Twice the effort, half the fun

Menopausal Rose used to like to run. Not any
more she doesn't -- too bloody tiring

As a runner for more than 20 years, at 53 Rose Levine is in excellent shape by almost any measure. She's slim, has good skin tone and looks at least 10 years younger than her age. A recent medical examination found nothing unusual. As a vegetarian, during her childbearing years she had been cautioned to make sure she was getting enough iron by including leafy green vegetables, broccoli and vitamin C in her diet.

She'd arrived at the doctor's office complaining of low energy. During the medical exam her GP, whose practice is largely made up of women and who had known Rose since college, found nothing unusual.

"Changed your diet recently?" asked the doctor lightly. It was a point of contention between them.

"If you mean am I still a vegetarian, yes I am. And eating like a horse as usual."

"Which means, I hope, you're getting lots of greens. No red meat I don't suppose?"

Rose smiled and made no comment.

"The reason I ask," continued the doctor, "you seem to be in your usual excellent health. I'm wondering if it's your diet."

"Please, let's not get into that again. I'm not depressed or anything except about little things like my poor time in the last 10K. I trained hard for a month and was really up for it but my time was one of my worst ever."

"I think you may not be getting enough iron. I'm requesting an analysis with your blood test. I'll see you in about 10 days."

When she got the results the hemoglobin levels were in the low/normal range. The doctor, who expected to find low counts was now somewhat concerned. Could there be something more seriously wrong with Rose?

Still unwilling to give up her iron deficiency theory, she called a hematologist she'd gone to med school with and after a short conversation, he faxed her over an article that he thought might have the answer.

A Cornell study published not long ago in The American Journal of Clinical Nutrition suggested that iron deficiency could indeed be the cause. Dr Jere Haas, one of the researchers (the study was headed by Dr Thomas Brownlie IV) indicated that even healthy women with such mild deficiencies that they showed no signs of anemia could find themselves plateauing. Says Dr Haas, "We didn't do [the study] to promote iron supplementation. [But]...women, in particular, should be concerned about their iron status even if they think they're normal."

The study of 41 women put 22 on a six-week regimen of 50 milligrams of an iron supplement twice a day, while 19 received placebos. After taking the supplement for 14 days all the women started exercising on a stationary bike for 30 minutes, five days a week. Both groups improved with those taking extra iron making the biggest gains --the more depleted the initial iron levels, the greater the improvement.

Dr Haas had another suggestion: "If the hemoglobin is normal, I might check the serum ferritin."

That was all the doctor needed. She had Rose come in for another blood workup. The serum ferritin levels test showed a concentration of less than 15 micrograms/L and then she knew her initial suspicions had been correct.

In this case, a 12-week iron supplement of 350 grams of slow release ferrus sulfate did the trick. A grateful Rose noticed the difference in her performance three weeks into the program and called the doctor to thank her.

Iron isn't always the answer, researchers caution. Sedentary patients in particular shouldn't expect much from a supplement unless they're having difficulty with things like climbing stairs and even then, only if more serious concerns have been ruled out.

Rose's physician had the last word: "I have other vegetarians -- and several vegans (no eggs or dairy) -- in my practice. I tell them all to make sure they eat their greens but I do wish they'd lighten up and have a good steak every now and again."