A Low Iron Case Study: How I Discovered and Recovered from Anemia

Redblood cells can't do their job without iron. Image via wikipedia.
Redblood cells can’t do their job without iron. Image via wikipedia.

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.

Make sure you have the doctor orders the lab to test your ferritin along with a complete blood panel (CBC). A CBC alone may not detect pre-anemic iron deficiency. Image via wikipedia.
Make sure you have the doctor orders the lab to test your ferritin along with a complete blood panel (CBC). A CBC alone may not detect pre-anemic iron deficiency. Image via wikipedia.

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?

I'm a 31-year-old cat mom to Cordelia and health care fundraiser in Nashville, Tennessee. I'm working toward a 20:00 5K, though I do race other distances throughout the year. I write about track workouts and tempo runs, recovery methods, and general life lessons.

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  1. So glad the underlying cause for your symptoms was discovered and treatment helps. I’ve been anemic in the past (pre-menopause) and why no definite reason, but I believe likely caused by low calorie consumption (problem especially for women athletes) and menstration.

  2. I have struggled with low iron. I was in a pretty bad bike crash about 5 years ago and had some serious bruising. Had a tough time for awhile and discovered my iron was 13; ferritin was 30 ish. Started supplements and got it back over 130. Kept taking supplements but started more triathlon training, and it started to drop down to the 80s, but still ok. During the summer of 2012, I moved to Colorado and trained for races and another ironman. Trained for Boston 2014 and about a month from the race, I started feeling sluggish and drained. I thought it was the peak of training and then the taper. The race was awful. I felt like ass the entire time. Tough to breathe and my arms & legs felt heavy. No reason for that since the race is at sea level. I thought it was a bad day until a week later I ended up in the hospital after fainting in the morning and having chest pains. Turned out my iron levels dropped over 50 points since living in CO, and I was starting to run low again. I started taking liquid iron which is awful, but very soon after, I started noticing that I could start working harder without feeling dizzy, and then I was starting to get closer to my goal times. I can get away with skipping a day, but 2 days in a row impacts me.

    I’ve talked with some elite athletes here, and I guess the altitude can really suck it out of you. My doctor has also told me that I need to drink more electrolytes such as G2 and Nuun since my body tends to sweat out more salt. It’s always something I have to keep in mind. Hopefully, you are feeling well!

  3. I’ve been suffering from fatigue for the past year after moving to Colorado. I never understood why, as my training and diet are great….reading this article motivated me to go get my labs done!

    One question: how long did it take to regain you iron levels? did you take iron pills or did doctors prescribe intravenous iron as well to speed recovery…I have big races in the months ahead and worry about recovering without taking time off.

  4. I was diagnosed with anemia 5 weeks ago. I’m a surfer and for last 2 years noticed a drop in my performance and energy level, also winded after going up one flight of stairs. I believed I was out of shape or tired from commuting too much, and there was nothing really wrong. I finally went to my GP because was having a lot of upper body strain injuries and had muscle pain that I couldn’t resolve. Doc checked for arthritis in a blood panel and found iron deficiency anemia. Hemoglobin 8.8, Ferritin 7, Iron 14… Currently using Ferrous Sulfate pills and increasing dietary sources of iron. I think the prevalence of anemia especially in pre-menopausal women and women athletes is significant and not well screened for, and as you mentioned as the sufferer, sometimes our unwillingness to wonder if there is a medical problem to explain poor sports performance can delay diagnosis for quite a while. Looking forward to recovering.

  5. Cool post. Glad you healed up! Were you able to find anything to suggest that weight training would hinder recovery? I was diagnosed with anemia this month. It seems like cardio should be pretty light, like walking and easy biking. I can’t find any research on weight training though. I’d love to use the next 3 months to get those massive strength gainzzzzz, but I’m not sure if it will have an effect on Fe absorption.

    1. Check with your doctor — any supplements they’ve recommended may factor in, as well as any supplements you might want to take to boost your weight lifting. Good luck!

  6. This sounds exactly like what happened to me. Training for the Flying Pig Half and all of a suddenly my performance tanked. Couldn’t do hills, couldn’t catch my breath and then I just couldn’t run. I was running with a couple of nurses in my group and they asked if I was anemic. I sent my daughter a text and asked who I would see for that and she got me right in with the cardiology group where she works. My blood oxygen level was below 80! My resting heart rate jumped from 45 to 68. Hemoglobin was only 7.6. Iron saturation was 8. I am now on 1000 mg of iron daily with 1500 Vit C. Had endoscopy and colonoscopy looking for blood loss. So far everything is negative. Had to drop out of training and have been ordered not only to not run but not walk competitively. This is such a bummer. Put my 1/2 bib up for sale today.