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IRON SUPPLEMENTS: RESULTS MAY VARY

? I'm a 52-year-old male and my running performance has been mediocre all season. My 10K times are off by about three minutes; it's twice that for a half-marathon. My doctor recently diagnosed low iron levels and prescribed a daily iron supplement. How quickly should I see a change?

John Mailey, Phoenix, AZ

[Editor's note: Hemoglobin resides in red blood cells, enabling them to carry and deliver oxygen to muscles and other tissues. Iron is an important component of hemoglobin and of muscle cells. Less than 20% of nonheme iron, the type found in non-animal-product foods, is absorbed into the body when consumed. Nonheme iron is absorbed better when taken with animal protein and vitamin C. Heme iron, the type found in animal products, is absorbed much better by the body.]

Typically, iron levels will improve within a month of starting supplementation, assuming the dose is adequate. You may need to stay on the supplement for several months. An important question beyond improved running performance is why the deficit? Illness, blood loss, poor diet and heavy training may be to blame. Make sure there is not a serious cause. Check for blood in the stool, get lab tested now and follow up annually.

Cathy Fieseler, MD, Tyler, TX

Hemoglobin (a complex protein-iron compound) levels should begin to rise within two weeks, and should continue to rise about one point per week after that. Low iron levels in a male in his 50s are unusual and always a bit worrisome. Have your physician make sure there is no undetected gastrointestinal bleeding, as this could be a serious problem.

Kim Edward LeBlanc, MD, PhD, FAAFP, New Orleans, LA

The life of the normal red blood cell in the body is four months. Therefore, whether the low iron levels are due to a low red blood cell count or low levels of hemoglobin within a normal count, it will take 120 days to completely replace these cells with better versions of themselves.

The body absorbs iron from foods (red meat in particular) better than in pill form. Ferrous gluconate is the best supplement choice, but won't get you back on track as fast as iron from food. If you became deficient as the result of a vegetarian diet your strategy may differ from someone recovering from a recent illness. Perhaps a history of heart disease or some other factor precludes your ability to acquire iron from red meat. Your diagnosing doctor should work with you to assess the cause, and so your dietary needs.

Kerry Ragg, DO, PhD, Athens, OH

Iron status is not a very good predictor of exercise performance capacity, but hemoglobin level is.

Melvin Williams, PhD, Norfolk, VA

COMPARTMENT SYNDROME OR WORSE

? I'm a 32-year-old female, 5' 4 1/2", 135 pounds. After four and a half months of triathlon training, I began experiencing pain in my interior and anterior (front) shin. It's concentrated in one spot, and only on my left leg. I received custom orthotics several months ago to alleviate pain in my foot. I spent some time getting used to them, and now this hits. I had been swimming, weight training, running and bike riding in various combinations, with often two sports in the same day. Now I've restricted training to one activity per day, but for the last six weeks I still cannot get rid of the shin pain. It used to pain me only after running, but now it's during running as well. Can I pool run if it's a stress fracture? What activities can I still do with exertional compartment syndrome? How are both of these injuries treated?

Mellonie Fleming, Atlanta, GA

From your description, you're characterizing bone pain, and it's therefore suspicious for a stress fracture. The pain to one spot and the fact that it has escalated from only after to during running are telltale of this kind of injury. If x-rays are unrevealing, I recommend a three-phase limited bone scan--not just a single-phase bone scan.

It's possible that you don't have a fracture and, instead, are suffering from periostitis, an inflammation of the fiber-like covering of the bone. Or it could be compartment syndrome, which occurs when the muscle swells inside its casing or compartment. Whether it's compartment syndrome, periostitis or a stress fracture, be sure to seek both an orthopedist and a rehab facility that specializes in treating sports injuries.

If you've got a stress fracture of the tibia, you're looking at at least six weeks off; you can, however, pool run. Just make sure your return to full training and competition is physician-supervised and gradual.

Kerry Ragg, DO, PhD, Athens, OH

You do most likely have a stress fracture. Periostitis is basically a step prior to a stress fracture. Rather than an irritation of the lining, the latter represents a crack in the bone itself.

The treatment for a stress fracture is different than for compartment syndrome. You need to let the fracture heal before returning to impact sports; this could take up to twelve weeks. Biking, like pool running, would be allowed.

Compartment syndrome usually can be treated with icing and anti-inflammatory drugs. Over-the-counter ibuprofen, pool running and stretching exercises may be sufficient.

I would have your orthotics re-evaluated, however, since the period of development of this injury followed receipt of the orthotic. They could be malaligned.

Melvin M. Brothman, MD, FACSM, Amherst, NY

Did You Know?

Popcorn is a whole-grain food.

Please note that Clinic responses frequently appear as excerpts of longer answers, especially when the inclusion of two full answers would result in redundant information.

RELATED ARTICLE: Are you bothered by an injury? Do you have a training or diet question?

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