Hemoglobin levels and training

[snaavt]

Hi there,

This will be a long shot but anyway, I’ll be making this post here in a hope of getting feedback from you members or - who knows - someone in my position.

I’m dealing with low hemoglobin for years now, and I’ve came accross that reality a couple of years after starting cycling more seriously.

Never had a hint of that deficiency before, but making back to back rides on the limit triggered the fact that I needed to make a doctors apointment.

I’m being followed for a couple of years now. Had 2 iron perfusions (500 ml each) only to discover that 1 month after receiving intravenous iron my hemoglobin levels were, again, very low (10 ish).

Suggested by one of my doctors, I’ve bough an hemoglobin reader, which I use every morning. I’ve started to discover that my iron levels are high when I don’t train for awhile (one week and I start to present my HB levels at mid 13s), but as soon as I have a training day, next day I feel dizzy and my HB levels drop to 10s again.

I do have a good meal routine (even if I could do better in that respect)

Curiously I have what I can assume to be “good numbers” for my age. I do have a high Vo2 max (since kid that I exercise) and an FTP around 280. My profile is a Puncheur and I’m 54 yo.

I can have a good performance in a Grand Fondo for my age if I plan to achieve a good HB level for the day, but if I have to make another race the next day, I’ll be shredded like someone had hammered me the day before.

I’m gathering literature about the subject, and I’ve came accross a scientific paper which relates exercise, low HB and plasma dilution in red blood cells.

I’m talking to my doctor about it on the next appointment and see what he thinks about it.

In the meantime, please be free to share your experience if you had some of these drawbacks or if you know someone who had.

Thanks a lot.

[Alex]

I know nothing about this. I could ask my Pro coach friend if he has heard anything.

Not sure if you are a chatGPT user but it is very valuable not as “the truth.” but as a place to seek ideas and formulate more questions. It sounds not so uncommon. I just pasted what you wrote there. Sorry I know you are looking for more human experience, I was just not sure if you checked this source.

------ GPT --------

This experience is relatable, especially in endurance sports, where the demands on the body often reveal underlying physiological limitations. Given your consistently low hemoglobin despite supplementation, the fluctuations you’re seeing could stem from several interconnected factors:

1. Exercise-Induced Hemodilution: During intense or prolonged exercise, blood plasma volume tends to increase as an adaptive response to training. This can result in “pseudo-anemia” or sports anemia, where hemoglobin concentration appears low but isn’t necessarily due to iron deficiency or true anemia. This adaptation helps improve oxygen delivery but can temporarily lower measured hemoglobin levels.
2. Iron Turnover and Loss: In endurance athletes, iron loss through sweat, hemolysis (breaking down of red blood cells from repetitive impact, especially if you ride long and hard), and gastrointestinal bleeding (from high-intensity exercise) is higher than in the general population. Even with infusions, it seems your iron demands might exceed supply, especially under heavy training loads.
3. Individual Absorption and Utilization: Some people don’t absorb or utilize iron efficiently, even with diet or supplementation. This can be due to genetic factors, underlying inflammation, or gastrointestinal factors that impair iron absorption.
4. Impact of Age: At 54, recovery and iron metabolism can be less efficient than in younger years. Age-related changes in the bone marrow’s ability to produce red blood cells or shifts in hormones (like EPO) that stimulate red cell production can affect your hemoglobin response post-training.

Your plan to consult with your doctor about exercise-induced anemia and hemodilution is excellent, as they might consider additional tests like ferritin, transferrin saturation, and C-reactive protein to better understand your iron status and any underlying inflammation. Additionally, tracking more metrics over time may help your doctors fine-tune your treatment.

[snaavt]

Hi Alex,

Thanks for spending the time to reply to my post.

Curious approach from you (Chat GPT) It never crossed my mind using it to check for this issue, but I’ll sure be using it from now on to dig into this.

[Robert_UCL]

Hi Snaavt,

I know a thing or two about iron. I am a hemochromatosis patient. That means my body absorbs all (and thus to much) iron. I have to donate blood to lower my iron levels. Hemoglobine is therefor never an issue for me.

If you would join me, we could make a perfect pair.

Since donating blood means losing fitness, I do everything I can to avoid iron. I train hard to destroy red blood cells, I became a vegetarian, I avoid heaps of vitamin C when I’m eating meals that contain iron, and I drink black tea and use a lot of turmeric, which restricts iron uptake.

The older we get, the more inefficient our body gets in dealing with nutrition.

As a dietician, my first question is: are you sure you are eating enough iron?
I would look for any combinations that I mentioned above and reverse them. So, if you are drinking a lot of black tea, stop doing that. If you like Indian food, eat less. Use vitamin C to stimulate iron uptake. I’m not referring to supplementation but to whole foods. Eat a lot of veggies. I teach my athletes to eat but to combine different foods.

Use more bell papers, eat your meat, and eat a lot of veggies. I teach my athletes to eat three kinds of veggies for each meal.

On the training side, you need to take a look at how intense you are training. I’m a puncheur too. I know the type. We like to hit(t) it.

But, considering our age (turning 50 in January), we need to adapt to a different style of training. Take it easy. You don’t have to bury yourself.

Long hours, weight training and running will push your iron levels down, a lot.

Here is my advice: start a nutrition diary. Do this for one or two weeks. Use one that shows you vitamins and minerals as well. Yes, this takes up some time, but you need it.
Train 4 weeks with a different approach. Try not to bury yourself in any training, but do short hit sessions with the high intensity limited to 10 minutes or even less. No more than once a week.
The rest of your training is zone 2.

After four weeks, check your fitness. If it is still the same, you will see that less effort doesn’t hurt.

Good luck and have fun, Coach Robert

[snaavt]

Hi Robert,

Thanks for having the time to reply and give all these insights.

As I told previously, I know I can do better (eating wise) but I’m also not an entirely slouch in that respect.

I do love coffee (I’m a coffee freak who takes 5 minutes to pull a expresso ) but I’ve learned to drink coffee in between meals because I know it’s a iron inhibitor.

I do make an effort for ingesting sufficient iron in my meals but do not suplement (or very rarely), and I’m not a meat fan, even if I eat some very lean meat (poltry and turkey breasts mostly) from time to time.

I do eat my vegetables though, but since I also know that they are non-heme and difficult to absorb, I try to eat watermelon and other iron rich fruits, grapes and dried iron rich fruits, many tuna and shelfish.

A nutrition diary is a good idea. Thanks. I’ll put it to the test.

All the best