Iron is one of the most critical nutrients for runners. It makes red blood cells, which carry oxygen to your muscles; it’s like the gas to our aerobic engines. But some of us, particularly women runners, don’t get enough iron to keep up with our athletic body’s demands. Iron deficiency occurs when the body has low iron, and anemia occurs when the body has a low red blood cell count. Iron deficiency anemia occurs when a low red blood cell count is caused by low iron. Iron deficiency anemia is also the casually mentioned “brief medical mishap” in my intro post.
In 2013, I trained for the Country Music Half Marathon with a training group. I was slow and getting slower. I was fine to think of myself as “not a runner,” and I was okay to train with the slower pace groups. Motivation and consistency were yielding no performance results. After a while of this, some more experienced folks from my training group suggested I could be anemic, or at least mildly iron deficient. I dismissed their comments thinking I was only unfit, not physically ill. I thought I must be lazy. Surely running was hard because of some deficiency in my character and effort. If I were more disciplined, ran more and ate better, I would improve. All the while I battled fatigue and weakness.
Following the April half marathon, I continued Saturday morning group runs. One particular Saturday remains impressed on my mind, as the bucolic setting was all that kept me from misery. Legs and lungs struggled. The last mile, with its short, steep rises, finished me. I walked a lot. Another time I tried running on the treadmill, wondering if the summer heat was causing me to struggle. I kept slowing the pace. 10:30, 11:00, 11:30. I couldn’t find a pace slow enough to manage an easy jog. My heart pounded, muscles burned, and sweat poured. I felt so defeated. I remember feeling empty. Yet I persisted. The final straw was when I ran with a friend who had to do high knees and butt kicks to slow himself down enough to stay with me. Just short of the finish, I stopped fast and proclaimed, “That’s it. I’m done.”
Something was wrong.
At the doctor a couple of weeks later, I described the horrible treadmill run. I told her that in a climate-controlled environment at a pace barely above a brisk walk, an easy pace should feel comfortable. She insisted I just needed rest. No, I told her, something was wrong. “Would you like to do a full blood panel?” “Yes. Definitely.” She called my office that afternoon. My lab results had returned, and I was severely anemic with almost no iron in my blood. My ferritin, which in a normal runner should be 50-150, was 10. Ten! She immediately prescribed 1,000mg/day of iron supplement.
I took the next month completely off to let the iron get into my system. I tested a couple treadmill runs, even eeking out a 6-miler, fueled mainly by pride. I spent a week in Haiti, where I led summer camp games for energetic kids. Not only did I not run, I didn’t think about running.
I returned to Tennessee after a few weeks off and built back gradually. I kept a wary eye on my Garmin, never wanting to go faster than 10:15-10:30. I feared reaching depletion before I made it back to the car. Then one Saturday, the day of the Tomato Fest, huge arts festival in East Nashville, I shed fear and tested myself. Running out 4 miles slow and steady in a favorite park, I ignored the watch and ran on feel coming back. I was in a zone, feeling myself strong and alive. I heard mile 7 beep at 9:30. My fastest mile ever! I stayed in that zone, allowing my mind and body to float over the familiar path back to the car. I finished with a 9-minute mile! I had run my fastest two miles ever at the end of a long run, returning from illness. What a victory. At Tomato Fest later that morning, I told every friend who would listen how happy I was.
A few weeks later I joined the Nooners, my beloved track group. One of the early workouts was mile repeats at Centennial Park. My first one was 8:30. I was ecstatic! The next two were 7:30. What?! This was blazing speed. I recalled all the times I stared at faster runners’ results. How did anyone run a pace that started with a number below 10? Much less 8? Lots of healthy people doing speed work, I would learn.
One thing I never did learn was the cause of my anemia. Yes, runners classically suffer from anemia or iron deficiency. According to one study, a little over half of us do. Somehow science concluded that red blood cells are damaged when the foot pounds the ground. I could not be more skeptical of that conclusion, on the sole, non-medical basis that it sounds bogus. Soccer players average 7 miles in a game. Are they all iron deficient? No. As far as I’m willing to believe, research hasn’t discovered the connection between running and iron deficiency. It’s a reality I live with, though, popping prescription supplements three times a day.
Thankfully, with my diagnosis, I learned to be kind to myself. I beat myself up for so long (I can trace the physical effects of anemia as far back as 2009); negative self-talk was ingrained. The thoughts in my head were brutal: you’re lazy, you’re self-indulgent, you don’t deserve success. I could go on. I cultivated a less critical view, because any number of factors—physical, environmental, and otherwise—are conspiring to defeat me.
Now, I’ll admit, I’m a work in progress. My mental and emotional rehabilitation are key features of my 5K training. At least I no longer have low iron as an obstacle to my goals!
Have you ever struggled with low iron or anemia? How did you know something was wrong?