Running and Anemia

For many, running is not just a form of exercise but a way of life—a pursuit that brings physical fitness, mental clarity, and a sense of accomplishment. However, beneath the surface of this seemingly straightforward activity lies a lesser-known phenomenon: foot strike hemolysis. This condition, though relatively rare, sheds light on the intricate relationship between endurance sports and the human body's physiological responses. Let's delve into what foot strike hemolysis entails, its causes, and its implications for runners.

Foot strike hemolysis, also known as runner's anemia or foot strike anemia, is a condition where red blood cells are damaged or destroyed due to the repetitive impact forces experienced during running or other high-impact activities. The term "hemolysis" refers to the breakdown of red blood cells (erythrocytes), leading to the release of hemoglobin into the bloodstream.

During running, each foot strike generates a significant amount of force, which is transmitted through the legs and feet. The repetitive pounding on hard surfaces, such as pavement or trails, can cause microtrauma to red blood cells passing through capillaries in the feet. This mechanical stress can result in the rupture or deformation of red blood cells, leading to hemolysis.

Several factors can contribute to the development of foot strike hemolysis:

Running Distance and Intensity: Long-distance runners and those who engage in high-intensity training are more susceptible to foot strike hemolysis due to the increased number of foot strikes and higher impact forces.

Running Surface: Hard surfaces like concrete or asphalt can amplify the impact on red blood cells compared to softer surfaces like grass or dirt trails.

Running Technique: Some runners adopt a heel strike pattern which can create more damage to red blood cells.

The symptoms of foot strike hemolysis can vary and may include:

- Fatigue

- Pale skin

- Dark urine (due to the presence of hemoglobin breakdown products)

- Mild jaundice (yellowing of the skin or eyes)

So if you’ve had recent blood work and been told that you are anemic, this is one factor to consider. 

Anemia of Chronic Disease

Understanding Anemia of Chronic Disease: Causes, Symptoms, and Management

Anemia of chronic disease (ACD), also known as anemia of inflammation, is a common type of anemia that often accompanies chronic infections, inflammatory diseases, and other long-term medical conditions. Unlike other forms of anemia, ACD is not primarily caused by nutritional deficiencies or blood loss. Instead, it is a result of the body's response to chronic disease.

What is Anemia of Chronic Disease?

Anemia of chronic disease is a condition where the body has adequate iron stores, but the iron is not properly utilized for the production of hemoglobin, the protein in red blood cells that carries oxygen. This dysfunction is typically due to an underlying chronic condition, such as an infection, autoimmune disorder, cancer, or chronic kidney disease.

Causes and Mechanisms

The pathophysiology of ACD is complex and involves multiple factors:

1. Inflammation: Chronic inflammation plays a central role in ACD. Inflammatory cytokines like interleukin-6 (IL-6) increase the production of hepcidin, a hormone that regulates iron metabolism. Elevated hepcidin levels lead to reduced iron absorption from the gut and sequestration of iron in macrophages, making it less available for erythropoiesis (red blood cell production).

2. Iron Homeostasis: In ACD, despite normal or increased total body iron stores, the availability of iron for red blood cell production is diminished. This is due to the aforementioned effects of hepcidin and the body's response to inflammation.

3. Erythropoietin Production and Response: Erythropoietin (EPO) is a hormone produced by the kidneys that stimulates the production of red blood cells. In ACD, the response to EPO is often blunted, and chronic diseases can also directly affect EPO production.

4. Red Blood Cell Lifespan: Chronic diseases can also reduce the lifespan of red blood cells, contributing to anemia.

Common Conditions Associated with ACD

• Chronic infections: Tuberculosis, HIV, and chronic bacterial infections.

• Autoimmune diseases: Rheumatoid arthritis, lupus, and inflammatory bowel disease.

• Chronic kidney disease: Impaired kidney function affects EPO production.

• Cancers: Particularly hematologic malignancies like lymphoma and multiple myeloma.

Symptoms of ACD

The symptoms of anemia of chronic disease are often subtle and can overlap with those of the underlying chronic condition. Common symptoms include:

• Fatigue and weakness

• Pale skin

• Shortness of breath

• Dizziness or lightheadedness

• Reduced exercise tolerance

Diagnosis

Diagnosis of ACD involves a combination of clinical evaluation and laboratory tests:

• Complete Blood Count (CBC): Typically shows normocytic or microcytic anemia with normal or increased ferritin levels, indicating adequate iron stores.

• Serum Iron and Total Iron-Binding Capacity (TIBC): Low serum iron and low TIBC.

• Inflammatory Markers: Elevated levels of C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR) indicating inflammation.

Differentiating ACD from other types of anemia, especially iron-deficiency anemia, is crucial for appropriate management.

Treatment and Management

The primary approach to managing ACD is to treat the underlying chronic condition. Additional treatments may include:

• Iron Therapy: Oral or intravenous iron supplements may be considered if there is concurrent iron deficiency.

• Erythropoiesis-Stimulating Agents (ESAs): In cases where anemia is severe and significantly impacts quality of life, ESAs can stimulate red blood cell production.

• Anti-inflammatory Medications: Reducing inflammation can help improve anemia.

• Nutritional Support: Ensuring adequate intake of essential nutrients like iron, vitamin B12, and folate.

Anemia of chronic disease is a multifaceted condition that requires a comprehensive approach for diagnosis and management. Understanding the interplay between chronic disease and anemia is crucial for effective treatment. By addressing the underlying chronic condition and optimizing anemia management strategies, patients can achieve better overall health outcomes and improved quality of life.

If you suspect this may be an issue for you, let’s hop on a free consult call:

A Hidden Reason for Fatigue: Pernicious Anemia

Anemia is a condition that reduces the ability of blood to carry oxygen, leading to fatigue and a whole host of other symptoms. This may be due to a reduction in hemoglobin, or a reduction of the production of red blood cells. Some common deficiencies that cause reduced red blood cells are B12 (cobalamin), folate, and iron. 

Unfortunately, it is common for someone to have low iron and low hemoglobin and get a diagnosis of iron deficiency. They are then told to supplement with iron. The problem with that is too much iron can be very detrimental, and even fatal in some cases. Although iron deficiency anemia is much more common, iron overload is also common and there is less awareness of it. So having an accurate diagnosis is very important. 

Pernicious anemia is the most common cause of anemia due to B12 deficiency. It can lead to irreversible blood and neurologic disorders. In fact, the word ‘pernicious’ means deadly. But don’t worry, it was named that way before we had answers. You can live a healthy life with pernicious anemia as long as you know what to do about it. However, that means you need to supplement it for life. 

Common symptoms of Pernicious Anemia: 

Feeling tired or weak

Shortness of breath

Feeling faint

Smooth red tongue

Pale skin

Chest pain

Nausea

Vomiting 

Loss of appetite

Heartburn

Numbness in the hands or feet

Memory loss

Blurred vision

Depression

These are just some of the symptoms of pernicious anemia. What exactly is pernicious anemia? It is an autoimmune condition that attacks the parietal cells of the stomach. The inner lining of the stomach has parietal cells and they have two functions; to secrete hydrochloric acid for digestion, and to secrete intrinsic factor. Intrinsic factor is a glycoprotein that binds to B12, where it then enters the small intestine where it is absorbed. 

There are other conditions that will inhibit the absorption of B12 such as SIBO (small intestinal bacterial overgrowth), low stomach acid, atrophic gastritis, H. pylori infection, celiac disease, and alcoholism. Use of metformin, a diabetes drug, also depletes B12 stores. B12 deficiency can also just be due to inadequate dietary intake. Plants do not need B12, so they do not store it. So you cannot get B12 from a plant-based diet despite what you may have heard. Some vegetables contain cobamides, a B12 analogue and actually inhibit the absorption of B12. B12 comes from animal products. 

B12 is an extremely important nutrient involved in the methylation cycle, genetic repair, and keeps your body’s blood and nerve cells healthy. Because of its role in blood cell production, when deficient, it can cause megaloblastic anemia. The important roles that B12 has explains the wide variety of symptoms. 

How do we detect pernicious anemia? Bloodwork is a good starting point. From there you can determine your B12 status and see your red blood cell levels. There is a test called a Schilling’s test that can help tease it out. You can also test antibodies for intrinsic factor. Seeing a functional medicine practitioner is likely your best bet. 

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