Running--It's in you blood

 

I am blessed to coach Cross Country in an area where it is not only a popular sport, but the coaches in the area are some of the bests in the state. While it’s highly competitive among the teams and coaches, it’s also a community that supports one another.  We communicate with each other on a regular basis.

Back during the summer, one of our rival coaches, shared some information about low ferritin levels in runners. Our girl’s coach researched the information and began to wonder if some of the girls on our team were struggling due to low ferritin levels.

Case in point.

We had a very dedicated senior girl that had impeccable work ethic and yet she simply couldn’t improve. She fought three years of never-ending fatigue and sluggishness. Three years of doctors telling her there was nothing wrong with her. Three years of constant disappointment. Three years of just surviving a sport she had once thrived in.

In a sport replete with mental and physical challenges, it can be difficult to know whether poor performances are caused by the mind or body. Yet after reviewing the document that was shared with our coaching staff, we began to wonder if there was more to it because she exhibited many of the common symptoms of iron deficiency. Her legs felt heavy whenever she tried to run, she experienced dizziness when standing up, and she felt unusually tired in the mornings and throughout the day.

Iron deficiency is a significantly underdiagnosed problem in distance runners. Low levels of hemoglobin in the blood, or low levels of the iron storage protein ferritin, can profoundly have a negative impact on your ability to have successful workouts and races.

Hemoglobin is the main building block for red blood cells, which carry oxygen from your lungs to your muscles. If you don't have enough hemoglobin, you can't make enough red blood cells, and as a result, your distance running performance will suffer. Furthermore, low ferritin levels can cause poor performance, even when hemoglobin levels are normal.

In a sample of high school cross country runners, about 13% of boys and 40% of girls were iron deficient at the beginning of the season. This study went a step further and followed the same sample of runners throughout the fall. By the end of the season, the prevalence of iron deficiency had increased to 27% of boys and 49% of girls. Even among those who were not classified as iron deficient, the majority had a decrease in their serum ferritin levels. The simple pounding of day-to-day training increases runners’ likelihood of developing an iron deficiency.

After a few months of taking an iron supplement, our runner knocked 3 minutes off her 5K time and she wasn’t the only one impacted by low ferritin. Over half our girls team had low ferritin levels.  Most weren’t as severe. The change in diet and added supplements for our runners made a huge impact on our team’s success.  We went from the 39^th best team in the state to the 13^th best team. 

The goal wasn’t just to get the girls back to the normal range of the average person, but at the level of a distant runner. The normal range is above 30.  The goal range for a female runner is 50 or above and 60 above for a male runner.  The runner discussed above was at a level of 6 and achieved improvement just by reaching the normal range of 30. 

How do you find out if it’s “in your blood.?”

The only way to determine if low iron is the cause of a runner's troubles is to get a blood test. You will need to request two separate tests: A "CBC," which stands for complete blood count, and a serum ferritin test.

Complete blood counts include an entire panel of tests, but the one you are interested in is your hemoglobin level.  Hemoglobin is reported in grams per deciliter (g/dL), or sometimes grams per liter (g/L), which is just g/dL multiplied by ten. A serum ferritin test, measured in ng/mL

A ferritin test requires a separate blood draw; the value you are interested in here is your serum ferritin level, which is typically reported in nanograms per milliliter, or ng/mL. You may also see it reported as micrograms per deciliter, or µg/dL—these units are equivalent.

When your doctor calls to report your test results, make sure you ask for the specific number and units for both hemoglobin and serum ferritin.  Hemoglobin levels very by gender and age. A lab report will indicate if your results are within range.

The serum ferritin level is often the missing ingredient in determining if a person is iron deficient. 

Remember a female runner should be greater than 50 and a male runner should be greater than 60.

What if you are like me?

My blood type is O negative Rh negative.  Until a couple of years ago, I had no idea what this meant. All I knew was I felt sluggish all the time and I couldn’t stop gaining weight.  My diet was very healthy for the most part due to my ulcerative colitis diagnosis back in 2013.  In fact, my diet and prayer had resulted in historical remission of my ulcerative colitis.

So why was I feeling so sluggish?

One of my doctors decided to do a full blood panel and the results were downright scary. My PSA was high. My testosterone was very low, and my RBC, Hematocrit, and Hemoglobin were extremely high.  I was a ticking timebomb for cancer and heart issues.

Without going into all the details, I wasn’t a ticking timebomb. Instead, I was a product of 2 rare combinations in my blood. O negative blood type is known as the universal blood type and makes up only 7% of the population.  However, it was the negative Rh component that was impacting the other factors.  A combination of the 2 often leads to a fluctuating PSA, a substantial drop in testosterone with age and higher than normal red blood cell volume.  On top of that, it also impacts HGH (Human Growth Hormone) which lowers your metabolism and impacts fat stores.

The paradox for me was a multitude of things and while it had a lot to do with my blood type; my hemoglobin was high, and my ferritin was low. I did not have anemia. I had malabsorption of iron which led to iron deficiency.

A normal or high hemoglobin level doesn’t always tell the story.  Low ferritin and normal hemoglobin can still lead to iron deficiency. This can impair your production of enzymes important for creating aerobic energy, so you're forced to dig into your anaerobic energy systems earlier, thus becoming fatigued more rapidly.

It’s important that you know your numbers. The medical community isn’t always well versed on the impact of ferritin in relation to endurance sports. Too many times iron deficiency is overlooked due to normal hemoglobin results. 

Luckily for me, I had a doctor who understood my crazy numbers. He increased my testosterone via pellet placement. He lowered my hemoglobin, hematocrit, and RBC through routine therapeutic phlebotomy. He increased my HGH with injections. And he is now working on regulating my ferritin levels through iron IV therapy.

As he said—“It’s all in your blood.”

Thank God for a Cross Country community that is knowledgeable!