Is Steak the Answer?
Is Steak the Answer?
Iron Deficiency, The Athlete, and The MPT
I naively thought a steak was the key to all of my problems; so little I knew. As I discuss in When the Wheels Fall Off, I did discover that I had an iron deficiency ~ one of those quiet symptoms of the MPT (menopause transition). What I didn’t know was why, and that would take some time.
Selectarianism
One of the things that made sense to me was that it was entirely believable I had an iron deficiency. I am a selectarian ~ meaning I rarely eat meat, especially red meat. I have been a selectarian (without knowing that was a term) since I was a young kid. It never occurred to me that my lack of meat eating could be a problem, until the Wheels Fell Off. At which point, it seemed like eating meat might be the solution to all of my problems. Problem ‘fixed’. Not so fast…
Let’s start with the iron deficiency journey.
Symptoms
To back track to When the Wheels Fall Off…
I was having extreme bouts of fatigue during work days during times I would have normally felt alert.
Bike rides I had done hundreds of times now seemed daunting. I literally thought on more than one ride I may not make it home.
Generally I wasn’t feeling like ‘me’. Grasping at straws, or a ‘fix’ as it were, I reached out to a nutritionist one of my workout coaches had recommended.
The ‘Team’: Nutritionist, Doctor and Me
On July 18, 2022 I called the Nutritionist and told her what was going on with me. She recommended I ‘check labs’ by having blood drawn at my doctor’s office. After that phone conversation I immediately checked in with my Doctor. This was my message to my doctor on 7/19/2022:
Hi. I left a vm yesterday on the nurse line, but am following up with an email. I have my annual exam scheduled for Sept. 14, but the last few months I have been having increasing hip pain. My conclusion is that the pain is related to late stages of peri-menopause and decreased estrogen. I am also starting to wonder if I might be iron deficient.
I spoke with a Nutritionist referred to me by my trainer yesterday who urged me to first work with my Dr. (you) to determine if I am having some deficiencies. My suspicion is potentially iron deficiency since I am an athlete in peri-menopause who eats very little meat. I have a pretty well rounded diet (lots of greens, veggies, grains, other protein sources), but I think something is lacking. My Nutritionist advised that I ask for some bloodwork to be done ahead of my appointment, to discuss with you, and potentially see if my annual appt. can be moved up. Then come to her if needed.
The Nutritionist suggested the following bloodwork:
-Omega 3 Index
-hemoglobin ferritin (not sure if that is one thing or two)
-Vitamin D (I know historically I have been low on this and planned to discuss at my upcoming visit)
-Thyroid function
The pain is mostly in my right hip joint. Initially I thought it was from cycling, but I do not believe that is the case. If I am having some deficiencies, I would like to get myself back in balance sooner than later!
Thanks for your help!
DeAnn
The reply from my doctor:
These orders are in as well as a DEXA bone density test.
If the pain is persistent or worsening consider seeing a primary care doc prior to September!
[*Note: I did the DEXA scan and know more about that now. At the time I was like ‘sure, okay’. Today I would definitely be more in tune with those results (which I was told were good). DEXA is a whole other topic, as is my Dr. journey.]
What I knew instinctively, thanks to the PhD I was giving myself in the MPT, was that seeing a primary care doctor was not going to be the answer. I needed someone who understood what I was going through as a 50+ athlete.
Blood Work
“Your body uses iron, an essential mineral, to build the red blood cells that carry fresh oxygen to your muscles via your bloodstream. When your levels are low, you run the risk of iron-deficiency anemia, which can leave you chronically tired, hamper your workouts, and also cause more random symptoms…” Next Level, Chapter 18 “Supplements: What You Need and What You Don’t” by Stacy Sims with Selene Yeager
My first labs were done on July 26, 2022. This is what they looked like:
My Ferritin was at 17, the bottom of the range was 8. This instantly was alarming to me.
My Hemoglobin was at 11.7, that was the BOTTOM of the range!
My Hematocrit was at 35.8, the bottom of the range was 35!
My RBC Count was at 3.91.
These results, out of many, specifically alarmed me.
After a few days I had to ask my Dr.’s office what these results meant (they hadn’t chimed in automatically), and I received this reply: “All your labs look great! They are normal and within range. ” But… I know me, I know my body, and I knew this was far from ‘normal’, so I reached out to my coach Sophie and soon-to-be nutritionist Rasa Troup.
This is what I was doing that day (going on a bike date), appearances (smiles) are deceiving:
Why I Worked with A Nutritionist to Start
August 4, 2022:
I don't expect either of you to do anything with this email, but since Sophie was curious to see my blood test results, I thought I would send to you both (attached are screen shots from the My Chart results). The Dr. never wrote me back about them, and when I asked yesterday the nurse replied today "everything is within normal range". I question this a bit, because some of these levels seem very close to the not normal range, particularly Ferritin, Hemoglobin, Hematocrit, and RBC Count. But what do I know??
Rasa ~ If something alarms you here in the test results, and you think a paid consult could be worthwhile ~ I can think about that. I am not a medical expert, but my gut (no pun intended) still makes me wonder if something nutrition related is going on. I do think my iron levels could be low based on what I can tell, which makes sense since I am not much of a meat eater. But really I have no idea.
Rasa Replied:
There are some labs that need nutrition intervention.
And so began my journey of working with a nutritionist to ‘fix my iron deficiency’, or so I thought that was my only issue.
This was a few days before the stress of building a cabin was starting to kick into high gear. Excavation had just begun on the Crash Pad. A time I now realize was the perfect storm for my body. Major life stress + major hormone fluctuations + iron deficiency.
My first meeting with Rasa was on August 8, 2022. We met virtually and of course this iron situation was front and center.
I took diligent notes, the first one being “Iron above 30, preferably 50. Ferritin. Difficult with nutrition itself. Will take close to 3 months to get to normal ranges of iron. Hemoglobin on low end. Anemia indicators: initial stages because hemoglobin dropping to low end.” Hearing Rasa talk about Anemia, and then googling it, was a bit terrifying. I have a lot of other notes about a lot of other things I learned at the time from Rasa, and although I was listening and understanding my mind continued to grasp onto the ‘get iron fixed….me better’ chain of thought. I desperately wanted to feel better.
The MPT (Menopause Transition) and Iron Deficiency
Rasa and I discussed menopause, but at the time (just two years ago!) so much less information and knowledge was available.
On August 8th I wrote my coach Sophie:
Just got off the phone with Rasa. She is GREAT! Thanks again for the recommendation.
What she has really pinpointed for me is an iron deficiency, so we are going to be working on that.
What is fascinating to me now as a person with a poor memory is to see what I was working through in these emails and in my head. The me of 2024 knows this was not the full picture, but the me of 2022 was sure the iron solve was key to me feeling better.
What I absolutely did not know also was that iron deficiency, particularly for non-meat eaters like me, is common during the MPT. Over a year later Stacy Sims posted this: Are You Iron Deficient? Are You Sure? (posted January 2023. my bold.) and I finally felt like I had part of the answer:
Perimenopausal women are at higher risk because estrogen helps downregulate an iron-regulating hormone called hepcidin. When estrogen declines and hepcidin rises, iron is harder to absorb. It is also common for women to suffer from low energy availability (so many nutrients, like iron, may be insufficient) and to follow a meatless diet—the RDAs for vegetarians are 1.8 times higher than for people who eat meat—because heme iron from meat is more bioavailable than nonheme iron from plant-based foods.
Ding ding ding! I had been reading about iron deficiency in perimenopause, but it was always linked to heavy bleeding during the menstrual cycle; I never had issues with that, so it was not helpful for me in connecting the dots.
In October of 2023 the NYTimes published How to Know if You’re Iron-Deficient, and What to Do About It (my bold):
If you have heavy periods, eat a vegetarian diet or are planning to get pregnant, consider asking your doctor to test your ferritin levels, which measures how much iron is stored in your body.
increasingly, researchers suggest that the cutoffs should be higher: for ferritin, between 30 and 50 micrograms per liter; and for hemoglobin, 13 grams per deciliter.
I had already learned from Rasa that as an athlete the goal was to get my levels between 30-50, ideally up to 50. It was nice to see the mainstream was catching up to the science.
On the same day the NYTimes also published More Than a Third of Women Under 50 Are Iron-Deficient. Although I was 52, what I found again in this article was not eating meat can lead to iron deficiency:
Vegetarians and vegans, who might not consume enough iron-rich foods, should also get checked regularly, said Elaine McCarthy, a nutrition researcher at the University College Cork, in Ireland, whose work focuses on iron deficiency and anemia. It is harder for the body to absorb iron from plant-based sources, and those who don’t eat meat, poultry or fish may “struggle a little bit more with getting enough iron,” she said.
To some people who are full vegetarian the need for iron may seem obvious, but for me it had never been a concern. Being a selectarian is pretty close to being a vegetarian, with the benefit of sometimes I can ‘feel’ I just need a steak ~ and have one. So back to that ~ unfortunately it was not the solve. I do believe red meat gives me boosts, but I just am never going to eat it regularly.
So, on August 14, 2022 I began taking iron supplements per Rasa’s guidance. 2 tablets of Ferrasorb daily, indefinitely until my levels got up to that target of around 50. I remember it well because we were at ROAM Basecamp camping and going over to our land where work had begun on the Crash Pad. This was the day before:
I had one of the best bike rides of the Summer and finally tackled this technical stretch on one of our favorite groads. Unfortunately this type of moment was a rare one that summer. I was excited to get going on my ‘Ferrasorb Fix’.
Every three months after I started on Ferrasorb I would go to the lab at the U of M and have bloodwork done. This is my charted journey on getting my ferritin levels up to where Rasa wanted to see them (30, ideally 50). June was a strange anomaly because I almost passed out when my blood was drawn so we ruled that result out (I was dehydrated from a dentist appointment earlier in the day). In this chart you can see how loooong it takes to get levels up:
It has now been 1 3/4 years (19 months) since I began taking Ferrasorb. In September of 2023 I had a new doctor and had my next set of bloodwork done. My ferritin levels finally got up to (past) where Rasa wanted to see them! At this time, Rasa advised to switch to taking the Ferrasorb supplements every other day, which I have been doing since. In December my bloodwork showed that switch appeared to be stabilizing my levels.
The Hormone Factor
One of the most fascinating things about the chart above is that I realized perhaps the MPT was not the sole cause of my low iron, it is possible it could have been a trigger, but knowing what I know now I am thinking the iron deficiency was already there. The chart above shows blood test results with my new provider (Health Partners), who was actually my old provider when I first moved to Minnesota. For some reason in 2012 I had bloodwork drawn and was interested to see my ferritin level was at 18 way back then! In my mind that solidified that I have likely been in a low iron state for many many years.
What I did not understand at the time was that what Rasa said were ‘some deficiencies’ were being exacerbated by the crazy rollercoaster ride my hormones were taking me on. I recently saw this chart and the middle diagram perfectly summarized what I realize today was going on in my body at the time, but did not realize then. What this shows is pretty much how I felt:
Credit: Navigate Menopause (my red circle).
So, I knew something was off for sure, but at the time I just couldn’t figure out why ‘all of the sudden’ I would be having iron deficiency issues. It seemed like it came out of the blue.
Fatigue is a symptom during the MPT, another one of those quiet symptoms you never hear about. Had I known that, and that these crazy hormone fluctuations were going on like this picture shows, it would have made SO much more sense. But again, as a long time selectarian, iron deficiency made more sense then. And so it became my mission to solve the iron deficiency.
I am lucky to know now that 1. I have an iron deficiency, which I know now thanks to the MPT and have been in treatment for. and 2. I was in the throws of late perimenopause and my body was trying hard to adjust to the ups and downs. I am also being treated for that, which is an upcoming story for sure!
So what’s next?
I am trying to switch to doing bloodwork every 6 months instead of every 3. In June I will have my levels checked and go from there.
So what have I learned?
Being nearly anemic is not good.
I should have been paying attention to this years ago; I wish I had known to do so.
MPT changes everything. Hormone fluctuations work in quiet ways and for me one of those was getting close(r) to an anemic state.
Getting help is important. Find a nutritionist who works with athletes and a doctor who understands your test results and keeps an eye on them with you (and for me both of these people are women, which I feel is very important).
Problems aren’t often ‘fixed’ but can be altered. And there often isn’t a single ‘fix’ (like a steak).
Why am I sharing this long story with you? My hope is that if you see some of yourself in this story a red flag goes up and you do some research and get some assistance in checking into it.
Taking an iron supplement is definitely not a be-all-to-end-all fix for me, but I do know now how important it is. I know enough now to know that I need to work with my team and keep monitoring my iron levels.
And I also know now being in the MPT means there is no ONE thing going on with your body, there are A LOT of things going on. It is important to work on some individual fixes, but you may need more than that one ‘fix’. I also was finding out in the midst of my iron deficiency that more was going on. It was time to find the right doctor to discuss my long list with, and so I did. More on that in an upcoming story. And more on my journey with Rasa coming up as well.