Low Hematocrit-What To Do

Triathlon Forum
1

I went for a regular physical with my GP doc a couple of weeks ago and received the lab results recently. Found out I am just below the ‘normal’ range for hematocrit. Normal is 39-52 and I am 38.7. My hemoglobin was slightly low too at 12.7 whereas normal for my age is 13-17. My doc isn’t too worried about it, but he did mention it in the report and said we should probably do some investigation as to why I am testing anemic. Normally, I wouldn’t worry too much, but now I wonder just how much harder this condition is making it for me on group rides with a bunch of guys generally 20 years younger. I am 55. I don’t really have any health issues, but my mom had colon cancer and my last colonoscopy was about 7 years ago. I am in the process of scheduling my next one to rule out some sort of bleeding ulcer…or something worse.

In the past, I have felt I experienced more problems cramping on longish rides and higher intensity rides. I chalked it up to hydration (and I know that’s an entirely debatable reason) and/or plain old over exertion. But now, I wonder if some of my problems have been the result of this mildly anemic condition. I eat pretty well including fairly frequent intake of foods rich in iron and I take a multi vitamin daily. I have started taking 65 mg of iron supplements each day to see if this makes any difference when we do a follow up lab test after my colonoscopy. If this doesn’t have a significant impact and I remain slightly anemic, what options are there to get into the ‘normal’ range? How much difference would this degree of anemia make with respect to athletic performance?

I’d like some feedback from the forum since I really don’t think my doc is well versed in sports medecine. I have no desire to engage in any sort of blood doping. I’d just like to hear from guys that may have been able to get their crit levels up with more conventional and legally acceptable methods.

TIA

Greg

2

I have a buddy who is a very good bike racer (5th in the National TT Championship a few years back) who is also anemic. In his case, there wasn’t anything UCI legal that he could do about it. He just avoided races at high altitude and is doing just fine. His only complaint is that he gets lightheaded when over 8000 ft.

3

How much do you train? Low hematocrit/hemoglobin levels have been diagnosed in endurance athletes in the past, it’s a bi-product of becoming more oxygen efficient.

4

Take a look at this, may help you out.
http://www.findingfreestyle.com/?q=blog_breakingthrough2010

5

see my article lasst week Tom Price How ST saved my life
Then Lets talk
.

6

don’t put too much stock in my (or anyone’s) post. anemia can be very serious, so stick with the dr’s advice.

that said, it’s not uncommon for endurance athletes to test ‘anemic’.

I use the quotes because the measures you mention are simply concentrations. And one early, and robust, response to endurance training is an increase in plasma volume. So, if you have the same number of red blood cells as before (whenever that may be), but more plasma (essentially water), then your concentrations are down. although you may have a perfectly healthy total number of red cells. In this case, it’s unlikely that your performance would be effected.

What to do? Keep training and don’t worry about it (as long as the bill of health is good - refer back to the first line as necessary).

Not a bad idea to look into the symptoms of anemia to see how they stack up to your case. But remember, fatigue is not “I rode 200 miles this week, and I’m tired”, it’s “man, I just walked up the stairs and I’m exhausted”.

In any case, the colonoscopy is probably a good idea, both to rule out a bleed, and to screen for cancer.

So, I guess my advice is to be careful about it, but don’t take it too serious. But also remember it could be serious. (this is why you don’t listen to the internets)

7

I went for a regular physical with my GP doc a couple of weeks ago and received the lab results recently. Found out I am just below the ‘normal’ range for hematocrit. Normal is 39-52 and I am 38.7. My hemoglobin was slightly low too at 12.7 whereas normal for my age is 13-17. My doc isn’t too worried about it, but he did mention it in the report and said we should probably do some investigation as to why I am testing anemic. Normally, I wouldn’t worry too much, but now I wonder just how much harder this condition is making it for me on group rides with a bunch of guys generally 20 years younger. I am 55. I don’t really have any health issues, but my mom had colon cancer and my last colonoscopy was about 7 years ago. I am in the process of scheduling my next one to rule out some sort of bleeding ulcer…or something worse.

In the past, I have felt I experienced more problems cramping on longish rides and higher intensity rides. I chalked it up to hydration (and I know that’s an entirely debatable reason) and/or plain old over exertion. But now, I wonder if some of my problems have been the result of this mildly anemic condition. I eat pretty well including fairly frequent intake of foods rich in iron and I take a multi vitamin daily. I have started taking 65 mg of iron supplements each day to see if this makes any difference when we do a follow up lab test after my colonoscopy. If this doesn’t have a significant impact and I remain slightly anemic, what options are there to get into the ‘normal’ range? How much difference would this degree of anemia make with respect to athletic performance?

I’d like some feedback from the forum since I really don’t think my doc is well versed in sports medecine. I have no desire to engage in any sort of blood doping. I’d just like to hear from guys that may have been able to get their crit levels up with more conventional and legally acceptable methods.

TIA

Greg

Ironically I saw this post as I finished up a presentation on iron deficiency.

First to note: there is a HUGE difference between iron deficiency (stage 1) and iron deficiency anemic (stage 3). Yes, being an endurance athlete does put on on the top of the “at-risk” categories.

What are the iron-rich foods you are eating? If you are not eating enough heme type foods and rather non-heme foods then your absorption rate could be much lower then you think.

From a lot of research I have just finished doing, a trend a noticed was the problem with people self-daignosing themselves “anemic”. This lead to them taking supplements (one a day/ Iron 65mg) and the problem was that they didn’t need these supplements. Instead they were making the situation worse, by taking too much iron and inhibiting other vitamins/minerals ability to be absorbed into the body. Go to another doctor/sport nutritionist, get more tests and go from there. Nothing on ST (as good as the aero-advice can be) will be beneficial compared to a sport nutritionist or doctor.

Good luck!

8

How much do you train? Low hematocrit/hemoglobin levels have been diagnosed in endurance athletes in the past, it’s a bi-product of becoming more oxygen efficient.

I doubt it’s enough to create a problem for me. I quite tris a couple of years ago because of the time demands of training and time away from my (now) 10 YO daughter, 13 YO son, and wife. Now, I just cycle about 150 miles per week during the season. Two or three rides during the week and long rides on Saturday & Sunday.

Thanks,
Greg

9

I have a buddy who is a very good bike racer (5th in the National TT Championship a few years back) who is also anemic. In his case, there wasn’t anything UCI legal that he could do about it. He just avoided races at high altitude and is doing just fine. His only complaint is that he gets lightheaded when over 8000 ft.

Good to know. I am also a private pilot with an unpressurized airplane. I haven’t had any episodes like that, though.

Glad to hear this doesn’t seem to affect his performance.

Greg

10

Take a look at this, may help you out.
http://www.findingfreestyle.com/…_breakingthrough2010

I read that a while back, but I had forgotten about the low crit he had to overcome. Glad to find out he was able to improve it using simple means and that he noted a significant improvement in performance as well.

Greg

11

That may still do it, though I wouldn’t write it off wheresoever I would keep In mind and definitely mention that you do such endurance exercises to your physician.

12

see my article lasst week Tom Price How ST saved my life
Then Lets talk

Holy shit! Now, I’ll get that colonoscopy scheduled right away…

Time to ‘check under the hood.’

Thanks for sharing your story.

Greg

13

don’t put too much stock in my (or anyone’s) post. anemia can be very serious, so stick with the dr’s advice.

that said, it’s not uncommon for endurance athletes to test ‘anemic’.

I use the quotes because the measures you mention are simply concentrations. And one early, and robust, response to endurance training is an increase in plasma volume. So, if you have the same number of red blood cells as before (whenever that may be), but more plasma (essentially water), then your concentrations are down. although you may have a perfectly healthy total number of red cells. In this case, it’s unlikely that your performance would be effected.

What to do? Keep training and don’t worry about it (as long as the bill of health is good - refer back to the first line as necessary).

Not a bad idea to look into the symptoms of anemia to see how they stack up to your case. But remember, fatigue is not “I rode 200 miles this week, and I’m tired”, it’s “man, I just walked up the stairs and I’m exhausted”.

In any case, the colonoscopy is probably a good idea, both to rule out a bleed, and to screen for cancer.

So, I guess my advice is to be careful about it, but don’t take it too serious. But also remember it could be serious. (this is why you don’t listen to the internets)

Well, my RBC was low too. Don’t know if this will post properly or not, but the lab results are below. There isn’t anything intimately personal here, so I don’t think there is any reason not to post it.

Component Your Value Standard Range Units
WBC 5.3 4.0 - 10.5 K/uL
RBC 4.20 4.22 - 5.81 MIL/uL
Hemoglobin 12.7 13.0 - 17.0 g/dL
Hematocrit 38.7 39.0 - 52.0 %
MCV 92.1 78.0 - 100.0 fL
MCH 30.2 26.0 - 34.0 pg
MCHC 32.8 30.0 - 36.0 g/dL
RDW 13.1 11.5 - 15.5 %
Platelets 197 150 - 400 K/uL
Grans 67 43 - 77 %
Grans (Abs) 3.5 1.7 - 7.7 K/uL
Lymph Rel. 23 12 - 46 %
Lymphs Abs 1.2 0.7 - 4.0 K/uL
Moncytes Rel 8 3 - 12 %
Moncytes Abs0.4 0.1 - 1.0 K/uL
Eos 2 0 - 5 %
Eosnphls Abs 0.1 0.0 - 0.7 K/uL
Basophils Rel 0 0 - 1 %
Basophils Abs0.0 0.0 - 0.1 K/uL

If you can give me any additional insight from the lab results, I’d be happy to hear it.

Thanks,
Greg

14

Thanks for all of that, Ben. As far as iron rich foods, thanks for mentioning the differentiation between heme and non-heme foods. Did a little bit of research and found out a lot of stuff about iron and diet. I could definitely tilt my diet more in favor of some of the heme type foods like meat, poultry, and fish. However, those are already staples of my diet that is already pretty healthy. Could do a little more, though. Also, I didn’t know about the hindrance of caffeine intake. I drink one cup of coffee a day in the AM and I was taking one iron pill an hour or so before the coffee. Probably negated all of the benefits.

Thanks for the input and I probably will look up a sports nutritionist after the colonoscopy and hopefully ruling out other issues.

Greg

15

As far as I’m concerned, you’re hemoglobin and hematocrit are normal or at least to say the slight decrease is negligible.

A lot of research has been done regarding bloodwork for annual physicals. When you are over the age of 50, there is only evidence to support checking a fasting blood sugar to screen for diabetes, fasting lipid profile to screen for cholesterol and potentially a PSA (prostate specific antigen) to screen for prostate cancer (this is still controversial).

So my question would be, why are we checking the hemoglobin anyway? Are you symptomatic? Are you tired, bleeding or excessively fatigued? If not, I’m afraid you may be reading more into that than need be. That does not represent a significant anemia. The only way one can call that “iron deficiency anemia” is if your iron (measured by ferritin) and hemoglobin are low together. Remember, those normal values are based on large populations but there are a certain amount of normal people who will fall outside of these parameters.

If the concern is about screening for colon cancer, this is an entirely different subject. Your risk should be assessed first. If you have no risk factors for CC and if you are between 50 and 75 then you can consider a colonoscopy or FOBT (stool test for occult blood). The slight decrease in your Hb has zero predictive value on whether or not you’re losing blood from the colon, unless there is a significant drop over time.

Hope that helps. My disclosure is that always consult your physician for final advice and don’t trust a website forum…even if I do sound credible :wink:

16

Wasn’t going to go into this much detail but one more thing…

You will see a measure there called “MCV”. This is the mean corpuscular volume and basically indicates the size of your red blood cells. Yours is 92, which is normal.

Normally in true iron deficiency anemia, the iron is low, the hemoglobin is low and the MCV is low: hypochromic microcytic anemia.

17

Thanks for that. I know the numbers aren’t anything to be worried about. I am only concerned about trying to get the crit number up into the so called ‘normal’ range because of my hobby, cycling. If I wasn’t actively pursuing an endurance sport, this wouldn’t even be a concern. In truth, I am asymptomatic with respect to the slightly low blood values.

Regarding the colonoscopy, my mom had colon cancer, so I am in a higher risk category. I really shouldn’t be going 8 years between colonoscopies at my age, but it happened and I only have myself to blame.

Thanks,
Greg

18

Tom - it sounds like you and I are in the same boat as far as numbers, RBC - 4.31, Hemo - 12.8 and Herma - 37.5. I am 49 and have been borderline “anemic” since I was a kid having to take a liquid prescription iron supplement that tasted dirtier than dirt! I have always felt limited by my lungs and not my legs and firmly believe my oxygen carrying capability is impared by my low numbers. I was a marathoner for the last seven years but have switched to duathlons and sprint (so far) triathlons. Please keep me in the loop if you find any method(s) of raising the levels short of eating a cow every week!

19

Tom - it sounds like you and I are in the same boat as far as numbers, RBC - 4.31, Hemo - 12.8 and Herma - 37.5. I am 49 and have been borderline “anemic” since I was a kid having to take a liquid prescription iron supplement that tasted dirtier than dirt! I have always felt limited by my lungs and not my legs and firmly believe my oxygen carrying capability is impared by my low numbers. I was a marathoner for the last seven years but have switched to duathlons and sprint (so far) triathlons. Please keep me in the loop if you find any method(s) of raising the levels short of eating a cow every week!

It is “impaired by your low numbers” in a strictly physiological sense - if you were a doping cheat and could maintain your Hgb/Hct at 50+ with EPO or RBC tranfusions your performance would in fact improve. But the trade-off is a risk of stroke and heart attack related to more viscous blood.

20

Greg,
Just reading your post b/c I had colon cancer last year and am a cyclist and was/am anemic. I’m a “healthy” 45 yr old master’s racer with a family, job, etc. Hit me out of the blue. Ends up I have what’s called “Lynch Syndrome”, which is a genetic defect that leads to colon cancers. With your mom’s history, I thought I’d write and let you know that Lynch is becoming known as something many people don’t know about. When you have you colonoscopy (and do it soon!), if there is any cancer, make sure they check for the Lynch tumor marker, etc. Just thought I’d mention it.

Shawn