Ask The Doctor: Anemia In Athletes

Dear Doc,

Over the past few months, I have felt more tired than usual. It's harder to wake up in the mornings for school and I feel like I can't recover from running. I have not changed my training and we are entering the off season but no matter what I try, I still feel so tired. I thought that maybe it was my diet, so I stopped eating meat several months ago but it seems to be getting worse. What can I do to feel better?



Although intense training can cause fatigue, it's important to know the difference between general tiredness versus fatigue due to other causes including iron deficiency anemia. 

What is iron deficiency anemia? It is defined as low iron stores in the blood. Iron is part of hemoglobin, which is a protein in your blood that transports oxygen to all the cells in your body. As an athlete, you can imagine the increased demand for oxygen in your brain, muscles and vital organs.

It can happen to anyone, but is more common in several groups:

Female athletes -- due to menstrual losses and restricting calories

Vegetarian athletes -- iron is less readily absorbed in plant-based diets (but see note below)

Endurance athletes -- increased loss of iron from sweat and other bodily fluids

Growing athletes -- as you grow, your blood volume is expanding rapidly and there is a greater need for hemoglobin.

You may fit into one or all of these categories which is why it is best, as an athlete, to see your primary care doctor on a regular basis to discuss how you are feeling and if any screening or diagnostic tests need to be performed. As much dedication that you put into your training, make sure that you are not ignoring your health and nutrition. 

Note to vegetarians: There are many endurance athletes who are vegetarians, from amateur to professional level, but iron from fruit, vegetable and cereal sources is not as well absorbed as it is in animal sources. Know what foods are rich in iron sources and combine those with Vitamin C for better absorption. The most important thing is that you are eating a diet that meets your nutritional needs. Speak to your doctor. Know what is most needed in your diet and eat foods rich in those nutrients and vitamins. A diet made mainly of whole foods (not processed) is always best. 

Try foods on this list to boost your iron levels and optimize peak performance:

In general, chose lean cuts of red meats, dark poultry and seafood 3-4 times weekly

Iron supplements are available but it's best to get iron from foods sources since supplements come with side effects like constipation and it will be better absorbed from your diet





Dried beans/Peas

Dried apricots




Cold cereal, fortified



Happy Running!


Dr. J's Disclaimer: While I am a licensed medical doctor in the state of Florida, the information presented in this website is for the purpose of information only. Yes, I am a doctor, but I am not your doctor and we have not established a patient-doctor relationship (although I'm so glad you are reading the information in my posts!). Conclusions drawn from the information in this website are entirely your own, created from your own perception, knowledge, and understanding. Actions that you decide to take based on those conclusions are done by your own judgment and of your own accord. Nothing read on this site should be relied upon to replace or overrule a licensed health care professional's judgment or clinical diagnosis

Dr. Johnson is a local physician, ultramarathoner, yoga teacher, mother of two runners and an all-around adventure-seeker.