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Anemia and Running: A Quick Guide to Maintaining the Optimal Iron Level

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Have you recently been struggling to complete your workouts? You might recently have noticed that you tend to feel more tired than usual. Do you know why is it happening? Have you considered getting your iron levels examined? When talking about anemia and running, you need to understand that iron is essential for the body and as runners you need to maintain an optimal level of it so as to perform better.  Deficiency of iron can impair your sports performance greatly. In fact, it has been noticed that over 50% of females have depleted level of iron stores. This means that dietary intervention might be necessary so as to prevent anemia. So can you run with low iron? Let’s find out more about it.

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Why is Iron Essential for Runners?  

Iron has a lot of functions to perform in the human body. It is involved in the functioning of the energy production and immune system. The other most important role that it plays is supplying oxygen to the muscles. 
One of the essential components of hemoglobin is iron and it is responsible for transporting oxygen and carbon dioxide in the body. It is also present in the form of myoglobin (the protein responsible for extracting oxygen from the hemoglobin molecules) in the muscles. 

When it comes to anemia and running, for your body to function properly, an optimal level of iron must be present. This happens because a lesser number of red blood cells would be generated and thereby the level of hemoglobin would reduce. 

During running, the muscles require more oxygen but due to the deficiency of iron, you wouldn’t be able to run for a long time and this is going to impact your running performance. Most runners often wonder is it ok to run with anemia? Well, you can obviously run but you would most likely begin to feel fatigued pretty quickly. 

why iron is essential for runners
Iron an important supplement for runners

Symptoms of Iron Deficiency in Runners

Determining the iron deficiency symptoms can be a challenging task especially if you are a runner. The most common symptom would be fatigue and shortness of breath. But, then these are the same things that you experience after a run. However, if you feel that you tend to experience signs of iron deficiency even after a short run, it might be wise to schedule an appointment for a blood test. 

It is a very simple test and even if you do not have an iron deficiency, you would be able to get an idea of your iron levels. This can help you to keep a check on your diet. However, if your hematocrit and hemoglobin are low, you are anemic. 

When facing iron deficiency, your iron and ferritin (a measure of your iron stores) would be low while your total iron binding capacity would be high. You must consider the normal ferritin levels for runners. What you must remember is the fact that a ferritin level less than 40 ng/ml in men and 30 ng/ml in women can impact your running and lower your performance. 

fatigue due to low iron levels
Signs of low iron levels

Causes of Anemia  

Diet and Absorption 

When it comes to anemia and running, an insufficient or poor intake of iron can be one of the primary reasons here. It is recommended that or the recommended daily allowance (RDA) of iron for women aged 11 to 50 is 15 mg/day.

When a woman is pregnant, the iron intake needs to be increased to up to 30 mg per day while during lactation; it must be 15 mg per day. During menopause, the recommended amount of iron is 10 mg per day. 

However, the main issue here is that iron isn’t particularly easy to absorb and only 15% of the ingested iron gets absorbed by the body. Absorption of iron is also dependent on the form of iron that is ingested, the status of iron in an individual and the meal composition. Iron can easily be found in several types of food, both plant, and animal origin.

The vegetarian runner would of course never consume animal origin food but it is a known fact that the iron absorbed by the body when consuming meat is better as compared to the iron found in plant products. However, the vegetarian runners can definitely enhance iron absorption by consuming Vitamin C rich foods. Avoid coffee, tea, soft drinks and foods that have food preservatives in them as these can reduce the iron absorption.  

Menstruation in Females 

In females, the blood lost during menstruation each month is one of the major causes of iron deficiency. In fact, women can lose as much as 30 to 50 percent of iron during menstruation. It is because of this that the females also lose the iron-rich hemoglobin every month. Each time women menstruate, they lose approximately 10 to 35 milliliters of their blood. 

This means that the women runners who menstruate on a regular basis can lose approximately 10 to 45 mg iron during their period which is surprisingly equal to the optimal iron absorption of three days. Therefore, if this loss isn’t supplemented with enough iron-rich food and vitamins, your iron level might deplete. 

menstruation in women runners
Low iron levels during menstruation 

Destruction of Red Blood Cells 

At times when the red blood cells are really fragile and do not have the capability to withstand the circulatory system’s routine stress, they would end up rupturing prematurely. This can lead to hemolytic anemia and might either be present in an individual since birth or may develop later. When it comes to anemia and running, at times there might not be any known cause.

Known causes might be thalassemia, sickle cell anemia, toxins released due to kidney or liver disease, stressors like drugs, infection, and spider or snake venom. Other than those, a few other causes can be prosthetic heart valves, severe burns, vascular grafts, severe hypertension, tumors, clotting disorders etc. 


It has been noted that the hemoglobin concentration and Red blood cell count is lower in athletes than the individuals who aren’t involved in any kind of exercises. You can ask this question- Should I exercise with anemia? Well, if you are anemic, it is ideal to consult your doctor before indulging in exercises. As you might be prone to various diseases and also injuries.

Why are runners more prone to low iron? 

Low iron is caused due to excessive physical activity and therefore a runner’s body demands more iron. Sports anemia is the term that is used to define the depletion of iron and the resultant reduction in anemia and hemoglobin levels. And that’s why if you are wondering- should I run with low iron, then we suggest you not to, as low iron levels can reduce the red blood cells and deplete the haemoglobin levels.

Sports anemia symptoms can usually be seen in athletes who significantly increase the intensity of their training. The additional need for iron in athletes especially runners might be due to a condition is known as hemolysis (discussed below). The other cause might be excessive sweating where approximately 0.3 to 0.4 mg of iron is lost per litre of sweat during working out. The iron lost due to sweat might almost be negligible but it can eventually add up over a prolonged period of time.

tired runner
Fatigue after intense workout

How do the Runners Lose Iron?

Talking about anemia and running, the runners usually need to consume more iron-rich foods than the non-runners. This is because they lose more iron and that can happen through the following: 

  • Through sweat: Iron can be lost through sweat if you workout in conditions that are hot and humid. The amount of iron lost through the means of sweat isn’t surprising but it would definitely take your loss percentage higher. 
  • Through your feet: For the runners involved in high mileage runs, a process known as hemolysis occurs where the red blood cells get damaged. This happens each time they hit their foot on the ground and this thereby leads to the reduction of the haemoglobin levels in the body. 
  • Menstruation in female runners: Female runners do find it extremely difficult to maintain their iron levels as they end up losing a lot of iron each month when they menstruate. 
  • Through the intestines: For a few athletes, loss of iron through the stomach or the large intestine can also be an issue. The amount of iron lost here is rather less but then again, it is a contributing factor in taking your loss percentage higher. 

Best Iron Supplements for Runners 

Maintain an optimal level of iron in your body requires you to consume Iron rich foods. This is especially true if you are a runner. In case you have a low level of iron in your body, it is essential that you consciously monitor the intake of iron.

So, how can you get the required level of iron from animal and plant sources? Include the below-mentioned foods in your diet and you would be good to go. 

  • Animal sources: Eat pork, beef or lamb at least three to four times in a week. Seafood must also be consumed. 
  • Plant sources: lentils, soybeans, tempeh, lima beans, tofu, cashews, dark green leafy vegetables, brown rice, swiss chard, collard greens, prune juice, blackstrap molasses etc. 
  • Also, include cereals and bread in your diet. If you are a non-vegetarian, you can combine both plant and animal sources that are rich in iron. Remember to avoid tea and coffee if you re anemic as they can interfere with the absorption of iron. Some of the famous athletes with anemia like to enhance the iron absorption of the body by including foods rich in Vitamin C in their diet along with the iron-rich foods. 
  • Vitamin C can easily be found in citrus juices like lemon or orange juice. It can also be found in Kiwi, Broccoli, Grapefruit, Melons, Strawberries, Tangerines, Tomatoes and peppers. By including all of these in your diet, your body would be able to dietary iron in a better way. 
best iron foods
Iron rich foods

Frequently Asked Questions

Q: What is the amount of iron required by a runner? 
A: As recommended by the Institute of Medicine, the dietary reference intakes (DRI) should be as follows:

  • Male or females of age 9-13: 8mg/day 
  • Females age between14-18: 15mg/day
  • Male age between 14-18: 11mg/day
  • Males between the age 18-50: 8mg/day
  • Females between the age 18-50: 18mg/day
  • Vegetarians (all ages): 1.8 x DRI

Q: Is running going to make me more likely to be anaemic?
A: Exercise in no way is related to making a person more susceptible to anemia. However, the low iron symptoms like excessive fatigue might become more evident earlier in an athlete. Anemia indicates a reduced level of RBC’s in the body of an individual. There can be several causes of it (the most common ones have been discussed above). 

Q: How does ferritin differ from iron, and is it important for runners?
A: In the spleen, bone marrow and liver, the iron is stored in the form of ferritin. The ferritin level in the human body has a great impact on the iron absorption. When the iron stores in the body are low, the absorption is enhanced.

Having low levels of ferritin does not mean that you are anemic. It hasn’t been proved yet that low levels ferritin can have an impact on the running performance. A few studies proved that a low level of ferritin doesn’t have any effect on the VO2 max while according to some other studies proved that the athletes (who had low levels of ferritin) demonstrated an enhanced performance after they supplemented their iron intake. 

All the athletes who exhibited an improved performance had their hemoglobin levels right at the normal range’s lowest end. This means that in addition to an enhanced performance, they experience an increase in the hemoglobin level. What this means is by supplementing your iron intake, you would be able to notice impressive changes. 

Q: Is anemia common among runners?
A: The deficiency of iron is more common in women than in men. In women, the deficiency of iron can mostly be found during the childbearing age and when they have menstruation. This mostly happens because of the inadequate intake of iron. Vegetarians, in fact, are at an increased risk of having anemia. They, therefore, need to pay a close attention to their daily intake of food.  

It isn't in any way true that the athletes especially runners commonly have anemia. However, they might have mild anemia which may go unnoticed but can in a way have an impact on the athletic performance. 

Q: How much iron do I need as a runner? 
A: The daily recommended intake of iron is dependent on a lot of factors like age, gender etc. As a runner, your body does require a bit more iron than the others as you end up losing the iron through a lot of factors. For vegetarian athletes, maintaining their levels of iron can prove to be challenging because very less amount of iron gets absorbed from plant sources. 

Talking about anemia and running, the human body only absorbs about 10% of the non-heme iron from grains and vegetables. With an iron-rich diet, taking Vitamin C also helps greatly in absorbing the non-heme iron. Get your iron levels checked from time to time so as to keep a check on it and take appropriate steps in case of deficiency. 

Summing Up 

Monitoring the iron status on a frequent basis along with nutritional and biochemical analyses is essential especially if are an athlete. Vegetarians also need to keep a close check on their diet so as to prevent iron-deficiency anemia. By consuming an iron-rich diet and getting your iron-levels checked from time to time, you would be able to enhance your performance. 

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