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.

WHO ARE THE DOCTORS WHO CAME?

First, Dr. Joel Kary is a physician out of Indianapolis.  Joel was a former track and cross country athlete.  Dr. Kary serves as a family practice physician with a specialty in Sports Medicine.  He is also the team doctor for Butler University Athletics and 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, we requested a local physician as well to share 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.

WHY IS THIS INFORMATION SO IMPORTANT?

Dr. Kary stated that various research show that 20-40% of female distance athletes could have potential problem with iron deficiency anemia.  That is very alarming and 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.

HOW DOES RUNNING CROSS COUNTRY MAKE MY DAUGHTER DIFFERENT?

          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 it’s officially confirmed. 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.

WHAT NEXT?

             It is first important to understand that your daughter is an endurance athlete and just that requires that she be looked at differently.  It is important to share this information with your primary care provider as many PCPs will look at your daughter only through the lens of a typical teenager and not the lens of an endurance athlete which will pose a problem 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.

WHAT IS THE BOTTOM LINE?

We want you to be be informed so you can make the best decisions for your young athlete.

GENERAL PATH TO SCREENING/TESTING AND WHY

1.  Get your daughter’s blood tested (Complete Blood Count and Ferritin) as soon as possible.  By learning this information as soon as possible we can avoid any lost 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!  Some medical providers will first want to only do a CBC test and only if your daughter presents with symptoms such as fatigue. However, a CBC does not provide all the information necessary.  Ferritin 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 ferritin tested as well.

2.  Get the results and discuss with the medical provider if a treatment plan is necessary.  Ferritin levels have a very wide range from 15 – 150 or higher.  Ferratin levels under 30, according to Dr. Kary, require some supplementation. Again, some medical providers may not treat these athletes because they test in the “normal” range and others who only recommend a multivitamin. This is a prime example in which our athletes need to see someone who understands their unique needs.

OTHER INFORMATION TO KNOW

Iron is difficult for the body to absorb but there are ways 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 for instance.  Try to avoid any calcium intake around the time of iron supplementation.

Iron is available in pill and liquid form.  Discuss the options with your medical provider. 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.