On August 20, 2014, I got blood work because I was feeling run down. Having dealt with low iron for almost 10 years at that point, I was fairly certain I knew the culprit. With just under 6 weeks left until Twin Cities 2014, I found out that my ferritin was 17 and my iron saturation was 17%. But of course, the doctor who called in the blood work left a message on my phone telling me that “everything is normal!”
So while I upped my iron supplements, we took it easy for a week before Terry tested me with a 4x 3mi workout that went really well just 4 weeks out from the 2014 US Marathon Championships. Then I was back on track.
That story ended with one of the best moments in my career, and that’s why I’m telling it now. Ever since 2014, I’ve been working to figure out why my ferritin won’t get over 50 to save my life and typically hangs around 30. The highest Ferritin I’ve measured in the last 3 years was 47 just after 2 weeks off from running. So yes, I know that quitting running will solve my iron problem, but while I’m still a professional athlete, I am looking for solutions that involve staying in the sport.
Just yesterday I received word that my ferritin is back down to 21 – a level that is historically workable for me, but I still feel all the initial symptoms of low iron that I typically experience. And after now 12 years of taking note of the telltale signs I recognize in myself, this is the list I’ve come up with:
- foggy brain
- way more reliant on coffee and naps
- generally sluggish and less peppy in everyday life
- quad soreness
- increasing poop stops during runs and especially hard efforts (this explains the one during TCM 2014, too)
- my ability to gauge sustainable efforts is definitely off
- long intervals get much harder than usual as the workout goes on
- hills are harder than usual
But here’s the weird part, and this is my call to all sports science, iron disorder, and hematology gurus out there: In the very same test (not fasting but well-hydrated), I got these indicators of low iron:
- Hemoglobin 12.3
- Hematocrit 36.6
- Ferritin 21
I also got these indicators of high iron:
- Iron Serum 173
- Total Iron Binding Capacity 310
- Iron Saturation 56%
I did take iron supplements on the day of the test, so that might account for some of the elevated levels, but I have often taken iron supplements on the day of a blood test and never seen those indicators so high – especially while also seeing my HGB, Hct and Ferritin so low! I have searched the internet through and through and I cannot find any information about the combination of high iron serum and saturation with low ferritin and HGB.
The only differences since my last test on June 20th, 7 weeks ago, is that I have gradually increased my training and in the past couple days, I have increased my iron supplementation again. I have tried cutting out coffee, but haven’t seen much of an impact. I have noticed that the summers have been historically bad for my iron – going all the way back to August 2005 when we first discovered the issue with a ferritin of 7 and HGB of 10.
It seems clear that while my body is absorbing iron through diet and supplements, it is not storing it, and somehow it’s not making the transition to usable iron forms. I have also seen that hepcidin has been found to correlate with iron levels and possibly impact them, and maybe Vitamin D has an effect on hepcidin? But I highly doubt that I am low on Vitamin D because I have gotten more sun this year than ever before in my life, thanks to moving to South Carolina.
After 12 years of struggling to manage my low ferritin while maintaining a high level of consistency and improvement in the sport, I’m sick of it and would love to know if anyone can give me answers. I’ve taken more iron supplements than you can imagine and that has done very little to elevate my ferritin above 30 while in heavy training (80-110 miles per week at sea level, typically with one workout and one long run).
I know I’ll be fine and I can bounce back from this just like I did in 2014, especially since I caught it earlier this time, but any insight would be greatly appreciated!