Crazy people do not like to be looked at like they are crazy. Perfectly sane, but lovably quirky people despise being looked at like they are crazy. When the white coat general MD walks into my exam room with a look of exasperation and a sigh of nutter-wasting-my-overpriced-time, all the little fighting hairs on the back of my neck pick up their mallets.
He exhales a deep sigh with sad pathetic eyes, “How ya doing?”
“I’m fine. I’m really tired.”
“Really? Well you don’t look anemic.”
“Thank you. Can we run my blood work please?”
“Are you bleeding?”
“No.” Unless we count money.
“Then you are not anemic. You can’t be anemic if you aren’t bleeding.”
“Well, I am a very competitive female athlete with a long history of anemia.”
“That doesn’t cause iron deficiency.”
BLINK I flip through pages of medical textbooks in my mind. Interesting. Iron Deficiency Anemia: besides bleeding, may be caused if the body cannot absorb iron or if the patient is not eating enough iron rich foods.
In fact, our bodies absorb only about 15% of the iron we ingest, and distance runners do just about everything possible to deplete the iron that they do consume.
Iron is lost through sweat and gastrointestinal irritation. It is temporarily lost through “footstrike hemolysis” (bursting blood cells through foot impact with the ground). Iron absorption is inhibited by calcium, coffee, tea, carbonated beverages and non-steroidal anti-inflammatories (all that ibuprofen some of you swallow). Women lose a substantial amount of iron through menstruation, making them more susceptible to iron depletion, but it is a concern for all distance runners-male and female.
Anemia, clinical iron deficiency, is not rare among runners, but even more common than iron deficiency is “iron depletion” due to low ferritin stores. Ferritin is an iron-containing protein that is primarily responsible for iron storage in the bone marrow. It is common among distance runners to have acceptable hemoglobin and hematocrit counts even when ferritin levels are severely depleted. For less active people, low ferritin levels are much less significant and don’t often draw the attention of medical professionals.
However, the results of low ferritin levels for distance runners are significant. While iron depletion rarely results in the general lethargy associated with true iron-deficiency anemia, distance runners with low ferritin will likely experience abnormal exhaustion, increased blood lactate, slow recovery, declining performances, heavy legs, muscular tightness, loss of motivation, and substantially increased risk of injury. Does any of this sound familiar?
Want more? Overuse injuries (the type of injuries distance runners get) double with ferritin levels under 20 and triple with levels under 12. I think it’s safe to suggest that iron depletion is rarely considered to be the root cause of these injuries. Instead we focus on mileage, running surfaces, shoes and the other usual suspects.
“Well when I was not bleeding three years ago, I had a ferritin level of 7. And when I was severely anorexic and not bleeding I had a ferritin level of 7. And my husband who has celiac sprue was diagnosed not bleeding with a severe case of anemia due to malabsorption of nutrients.”
“Are you still taking your antidepressant?” He questions with more sighs.
“No, they made me gain 10 lbs.”
“No they didn’t, your weight is the same.”
“Because I lost the 10 lbs. Look I looked it up on the internet and lots of women gain weight on those drugs.”
“OH,” the sarcasm bubbles, “The internet! Well people say they are abducted by aliens on the internet are you going to believe them?”
General MD? Perhaps YOU are an alien from the capitol of Uranus who needs to reconsider your specialty- proctology? Because Life Form, you are a real AxxHole!
Low, but in the normal range Ferritin level. Might this be why I run along for a certain amount of time and then completely fall off a cliff in a workout or in a race? Yep. Yep. Yeppity Yep Yep. Might my long history of having iron difficulties relate to why I run such a fine line between beautiful and broken? Perhaps.
Seperately, since Friday, I have had many easy runs to reflect once again on why I run- I love it. I forgive myself for sucking. Ultimately every time I have ever tried to run for a number, it has been a disaster. I cannot run for numbers. If the numbers happen to fall into place, I am thankful, but if I line up looking for a piece of me all I get is me in pieces.
Each set back be it small or large (and this will be such a small one thank you Halo! P.S. good thing I did not bring Halo up to Mr. MD. I doubt he’d see the beauty in imaginary friends be them mortal or divine) keeps my perspective fresh, keeps my chin down, and ultimately keeps my clock clean. It’s good for the soul to get your clock cleaned.
Tick-Tick-knock out- Tock-Tock. Hmmmmm, how does that saying go? Ah yes, Take a licking and keep on ticking.