Author’s reply

I agree that routine screening with a CBC and iron status is not required for most recreational runners. However, in the at-risk sub-population of elite endurance athletes, monitoring iron status is an important parameter of health and performance status. While we don’t want to burden the health-care system, prevention of disease is also an important component of health-care, not just reacting to disease as it presents.

In long-distance runners and elite endurance athletes, monitoring the status of iron stores is imperative. A big percentage of athletes develop anemia and RED-S, and consequences can be catastrophic, both from a professional standpoint and long-term health (osteoporosis). Testing once or twice a year could prevent negative outcomes. I have also seen, in practice, low iron levels for recreational runners. I can’t give advice on what supplement to take, or in what amount, without baseline bloodwork. The frequency is lower for non-elite athletes, but once a year is still a good idea for those more at risk for anemia, or if training volumes increase.

Rachel Hannah, R.D.