I am not a health care professional and I would recommend that you always take the advice of a qualified health care professional if you are experiencing any unusual symptoms related to the below article.  However, I have spent a number of years researching and teaching Heatlh Psychology and believe that by promoting health via education you can take more of a holistic approach in your health care.

I would therefore like to share some information about Iron because as runners, you need to be informed of your unique iron needs. This is a vast area and I have only touched the surface but hopefully I have simplified it so that it is easy to understand.

An iron deficiency is one of those nasty conditions that can disguise itself as being overtrained or under-rested when you take part in regular exercise or you could put it down to getting older, being busy as it tends to creep up on you without you really noticing it. Any drop in your running as you face an onslaught of fatigue tends to cause runners to watch as their running takes a nose-dive and there seems to be no ‘logical’ reason as to why.  Running mojo has been lost, tiredness sets in and when you do manage to get out of the door you feel like you have someone else’s legs on.  Sound familiar, then I would suggest getting a blood panel done as soon as you notice a dramatic change in your running, particularly for females.

Iron deficiency anemia is characterised by a decrease in hemoglobin concentration, which leads to lowered aerobic capacity which can be a cause of breathlessness. Iron deficiency anemia is diagnosed when one’s hemoglobin concentration drops below a certain point (usually between 12.0 and 13.5 g/dL in adults). It has been long known that iron supplementation benefits runners who have been diagnosed with iron deficiency anemia.

It is possible, however, to have a hemoglobin reading that doesn't result in being diagnosed as anemic, but still have decreased iron stores, characterised by having low scores on serum ferritin or transferrin saturation tests. This condition is known as iron deficient non-anemia. Runners with low ferritin levels often complain of lacking interest in or energy for training, especially harder workouts and racing. Having low iron stores can be confounding, because ferritin levels, unlike hemoglobin concentration, aren't checked on standard blood tests. So if you are going for a blood test it is important to ask for your ferritin stores to be checked.

Ferritin is an intracellular protein that stores iron in the body and releases it in a controlled fashion. The amount of ferritin stored is reflective of the amount of iron stored. For runners in training, the ‘normal’ recommended ferritin levels are markedly different from people who lead much more of a sedantry lifestyle  (Chuck 2014). The normal ranges and guidelines that GP’s have to adhere to is 24 to 336 nanograms per milliliter in men and 11 to 307 nanograms per milliliter in women. If you are on the lower end of the scale the GP may advise taking an Iron Supplement to help raise your ferritin stores but if this doesn’t work there may be another underlying reason for not being able to absorb iron. 

Low ferritin levels often mean an iron deficiency is present. This can be causedby long-term (chronic) blood loss from heavy menstrual bleeding, pregnancy, not enough iron in the diet, or bleeding inside the intestinal tract (from ulcers, colon polyps , colon cancer, hemorrhoids , or other conditions). WHO 2016

If you don’t have a GP used to working with runners they may wind up telling you that you are in the ‘normal’ range and have nothing to worry about when, in fact, an iron deficiency may be hampering your training ie low ferritin stores. Thus, as a runner, you need to be informed of your unique needs and be sure to speak up to your doctor.

I have personally struggled with low ferritin stores, after being out of breath, exhausted with a foggy head and found out that my ferritin stores were 12, so within the guidelines but still very low.  I took iron supplements but it made no difference and eventually I was diagnosed with not being able to absorb iron.  It was like I’d been asleep for months and then suddenly I woke up, the difference was incredible in how I was feeling.  I had to go to a private GP though because my NHS GP said I was within the guidelines.  The private GP said to me thouhg that “having a ferritin level of 12 when the range is between 11 and 307 is like saying to someone £12 is as rich as someone who has £307. The difference in these guideline levels are quite huge when you are training at your level”.  I was immediately prescribed B12 injections and as I said I have been feeling so much better.

For the average person, being within these guidelines is fine but there is controversy in the sporting world, especially runners.  McDonald (2016) said “To put it bluntly, an athlete running with a 12 ng/ml ferritin level will be feeling the effects of anemia and their training will be suffering. Runners need to be much higher on that scale”. She continues “Every athlete is different in terms of levels, I’ve seen athletes build their ferritin level to above 20 and they feel great, while others don’t perform well until 40. It is about seeing what works for you and being persistent in your health care. 

For more information visit

www.b12d.org - An extremely useful website

www.reneemcgregor.com - This lady specialises in sport nutrition and has written some excellent books and articles about the importance of nutrition

www.theironclinic.com/ A brilliant website that has set up an iron clinic in London and has written a couple of interesting articles that go into more detail than I can about Iron Deficiency

www.winchestergp.com - This is a private GP practice and the female GP here specialises in women's health care.

“My aim is to help you learn how to run, help you improve, to give you advice and show you where you may be going wrong. Running correctly enables you to run more efficiently and therefore the idea is that it becomes easier and less of a chore.