Iron Deficiency Anemia

Iron Deficiency Anemia

          On Sunday, May 15, 2011 the Centerville Girls Cross Country team welcomed in two physicians to discuss the unique needs of endurance athletes and how that relates to iron deficiency anemia.


First, Dr. Joel Kary is a physician out of Indianapolis.  Joel was my best friend in college as well as a teammate on our track and cross country teams.  Dr. Kary serves as a family practice physician with a specialty in Sports Medicine.  He is also the team doctor for Butler University Athletics.  He also is a consultant physician for USATF (United States Association of Track & Field).  Second, Dr. Brian Esselstein of Springboro Pediatrics joined the discussion.  Because Dr. Kary practices in Indianapolis I felt that we needed to have a local physician who shared the same understanding of the endurance athlete.  Dr. Esselstein has had two very successful daughters compete at the highest level in high school track and cross country.  The older of these two daughters struggled with iron deficiency anemia her senior year of cross country.  Dr. Esselstein has offered to be a local consultant for our team in regards to your daughter’s health and well being as it relates to performance and her iron storage and capacity.  His contact information is available at the end of this information sheet.


Over the past several years I have noticed a growing trend of athletes on our team struggle with iron deficiency.  Dr. Kary states that various research show that 20-40% of female distance athletes could have potential problem with iron deficiency anemia.  That is very alarming to me.  It is particularly a concern for an athlete who puts in all the work necessary in preparation for a season but then cannot meet her fullest potential because her body will not allow her.


          Once your daughter joins cross country she becomes an endurance athlete.   For that reason alone, your daughter is different.  You may have already thought this but now I am officially confirming it.   On a more serious note, the rigors of training for this sport lend it to require great discipline.  That discipline can sometimes lead your daughters to develop iron deficiency anemia more often as previously mentioned in the research Dr. Kary has read.


I have found it difficult to find a local physician who understands the needs of endurance athletes and not just look at your daughter as a typical adolescent.  It is first important to understand that your daughter is an endurance athlete and just that requires that she be looked at differently.  I want to explain that this information is not meant to discount your family’s physician.  However, recent examples have proven that family physicians will look at your daughter only through the lens of a typical teenager and not the lens of an endurance athlete.   This poses a problem only in terms of detecting and treating iron deficiency anemia.  This is because some “normal” ranges for tests identifying iron deficiency anemia are very wide.  These “normal” ranges again are adequate for a sedentary young person but looking through the lens of an endurance athlete this “normal” range is not as useful.


My hope as a coach is to inform you as a parent of what I have learned in my training as a coach and allow you to take the information and do with it as you please.  Below I have written out a general guideline your family could follow if you would choose to have your daughter screened/tested.   I will also attempt to provide some additional information as well.


1.  Get your daughter’s blood tested (Complete Blood Count and Ferratin) as soon as possible.  By learning this information as soon as possible we can avoid any loss time in her training that may hinder her best performances during the season.   Iron levels take a long time to raise because the absorption rate is so low – so the sooner the better!  I have found physicians will first want to only do a CBC test and only if your daughters presents with symptoms such as fatigue.  However, I have learned that a CBC does not provide all the information necessary.  Ferratin is a measure of “iron storage” and this tends to paint a more accurate picture for how your daughter is doing.  You may need to advocate for your daughter to have the ferratin tested with your family physician or you can work locally with Dr. Esselstein and he will make sure that it is included in the orders.  Dr. Esselstein is more than willing to help any of our athletes with the testing process or understanding any results of the test.  His information again will be listed at the end of this information.

2.  Get the results and discuss with the physician if treatment plan is necessary.  Ferratin levels have a very wide range from 15 – 150 or higher.  Ferratin levels according to Dr. Kary under 30 require some supplementation.   I understand some local physicians have not treated athletes because they test in the “normal” range and others who only recommend a multivitamin.  This is prime example where our athletes need to see someone who understands their unique needs. Dr. Esselstein is willing to help any of our athletes with the testing process or understanding any results of the test.  His information again will be listed at the end of this information.


Iron is difficult for the body to absorb but there are is a way to maximize the absorption rate.   Take the iron with vitamin C.  This can be in a pill form or as simple as orange juice.

There are also parts of a healthy diet that inhibit the absorption of iron.   Calcium does just that.  Try to avoid any calcium intake around the time that iron supplementation is happening.

Iron is available in pill and liquid form.  Discuss the options with your doctor.  Please note that liquid iron has been shown to have a higher absorption rate.  It can be mixed with orange juice but please use a straw to drink so that the iron will not stain the teeth.

Dr. Joel Kary

Dr. Brian Esselstein
Springboro Pediatrics
8 Sycamore Creek Dr.

David Dobson
Head Girls XC
902-9058 and

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