Welcome to another Reader Q&A! For those that are new readers, welcome, and you’ve arrived at a great time. This is the monthly(ish) post where I answer the questions that you guys have been asking recently, and this time around, the theme is iron deficiency. It’s a topic I haven’t gone into detail about for a while and still get lots of emails about, so I figured an update was long overdue.

This post will cover where I’m at now, and specifically, the changes I’ve made over the past year that have led to the greatest progress.

Hi Angela,

I recently read your Running with Anemia post and wanted to let you know how much it’s helped me. I trained and raced 6 half marathons in 2016, but found my energy levels getting more and more depleted as the training went on. I tried taking a full break from training but still felt tired.

Then I found out that I’m extremely iron deficient, and that’s how I found your blog. You mentioned in the post that you were still working on getting your iron back up, and outside of supplements, I’m wondering if there’s anything you’ve been doing that seems to be making a difference. I’m on a supplement now too, but want to make sure I’m doing everything I can to get my iron levels restored ASAP. 

I feel like this is a topic I could talk and write about forever because it’s had such a profound impact on the state of my health and my outlook on what it means to be fit and healthy over the past couple of years. For anyone who is fairly new to the blog, is dealing with anemia, suspects iron deficiency, or is generally just curious about my experience, I’d highly recommend reading my Running with Anemia post first. It summarizes my personal diagnosis, the blood test results, what I did about it, the supplements I took and the nutrition changes I made. Don’t worry – I’ll wait here for you. ?

Oh, and one more thing before we get into the juice of all this: a disclaimer. Just a friendly reminder that I’m not a medical doctor. What I’m about to share is based in my personal experience and is not intended to be consumed as medical advice.

Ok, now let’s chat.

This month marks 4 years since that half marathon where all the problems began. If you’d told me back then that anemia was something I’d still be dealing with 4 years later, I would have either not believed you or been very upset by the thought! But alas, it really has been that long and I’m still taking iron supplements while having my blood tested regularly. It took about a year after the initial diagnosis to find the one that works best for me, I’ve learned that supplementation alone isn’t enough.

2015 and 2016 were years of ok-but-not-stellar athletic performance. I did a lot of half marathons and tackled my first half Ironman triathlon in August 2015. While my keen interest in nutrition and food has been alive and well throughout, what I’ve come to learn is that for me specifically, all the endurance exercise wasn’t really jiving so well with my body.

Post-race with medal

Training aside, there were the demands of my full-time job (and the transition between them), the every-day life stressors we all encounter, and my type-A personality tendencies. The body doesn’t know the difference between different types of stressors, and because I’d been doing all this for so long, operating at the level felt normal. In retrospect I know it wasn’t.

Before I go on, let me be clear: I don’t have any regrets about my training and racing experiences to date. Sure, there were opportunities to do things differently, but in the moment, I loved it all. I still love the thrill, the endorphins, and the full experience of running. The sport was a huge part of getting back to feeling healthy in my late teens, and it’s helped me work through a LOT. The requirement for discipline in training, the long hours spent and the miles logged have taught me more about myself than I ever anticipated. Some of the most remarkable people I know are connections I’ve made through the running community. I firmly believe that all the experiences I’ve had as an athlete to date were required in order for me to gain the perspective I have now.

Running over the bridge in Banff

So what’s changed? 

Quite a few things. I’ve expressed my frustrations in working with family doctors in the past, and have found that the greatest successes I’ve had have been with help of natural medicine practitioners. This has proven to be the case again. Last year I shopped around for a naturopath and finally found one that I feel really comfortable with. We spent a long time talking about my entire medical history, major changes that have occurred in my life, stressors, diet, lifestyle – all the things. I’ll spare you the nitty gritty of it all, but very long story short, most signs (including my gut and my heart, once I got really honest with myself) pointed to the need for some reduction of my self-imposed stressors.

medal from bmo half marathon 2016

Running (less)

Once upon a time I would have been too stubborn to cut back on running mileage. Running helped me lose weight in high school, and even though my education had taught me otherwise, there was still a few stubborn cells in my brain telling me that if I cut back, I’d lose fitness. (SO silly!) Since being diagnosed as anemic I’ve been very aware of footstrike hemolysis, otherwise known as runner’s anemia. The theory is that when we run, red blood cells in our feet get crushed upon impact with the ground. Obviously for endurance athletes, this happens more often because they cover more miles. Some of the doctors I’ve spoken to have never heard of it before, yet there are plenty of studies like this one that suggest it’s definitely a thing. So I figured that I’d do an experiment: cut back on running in favour of other forms of exercise.

But what kind, you may ask? This decision was made in September of last year, very shortly after I pulled an adductor muscle – coincidentally (or maybe not) while running treadmill sprints. I physically couldn’t run or cycle for several months, and I knew that stopping exercise was certainly not going to make me a very pleasant person to be around. So I turned to weights.

This turned out to be a big blessing in disguise. The injury took longer to heal than I anticipated, so for a solid 4 months, I made friends with dumbells, barbells, kettlebells, boxes, BOSUs and anything else that didn’t stress the injured muscle. I did a bit of cross training on the elliptical and stair master to keep my cardiovascular fitness up, but this got boring fast. What really got me excited was how strong I was getting.

My adductor was fully back to normal in January, and I’ve kept up with this strength training emphasis while increasing intensity. (Let’s be real here – you guys know I love to sweat hard). These days my weekly running distance maxes out around 10 miles. I still schedule (and crave) one steady-state run around 40-45 minutes per week. It’s what I like to call my ‘head cleaner’ run because some of my best thinking happens during this time. The rest of the miles are is made up of short HIIT sprint sessions lasting around 15 minutes each, including warm-up and cool-down. Fast, intense, all-out efforts – BAM. Done.

The mind-body connection stuff

On top of the reduction in running mileage, continuing with my usual supplement and increasing the emphasis on strength training, there have been a few other significant changes:

  • Daily meditation and/or stretching – even if it’s only 5 minutes.
  • A weekly-ish hot yoga class
  • Daily gratitude journaling
  • Regularly eating a bit of organic red meat each week. As I mentioned here, it was weird at first having been pescetarian for such a long time, but I’ve become ok with the whole beef thing as long as I can be confident about the quality and source of the meat.
  • Not feeling guilty for taking some quiet time for myself on the weekends to recharge

Weekend matcha collagen latte

The results

Pretty darn positive across the board, in my opinion. All of the above have been part of my day to day routine for a solid 5 months and counting. In addition to being leaner, more flexible and stronger, my digestion is better than it’s been in years. On most days (we all have a few off ones), I have way more energy. Situations that used to make me irritable and snappy don’t affect me at all like they used to. I feel much more at ease with myself than this time a year ago.

Quantitatively, prior to adopting this approach I hadn’t seen my ferritin reading exceed about 25ng/mL. Since January it’s been consistently above 50ng/mL. Having been at <4 in May of 2013, it’s been a long slog to get it this high and that increase in energy tells me that what I’m doing is working.

yoga in the rain at the grouse grind

Photo credit: Britt Gill

Summing it all up

The body is a complex, amazing, fascinating, confusing, and beautiful thing. I get a lot of questions like the one at the beginning of this post, very often from women just like me who want to get their anemia sorted out as fast as possible – usually because there’s races on the calendar, or just because the thought of not being able to run at the same level as they’re used to just isn’t fathomable. Running is part of their daily routine, it’s what they do to get away from problems and to solve problems, to unwind and to become energized. It’s at the heart of some of their social circles, and it’s what they do for fun. I totally get it, because I was there.

In retrospect, the #1 piece of advice I’d offer to any woman struggling with anemia – as hard as it is to hear – is to have patience and to try to be ok with the fact that it’s probably going to take a while. Sure, if I’d listened to a few wise people around me back in 2013 and adopted a lower-stress lifestyle, perhaps I could have restored my iron levels a little earlier. As is the case with many things, this was a lesson I needed to learn first-hand and apparently it took 4 years. Stressing about being iron-deficient isn’t going to make the situation better, and if anything, it’ll just make it harder for your body to absorb the iron (and all the other nutrients) from your food and supplements.

In addition, if you’re willing to come at this with an open mind, I’d also suggest considering:

  • Yoga and meditation (and it doesn’t have to be sitting cross-legged on the floor or doing endless chaturangas. Walking, stretching, and other forms of mindful movement count.)
  • Identifying and reducing sources of stress that you can control
  • Taking a serious look at the type of exercise you’re doing and being open to trying other forms
  • Keeping track of how the foods you eat make you feel (digestion + energy)
  • Making sure you laugh at least once a day
  • Getting your blood tested every couple of months, especially if you’re on a supplement

Lastly, remember that your body is unique and very different to mine and everyone else’s in the world. What’s worked for me might not work for you. If going to a yoga class stresses you out, then don’t do it! Another key learning I’ve had as a result of working with all sorts of doctors over the years is that at the end of the day, when it comes to a lot of health issues, we’re our own best doctors. Intuition is a damn good guide, and the trick is being able to get quiet and honest enough with yourself to hear what it’s saying.

Unlike most posts, I don’t have any questions to turn over to you. Just lots of love to send your way. ?