In 2018, my wife was coming off a difficult cross-country season. Throughout the season, her times progressively got slower and slower. What was wrong? Was her training inadequate? Was it psychological? She had run 29:51 for 6k when, just a year earlier, she had clocked nearly 2 minutes faster. After several disappointing performances, she visited the doctor for a blood test. The results showed normal hemoglobin and hematocrit levels, but her ferritin was “undetectable (<4).” She started iron supplements, and by the 2019 season, her time improved to 24:04 for 6k.
Iron deficiency has impacted many runners I know, including my mom, brother, sister, and dozens of athletes I have coached. Performance gradually declines, motivation fades, and what was once an enjoyable sport becomes a struggle.
What is Iron Deficiency?
Iron is essential for producing hemoglobin, a protein in red blood cells that carries oxygen to your muscles. Without enough iron, your muscles cannot get the oxygen they need to perform well.
Iron deficiency and iron deficiency anemia are related but different stages of iron depletion:
- Iron deficiency occurs when iron stores are low but hemoglobin levels remain normal.
- Iron deficiency anemia is a more serious condition where the lack of iron causes insufficient hemoglobin production, affecting overall health and performance.
The Importance of Ferritin
Ferritin is a protein in red blood cells that stores iron in the body. A ferritin test reveals the amount of stored iron, which is crucial for endurance athletes. Unlike hemoglobin or hematocrit, which may remain normal even in the face of low iron, ferritin directly reflects iron reserves. Even with normal hemoglobin, low ferritin can lead to poor performance.
Testing and Treatment
I recommend that athletes consult a sports medicine doctor for a ferritin test. Sports medicine professionals are more familiar with the specific needs of endurance athletes. For the general population, ferritin levels between 15 and 20 might be sufficient. However, for endurance athletes, this range can be limiting. I typically aim for ferritin levels over 50, ideally above 70. It is important to consult with a doctor before starting an iron supplement so they can recommend the correct dosage and timing.
When an athlete is diagnosed with iron deficiency, changing the diet alone usually isn’t enough to restore ferritin levels. Iron supplements are often necessary. I typically see improvements in ferritin after 2 months of consistent iron supplementation. Based on my experience, here are three effective options:
Iron deficiency can be a difficult process to navigate. Finding a doctor, getting the test, finding a supplement that works for you, and balancing training load on top of everything else.
If you have any questions, I am more than happy to have a conversation! Feel free to reach out to me at myerschristopher14@gmail.com or connect on Instagram @MyersRunProject.
