Pumping Iron... Or Failing to.

I've been feeling really rubbish lately.  Headaches, fatigue, not sleeping well... all symptoms that could be attributed to many different things: a bug (it's that time of year), menopause, fatigue from training.  

I've been waking in the night, unable to get back to sleep.  My HRV has been low, and my resting heart rate high. I've felt tired during the day, and felt like I've been underperforming in training.  My heart rate has seemed higher than normal, and I've felt as though my lungs (and the rest of me) just haven't been quite right.  

Then last week, I sort of fell off a cliff.  Felt as though I couldn't function.  Felt the need to sleep during the day.  I took time off work, assuming I had the beginnings of the flu.  We've been to plenty of patients with flu and various other respiratory bugs recently, so it wouldn't be surprising. 

But flu symptoms never materialised. What the heck is going on?  

I decided to go to the doc and ask for a blood test related to fatigue.  I'd considered asking for testing a few months ago, just to check how everything looked, and then again a few weeks ago when something felt a bit off - but now it seemed particularly pertinent.  

A couple of people suggested it could potentially be low iron... I was turned away from giving blood years ago because my iron levels were too low.  And idly doodling around the internet it seemed that low iron is fairly common in menopausal women, endurance athletes and those who are restricting eating in order to lose weight.  Well, that describes me pretty well: could that be it?  No assumptions here though - I know Dr Google can lead a person down a million wrong tracks. 

I thought I wouldn't get the test results back for a few days, but surprisingly whilst cooking the tea on Thursday evening, a text arrived from my GP surgery: 

        "Bloods all look great except for a borderline Ferritin (iron) level of 25, your blood count is normal at 138.  There is some research that higher Ferritin helps with energy (and training!) so might be worth adding a supplement into your day."

Well, there it is... No anaemia: my haemoglobin levels are normal.  But not enough Ferritin. Not quite low enough to be considered medically 'low' (in the UK that level is around 15, although there seems to be some variation in this) - although for someone training regularly, the recommended 'low' level seems to be around 50, with a healthy level 100-200.  And slightly raised inflammation markers which can, I understand, mask Ferritin levels even lower than shown.  

I decide to read everything I can find on it - and it takes me less than 5 minutes to discover that almost all of the fatigue-related symptoms I've been experiencing can be attributed to low iron.  

Credit: Iron deficiency without anaemia: a diagnosis that matters https://www.sciencedirect.com/science/article/pii/S1470211824033190

Of course, for at least the last 19 months I have been tracking my food intake fairly accurately using MyFitnessPal and Fuelin.  These do have a caveat attached to them, which is that most people only input either calories, or macros (fat, carbs, protein) when they enter a food item into the database, so not all the entries are accurate for micronutrients such as Iron, Vitamin C, Vitamin D etc.  However, my entries give a good idea of how much iron I've been eating... 

Nowhere near enough! 

Add into that my complete lack of awareness that caffeine (tea & coffee), tannins (tea), and calcium (dairy products) significantly reduce the absorption of iron from food into the bloodstream, and you have a pretty good idea why my iron levels could be very low.  I haven't been taking in anywhere near sufficient, and I had NO IDEA.  Time to start educating myself in something new! 

Asking around, it seems I know quite a few people who have either been deficient in iron, know someone who is, or in one case have too much iron (Haemochromatosis), so I was able to learn a little from friends & contacts.  And then, being me, I decided to read as much as I could find about iron deficiency in athletes, and in perimenopausal women.  The message is clear: iron levels can be connected to almost every significant function of the body, and certainly with all of the things I've been struggling with.  

Could it be that low iron levels have been behind quite a few of my struggles over the years?  I don't know this for sure, and perhaps never will - but could they be connected to my struggle to lose weight, and the feeling that I always have to work harder than others to improve fitness?  

To begin with though, I took some immediate actions.  I got hold of some iron supplements, and made the first meal after receiving that message an iron-rich one.  

Now, I'm a firm believer in the placebo effect.  If you believe something will help, then it probably will - at least to some extent.  But the speed at which I started to feel better was, frankly, nothing short of astonishing.  Within a day I had more energy.  My headaches started to improve.  It didn't fix everything immediately, I tipped back into having a headache from time to time, after a tiring day, a crap sleep or a hard workout.  But my symptoms began to change, and the difference was noticeable- the headache would disappear within a couple of hours of taking an iron supplement with some vitamin C.  

I'm now a couple of weeks on from beginning to make those changes, and the difference is really quite stark: my HRV has returned to normal, I'm sleeping better, and I feel better than I have for ages.  

Garmin assessment of my HRV trend for the last 4 weeks.  

It's been in the 'low' or 'unbalanced' category for some time. 

So, onwards and upwards.  Turns out Iron really does have quite a dramatic effect on health and wellbeing, particularly if you're actively training.  For my next steps I've made an appointment with my Celtman-Blue-T-shirt-GP next week to discuss how to manage it from here on in, and I'm considering monthly private blood testing to allow me to track my progress. I've made some significant changes to my eating patterns, and I've asked to see my medical records to see if I can work out how long this may have unknowingly been an issue.  If I've been training with low iron stores for months or even years, then correcting that to 'optimal' levels could make a huge difference.  

Another hurdle overcome - or at least, on the way to being so.  It could take up to 6 months to be fully on the way to being fixed.  There will undoubtedly be others, but this feels like a pretty big win.  

Lesson learned: don't neglect the micronutrients!