Elliot:

Thanks for writing in about your ferritin problem. Your right to be taking action as 14 is quite low. In my experience anything under 30 and the athlete will suffer severe performance degradation and fatigue. Under 50 is where we begin to see the first symptoms of fatigue and poor recovery with some performance drop off.

I’ve had a fair bit of experience coaching young women and many have had low ferritin. Ferritin is slow to respond to iron supplementation. Finding the right iron supplement and dose can take time. Iron is normally bound to another element(s) and ferris sulfate is the most common to find in drug stores. It’s the cheapest and, from my experience the least bio-available and the hardest on your gut. It causes constipation in everyone I know of who’ve used it. Ferris Gluconate on the other hand seems to be much easier on the gut and more bio-available. It is harder to find though. Shopping on line will make the process easier.

Heme iron, the iron that is the hemoglobin protein in animal muscle is the most absorbable/bio-available type of iron supplement. This is where the old axiom of eating red meat to cure anemia comes from. IT WORKS.

Heme-iron supplements are available and I think they work the best of anything I’ve seen used other than chelated iron which is also more easily absorbed.

As for dosage: Normal it is recommend to take more until you get adverse reactions like constipation or upset stomach. Here’s the rub: Having too much iron floating around in your blood (not bound to ferritin) can be a bad thing. Iron toxicity is dangerous and ironically the symptoms of iron toxicity are the same as those found when you have low iron, low ferritin levels. That is; fatigue, low energy and lowered work capacity. I always suggest that athletes get a full iron panel done along with their ferritin tests. I’ve usually seen the use of 15-20mg/day of elemental iron. Read the label to see how much elemental iron is in the supplement

Low ferritin with high iron levels indicates that your body is not making more ferritin in response to the increase in iron. I suggest monitoring all these levels throughout your recovery. Continued dosing with iron supplements, in this case, can lead to iron toxicity. There can be other underlying medical contributing factors that need more workup.

I’ve never personally used IV iron but have heard of some athletes who did use it and got very quick results in returning to health. Obviously you will need to consult your doc about this.

I hope this info helps. Good luck.

Scott

Elliot;

I do not have any specific brand I can recommend over any other. I just do not have enough knowledge about this to speak with any authority. I understand your concerns about maybe getting lower quality supplements and I just don’t know what to tell you.

I will tell you that I have seen this issue MUCH more frequently with vegetarians than with those that eat red meat. For about 15 years I coached junior XC skiers (mostly girls around your age) and typically had 1-2 vegetarian girls each year that struggled with low ferritin. It’s just a reality that we are evolutionarily adapted to absorb natural source Heme-iron better than these artificial iron salts that come in tables and liquids. If you want to stick with your vegetarian diet (fish does not contain heme-iron) you might consider getting some heme-iron supplement.

A Cautionary Tale: In the early 1980’s I switched to a vegetarian diet when I was ski racing and training a high volume with lots of intensity. At the most important time for me, leading into Olympic trials in 1987, I became extremely fatigued. Training had notched to a higher level and I was not responding. I was a wreck. I got tired climbing a flight os stairs and would have stop and catch my breath and let my legs recover. Maybe these symptoms are familiar to you? I’d never heard of ferritin but luckily for me a doctor who worked with the US SKi Team had and got me tested. My ferritin was 9. He asked me if I was vegetarian. When I said yes he told me to go have a steak dinner. I did just that. I never took an iron supplement but with in a month or 2 (I can’t recall the exact time. It was a long time ago) of starting to eat meat my ferritin was up in the 30s and I felt so much better. It continued to improve for months and I managed to salvage the tail end of my ski racing season.

Scott

Hi Elliot,

Just some practical nutrition guidance for you on your low iron.

Firstly who carried out your blood test? If it was your doctor I would hope he/she would have advised accordingly on dose and duration of iron supplement. It can take up to 3-6months to restore low iron levels (iron deficiency) or anaemia (usually classified as levels lower than 12 so you are right on the cusp) via supplementation.

As Scott explains I would like an individual endurance athlete particularly female to have serum ferritin levels above 50 to ensure optimal performance and health. I would carry out a full assessment history as to why your levels may have dropped (e.g. vegetarian diet as you follow so lower intake of animal based iron (the haem iron Scott refers to), menstural losses/blood flow, training at altitude, endurance training all of which increase requirements for iron intake or cause an increase in usage of iron). In order to then put in strategies to prevent them from dropping again.

When taking an iron supplement it is important to:

1) Take it with a source of vitamin C such as a glass of fruit juice which aids the absorption or iron.

2) Avoid drinking any caffeine substance 60mins around taking the supplement as caffeine inhibits the absorption of iron.

3) It is also important to increase your intake of iron rich containing foods, as ideally you do not want to stay on the supplement long term but to support iron levels via dietary intake.

4) As a vegetarian and young female endurance athlete your daily iron requirements are increased so it is about planning a more considered dietary intake to include iron rich plant based foods daily.

5) It is about finding one that does not upset your stomach.

I would caution against an IV infusion especially if you are competing nationally or internationally as it is prohibited by the world anti doping agency (WADA).

Elliot if you want to sign up to a phone consult we can chat this through in detail and I can give you more support. It’s important you get this right both short term and in the long term and get individual guidance for you.

Hope that helps.

Rebecca Uphill Athlete Dietitian

Hi Elliot

I’m a human who is an athlete, nurse practitioner, and also experienced very low ferritin levels. I agree to the great (evidence based) information has been provided above.

I have received IV iron (common therapy in Canada if your levels are so low). It was amazing, and I can actually enjoy going up hill now. Yes, it is prohibited by the world anti doping agency (WADA).

Couple of Tips:
-I added list of foods contain high iron/vitamin c on my phone as reminder (grocery shopping), found the visual cues helpful.
-The “Lucky Iron Fish” is a simple and effective cooking tool that adds extra iron to your daily foods or drinks. It was develop by a colleague of mine, initially as creative way to treat iron def. anemia in Cambodia. Iron deficiency negatively impacts over 2 billion people on the planet. Yikes!
-Since it can take 3-6 months (or longer) Floradix Liquid Iron 6x500mL bottles cost $239 (Canadian), ferrous gluconate tablets likely more cost saving (1 bottle per month (at max dose 100mg/day) cost $4.74 cdn).
-Liquid forms of iron tend to stain your teeth.

-if the iron upsets your stomach;
-you can try taking it a bedtime.
-take iron supplements with meals (iron absorption is enhanced when supplements are taken on an empty stomach; however, tolerance and adherence may be improved when iron is taken with meals)
-iron supplements can be taken every other day.

-I wouldn’t personally train at high altitude with ferritin levels below 50 (I imagine it would feel very terrible and my suggestion is based on former high altitude training protocol-best to ask Scott).
-adequate ferritin levels is also helpful to support your immune function, which I think is very important to endurance athletes.

I hope this is helpful

This isn’t a full fledged solution by any means, but I like to eat oysters for iron. Mollusks have much more iron than fish, and oysters are quite sustainable as far as seafood goes. Smoked oysters in a can are super convenient and delicious on crackers after a workout! 🙂