Pumping iron

Unfortunately the title of this post doesn’t refer to my massive guns (hah), but rather to a familiar nuisance called…anemia. I’ve dealt with this in the past and am pretty attuned to the symptoms by now. A few weeks ago I noticed that I was feeling more fatigued than usual and wasn’t recovering from workouts as quickly as expected. I was also sleeping a ton (think: 9-10 hours a night) and experiencing what I call “race-y heart”. I like to think that I’m in decent shape, so when my heart starts beating fast after climbing a flight of subway steps…I know something is amiss. I recently had a complete blood count (CBC) at my doctor’s office and the results were as I expected – iron serum and ferritin levels were both low. Note: I am by no means an expert on diagnosing or managing anemia, I only have my own experiences to draw on, but since it’s fairly common I thought I’d share what works for me (and what doesn’t). Kelly (an R.D. in training!) just wrote a great post about iron rich foods – you should check it out. If you follow her advice, you may be able to avoid iron supplements in the first place!

Iron serum levels are the amount of iron circulating in your blood, while ferritin levels measure the amount of stored iron that you have in your system. Serum levels can be relatively normal even when ferritin levels are low, so I think it’s important to get both checked.
Normal serum iron levels are approximately 50-150 mcg/dL for young females (mine is 34, oops). And normal ferritin levels are approximately 12-160 ng/mL (my results were a 10). I talked in length with the doc about my results and why they are what they are. My regular menstrual cycle (three cheers for that!) combined with the 40-70 miles/week that I’ve been running this year likely took a toll on my iron levels. I’m currently supplementing with over the counter iron pills, but I have a Rx for liquid ferrous sulfate (more easily absorbed by the body) that I need to fill ASAP. Dosage really depends on how anemic you are/height/weight, etc. so talk to your doc for specifics.
A few things I’ve learned from experience –
  • *Iron supplements can upset your stomach. I never ever take them before a run – personally, I think before bed is best.
  • *You may have stomach issues (ranging from nausea to diarrhea to constipation) – fun times! Sometimes taking the pill with a some crackers or bread helps.
  • *Milk, caffeine, antacids, and calcium supplements can decrease iron absorption and should not be taken at the same time as iron supplements. However, vitamin C increases absorption – I used to mix my liquid ferrous sulfate with orange juice, lots of ice, and a bendy straw. It made it almost palatable. Almost.

Obviously supplements are not ideal for the long term, but for now I’m going to have to deal with it. I’ve been supplementing for about a week and feeling a teensy bit better.

I headed back to the indoor track last night and had a surprisingly good workout. The deets:
  • 2 mile warm-up (stomach wasn’t feelin’ so great on this one…oh heyyyy iron pills)
  • 1000m @ 3k race pace – I ran this in 3:48 (~6:07 mile pace)
  • 200m slow jog recovery
  • 3 x 400m @ mile race pace – 82, 80, 79 (~5:20 mile pace)
  • 200m slow jog recovery after each repeat
  • 1020m @ 3k race pace – 3:51 (~6:04 mile pace) *I started in the wrong spot, so this repeat was about 20m too long.
  • 2.25 mile cool-down (SO WINDY AND COLD, GAH)
  • Total: 6.75 miles

This was a tough workout, but I’m pretty pleased. I felt strong the whole time and it was nice to see a sub-80 400m. I haven’t run that fast since college! After months of marathon training (slow long runs, tempos) it’s been kind of a shock to the system to run this fast. However, I think ultimately it will do the body good.  I have a bunch of races coming up (Coogan’s 5k on March 6, NYC 1/2 on March 20, Cherry Blossom 10 miler on April 3, and the Brooklyn 1/2 on May 21) and I have my sights set on some PR’s. Here’s hoping I get this iron level situation sorted out ASAP! In addition to the supplements, I’m going to try and get lots of sleep (I’m currently averaging 7-9 hours/night) and add in some red meat (like burgers!!).

I haven’t cooked anything particularly interesting lately, but I did get my hands on some yummy treats called Picky Bars. This company was started by 3 elite runners (including 2 time USA 5k Champion, 5 time NCAA Champion Lauren Fleshman!) and they are gluten and dairy free. I ordered some bars awhile back and finally dug into them yesterday pre-track workout. At first they seemed a little small, but they’re quite dense (~200 calories, 28 g carbs, 6g fat, 7g protein), so they’re filling. The consistency is sort of like a lara bar, but firmer (I like this!) and the taste reminded me of a cinnamon-y oatmeal cookie. It was yummy! Right now the only way to get these babies is by ordering them online, but I think they’re worth it. Each bar came wrapped in a little baggie with nutritional info attached – it looked like they had been made and packaged with a lot of care. (And p.s. I bought these with my own cash $$ – nobody is paying me to say this!)

Anyone else dealing with iron level issues? What worked for you/what didn’t?
  • Thanks for posting this!
    I had a blood test 2 years ago just as a pre-surgery thing and they noticed I was anemic. It wasn’t surprising based on my age, gender, and running, but I think I fixed it back then just by makign sure to eat iron-rich foods. I now take a multivitamin (I remember to most days, at least!) which would, in addition to the food I eat, definitely do the trick.
    I’m wondering if you know, though, there’s no way sans-blood test to have your iron levels checked, right?

  • I have an iron deficiency because I have Crohn’s Disease. I have anemia and all that good stuff. My doctor has given me iron supplements to take, but in all honesty I’m lazy and I don’t take them. I know that’s terrible, but I won’t lie and say I pop those pills daily! I do, however, eat lots of steak. Soooo steak = iron. Win win.

  • Thank you for writing this – this is so helpful for me. My doctor says I have “mild” anemia (I can’t remember the exact levels but have it written down) and her suggestion was to take a supplement. I haven’t really been doing it, and this is reminding me that I really need to. When I climb stairs sometimes I am so out of breath (and I’m pretty sure I’m not out of shape!) and I have been a lot more tired than usual. I’m good at bothering other people about their health issues, but I’m not so good about my own, so thank you for the reminder that I need to start paying more attention to it!

  • Get lot sof rest and I hope things get better soon!

  • Megan,

    Thanks so much for the unsolicited positive review of Picky Bars, we’re really glad you liked them.

    Lauren has written a couple of times on iron deficiency for runners if you’re interested. It’s a common problem that she’s faced as well. Here’s a link to boosting iron as a vegetarian and another on anemia and running.

    Good luck on boosting your iron levels and upcoming races! I’m also a big fan of boosting iron levels by increasing burger consumption.

    Jesse Thomas (another one of the Co-Founder runners from Picky Bars, and also Lauren’s husband).

  • This was a really good post! I was always told by my grandmother to eat Farina as a well to increase iron levels.

  • Oh the iron woes! I had a ferritin level of 8 when I got checked, and my coach decided it was best to take 6 weeks entirely off any sort of exercise (so much free time!!) and take liquid ferrous sulfate twice daily. After 6 weeks, my levels were back in the 40s…not great, but better!

    I didn’t know you needed a prescription for ferrous sulfate! I’ve always just gone and picked it up over the counter from Duane Reade…sometimes they just need a few days notice to order it.

  • oh man – sorry about your iron woes! I think some people are just more prone to it. Glad you’re doing what you gotta do and feeling a little better though.

    Fortunately, I’ve never had iron problems. Just everything else under the sun! See you soooooooooon 🙂

  • I didn’t have iron deficiencies but I did take iron supplements in preparation for my Pikes Peak race last year. It’s supposed to help your red blood cell count. I didn’t get altitude sickness and I finished the race so success! 🙂 Hope you’re on the mend and getting back in the routine.

  • J

    I had a full line of blood tests 3 years ago when I was really tired around 7:30pm each night and felt like I could go to bed. I was deficient in vitamin D and B but not in iron I guess. I haven’t been tired like that since that time so I don’t even know if I am deficient at all. I was just thinking about what foods I eat that do have iron in them and I know I eat meat but besides that I don’t know if I eat a lot each day!

  • I love this post! I was just at my doctor’s for my yearly check-up and I have to do some blood work because he thinks my iron is low so this info could be really helpful for me!

  • Stephanie

    Thanks for posting this! I too am anemic and get the racy heart thing and some days find it hard to get off the couch. I drink coffee all the time and barely feel energized afterwards and now I know why. Keep up the fight and know that ultimately, you are doing the best thing for your body by running and being in tune with yourself.

  • I’ve been low on ferritin levels before. I only find out when I try and donate blood. My levels have been normal recently and I’m not turned away from donating blood.

  • Haile Gebrselassie recommends eating Teff (the grain used to make Injera, the soft Ethiopian bread) as a rich source of iron 🙂

    Also dark red kidney beans made with a rich tomato sauce is a pretty good source.

  • i actually have a doctors appt next week to get this checked out. pretty much the same symptoms as you so hopefully i get some answers. fingers crossed! thanks for this post 🙂

  • I’ve had issues with it, but I’ve found with my current diet that I’m able to stay on top of it without taking any additional supplements (always a good thing).

  • Pretty nasty times on that workout despite your iron troubles! I have not dealt with anemia myself (hemochromatosis gene carrier over here) but from what I know about it it seems tricky to deal with. I hope you figure out methods that work for you.

  • Once again, you and your awesome doctors. I don’t think I’ve ever had my iron levels tested?

    I suspect I could have an issue with it, because I stopped eating meat a year ago (I eat fish), and I understand that meat is a great source of iron. I have bouts of fatigue for sure. But that might just be because I often have insomnia

    When you have a chance, I would love for you to talk about food sources of iron besides pill supplements and meat.

  • Kate Freed

    It is so strange that you posted this because I just went to my doctor yesterday because I have been having tingling/numbness in my hands and feet very frequently and she is having me have my iron levels and B-12 levels checked out as the first step, she she knows I’m a distance runner and rarely eat red meat. I’ll let you know how it turns out! This post was very informative. Thanks!

  • I eat lots of lentils. My mother-in-law makes a mean lentil soup and she actually showed me how to make it. Really good. I usually make a huge pot for the week and have some everyday. Here’s the recipe in case you’re interested, though I am sure you already have a good lentil recipe:


    I’m needing more iron now since I’m expecting a baby this June. I find that I’m very tired mid-way through the day… like I need a nap.

  • AR

    I eat raw cow. That’s how I roll.

    I really need to get by iron tested again as I’m pretty sure its low. And my back still hurts. We’re twins. Imma do a shot in your honor.

  • Kate Freed

    PS: You should post some high-iron, healthy recipes!

  • elle a

    Yes! It’s hard. My ferritin doubled (it’s still fairly low) in 6 weeks after being very careful about when I took my iron supplements–one an hour after after a simple breakfast (ex. oatmeal + strawberries) and 2 hrs. before drinking coffee, one in the mid-afternoon timed around a snack, and one right before bed.

    Please do post iron rich recipes!

  • I recently suspected I had low iron and tried a supplement and felt a ton better. I bought a fancy iron supplement from WF and that be part of the magic 🙂

  • Laura

    Sardines! Tasty, sustainable, protein-packed, and a good source of several nutrients that can sometimes be tricky to find elsewhere in your diet: vitamin D, calcium, selenium, and iron. For an easy lunch, I like to mash 1/2 a can of sardines with 1/4 of an avocado, sprinkle in some pepper and tumeric, and spread it on a wrap with a sliced tomato, sliced onions, and some broccoli sprouts. (One caveat if you work in a small office, as I once did: pack the sardines in a disposable container and dispose of it in the outside dumpster. Co-workers may not appreciate a fishy breakroom!) For Sunday brunch instead of my usual steel cut oats with fruit, I’ll sometimes serve a poached egg and sardines on a bed of greens, with half a blood orange on the side.

    A word to the wise about iron supplementation: Iron is stored in the body, and so too much iron is just as bad (or worse) than too little. If you haven’t had a blood test don’t assume that you need a supplement simply because you feel fatigued. My little brother found this out the hard way while I was off at college: he ran out of his multivitamins so he started taking my Women’s One-a-Day, and developed 3 big welts on the back of his thighs. The doctor did a blood test, and it showed that his iron levels were way too high.

  • @Laura – good suggestion re: sardines! i was just discussing them with a friend the other day 🙂 they’re a great source of omega-3’s, too!

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  • I was anemic in college, but haven’t had bloodwork done since then. I’ve tried, but my veins are so small, that if the Dr. is able to get the needle in, nothing comes out! I really need to get that checked out b/c I have a suspicion that I’m anemic again, and with marathon training coming up, that is not good! Hope the supplements help you!

  • So I’m a little behind but I’ve struggled with this for years and years. While my iron levels aren’t technically anemic, I’ve had bouts of really REALLY low energy throughout the day and have been taking an iron supplement (slow-release vegetarian capsules) along with Ester C (for absorption). I can really tell when I miss a day! Hope you find what works for you.

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  • JST Books

    how much iron supplement should be take?

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