TORONTO - The image of a sobbing Paula Findlay crossing the finish line in last place will be one of the most enduring of the London Olympics.
The distraught 23-year-old triathlete from Edmonton said she just "had nothing in my legs," which she now believes was largely the result of iron deficiency anemia.
Canadian sports medicine and nutrition experts say Findlay's health diagnosis isn't particularly surprising.
"Probably our highest risk group is the female elite endurance athlete," said Dr. Julia Alleyne, who's worked with Canadian athletes at five Olympic Games and is the medical director for Sport Care —the sports medicine clinic at Women's College Hospital in Toronto.
Findlay announced earlier this week she was cutting her season short due to iron deficiency anemia. She had hoped to make up for her heartbreak in London with a strong showing at next month's world championships in New Zealand before recent blood work showed low levels of iron.
"Unfortunately the numbers came back with some of the lowest iron levels that the doctors had ever seen,'' Findlay wrote in a blog entry earlier this week. "It is a simple but quite serious problem that likely had a huge impact on my race in London, and got overlooked because of the focus on healing my injury."
Anemia occurs when a person's blood contains insufficient red blood cells, which carry oxygen to tissues. Symptoms include fatigue, weakness, lightheadedness and mood changes.
"If you're iron deficient, it's more difficult to recover between hard intense effort, it's harder to clear lactic acid, there's not as much oxygen in the blood, which would affect endurance," said Kelly Anne Erdman, a dietician and former Olympic cyclist.
Women are more susceptible to iron deficiency anemia because of menstruation and because of their diet — they eat less red meat than men.
Athletes are even more susceptible because iron is lost through both sweating and through the digestive system during exercise.
Iron is also lost through "heel-strike hemolysis," a process that sees red blood cells destroyed with each running step.
Mild iron deficiency can be difficult to detect, said Alleyne, and many athletes don't show symptoms until the condition is moderate to severe.
"Signs in athletes would be differences in training. . . times dropping, recovery time lengthened. That's what should trigger that maybe we should do your (blood) testing more frequently," Alleyne said.
Findlay's diagnosis was more bad news for the former world No. 1 triathlete. A hip injury that had plagued her for a year limited her to just six weeks of quality training before the Games. She had hoped to build on those few weeks and salvage 2012.
Now Alan Trivett, director of Triathlon Canada, is investigating how Findlay's condition wasn't discovered by doctors ahead of the London Games.
Wynn Gmitroski, who has coached some of Canada's top middle-distance and distance runners, said stress can play a key role in an athlete's iron levels and overall health.
"It comes down to number one, nutrition, and number two, trying to moderate levels of stress," said Gmitroski, the lead coach for the National Athletics Centre in Victoria and a registered physiotherapist. "If a person's stressed out, they're training too hard, and not recoveirng, digestion shuts down. You have to be in a relaxed state to be able to digest food properly and absorb it."
Gmistroski doesn't feel fingers should be pointed in Findlay's case.
"It would obviously come down to pathways of communication and a lot of it comes down to the athlete's responsibility, stepping forward and saying there's something going on and seeking help," Gmistroski said. "Really it's not something that comes down to blame overall. The reality is when the wheels come off and people get stressed out they start forgetting about the little things and stuff like this can be missed."
Findlay had been considered a favourite for a medal in London after winning five International Triathlon Union events including one on the London Olympic course. But she injured her hip just before a World Cup in Edmonton in July of 2011, the beginning of her downward spiral.
She spent months trying to determine the nature of her injury and attempts to train through it led to more setbacks. She split with her coach Patrick Kelly in June and joined forces with Olympic champion Simon Whitfield and his coach Jon Brown two months prior to the Games.
The day after the women's triathlon, an emotional Whitfield criticized Findlay's team, saying her situation was "completely mismanaged."
Triathlon Canada hired Libby Burrell as its new high performance director earlier this month, a move Whitfield tweeted was "Great news" for Triathlon Canada.
Erdman said iron levels are constantly fluctuating, and that endurance athletes should have blood work done at least three times a year. She said endurance athletes with chronic iron problems should be tested as often as every six weeks.
Because the life span of a red blood cell is about three months, there's no quick fix for iron deficiency anemia.
Through iron supplements and a diet of iron-fortified foods such as red meat and green leafy vegetables, Alleyne said it might take up to two to three months for Findlay's condition to turn around.
The world triathlon championships are Oct. 18-22 in Auckland, New Zealand.