A group of runners in a park with emphasis on their feet and posture.

What Is Runner’s Anemia?

Perpetual exhaustion and lack of motivation can make it difficult to maintain a running routine. If you’re having a hard time keeping up with your training, an iron deficiency may be the cause.

To help you get some answers, we’ll explore runner’s anemia and explain what it is, what causes it, symptoms, and treatment options.

What is runner’s anemia?

A group of runners running on a bridge together.

Runner’s anemia is a condition that occurs when a runner doesn’t have enough iron in their blood. Anemia isn’t the same thing as iron deficiency. It’s a more severe form of iron deficiency that can have different causes.

Although anyone can be anemic, it’s widespread among runners. Research indicates 56% of joggers and competitive runners suffer from anemia or low iron levels in their blood.1 

Runner’s anemia, specifically, affects runners in one or more of the following ways:

  • Low iron: This is when the body uses more iron than you replenish with food sources.
  • Low hemoglobin: Hemoglobin carries oxygen to the muscles through blood. When hemoglobin levels are low, the muscles don’t get enough oxygen to work correctly.2
  • Low ferritin: Ferritin is a protein that stores iron. Your red blood cells and other body parts need iron, including your liver, bone marrow, and muscles. Without enough ferritin, your body will be low on iron stores.3

What causes runner’s anemia?

A group of runners on a track.

A few individual factors can work together to cause runner’s anemia:4

  • The constant impact of your foot hitting the ground while running can break up the red blood cells in your body and destroy them. This is called foot strike hemolysis. 
  • Your body produces more red blood cells during endurance sports like running. As a result, you’ll need to eat more iron to keep your blood iron and hemoglobin levels balanced for ideal oxygen transportation to your muscles. If you don’t, you may become anemic.
  • When you exercise intensely, your body produces more hepcidin, a hormone that regulates how your body uses iron. An increase in hepcidin can inhibit your body’s ability to absorb iron.
  • You also lose iron when you sweat or menstruate, which increases your risk for runner’s anemia.

A low-iron diet could potentially cause iron deficiency, but that’s much rarer in adults unless a runner is dieting, restricting their calories severely, or eating a vegan or vegetarian diet. Maintaining a well-balanced diet for runners can help prevent runner’s anemia.

Since endurance sports are a common denominator in all these factors, long-distance runners are more likely to develop runner’s anemia, especially female runners who menstruate.5

What are the symptoms of anemia in runners?

Two runners taking a break on the side of the track.

The symptoms of runner’s anemia aren’t always easy to spot, mainly because you might mistake your fatigue for overtraining or other training-related factors. However, the most common symptoms of anemia in runners are:6

  • Persistent fatigue
  • Shortness of breath
  • Rapid heartbeat
  • Difficulty recovering between workouts
  • Heaviness in the arms and legs
  • Muscle tightness
  • Low motivation
  • Decreased athletic performance
  • Increased likelihood of illness and infections

Not getting treatment for runner’s anemia can also result in additional health issues, such as:

  • Reduced cell function
  • Reduced VO2 Max (the maximum amount of oxygen your body can use during exercise)
  • Thyroid problems

Why should runners care about iron levels?

A group of runners in a park.

Red blood cells contain hemoglobin, a protein that contains iron and transports oxygen to your muscles for optimal performance when you run.

When your body is low on iron, it won’t produce as many red blood cells, and your hemoglobin levels will also decline. As a result, your muscles won’t get as much oxygen, and your running performance will suffer.

So if you’re focused on your running performance, maintaining healthy iron levels is essential!

How to treat runner’s anemia

First, it’s a good idea to see your doctor to rule out any other possible causes of your symptoms. The doctor can test for anemia with a blood sample and look at the quality and volume of your red blood cells to determine whether you’re anemic.

If your doctor determines you are anemic, they’ll most likely recommend some of the following treatment options.

Dietary changes

A view of foods that are high in iron.

Eating foods high in iron can help with anemia. Examples include:7

  • Dark leafy green vegetables
  • Red meat
  • Pork
  • Poultry
  • Seafood
  • Beans
  • Dried fruit
  • Iron-fortified cereals, bread, and pasta
  • Peas 

Also, pairing these iron-rich foods with those high in vitamin C can help your body absorb iron better. Examples include broccoli, melon, strawberries, oranges, peppers, tomatoes, and leafy greens.

Iron supplements

View of various supplements.

Your doctor may also recommend an iron supplement if dietary changes aren’t enough. Since some supplements can have side effects, it’s best to ask them for a recommendation based on your medical history and blood test results. 

Make sure to follow your doctor’s instructions and the dosage recommendations carefully. Too much iron can also be harmful.

Cook in cast-iron pans

View of cast-iron on a wooden shelf.

Preparing your food in a cast-iron pan has been shown to increase the food’s iron levels and help you consume more. Your food absorbs microscopic specks of iron from the pan, providing a more iron-rich meal.

Update your footwear

A woman tying her tennis shoes in a forest.

If you’re an endurance runner and primarily run for long distances on hard surfaces like concrete, your runner’s anemia may mainly result from foot strike hemolysis. In this case, it’s important to replace your running shoes regularly to decrease the impact of running on your feet.

If your shoes are worn down, and you’ve run more than 250 to 300 miles in them, it’s time for a new pair. Maintaining a good pair of running shoes and running on softer surfaces like packed dirt, whenever possible, may help prevent runner’s anemia. 

You might also consider running indoors on a treadmill with Vingo. You’ll still have fun, explore a variety of running routes, and reap the benefits of exercise without pounding your feet on the hard concrete for hours. If you need motivation, check out our guide on mastering long-distance treadmill running.

Key Takeaways:

Runner’s anemia is common in endurance runners, especially among females. Although symptoms can be difficult to identify, the best way to determine if you’re anemic is to have your doctor test your blood. Several treatments for runner’s anemia can help you feel better and improve your performance. Options include dietary changes, iron supplementation, and new running shoes for better support.

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  1. Hunding, A., Jordal, R., & Paulev, P. (2009). Runner’s Anemia and Iron Deficiency. Acta Medica Scandinavica, 209(1–6), 315–318. https://doi.org/10.1111/j.0954-6820.1981.tb11598.x 
  2. World Health Organization: WHO. (2019). Anaemia. www.who.int. https://www.who.int/health-topics/anaemia#tab=tab_1 
  3. Ferritin (Blood) – Health Encyclopedia – University of Rochester Medical Center. (n.d.). https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=167&contentid=ferritin_blood 
  4. Milligan, K., & Milligan, M. (n.d.). Sports Anemia: Anemia in Athletes. https://mospace.umsystem.edu/xmlui/bitstream/handle/10355/13520/AnemiaAthletes.pdf;sequence=1 
  5. Goolsby, M. A., MD. (n.d.). What Female Athletes Should Know about Iron Deficiency. Hospital for Special Surgery. https://www.hss.edu/article_athletes-iron-deficiency.asp 
  6. Iron deficiency anaemia symptoms and treatments. (n.d.).  https://www.nhsinform.scot/illnesses-and-conditions/nutritional/iron-deficiency-anaemia
  7.  Iron deficiency anemia – Symptoms and causes – Mayo Clinic. (2022, January 4). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/iron-deficiency-anemia/symptoms-causes/syc-20355034

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