I first want to tell you that my knowledge about iron and vitamin b12 is based off of my personal experience, knowledge I've gathered from doctors & nutrition experts, and from what I've read online. I am also not a registered dietician. But I do think what I have to say might be interesting and helpful to you athletes out there.
About 5 months ago in July 2014, I figured out I was both iron- and vitamin b12-deficient. Iron and vitamin b12 deficiency really really sucks. If you can imagine how I'm feeling in the following photo, you get how much it sucks.
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| Embarrassing photo of me on Long's Peak, before acclimated to Colorado, feeling like vomiting! |
So what are these things, and why do they matter?!
Iron is a mineral most people have heard of. You know, "Fe" on the periodic table, a metal used in manufacturing cars and tools, and apparently the most common element found on Earth. You've probably also heard of it in relation to the foods we eat. For example, most people are aware of red meats being iron-rich.
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Iron is important in proper functioning of the body. The roles iron plays in the body are complex, but in general, iron is imperative in (1) creating healthy red blood cells and (2) transportation of oxygen throughout the body. The more healthy red blood cells we have, the more oxygen is able to transport around the body. Our muscles and organs need oxygen. Oxygen is required for energy production. So without iron, we will have less healthy-functioning red blood cells, a decreased ability to transport oxygen throughout the body, and a decreased ability to produce energy. Simply put, less iron means your muscles can't produce much energy! Now imagine trying to exercise using muscles that can't produce energy...
So what about vitamin b12? Vitamin b12 is probably not as well known as iron. Although everyone knows we all need vitamins. Vitamin b12 is one of several b-vitamins and it is specifically involved in the body's energy metabolism. Energy metabolism is the body creating energy from nutrients. Along with energy production, vitamin b12 is necessary in proper functioning of the brain, DNA synthesis, and red blood cell production. So here we have another important nutrient involved with red blood cells and energy. No vitamin b12 means no new healthy red blood cells. And once again, we need those red blood cells to function properly if we're going to transport oxygen throughout our body. Vitamin b12-deficiency can cause a number of horrible problems. It may contribute to Alzheimer's disease, or general dementia and memory loss. It also can cause symptoms of psychosis, personality changes, and depression.
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Below are side effects both iron- and vitamin-b12-deficiency can cause. Many symptoms exist for both iron and b12-deficiency because of their similar roles in the body, so I listed everything together and in no particular order.
Iron and B12 deficiency symptoms:
- general fatigue
- muscle weakness
- shortness of breath
- pale skin
- dizziness
- lightheadedness
- irritability
- memory loss
- cravings for non-food items such as ice
- weird tingling feelings in extremities
- depression
- mood swings
- soreness of tongue
- cold hands and feet
- fast/irregular heartbeat
- brittle nails/dents in nails
- tendency to get respiratory infections
- lack of motivation
- headaches
- easy bruising
- weight loss
- nausea
The more deficient, the more serious the symptoms. Extreme deficiency in iron can cause heart failure and extreme deficiency in vitamin b12 can lead to many neurological problems including but not limited to: peripheral neuropathy, spinal cord diseases, blindness, dementia, and symptoms similar to Parkinson's Disease.
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| photo: tx.english-ch.com |
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Iron and vitamin b12 deficiency symptoms may be more intense and noticed sooner in athletes. This is because of our increased demand for oxygen during exercise. I'm not sure I would have noticed anything was wrong if I wasn't an athlete. The following is a list of some of the symptoms I personally felt before I knew what was wrong with me.
Symptoms I personally noticed:
- muscle weakness
- shortness of breath during exercise
- dizziness especially during exercise
- lightheadedness, especially when standing from bending over
- much slower muscle and general recovery
- I just wanted to sink my teeth into stuff like gum and my pencil
- mood swings & irritability - sorry friends ;)
- very painful cold hands and feet
- nausea
- decreased desire to eat
- constant tingling on my right shin that caused me to keep itching the same spot
- easy exhaustion
- possibly worse memory than I used to have
- sometimes trouble thinking clearly and logically
- pale/sick-looking skin on face, easier to notice without a suntan
- lung colds that lasted weeks
After almost half a year on supplements (daily iron, vitamin b12 & multi-vitamins), these symptoms have disappeared and my iron and vitamin b12 levels are basically normal. Keep in mind, normal may be different from person to person. And some symptoms still exist that I don't think are abnormal. My hands and feet still get cold, but I haven't noticed the horrible pain. I still don't always have the best memory for things people tell me. And of course I still can be irritable, but can't we all! :)
So as athletes, iron- and b12-deficiency can really cause a deterioration in performance, no matter the sport. As a runner, I noticed a decreased ability to recover, a decreased ability to run fast, less endurance (meaning I'd tire sooner on a long run), I felt like passing out especially when going uphill, I would feel nauseous, I would get very unexplainably emotional and irritable during runs, and I got some bad respiratory colds that wouldn't go away for weeks. The closest thing I can compare it too is when you stay up all night, are a little hungover, and try to go for a run - that totally exhausted, nauseous, burning-in-the-muscles feeling. I really just didn't want to go for runs. No motivation. Lots of frustration. And it was hard to describe to my friends who watched as I trailed way behind them. When you say to your friends during every run, "I just don't feel good, I'm exhausted, I'm out of breath, I feel like I'm just going to fall over," it's hard not to sound like you're just making excuses for yourself. Having no explanation at first why I felt so bad was very frustrating.
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| At the end of Zion Traverse with a horrible never-ending lung cold. |
The low mileage, of course, was because I just couldn't run, I didn't want to run, and my runs got me nowhere in training. Looking back now, I had this constant burning in my calves on the uphills. My calves were on fire on the ups, not even going fast. They wouldn't recover, they felt like bricks. I thought maybe it was my shoes or a lack of foam rolling. But I no longer have calf problems and I haven't changed shoes or started foam rolling anymore than I used to.
At first I wondered if I was overtrained? Maybe I had adrenal fatigue? I ruled both of these out because I'd only been running between 10-40 miles per week. So it didn't seem likely I was overtrained or had adrenal fatigue. And one day it suddenly occurred to me that I may have iron-deficiency. I'm not sure why it didn't occur to me sooner.
I've had my blood tested 3 times since July, and the results are as follows:
July 23, 2014:
ferritin - 48.7ng/mL
b12 - 509pg/mL
August 22, 2014:
ferritin - 30.8ng/mL
b12 - >1,000pg/mL
October 30, 2014:
ferritin - 54.6ng/mL
b12 - >1,000pg/mL
A couple things to mention:
(1) Ferritin is iron storage. Getting your iron tested will tell you how much iron is actually in your blood. Getting your ferritin tested will tell you how much iron is stored in your body. So when someone refers to iron-deficiency, it could mean either your iron is low, your ferritin is low, or both. In my case, my ferritin was low.
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(2) It's normal for your ferritin to decrease even more after you've started supplementing. I don't know the exact science, but in general it's because your body is working on creating new healthy red blood cells to replace the unhealthy ones. When you're iron and b12 deficient, your red blood cells may not be forming correctly. And in creating new red blood cells, a lot of iron is needed. So the ferritin may temporarily go down before going back up.
(3) You cannot overdose on vitamin b12 but you can overdose on iron. So my b12 being over 1,000pg/mL isn't a problem.
Ideal range of ferritin levels:
12-150ng/mL for women; 12-300ng/mL for men
Ideal range of vitamin b12 levels:
200-900pg/mL
Don't take those "ideal" ranges too seriously...
Everyone is different, and athletes are different than non-athletes. Ideal levels based on what I've heard more directly from friends may be more like 80ng/mL-120ng/mL for ferritin and greater than 800pg/mL for b12. From what I've heard, close to 100ng/mL is probably ideal for iron and the higher the better is probably ideal for b12.
There is just so much varying research that it's probably best to go on how you personally feel! Your family doctor doesn't know any better either. He/she will only tell you the ideal range based on current research. I went to one doctor who said my 48.7ng/mL was very low. And when I went back a month later, a different doctor said my (even lower) 30.8ng/mL was normal... so yeah. Who's correct?! I am correct!! Neither of those levels are normal for me because I didn't feel well at either of those levels!!!
Also keep in mind that if you are both iron and b12 deficient, it might be like a double whammy in terms of how bad you feel.
If you're an athlete who is feeling more tired than usual, consider getting your blood tested. It seems more common in the running community to blame the fatigue on overtraining before considering iron deficiency. And it's even less likely to consider vitamin b12 deficiency. But the truth is, both are pretty common deficiencies.
- 1 in 4 people are iron deficient.
- Most people consume enough vitamin b12, but not everyone absorbs it well.
I'd like to tell you the perfect way to get more iron or b12 if you're deficient, but the truth is, I don't know the perfect way. I don't know the perfect supplement. My method is to ask around and see what works for people, or to just try something out and see if it works. Below is what I've been taking. Before that giant costco multi-vitamin, the doctor had me taking pre-natal vitamins. A friend of mine who has his PhD in nutrition, Jon Clinthorne, told me some brands have more additives than others, which could be bad. So I'm not sure the cheap costco brand vitamin is my best choice for the long run. Another thing Jon mentioned is to take the b12 that is methylcobalamin sublingual. Not the cyanocobalamin. And sublingual means it dissolves under the tongue, allowing it to absorb more efficiently.
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| Keep in mind non-heme iron isn't absorbed nearly as well as heme iron. photo: www.ihcginjections.com |
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| All animal products have vitamin b12. Some will argue algae and few other plant sources have b12, but I don't know enough research about that to agree one way or another. photo: www.vitaminsestore.com |
Feel free to ask questions in the comments below!
And don't forget to follow me if you enjoyed this post!
References:
Jonathan Clinthorne, PhD - http://ultranutrition.blogspot.com
http://www.nhlbi.nih.gov/health/health-topics/topics/ida/signs
http://www.mayoclinic.org/diseases-conditions/iron-deficiency-anemia/basics/symptoms/con-20019327
http://www.webmd.com/food-recipes/guide/vitamin-b12-deficiency-symptoms-causes
http://www.nelsonsnaturalworld.com/en-GB/uk/our-brands/spatone/iron-essentials/role-of-iron-in-the-body
http://www.nlm.nih.gov/medlineplus/ency/article/002403.htm
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