Iron Deficiency Anemia : What Athletes Need to Know

Iron Deficiency Anemia

By Amy Tribolini, MS, RD, LD

Iron deficiency anemia can break down even the toughest competitors and it is more prevalent than you may think.  Approximately 10 million people in the United States are iron deficient and 5 million suffer from iron-deficiency anemia.

While mild anemia can go overlooked within the general population, it can have a significant impact on performance in athletes.  It is definitely valuable to be informed of early warning signs of a deficiency and understand what your options are.

The diagnosis of iron-deficiency anemia may not be more common in athletes vs. non-athletes, but data shows that athletes are more likely to overlook or confuse the symptoms.

Does Running Increase my Chance of Getting Anemia?

Running and high levels of physical activity do not necessarily increase your chance of becoming anemic, but it may cause you to overlook the symptoms longer and neglect to seek treatment.

High-level endurance athletes, such as ultra-marathoners and triathletes, are at an especially high risk of overlooking iron-deficiency anemia because they tend to shrug off some of the common symptoms, such as: muscle burning, shortness of breath, nausea, fatigue, and increased frequency of respiratory illnesses.  Because of the stress and fatigue that can naturally coincide with the rigors of training for extreme endurance events, symptoms of iron-deficiency can easily be confused with symptoms of overtraining.

How Does Your Iron Level Effect Running?

Iron plays an imperative role in transporting oxygen to muscles.  Hemoglobin, the primary transport system for both oxygen and blood in the body, is largely composed of iron.  If you want your metabolism to function normally and your muscles to receive oxygen, you must maintain an adequate level of iron.

In a healthy athlete, regular exercise increases red blood cell mass and plasma volume.  These natural adaptations lead to heightened oxygen delivery and potentially enhanced performance.  In an athlete with iron-deficiency anemia, these adaptations do not take effect as efficiently and the athlete may struggle harder to perform at their baseline activity level.


I’m a Healthy Athlete, How Could I Have Iron Deficiency Anemia?

There is a strange phenomenon known as foot-strike hemolysis that some runners may experience.  What this literally means is that red blood cells are being destroyed during exercise.  The theory behind this is that the capillaries in the feet are being compressed from the foot strike and this results in red blood cells being physically damaged.  While this phenomenon has been scientifically documented, it does not account for a huge drop in red blood cells; and often times cannot be detected on a routine blood test.

Another explanation is simply diet.  Athletes are often times particular about their diet and may omit certain foods or food groups in hopes of meeting their race weight or performing better.  If high iron foods have been largely omitted from the diet, it is understandable that iron deficiency will occur.

How Can I know if My Iron Levels are Low?

If you feel healthy and have not been having any difficulty training at your normal level, you would not necessarily benefit from undergoing screening for iron deficiency.  Often times, it is difficult to get insurance to pay for screening if there are not documented symptoms of deficiency.

If you have been experiencing decreased energy, weakness, shortness of breath, headaches, lightheadedness, or an unusual drop in your athletic performance, these are not symptoms to overlook or train through.  The simplest way to identify iron-deficiency anemia is to go to your primary care physician and have labs drawn.

What If My Iron is Low?

If you have low iron levels or have been diagnosed with iron deficiency anemia, it will be important to first discuss treatment options with your physician.  Your physician may prescribe a supplement to treat your specific level of deficiency but it will also be important to start incorporating high-iron foods into your diet to prevent this from happening again in the future.

What are Some High Iron Foods to Choose?

There are two forms that iron comes in: heme and non-heme.  Animal products such as beef, chicken, oysters, turkey, and eggs are examples of foods high in heme iron.  Non-heme iron can be found in foods like beans, tofu, lentils, spinach, peanut butter, and brown rice.  Your body can benefit from either type or both as long as it is getting adequate amounts.

If you want to boost the amount of iron your body absorbs from these high-iron foods, pair them with fruits and vegetables high in vitamin C.  Vitamin C is known to increase the absorption of iron and allow it to be more readily absorbed.

Iron Deficiency Anemia


Miller, J. L. (2013). Iron Deficiency Anemia : A Common and Curable Disease. Cold Spring Harbor Perspectives in Medicine, 3(7).

Zielińska-Dawidziak, M. (2015). Plant Ferritin—A Source of Iron to Prevent Its Deficiency. Nutrients, 7(2), 1184-1201.

About the Author:

Amy Tribolini currently works as both a Registered Dietitian and Nutrition Professor. She lives, trains, and competes as an ultra-runner out of Colorado Springs, Colorado. Amy specializes in fueling endurance athletes, athletic performance, and plant-based diets. Amy holds both a Bachelors Degree in Dietetics and a Masters Degree in Human Nutritional Science from the University of Wisconsin

Instagram- @ultrarunningdietitian

Email contact: [email protected]

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