Straight Talking Iron For Runners: IV treatments, pills, doses, and runner norms

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 is ‘Iron Level Upkeep for Runners’.

runner eating pizza

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.
blurry runner
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 in storm

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?

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60 thoughts on “Straight Talking Iron For Runners: IV treatments, pills, doses, and runner norms

  1. 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. 🙁

  2. 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 :P) 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! 🙂

  3. 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. 🙂

  4. 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! 🙂

  5. 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!

  6. 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!

  7. 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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  9. 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!

  10. 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!

  11. 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

  12. 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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  16. 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! 🙂

  17. Sorry for the late response, but I just found this article! I am a runner just diagnosed with anemia due to an extra long and heavy period so I also have to address that issue as well as this anemia. My ferritin wasn’t checked just H&H and diff so I will ask for that on my followup in 8 weeks. Anyhoo, my question is, how long does it take to start running better? I went from running back to back 10 milers to barely being able to run 2. I’ve been on the iron for a little over a week. I had so many goals for the fall, and I can’t bear to see them all slip away.

    • oh, hang tight, Sara! I’m so sorry to hear that u were anemic but the good news is u’re getting things moving in the right direction!! time-frame is different for everyone, and i’m not sure how low u were. and also how much iron u’re taking dose-wise. if u’re taking the iron pills i will say that u will start to feel better after a few weeks, but it will take some months to restore ur reserves and feel the effects. brace yourself for potentially 6months, to feel ‘normal’ but each week u’ll feel much stronger than how crummy u were feeling. again, it could be much quicker, i don’t know where u’re starting from. be patient and just remember u WILL get back. u can email me if u want too. 🙂

      • Thanks again for the article. I just wanted to come back and update for people who find your article when researching. After being on iron for 2 months, most of my counts are back to normal, there are a few that are still a little out of range so I will be taking iron for another 3 months. I started feeling better after 2.5 weeks and was able to pick up my training and PR’d my half-marathon last weekend. I am constantly amazed how my running has improved with the iron, I call it my performance enhancing drug!! 🙂

        • thanks for the update! yes, you will keep feeling better, which should be so motivating and a relief for you. keep it up! i would like to just say, iron isn’t a performance enhancer…it just gives you back what you SHOULD be feeling like normally, you were just so depleted! 🙂

  18. Good article! My daughter is a DI cross country athlete and has always had a low ferritin. She takes 3 325mg FeSO4 tabs a day along with VitaminC. She eats all the right foods. She’s tried liquid iron as well. I’ve taken her to a hematologist hoping to get her an iron infusion, but he won’t do it because her HGB is 12.9. Her Ferritin is 11, and never goes above 23. When will a doctor prescribe the infusions? She just cant keep up with her teammates because she’s so tired and her legs are always burning and heavy. She’s been on the max dosage of iron pills for about 4 years.

    • ugh, oh my gosh, i’m SOOO sorry andrea!! it definitely sounds like ur daughter needs that iron bump. i’d suggest trying to find another doctor…one who is used to working with athletes. is that a possibility??? have u talked to the coaches?

      • After futile attempts to get my daughter an iron infusion all over southeast Ohio, we finally got her in to see a hematologist at Ohio State and she is wonderful! Her ferritin level then was 9. My daughter had a 500mg Iron Dextran infusion the next day ( half the maximum dose). She started feeling better after a couple of weeks, but she didn’t feel better running until almost exactly 2 months post infusion. She went back for her 3 month check-up last week and her ferritin was a shocking 15. The dr told us that OSU recently was approved to start giving iron infusions called feraheme (not sure of the spelling). These infusions are only 10-15 minutes long as opposed to the 6 hour infusions of dextran. They also don’t require being premedicated with Benadryl and don’t have as many allergic reactions. The nurse monitors you for 30 minutes afterwards and then you’re on your way home. She had this infusion last week and will have another one next week.

        • Thank you SO much for sharing yours and your daughter’s story, Andrea!! This will help so many others, I know. I’m sorry that it was so hard for you guys to finally get hooked up with the infusions at first, but this new kind of infusion sounds AWESOME!! yea, sitting there for hours and hours is not fun, and the lower allergens. I’m really interested, will you please keep me posted on how things progress?? I’m going to be sending positive vibes your guys way and I KNOW your daughter will be back out there feeling strong and kicking butt soon!! all the best! 🙂

        • I am not sure anyone will see this old post but was wondering if you could send me the doctor at Ohio State that treated your daughter. My daughter also. D 1 runner has struggled with anemia for 6 years. Also, do you know if the doctor had to get NCAA approval to do the infusion.

  19. Hi, it is great finding this to read! I started running almost 2 years ago and was pleased with my times for a few races…then all of a sudden everything changed quickly! I thought it was the humidity causing me to be so slow, my race time slowed by well over a minute per kilometre with lots of walking! 🙁 I had routine blood work done and was excited to get back on track but my hemoglobin levels continued to drop. This week was the first of 10 IV iron, one per week…I sure hope it does the trick! I signed up for races not knowing and it is disappointing to struggle just to get it done! It is nice to hear others stories so you don’t feel so alone, I am kinda tired of people assuming I am not eating and looking after myself!

    • Thanks, Wanda, I’m so happy this was helpful to read and sounds like nice timing in sync with your IV’s!! I PROMISE you, you will start feeling better. There will be improvements right away (anything is darn near better than feeling like u can’t pull urself out of bed to walk! lol) but it’s a gradual thing…be patient but i SWEAR there will be life back in those runner legs! sending all my best! 🙂

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  21. Thanks so much for writing this article. I am a runner who runs about 6 days a week and am on my colleges cross country team. I was having a lot of problems running this year and was tested for anemia, where i found out my levels were low. I’ve been taking iron supplements twice a day for about a week now and i do feel a little better but how long does it generally take to get myself back to where i was. Im not as tired but im just not cranking out the splits i was before. Is this normal or should i increase to 3 a day?

    • Hi Diana and I’m SOOO glad the article was able to give you some help/hope and the GOOD news is you have an ANSWER as to why you were feeling so tired and even better news it’s an ‘easy’ thing to fix…it will just take some time. i don’t know your levels and dosages you’re taking so i can’t give you specific answers. The amount of time until you feel 100% really depends on just how depleted you were. ex: if you were 6 vs. 26, etc. That said, if you’re already feeling better after only one week that’s a MAJOR step in the right direction. But to be honest it will take weeks if not a few months until you’re firing on all cylinders…so keep looking long term, don’t let that sound discouraging, because while it may take some weeks for you to be 100% the improvement factor will be quite marked and each week you’ll be surprising yourself how much better you feel. Any questions let me know and keep me posted, and GOOD LUCK!! Cheers from Cali!! 🙂

  22. I’d like to add a little information that might be of interest. My teenage son, who runs both cross-country and track, was having some poor performances this season. His 5K times were nowhere near what they should have been, given the amount of training he puts in all year. And, he was getting worse, not better, as the season rolled on. We had him tested, and his ferritin level was only 12! Heck, that would be low for ME; his should be way higher. He’s on supplements now, and I think he can look forward to a great track season. I post this because it’s not just women who have to pay attention to iron. Even a seemingly indestructable 16-year-old male runner can have issues.

    • Exactly! Both males and females need to be aware of their iron levels…no one is immune. I’m really glad your son was able to get himself back headed in the right direction and restore that ferritin level. Sending cheers and well wishes!

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  24. Yes, I realize I’m posting years after this was released, but darn, I’m so glad I found your article! Thank you so much for sharing your story. I’m a runner of 30 years, and decided to try to qualify for Boston this year, which in turn has increased my training like I’ve never seen before. Started training in January for a qualifying marathon that is less than one month away (Oct 8). Unfortunately, I’ve been struggling to maintain my paces recently. I’m doing it, but hanging on for dear life. One big symptom was ice chewing. I couldn’t get enough of it. I knew this was a side effect of anemia and thought I’d go get checked. Anyway, I got a 10 on my Ferritin level. Read enough to know it should be much higher, and don’t have time to wait for pills to kick in for this race. My doctor won’t do an iron infusion because all my other numbers were fine. Do I push back and go see a hematologist? It’s just been soooo much training for it to come down to this. (60 miles a wk) Sorta bummed, but wondering if can be fixed within a month for my race. They want me on the pill supplement 325mg. I started this, but thinking I may do the liquid iron. (Maybe 2x a day?) I’ll also be sure to eat more iron rich foods. How does a runner of 30 years not know about any of this? Geez! Lol. Thank you in advance for any response, and thank YOU for posting your story! It was quite helpful!

    • I am sorry I am just reading this. My son was supposed to have his breakout year this XC season as a junior. Had a 15:59 PR his very first race of the season, and has gotten progressively slower each race since. He is running 90 secs slower on average now than he did only 2 months ago. It is so hard to watch. He would be in the lead each race, just to have his legs give out the last few hundred yards. His ferritin was measured at 24 two weeks ago, and fortunately we found a dedicated sports doctor who knows this is WAY too for a competitive distance runner. But the problem was, how do you get the levels where they need to be quickly, without an infusion? We researched and are using Proferrin ES. Check it out. It is a heme-sourced iron pill, which is much (up to 23x) more efficient than a standard iron supplement. It all has to do with how the body process heme iron vs non-heme iron. Not cheap, but it has a great reputation. He has only been on it a week, and we will not have his levels retested until after the season, but we’ll see what happens at districts and then states in a few weeks.

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