Running with Anemia

Read Time: 8 Mins
Most of you know that I love to run. Many of you know that I finally get to run my first Boston Marathon in April after qualifying for the 3rd time. But these last few months of running have been extremely difficult. I thought I’d share my experience in case anyone else out there is dealing with the same thing.
I’ve been doing marathons consistently for the last 2 years injury free (okay a few month of plantar fasciitis and a bruised knee bone from a fall). But in early November, I remember showing up to run with some friends that typically run faster than I usually do for my slow run. I can normally keep up and I like to do it occasionally, but the 13 miles that we did that day really pushed me. I struggled to keep up, but somehow stayed with them..... After that run, things continued to go downhill. I felt like every run was failure. I couldn’t pinpoint it, I just felt tired running and struggled to run the miles or pace I was planning to do that day.  After taking off a few days here and there, trying to get more rest, I felt that maybe I was maybe on the verge of overtraining. I had a fun family 5k coming up at Thanksgiving and thought that I’d take a few days off before and hope I could run well. Well I ran my slowest 5k “race” in years (ran 23:00) I ran as best I could…had heavy legs and just felt really out of shape.

anemia main 

I had a half marathon coming up Dec 12 that I had hoped to beat my PR  (1:37), I debated doing it now because I knew I wasn’t running well. At the last minute I decided to show up and just run easy to get some miles in. I brought my music and headphones (which I never do) and started running. First 2 miles I felt pretty good, then by mile 4, I felt worn out again. I could tell this was going to be a tough race to complete. By mile 5 I wanted to quit. This was really unsually for me, but my hamstring started to pull a bit and I felt soooo out of shape. The course was up and down. I could not run the hills (what was wrong with me?) so I decided to walk them and then run down. I painfully finished in 1:55? and told myself that I just need to take a full week or two off. 
Come Christmas time, visiting family out of town I decided to try running again with my sister in law. No change. The break did not rest my legs. My pace was 1 min slower on easy runs and that felt difficult. Legs were heavy constantly. Even when not running. Heart rate was even higher as I got a watch with a HR monitor. I finally told myself I would get blood work done and see if anything showed up. Ironically, I had a work trip to Flagstaff (altitude) of all places and was invited to run with some elites. It was a dream come true for me but knew I couldn’t keep up on an easy day for them. I sadly joked I’d run a couple miles and then watch. Of course our run was in 7500 ft elevation and there was a good hill after mile of running. The hill absolutely wiped me out. Needless to say, I made it maybe 2 miles with them and then I went my own the rest.
I finally made it to the doctor and found that my hemoglobin was 8.6! The low normal range is 12 for females. Last time I was anemic was 7 years ago while pregnant and it wasn't that low. Anything lower than an 8 and they do blood transfusions. The body needs iron in the red blood cells to to help transport oxygen to the muscles and most importantly the heart. My heart had been working on overdrive for the last couple months. My last run, I couldn’t run 10 min miles without the HR being 180-185! 
My doc had just said that I needed to take an iron pill a day and come back in 3-6 months. Really? That’s it? When can I run? Is it dangerous to run with a constant high HR? I don’t have 3-6 months. Why are my levels low? Thankfully I saw a hematologist a week later to get a second opinion. He knew I wanted to get back to running and get to Boston. He said with my low numbers I could do an Iron Infusion, but we checked my levels after I had spent a week of no running, eating LOTS of iron and taking 1-2 pills a day and it was now 9.9! Pretty good for a week. He told me that since they’ve come up a bit, I could try running as long as my heart rate wasn’t crazy high, he told me to keep eating lots of iron, take 3 pills a day and get blood draws again in 2 weeks. He also checked my iron, ferritin, TIBC levels and B12 and reticulum count which were as expected.
anemia food

Foods with iron: spinach salad with pine nuts, lemon/ceasar vinaigrette brown rice with steak

So here I am just over a week later, pumping iron into my system like a crazy woman, 3 pills a day and eating pumpkin seeds, red meat, chicken, tuna, fish, eggs, spinach, prunes, brown rice etc. Thankfully…I’ve been able to run and each day has gotten better! It has been hard to run 2 days in a row without heavy legs, but I finally did that yesterday with no problems. HR has calmed down almost 20-30 bpm! My legs are not constantly heavy throughout the day anymore. I’m taking less naps ;) I feel like I am running on fresh legs (so far) and I can run hills without walking! I honestly feel like a new runner.
At the time, I was unaware, but I found out that my hemoglobin was 11.2 back in June. My last marathon was April 30th. If I would have known that I would have taken steps to up it then. So for the last 6 months it has been coming down. I’m really not sure why yet. I feel I eat pretty healthy, I wasn’t training hard this fall, I don’t have heavy cycles at all. So hopefully in the next few weeks we might have some better answers. 
It was really hard to find info on running with severe anemia. Having low iron or ferritin levels is different and will make you fatiqued, but when you are severely anemic, the body is really struggling to function properly. It can put serious stress on the heart as it struggles to get oxygen. Thankfully my hematologist knew I could run EASY again once my levels had come up a bit and the heart rate wasn’t at my max when running. Hopefully things will get even better over the next couple weeks.
  • Take sustained-release ferrous sulfate, 
  • I’ve heard people say liquid iron absorbs better, but my hematologist said it doesn’t make a difference and the liquid is messy and can stain teeth. 
  • Runners should be ABOVE the low ranges for optimal performance. (Great article here by University Health News)
  • Don’t take iron pills without doctor approval (there is a such thing as iron poisoning)
  • Take Vitamin C or citrus with iron pills to improve absorption
  • Don’t take Calcium, heavy dairy products or coffee within an hour of taking the pills (can inhibit absorption)
  • Iron pills can increase constipation. Drink lots of water
Hemoglobin 11.2
Hemoglobin (Hgb) 8.6  (12.0-16.0)
Hematocrit (HCT) 30.8  (37.4-48.3)
Red Blood Cell Count (RBC) 4.10 
 MCV 75.1 (81-98)
 MCH 21.0 (27.0-32.0)
 MCHC 27.9 (27.0-32.0)
RBC (RBC)  4.55mil/uL (4.0-5.5)
MCV (MCV) 75.2fL (81-98)
MCH (MCH) 21.8pg (27.0-32.0)
MCHC (MCHC) 28.9g/dL (31.0-35.0)
IRON BLOOD (TIBC BLOOD) 32mcg/dL (50-175)
FERRITIN (FERRITIN) 32ng/mL (15-204) (Runners should be above 50ml)
STAGE 1 Iron deficiency: Ferritin < 20 ng/dl. Takes approximately 1 month to come back from it.
STAGE 2  Iron deficiency (erythropoiesis): Ferritin < 20 ng/dl, Transferrin Saturation < 20%, Serum Iron < 60. Takes approximately 8-12 weeks to come back.
STAGE 3 Iron Deficiency Anemia: All of the above plus a hemoglobin less than 12 g/dl and hematocrit less than 38% (for athletes; non athletes they usually use 36%). Usually takes 4-6 months to fully come back.
According to this chart, it says its may take 4-6 months to get back. I’m already feeling pretty good 3 weeks, I hope it only takes a month or two, but it makes me wonder just how much better I can feel and how long I’ve had somewhat low levels.

When hemoglobin gets below an 8.0, it often need medical attention, either a blood transfusion or Iron IV infusion. I cant believe I was trying to run, let alone in altitude with an 8.6 level.

I'm just glad to be climbing the ladder. I can't wait to see what my levels will be next week. My goal is to be the fastest recovering anemic ever, ha! 


Common types of anemia in runners 
Read about a runners experience with Anemia and fibroids

difference between real and false iron deficiency
Chart with iron levels
Chart with Hemoglobin levels
Runner forum discussion
Jaime and Sheeva
Jaime and Sheeva

We, Jaime and Sheeva, are fertility specialists who work and live in New York City. For a full run-down of education and articles written, click here. Our practice is devoted to helping women achieve their goal of parenthood. Using a team approach (two minds are always better than one) rooted in honesty and transparency, we are... Read More