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Foot Strike Hemolysis - An Insidious Cause of Anemia in Athletes

by Dr. Jason Barker November 28, 2017

Foot Strike Hemolysis - An Insidious Cause of Anemia in Athletes

Iron deficiency anemia is a common cause of fatigue in athletes. While diagnosing iron deficiency anemia itself is relatively easy, the more challenging aspect is discovering why   a person is anemic in the first place.

Low iron diets (vegan, vegetarian) are the most common cause for iron deficiency. Women with heavy menstrual bleeding can sometimes become anemic from this as well (and this is made worse with low iron diets!) Otherwise, the body really has no direct avenue for iron loss, other than negligible amounts lost in the course of epithelial cell shedding from the GI and genitourinary tracts.

However, athletes are subject to a more insidious form of iron loss known as ‘foot strike hemolysis’ where red blood cells are subsequently destroyed as they pass through the feet from the repetitive pounding of running. Of course, it takes a lot of running for this to happen, and a while to manifest.

While runners aren’t the only athletes (its been reported in rowing, swimming and weight lifters) susceptible to exercise induced hemolysis (destruction of red blood cells), runners do have about 4 times the red blood cell destruction that other athletes do. High mileage runners, or those in which training volume increases to a point where red cell production mechanisms are overwhelmed by training (twice daily runs, marathoners and ultra runners, etc) are at greatest risk for ‘foot strike hemolysis’ caused anemia.

So, how do we prevent foot strike hemolysis from happening? You can’t, unless you want to stop running! Rather, the key here is to make sure you monitor and maintain your iron and red blood cell (RBC) numbers.

If you’re a high mileage runner, or someone who has a history of anemia, you need to check iron and RBC numbers every 6 months. It’s a simple, inexpensive test to do – let your doctor know your history, and that you’re a high mileage runner and make sure you get this test done. Don’t get behind with this! Once you’ve become anemic, it’s a deep hole to dig yourself out of – plan on at least 3 months until you feel ‘right’ again!

If you are trending toward low iron, it’s ok to use an iron supplement judiciously. Don’t wait until your lab numbers show actual anemia before you start treating it – remember the idea here is get adequate iron stores in your body, so it can offset any extra iron loss from foot striking, your diet, or menstrual status!

You do need to be careful with iron – it should only be supplemented under a physician’s supervision and with lab testing to monitor whether you need it or not. More is definitely not better here!

Dr. Jason Barker
Dr. Jason Barker


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