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Iron Deficiency In Runners

[Listen to an audio version of this blog HERE.]

I started running 15 years ago. I say that as if duration implies expertise, and to some extent, it does. But, when I began running I didn't have a proper watch. I wore sneakers from Shopko. I didn't have "running" clothes and I didn't know anything about food, nutrition, or hydration. I learned as I went, from coaches, other athletes, magazines, and shoddy internet articles. I didn't know what "rolling out" was until I went to a running camp at my future university when I was 18. I didn't do yoga or cross train. My training plans consisted of hand-written training logs and early morning runs. It was unsophisticated or pure, depending on your level of cynicism.

The first time I even knew that iron was something to be aware of as a thing-that-could-impact-my-performance was at the end of my Freshman year of college. I'd had a really great year, earning All-Conference accolades and outpacing even my coaches' expectations. However, by the time the end of the outdoor track season rolled around, I was dead tired. I'd been competing and training at a very high level for longer than I was accustomed to. The first year of college brings many changes and challenges, not the least of which was eating different food, sleeping poorly in loud college dorms, and adjusting to a heavier scholarly workload.

But my fatigue wasn't normal. I felt weak, and my heart rate was consistently elevated. A simple, hour-long run suddenly felt impossibly hard. I was getting dizzy and lightheaded often and I felt colder than I should have in the humid days of late Illinois spring. My nails were brittle and peeling, but I didn't really notice these minor signs. I just knew I was tired.

My trainers ordered a blood test to check my iron levels. The specific test I received checked the levels of ferritin (a blood protein that contains iron). A normal ferritin level for adult women is 20-200 µg/L (micrograms per liter). My first test revealed exceptionally low levels: 6 µg/L. My doctor prescribed a liquid iron supplement like this one, and my iron levels returned to normal ranges within a month. It usually takes 2-3 weeks of consistent supplementation for iron deficient symptoms to reside, and long-term supplementation can ensure symptoms don't return.

Initially, iron deficiency can be so mild that it goes unnoticed. But as the body becomes more deficient in iron and anemia worsens, the signs and symptoms intensify.

To reiterate, symptoms of iron deficiency include:

  • Extreme fatigue

  • Weakness

  • Pale skin

  • Chest pain, fast heartbeat, or shortness of breath

  • Headache, dizziness or lightheadedness

  • Cold hands and feet

  • Inflammation or soreness of your tongue

  • Brittle nails

  • Trouble concentrating

  • Unusual cravings for non-nutritive substances, such as ice, dirt or starch

  • Poor appetite, especially in infants and children

Women are at a higher risk of anemia due to our periods (duh). Losing blood means we lose iron, so women with heavy periods are at a higher risk of iron deficiency. Women who do not eat meat products are at a greater risk for developing an iron deficiency too, because red meat contains higher levels of heme-iron, which is a more absorbable than the non-heme iron found in plant-based foods. When my ferritin levels were at a 6, I wasn't eating red meat and as I slowly became vegan, I began constantly battling iron deficiency.

Because I wasn't eating meat, I treated my iron-deficiency with iron supplements. I tried many different types, but the one that worked best for me was by Thorne Research (find it here). Iron is best absorbed if taken an hour before meals, but even if you time your food consumption correctly, iron supplements may upset your stomach. The liquid iron I was first prescribed was easier to digest, although it tasted horrendous.

If you'd rather eat your iron than take it in a pill, choose the following iron-rich foods:

  • Red meat, pork and poultry

  • Seafood

  • Beans

  • Dark green leafy vegetables, such as spinach

  • Dried fruit, such as raisins and apricots

  • Iron-fortified cereals, breads, or pastas

  • Peas

As I mentioned earlier, it's easier to absorb iron from meat, so if you choose to forgo meat, you'll need to increase iron-rich, plant-based foods. I tried this, but it never really worked for me so I consistently supplemented with iron pills.

Pairing iron-rich foods with vitamin C rich foods enhances iron absorption. Foods that are high in vitamin C include:

  • Oranges

  • Broccoli

  • Grapefruit

  • Kiwi

  • Leafy greens like spinach and kale

  • Melons

  • Peppers

  • Strawberries

  • Tangerines

  • Tomatoes

  • Sweet and white potatoes

  • Papaya

  • Winter squash

If you're not sure whether your fatigue is due to low iron, ask your doctor for a blood test. It's a quick and simple way to determine if you're anemic, and you can begin diagnosing the problem from there. If your iron levels are low, bringing them up to normal levels is a fairly simple and painless process.

P.S. Read more on running and anemia from the National Center For Biotechnology Information HERE or read a story about another runner with low iron levels HERE.


Sarah Rose

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