Iron Deficiency + The Athlete: Part II

If you recognize the food on the left side of the plate above as red lentils (a red lentil soup), then you may also know it to be a rich source of the mineral iron. 

I’ve written about iron in detail before, but a recent research paper on  impaired iron and endurance athletes reminded me that I need to periodically review this topic. 

Nearly all of my female clients in the past few years have come to me with iron deficiency, iron-deficiency non anemia, or iron-deficiency anemia. This has been true whether they are endurance athletes or not. And whether they’re highly active or not.

Here’s a refresher on the difference between those three:

Stage 1: Iron Deficiency: Iron stores in the bone marrow, liver, and spleen are depleted, indicated by ferritin values less than 35 ng/mL, Hemoglobin values > 11.5 g/dL and transferrin saturation >16%

Stage 2: Iron-Deficient Non-Anemia: Red blood cell production decreases as the iron supply to the bone marrow is reduced, indicated by ferritin values less than 20 ng/mL, Hemoglobin >11.5 g/dL, and transferrin saturation < 16%

Stage 3: Iron Deficiency Anemia: Hemoglobin production falls, resulting in anemia, indicated by ferritin values less than 12 ng/mL, Hemoglobin <11.5 g/dL, transferrin saturation less than 16%. 

While iron deficiency may be much more likely in women, it’s not a female-only issue. 

It used to be that when there were signs, symptoms, and laboratory results indicating deficiency of a nutrient, I did just the typical nutritionist thing of recommending eating more foods rich in that nutrient, increasing bioavailable co-factors in the diet, adjusting timing of nutrient intake so absorption increases, and according to the circumstances, recommending varying amounts of supplementation. 

Generally, that’s a pretty good and standard game plan.  But to a certain extent in many cases, it was band-aiding the real issue. Or at least not getting all the way there. 

Why is nutrient absorption impaired in the first place?  Did the individual merely need to increase nutrient intake and we’d solve the problem? Was it just an issue of increased demand or not eating foods rich in that nutrient?

What I started finding was that even with continued intake of iron-rich foods, or in some cases high-dose supplementation, we’d still have low levels of iron (and often of other nutrients).

So what’s happening here? 

It wasn’t until I had continued professional training on gut health and malabsorption that I began having some personal aha moments. 

When I began addressing the issue of nutrient deficiency from the standpoint of improving the person’s digestion and absorption and calming the nervous system (which is so incredibly entwined with gut health), absorption of iron and many other nutrients drastically improved. 

We were finally treating the issue. 

Which is to say, that still doesn’t mean it’s easy. Figuring out which puzzle piece or perhaps multiple puzzle pieces of the GI system are impairing absorption of nutrients and digestibility of food can take some time and it can take some persistence. But it’s so worth addressing. 

Here are some factors that might be causing impaired absorption of dietary and supplementary iron and/or increased need.  Check all that apply for you. The more that apply, the more likely absorption and/or intake of iron will need addressed.

  • Female of menstruating years 
  • Endurance athlete
  • Digestive Symptoms – Pain, Bloating, Gas, Loose Bowel Movements, Undigested Food in Stool, etc.
  • Have low stomach acid (quite common and most people are completely unaware)
  • Follow a vegetarian, vegan, or plant-based dietary pattern
  • Omnivore who avoids red meat
  • Fast eater or eats while distracted or stressed
  • Low estrogen or testosterone levels
  • Supplemental intake of other minerals at the same time as iron, not-including nutrient cofactors when consuming iron rich foods or supplements, and/or consuming foods and beverages that prevent absorption at meals rich in iron
  • Taking prescription medication(s) – depending on the medication if may impact nutrient absorption or change physiology so there’s an increased need
  • Lack of knowledge about how to eat a balanced diet or poorly planned dietary pattern
  • INFLAMMATION! – Particularly inflammation of the gut (may be asymptomatic or not obvious)

Want to Know More?

If you’d like a refresher on iron, check out my first article on this topic.

Need help with iron or absorption of other nutrients? Within my nutrition practice, I specialize in endurance athletes and digestive imbalances. If you’ve struggled with chronically low iron or poor absorption of other nutrients, I encourage you to reach out to me for more personalized support.

What does Healthy Digestion Look Like?

What’s considered “normal” in our modern culture doesn’t necessarily mean it’s healthy or optimal. 

What are signs that your digestion is working optimally?

  • Healthy appetite 
    • being ready for a morning meal by 7-9 am, feeling hungry again 3-6 hours later and at steady 3-6 hour intervals throughout the day. 
  • Steady energy throughout the day
    • no fatigue or big drops in energy after eating or mid-afternoon, or difficulty waking up or getting going 30 minutes after waking.
  • One to three bowel movements daily, which pass easily and are formed like a banana
    • no visible food, mucus, fatty film, or off colors
  • Clear skin
    • free of acne, itching, inflammation, and rashes
  • Focused mind and inspired thinking
  • Your athletic performance is reflective of your training
  • Balanced hormones and menstrual cycle (if a menstruating female)
    • no PMS or menopausal symptoms

What are signs that your digestion is not working optimally?

  • Lack of appetite, or only tolerating very small amounts of food before feeling full 
  • Fatigue throughout the day, or crashes of energy after meals or during certain times of day; 
    • difficulty getting going in the morning
  • Sluggish or rapid digestion 
    • feeling hungry again within 1-2.5 hours after a meal, or like food sits in your stomach after a meal, resulting in excess fullness
  • Less than one bowel movement daily, difficulty passing a stool, or having to go multiple times per day
    • diarrhea, loose stools, deer pellets, visible food, mucus or greasy film; colors other than chocolate brown
  • Digestive Symptoms
    • bloating, gas, reflux, pain, cramps, gurgling, nausea, food intolerances
    • cravings for certain foods; particularly sweet or salty flavors
  • Skin Irritations
    • eczema, psoriasis, rashes, hives, acne
    • tooth Indentations on the tongue’s edges; a white, black, gray or yellow coating on the tongue
  • Brain Fog or Irritability, Depression, Anxiety, Scattered Thoughts
  • Your athletic performance is suffering despite training, or you continue to encounter performance or training set-backs
  • Hormonal Imbalances and menstrual cycle symptoms 
    • PMS or menopausal symptoms 


Are all of these really related to digestion? 

The answer is yes! The ability to take food and break it down into nutrients, and assimilate it into the body to be used as energy is the basis for building healthy body tissue (and thus a healthy body!) The health of your gut microbial community and intestinal lining directly impacts your health, hormones, and ability to tolerate food.

Next Steps

Do you find indications that your digestion isn’t working optimally? Within my nutrition practice, I specialize in endurance athletes and digestive imbalances. If you routinely struggle with any of the above symptoms,  I encourage you to reach out to me for more personalized support.

“Healthy” versus Healthy For YOU

Is this kale salad healthy? Yes.
Is it healthy for YOU? That’s individual.

Eating Right For You

A common Ayurvedic proverb states that “When diet is wrong, medicine is of no use. When diet is correct, medicine is of no need.

Ayurveda is often considered the mother of medicine, and the oldest medical system in the world. Regardless of whether that is entirely true, Ayurveda is a traditional medical system originating in modern day India. Traditional Medical Systems, including Ayurveda, Traditional Chinese Medicine, Western Herbalism and others, use energetics of foods, herbs, and your body to arrive at balanced and optimal health in your whole self. Meaning mind and body (and soul).

The Why: Energetics Explained

Energetics means the quality that is present in the environment, your body, or the ingredient, and the effect it has on whoever is being exposed to it. The most basic energetics to work with are hot, cold, (and thus heating or cooling), and wet, dry (and thus moistening/dampening, or drying).

In most places in the northern hemisphere, the energetics of the environment make fairly big shifts with the seasons. Late winter and early spring tend to be cool or cold, and wet or damp, summer, depending on where you are located, is often hot and dry, or hot and humid (damp). Etc.

When we’re using a food as medicine approach, the best way to achieve balanced and optimal health is by eating in a way that has the opposite quality of the body or of the seasonal environment that we’re a part of – eating in this opposite approach then provides balance for the body to be at, or return to equilibrium, where health occurs.

So in the hot, dry weeks of high summer (where I live), we can return to balance by eating meals that are cooler and more wet/soupy/moist.


An example is sipping on a cucumber infused water (cooling, moist) on a hot summer’s day, or having a mildly spiced coconut-based curry (cooling, moist, easy to digest) instead of pungent and spicy carne asada tacos (heating/pungent) on corn tortillas (drying) with tomato and jalapeño-based salsa (heating/pungent). 

Likewise, using energetics to determine the right food for you vs. what’s considered “healthy,” means tuning in to your own symptoms. 

an example of cold + dry: raw walnuts

Energetics of Your Body

In addition to eating in tune with the weather outside, or the season, it’s equally and sometimes more important, to adjust meals to what’s going on in you. 

Do you tend to be a hot and dry person? Or how about cold and dry? Warm and wet? Or cool and wet? 

Dry symptoms include: having dry skin, hair, scalp, or digestion by way of constipation (either not having a bowel movement daily, or small, dry, difficult to pass bowel movements), having gas, bloating, and achy, popping joints. 

Wet symptoms include: a wet, phlegmy cough, mucous, sluggish digestion, or feeling like food just sits in your GI and smolders after eating, fungal overgrowth, a heavy coating on the tongue, swelling in the lower legs or hands, retaining water, excess weight gain that you just can’t lose. 

Hot symptoms include:  rashes, hives, skin flare-ups, having a hot temper, reflux, heartburn, feeling consistently frustrated or easily angry, night sweats, excess sweating, inflammation, feeling overheated

Cold symptoms include: circulatory constriction, feeling routinely cold, experiencing cold hands and feet, poor digestion or need to take supplements to properly absorb food and meals, feeling emotionally heavy, depressed, or sad, lack of motivation, and fatigue

From those lists, you can probably determine how you feel generally, or from day to day. Eating foods that have the opposite energetics to what you’ve experiencing can be extremely helpful. 

Oatmeal with cinnamon, stewed peaches and tahini

An Example of How to Shift Preparation of a Meal

Let’s take a look at an example of a simple shift at breakfast time. 

Say you’re experiencing lots of dry symptoms (dry skin and hair, constipation, extra gassy, and bloating, as well as popping joints). And you also have poor circulation in your hands and feet, and generally run cooler. Your current energetics are cold and dry.

Instead of eating your routine breakfast of dry muesli and chopped nuts mixed in with cold yogurt and raw fruit, a more balanced and “good for you” breakfast with similar ingredients is a cooked oatmeal (or cooked muesli), with the fruit stewed or cooked in, and some warming spices added – spices such as cinnamon, nutmeg, ginger, allspice, or a sprinkle of cloves. And if you’re consistently experiencing constipation, gas and bloating, leave out the cold, dry nuts for a few weeks. Instead, a simple shift is to cook the oatmeal with a spoonful of ghee or sesame oil to provide moisture, warmth, and an easy to digest fat source while you’re returning your system to balance. 

Summary

The simplest way to describe the process of choosing what to eat and how to prepare meals based on energetics is that like attracts like and opposites provide balance.

What often confuses or sidetracks people is that when we’re out of balance, we tend to crave what makes us even more imbalanced. It’s the like attracts like part of that statement above. And, it can be easy to confuse intuitive eating and eating based on our cravings.

Next Steps

If this topic is intriguing to you, check out another article I wrote on the topic, regarding seasonal eating during late winter and spring. That article gives several spice options for adding more gentle heat to meals, and helping out your digestion.

Within my nutrition practice, I specialize in endurance athletes and digestive imbalances. If you routinely struggle with any of the above symptoms,  I encourage you to reach out to me for more personalized support.