Wednesday, March 27, 2013

Iron, man.

My surgery in November had a number of complications, one of which was blood loss that led to the modification of my "minimally invasive" procedure to one involving a lengthier recovery.  I lost nearly a litre of blood, which I have been told is approximately a quarter of the blood volume in someone my size.  Not ideal.

My focus had been almost exclusively on physiological recovery, and I had not given much thought to the implications on a cellular level.  When I started running and cycling in January,  I naively thought it would be back to business as usual.  Although I felt constantly fatigued, out of breath and terribly out of shape, I attributed the way I felt to the long period of inactivity.  Suck it up, buttercup.    

Short tempo runs were exhausting.  Leg speed was non-existent.  Getting out of bed was hard, but training was even harder.  I constantly had the sniffles, caught the flu three times and was cold...all the time.  Track and swim sets left me nauseous and out of breath.  Despite the sheer joy of being able to race again, understanding exactly how my legs had turned to lead in three months was a frustration.  With a couple of years of ironman training behind me, I have grown accustomed to feeling tired and kept telling myself to suck it up.  However, realizing that even something as simple as a track workout will leave you physically destroyed is not a good feeling.

Then, two weeks ago, came an "aha" moment.

Blood test results came back indicating my ferritin level was 19, a third of what it had been in the fall, pre-surgery.  While this is considered within low end of "normal" range for a female, it borders on anemic.  For a female endurance athlete, it is just downright too low (it is generally suggested that a level below 30 in a female athlete will cause performance issues).  Low iron means too little oxygen is being delivered to my muscles...meaning all of the symptoms I was experiencing make a whole lot of sense.

In general, I am pretty regimented with my diet and feel that I am quite knowledgeable about performance nutrition.  Even so, the last couple of weeks have been a bit of a crash course in damage control through diet!  While the low iron levels are most certainly due to blood loss from surgery rather than a chronic condition, my diet is the single biggest way that I can impact my iron stores right now. 

It has been interesting to learn more about the various sources of dietary iron and ways to maximize iron absorption through diet.  For instance, vitamin C is thought to enhance absorption (oranges...good!) whereas calcium and food with tannins are thought to inhibit it (large latte..bad!).  Always a sucker for developing meal plans, this new focus definitely makes my diet even more *weird* than before!  Low-sugar, high-iron, gluten-free, high-protein, low-fat, caffeine-free...anyone?  That really ought to make you want to come to a dinner party at my place. ;)         

My new morning and evening cocktail. 

Luckily, a diet in iron does not necessarily mean having to choke down liver and onions (sorry, mom, I really do hate that sh*t).  Iron comes in two types:  heme (the most absorptive), which is found in animal products, and non-heme, which is found in vegetables and grains.  I do eat red meat a couple times a week, but was excited to see that other types of protein (such as mussels, tofu and eggs) rate highly.  Green and leafy, another staple of mine, also factors well.   Moules frites...yes!  Chocolate...yes!  

While it remains to be seen whether the focus on diet will positively and beneficially impact my iron levels (the next blood panel is in May), the biggest lesson I have learned is that toughing it out is not always the right answer.   Distinguishing *good* fatigue from a real physiological problem can be a bit of a challenge, but I need to get better at it.  In retrospect, the nagging fatigue was a pretty good indicator that it wasn't just me being a softie (which, for the record, I kind of am).   Swim, bike, run may be on the schedule...but rest, recovery, diet and taking care of myself are equally important to my performance as an athlete.  

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