It was my acquaintance friend - a professional athlete (long jumper) and trainer - calling from Southern California. My rock climbing friend Carlos introduced me to her this past spring, and not only is she an amazing athlete, she's also one smart chic.
We chatted for nearly an hour as she filled me in on all that she knows about iron deficiency and ferritin levels from working in the athletic world. She explained, what science knows about ferritin, a person's ferritin levels shouldn't matter all that much. But, she continued, athletes in her training circles KNOW that they do, and a ferritin level below 25 will begin to negatively impact an athlete's training and performance.
Again, I was at 4. Now at a 12. I've done much reading that recommends women aim for a ferritin level above 50 to avoid fatigue and exhaustion. I'd imagine at least a third of the women in the US have at one time or another experienced the negative impacts of iron deficiency. Primarily, I think, because women in the US have been swayed to believe "milk does a body good." But when it comes to iron absorption, an abundance of calcium in a women's diet isn't all that helpful.
Here is the update e-mail I wrote my doctor a couple of weeks ago:
Dear Dr. _______ ,
GREAT NEWS! I started taking iron pills regularly again – 2 a day with orange juice following my work outs. Already, I feel like a brand new person.
I didn’t realize how iron deficient I still was – as a runner - until after we spoke a couple of weeks ago.
I was struggling, wondering how I could feel like I was dying the past couple of months when my blood work registered normal. My increasing heart palpitations and breathing issues concerned me most. After you confirmed I wasn’t dying, I wondered if I might have an anxiety disorder, or that I might need anti-depressants to help me function better.
As it turns out, I just needed more oxygen.
After our phone conversation I sought to understand this thing called ferritin that you mentioned was in the normal range as a 12, but still on the low end of the spectrum. My search led me to articles about running and low ferritin. And, how really, as a runner, my ferritin levels ought to be above 20 (ideally, above 30), in order for my body and brain to function properly. (* I found a correlation this past year that my body would also crash after participating in all day training seminars, where I was thinking A LOT. I didn’t realize how much oxygen the brain needs for thinking, and how much I had been depriving mine.)
I had no idea ferritin levels are important as they are, and that ferritin levels drop when working out even when an athlete’s hemoglobin levels are normal. No wonder I felt miserable. And, especially so, last summer, and again this summer as I ran in hot, humid weather (foot strike hemolysis certainly didn’t help). I wasn’t taking in enough iron to keep up with what I was losing. (My mistake biggest mistake was lightening up on iron pills last summer - from 2 pills to 1- when my hemoglobin levels returned to normal. When they registered normal again in September, I could only assume my body must be taking a hit for the hard stuff I’ve been through, rather than a lack of oxygen. I let up on iron pills even more and started counseling.)
I also found it fascinating to learn that calcium - along with coffee, tea, caffeinated soda, and alcohol - inhibits the absorption of iron into your system. I didn’t realize the iron in my cereal was being compromised by the milk I poured on top of it. Or, drinking soda with my Shake Shack burger would minimize the amount of iron my body would receive. Although vitamin C helps, I’m now careful to find orange juice that isn’t fortified with calcium to take with my iron pills right after my work outs.
I suspect and am concerned that many women are unknowingly starving their bodies of oxygen and facing headaches, fatigue, depression, and miscarriages all because the normal ferritin level for women has been set too low by the medical community.
I’m confused why the University of Michigan sets the minimum for ferritin at 6, the lab in New York at 10, and Health Wise/Web MD sets the level at 18. Unfortunately the impact of low ferritin in women appears to be under researched. I’m now on a mission to find scholarly support to write an article that I hope will help other women be more aware of the importance of their ferritin level.
One thing is for sure, LIFE is soooooo much better with OXYGEN! J
Thanks again for helping me in my journey to find answers to what has been going on with my body. I know you recognized all my symptoms to be reflective of iron deficiency, I was just confused how I could still feel so miserable when I was no longer anemic. Thanks for being patient with me on my last visit to see you. Seriously, I’m super thankful to have a doctor who takes time with his patients.
A few of the more notable articles I found:
Article on by Dr. Melanie Schorr, MDMedical School at John Hopkins
Residency at Harvard’s Brigham and Women’s Hospital in Boston
Division 1 all American runner at Dartmouth College
Research StudyEffect of iron supplementation of fatigue in nonanemic menstruating women with low ferritin
More on running and low ferritin
What is ‘normal’?
For the average person, normal ferritin levels are quantified as 12-300 nanograms per milliter (ng/ml) for men and 12-150 ng/ml for women. To put it bluntly, an athlete running with a 12 ng/ml ferritin level will be feeling the effects of anemia and their training will be suffering. Runners need to be much higher on that scale.