Advice on Strategy for Restoring Iron Levels Before IMKY (Oct 13)?

Triathlon Forum
1

I’d like to get some advice from some knowledgeable Slowtwitchers about the best way to get my iron levels back up and keep them up before my IM on Oct. 13th. I was feeling super sluggish on my rides and runs so I had my blood tested on August 22nd and found out my iron levels were very low (Iron: 26mcg/dl; Iron saturation 7%; Ferritin 10ng/ml; Hemoglobin 11.5g/dl; and hematocrit 38.2%). My PCP has me on 325mg of ferrous sulfate twice daily. I don’t have internal bleeding; the doc just said that this is common in runners.

I am seeing mixed results from day to day. Some days I am feeling very strong and some days I can barely make it through the workout. I assume my iron levels may be fluctuating? Is there a way to help facilitate or expedite the iron level restoration before my race and keep them up? (I am taking B12 vitamins every and drinking OJ.) Should I take some time off and let the levels recover? If so, how much time? Any other advice?

BTW: M/56/143 pounds - otherwise in great shape.

Anyone else had to deal with something similar?

Thanks for any insight on this; I’ve trained very hard and I’m starting to panic.

Bill

2

Are you taking it on an empty stomach? It is best absorbed that way, even though it can cause some stomach upsets. Make sure not to drink milk or take a multivitamin while taking iron, since certain minerals can inhibit the absorption of it.

3

I have had similar issues, but I don’t have a crash program for you. My physician wasn’t as concerned about it as I was. He recommended changes in diet IF I was concerned – more lean red meat and vitamin C. I started taking a (younger) women’s multivitamin with iron. (Older women’s vitamins often don’t have iron.) Before my next blood work – six months later – my iron levels were good.

One caution, though – excessively high iron levels can be worse than excessively low. You can poison yourself with too much iron supplementation. Be careful.

4

Ribeye steaks!

5

Thanks for the word of caution! I’ll watch that!

6

Are you taking it on an empty stomach? It is best absorbed that way, even though it can cause some stomach upsets. Make sure not to drink milk or take a multivitamin while taking iron, since certain minerals can inhibit the absorption of it.

I’m trying to, as much as I can. I know that antacids disrupt absorption too, so I completely avoid those.

7

It takes time to get iron up again - 4 weeks, or sometimes months. Footstrike hemolysis (how runners lose more iron) wouldn’t likely be the only reason - do you think your diet was low iron before? This would be an ideal place to consult a registered dietitian due to concerns for toxicity.

8

It takes time to get iron up again - 4 weeks, or sometimes months. Footstrike hemolysis (how runners lose more iron) wouldn’t likely be the only reason - do you think your diet was low iron before? This would be an ideal place to consult a registered dietitian due to concerns for toxicity.

Yes, my Iron could have been low for a while - maybe since last year. I don’t typically eat a lot of red meat (though I sure do now!!). I typically ate a lot of rice, chicken and vegetables. I will for sure check with a dietitian

9

I’d like to get some advice from some knowledgeable Slowtwitchers about the best way to get my iron levels back up and keep them up before my IM on Oct. 13th. I was feeling super sluggish on my rides and runs so I had my blood tested on August 22nd and found out my iron levels were very low (Iron: 26mcg/dl; Iron saturation 7%; Ferritin 10ng/ml; Hemoglobin 11.5g/dl; and hematocrit 38.2%). My PCP has me on 325mg of ferrous sulfate twice daily. I don’t have internal bleeding; the doc just said that this is common in runners.

I am seeing mixed results from day to day. Some days I am feeling very strong and some days I can barely make it through the workout. I assume my iron levels may be fluctuating? Is there a way to help facilitate or expedite the iron level restoration before my race and keep them up? (I am taking B12 vitamins every and drinking OJ.) Should I take some time off and let the levels recover? If so, how much time? Any other advice?

BTW: M/56/143 pounds - otherwise in great shape.

Anyone else had to deal with something similar?

Thanks for any insight on this; I’ve trained very hard and I’m starting to panic.

Bill

Bill…an MD here…not a primary care doctor but one with significant interest in all things iron.
You have iron deficiency anaemia based on that data.
In a male this is unusual. even in athletes.
Often this is investigated to make sure there is no source of iron (ie blood) loss causing this to happen (if you were female these values would be borderline as well).
Short term…get an iron infusion. It will restore your levels very quickly with minimal side effects. Lots of data about the use of IV iron in athletes. BUT-you also need to be worked up properly as for why you have become iron deficient and anaemic in the first place. Your Hb should be up around the 140 mark and this and your iron deficiency will have you feeling crap with little energy. Your iron levels will not be fluctuating.

10

You’re welcome. And also, if no one has mentioned it yet, if you’re a tea drinker, hold off on that for awhile too. A good dietary assessment would be a big help to get to the root of it. And as Amnesia mentioned, an infusion could be a highly effective alternative to throwing in the towel on IM Lou - best wishes there - my favorite race!

11

I’m right with you on this.

I’m 51; heavier than you.
After 6-7 months of repeat respiratory infections, blood tests at the start of Aug showed similarly reduced haemaglobin and iron deficiency (120g/l haemaglobin, red cell count OK (but slightly reduced cell size due to lower Haemaglobin), but lower ferritin (just 7).
Endoscope tests (up and down) showed no internal causes.

I’m prescribed the Iron tablets too, similar dose of ferrous fumarate 305mg x2 a day.
Pharmacist advice was to take with orange juice as the Vit C helps absorption. Also told to take say half an hour or so before food to max the absorption (taken with food is less effective for absorption, but was told that’s still better than not taking at all if you find the tablets upset your stomach - supposedly they can give some people stomach ache.
Dairy / milk really reduces the absorption (pity as I rather like milk !!)

I’m finding I can get say 3 days training then need/want a day off (vs the 5 or 6 days train then a rest day as normal when IM training).

Also I’ve got the ‘top 30% missing’ - I’m feeling that I’m operating at 60-70% or so especially on the bike.
I can still comfortably do a 100+ mile ride in with 8k+ climbing and the legs feel fine at the end . But i can only ride that in zone 2 or maybe bottom end of zone 3 heart rate. No sprinting, no big efforts, i have to just winch up hills. I can’t seem to go over about 130bpm on hilly bike routes at present without being totally out of breath after 20 seconds hard, and the max HR on these rides is about 140 (Normal max HR for me on the tail end of an FTP 20 mins test is 180).

Sample of n=1, I’d say I’m feeling a third of the way back from the worst i was to ‘normal’ after about 4 weeks on the tablets. (Comparing on the bike the same pattern of reduced HR was there say 8 weeks ago but then it was ok at 110bpm but blowing at 120 or above. So a defo improvement of say 15-20bpm higher now to hit the new false ceiling, but I’d normally only have expected the level of rotally out of breath etc at 170+.

At that rate it will be another 2+ months to be fully back ‘on it’. Which chimes well with what my doc indicated (‘a few months’).

I’ve a full distance race in 3 weeks.
I’m expecting to get my arse handed back to me on a plate 🙄
But I’m going to give it a go anyway and see what happens with no expectation by me as to any performance - I’m now treating it as a nice day out swimming (which I’m very comfortable with) and a big bike ride, and then what ever it is on the shuffle and see if i get round.

I’d be interested to know how you go on.
And also why your doc thinks it’s common with runners…my doc is a swim coach, good competitive masters swimmer himself and knows I’m doing tri - but didnt suggest anything to do with sports (his concern was it can oft indicate
internal losses, hence the endoscope exams arranged very quickly for me).

Best of luck with the recovery.

12

liquid iron supplement called Floradix. drop a shot into some OJ. it absorbs much better than pills and works much faster. also cheeseburger help. less chance of constipation too. its expensive but works 10x better and faster than pills. health food stores or Amazon.
,
certain foods leech iron (coffee, wine) etc. so avoid those until an hour or so after taking the iron

13

Bill…an MD here…not a primary care doctor but one with significant interest in all things iron.
You have iron deficiency anaemia based on that data.
In a male this is unusual. even in athletes.
Often this is investigated to make sure there is no source of iron (ie blood) loss causing this to happen (if you were female these values would be borderline as well).
Short term…get an iron infusion. It will restore your levels very quickly with minimal side effects. Lots of data about the use of IV iron in athletes. BUT-you also need to be worked up properly as for why you have become iron deficient and anaemic in the first place. Your Hb should be up around the 140 mark and this and your iron deficiency will have you feeling crap with little energy. Your iron levels will not be fluctuating.

Thank you for taking the time to respond, Doc. That’s the type of feedback I was looking for. I may have to ask around to find a doctor who will give me the infusion; I am not sure my PCP is inclined to do that, for whatever reason.

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Also I’ve got the ‘top 30% missing’ - I’m feeling that I’m operating at 60-70% or so especially on the bike.
I can still comfortably do a 100+ mile ride in with 8k+ climbing and the legs feel fine at the end . But i can only ride that in zone 2 or maybe bottom end of zone 3 heart rate. No sprinting, no big efforts, i have to just winch up hills. I can’t seem to go over about 130bpm on hilly bike routes at present without being totally out of breath after 20 seconds hard, and the max HR on these rides is about 140 (Normal max HR for me on the tail end of an FTP 20 mins test is 180).

Best of luck with the recovery.

Wow!! Holy crap, that’s my experience to the letter! On some rides I just can’t seem to punch through that 140bpm barrier (even though, like you, my normal max is around 182!) My last Ironman I averaged 20.7mph on the bike; right now, I’m lucky to average 18.5!! And I can’t climb for shit anymore. It’s frustrating. I am going to try to look into the IV infusion option, if I can find it. I’d love to stay in touch and compare notes and see how you manage over the next three weeks!! Likewise, best of luck and I’m with you there in spirit!

15

I’ve had low ferritin before while simultaneously going through a bout of poor training and also likely being too tight with my diet. I was told liquid iron w/ orange juice, ~2hrs away from any other food/drink, and preferably right before bed. Fast forward ~10yrs later and my last physical my iron levels were almost too high. One thing that has really changed is my diet . . . I eat so much healthier than I did back then, particularly in the vegetable department. So I have no advice related to getting you ready just for Louisville, but I’d probably look to increase your vegetable (especially spinach, kale, broccoli, brussel sprouts) and legume intake.

16

Bill…an MD here…not a primary care doctor but one with significant interest in all things iron.
You have iron deficiency anaemia based on that data.
In a male this is unusual. even in athletes.
Often this is investigated to make sure there is no source of iron (ie blood) loss causing this to happen (if you were female these values would be borderline as well).
Short term…get an iron infusion. It will restore your levels very quickly with minimal side effects. Lots of data about the use of IV iron in athletes. BUT-you also need to be worked up properly as for why you have become iron deficient and anaemic in the first place. Your Hb should be up around the 140 mark and this and your iron deficiency will have you feeling crap with little energy. Your iron levels will not be fluctuating.

Thank you for taking the time to respond, Doc. That’s the type of feedback I was looking for. I may have to ask around to find a doctor who will give me the infusion; I am not sure my PCP is inclined to do that, for whatever reason.

Presuming you are based in the USA (I am not), I do here it can be a bit tricky but ask around. The new formulations can be infused in 20 mins and results in 3-7 days. You will almost certainly feel a lot lot better.
I will try and dig up some papers on this if you like when I am out of the OR today.

17

.

Presuming you are based in the USA (I am not), I do here it can be a bit tricky but ask around. The new formulations can be infused in 20 mins and results in 3-7 days. You will almost certainly feel a lot lot better.
I will try and dig up some papers on this if you like when I am out of the OR today.

Thanks again very much - I’ve already started researching some infusion centers around here (central Ohio in the U.S.) I will start calling in the morning!

And thanks for all the helpful responses everyone!!! That’s why I love this site!!

18

Take with vitamin c or drink oj. It helps the absorption.

19

dark green leafy veggies like spinach. Also spirulina (sp2life) is fantastic for this.

20

Hi Gville
Thought I’d give you an update and compare notes.
I’m now 6 weeks into a 7 week course of the iron tablets (Actually started 7 weeks ago but had 1 week off them as part of the prep for the endoscope work).
The HR levels have been improving week on week, but not yet back up to ‘normal’ for me.
I was in the Xtri on the Isle of Man last weekend. On the bike, 116.5 miles and just under 10k feet climbing. Ohh and blowing a gale all day and rained sideways for part of it too. NIIIICE.
I averaged about 130 bpm on the bike leg overall, with a peak of 160 (and quite a lot of short excursions into the 150-155 sort of range). I’d say the ‘average when actually pedalling with effort’ was about 140. But some multiple-minutes uphill sections at 150+. The average is pulled down a bit due to many downhills where I wasn’t pedalling much (due to the conditions, it was awash in places and some roads at lower levels had lots of wet leaves etc).

I’d still say I’m maybe 60% recovered from the worst of the illness s of July - the 'pattern’of HRs vs when its fine and when I’m blowing is similar but all the lines are now higher than 6 or 8 weks ago.
I probably lost 1.5 - 2 hrs on the bike vs where I’d be capable of on a good day. I’d guess that splits equally into 1/3 not being physically able to go harder due to the low haemaglobin, 1/3 due to the lack of much decent training in 6-8 preceding months due to it, and 1/3 the very hard conditions of very windy + raining hard etc.

My doc did also say it would take several months to fully recover the iron / haemaglobin levels, then a.lot of time after that to regain the full previous fitness, esp at our age).
Next steps are blood tests next week, see what the scores are. Then if Haemaglobin is back up, no more tablets and re-test a few months later to see if it’s remained OK or has reduced again.

The race itself… was fantastic - a wonderful island and great bike route with lots of stunning scenery (when not in the middle of rain clouds with 50 yard visibility). As expected I was well behind the the cut off for doing the final 10k run section (up the 2nd mountain to the simmit finish), but it was a great day nonetheless.
I’m hoping to head back next year with proper training and some fitness to do the race and my brilliant support team justice !

Hope your training and recovery are going well.