletes– he has them take the liquid iron in OJ with Vit. C (1 tsp) in the morning and then again in the evening. Then, he has them get their ferritin retested a month after supplementing. You keep following the protocol until the ferritin gets above 50. Once she’s above 50, then she can back off to supplementing 1 tsp/day or 3-5x/week (depending on the value). You can drink the liquid ferrous sulfate elixir in OJ with a straw to help prevent teeth discoloration– helps bypass the oral cavity. I’ve been taking it for almost 5 years now, and I think my teeth look fine! Also, someone recently told me that the Nature Made brand of pills (can get at Walmart) seems to work the best of any pill brands.

          • Great – Nature Made is what she’s taking, got it at Costco. I will search online to see where I can get the ferrous elixir – I visited 4 stores locally to no avail. Was the reference to 1 tsp the amount of liquid to add to the OJ, or a reference to the vitamin C. I assume the iron, but wanted to be sure, because that would be my next question! I have also read that ferrous fumarate is good – there is much more elemental iron available than with the gluconate or sulfate. But I haven’t seen anyone carrying that.

            I must add, I am so grateful for this information from you. There is a dearth of knowledge regarding this topic amongst doctors, coaches, other running parents. I would be much more frustrated were it not for your blog AND your follow-up comments. THANKS!!

          • runcamille says:

            Hi Jona– this is the regimen that my friend, Steve, followed with his Nike athletes– “Iron pills were nature made. The regimen was simple. Depending on ferritin levels, we’d start with 1 for 1 week, 2 for 2 weeks, 3 for 2 weeks, and 4 for 2-3 weeks. After you got to 4, we’d check ferritin, see where it went then taper down to 3 or 2 depending on how high it went. Maintenance dose was almost always 2-3, unless it got scary high. Taken with vitamin C. Taken away from hard workouts.”

            Liquid iron is measured in tsps. The units for Vit. C is mg, so 500mg-1000mg. I don’t worry about taking Vit. C (just take the liquid iron in the OJ), but my iron is fine. For someone who’s iron/ferritin is low, they probably should take extra Vit. C.

            I wrote this blog post in 2011, and even I’m still learning and hearing ideas from other athletes/sports professionals. When I lived and trained at the Olympic Training Center, Dr. Wilber raved about Ferrous Bisglycinate Chelate. I’ve heard from other athletes about ~Hemaplex and the Nature Made iron pills. The Nature Made pills is what they use with the Nike athletes. Personally, I’ve done fine with the Qualitest Ferrous Sulfate Elixir (which I always have to ask the Pharmacist at Walmart to order).
            http://www.vitacost.com/natures-plus-hema-plex-90-softgels?csrc=BNR-criteorm-097467037694_234X104-browse

            The athletes/coaches have practical experience on their side and know wayyyy more than the doctors, and maybe even ahead of what the researchers know (who later confirm what the athletes already know!). However, I also think athletes can get caught up in “placebo effect” type stuff, thinking something is helping them… when actually the mind is willing the body! With iron though, the research definitely backs it up. Glad to be of help! Good luck to your daughter and track season!

          • Hi Camille,

            I have one more follow-up question for you. I ordered the ferrous sulfate elixir, in the brand you recommended. Costco got it for me at a cost of about $5 a bottle. But I noticed that the amount of iron per teaspoon is lower than that of the pills she has been taking. I was wondering if somehow the liquid, while it has less iron in it, enables a higher percentage to be absorbed, resulting in a higher delivery of iron. If so, what is the explanation for that? My tendency is to just have her take the pills since the dose is higher, but maybe a body can only absorb 50% of what comes in a pill form versus 75% absorption via liquid. I’m making up numbers here. Let’s assume that either dose is taken on an empty stomach with 8 ounces of orange juice. Does the liquid pack a more powerful punch?

            Thanks so much for caring. I am really interested to see what her blood test results are in a couple of weeks!

          • runcamille says:

            Hi Jona, despite a lower iron content, liquid is easier for the gut to digest and absorb than a solid pill. Really though, it comes down to personal preference and what’s easier on one’s gut. Some people have problems with the liquid (~constipation, gut issues), so the pill form causes less problems.

          • Just checking back in Camille. To remind you – my daughter is a senior in high school. Her 1600 PR of 5:20.96 was set when she was a freshman. She has come close to it each year, but has been unable to beat it. Until last Friday when she ran a 5:08.55. Hallelujah!! She was offered a small athletic scholarship last winter, but when the coach found out about the ferritin last month, he upped the offer and offered more if she runs sub 5:05. I am now thinking she could run sub-5! Her ferritin is still below 30, but she is taking supplements and still has 5 weeks until State.
            Thanks so much for your advice regarding the iron supplementation!!

          • runcamille says:

            Hi Jona, sorry there’s been so much hoopla this week– missed your message. Great news!!! Thank you for the update! Glad your daughter is doing well and seeing the impact of iron supplementation in her race performances. Keep the momentum going!

          • Just got her test results – 47.9 and climbing!

          • Hi Camille: just wanted to say thanks again for your help with the low ferritin issue my daughter had. She ran last weekend at U of O, and got her name up on the scoreboard at Hayward Field! So cool, and only possible because she got the iron levels back up where they should be. Her HS teammates also benefitted from your wisdom, such that she an one other have DI scholarships. I can’t really express how grateful I am to you for sharing this information that set us on the right path. Wanted you to know. Blessings!

  19. Andrea Nist says:

    Camille, do you recommend stopping the iron supplementation a for a day prior to having the ferritin check in order to avoid any falsely high readings?

    • runcamille says:

      Hi Andrea! No, you probably want to be in your normal routine to get a true reflection. However, I can’t imagine it making that much of a difference either way (although I have heard that being sick/state of inflammation will make one’s ferritin falsely high)– not sure how “volatile” ferritin status is. So if you normally supplement… keep supplementing. If you don’t supplement, don’t start supplementing right before the test.

  20. I have recently done my blood test , and all my numbers are good except my Iron is high. I had never had this problem before. Indeed, in the past I had defeciency of Iron. I also run Marathon, and exercise almost on a daily basis. Any recommendation to resolve my high Iron level in my blood. Thanks

  21. Thanks for the information on iron & running. Very helpful! I have been struggling with poor racing performances and hit & miss on being able to hit workouts times and gone through periods of extreme fatigue that only a week or two rest will bring me back to feeling normal only to get back into this rut of running poor and fatigued in about 3-4 weeks after the rest. I run about 60-70 mpw. I am getting my iron test this week but starting supplementing in the mean time with liquid ferrous sulfate in hopes of getting my iron up for my marathon in 2 weeks. Can recommend how much to take at one time? 20-30 mg? How much can the body absorb? Thanks so much!

  22. So I am a college distance runner running 60-70mpw…should I take a teaspoon of liquid iron 3-4 times a week or every day?
    Thanks again for this great article!!! I was always a little nervous about over-dosing bc my doctors always warn me about that and say that my ferratin is “fine” when it is between 25-33, but I don’t agree…and I don’t think you would either! :)

  23. Is it okay to take iron WITH meals? I take liquid iron on an empty stomach every morning before my runs, so I don’t eat breakfast until 2 hours after I’ve taken the supplement. Would it work okay to take the iron WITH meals, too? I’ve been having trouble getting my iron up. It was 44 last fall, fell to a 25 this past winter, and now it’s only climbed to a 29 for this fall. Thanks for your help!

Trackbacks

  1. [...] There is research showing there are “responders” and “non-responders” to high altitude. I strongly believe the reason for this lies in iron-status. If your ferritin is low or even low-normal BEFORE you go to high altitude (lets say below 50, according to the research), you will have a difficult time responding positively to the high altitude. Ferritin is the protein used to store iron and is used when needed to make oxygen-carrying red blood cells (RBCs), one of the main benefits to high altitude. At high altitude, you have a surge in your endogenous production of erythropoeitin (EPO), which stimulates new RBC formation. If you don’t have enough iron to produce RBCs, you will have a difficult time responding positively to the high altitude. Thus, it is important to get your ferritin checked beforehand (try: http://www.healthcheckusa.com) and to load up on iron before and during the high altitude stint. I previous did a very detailed blog post about Iron Supplementation . [...]

  2. [...] the past month loading up on liquid iron in OJ and Vitamin B Super Complex (see blog post about iron supplementation ). I definitely feel fresher and more rested than I did 2 years ago when I went to train in [...]

  3. [...] bat, I thought, “Wow, I love this guy!” You can read my post I did a few months ago on iron supplementation . I wasn’t kidding when I say your ferritin/iron is the single most important thing every [...]

  4. [...] in the sunshine…. DON’T ASSUME your Vit. D status is Ok. Just like I talked about with iron, because you eat meat…. don’t assume you’re getting enough iron to meet your [...]

  5. [...] I strongly believe the reasons I haven’t gotten sick for 4 years is because of 1) Taking extra Vit. D in the winter, and 2) Taking liquid iron in OJ. I actually take both of these year-round, but during the winter I take an extra weekly dose of Vit. D (supplementation of 2000IUs daily and an extra 5,000IUs once a week). You can read my previous detailed posts about Vit. D here (Extra Vit. D, esp. in the winter ) and iron supplementation here (Iron Supplementation ). [...]

  6. [...] stretch as well. To eliminate other concerns etc. Please go see a doctor Powered by Yahoo! Answers Michael asks… Calf cramps when running/jumping? Hi, lately I've been getting calf cramps while I'…alf cramps when running/jumping? Hi, lately I've been getting calf cramps while I'm playing sports. [...]

  7. [...] year, I did a detailed blog post about Iron Supplementation, particularly it’s importance to red blood cell (RBC) production. In addition to needing iron [...]

  8. [...] far as checking ferritin (marker of stored iron), you can read my detailed blog post about iron supplementation. I also blogged about how I started taking Super B Complex. Both iron and B vitamins are very much [...]

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