If you’re reading this and wiping steak blood juice from your lips because you’re a runner and know how important it is to get that iron into your blood, then this post is JUST perfect for you! 
Actually, my latest article up on Competitor.com is ‘Iron Level Upkeep for Runners’.
Eating steak pizza isn’t going to be enough iron, in addition to diet you should be supplementing.
I wanted to share a little more about anemia and iron levels for runners because it’s something that I’ve had to deal with myself and know just how sh*tty it feels to be running when your iron levels are sub-par. And since I’m not a certified smarty-pants and rather get my knowledge from good old fashioned experience and being able to leech all the information I can from the certified smarty-pants I’ve been lucky enough to work with and train under, here is where I can be a little more free with the advice if you know what I mean.
Let me cut to the chase and bottom line this for you off the bat: If you’re a runner you need to be taking iron supplementation in ADDITION to anything you eat. To be frank, every single world-class, competitive, and ‘runner’ runner that I know, be them man or woman, take iron pills, liquid iron, or get iron injections.
If you’re training as much as runners do, there is just no ‘realistic’ way to get the amount of iron necessary through diet alone. Some people have this thing where they don’t like pills or ‘fake’ things, I respect your beliefs, but at the same time you’re only doing yourself a disservice.
In the article I stress how if you don’t have a doctor experienced in working with competitive runners, they could be telling you that your iron levels are in the ‘normal’ range when, in fact, they are anemic compared to runner standards. The ‘average joe’ levels are not going to cut it, and if you get your blood tested and your ferritin is hovering around 20 ng/ml there is then a reason why you’re feeling like crap on your runs.
When I got my levels tested way back when, I was at a 9 and at that point was rejoiced to finally be able to have an answer as to why my running was feeling so dang hard. Weird right, that I was happy to be anemic, but the good news about low iron is that it’s one of the ‘easier’ things to fix once diagnosed.
Again, the article explains a lot about that, but what I’d like to share here is a little about my iron infusions and then some tips that since I’m not a doctor can’t just toss into other articles I write:
Iron Infusions:
*Process: Sounds scary, and to a needle-phobe it wasn’t a trip to the Pop-Tarts store, but honestly, they weren’t that bad. I went in for three sessions on three successive days, each visit lasted for 3-4 hours hooked up to the IV bag and outside of the prick it didn’t hurt. It felt a little cool where the iron was going in, but that’s all.
*Nausea: What I WILL warn you about is that iron can make you feel a little nauseous and with a headache if you take a lot at once. A few hours after my first IV treatment I felt pretty sick; I went to bed and was fine the next day. The other two days of treatment I felt fine afterwards though. Everyone is different, some people may not even feel bad the first day, but I think because my levels were quite low to begin with and I hadn’t been taking any iron pills, it was a bit of a shock to my system.
*Blood Levels: I went from single digits and up into the 20′s pretty much within days. It was awesome, and as I took pills after that, my levels kept rising rather quickly.
Iron Pills:
*Commonality: The vast majority of runners I know go the pill route, they are super easy. All you really need to be aware of is you need to take them with food (or you’ll probably feel sick) and take them with Vitamin C to help aid absorbtion. Try to not take them with calcium because that will block absorption a bit.
*Doses: I’d suggest aiming for around 60-70 mg per dose if you’re maintaining and just running a moderate amount. If you’re in high training and competing I’d say you should at least double that; when I was doing hard training I’d safely be having four 65 mg pills a day spread into two doses. People worry about iron overdosing, but unless you’re a kid or weigh 70 pounds you’re not going to die, probably just feel sick. That said it is IMPORTANT to note that I didn’t just go pound four pills off the bat, you need to gradually increase your iron intake, start with one pill a day for a week, add a second pill the next week but spread it out at least 6 hours and go from there. And you could stick to that amount, get your blood tested regularly and adjust your iron intake accordingly.
Running with anemia feels like you’re trying to run through tornado, those splits are off but they feel four times the effort.
Iron Blood Levels:
*Runner Norm: Because of iron toxicity phobia people tend to be a little shy of sharing just how high they’d like their levels to be. I’d say that runners should aim to be at least around 70 ng/ml, and to be totally honest I’d say even try to stick around 100 if you can. Some people just can’t get that high, but going with the better safe than sorry logic, shoot for that.
If you have any other questions, feel free to leave them as a comment and I could do another post if there is enough interest. Low iron, known as anemia, is quite common in both men and women and it is incredibly crushing and frustrating to deal with as runners. Or, more correctly, it is brutal to deal with before you find out that is what you’re dealing with. From there, getting supplementation and into an iron maintenance routine is an easy way to get your running back on track!
1) Have you ever dealt with anemia? What was your experience like?
2) Do you take any kind of iron supplementation?
3) What ways do you then try to still get iron into your diet?
Hello! My name is Cait, I'm a freelance writer and artist who is more than a little obsessed with running. The Arty Runnerchick is dedicated to connecting with other runners and those sweat obsessed through words and art! 
I’ve been all into the Iron and Vitamin B stuff lately. Iron supplements are new to me. I’m wondering if needs are different from men and woman. Interesting post. How’d you get so darn smart? And btw, thanks for your comment my way. I’m taking down the post just cause of stuff, but thanks.
YES!! you need to get on that iron, mister, and it’s just as important for you guys. I know a lot of men get sort of ‘overlooked’ because iron is hyped on so much for women, but all the top guys are taking their ferritin too. and i’m glad u know my sentiments are there for you, but i totally understand wanting to take down the post. so sad.
Cait, I can’t thank you enough for this post. I haven’t reached anemic levels but was picked up as low in iron in the middle of last year, and it was a relief to have an explanation for my persistent tiredness. At the same time, I felt terrible because one of the things I was aware of when I stopped eating meat was the need to get enough iron elsewhere – I definitely felt like a failed vegetarian!! Realising that dietary sources may not be enough even if I did eat meat is a big ‘aha’ moment (and makes me feel stacks better!) and this is a great overview of the options
I still try to get as much dietary iron as possible but now take an iron supplement most days (sometimes I forget
) and feel better for it.
oh, i’m so sorry you’ve had to struggle with waning iron levels, and wat u share is not uncommon to vegetarians and vegans, it’s an important element that can get overlooked. so i’m so glad u’re supplementing now!
I give this post an A+!
Thanks for making aware this issue that I think a lot of people have but may not recognize!
awww, thanks!
Thanks for posting Cait! I sometimes feel like I might be low, but I’m never really sure. I don’t get tested and I don’t take supplements. What, for you, is moderate training?
Are you talking to recreational runners, or people who are training more than once a day? Is it runner exclusive, or is it necessary for cycling as well? I would love to know some of the variables here!
hey girl, you NEED to be on iron. i’d suggest getting tested and try looking for a supplement…start with some pills and aim for a dose 65mg once a day for awhile and let me know how that goes. and it goes for any endurance type athletes, so yes to cyclists. u got my email, girl, shoot me a line if u need/want any other advice.
Hey Cait, I’ve been very anemic in the past. We’re talking a hemoglobin level of 7.3 and a nonexistant ferritin. Even now, my hemoglobin level is normal, but the last time it was checked, my ferritin was below 20. My doctor told me that I didn’t need my liquid iron anymore, but I still take it every day I run (5 days a week generally).
You didn’t mention liquid iron, but what really worked for me was liquid ferrous sulfate. I don’t know anything about infusions because I wasn’t that sick (actually, I was that sick, I just don’t think my doc at the time knew how to treat an athlete). I take liquid ferrous sulfate mixed into juice at night, and that’s what really helped me. Started taking it about 4-5 months ago because even though my levels were in the normal range (normal for a sedentary individual or casual exerciser who goes to the gym 1-2 times a week, not a runner training for a half marathon). It really, really helped. It’s cheap too, less than $10 for a bottle and the bottle lasted me about 3 months. It’s good for those who need a little more than a pill but don’t need pricey infusions.
Just so you know, my 5K time when I was severely anemic was a 33:15 (May 2010). After supplements and even running LESS, I was below 30 minutes that September. I train a lot harder now and obviously supplement, but I’m in the 22-23 minute range now. It’s amazing how many female runners just think they’re slow when really, they need more iron in their lives.
wow! i cannot thank all of you enough for your info on all of this. I never knew that my anemia could effect my running. I just knew that I was someone who could never ever donate blood because of my bad anemia. No wonder my runs are so difficult for me. i am going to try a higher dosage of iron and see if it helps.
YES!! know that what u are running now will feel SO much better/easier once ur iron levels get higher, please go in there and get a higher dosage.
hey! i did address liquid iron in the article, i know of a few friends who liked it but it upset their stomach and was a little harder for travel than the pills. i’m glad u’ve gotten ur iron levels back up so u can kick butt!
Good post. I will have to be more aware of this, but I don’t think it is something I have dealt with yet. Thanks for the info though!
i would say it’s worth it to start taking at least one pill to be on the safe side…couldn’t hurt…hehe.
Lots of great info here! I’m going to make sure my Dr checks my iron levels at my next appt.
thanks and i hope u do get those checked!
Thanks so much for this. I knew that running with low iron levels isn’t good, but it’s helpful to hear from another runner how low iron levels feel. They feel terrible. I just had a full blood work-up (your timing is impeccable) and my ferritin is 6.6 ng/ml. No wonder long runs are just tough. I will be starting a supplement program and hope to see results in a couple of weeks. Thanks again.
oh no!! start upping those iron levels, and like i said, while anemia really STINKS to have, there is a kind of ‘excitement’ in figuring out why u were feeling so bad and that it will get better soon!
Great article Cait!! Have some fellow runners this may well be applicable to!
Anyone know if iron levels are checked when you donate blood? I do so regularly and I only pay attention to BP and hemoglobin.. which have been awesome lately!
Hi Jarrod,
Yes they are and if you are low by their standards they wont let you donate. Often I have to have a second test before I can donate because I walk the line of what is low iron for donating. You could probably ask them when you donate what your iron is but I doubt a prick test would be as accurate as doctor though…
Hope this helps!
thanks and great to hear u are in the AWESOME iron levels category.
and great job for regularly donating blood too, such a great thing to do!
Hello Anemic-buddy! Great article Cait, and thanks for reminding me to go and have a blood test. Oh joy…
My family has weird iron levels. My grandmother has hemachromatosis, which causes a build up of iron in the blood and is really bad for your liver and other organs so she used to have to have pints of blood removed every couple of months. My Mum carries the gene (as do I) but was always anemic. For some reason, even though I eat a well-thought-out vegetarian diet with plenty of iron rich lentils and spinach etc, my body just sheds iron. And pills are out. So injections it is!
On the plus side it means I can run, and the nurses at our local clinic are very friendly
i feel like we are twins in more and more ways all the time!! hehe. i’m sorry that u’ve had to struggle too…BUT at least u’ve found a way to deal with it, stay iron heavy, and most importantly run!
i’m sorry that ur poor grandmother has some really bad iron troubles, wish her my best. XOXO
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Great post! I have had severe anemia in my past but not from running. Unfortunately, I had to have a hysterectomy due to tumors (which were causing the anemia). Since then I’ve been okay. My iron level still stays on the low normal side but it is normal. I honestly don’t take any supplements anymore due to the fact that I have stomach issues and they are too hard on me. After reading this though, I’m wondering if this is why I struggle so much with running. I just try to eat a good balanced diet and get regular checkups that include blood work.
oh goodness, i’m so sorry that u’ve had to deal with low iron but on a much more extreme level…do take care girl! and YES i’d say that right there is prolly making running even harder, so get those workups often and take care!
I’ve never had to deal with anemia, but these are some great tips, thanks!
u’re welcome.
Thank you so much for this info! I have had anemia all my life. And I get especially tired with it when i have my period. But i never knew how anemia could effect my running. i wil definitly be looking into iron supplements in higher dosage. thank you!
oh goodness, anemia will REALLY make a difference in how u feel running-wise, i’d def talk to ur doc.
Great post. You have definitely got me thinking about this whole runners and the average joe don’t have the same iron level requirements.
I have never been diagnosed by a doctor as low iron and have always been JUST inside the healthy range. So I am aware that I need to be careful but would be curious as to whether my iron levels are high enough for my training. I second all of Kate’s questions – do your recommendations apply to recreational runners or more so the elite athlete?
More gold from the Arty Runner Chick!
PS – Only 7 more sleeps and I can tear open my cool running tees …but who is counting?!?!
thanks girl! and if u’re iron levels are hovering around 20 or ‘normal’ on that scale, u definintly should try to up those stores and i’ll say about 99% certainly that u’ll be running better. which means even MORE kick@$$ for u!
and count down away!! hehe
Linked to your site today on my blog! Wanted you to know…
Thanks for your post! I plan to do some research about what I need to keep my body healthy!
thanks for the link loving and let me know how ur own iron journey goes!
I’m glad I read this article, you give very good advice. I bought some iron pills about a month ago, having never tried using any supplements in the past. I hadn’t felt bad on any runs or anything, I just felt it couldn’t hurt.
I tried taking two per day, mostly in the evening, and it definitely upset my stomach, even when I tried taking them with meals, so I just stopped taking them. But you have inspired me to try again. I think this time i’ll just try one pill and make sure I do so with a good meal.
p.s. still soda free! I feel soooo much better, and I think I look healthier, too!
S!!! please get taking those iron pills, we’ll find a way to not make u sick. all the guys should be on them when training like u do. the thing is u were prolly just taking too much at once compared to having never taken them before. try taking one pill (or somewhere around 40-60mg) just once a day with some food. do that for a week, and then try to add a second pill in the morn or middle of the day with food. lemme know how that goes.
and way to GO on that soda free living…ur bones and ur body is loving u.
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Thank You Cait!! I am fairly new to running (1/2010) and started by training for a marathon and have done 6 since with a couple halfs and many other shorter distance races, trail races and also took up cycling since then. During these years I was also a regular…..blood donor! Last summer was my 2nd season in a running club and I had improved greatly from the first year, till mid-season…I felt half way through a run/cycling event I was just “losing it”, the tank was empty. After I read your article I self assessed and all the symptoms pointed to iron-defficiency, so I went to my doctor to get tested letting her know I specifically needed to also have ferritin levels. I kind of had a complex letting her know that I was always tired (or am I just being lazy)? but I held strong and got the tests done…Holy crap! you are SO right about finallly having the answer to why I feel like I do. Ferritin is at 12, red blood cells,hemoglobin and hematocrit are all below normal average…taking iron supplements now and can’t wait to see how I do this season… Thank YOU!
BIG HUGS!!! oh my gosh, Kenna, I’m SO happy that you were able to get the help that you needed!! it are comments and emails like this that seriously do make my day.
it sounds to others crazy to have never felt happier to be ‘sick’…but i know exactly how u feel! be excited because now u’ll be getting healthy and will start feeling better soon! keep me posted and email me anytime if u have a question! 