Discussion: Iron problems

As many athletes are aware (especially the ladies) many top runners suffer from lack of Iron in the blood, which in turn leads to lower than average performances and really tired legs during training. Since moving to my new home in Austria, I have been having these problems as well, almost 10 years now.

The problem certainly started due to my constant nose bleeds (due to fine dust) and to the extremely high concentration of Calcium in the our drinking water. The nose bleeds have continued, leading to a decimated nose cartilage and I have switched to bottled water.

I have seen more than my fair share of doctors, and they have all offered up their magic cure, but so far it hasn't worked. I have also taken iron tablets on occasion and we try to eat red meat as often as possible - but this is still not helping, so here come my questions.

What do you guys do?
How do you get more Iron into your system?
What foods should I avoid that rob me of Iron?
Any secrets, tips, ideas would be most welcome :)

Please note I'm not looking for the doctors point of view, but rather tips from experience. As you can see, up until now the doctors here have offered up squat!

Richard.

Even though I'm female, I can offer you some ideas, because I have long term low iron levels as well as low haemoglobin levels.
To increase your absorbtion of dietary iron, it is useful to eat or drink high vitamin c foods with your red meat or cereal foods. Avoid caffeine at the same meal.
Sufficient sleep is helpful for iron absorbtion.
Iron supplements are good, especially if they also contain viamin C. Take them an hour after the main meal, with plenty of water. If you take these every day they can contribute to constipation for some people. We can only absorb a small percentage of the iron we intake, so it is important to maximise our body's ability to use what we can.

I echo the avoiding caffeine advice. That was the biggest predictor of how my iron levels would be.

A propos caffeine - if you drink tea during or soon after a meal, the flavonoids can lower iron update from plant sources. However, the flavonoids do not affect iron uptake from animal sources.

I can still drink coffee though, in the morning, cause if coffee is a no go, I'll rather pass up on the training :)

I'm a vegetarian, but not quite a vegan. My Ferritin was low although my hemoglobin was OK. Couple of things I found out-
Iron in vegetables needs vitamin C to absorb. If you're eating spinach or kale, have red peppers or orange juice with them.
Blackstrap Molasses is high in iron.
Here's one I bet you didn't know- Canned clams have 8 times as much iron as beef, 3X as much as liver. They are by far the food highest in iron I've seen. Mussels and shrimp are also high.

I'm taking a supplement too.

I take a liquid iron supplement, cook my red meat only to medium, which means it is still pink inside, and also eat lots of mussels and spinach. If you cook the meat behind medium you rob yourself of some of the iron in the meat. Fortunately with all of the running, I do not have cholesterol issues.

I had anemia which was not corrected by four months of very high dose (prescribed) iron pills (500mg/day of ferrous sulfate for 2 months, 1.8g/day of ferrous gluconate for 2 months).

Once my appointment with the GI doc came up after four months (such things take a while in Canada), he scheduled some tests, and I was diagnosed with Celiac (Coeliac for the Brits) based on a biopsy. This affects just under one percent of the population, and is underdiagnosed due to lack of awareness and familiarity by doctors (improving a bit nowadays). (An internal medicine doctor at a university hospital missed it despite lots of tests. Diagnosis rates are like 1 in a thousand, i.e. one in ten people who have it.) It's one possible reason for low iron and other nutirent absorption problems (anemia is a classic way it first manifests), and easily tested for. (If you get checked for this, get a biopsy (painless), not the flaky blood tests.) If positive, the cure is dietary changes. (Be prepared to gain 20-30 pounds when your body starts absorbing nutirents better though. I gained 15 pounds in three weeks, while eating the same or less.) Since it's also highly correlated with several other auto-immune diseases (type II diabetes, etc.) and a few cancers, it's worth discovering if you have it.

I think the US RDA for iron is 18mg/day, and there seems to be some evidence that even that level can lead to heart problems in men. Some multi vitamins now have lower iron supplements for men only.
As Jim suggests, it may be an absorbsion issue.

Liquid iron gets absorbed way better than solid (pills). Try to get capsules as it doesn't taste at all (as opposed to taking spoonfulls of it).

I experienced a very similar story to JimBaker here in Australia (ie was diagnosed with Coeliac Disease). Its just one possibility but I would also suggest speaking to the doc and having test to hopefully rule it out (if not done so already). The diet treatment hasn't made me run faster (doh!) but hopefully avoided worse problems in the future. BTW JimBaker some Aussie researchers are making good progress on a possible pill teatment to allow Coeliacs (Celiacs for NthAmericans) to be able to eat some amounts of wheat again tho probably still 10-15 yrs from full FDA approval.

Yes, I've definitely been reading about such things.

Other possible causes of anemia include (undetected) blood loss, for which tests include fecal occult blood test (for nonobvious blood in the stool), one of various tests for ulcers (such as a breath test), and perhaps colonoscopy (for colon polyps and such). Presumably your docs have done some or most of these already. (If not, perhaps time to try another doc.)

I definitely wouldn't just assume that the low iron is due to your nose bleeds. (I discovered my anemia when going to give blood for about the fourth time in a couple years...but blood donation was not the cause of my anemia, only perhaps what made the problem obvious.) Does everyone in Salzburg have constant nose bleeds due to fine dust? If not, I'd try to find out why you have them.

THe first diagnosis that comes to mind with chronic nose bleed is polyps in the sinuses.

Really? I had chronic nose bleeds (often daily or several per day) but no one could ever tell me why. I don't think I had polyps in my sinuses. But it would almost be impressive to be able to say that that's what it was. Kind of like having an impressive scar. Gross but neat all at the same time.

I have no inputs on iron problems.

Hm, some really helpful advice, thanks to you all.

I will be seeing a doctor next week and I'll ask him about some of these things mentioned above (need to find the German translation :) ). Most of the tests I have done, but a few I haven't.

Additionally I'm going to try an Iron supplement with Vit C included - maybe it will improve things.

If anybody has got some more great ideas, then please post them,

Many regards,
Richard.

I have some impressive scars as a result of iron intake. Doesn't get absorbed very well in the solid, barbed-wire form, though.

Celiac is Zöliakie in German. My wife has the same disease. Your symptoms of general exhaustion could point to celiac, since it prevents the body from absorbing nutrients in the body. While it can't be cured, as long as one stays away from all wheat and gluten containing products (which includes many items one doesn't suspect to contain traces of wheat or gluten), a person with celiac can lead a 'regular' life.

Those of you with celiac disease may be interested in (or already know about) a cookbook reviewed in today's local paper here, with recipes developed by a chef trained at the Culinary Institute of America (CIA) (so they taste as good as they look)... Easy Gluten-Free Baking by Elizabeth Barbone. available here or here