Running with Anemia

Running with Anemia - Eat Spin Run Repeat

This is a long-overdue post, and one I’ve been meaning to write for months now. It’s also content-loaded, so grab your favourite beverage and a snack, and let’s have a chat.

Over the past year I’ve received several emails, blog comments, and in-person questions about how I found out I had anemia and how I’ve dealt with it. There have been a number of posts where I’ve talked about the various supplements I tried and the impact that all of this had on my training throughout 2013, but after having had a really successful 2014 in terms of getting my ferritin levels up (more about what this is in a second), I figured it would be a good time to put everything in one place.

Photo credit: abhijith3747 / Fotolia
Photo credit: abhijith3747 / Fotolia

How it all began

Let’s rewind to May 2013. I’d just run the Goodlife Toronto Half Marathon, and while it wasn’t a PR, I still had an ok race. I hadn’t done much outdoor training prior to that race but had been logging plenty of miles on the treadmill through the winter and early spring. My hill-hating self really didn’t like the enormous slope around mile 3 of the course, and I remember it feeling really hard. It took me longer than expected to bring my heart rate back down in the miles that followed, but eventually I got back into my groove and carried on for the rest of the (reasonably flat) course.

my bib for the half marathon

I got home after the race, showered and ate, but couldn’t stay awake later in the afternoon. I napped, woke up for dinner, then went straight back to bed.

In the days that followed, I eased back on my workouts as usual post-race in order to recover properly. Normally after a half marathon I have the energy to get right back into training in the days that follow and it’s more an issue of forcing myself to hold back that I deal with, but this time, I couldn’t shake the tired feeling. Even an easy elliptical workout felt like a challenging sweat session.

About a week later, I went on a mini-holiday to Montreal. My plan was to run a bit outside while I was there, but it rained for almost the entire trip and I didn’t feel like it. Feeling like I should at least get some sort of physical activity, I did a couple of TurboFire workouts. These don’t normally make me sweat very much but I found my heart rate jumping up way too early every time I tried. I napped most afternoons and slept at least 8-9 hours each night.

After 2 weeks of being back home in Ontario, my running fitness still wasn’t where I expected it to be. My energy during the day at work was ok, but every time I tried to do any sort of cardio, it felt as though my legs were suffocating within about 5 minutes. It was like enough air just couldn’t get into my body with each breath and before I knew it, I was dripping with sweat. For someone who has been starting the majority of her days with physical activity for the last 9ish years, this was frustrating and I knew it wasn’t normal.

Doctor says…

I made an appointment with my (at the time) family doctor to describe what was going on, and to request bloodwork. I mentioned that I suspected my iron might be low, because like every patient does, I’d already done plenty of self diagnosing with the help of Dr. Google.

(Source)
(Source)

I brought up the possibility of footstrike anemia, also known as footstrike hemolysis or hemolytic anemia. In simple terms, one of the causes of this type of anemia is the repeated crushing of red blood cells with every strike of the foot. (Seriously, it’s a thing and here’s a study about it.) As you may have guessed, this is a common diagnosis for runners to receive since a runner’s feet are constantly pounding pavement (or treadmill belts). My doctor said she’d never heard of it, Googled it, and told me that I should just stop running. Um…. no.

Annyways, she gave me the form I needed to get the blood taken. About a week after having it done, I called to follow up because I hadn’t heard anything.

The nurse told me on the phone that the results showed an iron deficiency and that my doctor recommended taking an iron supplement. No mention of what kind, how low my iron levels were, how low my iron was, or what dose. I asked these questions, and the response was “just a standard iron supplement from a pharmacy should do the job.” I asked to get a copy of my results and was told yes, as long as I went into the clinic and paid $1 per page to have them printed. (Seriously?! But I did it.)

lab test screenshot

Iron deficiencies come in many forms, and there are a number of things that need to be considered – red blood cell count and size, hematocrit, hemoglobin, and ferritin. In my case, things were low across the board but what needed the most attention was ferritin. Mine was rock-bottom. Let me quickly explain what this measurement means.

What’s ferritin?

Ferritin is a protein that allows the cells of our bodies to absorb iron. Most of our ferritin stores are in the liver, spleen, muscles and bone marrow, and this number on a blood test indicates how much iron is stored in the body. The normal range for women is broad – 11 to 307 nanograms per milliliter according to the Mayo Clinic – but do you want to take a guess at what mine was? 4. Pretty much non existent. My naturopath at the time took a look at the results and confirmed that I was about as anemic as it gets.

And so the supplement testing began…

Contestant #1: Salus Floradix by Flora Health

Details: Each 10mL dose (to be taken 2x daily) contains 10mg elemental iron in the form of ferrous gluconate, as well as vitamins B1, B2, B6, B12. The liquid needs to be stored in the fridge, but this supplement also comes in tablets that do not. Full specs can be found here.

floradix iron

Floradix was recommended to me by a few naturopathic doctors, holistic nutritionist friends, and female endurance athletes. It’s known for being easy on the gut, vegetarian-friendly, and easily absorbed. By easy on the gut, I’m referring to two key things: No stomach aches and no ‘backed up pipes’ – a very common side effect of iron supplements! This one didn’t cause me any problems, and I did feel better after a few days. However, I think it’s just because my iron was SO low that anything would have helped. After two months, I was back to my tired self and my blood tests showed no improvement.

Contestant #2: Genestra Liquid Iron

Details: Each teaspoon (5mL) contains 15mg iron in the form of ferric pyrophosphate. The recommended dose for adults is 1 teaspoon 2x daily (a total of 30mg iron), or as recommended by a healthcare practitioner. Mine told me to take 2 tablespoons, or 90mg daily. Full specs can be found here.

genestra liquid iron

Another liquid iron was up next because I’d been told that these are typically easier on the gut. By this time – around fall of 2013 – I was struggling with some bad digestion issuesso this was a top priority. Genestra Liquid Iron is vegan friendly, has a decent taste (I liked it better than Floradix, which tasted like funky grape juice) and didn’t cause me any problems.

This supplement got me through for most of the fall and winter, and while I started to feel improvements in my fitness on a consistent basis, I still wasn’t fully back to normal and my ferritin number had barely moved. Back to my family doctor I went, begging for a referral to a specialist, which she gave me. (I also got a new family doctor at this point.)

Contestant #3: Euro-Fer Iron Capsules

Details: Each capsule contains 300mg iron in the form of ferrous fumarate. Euro-Fer (from what I understand) is the generic version, but Palafer is the name brand for this supplement. The dose recommended to me was 1 capsule daily. Full specs can be found here.

euro-fer iron

Ding ding ding! We have a winner! The specialist I saw in January 2014 figured that the earlier doses had been far too low to have caused any substantial changes, so he suggested Euro-Fer iron which is available over the counter. (Floradix is available off the shelf here in Canada, and Genestra is also an OTC.) He warned that because the dosage was significantly higher, I might experience some digestive discomfort but this was totally not the case. For the record, he also said that refraining from running was totally unnecessary, so we’re pals. 😉

After only 1 week, I felt awesome. My cardiovascular capacity felt like it was back and while I was still taking it pretty easy in the gym, the buckets of sweat I’d initially experienced weren’t gushing out of my pores any more. Another perk was the cost – Euro-Fer is available for between $5-8 depending on where you buy it, making it a much cheaper option than the other two mentioned

Is it really working?

New blood work done around August and October 2014 showed that my ferritin was up from 4 to 12, putting me at the very bottom of the normal range (but at least I’m IN the range!!!) The evidence that it was working showed in my lab tests, but also in my race performance. I hit a new half marathon PR of 1:28:30 in June and continued to have some great races throughout the summer – a much welcomed feeling after having had such a crappy 2013 race season. My most recent test done in November showed another 12. #winning

Waterloo 10K Classic

 A note about types of iron

According to Anemia.org,

“There are two general types of iron supplements which contain either the ferrous or ferric form of iron. Ferrous iron is the best absorbed form of iron supplements. Most available iron pills contain ferrous iron. There are three types of ferrous iron supplements commonly found: ferrous sulfate, ferrous fumarate, and ferrous gluconate. While all three come in a 325 mg tablet size, each one contains a different amount of the form of iron used by your body, called “elemental iron”. When choosing an iron supplement, it is important to remember to look at the amount of “elemental iron” in each tablet, instead of the size of the tablet.” Source + read more here.

So why did the Euro-Fer work better than the others? The specialist I went to said that he’d seen much more success on ferrous fumarate than other forms of iron, and perhaps switching AND increasing my daily dose was what my body needed.

What about food?

Obviously, nutrition plays a huge role in one’s iron levels and health in general. My diagnosis shocked me initially because although I hadn’t been a red meat eater for about 10 years, I consistently ate lentils, chicken, seafood, beans, and TONS of spinach. (It turned out that my spinach consumption caused its own set of gut problems that seemed to do more harm than good.)

spinach and kale

The thing to know about plant-based iron-rich foods like spinach, beans and legumes is that they contain non-heme iron, which (as you may have guessed) comes from plants. Our bodies can still use it, but they don’t absorb it as well as heme iron, which comes from hemoglobin in animals. So while I was probably getting plenty of non-heme iron, my body wasn’t absorbing it. As you may have heard in the past, we’re not necessarily what we eat, but we are what we absorb.

lentil kale and tempeh saute

What dietary changes did I make?

First, I sucked it up and ate some steak. It was weird. My tastebuds didn’t know what to think of the foreign morsels in my mouth which I tried to hide amongst lots of vegetables (like in this stir-fry). But I did this because it was August 2013 and I had the Lululemon SeaWheeze Half Marathon coming up which I was desperate to get better for. My steak of choice was usually sirloin or eye of round, produced by Aspen Ridge. This company raises their cows humanely on a 100% vegetarian diet, free of antibiotics and hormones.

Ginger-Orange Beef and Pepper Stir Fry - Eat Spin Run Repeat

Since then, I haven’t been eating steak as regularly because truthfully, I don’t love it and my Euro-Fer iron supplement has been doing a good job. However, there are a few guidelines I still follow and would recommend to anyone facing the same issues:

  • Take the iron with a form of vitamin C to boost absorption (ideally a food source of the vitamin, not another supplement)
  • Avoid caffeine and dairy around the time of taking the iron as this hinders absorption. (So if you need to have your coffee in the morning, that’s probably not a great time to to do it)
  • Incorporate a variety of non-heme and heme iron sources into your diet. Obviously vegetarians and vegans will have a much harder time with this since heme iron comes from animals, but I still think eating a variety of plant-based non-heme foods helps. Mayo Clinic has a good list hereNote: Because I have a sensitivity to spinach, I keep my intake low and instead incorporate lots of other leafy greens like kale, swiss chard, collards, herbs, and lettuces. 

Vegan Lentil and Veggie Stuffed Peppers - Eat Spin Run Repeat

Where I’m at now

I’ve been taking the Euro-Fer ferrous fumarate supplement for nearly 1 year now, and feel 100% back to normal – and better. I’m not sure exactly sure if my iron was low prior to 2013, or if it just took a really steep hit in that spring half marathon. However, the lab tests and my physical performance in athletics has me pretty convinced that lots of progress has been made. While it would be ideal to boost my ferritin a little higher, for now I’m content with where it’s at and fully intend to keep an eye on this whole situation as I train for my first half Ironman this year.

running along the sea wall in vancouver

Phew. Now that I’ve written you all an essay, let’s flip the conversation over to you. I’d love to hear about any of your experiences with iron deficiency, regardless of whether you’re a runner or not.

  • Are there any supplements not mentioned here that you’ve seen success with? 
  • Have you tried anything other than supplements, such as iron injections?
  • Has anemia affected your ability to compete in athletics, or did it in the past?

My hope is that this post will be a resource for anyone dealing with a similar situation to the one I experienced. Your comments below will make it even more valuable, so feel free to go into as much detail as you like!

Disclaimer: Please remember that I’m not a doctor, and none of the content in this post is intended to be interpreted as medical advice. If you do suspect that your iron is low, it’s best to check with a healthcare professional before beginning to take any supplements etc. Thanks! 🙂

84 thoughts on “Running with Anemia

  1. Happy Monday. For starters my husband, teen daughter and I are on day 4 of your 14 day core challenge. Wow abs are sore but feeling great. It’s a tough one!!! Thanks for sharing this detailed information post on anemia. I only had low iron while pregnant with both of the children. However my almost 15 year old daughter just had her annual physical and she has a bit of anemia. We are in the early stages of helping her get her levels up to normal right now. You detailed out your research well and I am so happy your levels are going back up. Bring on increased energy and half Ironman for you!!!

    1. I’m so glad you’ve got some of your family on board, Desiree! That’s awesome to hear. The great news about your daughter’s diagnosis is that you’ve identified it early, so you can prevent it from getting too low as mine did. Good luck and Happy Monday!

  2. I may die early 😉 but I use a fairly cheap iron supplement every day as well…inspired by YOU! I have never struggled with low iron, but it certainly is something that I actively avoid, especially seeing what you needed to go through.

    Cracker of a post!

    1. Hi Pamela! I don’t think it was specifically caused by running only, but based on what I’ve read and judging by the prevalence of iron deficiency anemia in female runners (and endurance athletes in general), it sounds like there’s a link. I’m just glad I don’t have to give it up!

  3. Now THAT is an informative post!! I tested for low iron ONCE a really long time ago and the last time I had my blood checked, my doctor said my levels were fine!! I found it kind of surprising because I don’t really pay much attention to what I eat these days. You already know I don’t eat red meat, nor do I take any supplements…so I don’t know how the heck I fixed myself. No complaints!! Now I’ve just got to figure out these digestion problems and we’re all set!!

  4. Are those results in the picture yours? I noticed that your white blood cell count is low, as is mine. Are you doing anything to address that or has your doctor expressed a concern? My WBC is 3.1 and I have to go in every 3 months so my doctor can monitor it. I have also been to a hematologist/oncologist who says everything is normal. I don’t get sick too often, but I do worry about it being low. My dr. very strongly recommends the flu vaccine, which I do get since I worry about a lowered immunity. I also take vitamins and supplements and eat a healthy diet, but I wonder if there is something more I can do. I would love to get your input on this. Thanks!

    1. Hi Suzanne! Yep those results were from when I first tested low (when I decided something was definitely wrong back in May/June 2013). My ferritin was 4 at that point, but yes, my WBC count was low too and still is occasionally. I’ve managed to get it up to 3.9, and from what I understand, the normal range starts at 4. Mine tends to fluctuate a bit and my doctor and naturopath both pointed it out, so we’re watching it to see what happens over the next couple of months. Like you, I don’t get sick often but I think diet and other lifestyle choices have a lot to do with that. I’ll let you know if I get any other info about the low white blood cell thing next time I chat with my naturopath. 🙂

      1. I’m dealing with this same, exact scenario right now. My doctor explained that he actually expects to see a lower WBC count from athletes who work as hard as we do because our bodies put a priority on creating RBCs.

  5. This is my first time here. It’s great to see this post and to see another runner addressing this!

    I too struggled with anemia and had a ferriten of 4. My initial bloodwork, my doc did not test that, so I have no clue what it was when I was really sick, but back in 2010, my HGB was 7.3 (normally they transfuse at 8, but I was up walking around and working but struggling every day). I currently take a few iron supplements, including Feosol pills which are probably the best, IMHO. I do the liquid occasionally as well. I have heard of Floradex (not tried it) I’ve never heard of Euro-Fer, though. I had to do most of my research online myself as well. Most doctors don’t “get it”, they don’t even test ferritin or they say your results are normal… but what’s normal for a person who works out 2-3 times a week might not be enough for someone training 6-7 days a week.

    My anemia was diagnosed when I was a beginner runner (2010), and I thought I was just slow. I suffered through a 33 minute 5K before getting help. After a month of not running and slowly, slowly, slowly building back up, I broke 30 only running maybe 2x a week, just because of the supplements. Keep in mind, I was still a beginner runner. Now I’m consistently in the 22’s or high 21’s but it’s been a few years and training has obviously helped ;).

    I always wonder how many runners may have anemia, even if it’s not super severe (mine took 6 full months for my HGB to even be in the normal range)… maybe even mild cases, but they just “think they’re slow”. I get that it’s fun to “embrace your pace” no matter what it is, but if you train consistently and get worse results, it’s something that athletes, especially women, should look into.

    1. Hi Amy,
      Wow, thank you so much for sharing all of this and I’m glad you stopped by! I totally agree with you that we have to take responsibility for doing our own research because only we know what’s ‘normal’ for our bodies. Running can be difficult at the beginning for newbies, but I can only imagine how much tougher it must have felt for you while dealing with such low iron at the same time. That’s awesome that you’ve chopped so much time off your 5k though – 21/22s are very respectable results! 🙂

  6. yes yes! you know i am so glad you posted this. It’s a constant work, the health part. Especially for active people. I take floradix too. I love it! and you just reminded me i need blood work done again.

  7. Thanks for this post Angela. I have also experienced low ferritin. I found out about the problem after participating in a study with the Australian Institute of Sport. The study was looking at the effect of IV iron on running performance. When they did the initial screening I was eligible to participate in the study but before the study started I competed in an Ironman triathlon. By the time of the study (where I was on the control group) my ferritin was low (10 and they had a cut off of 30 for the study and recommend 50 for female endurance athletes).
    Despite advice from the AIS sports doctor my regular doctor would not take me seriously because when I got another blood test my ferritin was 17 so within ‘normal’. Eventually she recommended a supplement, ferrograd-C (ferrous sulphate), and on advice from a dietician changed my oral contraceptive pill. Happily my ferritin level improved and after 6 months test was 56!

    1. Hi Jennifer! Wow, I bet you’re glad you were initially screened and accepted for that study, hey? Based on what I’ve read from others, it sounds like iron deficiencies get missed and ignored frequently. That’s wonderful that you’ve been able to find a new combination of treatments that has you right back up in the 50s… this is super nerdy, but I’m jealous of your high number! 🙂 I love reading about endurance athletes like yourself who have been able to tackle these issues and maintain awesome performances in sport. Hoping I can do the same!

  8. This was a great post!! When I found out about my low iron, I took Euro-Fer but it was way too harsh for me. I would get nauseous and stomach cramps. It was terrible. Now, I take the floradix pills and they are so much better for me. I was taking the liquid at one point but it became annoying since it was hard to travel with.

    I’m so glad your levels are back to the normal range!

  9. I’ve been a vegetarian for over 30 years and so know how tough it is to get enough iron. It’s not that other foods don’t have lots of iron but I learned the hard way that it’s not in a form your body can easily absorb. Food combining with Vitamin C rich food helps. I could always tell when I was low in iron because I’d drag my butt through workouts. That always raised the alarm for me (that and being turned away at Canadian Blood Services for low iron levels.) Like you, my ferritin level hit a low of 7. My doctor prescribed Euro Fer (300 mg tablets) and it worked like a charm. No side effects whatsoever, I didn’t know it was available over the counter though. Much cheaper too! Thanks for a well researched and VERY informative post!

  10. Hey –

    I am a professional runner for Nike – I live in London.
    I love reading your blog too! I have had problems with low iron and still have to be careful with mine. My Ferritin has been as low as 9. When it was this low I had an iron injection repeated after 8 weeks.
    It 100% effects performance and training when your iron levels are low. It also takes around 6 weeks to notice and improvement once your iron levels are back up to normal.
    Since then I think the biggest changes I have made which has really helped is…

    -The timings of my iron supplements (not around food/milk/coffee)
    -More red meat + green leafy vegetables

    The best iron supplements I think are the liquid ones – as they seem to absorb better into my system. I also take a smaller dose but spread it out 3X per day instead of one big dose!

    I hope this helps 🙂

    Charlotte

  11. Anemia is how I ended up pregnant with baby #3 almost 5 yrs ago. I had the same symptoms as you, and VERY heavy periods (filling a menstrual cup in an hour). My Dr. suggested it was related to my IUD. Unable to deal with the heavy cramps etc, I made an appointment to remove my IUD, and less than a month later I was pregnant (oops). We then thought I had extreme pregnancy fatigue, but after the first trimester and the fatigue wasn’t going away it was discovered that my iron levels were low. I took Palifer, and Euro-fer during my pregnancy, then was able to switch out to the liquid iron supplements. I now take Floradix. Did you know that Anemia is a world health problem? I learned about the Iron Fish Project and have bought a few fish to help families in Cambodia. Iron Fish are made of old iron tire rims, and when put in a pot with boiling water, absorbable iron leaks into the food, giving families in developing the iron they need so they can be alert etc. I’ve been meaning to blog about it, but just haven’t gotten around to it.

    PS – good luck at Ironman 70.3 Muskoka… I’m registered to do it too!

  12. Good article, I can relate since out of curiosity I had some blood work done last year and found my ferritin number was also low. As a long time vegetarian, I just thought I’d get the test done and see what came of it, I was not feeling “low” or tired at all, and running was going well.

    I spent a bit over six months taking iron pills daily (often with an orange or Vit C pill) my ferritin doubled! I had some secret hope that I would feel like super man, but there has been no real change in how I feel. Oh well, at least I know that my iron is back to a health level 🙂

  13. I’m soooo glad you found a new family doctor. Any doc that tells me “not to run” is fired immediately because that is crap. My iron is slightly on the low side, but what’s affected me more is low B12. I’ve been taking a supplement and I’ve noticed significant changes in my energy levels.

    Great post!

  14. Angela, iron deficiency anemia is fairly common and low ferritin (without a dip in hemoglobin aka low iron stores) is incredibly common in females. I am surprised you think it is often misdiagnosed as it is commonly ordered blood work. Anyways, to not confuse your readers, you may want to explain that iron deficiency anemia is different than hemolytic anemia, although both may occur in runners. This explains it well: http://www.pathologystudent.com/?p=2290

  15. I had a severe iron deficiency that I found out about last year. I slept a lot, had constant headaches, and felt awful almost all the time. I got my levels checked and I was really really low (worse than you)! I’ve been taking ferrous sulfate for a full year now, plus a multivitamin every two days (I can’t take it every day since it makes me feel ill) and I’ve been feeling a lot better. I can workout again, and feel like a normal person again. it’s been great, and I’ll probably still be on the pill for a long time. Last time I checked my blood I was in the 30’s, but they want women to be around 80 ppm. good luck 🙂

  16. This is a great, informative post! Thanks! I looked up the Euro-Fer but was disappointed to see that it also contains additive and food colorings in the non-medicinal ingredients 🙁 Unfortunate…do you look at that stuff? I guess it doesn’t bother you if it’s helped you!

  17. This in an amazing post. Its great to know its not usual to end up in this state suddenly.
    I have just been told I am anaemic and my levels are as low as yours were. There is little information about how it affects you running wise etc. Really good to read something with a positive outcome. Thank you and Keep running!
    😀

    1. I’m so glad you found it useful, Stacey! Iron can be such a tricky thing to figure out, especially since it takes time to see results. I’d definitely recommend trying a few different supplements to see what you feel best on because it really did take a lot of experimentation for me before I started to truly feel better. It’ll involve getting some regular blood work done to see if things are changing, but in my opinion, it’s worth it for your longer-term health!

  18. This is an awesome post. I’m a little late in reading it, but I recently just got diagnosed with some pretty severe anemia. I am like you, Angela, where my ferritin and hemoglobin were at rock bottom. Recently heart rate during easy runs (I mean easy…2 miles at 10 min pace) and heart rate gets over 200 every time. YIKES! I am on prescription iron 325 mg 2x/day perscribed to me by my wonderful sports med doc. I definitely do agree that every persons body is so different and that you should “listen to your body.” I have been taking this for almost 2 weeks and have not yet noticed a difference. Your post is helpful and hopeful in knowing that levels will go back to normal at some point and I do not have to give up running. What a tragedy that would be!
    Thanks for your insight Angela.

  19. Thank you!! I hadn’t thought of the different amounts of elemental iron before, and my doctor was slightly horrified at the amount of ferrous gluconate I’d been taking to maintain the low end of normal. Well, duh now–maybe that’s because it has less elemental iron than ferrous sulfate. Honestly, I’m freaked out because they said I might need an iron infusion, but at least I have something else to try, first!!

    1. You’re most welcome, Ellen! I actually had considered the infusions as well because one of my friends swears by them, but I’ve heard they can leave a pretty nasty bruise so that’s why I just tried to find a supplement first. I hope you can find this one and that you have the same success that I have with it!

  20. Stumbling upon this super-helpful post a year late. Last summer after a 100k race I started finding ordinary runs difficult, in the same way that you describe: spiking heart rate, out of breath, excessive sweating, but no physical pain. I started having to stop for a minute or so after 5 miles, then 4 miles, then 3 miles, then multiple times during a run. The worst was during a 7 mile run when I had to stop 12 times. Dr. Google did not lead me to iron deficiency but instead to the idea of chronic fatigue syndrome, but that just didn’t seem right. I was not running high mileage (consistent 20-40 miles per week for years), the 100k wasn’t that taxing (it was a navigation race where you had to find checkpoints along the way, which involves a lot of walking), and I wasn’t tired when I wasn’t running.

    I spent the fall just walking while listening to podcasts, which was super-easy but not that satisfying. I never felt tired during these walks and my heart rate barely cracked 100. Then in the winter I found a group of slower runners (around 9 minute pace, versus my traditional 7 minute pace). This has been super-easy also but least I’ve made some new acquaintances. I did another 100k navigation race walking the entire way and was able to finish in the middle (a good slow navigator will beat a fast person who makes mistakes).. Every so often I’ll try something faster or harder and find myself gasping within minutes. I figured that on top of whatever the original problem was, I had lost a lot of my aerobic fitness after 8 months of moving slowly. I resigned myself to a noncompetitive future and figured there are far worse problems to have.

    Then I finally saw a doctor. It was the first time in at least 10 years, except for acute situations like when I had a bad case of poison ivy. It just didn’t seem necessary; I had always felt fine. My doc ordered blood work and lo and behold, my iron numbers were outrageously low. My doc, who is a half-marathoner herself, ordered Euro-Fer. It’s too early for anything to have changed yet, but here’s hoping!

    1. Hi Frank!

      Thank you so much for your comment, and I’m sorry for the slow response. Your story is so similar to what I’ve heard from other endurance athletes, and your discipline in scaling your training way back is absolutely admirable. As someone who loves the endorphin high of running, I can certainly empathize with the frustration of not being able to perform to the level that you know you can.

      I’m so glad you finally went to the doctor and got a solid answer, and that’s awesome that she’s an athlete as well who understands that you’re not going to flat-out “just stop running”! The best piece of advice that I can offer (even though it’s easier said than done) is to be patient with the iron supplement. Luckily, you’re starting out with one that (in my opinion) is really good. As I mentioned in the post, my iron was so low that even Floradix made me feel a bit better initially. My ferritin was at 4 in May of 2013, but last August, just over 2 years later it was up to 24 which was a huuuuge improvement! You might have already started seeing results over the past week, and I’d love to hear how things progress for you throughout the course of this year. I’ll be keeping my fingers crossed that you’re able to get back to your usual training soon!

  21. Hi, my name is Anj and Iv suffered with Anemia since I was about 9/10 years old, I’m now 38 & still struggling with it. Im trying to train for triathlon but can only manage running for about 1min 30sec b4 my muscles feel like lead.iv been taking ferrous fumarate liquid as I’m lactose intolerant. Is the liquid the same as those Euro-fer capsules you were taking?
    I’m so tired of feeling fatigued 🙁

    1. Hi Anj, that’s a great question. I’m not 100% sure to be honest, but it could be that the concentration of the actual elemental iron in the liquid supplement you’re taking is lower than what is in the Euro-fer capsules I take. Each capsule is 300g ferrous fumarate, equivalent to 100mg elemental iron. I would check the concentration of your supplement and ask your doctor if they’d recommend going for a higher dose. Hope that helps!

  22. Hi! I just came across this post. I love all the information you put in about your decreased iron levels. What is your status now? Do you still use that iron and do you only take one pill a day still? I currently take IronFeraMax 150… Was working at first, but not any more.

    Thank you!!

    Morgan

    1. Hi Morgan!
      It’s funny you mention that because I just got a lab requisition done to get tested again. I will report back with where I’m at, but the last time I was tested (late last year), my ferritin was at 25 so I’ve definitely made some great progress since the date that I wrote this post! I’ve learned that it can take a really long time for iron to be restored – it seems to be the case for everyone I’ve talked to. And yes, I still use Euro Fer and am taking one capsule per day. I learned when I moved here (to Vancouver) that Costco will order it in, so I’ve been doing that and if I recall correctly, my bottle of 500 capsules cost about $70 CDN, which is far cheaper than any other iron I’ve found and for me, it works better too. Perhaps it’s worth experimenting with another brand to see if that helps you? Hope this helps!

  23. Same problems here. My level is 11 and feel tired constantly and constant injuries. I tried Euro Fer but it constipated me. (I’m mostly a plantbased eater and have difficulty digesting red meat which in me, slows down digestion). But I guess I will have to join my husband in eating steak once a week because while I hate the taste, I hate constipation more. 😉

    1. Hi Nicky,
      I’m so sorry you’ve been having trouble finding a supplement that works for you. I also still eat steak occasionally but like you, it definitely slows my digestion down. I have a friend who was also very anemic a while back and opted to go the route of iron injections. I’m not sure if you’ve tried that already, but it might be worth looking into if you feel you’ve already tried a ton of supplements. From what I hear, it leaves a bit of a bruise but seems to do the job!

  24. Awesome post, Angela. I experience the same scenario as you, although my lowest ferritin was 8 instead of 4. Same situation where my doctor told me I was “fine” once I got it up to 12. Finally find a great sports medicine doctor who actually understands internal medicine and endurance athletes, but he’s in Texas and I’m in Michigan. At any rate, he wouldn’t let me run, if he was here, until I got my ferritin up to 40! So I ran my first marathon and Boston qualified on a ferritin level of around 18! My new doctor and I are trying three things:

    1. Iron supplement – Ferrex
    2. Lactoferrin – binds iron at a rate 300x that of serum transferrin
    3. Vitamin D supplements – huge correlation between Vit. D deficiency and anemia in runners. Possibly indicates an absorption problem.

    Now my question for you: Do you find it’s harder for you to acclimate to running in the heat because of your anemia? Because I feel like I just can’t acclimate! I can’t tell if it’s because my ferritin and iron are super low (I’m having blood work done soon) or because they’re sort of low because I’m anemic, and humidity make it harder to transport oxygen, which is already hard for us.

    Thank you for a great post!

    1. Hi Megan,
      Wow, thank you so much for sharing all of this great insight! I’m thrilled to hear that you’re having success with the approach that you’re taking, and you’ve inspired me to also have my vitamin D checked next time I get my blood work done. Regarding the heat acclimatization, I’m not sure I have a great answer for that as I haven’t really had the opportunity to run in extreme temperatures (or I guess I should say, I just avoid them because I tend to run in the early morning rather than mid-day. However, I’ve read that people with anemia tend to be more sensitive to others to temperature, and this is definitely true of me as I HATE the cold! I’d say that assuming there are no red flags when you get your blood tested again, if you find yourself sweating a lot in hot temperatures, it would be a good reason to pay extra attention to hydration and replenishing electrolytes.

      I would absolutely love to hear about what kind of results you see after a few months of trying your ferrex/lactoferrin/vitamin D approach. Feel free to shoot me an email at any time to let me know, and I’m glad you found this post useful!

    2. Would love to know the name of the doctor in Texas. I assume he can work remotely with clients. Also, we normally supplement with Vitamin D3, but will make a note to be vigilant on this. Great info. Very curious about the lactoferrin.

  25. Great article! I just got diagnosed with a ferritin number of 2. I’m really tired a the time but still manage to swim, bike, run some days better then others. I have been taking EZEN 200 for 2 days. How long did it take you to feel better? I’m a very active mother of 2 who teaches PE, I’m tired of feeling tired. Haha

    1. Hi Tracy!
      Wow, it sounds like you’re very familiar with the exact same things I’m feeling. I haven’t actually heard of EZEN 200 before but I’ll check it out because I’m always curious about what other supplements are out there. Initially when my ferritin was rock-bottom, I actually started feeling better on Floradix – even though it did nothing to boost my ferritin. My doctor at the time figured I felt better because really, it wasn’t possible to get worse! However, it wasn’t until I got on Euro Fer that I started feeling better on a consistent basis. After about a month I felt like my energy was back, and during that period I made a good point of not pushing myself super hard because I knew that being hard on my body would probably only make it take longer to recover. As of right now (July 1st 2016), the highest my ferritin has been is 25 (end of last year) but it’s since fallen to about 17. I’m working to bring it back up again with more iron-rich foods and lowering stress because it seems logical to me that being less stressed out would only help our bodies to absorb nutrients more effectively. I’m keeping my fingers crossed for you in hopes that your supplement brings you the results you’re hoping for, and that you feel back to your normal self soon!

  26. Hello,
    I think I’m experiencing the same thing with a steady decline in performance since breaking my marathon PR in Berlin this past September. I’m waiting on the results of a blood test to confirm my suspicions, but I was wondering if you could tell me how long it took for your trainings to feel back to normal and for you to perform strongly again after taking the supplements? Did you take any time off of running or push through the fatigue? Did they help straight away?

    Thanks!

    1. Hi Samantha!

      Thanks for your comment, and I’m sorry to hear you’re seeing a decline in your performance. I wish I could tell you that seeing my iron come back up happened quickly, but unfortunately that was far from the case. It took me just under a year to find a supplement that worked well and to see the blood work that backed it up. Even so, my ferritin stayed very low from 2013-2016, and it wasn’t until very recently (Jan 2017) when my blood tests showed that it finally rose to 52. Because it was SO low when I was initially diagnosed, even just a couple of weeks on supplements made me feel a bit better, but I definitely needed to scale way back on my workouts. I stopped running during the 5ish months post-diagnosis because it physically felt completely exhausting and did other forms of less cardiovascularly-intensive exercise like strength training.

      To be honest, I probably returned to running faster than I should have because I had a race on the calendar that I didn’t want to give up on. If I could give you one piece of advice it would be to let your body have the time it needs to recover. In retrospect I wish I’d waited a little longer because I think this would have decreased the time I ended up spending with rock-bottom ferritin numbers. Stress, nutrition and rest all factor in and impact your body’s ability to absorb iron (among all the other nutrients) so taking a break from running is just a piece of the solution. I know I still haven’t got it 100% figured out, but these days I’m feeling far more confident about the approach I’m taking to bring my iron back in check.

      I hope this helps, and feel free to ask if there’s anything else I can help answer for you. 🙂

      1. Hi Angela,

        Thanks for writing back! The results came back as expected, with my ferritin at a 5 and my hemoglobin and serum iron also very low. I’ve since let myself take 2 weeks off of running with lots of cross-training and my energy levels are beginning to rise, but it’s clear I’m nowhere near normal, especially when running, even at a slower pace.

        I had long since cut red meat out of my diet, and am determined to bring my iron levels back up simply with supplements + lots of non-heme iron, but others are dubious. Did you speak to a nutritionist before re-introducing red meat into your diet? For now, I am waiting to see where my 6-week test results lie before succumbing to eating more meat.

        As for trainings, I am trying to re-introduce them slowly, but it’s very hard to be patient. I’m sure pushing too hard will only set me back, but with race objectives, it’s hard not to train.

        1. Hi Samantha,
          Sounds like you’re in a very similar situation to where I was! Good for you for taking 2 weeks off. I know it’s a lot easier said than done, so truly, I’m proud of you! Regarding the red meat issue, I didn’t speak to a nutritionist but relied instead on my educational background in nutrition. Non-heme iron sources aren’t absorbed as efficiently by the body as heme sources, and knowing that my diet was already high in non-heme iron source like spinach (which I developed an intolerance to), lentils, other beans and legumes, nuts and seeds) I was pretty sure that I needed to make a bigger change if I wanted to see results.

          The other factor at play was that I had a race 3 months away that I really really didn’t want to miss, so I was pretty much willing to do anything to feel better. I knew that with my running background I had the cardiovascular fitness to run and could always walk if I needed to, but being well enough to run in 3 months was my primary goal (even if it wasn’t fast.)

          I started out by adding red meat into my diet once per week. It was in small quantities – usually hidden in lots of stir fried veggies and chopped up into small pieces so I wouldn’t notice them as much. Surprisingly I didn’t have bad digestive issues when I reintroduced it, despite having been following a diet without red meat for over 10 years. It was more of a mental game, and what I found made me feel better was only purchasing quality cuts of meat – hormone-free, organic, and antibiotic-free. I still maintain this today and even though it costs a bit more, to me it’s worth it to know that I’m not putting unwanted drugs into my body AND keeping my iron in check. I know that there’s a lot of debate around whether we should or shouldn’t eat animals, but my stance is that what’s right for one person is different to another and in my personal experience, eating red meat along with supplementation and a number of other lifestyle factors have been what was needed to get my iron back up.

          Regarding your training, I don’t know about you but the need to sweat was what was getting me most frustrated. As I’m sure you would agree, running can make you sweat like nothing else, not to mention those endorphins! One thing you might want to consider is hot yoga. I say this for a number of reasons, but primarily because it’ll get you nice and sweaty which was the feeling I missed when I had to reduce my mileage. It’ll also help improve your mobility (something runners neglect but need to do in order to prevent injury), and reduce stress (which is also needed in order for the body to be in a state where it’s able to absorb nutrients.) Just something to consider. 🙂 Keep me posted with how you get on!

  27. I had a similar experience with lost running performance, and had multiple blood tests, such as yearly physical, with across the board low numbers and my doctor never told me. It was only when I went hunting for the exact values for Hemoglobin when i felt fatigued, etc that discovered I was anemic. I take Hema Plex, and I also like the Trader Joe’s Prenatal multivitamin as a lower dose of iron. Both have amino acid chelated iron, and I have had no side effects.

  28. Hi
    Thank you for this article! I’m a runner struggling with anemia right now. My experience is very similar to yours. I love to run…Did you take time off from running to get your levels back in normal range?
    Carla

    1. Hi Carla,
      Thanks for commenting! Yes, I did end up taking some time off of running in order to bring my ferritin back up. In the early stages, I had no choice as even running for 3 minutes at what should have felt like an easy pace felt hard. I switched over to doing more strength training – something I’d always placed secondary after running. It’s taken a long time for my ferritin to come up to what’s medically considered ‘within range’, and a number of factors have contributed to this. Stress reduction, supplementation, nutrition and mixing up my exercise regimen have all helped. I hope this helps you too, and good luck bringing your iron up. It will take patience, but if I can do it so can you!

  29. Your story is identical to mine, including the Toronto Waterfront Half Marathon PR! (Mine was 1:28:53 back in 2015.)

    I supplemented with ferrous fumerate as well and it was really effective (no digestive side effects either). Stupidly I stopped supplementing last fall when my naturopath confirmed that my hemoglobin and ferritin stores were back within normal ranges. But my race performances have taken a huge hit this winter (Vancouver Island Race Series) and I suspect I need to start supplementing again.

    Thanks for the resource and for sharing your story,
    Carolyn

    1. Thank you for sharing your story Carolyn, and wow, do we ever have a lot in common! I like to think that one day I won’t have to take iron supplements any more, but for now I’m just focusing on trying to further increase my ferritin until it’s well within the normal range and my energy levels are consistently high. Stress management has been a huge part of my change in regimen, and I don’t know why it didn’t occur to me earlier that it’s no wonder my body wasn’t absorbing the iron when I was constantly putting it under so much stress.

      I hope you’re able to boost your iron back up again, and that you’re able to log some solid races this summer too!

  30. Hi Angela, so glad that I found your post this morning! Thanks for all of the great info. I have been having trouble keeping my iron levels up, including my ferritin stores. I am having a difficult time with endurance during my runs, feeling tired a lot and moments of dizziness. I just ran my first 16km race on Victory Day, and would like to keep training for my first half marathon in the fall. My doctor recommended me to take ferrous sulfate 300mg with 60mg elemental iron twice per day. I do this for a few months to bring up my iron and iron stores and then she says I can stop taking it. Then a few months later, I start all over again….This time my white and red blood cell counts are low, as well as my hemoglobin and hematocrit. My ferritin is 14. Could you tell me what the elemental iron content in the Euro-Fer Iron capsules is, that you take? Did you only take one capsule per day? And do you always take the capsules, or quit taking them when your iron and iron stores reach a certain number?
    Thanks so much Denise

    1. Hi Denise!
      Thanks so much for your comment, and I’m thrilled you found this post too! It sounds like you’ve been experiencing similar symptoms to what I went through. For Euro-Fer, each capsule is 300mg and contains 100mg elemental iron. I take two of these each day (one in the morning, one at night) and have found that doing so is what’s helped my iron increase. There were periods of time where I was only taking 1, but back then noticed my ferritin declining again. I haven’t tried recently and may as I’ve been eating red meat about 1x/week again, but in general, I’ve sort of come to accept that it’s a supplement I might have to take long-term. Fortunately, it’s one of the cheapest iron supplements I’ve found and has been very friendly on digestion relative to others.

      I hope this helps. The other thing I’d add (and your doctor has probably told you this) is that it’s important to keep getting your iron monitored, especially if you’re upping your dose. The main thing I watch for is ferritin since that’s what I’ve struggled so much to boost, and I get my test done every 3-4 months or so to ensure that things still looks ok. With all of the health practitioners I’ve worked with, they seem to think it’s an absorption issue that I have, which is why I’ve had to supplement on an ongoing basis as opposed to just topping up to normal and stopping. Let me know if you have any other questions, and best of luck with getting this sorted out! Patience is definitely a virtue. 😉

  31. Wow I am SO glad I found this post!

    I was training for a not long (14.7km) but hard (385metre elevation gain in 6.6km) road race. I found I was really tired, needing to nap after runs, getting headaches, etc but I was struggling through. I ran a PR 5k in 21:39 two weeks before my race.

    Then, for the first ever, I had to DNF my run. I was at 28 minutes at the 5k mark& at 9.3k when I dropped out my time was 1hr15min with just no ability to even put one foot in front of the other. That was Saturday that just passed. I have tried to run twice since then& I am not able to go a minute or two at an absolutely sluggish pace before muscle fatigue and respiratory distress sets in. I am headed to the doctor this coming week to hopefully get it sorted out. So disappointed at the time frame for recovery as I have a race in less than 2wks that I was looking forward to.

    1. Yvonne, I’m so sorry to hear about this and can definitely identify with the feeling. I’m sure it’s hard to wrap your head around at this point, and know this was something I struggled with too. It’s not to say that iron deficiency is the issue – perhaps you might be overtrained? Regardless, good for you for making the decision to go see a doctor about it. You’re being proactive, and the sooner you can get an answer the sooner you can start working towards the fix. Keep in mind that the long timeframe I talked about in this post is just my experience, and while I’ve heard that it’s been similar for others, it’s not to say that yours couldn’t happen sooner. (Also not sure if you got here from my other post but I recently did a Reader Q&A specifically on where I’m at with anemia 4 years later). Good luck with your doctor’s appointment, and I’m definitely happy to answer any questions based on my own experience if you have them after that. 🙂

  32. Thank you so much for writing this post Angela. I relate to a lot of what you wrote. I am new to running, and started training 3 months ago for my first half marathon. Race day chip time was 3:10 to complete and I couldn’t understand why I was so slow when I trained. I continued to run after and it took everything out of me, my legs felt like lead. So at that point I figured something wasn’t right. I made GP apt and got some bloodwork done and I do have Anemia. My Hemoglobin is 9.5 and iron is 3. I don’t think it’s related to running because I’ve just barely started running. I was researching what supplements to take when I came across your blog. I was going to try Floradix, but I think I will try to see if I can get Euro-Fer. I was going to sign up for a 5k race this month, the Colour Run. I think I could do it as it’s not a timed run and it looked pretty fun. I don’t want to stop running!

    1. Hi Juli!
      It sounds like you know exactly how I felt! I agree – it is interesting that after only 3 months you started to notice this, so perhaps it was an issue and your training has just made it more noticeable. I found that Floradix helped at first when my ferritin was <4, but I think ANY form of iron would have made me feel a little bit better at that time because I was so low! I'd definitely recommend Euro-Fer if you can find it, and if you can't, try ordering it at the pharmacy at Costco. I've been unable to get it at drug stores here in Vancouver but Costco orders it in for me which is great. I think your mindset is right about not putting pressure on yourself to run races for time over the next little while. I'd love to hear how you get on with supplementation, and just in case you haven't found my more recent anemia update post, you can check that out here. Good luck! <3

      1. I couldn’t find Euro-Fer but bought Palafer, apparently it is the same thing with 100mg of elemental iron. I did have low ferritin levels two years ago, but once I got my levels up I quit taking it, and I didn’t think I would continue to have issues with it, so I’m disappointed that this seems to be something I will have to keep an eye on. So yes, I think running just made it more noticeable. thanks for the link to your most recent post, I’ll check that out.

  33. I’d been having extreme cramps in my calves for 2 years. Two years ago I wasn’t able to run a mile without stopping to stretch and did worse than the 80 year old woman in our annual half marathon, finishing last. Two months ago I wasn’t able to run a tenth of a mile without stopping. So I took aspirin & ended up with weirdly heavy periods. If it hadn’t been for that, I wouldn’t have bothered with the doctor. Good thing I did – ferritin of 3 nanograms per milliliter and hemoglobin of 5.6 g per deciliter. Doctor demanded I get a blood transfusion immediately, then get a colonoscopy, transvaginal ultrasound, fecal test, etc. I refused, but stopped the aspirin & took 260mg over the counter iron per day with my back yard grapefruit juice. I looked for a second opinion, making an appointment with another doctor for 2 weeks later. I didn’t die during that time, and by then my hemoglobin was up to 8 g per deciliter, so no transfusion necessary. Went to see the specialist 2 weeks after that. Hemoglobin was 11.3 g per deciliter. He said I don’t need any colonoscopies for the next 4 years or until menopause, whichever comes first. I went for a 1 mile run this morning for the first time in 4 months. This was an impossible feat only a few months ago. I might even be able to get back to my weekly 12 mile run before the Rock n Roll marathon zooms past my house in January.

  34. Great post!
    I have been diagnosed as slightly anemic and have been experiencing extreme fatigue (falling asleep at work…!)
    I’ve got a half ironman at the end of the month and am worried, as I’m recovering from the flu which I caught from work where people are sick about twice a month.
    I’ve put a lot of time and money into training so I really would like to do the race.
    Where is Euro-Fer available? I live in the Vancouver area.
    At the moment I’m taking Trophic brand pills which contain 205mg of Ferrous Bisglycinate, with 40mg of elemental iron, twice a day. I also had switched fromsoy protein to whey protein a few months back, which I think was a big factor in leading to my current situation.

    Thanks in advance.

    1. Hi Maki!
      Thanks so much for your comment. Right now, the only place I’ve managed to find Euro-Fer here in Vancouver is Costco. They don’t carry it normally, but they order it in for me and it usually takes about 4-5 days. What you could do is call their pharmacy and request it, and that way you’d only have to physically go there once! EuroFer is the generic brand, and from what I understand, Palafer is the name brand. I’ve never tried Palafer so can’t speak for it, but EuroFer has worked wonders for me and it’s very cost-effective. I’ve also had no GI issues with it. Let me know how you get on, and best of luck with your training/taper… I hope you’re able to get yourself feeling healthy again before your race!

  35. Wonderful comments, I just found your blog. I have struggled with low iron since my youngest son was born 23 years ago. I am not a runner but I walk a lot (to keep things moving) because I take the iron pills. Recently my levels were extremely low (6), they gave me a transfusion and I felt FABULOUS for about a year. Now they are low again (I am still taking iron). They have done all the testing and find no reasons. My doctor suggested coming in every 3 months for a mini transfusion – I said no, what other options do I have. She told me to try 2 iron tablets yikes! not sure I can walk that much. I will be ordering this brand Euro-Fer and trying that. Hoping this will help. Thank you and everyone for the comments.

    1. Hi Gayle!
      I’m so glad you found this post, and thank you so much for your comment. It sounds like your doctor’s recommendation to take 2 tablets is similar to what mine told me, and if I had to do that with other supplements I’m not sure my digestion would be able to handle it either! I’d love to hear how you get on if give Euro Fer a try. I’m sure you’ve read the other comments already, but if you can’t find it, the brand name version is Palafer. I’ve not tried that yet so I can’t claim that they work exactly the same, but I think either would be worth a shot. Good luck! 🙂

  36. Wow I’m really glad I found this post, thank you Angela! The past few months I have suffered with exhaustion, headaches, terrible anxiety and depression. I’m a female runner and I just get the results from my blood test back– I have a ferritin level of 2. I had a feeling I had low iron but I had no idea it was this extreme. I’m planning on making some changes to my diet, but I have to keep running, it’s one of the only things that keeps me sane. It feels reassuring to know that many other female runners have gone through this problem, so thank you so much for sharing.

    1. I’m so glad you found it too, Ava. It sounds like you’re taking the right first steps to getting your situation improved, and I hope you’re able to find a supplement or alternative approach that brings your ferritin back up. One of the biggest things I learned is that it takes a lot of patience and willingness to listen to what your body is asking for, so stick it out and stay positive!

  37. Thanks for this post and yes, I’ve also struggled to get any help from doctors. I have an added element I’d love your advice on. I’m consistently plugged up (have been for years) so taking the tablets seems like the worst thing. I’ve had an infusion but I can’t seem to keep the iron up and run and am just repeating this cycle. I’m a vegetarian who is now eating red meat but experiencing no relief. I ran an ultra in May and since then, running even a couple miles makes my legs feel like lead. I want to jump back into it and train again but am feeling a bit out of luck!

    1. Hi Emily,
      Thanks so much for your comment. It sounds like you’ve had quite the experience over the last little while but hopefully some of my suggestions might give you some new ideas. I’ve never done the infusion method, but perhaps it’s possible that your body isn’t absorbing that form of iron? I’m not sure if you’ve read my more recent anemia update post, but I had to try a few different formats before I found one that didn’t cause me any digestive issues, actually made me feel better, AND made a difference in my blood work. The one I’m taking now happens to be the cheapest cost-wise (Euro-Fer is the brand) and I have no digestive side effects.

      Other considerations might be diet – are you getting enough fibre to move food through your digestive system, staying hydrated and eating prebiotic and probiotic rich foods to keep your gut healthy? That could be an area that’s being overlooked, and trying to run and train for races can certainly add further stress on the gut. This could not only be causing digestion issues as you describe, but also making it tough to absorb iron. I’m not a doctor, but do these things sound like they could be contributing?

      1. Also: Vitamin C Vitamin C Vitamin C. You need it to absorb iron. Lucky for me I have enough oranges in my yard six months a year to eat 5+ a day, juice some more, & still have some to give to my mom. No more extreme leg cramps nor dying of suffocation!

  38. I’m a runner as well, who has always struggled with anemia, even while taking iron supplements. In fact, it finally lead me to being diagnosed with celiac. I would suggest that if you have constant struggles with anemia that it would be a good idea to have your doctor test you for celiac, which could be the cause of iron absorption issues.

  39. Wow!! A ferritin level 4 is very low. I have been anemic for years. Mine was that low and the doctor began talking about a blood transfusion, you didn’t get a phone call…I didn’t want a blood transfusion so I went to a hematologist. Now I get iron intravenously. I have taken some of the stuff you mentioned between my infusion. It helps me wait a little longer. I have an absorption problem. Your diet must be awesome to go from a 4 to a 12. I’ve ran off and on for years. This past year I have really stuck with it. I’ve been thinking is my iron low again already? Low iron creeps up on you most of the time so you don’t always notice til it’s rock bottom. When I have an iron infusion I feel like I go from sick to Wonder Woman. It’s amazing for a month. I not sure if years of it is healthy. It’s so important to do our own research. Doctors are good but we have to take responsibility of our own health. So many people take the tiny red iron pill and have no improvement and keep going back to the doctor. I did that for years. I had to find out the cause of my low iron myself as well. ??‍♀️?

  40. I know this is an older post but I just wanted to quickly thank you for writing it. It was so incredibly helpful to read your experiences with running and anemia. When I found out that I was anemic, I didn’t connect it to my poor running performance as of late and assumed that I was just a slow runner/bad at running. It was so nice to hear about your experiences. Hopefully my running will improve as my iron levels do.

  41. This post is extremely helpful. I have stopped running, walking and even “living” due to low iron levels. I seriously dont have the energy to do anything anymore. Im desperate enough that this week I started eating 3oz. of chicken liver daily. I too have eaten lots and lots of spinach daily and wonder how this could have happened. Perhaps, like you, its not being absorbed. I started eating dairy again as well. For me, I feel the Vegan lifestyle was my downfall. I just cant be healthy giving up both dairy and meat. So, I choose dairy. Im eating both until I get my levels up but I wanted to thank you for your post and its inspiration to see a Dr and monitor the levels consistently.

    1. Aw Goldi you are so, so welcome, and I’m thrilled that this has been helpful to you. You should be really proud of yourself for listening to your body and being willing to try different approaches. I know it’s not always easy to wrap your head around incorporating these foods back into your diet (it certainly wasn’t for me – definitely took me a while!) but when I started noticing how much better I felt, I was sold. I think there’s certainly a right time for everything in our lives, and being 100% plant based could work really well for someone at one point of their life, but not quite as well later on. Wishing you the best of luck with figuring out your best approach, and keep trying. It was a big game of patience for me and felt like it took FOREVER to start seeing changes, but they’ll come if you’re willing to try. You’ve got this! 🙂

  42. Hi Angela,
    I sure hope you can help me. I have low rbc (4.0) but very high ferritin (575) I have been to every kind of doctor and they say I am not anemic. The high ferritin is an indication of chronic inflammation but no one has run any tests to find out what is causing the inflammation. I have run 15 marathons including 3 Bostons but I am so exhausted I can only run 2-3 miles very slowly. Let me know if you have any suggestions. Linda

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