Prairie to Peak Running

Fact is, our bodies need iron. We need it for many functions, including making hemoglobin, a protein in our red blood cells that carries oxygen throughout the body; and making myoglobin, a protein in muscle cells that stores and releases oxygen. We also need this essential mineral to help produce hormones and energy, as well as immune function. Yet, our body can’t make iron, so we must get it from food or supplements.

Many factors can cause a deficiency in iron, including our diet, our body’s ability to absorb iron, and when we lose iron through sweat and feces. Females who menstrate also take a hit when it comes to their iron levels, as they lose about 16 mg of iron during a typical menstrual period. Then, when we add a pregnancy to the mix, a female’s iron levels can drop even more, mainly because pregnancy increases one’s blood volume 20-30%, which then increases the body’s iron requirements. 

 As athletes, when we are deficient in iron, our energy levels and endurance take a hit. Without healthy red blood cells our muscles won’t get enough oxygen.  An ultra runner’s iron requirements are higher than an average adult – a ferritin level that is less under 50 μg could be considered low for runners (as opposed to 15-30 μg); mainly because the tissue remodeling and muscle hypertrophy, as well as the impact forces of your foot hitting the ground breaking down red blood cells, require iron to help produce new tissues and blood cells.

As a result, pregnant ultrarunners are often in the top category for being at risk for becoming anemic. Based on experience and research, here is what you can do: communicate with your provider about your activity levels and stay on top of your blood work, take your prenatal daily and supplement with additional iron if needed, eat iron rich foods, and if available and required, consider receiving iron infusions. Your healthcare provider is your go-to for prescribing iron supplementation, but as an endurance athlete, you may need to advocate to keep your iron stores up higher than the regular population. 

Throughout both pregnancies I had to adjust my supplementation as my iron requirements changed. I got frequent blood work done and met regularly with my midwife. I wasn’t perfect in taking my supplements or adjusting my diet, but I did notice a difference when things were improving. In fact my iron levels were higher in my second pregnancy, yet I still opted for an iron transfusion in my third trimester, and it was helpful for my runs, as well as for my delivery and recovery. 

Know your body, advocate for yourself, and keep on running!  

References

Anemia is a risk with heavy periods. Here’s what to do. (n.d.). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/menorrhagia/expert-answers/heavy-periods/faq-20058365#:~:text=Heavy%20periods%20lead%20to%20blood,among%20other%20signs%20and%20symptoms.

Precision Hydration (2023, October 2). Should endurance athletes use iron supplements? https://www.precisionhydration.com/performance-advice/nutrition/should-endurance-athletes-use-iron-supplements/#:~:text=This%20is%20because%20of%20the,new%20tissues%20and%20blood%20cells.%20%20https://www.massgeneralbrigham.org/en/about/newsroom/articles/iron-supplements-for-female-athletes

The importance of iron in your body. (n.d.). American Red Cross. https://www.redcrossblood.org/local-homepage/news/article/iron-in-blood.html#:~:text=About%2070%25%20of%20the%20iron,carry%20oxygen%20throughout%20your%20body.