Ok, so I completely understand what you’re going through because I’m going through it too. Hopefully I can offer some help.
Quick background: I’m a triathlete as well. All last year I struggled with severe insomnia. I figured that the constant fatigue I was feeling was primarily due to the sleep issues. I finally lost my patience with my doctor and got blood work in November - I’m anemic (hemoglobin at 116, ferritin at 11). I also have some other issues but your question is about anemia, so I’ll stick to that.
I’ll answer your questions first, then give more details on my ongoing experience.
- Could this be a major contributing factor in why I have no power?
In my experience, yes. Among others, anemia causes fatigue, dizziness, shortness of breath, insomnia, difficulty concentrating. Not only will these impact you on FTP test day, they also have a massive impact on your day-to-day training and have a big impact on your overall mental/emotional health which will impact your training and performance.
- Is it helping or hindering to continue to train while my iron is low (I’m thinking if I do z2 type training, I can make the cells I have more efficient at transporting oxygen , so then once my iron raises I’d be even stronger aerobically).
I trained through it. It was really hard, I often failed and felt pretty bad about myself and my recovery time was longer than I was used to. So training while you don’t feel great may have a detrimental effect on your motivation.
Running and swimming are low impact and I haven’t found any research to indicate that these cause or make you more susceptible to anemia. Running, however, does. Running is high impact and you damage red blood cells as the blood circulates through your feet - endurance runners are often at a higher risk for anemia.
You could dial back the running a bit or make sure to run on softer surfaces like trails or a track or a treadmill.
- Has anyone suffered from this and fully recovered (most that I find online , people are still struggling after a year in). I also haven’t been able to find a lot of first hand information from athletes (vs general population)
From what I’ve read, you can see improvement in three months through taking iron supplements. This doesn’t mean that you’ve “cured” your anemia, but that you’ve seen improvement in your blood work.
However, I couldn’t find any real defined benchmarks for ferritin levels in endurance athletes, male or female. My doctor was massively unhelpful here as well. Like you’ve found online, for some people it takes years and is an ongoing consideration.
- Could anemia play a role in having a reduced metabolism?
No idea. But if you’re tired and fatigued all the time you’re less likely to train and train well. And if you’re someone who eats when stressed, you’re going to gain weight.
I’m supposed to do my first half ironman in October but now i’m questioning if that is realistic
Everyone is different, but I think you would be fine. You have about 9-10 months to work on your iron levels and fitness. I would keep notes on how you feel and your nutrition alongside your training notes and have blood work done at 3 and 6 months to see how you’re trending.
I raced two 70.3s last year (June and end of July). June was tough but a 12 min PB, July was miserable (6 min slower than June) and recovery was brutal - I didn’t race again after July. It was really hard. I was going to race my first IM in the fall, thank god I pulled the plug on that.
It had crossed my mind that I might be anemic in the spring, but I have a great diet and I eat meat. I even focused on increasing my dietary intake of iron throughout the summer and fall. In November, I got blood work done. Anemic (and also deficient in a few other things that cause fatigue, sleep disruption etc).
My doctor called and recommended that I eat more leafy greens and red meat. I called back and told her she could give me a reco for an iron supplement, or I could figure out which one to take on my own since my diet is already full of dark leafy greens and red meat.
I started taking: Fermax (2X150mg) and Vitamin D (2X1000iu). (I am also Vit D deficient). I also took a 10mg/day serving of Floradix for the first month.
I also did a lot of reading and changed how I timed my nutrition throughout the day. I realized that_how and when_ I was eating was likely contributing to my anemia. Here is what I learned:
Caffeine blocks iron absorption. Caffeine can have an effect as long as 1-2 hours after you have it, and can inhibit absorption even if you have your coffee/tea/etc an hour after your iron intake.
Calcium, Magnesium, zinc all inhibit absorption. So foods that are fortified with calcium (like cereal, dairy, etc) are going to block absorption of iron. So you want to keep an eye on nutrition labels.
Heme vs. non-heme iron - Heme iron is the type of iron found in meat, non-heme is the iron found in veggies. Non-heme is not easily bio-available, so you want to pair non-heme iron with a food that makes iron highly bio-avail:
Vitamin C/ascorbic acid - makes iron highly bio-available. If you’re eating a bunch of beans/veggies high in iron, pair it with a food that is high in vit. C.
Phytates - these are found in oats, whole wheats, beans, nuts, etc. These block/slow iron absorption. Vitamin C will help. Some veggies need to be cooked to release (not sure if that’s the right word) Vitamin C or breakdown phytates. or make iron more available. Spinach would be an example of this for iron.
Iron is more easily absorbed on an empty stomach, so take your supplements 1-2 hours before and/or after a meal. I take mine in the evening with either a piece of fruit for the vit. C or with half a Vitamin C supplement. This also means that I’m taking it as far away from my caffeine intake as possible. A lot of people seem to have stomach issues with iron supplements, I have a rock solid gut and have not have had any issues.
Vitamin B12 helps your body create new red blood cells. A B12 deficiency will contribute to iron-deficient anemias. If you didn’t have this tested, it might be worth considering this as a supplement and definitely having it tested next time.
Nutrition labels - Canadian guidelines say men should have a daily intake 8mg, women 18mg. However, nutrition labels in Canada are based off of a % DV of 14mg. So if you’re a woman basing your iron intake off of the % on the nutrition label, you’re in a deficit. Fun, eh?
How am I feeling now? (2 months of supplements and “reorganized” nutrition/diet timing)
Effing great. It is like I didn’t realize that my brain was on a massive dimmer switch and someone just flicked the lights back on.
Disclaimer - I was also having sleep issues and so a huge part of feeling better is that I went from sleeping an avg. of 3.5-3.5 hrs/night to 6 hours within the first week to now almost consistently 7!
I have increased my FTP by about 16% (I’m finishing up Triathlon Full Dist Base next week).
In my masters swim club lane, I went from even/slower than my 2 regular lane mates to smoking them on mid- to long-distances. I noticed this at about the 3-4 week mark, and I’m only getting faster.
Completely subjective, but the difference I’ve felt in my cognitive function is almost unbelievable. My memory has improved. My attention and focus has improved. My creative thinking and problem solving has improved. It’s like the neurons in my brain were trying and failing to fire through jello before, but I had no idea because I had just gotten used to feeling that way.
Once I get my blood work in Feb, I’ll be sitting down and sketching out my races and goals for the season. I decided I wanted to wait to see how my blood work looks and how I’m feeling before I could evaluate where I am with fitness and where I want to aim for.
You totally got this and I’m sure that you can still train for and crush your 70.3 in October. You know where you’re at and are taking steps to improve. That’s waaaay ahead of where I was a year ago!!
I know that everyone is different and that my experience is n=1. But I think the best way to look at this is to outline the steps you’re taking to correct the issue, making sure you execute your plan, pay attention to how you’re feeling and then have your repeat blood work done in 3 months.
Ps. Unless you live on the equator there’s a good chance you’re also Vit D deficient. Vit. D deficiency can cause/contribute to fatigue, depression, sleep disruption, and other really fun stuff. Vit D is soluble so take this one with a food that has fat in it.