Australian Cycling Forums - Bicycles Network Australia

Just got news from the doctor after a regular checkup that I am significantly anemic and have been sent for a double scope to assess whether I have an underlying problem (ie bowel cancer, stomach ulcers). This is a huge shock as I have fought hard over the last year to regain my fitness. I have had "low" iron levels for a long time now (advised during giving blood), over 10 years and have to take prescription medicine due to a lifetime of reflux (since a baby). What I am querying is whether an intense cycling regime (commuting 21km each way five days a week, often at high intensity but with regular recovery rides and one longer medium to hard intensity 2hr ride on the weekend) coupled with my lower natural iron levels, decreased diet (I have lost almost 20kgs in 10months) and the reflux/associated drugs have devoured all of my iron stocks?

I have taken low concentration iron tablets for the last three months with no impact.

I am freaking out more than a little as I am 38, healthy (72kg/174cm tall), fit, eat well (I am definitely not vegetarian) including lots of fibre. And my research indicates that blood loss is the primary concern with anemia (ie from ulcers or bowel cancer- which scares me sh?tless pardoning the pun).

Is there anyone out there with some sage advice or should I await the double scope (irst time for this also) and associated indignities to find out what the future awaits?

Thanks

Have you have full iron studies done? These give a better indication of the total iron levels in your body than just haemoglobin. But I'm assuming your GP would have done them before sending you off for endoscopy.

There are things you can do to enhance iron absorption but once again I would assume your doctor has discussed this with you at some point. Iron metabolism is pretty straight forward. If your levels are low you are either not absorbing enough or are losing it through blood loss.

Lastly, not all anaemias are related to iron levels; there are lots of other causes including autoimmune conditions.

Sounds to be a bit complicated. You should be patient and wait for the investigation results. But given your gastric history, I wondered if you have pernicious anaemia or associated conditions to be a contributing factor?

Otherwise depends on your level of anaemia and presence of symptoms, you should adjust your activities accordingly. Anaemia may be associated with fainting episodes and as such, riding on the road and at speed may not be safe. Further, health is attained through long term exercise rather than a short intense program. As such, I'd say that you should at least back off from your high intensity regime. Having said that, 20km ride at a comfortable pace should not be a problem if you have been a regular rider.

YMMV.

Thanks for the replies and advice. To clarify I have extremely low ferritin (iron stores) so it is iron deficiency anemia that I have. Nothing has been ruled out at this stage but with my history of GORD it is a front runner for the cause of blood loss. It is so annoying as I have felt fantastic the last 4-5 months.

Yeah, I'd say wait for the results before you freak out. There are so many reasons for this, and from memory heavy exercising may contribute to lowering iron levels ( e.g. in runners the theory is that the pounding of the foot smashes red blood cells), or heavy periods ( not sure if you are male or female) coupled with insufficient absorption of iron from supplements. I had some issues when I was vegetarian/vegan and had heavy periods (ferritin down to 15), took good quality iron supplements, but this did not make any noticeable difference over 6 months. It all came good when I resumed eating meat.
Hope you get it sorted soon, its not a nice feeling being low in iron.

Cheers,

Sturgis

CXCommuter wrote:Thanks for the replies and advice. To clarify I have extremely low ferritin (iron stores) so it is iron deficiency anemia that I have. Nothing has been ruled out at this stage but with my history of GORD it is a front runner for the cause of blood loss. It is so annoying as I have felt fantastic the last 4-5 months.

How many years have you been vegan for cxcommuter?

durianrider wrote:

CXCommuter wrote:Thanks for the replies and advice. To clarify I have extremely low ferritin (iron stores) so it is iron deficiency anemia that I have. Nothing has been ruled out at this stage but with my history of GORD it is a front runner for the cause of blood loss. It is so annoying as I have felt fantastic the last 4-5 months.

How many years have you been vegan for cxcommuter?

Durianrider I have never vegetarian or vegan- but have eaten less meat over the last year trying to increase my vegetable intake and reduce overall energy intake (mostly achieved this from stopping eating refined sugars like softdrinks, juice etc).

I thought only vegans get iron deficient cos plants don't contain iron. Or protein.

I know its common practice in pro sport to do iron injections but Im not recommending that.

Can meat eaters really get iron deficiency? I guess it might explain why every supermarket in the western world sells iron pills.

durianrider wrote:I thought only vegans get iron deficient cos plants don't contain iron. Or protein.

I know its common practice in pro sport to do iron injections but Im not recommending that.

Can meat eaters really get iron deficiency? I guess it might explain why every supermarket in the western world sells iron pills.

Is that a serious statement?

Strawburger wrote: Is that a serious statement?

You obviously haven't had the pleasure of reading durianrider's "enlightening" posts before. The logic goes something like this. If a person who eats meat is also iron-deficient, then the only conclusion is that all the research that has shown that vegetarians and vegans can struggle with iron and B12 levels are all simply conspiracy theories.

No haven't read them. Thanks for the heads up! Better start eating red meat again before I become anemic

Strawburger wrote:

durianrider wrote:I thought only vegans get iron deficient cos plants don't contain iron. Or protein.

I know its common practice in pro sport to do iron injections but Im not recommending that.

Can meat eaters really get iron deficiency? I guess it might explain why every supermarket in the western world sells iron pills.

Is that a serious statement?

No. He's just trolling again.

Just had the double scope. My gut is fine and no major issues with the colon aside from moderate diverticular disease (pouches in the colon wall). The doctor said not a real problem but longer term an issue. I need to get back to my referring doctor for a discussion but it appears a combination of exercise, potential occasional colon bleeding, giving blood and reduced absorption of iron due to acid reducing medication has caused this so I have to remove as much as I can from this list (no blood donations, increase iron and fibre in the diet).

Thankfully nothing scary but another thing that needs long term maintenance (Diverticular Disease is called the Western Disease as it appears our low fibre diet means it is largely seen in europe, north america and australia/new zealand)

Just chuck a spoonful of psyllium onto your morning cereal and it should help.

I had a screening colonoscopy last year (family history of bowel cancer). Bowel was fine except for mild diverticulosis - much to my annoyance, because I eat a reasonably high fibre diet already. My gastro suggested the psyllium trick and said I'd have to do it for the rest of my life. Great! Just what I wanted to hear!

I chuck it on my muesli and add a little extra fluid (milk in my case) to compensate.

Just had my three month review and blood test- looking much better- iron stores risen from 17 to 115 (recommended minimum 30), aiming for 250-300 as the maximum is 500 (not sure of units sorry). Good news as getting a bit sick of eating as many boiled eggs as Durianrider eats bananas (not quite but up to three a day at doctors orders) plus steak/beef regularly and two iron tablets a day. Will be down to 1 iron tablet a day, with 1 egg a day also for the next six months. Getting enough fibre not a problem based on my diet according to the doc.

ps. sorry to reinvigorate this old topic.

CXCommuter wrote:Just had my three month review and blood test- looking much better- iron stores risen from 17 to 115 (recommended minimum 30), aiming for 250-300 as the maximum is 500 (not sure of units sorry). Good news as getting a bit sick of eating as many boiled eggs as Durianrider eats bananas (not quite but up to three a day at doctors orders) plus steak/beef regularly and two iron tablets a day. Will be down to 1 iron tablet a day, with 1 egg a day also for the next six months. Getting enough fibre not a problem based on my diet according to the doc.

ps. sorry to reinvigorate this old topic.

It's good to have an update and sounds like you're going ok. Good news!

CXCommuter, are you aware that if you carry out a lot of physical activity, as many riders would do, then your red cell count will naturally be low. I'd guess that many/most on this forum do intense exercise for long stretches.

When you head to the Red Cross to give blood they may assume that you are anaemic but, in my experience, seldom suggest that it may be recent or extended high intensity physical activity and that everything is working as it should.

Periods also reduce the red cell count.

So, evaluate as to whether your are, indeed, anaemic or just working hard. If it's just hard work then address it with diet or iron supplements or both. If using iron tablets be prepared to have work a little harder than normal when you take a crap, some do constipate you a bit.

From your update it seems that these are steps you have taken anyway.

ColinOldnCranky wrote:CXCommuter, are you aware that if you carry out a lot of physical activity, as many riders would do, then your red cell count will naturally be low. I'd guess that many/most on this forum do intense exercise for long stretches.

When you head to the Red Cross to give blood they may assume that you are anaemic but, in my experience, seldom suggest that it may be recent or extended high intensity physical activity and that everything is working as it should.

Periods also reduce the red cell count.

So, evaluate as to whether your are, indeed, anaemic or just working hard. If it's just hard work then address it with diet or iron supplements or both. If using iron tablets be prepared to have work a little harder than normal when you take a crap, some do constipate you a bit.

From your update it seems that these are steps you have taken anyway.

ColinOldnCranky- agree 100% with you on the working hard affecting iron stores. Unfortunuately it didn't explain the really low iron stores which came from a perfect storm of lower than normal absorption due to taking acid reducing medication (for reflux), giving whole blood and lots of intense exercise (no periods thankfully as being male). Having removed the first cab off the rank (blood donations) and iron supplements things have improved without impacting my exercise etc. All undertaken under doctor request/supervision. Aiming to restart plasma donations in the new year as I consider it a civic duty to assist this vital service.