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Anemia As An Athlete

I have been on and off with supplementation over the years. In recent years I stopped taking supplements in an effort to get what I need from my food. All that has changed again after the annual physical I had a couple of months ago.

At the appointment my doctor (who I can’t even begin to tell you how much I love) said she wasn’t going to do a full blood workup on me because everything has looked so good over the last couple of years. She said I’d be good with just a finger stick. I was surprised to receive a call from her nurse the next day asking me to come back in for the full panel. She told me my hemoglobin came back really low and started asking me if I’d felt tired lately or if I had been experiencing other symptoms of iron deficiency. I was surprised to hear this because in the past doctors have always remarked on how high that count usually is for me…usually more towards the normal range for men.

I went back in for the blood work and just a few days later I received a call from the nurse with an iron deficient anemia diagnosis. And not just a little anemic but full on. She told me I needed to start taking iron pills immediately and then encouraged me to start including things like kale, beets and red meat in my diet. I told her I had the kale and beets covered!

I have to admit that I was a little frustrated with the diagnosis. I pay a lot of attention to my diet and the things that I put into my body. And in the last year and a half I have eaten more meat than I have in five years. I did a ton of reading and research and talked to a lot of friends, family and doctors about it. My grandmother has battled with chronic anemia on and off but it’s not usually something that’s really genetic.

The symptoms did make sense. Some of the most prevalent for me were fatigue (especially when working out), feeling cold (especially in the hands and feet) and brittle nails.


I started taking the supplements a few days after the diagnosis. I am taking iron, omega 3-6-9 + vitamin D, probiotics and a prenatal. Iron for the anemia, the omega for general health with all the systems in my body, the D because I have been slightly low in that over the years too (but not to the point of concern), the probiotic to help with digestion because iron is really hard on your stomach and the prenatal for an extra dose of folic acid which helps the body absorb iron.

And the result? I feel a million times better. I didn’t even know I felt so bad. My energy levels are higher during the course of the day, I don’t fall asleep on the couch at night and my workout performance is night and day.Β I have written about this several times but over the last 9 months all workouts other than yoga have felt a million times harder. I got to the point where I could not run without stopping every five minutes or so because my body felt so dead. I actually started to hate to run and it was a huge deal if I could run the three mile loop I’ve run for years with no problem without stopping. I went from consistently being one of the first to finish in CrossFit WODs to being the very last. I brushed all this off to hitting the 30 mark and not working as hard on endurance training now that I don’t distance run anymore.

After this all came to light I did some research on anemia and athletes and came across an article from Vanderbilt University which states,

“All people who have Iron Deficiency Anemia suffer, but athletes with the disease have even more noticeable symptoms that adversely affect their performance. The main reason for their acute observation of a problem is the decrease in VO2 max, which is a direct measurement of how much oxygen a person uses in a set period of time. An athlete’s VO2 max is something he/she constantly wants to improve. With anemia, by no fault of the athlete, it decreases drastically. That amount of oxygen that an athlete can use in a given period of time decreases by a significant amount.Β Doubtlessly, anemia will affect athletic performance. The athlete loses breath after a much less intense and shorter duration of exercise. The fatigue and weakness also hurt the athlete’s ability to perform in sports. Even a slight decrease in hemoglobin causes a considerable effect. A comparison of marathoners with high hematocrit to those with low hematocrit shows that a higher hematocrit was associated with faster times.”

Since starting the iron supplement, I seriously feel like a new person when I run and lift. Well, actually I feel like my old self!


In addition to the supplements you may have noticed that I am also increasing my red meat intake and of course still focusing on eating all those other healthy and iron-rich foods that I love like kale, pumpkin seeds, beets, broccoli, dried fruits, etc. Many other sources say that tea and coffee (caffeine) block the absorption of iron so I have cut back to one cup of coffee in the morning (usually) and stopped drinking tea with my lunch.

I still wish I had a clearer answer as to why my body isn’t absorbing iron but for now I am relieved to be feeling better. The good news is that I am not sentenced to stay on these supplements forever and once I get my iron levels back up my body should be able to self-regulate and hopefully keep the levels where they are supposed to be.

I have been so back and forth about whether or not to share this on my blog but it is a health related topic that many people (especially women) struggle with so I hope that I can help someone else by sharing my story. Please let me know if you have any questions, suggestions, experiences, comments, etc. I would love to hear them.

{ 65 comments… add one }
  • Shanna December 18, 2013, 3:31 pm

    I was anemic when I was younger. I used an old school remedy….Black Strap Molasses. Worked like a charm.

    • Jen December 18, 2013, 3:33 pm

      thank you so much for that suggestion shanna!

  • Linda December 18, 2013, 3:40 pm

    I’m so glad you wrote this post! So many women experience fatigue and write it off as age related, work, lifestyle, family, etc, etc. I was feeling very fatigued where I needed to nap mid-day, could muster up just enough energy to get through my workouts, and of course, fell asleep on the couch more often than not and usually before 9:30. If I didn’t get my 8 hours sleep minimum I was worthless. So I had my blood work done and while my iron levels were good I had some other levels that usually indicate issues with B-12 and Folate. It turned out to be I was very low in B-12. I started over the counter supplements the next day and almost immediately I felt so much better!

    • Jen December 19, 2013, 10:07 pm

      hey linda – yes, when the nurse asked if i had been feeling tired my reply was, “well, i guess i just go hard so much that i didn’t notice.” i’m so glad to hear you are feeling better!

  • Kira S December 18, 2013, 3:43 pm

    I also was anemic as a child. In fact, the first pills I learned to swallow were these ENORMOUS iron pills. Two years ago I was diagnosed as Vitamin D deficient, but now everything is under control. Glad you’re feeling better!

  • Holly December 18, 2013, 3:53 pm

    Thank you for sharing this! I have been feeling awful in my WOD’s lately and maybe this is why?? I think I might schedule a doctor visit! I do not take ANY supplements….no vitamins, no shakes, no nothing! I try to get everything from my diet but maybe it’s time to look into vitamins. I have a sensitive stomach and in the past, when I was pregnant, I had a really hard time taking prenatal vitamins. Have you had any stomach issues taking so many vitamins?

    • Jen December 19, 2013, 10:09 pm

      hey holly – no stomach issues. thank god! i think the probiotic helps and the prenatal that i’m taking is whole food based and gentle on the stomach.

  • mary @ minutes per mile December 18, 2013, 3:59 pm

    great post. thanks for sharing. enjoy your steak! πŸ™‚

  • Melinda December 18, 2013, 4:15 pm

    Very timely post! It just reminded me that I’m due for my annual physical. I went in for one last year for the first time in years, and was diagnosed as Vitamin D deficient. She said that about 90% of people she tests are deficient. I’ve also been feeling a little run down lately, but have just been dismissing it as working a lot. I guess there could be something more to it than just that.

    • Jen December 19, 2013, 10:10 pm

      i definitely recommend taking a supplement. especially because vitamin d is essential for proper calcium absorption. you will probably feel better too!

  • LeAnne December 18, 2013, 4:24 pm

    Thank you for this post! My Mom and I both have been very anemic in the past, (my levels are so-so now), but I still try to supplement with Slow-Fe a few times a week and then take multivitamins with iron on the other days. The problem is..I have a LOT of acid reflux and other digestive issues..especially when I take iron. Have you found the probiotics to be effective in helping that? It would be great to see a follow-up post sometime soon!

    • Jen December 19, 2013, 10:11 pm

      i take the iron at night and i think it helps that i’m resting while it’s doing its thing. i do think the probiotic helps as well.

  • Hillary | Nutrition Nut on the Run December 18, 2013, 4:29 pm

    glad you shared πŸ™‚

  • Nikita December 18, 2013, 4:42 pm

    Thank you for writing this post! I have suffered from chronic anemia since I was a teenager due to Crohn’s Disease, even having to have iron transfusions in hospital. It’s true, once you think about it, that athletes would feel the effects of anemia more intensely due to the lack of oxygen – something many women don’t think about and blame it on poor performance. I’ve found that spinach salad with strawberries is a great supplement with meat, as I’ve heard vitamin C helps absorption of iron too. I don’t eat red meat due to digestion issues so I’ve had to get creative with iron sources! Broccoli also has iron so I eat that as snack. I hope you continue to feel better!

    • Jen December 19, 2013, 10:14 pm

      wow, that is a crazy story and i’m sorry you have been through so much. thanks so much for your insights on what has worked for you! very helpful!

  • Toni December 18, 2013, 4:46 pm

    This post really hits home. Early this year I was diagnosed severely anemic and had to undergo infusion treatments to help rise my hemoglobin levels. Unfortunately my body is not absorbing iron at all and the levels keep dropping. If i wasnt a runner I never would have looked into what was going on. I went from running a half marathon in 1:47 to barely completing one in under 2:29. My body was exhausted and felt like I couldn’t breathe or control my heart rate. Unfortunately they still don’t know why but I will keep on going until they do!

    • Jen December 19, 2013, 10:16 pm

      toni – i am so sorry to hear about your struggles. that is tough. what do they think is causing it? isn’t it so crazy how much it impacts the way you feel when working out? i can’t believe i let it go on for so long.

  • She Rocks Fitness December 18, 2013, 4:46 pm

    Interesting piece and I’m glad you shared this, because I am actually having similar symptoms that you had before you started on your supplements. I make sure to eat a lot of red meat, but may have to go to the doctor or start taking some vitamins similar to yours, cause at this point I do not take anything. Like you I try to get it all from foods. πŸ™‚

    • lindsay December 18, 2013, 7:16 pm

      Floradix is another great iron supplement that is liquid and great absorption. It’s at whole foods. Thanks for sharing Jenn! I know a lot of women have gone through this as well. Support is key!

  • Ashley December 18, 2013, 4:51 pm

    I am so glad you posted this!! I have been anemic for awhile, even though I was taking iron supplements. I assumed that the iron wasn’t getting absorbed, but hadn’t done the research to figure out why. I will try taking the iron and pre-natal vitamins and see how it goes!

    • Jen December 19, 2013, 10:21 pm

      fingers crossed for both of us!

  • Mary Ann December 18, 2013, 5:32 pm

    So glad that you posted this. I too suffer from poor iron levels ( level of 6.6 = very low) so I took a supplement as well. I found the NOW brand has a ‘non-constipating’ formula. I also take 250 mg of magnesium to help. I keep tabs on my iron levels by donating blood to the Red Cross. They let you know when your iron levels are too low to donate.
    Thanks for yet another great post.

    • Jen December 19, 2013, 10:22 pm

      thank you so much for your feedback. that is so helpful.

  • Amelia December 18, 2013, 5:36 pm

    That stinks that you had to battle with this. Stress (of any kind- physical or mental) also exhausts us. Combine that with low iron levels and vitamin D levels and no wonder you feel off! Glad you were able to get on supplements to nip it in the bud. πŸ™‚ Getting the vitamin D up makes a WORLD of difference!

    • Jen December 19, 2013, 10:23 pm

      i totally agree. i had a long conversation with my therapist about it and she said that a lot of times anemia can also be caused by “draining” in our lives and i’ve definitely had some of that going on in regards to work and relationships.

  • Bonnie December 18, 2013, 5:45 pm

    I was diagnosed with anemia for the first time at 16. My doctor told me to start cooking everything in a cast iron skillet and the problem would fix itself. Cooking in a cast iron skillet infuses everything with iron. I do take a fish oil/iron pill every now and then when my energy is low but I’m basically good now. Good luck!

    • Jen December 19, 2013, 10:24 pm

      i do cook in cast iron! regularly! glad to know you’ve gotten yours up to a sustainable level!

  • Amanda @Fitforgloryfoundbygrace December 18, 2013, 6:08 pm

    You probably know this, but calcium will inhibit the absorption of iron (if eaten at the same time, which is why spinach actually ends up being a poor source), and Vitamin C enhances it! So eating these foods at the same time can help (or hurt)! Fortified cereals are great too πŸ™‚

    • Jen December 19, 2013, 10:24 pm

      yes! great point!

  • julia December 18, 2013, 6:20 pm

    Just a suggestion, not at all intended to be preachy, but perhaps the transition back to eating meat has caused the iron deficiency. On a per calorie basis, leafy greens (which I know you consume regularly) and beans are higher in iron than meat.

    “Dried beans and dark green leafy vegetables are especially good sources of iron, even better on a per calorie basis than meat. Iron absorption is increased markedly by eating foods containing vitamin C along with foods containing iron. Vegetarians do not have a higher incidence of iron deficiency than do meat eaters.” http://www.vrg.org/nutrition/iron.php

    • Eva December 18, 2013, 11:27 pm

      I was going to mention the same thing! I don’t eat meat and never have low iron. I eat a ton of leafy greens and beans.

      • Anne December 19, 2013, 12:02 pm

        Same thing. No meat and a lot of beans and whole grains, and a very high level of iron. Maybe your portions are too small for your level of activity Jen…

        • Jen December 19, 2013, 10:35 pm

          julia – i so appreciate your insight. it’s something to think about but overall my digestion feels a million times better since i stopped eating a predominantly vegetarian diet and reintroduced more meat. it’s a slippery slope. i feel like everything is a trade off for something else.

          • Jen December 19, 2013, 10:35 pm

            eva – thanks for the input. i will definitely increase my intake of those things even more!

            • Jen December 19, 2013, 10:38 pm

              anne – i actually workout less and eat more than i ever have before. the great thing about having a blog is being able to see what you were doing years ago. my nutrition and portions are definitely different now and i average well over 2k calories per day. so i’m not sure how portions could influence iron levels? i really want to know what is causing it instead of just treating it. lots to think about…

              • Anne December 20, 2013, 9:08 am

                Ok, maybe I don’t see de 2K when you post your meals, your portions seem like half of what I eat and I do half of the sport you do, but we are all different of course in metabolizing food πŸ™‚ Good luck.

          • Stacy December 20, 2013, 9:34 pm

            Hey Jen,
            I’ve had digestive issues for years, and avoided meat because it seemed to be tough on my stomach. Once I started taking probiotics, meat was no longer an issue, and eating more of it and fewer beans/legumes like you said, has made a world of difference! All of this food and health stuff really is such a trial and error system, and you just have to figure out what works best for your body! Glad you are feeling better πŸ™‚

  • Caroline December 18, 2013, 7:19 pm

    I’ve been borderline B12 anemic for the past five years or so. I DEFINITELY notice it in my every day life.. it’s so tough being tired all the time. Thanks for writing this, learned a lot in the post and comments!

    • Jen December 19, 2013, 10:25 pm

      you’re welcome. thanks for the comment!

  • Danielle @ LabelsAreForTinCans December 18, 2013, 9:06 pm

    Thanks so much for sharing! I was super low in iron a year ago – try as I might to supplement with food I went on supplements and it made a WORLD of difference. I am currently off them all but this is a good reminder to get checked regularly!

    • Jen December 19, 2013, 10:26 pm

      we really just have to accept that it’s necessary sometimes. health always comes first!

  • Kaitlyn December 18, 2013, 9:14 pm

    thank you thank you thank you!, jen i cannot even tell you how timely & relevant this post is for me. i recently went to get my wisdom teeth pulled, but after being given a small dose of the general anesthesia, had a vasovagal response/syncope. which basically means, my heart & blood pressure slowed so much that I passed out…due to anemia. :/ not at all fun to hear, but definitely connected a lot of dots for me as to how id been feeling. I’ve been taking charge like you and working out the kinks to get my supplements and diet right! glad to hear you are feeling better..keep us posted! <3

    • Jen December 19, 2013, 10:26 pm

      kaitlyn – i know exactly what you’re talking about and it’s such a scary feeling. i hope that you get your body straight and get to feeling better. xoxo

  • Kelly December 18, 2013, 10:08 pm

    Is the prenatal just a general prenatal vitamin? I have really low iron and take iron pills (when I remember, which isn’t often enough). I will start taking prenatals if those will help!

    One of the reasons I find it challenging to take the iron because my doctor told me it’s best to take it on an empty stomach and that if you have it anytime around when you’ve had some kind of dairy product that it doesn’t get absorbed. I find that hard!

  • Mayra December 19, 2013, 3:43 am

    Glad you shared too Jen! Time for me to go get a checkup.

    PS. Happy for you that you are feeling better! πŸ™‚

  • Sarah December 19, 2013, 11:17 am

    Thanks for your post Jen, it certainly hits close to home for me! I was diagnosed with severe Aplastic Anemia early in Sept. after being hospitalized for really low blood levels. I had been feeling fatigued with exercise and just chalked it up to my busy traveling schedule this summer. It has essentially frozen my life for the time being and really changed my perspective, requiring me to live with my parents as I get treatment and be thousands of miles away from my husband. But, I love hearing your success and am optimistically looking forward to getting past this little setback and on with my life!

    • Amy December 19, 2013, 2:36 pm

      I am sorry to hear this. It’s hard when you work so hard and think you are doing everything right. Were you taking a multi-vitamin? Do you mind me asking who your doctor is? I am looking for a new primary. Thanks so much for sharing and glad you are feeling better.

      • Jen December 19, 2013, 10:30 pm

        sarah – wow, what a story. i’m so sorry to hear about your health struggles. how are you doing now? i can’t even imagine. thinking of you.

        • Sarah December 20, 2013, 10:15 pm

          Thank you, Jen! It’s still a struggle in getting my levels up enough to be off transfusions, but I’m hopeful for some upward movement over the next month πŸ™‚

      • Jen December 19, 2013, 10:31 pm

        amy – i was not taking a multi prior to this. my physical was done with my OBGYN. her name is tracy larson with randolph OBGYN. she’s amazing but not sure if she’s going to stick with her practice πŸ™

  • Dana B December 19, 2013, 8:55 pm

    Those prenatals are great because they are food based and they don’t upset your stomach! When I was taking synthetic prenatals, they made me so nauseous.

    Glad to hear you’re feeling better.

    • Jen December 19, 2013, 10:31 pm

      yes, they’ve been great!

  • Rajul December 19, 2013, 9:38 pm

    Thank you for opening up about this Jen and encouraging the rest of us to! I have had iron deficiency (cured I swear by green smoothies! vegetarian and couldn’t tolerate iron pills) and thalassemia (my red blood cells are shaped funky so they don’t carry hemoglobin as well). I live with a hemoglobin between 9.0 and 11.0 and boy do I feel a difference especially in cardio endurance/running when I’m in the lower range. I just found out my D is low so I was told to start on 2000 IU twice a day. I was told the oil based drops of Vit D3 absorb the best so I got some at Whole Foods. They are pricey but each bottle has 900 drops so it will last a good while.

    • Jen December 19, 2013, 10:32 pm

      you are welcome. love your green smoothie fix. unfortunately, did not work for me. i drank them for 5 months straight πŸ™ i hope the D helps you with your energy levels too. thanks for the rec on WF.

  • Annie @ herightfit.com December 19, 2013, 10:36 pm

    I’ve struggled with this for years. Make sure to avoid taking your supplements with calcium. Iron can inhibit calcium absorption when taken within about two hours of each other. Instead, pair iron with a vitamin C supplement. That helps iron absorption. I also found taking B12 supplements helpful when I was low on iron. I really try to avoid supplements but sometimes, you’ve got to say, “OK! My body needs more!”

  • Jo December 20, 2013, 7:55 am

    I can definitely relate. Every time I stop taking iron, I start to REALLY struggle with my running. I find this very frustrating. I want to be able to get all I need from real food, but it just doesn’t work for me.

  • heidi December 20, 2013, 5:19 pm

    Thank you so much for sharing this Jen!!!

  • Linda December 21, 2013, 2:38 pm

    Thank you for sharing Jen. Recently I had blood work done and was told by my doctor I needed to take iron supplements. Well, like everyone else I’m extremely busy but I’m also extremely forgetful to the point that I never remembered to pick up my prescription. Fortunately for me upping my iron intake through food such as kale, spinach and red meat is all it took. When I went back to the doctor I was no longer anemic. I know every person is different but hope this puts your mind at ease.

  • eleace February 8, 2014, 6:18 pm

    Thank you so much for sharing. Its made a huge difference as I wasn’t sure about the vitamins to take with the iron or even what type of iron to take. I’ve done my research and Feosol a reccomended iron. I am a Trainer i’ve not been able to teach my classes the way i want to as I am out of breath very frequent. I’m so greatful that you shared your story and the supplements you take along side your iron tablets.

  • Diana October 25, 2014, 11:34 pm

    I loved reading your article because I am having the same problem with low iron levels. I was wondering how long after you started taking the supplements did you start feeling better during your workouts? Ive been taking them for about a week now and I do feel better then I did before but I still get tired during workouts and im definalty not where I was before. Do you think this is normal?

  • Carrington January 24, 2017, 1:29 am

    Thank you so much for writing this!!! I really appreciate it! I ADORE running and last year (when I was a freshman in highschool) I started cross country (yahoo!). I absolutely LOVE it! I did really well last year (I did track in middle school) but this year’s season was awful! I went from being on varsity to low jv. I felt so awful because I felt like I was working hard, if not harder than last year. But every day at practice it just felt impossible to move. Even stretching or strength building, small sprints…mmm mmm! And I started walking. A lot. I hate walking at practice! During races I would take a step and feel like I was hitting a wall for the entire thing. I started napping regularly after school, always felt tired, was dizzy frequently, and I don’t know if this was contributed to anemia, lack of sleep or hormones or what, but I think I went through a slight state of depression because I would come home every day and cry. My coach thought I might have anemia so she encouraged me to go to the doctor. I did that and found out I was anemic so I’ve been taking iron supplements. I’ve been trying to get more sleep and I also am lactose intolerant so I’ve been taking calcium supplements but I just found out calcium supplememts could block iron absorbstion so am going to take iron at breakfast and dinner and calcium at lunch. I am so thankful to have been able to find out what is wrong with me! Iv’e felt so robbed from being anemic-it really changes everything. Anyways there’s my little tangent and story-sorry it was so long!
    My question is: Track is starting very soon. I just started taking iron about a month ago and am just now starting to see improvements (I think?) and am in the process of changing my diet to be healthier, more nutritional and I’m working on accomidating for my lack of iron. I was wondering what you think about me starting track? Should I rest and get fully “back to normal” before I do another intense sport or do you think I will be okay? Thanks again for sharing your story!

    • Shauna April 7, 2017, 10:05 pm

      I can relate to this so much. I did cross country this season and I loved it as a freshman I ran varsity meets. I have been running track since 7th grade last year in 8th grade I loved track and it was one of my best seasons. But high school track comes along and I’m not doing too well. At first, I thought it was because I was out of shape but however, it’s been almost 2 months since track started and I’m doing really bad. Like you I was varsity now I am one of the low jv’s. I started to crave ice and eat it non-stop, my palms become really cold when I run, I become really tired ( I don’t know if that is because of school and track), and my mile time has increased by 20 secs. I don’t if I have iron anemia or I’m just being crazy. When you realized you had iron anemia did you take a break from running? I’m also starting to lose my passion for track.


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