Hepcidin elevation may be a factor in some iron deficient runners
04/14/2019 6:47:16 PM
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Joined: Dec 1969
Posts: 344
I have encountered runners who have persistent iron deficiency as measured by serum ferritin levels less than 30 who are not successful at increasing their total body iron stores with oral iron supplementation of heme iron (Proferrin) or non heme iron (iron sulfate, iron gluconate.) When tested for H pylori colonization of the GI tract that might block iron absorption, and for the antibodies for celiac disease, these runners have neither. I have recently encountered a study in which hepcidin levels were done on rowers before extreme exertion, five hours after exertion, and a day later. In this study the rowers had a rise in hepcidin five hours post exertion with return of hepcidin level to baseline by the next day. Hepcidin is the hormone made by the liver that inhibits absorption of iron from the GI tract. I think it is possible that some of our runners who are not responding to oral iron have elevated hepcidin levels, or might be taking their iron supplements at times when their hepcidin levels are high (in the six or eight hours after they run.) Hepcidin levels have only become available to physicians outside of research studies in the last year or so. When I attempt to find out what a hepcidin level costs, I repeatedly see the term "expensive" but have had difficulty finding out exactly how expensive. I have not done hepcidin levels on athletes, because we do not know how to make hepcidin levels lower, up until recently they were not available, and because of concern about expense and insurance coverage. With the information that has been learned from the rower's study, it would seem prudent to have our athletes take oral iron in the mornings if they are running in the afternoon. It might also make sense to realize that there is a subset of athletes who are iron deficient who aren't going to absorb oral iron well, even in the absence of celiac disease or H pylori colonization of the GI tract. I have also seen a study done in rats in which psychological stress elevated hepcidin levels. I have heard anecdotal reports from coaches about poor response to oral iron in runners who have psychic stress in their lives, and wonder about this as a factor for some runners as well. Eur J Appl Physiol. 2015; 115: 345–351. Effect of intense physical exercise on hepcidin levels and selected parameters of iron metabolism in rowing athletes BMC Gastroenterol. 2009; 9: 83. Published online 2009 Nov 13. doi: 10.1186/1471-230X-9-83 The effect of psychological stress on iron absorption in rats
I have encountered runners who have persistent iron deficiency as measured by serum ferritin levels less than 30 who are not successful at increasing their total body iron stores with oral iron supplementation of heme iron (Proferrin) or non heme iron (iron sulfate, iron gluconate.) When tested for H pylori colonization of the GI tract that might block iron absorption, and for the antibodies for celiac disease, these runners have neither. I have recently encountered a study in which hepcidin levels were done on rowers before extreme exertion, five hours after exertion, and a day later. In this study the rowers had a rise in hepcidin five hours post exertion with return of hepcidin level to baseline by the next day. Hepcidin is the hormone made by the liver that inhibits absorption of iron from the GI tract. I think it is possible that some of our runners who are not responding to oral iron have elevated hepcidin levels, or might be taking their iron supplements at times when their hepcidin levels are high (in the six or eight hours after they run.) Hepcidin levels have only become available to physicians outside of research studies in the last year or so. When I attempt to find out what a hepcidin level costs, I repeatedly see the term "expensive" but have had difficulty finding out exactly how expensive. I have not done hepcidin levels on athletes, because we do not know how to make hepcidin levels lower, up until recently they were not available, and because of concern about expense and insurance coverage. With the information that has been learned from the rower's study, it would seem prudent to have our athletes take oral iron in the mornings if they are running in the afternoon. It might also make sense to realize that there is a subset of athletes who are iron deficient who aren't going to absorb oral iron well, even in the absence of celiac disease or H pylori colonization of the GI tract.
I have also seen a study done in rats in which psychological stress elevated hepcidin levels. I have heard anecdotal reports from coaches about poor response to oral iron in runners who have psychic stress in their lives, and wonder about this as a factor for some runners as well.

Eur J Appl Physiol. 2015; 115: 345--351.
Effect of intense physical exercise on hepcidin levels and selected parameters of iron metabolism in rowing athletes

BMC Gastroenterol. 2009; 9: 83.
Published online 2009 Nov 13. doi: 10.1186/1471-230X-9-83
The effect of psychological stress on iron absorption in rats
04/15/2019 1:15:32 PM
Coach
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Joined: Sep 2013
Posts: 266
@kcolter As always, thank you for the valuable information you continue to share with our athletes, parents, and coaches (plus your help with my dissertation)! I found the same information you did, pertaining to hepcidin. Inflammation (caused for various reasons) elevates hepcidin levels. Elevated hepicidin levels inhibit iron absorption, possibly as a defense mechanism to deprive nutrients to invading pathogens. More studies are required to unlock its full potential in the diagnosis of iron depletion. If you're up for a long read....enjoy :) [url=https://www.raypec.k12.mo.us/DocumentCenter/View/17581/Swift---Iron-Deficiency-Dissertation-FINAL-COPY-1]Iron Deficiency and Endurance Athletes[/url]
@kcolter

As always, thank you for the valuable information you continue to share with our athletes, parents, and coaches (plus your help with my dissertation)!

I found the same information you did, pertaining to hepcidin. Inflammation (caused for various reasons) elevates hepcidin levels. Elevated hepicidin levels inhibit iron absorption, possibly as a defense mechanism to deprive nutrients to invading pathogens. More studies are required to unlock its full potential in the diagnosis of iron depletion.

If you're up for a long read....enjoy :)

Iron Deficiency and Endurance Athletes

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