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Iron-deficiency anemia


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lutzwalker
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posted Mar-07-2007 06:23 PM     Click Here to See the Profile for lutzwalker     Edit/Delete Message   Reply w/Quote
On Monday, I learned that I am severely anemic (hemoglobin is currently at 6.4). I had suspected for several months that something was wrong as my running performance continued to deteriorate, but I had no idea it was this bad!

The blood tests so far seem to indicate iron-deficiency anemia, and my doctor has me taking iron pills three times a day while we wait for more results. I think I already feel a little better, although that may be more psychological than anything else at this point.

Has anyone else experienced something like this? If so, how long did it take you to get back into running, and did you notice a difference in your performance when you did? I would really appreciate any information, advice, or encouragement you could give me. Thank you!

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lissasays
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posted Mar-07-2007 06:50 PM     Click Here to See the Profile for lissasays   Click Here to Email lissasays     Edit/Delete Message   Reply w/Quote
Lutzwalker, I'm glad to hear that you're feeling better. Would you mind sharing the symptoms that you noticed prior to being tested? In what ways did your performance deteriorate? I am thinking of getting testing for anemia myself and am curious to learn about how it's affected other fellow runners out there. Did your doctor link yours to sports anemia caused by running?

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vzhokie
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posted Mar-07-2007 07:03 PM     Click Here to See the Profile for vzhokie     Edit/Delete Message   Reply w/Quote
Whoa - 6.4! I'm surprised you were walking!

I was also diagnosed with IDA (hgb 9). Running at that level was impossible for me. You will notice a HUGE difference, starting in a couple of weeks. You should definitely wait awhile to run. You could do major heart damage right now. It will seem like the easiest thing you have ever done - "anemia tired" on a run is so much worse than the expected exhaustion from pushing yourself. Anything will seem easy soon!

Some words of advice, having gone through this twice now:

Keep up with your supplements. It's easy to slack off after you are feeling good for awhile. It will take you at least a year to build up your iron levels again. I stopped after a year and it came right back, so now I'm on them for good.

Also, try to track down the source of your anemia, unless it's obviously from monthly cycle (if you're a woman!). It can be caused by GI bleeding, among other things.

Don't push yourself at all while you're still anemic. Your body doesn't have enough oxygen to do much, so just do only what feels good. You will start feeling better soon: less cold, more energy, no headaches, etc. I also got really bad restless legs syndrome, which went away with iron supplements. Good luck, and keep us posted!

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lutzwalker
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posted Mar-07-2007 07:34 PM     Click Here to See the Profile for lutzwalker     Edit/Delete Message   Reply w/Quote
Thanks for your reply, Lissasays! I'm happy to answer your questions. I think this is going to be pretty long, so I apologize in advance. I don't want my main point to get buried at the end, so I'll say it right now: definitely talk to your doctor if you have any suspicion of anemia. The initial test (CBC) just requires a simple blood draw and yields all sorts of useful information. By the time I finally went to the doctor, my iron levels were low enough that he was worried that I might need a transfusion soon. I was completely shocked that he was so alarmed by the test results, since I basically felt fine, if not great, when I wasn't trying to run. He told me that if I wasn't young and (otherwise) healthy, he would be surprised if I could even function with such a low hemoglobin count. So - get it checked out before it gets to that point!!!

Anyway -
The symptoms that led me to suspect anemia were:
Increasing fatigue, weakness, and lack of stamina - not just in running, but in other physical activities too
Shortness of breath when I ran, even at paces that were much slower than the ones I had been maintaining with no problem before
Headaches
Difficulty concentrating
Irritability
Dizziness and rapid, pounding heartbeat any time I climbed a reasonably steep hill (even walking) or a flight of stairs

Now, for my deteriorating performance:
I started running seriously last August - before that, I'd run very sporadically for about ten years, but had always been pretty active - and it went extremely well at first. I placed second in my AG in a tough local 5K, impressed my friends with my training paces, had a great time running, lost weight, and generally got all sorts of positive reinforcement.

Around mid-October, I noticed that maintaining my previous paces was becoming more and more difficult. I read quite a bit on these forums and elsewhere, realized that I might have taken on too much too soon (among other things, I had no concept of an "easy" pace - I went all-out on every run and was obsessed with timing myself), decided I was overtrained, and took a week off.

When I started running again, I felt rested, but continued to get slower and slower with constant or even increased effort. I didn't know what else to do, so I just kept running. By December, my 5K time (on a much easier course) had increased by three minutes, and I was frustrated and bitter. Since overtraining didn't seem to be my problem, I decided my aerobic fitness probably needed work and decided to try low-heart-rate training. I got a HRM for Christmas, did some more reading, and started trying to keep all my runs under MAF. At first, it felt great to have an excuse to slow down, and I really enjoyed it. Gradually, though, I noticed that I was falling into the same pattern of similar effort yielding worse and worse results. When it took me 56+ minutes to complete a three-mile run while staying under MAF last week, I decided it was time to see if there was something else going on - and that's how I ended up in my doctor's office.

I haven't had the chance yet to have an in-depth conversation with my doctor about the possible causes of this, so I don't know if he will make the connection with running or not. But I'll definitely bring it up and will let you know what he says. Again, I'm sorry this is so long, but I hope it's helpful!

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lutzwalker
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posted Mar-07-2007 07:44 PM     Click Here to See the Profile for lutzwalker     Edit/Delete Message   Reply w/Quote
And it must have taken me a VERY long time to type that all up, because I didn't see vzhokie's post until I was done! Thanks so much for the advice and encouragement, vzhokie - I really appreciate it. Having gone through the same thing, you must understand how discouraged and frustrated I've been lately!

I am a woman, but my periods aren't particularly heavy or long, so I don't think my menstrual cycle is what's causing the anemia. I think the other tests we're doing now are meant to determine the cause - we'll see...

And as tempted as I am to get right back out there (I have to admit that I was thinking about it even today), I'll do my best to wait to run. How long do you think is reasonable? (I'll ask my doctor too, of course, but I'm curious to hear what others who have been anemic think.)

Again, so many thanks - you've really given me hope.

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teetime
Cool Runner
posted Mar-07-2007 11:06 PM     Click Here to See the Profile for teetime     Edit/Delete Message   Reply w/Quote
quote:
Originally posted by lutzwalker:
On Monday, I learned that I am severely anemic (hemoglobin is currently at 6.4).

Has anyone else experienced something like this? If so, how long did it take you to get back into running, and did you notice a difference in your performance when you did?


I had something very similar happen (though it's been about 10 years now ... I was just 20 I think). I was running 8miles a day, day in and day out, and then I just could NOT. I am sure things slowly got bad but all I knew was that one week I went from having trouble with my run to literally having to walk at mile 2 (and, especially in those days, I walked for nothing!) I was on the phone explaining my problem to my mother (who is also a doctor) and as we spoke she looked up at a picture taken of me a few months prior and said, you are totally anemic. It turned out I was TOTALLY anemic ... a bit worse than you even.

I had ALL sorts of tests ... blood tests, checking the poop for bleeding tests, and some other things too. In the end nothing showed up (thankfully) and my doctor (a GREAT man) labeled it iron deficiency anemia. Like you I went on a heavy dose of iron suppliments and I also really looked at my diet. In those days I was apt to undereat/restrict and ate meat rarely. I added more meat and also tried harder to eat regular meals.

I don't remember just how many weeks it took to get back to running regularly but it wasn't too too long. In terms of improved performance, it wasn't as if I all of a sudden was super fast but I got back to strong 8milers pretty quickly. (I wasn't racing or timing myself at that piont so don't really know but I do remember realizing that I'd been feeling badly for weeks before I even noticed I was feeling badly.)

I still take iron suppliments and every now and again check my numbers (I tend to be border line all the time but have never dipped really low like that since.)

You'll get better and not only your running but your entire day will feel better soon. You just want to think about why it might have happened so that you can keep it at bay in the future.

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teetime
Cool Runner
posted Mar-07-2007 11:14 PM     Click Here to See the Profile for teetime     Edit/Delete Message   Reply w/Quote
quote:
Originally posted by lutzwalker:
And as tempted as I am to get right back out there (I have to admit that I was thinking about it even today), I'll do my best to wait to run. How long do you think is reasonable? (I'll ask my doctor too, of course, but I'm curious to hear what others who have been anemic think.)

Again, so many thanks - you've really given me hope.


Oh, I too was so eager to tell my story that I didn't see all the other posts. Like you, my doctor was really surprised I was at work each day, walking around, being normal other than unable run, but I think that I was super stubborn and just trucking on!

In terms of health dangers and running while still anemic, I didn't really worry at the time. I figured my body would tell me what I could and could not do (I'm not saying this was the right choice but it's what I did). At the time I was pretty anxious in general and working out helped. So what I did was walk my 8mile route (luxur y of time at 20). Then I started to add in jog bits as I felt better. I just worked back up from walking it all to running it all, using my body to tell me where I was (I really got to the point where "pushing" through it was NOT an option ... my legs would just not work. It was a very specific feeling, I was able to breath but my muscles would just not work. As that faded I just turned walking into running.)

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sweetiemfw
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posted Mar-08-2007 12:06 AM     Click Here to See the Profile for sweetiemfw   Click Here to Email sweetiemfw     Edit/Delete Message   Reply w/Quote
I've had trouble with iron deficiency not too long ago--not as bad as you guys, but I still had a decrease in performance, fell apart at the end of races and workouts, burning/dead legs, dizziness. I began taking liquid iron, about 1-2 teaspoons, twice a day, about six weeks ago. Since then, my times have improved quite a bit, and I'm back to my previous level. I'm just concerned with dipping back down there again, so to be on the safe side, I'm tempted to keep taking this amount indefinitely. However, I heard too much iron can be very bad. I don't know how much I need though doing 70-75mpw. I don't know if I should maybe stay at this amount for awhile longer, then cut back to once a day and stay there? Anyone with experience with this, input would be appreciated.

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lutzwalker
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posted Mar-08-2007 01:04 PM     Click Here to See the Profile for lutzwalker     Edit/Delete Message   Reply w/Quote
teetime - wow, you sound a lot like me! I think I was also getting through my days out of sheer stubbornness recently. Thinking about it now, I realize that my general lethargy, inability to focus, and exhaustion after even a very easy, short run were warning signs, but I guess I gradually got used to feeling this way. I can't wait to experience "normal" again. Thanks for sharing your experience. The way you started up running again makes a lot of sense, although I will have to be pretty cautious since I'm terrible at listening to my body.

sweetiemfw - I'm also concerned about iron overload. I wasn't sure from what you wrote whether a doctor had told you to start taking the liquid iron, but if not, it's probably a good idea to talk to someone. When I started reading about anemia, I came across many recommendations to avoid self-medicating with iron, not just because of the danger of overload, but because the iron deficiency might be caused by an underlying problem that needs to be treated even if taking the iron makes you feel better. A doctor should also be able to help you figure out the correct dosage to maintain your current levels. I'm glad to hear that iron supplements have helped you so much!

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lissasays
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posted Mar-08-2007 04:24 PM     Click Here to See the Profile for lissasays   Click Here to Email lissasays     Edit/Delete Message   Reply w/Quote
Lutzwalker, just wanted to say thanks for starting this post and to everyone who shared info on their experiences with anemia and running. This is such an interesting topic, because it seems like there's a fine line in diagnosing this. It's so easy to link tired legs and fatigue to overtraining, and even lack of sleep. But it's clear that even with mild symptoms, it could be anemia.

I have a family member who is a nutritionist who believes strongly that runners (and especially women runners) are very susceptible to sports anemia. She stressed to me the importance of getting tested before taking supplements to determine the correct doses and forms. Apparently not all are created equal and have different effects on the system.

Keep us posted on how you're all doing!

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westendgirl76
Cool Runner
posted Mar-08-2007 04:35 PM     Click Here to See the Profile for westendgirl76     Edit/Delete Message   Reply w/Quote
This is all interesting to read-I have suspected anemia for the last 2 years (not been running well as opposed to my '04 times, really tired all the time), but doctors keep telling me otherwise. (the last one I went to said he just "indirectly" tested my iron and "if i was able to run the marathon, then he's positive I don't have anemia." Mind you, compared to my '04 times, I could have done the marathon much better than 3:58...) And the symptoms that the OP mentioned sound exactly like what I have...

Anyway-what are the correct tests I would need to get? And what type of doctor would listen to me and get me these tests? (If anyone has any recommendations for any in the NYC area, would be much appreciated...)

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lutzwalker
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posted Mar-08-2007 05:28 PM     Click Here to See the Profile for lutzwalker     Edit/Delete Message   Reply w/Quote
lissasays - I'm very happy to have started a topic (my very first) that is not only enormously helpful and encouraging to me, but interesting and useful to others! Your family member's view on sports anemia sounds convincing to me - does she have a theory of why this might be the case? As you say, part of the problem in diagnosing anemia seems to be that most of the symptoms are so non-specific that it's easy to attribute them to other factors in our lives - especially since as runners, we tend to spend what some might consider excessive amounts of time exercising, and we often are at the lower end of the healthy weight spectrum.

westendgirl76 - that doctor sounds horrible! I have absolutely no medical knowledge, but just based on the tests I've had done, I would be very surprised if there were an indirect way to test for iron. Maybe my experience with my doctor (who is a family practice doctor, no sports background, not an athlete) wasn't typical, but I was pleasantly surprised at how easy it was to get him to order my tests. I use a big HMO that isn't known to be particularly generous, but as soon as I mentioned anemia (I had actually come in for something completely unrelated and minor) he started suggesting tests.

I started with:
CBC without differential - this had about ten components, but the ones the doctor seemed to find most alarming were low red blood cell count (rbc), very low hemoglobin (hgb) and very low hematocrit (hct).
Thyroid stimulating hormone (the doctor suggested that my fatigue might be related to my thyroid, not anemia; this came back normal)

Then I had:
Iron and total iron binding capacity
CBC with differential
Reticulocytes and hemoglobin concentration
and am still working on a (sorry, gross) fecal occult blood test.
I haven't spoken with my doctor again since these came back, so I don't know exactly how to interpret the results or what he was looking for. But the initial CBC seemed to be enough to convince him that I was anemic - now we are just trying to identify the exact type of anemia and the cause.

I'm on the other side of the country, so I can't offer any recommendations, but I do hope that you find a more sympathetic doctor very soon. I can't imagine feeling this way for two years... a few months was more than I could handle.

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vzhokie
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posted Mar-08-2007 05:41 PM     Click Here to See the Profile for vzhokie     Edit/Delete Message   Reply w/Quote
The most appropriate ways to test specifically for iron-deficinecy are a serum ferritin test (deficiency will show ferritin less than 10) and TIBC (will be high with deficiency, >450).

Sports anemia, also called dilutional anemia or pseudoanemia, would never cause a hemoglobin reading anywhere close to 6.4. It is cause by dilution due to a greater than normal blood volume, and is usually pretty subtle. For women, the normal hgb is 12-16g/dl. Sports anemia might cause you to be at 12 or 11. Also, your RBC count might be a little bit low. Nothing drastic, though!

As for supplementation, I was also worried about overloading on iron. My hematologist just laughed at me. She said my iron stores were non-existent (ferritin=6), so it would take a very long time to even get up to normal. Couple that with the fact that I am obviously losing blood or not absorbing iron well, and she said it would be pretty much impossible for me to overload. It can happen to people who try to diagnose themselves, though. No supplementation should be done until the iron tests come back low.

[This message has been edited by vzhokie (edited Mar-08-2007).]

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westendgirl76
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posted Mar-09-2007 10:33 AM     Click Here to See the Profile for westendgirl76     Edit/Delete Message   Reply w/Quote
lutzwalker-thanks for your reply. in the doctor's defense, he was nice, but I don't think he was very well-educated in the fact that runners/athletes do have different needs than couch potatoes. So I need to find a doctor that does understand that. I know a lot of people from NYC are on this board, hopefully someone will see this...

thanks again!

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HSunshine
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posted Mar-09-2007 12:46 PM     Click Here to See the Profile for HSunshine   Click Here to Email HSunshine     Edit/Delete Message   Reply w/Quote
quote:
Originally posted by teetime:
I had something very similar happen (though it's been about 10 years now ... I was just 20 I think).
<snip>
You'll get better and not only your running but your entire day will feel better soon. You just want to think about why it might have happened so that you can keep it at bay in the future.

Same thing happened to me over 10 years ago, I was about 15 at the time and my hemoglobin got to about 7.5 (as I recall). Same thing, I was running just fine and then all of a sudden, it seemed, I could barely get up a flight of stairs without feeling like death. I was finally carted to the Dr. because I passed out a few times - yikes!

I was put on iron pills and it took me a long time to feel back to normal -- but then again the pills made me very sick so I was, um, slightly less inclined to take them regularly. Ah, teenagers. I still take iron and highly recommend you take these if you can:
http://www.vitacost.com/EnzymaticTherapyUltimateIron
(Well, I don't care where you buy them, this is just a picture of the botttle The sell them at Whole Foods as well)
I've had much better luck with these pills versus the regular non-heme form of iron - no side effects and fewer pills.

Just my experience, hope you feel better soon!

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lutzwalker
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posted Mar-09-2007 01:25 PM     Click Here to See the Profile for lutzwalker     Edit/Delete Message   Reply w/Quote
westendgirl76 - best of luck - let us know how it goes! And by the way, this morning I did get back the results from the serum ferritin test that vzhokie mentioned. Anything below 13.0 was lower than normal for this test, and I was at 2.0. I know it's irrational, but that number disturbs me more than any of my other results. It's so close to zero...

HSunshine - thanks for the iron recommendation. So far I'm doing fine with the little green ferrous sulfate pills: no side effects, even though I've been taking them on an empty stomach. Whether they're actually replenishing my iron stores remains to be seen, though.

[This message has been edited by lutzwalker (edited Mar-09-2007).]

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rhoon phast
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posted Mar-18-2007 11:51 AM     Click Here to See the Profile for rhoon phast   Click Here to Email rhoon phast     Edit/Delete Message   Reply w/Quote
Having been a bit tired and unable to handle my own fairly moderate training, I've been following this thread...I'm paying more attention to iron and waiting to see if my lethargy is still with me after 7 days of supplementation. If so, it's off to the doc I go.

But my reason for this post is just to find out how lutzwalker is doing 10 days after the last post? Curious what you've learned so far.

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Acb8d2
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posted Mar-18-2007 01:46 PM     Click Here to See the Profile for Acb8d2   Click Here to Email Acb8d2     Edit/Delete Message   Reply w/Quote
Is the only option to start taking iron pills? Does a change in diet help with this at all? Or is it too severe for diet? Sorry, I don't know much about it but I know I eat very little red meat and lack veggies consistentlyso I wonder if I'm letting myself get depleted... maybe all high mileage runners are just tired.

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vzhokie
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posted Mar-18-2007 03:52 PM     Click Here to See the Profile for vzhokie     Edit/Delete Message   Reply w/Quote
Seriously, it is really important not to take iron supplements without taking a blood test first! Hemochromatosis (too much iron) is a common disorder:
http://digestive.niddk.nih.gov/ddiseases/pubs/hemochromatosis/index.htm
The symptoms can be similar to anemia, so please don't self-diagnose. A quick blood test will certainly show if you need to supplement.

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lutzwalker
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posted Mar-18-2007 09:13 PM     Click Here to See the Profile for lutzwalker     Edit/Delete Message   Reply w/Quote
rhoon phast - I'm definitely feeling better, thanks for asking! But no real news yet. All I know for sure is that my anemia is definitely caused by iron deficiency, rather than B12 or folate deficiency. As to what's behind the lack of iron in my system, the only test that might have been helpful came back negative. I did find the following passage in Pfitzinger's Road Racing for Serious Runners quite interesting:
"For premenopausal women runners, maintaining normal iron levels is often a challenge. Besides menstrual blood loss, women runners' iron levels tend to be low because of low iron intake, foot-strike hemolysis (breakdown of red blood cells when your foot strikes the ground), increased blood volume from training, iron loss through sweat and urine, and iron loss through the gastrointestinal system." (79)
This sounds to me like something more than the sports anemia that lissasays and vzhokie were discussing. Thinking about my eating habits, I do realize now that I probably haven't been taking in anything close to the RDA for women - and according to Pfitzinger, that's for sedentary women!

Anyway, walking up stairs or hills no longer leaves me dizzy and exhausted, and I hardly ever get the rapid/pounding heartbeats anymore. However, it's hard to know exactly how much better I'm doing, because my doctor has ordered me not to exercise at all for a month - no running, no weights, nothing! So please, those who are feeling run down and having symptoms similar to mine, see a doctor NOW and ask for the appropriate blood tests (and, as vzhokie said, don't start taking supplements without test results that indicate iron deficiency) - don't let it get this bad, because I'm sure a month without exercise would make you as miserable as it's making me. I'm supposed to see my doctor again and get retested when the month is up so that he can give me permission to start exercising again, and I'm already counting the days.

lissasays and westendgirl76, I would love to hear how you are doing with your symptoms, too...

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rhoon phast
Cool Runner
posted Mar-22-2007 11:15 PM     Click Here to See the Profile for rhoon phast   Click Here to Email rhoon phast     Edit/Delete Message   Reply w/Quote
lutzwalker, thanks for the update. Hope you continue to make progress and get back into a rhythm.

I get the impression that people are concerned that I'm taking supplements without having been to a doctor. I'm actually just eating a higher iron diet, since I normally eat a very low iron diet. The eight weeks before I started seeing a real pattern of declining ability to handle hard workouts were marked by major nosebleeds on average once a day. I'm still putting in 40 miles a week without much trouble, just have had to keep it all at easy miles. And no, I don't have hematochromatosis. So far, I feel a lot better already after a couple weeks of better diet. I was also starting to feel ravenous all the time, and that's gone. I'm not planning on another hard workout until next week at present, and will let you know how that is.

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Troy

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Joanna
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posted Mar-26-2007 11:56 AM     Click Here to See the Profile for Joanna     Edit/Delete Message   Reply w/Quote
If you want to increase your iron absorption it is important to know that coffee inhibits iron absorption Make sure you don't have coffee within an hour of having a meal/supplements. Also, vitamin C helps with iron absorption, so have a glass of orange juice with your meals.

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Gingerbread
Cool Runner
posted Mar-27-2007 05:31 AM     Click Here to See the Profile for Gingerbread   Click Here to Email Gingerbread     Edit/Delete Message   Reply w/Quote
quote:
Originally posted by Joanna:
If you want to increase your iron absorption it is important to know that coffee inhibits iron absorption Make sure you don't have coffee within an hour of having a meal/supplements. Also, vitamin C helps with iron absorption, so have a glass of orange juice with your meals.

True, I believe it's the tannin in coffee and tea, btw, that inhibits absorption. And if orange juice doesn't appeal or wouldn't sit right with a particular meal, red bell peppers have a LOT more vitamin C than orange juice and are quite sweet and tasty. Actually, green bell peppers have a lot of Vit. C, although not as much as red, and I think they also have more than oranges. I just offer this as an option.

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JgirlB
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posted Apr-09-2007 09:08 AM     Click Here to See the Profile for JgirlB   Click Here to Email JgirlB     Edit/Delete Message   Reply w/Quote
I just wanted to let you all know that I am SO grateful I found this thread! I was recently dignosed with IDA with a level of 9. I was amazed to see others with less than mine!!!

I started getting in shape (after long need) and found that after a sinus infection I was so weak and tired. I went back to the doc for tests and got my results.

I confess I am no where near where you all are in terms of physical fitness and running isn't my niche, LOL. I actually found this doing a google search. (I feel like I need to explain...)

My biggest problem is feeling like my legs are just too heavy to move the way I want them to some days and my eyes just won't move and change focus as quickly as I want them to. My head feels like it could just do its own things separate from my body. LOL! I have been on my supplements (3Xs daily) for two weeks now and am waiting for the relief.

I'm sorry to but in with my post; I just truly wanted to say I'm so glad I found this thread. I hope you all feel (or continue to feel) better, and I wish you all continued success with your running careers!

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renner1
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posted Apr-10-2007 03:03 PM     Click Here to See the Profile for renner1     Edit/Delete Message   Reply w/Quote
quote:
Originally posted by lutzwalker:
On Monday, I learned that I am severely anemic (hemoglobin is currently at 6.4). I had suspected for several months that something was wrong as my running performance continued to deteriorate, but I had no idea it was this bad!

The blood tests so far seem to indicate iron-deficiency anemia, and my doctor has me taking iron pills three times a day while we wait for more results. I think I already feel a little better, although that may be more psychological than anything else at this point.

Has anyone else experienced something like this? If so, how long did it take you to get back into running, and did you notice a difference in your performance when you did? I would really appreciate any information, advice, or encouragement you could give me. Thank you!


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