The latest question in our Ask a Coach series comes from a college athlete suffering from anemia.
Question: Since I know this is fairly common among female runners, I am interested in knowing how long it typically takes for people to start racing well again after beginning supplementation. Additionally, should training be altered? And if so, what kind of changes would you recommend?
Run SMART Coach, Alicia Shay: First of all, knowing that it is difficult for many female distance runners to keep their iron in a normal range, it is imperative that you are always proactive so that your iron doesn’t get too low and you have to dig yourself out of a hole and lose time training. You can do this by taking a daily iron supplement and also always eating a diet rich in iron. I am a huge proponent of trying to get as much iron as possible through natural source and then as a last resort, taking supplements.
The most obvious way to consume iron is to eat red meat. However, many females avoid red meat because they think that it is unhealthy but moderate portions of lean red meat (especially organic or grass fed red meat and organic liver) are completely acceptable in an active athletes diet. Another great way to incorporate significant amounts of iron into your diet is to cook your food in a cast iron skillet. The iron in the skillet absorbs into your food, especially liquids, sauces soups and stews. Some other foods high in iron are: cooked spinach, cooked swiss chard, most green vegetables, sea vegetables, steamed clams, chickpeas, lentils, navy beans, iron enriched cereal (just don’t eat them with milk), oatmeal, cream of wheat, non calcium fortified tofu. When choosing foods high in iron, keep in mind that iron is bound in two forms, heme (mostly found in meat) and nonheme (mostly found in non meat forms of food). Heme iron absorbs at a rate around 23% and nonheme iron absorbs at rates of 2-20%. So, eating moderate amount of meat is the best natural way to increase your iron stores. The absorption is greatly increased if you also eat food high in Vitamin C along with the food that is high in iron (tomatoes with red meat, lentils with potatoes or sweet potatoes, oatmeal with berries, etc).
All that being said, when you iron stores are very low (such as yours) and you are trying to continue training, it is best to also include a supplement. You mentioned that you are taking liquid iron two times per day along with sub lingual Vitamin B. That is exactly what I would recommend that you do except that I would also recommend that you also take 500 mg of Vitamin C with your iron because it will increase the absorption dramatically. Also, some things that can inhibit iron absorption are foods containing tannins (coffee and tea), phosphorus (milk), fiber (whole grain, high fiber cereals and bread), and oxalic acid (almonds, cashews, chocolate, cocoa, raw spinach, soda). Avoid eating these things within 30 minutes of taking your iron supplement.
Concerning training, despite your frustrating race, it sounds like you are on the right path. It was very smart of your to take it easy for a little while and focus on rebuilding your iron stores during the rest of indoor season. Most often, athletes notice that they are feeling better after two weeks of supplementation but it take longer for them to feel good during harder efforts (workouts and races) because you require even more oxygen consumption than if you were just doing and easy run. Fortunately, this usually resolves itself after four to six weeks of hard-core supplementation and diet change. In the meantime, you don¹t have to stop training completely but it is good to back off a little bit. This could mean taking a break from racing for a few weeks (which you are doing), not doing really intense workouts, shortening workouts and scheduling an extra day of recovery between workouts. It really sounds like you are already on the right track and you should be feeling much better in a couple of weeks. I know that it is probably frustrating because you feel like you are losing fitness but I think that you will be amazed in a few weeks at how good you feel and you will not have lost that much (if any) fitness. After you feeling like you have fully recovered just remember to be proactive and eat a diet high in iron. Also, you don¹t need to continue taking liquid iron but it would be beneficial to take a supplement or multivitamin that has iron in it (but no calcium).
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