Q+A: How can a vegetarian eat enough iron?

Our experts answer real-life questions


Posted: 9 September 2000
by Ellen Coleman

Q A few years ago, I was diagnosed with anaemia. Eventually I was able to correct it, but now I’m feeling anaemic again. I’m not a vegetarian, but I’m sure I need more iron. Can you recommend a diet that will give me enough?

A It can be a challenge for female runners to get their recommended daily intake of iron (18mg). Here are four strategies that should help:

1. Eat lean red meat. Iron is absorbed better from animal sources than from vegetables, so try to eat two to four servings of lean red meat per week. Also, combine animal and vegetable iron sources at the same meal to increase iron absorption from the vegetable source. A good dinner selection would be a meat and bean casserole. Good iron-rich vegetarian foods include beans, peas, split peas, dark-green leafy vegetables, grain products and iron-fortified cereals.

2. Consume vitamin C along with iron, as it enhances iron absorption (eg drink orange juice with an iron-fortified breakfast cereal).

3. Prepare food in cast-iron cookware. This will increase your iron intake, as iron from the pots and pans leeches into your food. The more acidic the food and the longer you cook it in the iron pot, the more iron you’ll take in.

4. Runners with a high risk of anaemia (eg menstruating women) should have their iron levels checked routinely. Get your doctor to review your plasma ferritin (storage iron), transferrin (transport iron) and haemoglobin, as such tests can detect iron deficiencies early. Once you have an accurate diagnosis, it shouldn’t be hard to increase your iron stores through diet or iron supplementation.

Ellen Coleman, nutritionist and author of Eating For Endurance


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Over the last few months I've been struggling with my running. Despite regular training I was getting worse and couldn't run up hills. When I came last in a 10k I decided I needed to get checked out! My doctor did various tests and diagnosed me as very anaemic 7.9. He was very suprised to find that I didn't have more symptoms apart from my running performance. I've now been treated with iron and am feeling much better and enjoying running again.
My doctor has arranged for various investigations because he is concerned about the cause of it. I've never had a problem with anaemia, even when I was pregnant. However, a few people in my running club have said that running can cause anaemia (I started increasing my running last year to 20 miles a week, although I have always done some exercise). Can running cause this degree of anaemia and if so why? I'm keen to find out as the doctors don't seem to think it has anything to do with it.
Posted: 12/07/2004 at 14:49

Hi Liz,
I, too, experienced a serious relapse in training which sent me to the doctor who diagnosed very low iron stores. The general population should have stores at 50-90 (whatevers), endurance sports people should be somewhere as high as 200 and I was 10! Only at about 300+ are you ODing on iron (and you can, the symptoms are very unpleasant). My doctor explained that for some the very act of running can reduce iron and if you want to run (and who would discourage it?) it just means that you have to be on suppliments permenantly. However, I have now been taking high dose iron for three months and only feel a little difference. For me, and possibly for you, absorbtion may prove to be the problem which can be linked with B vitamins, vitamin C or eating/drinking something that interferes with take-up. Tea, for instance, reduces effective absorbtion.
So, yes, running can definately have an effect on iron levels. Hope you get it sorted. Come to that, I hope I do too!
Posted: 22/07/2004 at 21:39

Drinking orange juice with your iron supplements will help absorption. Some people don't handle the ferrous sulphate that doctors prescribe too well. I've heard that a liquid iron supplement ( called floradix I think) available from health shops can be easier on the stomach.
Posted: 23/07/2004 at 09:03

Try Spatone (available from Boots or Holland and Barrett) - its more expensive (about £6:00 for one month's supply) but more easily absorbed so might help.

Jules
Posted: 23/07/2004 at 09:11

I've had anaemia from running. I was told it was through losing iron in your sweat. Get in some liver, lentils and mussels all washed down with orange juice and avoid tea and coffee which affect absorbtion.

Posted: 23/07/2004 at 13:14

The artical this thread refers to is "Q+A: How can a vegetarian eat enough iron?" and the 1st pint reads: -

1) Eat lean red meat ....


DOH!
Posted: 17/08/2004 at 14:22

Tee hee.
Posted: 17/08/2004 at 15:06

I was struggling with my running and had low iron levels detected when I went blood doning. GP not very helpful, sent for a further blood test. Path. lab. recommended taking vitamin B12 which has really helped improve breathlessness. GP's receptionist advised taking iron tablets which I had no intention of doing due to side effects in the past. It is a bit frustrating when you are trying to improve your own health and gain specific medical advice to achieve that but you are not a priority as you are not really poorly.
Posted: 06/12/2007 at 10:57

I have just had blood tests because my legs were feeling really heavy and tired and I suddenly couldn't run further than 2 miles before having to stop even though I am in the middle of marathon training.  The doctor said I have 13 'whatevers' and said an average person should have around 70.. Have only just begun taking Ferrous Sulphate tablets so don't know how well they will work, fingers crossed.  I am vegetarian but thought I had been doing well with the number of beans and greens I eat!

So I am upping my intake of spinach, vitamin C (to help with absorption of iron) and - dark chocolate! I have only recently found out that running uses up more iron..

Apparantly (thanks to Artful Hen for this... which she got from her book 'Advanced Marathoning' by Pfitzinger and Douglas)

  • Runners tend to have lower iron levels than sedentry people
  • Marathon runners tend to have lower iron levels than runners who do shorter distances mainly due to higher training volumes
  • Iron loss in runners happens because of  increased blood volume (ie less iron to go round); low iron intake (partic for veggies but also the high carb/low fat, low cholesterol diet means runners don't eat much red meat; foot strike haemolysis - particularly if most running on roads or fat; iron loss through sweat and urine (not so much unless training in hot conditions - the amounts are miniscule, but runners sweat more for longer); and iron loss through the GI system - a prob for some marathoners: GI tract bleeding!!  Again, a tiny amount, but over a period of time...

Posted: 18/03/2008 at 11:39

Yup, been there, done that!

Dried apricots are also fab - with having vit C in them too, they aid absorption of the iron.

I found ferrous sulphate helped pretty quickly - I felt a good bit better within a week, and continued to improve for a few weeks.

Enjoy the black poo!


Posted: 18/03/2008 at 12:22

Oh thank you Nessie, I had been worried it might take a long time to feel the affects so glad to hear it only took a week for you.
Posted: 18/03/2008 at 17:59

You can't imagine how much better I feel for reading this!  Obviously, not that you've all been through a tough ride with a decline in your running, but to know that I'm not alone and that maybe there's a valid medical reason for my recent poor performance at local races is very reassuring 

To feel like you're on the up, putting a PB for a 10k and then to complete a slightly shorter race, just weeks after, in a far slower time (I'm talking 3-4 minutes, not seconds) and to start to be beaten others   that you're usually beating by minutes, really knocks the confidence and starts to make you fall out of love with running.

 Having only found running in the last 18 months (and I'm in my 30's now and 5 stone lighter than I used to be), I was beginning to wonder if my PE teacher at school was right, when they wrote in my autograph book on the day I left secondary school, 'another world beater bites the dust'. That's stuck with me all these years and I know I'll never be the best, but to take such masssive backward steps, so quickly, doesn't sit right.

I'm going to the doctors for a blood test next week, so hopefully I'll have confirmation that this is my problem too (and hopefully not just that I've just gotten really c**p at running) and I'm hoping with the right supplements, I'll be back on the up.

 Thanks for inspiring words.


Posted: 19/06/2008 at 13:20

I too fle tthat tired feeling and yes it was low iron and now its low B12.  I have been taking iron tablets but  have been told to give them a rest and try and increase my daily food allowance for B12, i find this hard especially been a vege and a faddy eater, so extra cereal is what i am doing.  I didnt realise running would contribute to this
Posted: 19/06/2008 at 18:52

Hi everyone!

To report back on my progress - I felt the effects of my iron tablets within about 2 weeks I'd say. Didn't manage to get in any more long runs before marathon day but decided an extended taper (5 weeks) might have been what my body was crying out for anyway. Managed a tiny (15 second!) pb so all was not lost and I did feel loads better after the tablets started doing their thing.

The tablets (ferrous sulphate) have been playing havoc with my stomach a bit but only got a couple of weeks left of them anyway so have been sticking it out. Low point was actually last Weds eve when I had to take an extremely unpleasant 'pit stop' in a field in the middle of a 10 mile road race Sorry if nobody wanted to know that!!

I also got called back by GP to be told I had low vitamin D levels too so been put on calcium+vitamin D tablets... so I should feel like Superwoman in no time apparently! 

Kathryn - if you've not injured yourself and there's no other obvious reason why you have got slower then sounds quite likely it is lack of iron or similar so fingers crossed the blood tests will shed some light for you. It was a massive relief when I found out I must say. Good luck! 

Suzanne - I am 'faddy' eater as well as a veggie too, it's not the best... but have kept up with the spinach and vit C and am definitely thinking more about what I eat now. Sounds obvious to me now but it's clear what I eat really does have a direct affect on my running. 


Posted: 19/06/2008 at 20:28

Thanks for that and yeah food definately does affect the way we train.  Running has been the best thing to help me eat better, but i'm injured at the moment so not a happy bunny...
Posted: 21/06/2008 at 08:03

Ah.... didn't know that running impacts on aneamia.... explains a lot too. I started training last autumn half heartedly and increased it to a proper schedule in January but then was unable to donate blood as I was anaemic again and have to leave it till September now. I have increased a lot of my green veg intake and vit C and all that but have also increased my training and yesterday  on a regular route I found it to be real hard work.

So from going off the advice you lovely people have posted I am going to have a chat with a pharmacist about getting an appropriate multivitamin to cover all bases!! I am not  so much a faddy eater as I get IBS and so sometimes I can't stomach fruit and veg and sometimes I can't stomach wheat based stuff but it varies and adds to the fun fun fun of it all!!


Posted: 26/06/2008 at 10:41

Hi Lucy - glad this thread has helped. multi-vit sounds a good idea... I've nearly run out of iron tablets so definitely going to do the same and get some good vits that contain iron for when they do.

Such a pain that diet has to affect our running ability in so many different and awkward ways!  


Posted: 26/06/2008 at 23:34

I feel so much better having read all these messages. It is reassuring to know that my problem is common especially among female runners.

The past 8 months have been a disaster as far as running and competing have been concerned. I've wasted lots of money on entries to races that I ended up not doing!

I couldn't run all winter because of  injury. Once the Achilles tendinitis and heel bursa had cleared up I found I couldn't run because my legs felt heavy and I couldn't breathe. In the past few years I have run a marathon and completed two half ironman triathlons so it didn't seem right that I couldn't get up a hill without stopping. I put it down to a busy life and old age (I'm 43!) and just got more and more frustrated. Soon I began to dread running - when I used to love it. I stopped training with my club as I couldn't keep up.  After a few months of increasing dizziness,  insatiable cravings for rocket and spinach (I'm a veggie!)  and unwanted weight loss, I decided it was time to see the doctor. The upshot of t he blood tests is that I am anaemic  (haemaglobin of 9) so have been prescribed iron tabs and am being investigated for coeliac disease and to see what my ferritin levels are.

 Looking forward to feeling and running better soon - although I've been told it can take months rather than weeks.


Posted: 07/07/2008 at 23:03

I have also suffered with anaemia, the kind that affects the stored iron rather than the hb levels. At my worst I had only 3 'irons'  (as they're referred to in our house), and after 6 months on the ferrous sulphate tablets I still only have 17. I managed to get it up to 21 at one point, but it seems my body just doesn't like it! I can only manage 1 tablet per day, as I have IBS too and it interferes if I take more than 1.

Suffice to say broccoli is my new best friend! As long as it's steamed and with a nice big steak  (sorry veggies!). Can't stand liver, but love spinach etc. And I always try and take my tablet with orange juice.

I think it's going to be a permanent thing for me, my doctor told me if it was going to go back up to normal levels (20-200ish) it would have done by now. Bizarrely I can still give blood, which is really important to me. Weird eh? I can tell when it's a bit worse than usual, I have no energy whatsoever, and just walking around at work is an effort. Fingers crossed it's ok(ish) at the moment, but it's nice to know that plenty of other people are in the same boat


Posted: 08/07/2008 at 09:39

Well, I've had the results of my latest blood test and my ferritin is only 3! So, I have to have a long lay off from running and will probably be on iron tablets for at least 6 months. I don't know how I'm going to be able to cope without the buzz of running but hope that it will be OK still to cycle and swim a bit.

 And yes, another race entry bites the dust  - I was meant to be doing a local triathlon on Sunday but have been forbidden to. This is probably a good thing as I really don't think I could run the 10k at the end of it.

Anyone had a similar experience who can tell me just how much training is OK and won't jeopardise a speedy recovery?


Posted: 12/07/2008 at 14:08

Jenny, sounds like you're in the same situation as I was about 6 months ago, my ferritin was only 3 when it was first picked up on. At the time I wasn't training much as I was just soooo tired (fell asleep waiting to see the doctor  at one point!), but my doctor told me if it made me feel better, a short run a couple of times a week was ok.

I hope you start to feel better soon, it's horrible feeling so rundown and tired xx


Posted: 13/07/2008 at 12:11

Thanks for that, little lawyer. I will try a couple of short runs - ideally without any hills!

How long did it take for your ferritin levels to go up?


Posted: 13/07/2008 at 14:32

erm... I had it tested every 3 months, and it went from 3 to 15 to 21 to 17. Apparently the lowest it's supposed to be is 20, but my doctor now reckons it's not going to get much better and doesn't think I need testing again for 6 months. I do feel much better now than I did back then, still not 100% but nowhere near as bad.

I can tell if it gets a bit low again, I get more lethargic and go and attack the broccoli and spinach! You'll get more tuned into it as time passes, you'll recognise when you're just tired or when it's more than that.


Posted: 14/07/2008 at 10:43

Thanks - your comment about the broccoli explains my insatiable cravings for rocket over the past few months. Been getting through bags of the stuff!

So, looking at your blood results, it could take up to 9 months to be back to anything near normal. A sobering thought. ...


Posted: 14/07/2008 at 11:03

Hi All - I was just browsing when I came across this thread. 

 Please can someone list their symptoms for me. 

I have seen a gradual decline in my 10k times, and my training schedule is much shorter than it was at the beginning of the year, although it does contain more speedwork.  Between January and March, I was running 35+ miles per week, now I am only running a maximum of 25 miles per week and yet I am feeling incredibly tired. 

I had to walk home from my long run last night.  I was only 2 miles into it , but was heavy legged, I couldn't catch my breath, was sweating profusely and generally felt a little sick.  This was after falling asleep for 3 hours in the middle of the afternoon.  Over the past couple of weeks, I have been needing a sleep when I get home from work too.  Does this sound familiar to you?  I guess the answer is to see my doctor for a few blood tests and go from there.


Posted: 14/07/2008 at 11:28

Jenny - it's entirely possible your levels could go up quicker than mine. I think to be honest my body doesn't like the ferritin very much and is fighting whatever I try to do. Everyone's different, so don't get too down about it. I hadn't thought of rocket, must try that  I really wish fruit had lots of iron in it, as I'm much more a fruit person than a veg person, which doesn't help!

RS - I was incredibly tired all the time, falling asleep at the drop of a hat (including at my desk, waiting to see doctor etc), and put weight on. To date I've put a stone on, and am struggling to shift it.  That said, everyone's different, definitely get your doctor to do the blood tests, the results should come back after a couple of days.


Posted: 14/07/2008 at 11:47

Has anyone had low B12 levels, last time i went to the doc i was told this.  I've read this can cause some tiredness, but also if too low is irriversible, attacks the nervous system.. Does anyone know anymore facts on B12 deficiency or is suffering too. 


Posted: 14/07/2008 at 18:15

Off to the docs tmrw. Just been turned back from giving blood for first time in 20 years for having a too low Hb count 13.1. Training has been hard work the last 2 months and my  times are worsening.

At 41 was beginning to think that something more sinister could be developing, but now a bit more reassured since this  issue seems  more prevalent in runners. I usually train about 13 miles a week with a 10/13 mile run at the weekend, Looks like iron tablets for me.


Posted: 06/08/2008 at 20:53

Felt tired all the time after doing my third London marathon in April and after couple of weeks off (one with a nasty cold) tried to ease into running but legs like wood and worsening on every outing so had blood test.  I have just started Ferrous Sulphate x 2 a day due to low ferritin 13.6 (don't know what hb is).  Not sure how much running I should do though as surgery advised that it'd be ok but I'd feel breathless and entirely my choice!   Any thoughts please?  Oh, I'm post menopausal and wrong side of 50!
Posted: 04/06/2009 at 12:47

This might be a silly question but do you feel worse when you've got your period when you've got an iron deficiency?  I've never been allowed to give blood due to low haemaglobin (or however you spell it) levels and its not something that's affected me.  Then recently I've upped my training quite a bit and felt fine until I had my period and I felt completely wiped out the whole time.
Posted: 04/06/2009 at 14:35

I'd probably say take it a bit easier on the running this week but after a week or two on the iron tablets you should notice an improvement and then you can get back to training normally.  I had really low iron levels about 2 months ago (not sure which reading is the ferritin and which is hb but one was 2 and the other was 9.5) and after being on the iron tablets for 2 weeks I noticed significant improvements. 


Posted: 04/06/2009 at 15:33

Hold on, going back to someones comment about enjoying black poo, well I noticed this recently, does this show lack of iron in my blood? I've been struggling lately with my running..
Posted: 05/06/2009 at 17:35

twixx

the black poo they were talking about comes from iron supplements.

 If you are not taking iron supplements, you should go and see your doctor to check what is causing it . It could be nothing but it might have a medical cause. Better safe than sorry.


Posted: 06/06/2009 at 22:49

Thank goodness!  I'm another one!   I've had low iron on and off for years, with symptoms mainly of slower running, dizziness and shortness of breath (and sometimes scary mood swings!)  I didn't know that running itself (rather than just being very active generally) depleted your stores, but it will be nice to be able to explain my better half that I'm not alone! 

Thought I should mention that often your haemoglobin can be ok, but your ferritin can be right down and my surgery only test for ferritin if I specifically ask them to- so don't just ask for an iron test - be specific!  Oh, and another symptom I had was insatiable cravings for crunching ice.  Weird.


Posted: 08/06/2009 at 11:27

Thanks Gemma, I do feel better now after a couple of weeks on the iron tablets although I'm still a bit breathless when I run and it still feels hard but fingers crossed it will get better in time and with patience!  Not very good on the patience front I must admit!!!


Posted: 17/06/2009 at 15:22

I was diagnosed with Coeliac Disease in  1984. This an allergy to Gluten and will cause anemia through mal-absorbtion. GP's are more familar with this now but still overlook it sometimes.
Posted: 07/07/2009 at 11:30

Hi,

I have struggled with aneamia for a few years - on iron pills but my levels go up and down, and it has certainly affected my running.  Some days I do well then - boom - I can hardly lift my legs, feel breathless and just so very, very tired!  I'm 35 and some days feel 95 but I love running. I have accepted that I won't break any land speed records and try to focus on enjoying my runs and appreciating my surroundings rather than get hung up on times.  If I'm feeling strong, I might push myself a bit  in terms of distance and speed but I do try to ensure I have rest days and taper weeks. Best advice I can give is listen to your body and accept that traditional training schedules can be difficult to stick to with this condition so it's easy to feel like you're not progressing  - just do what you feel able to and be kind to yourself! At least we are keeping fit and not letting it hold us back - we have brilliant endurance!


Posted: 09/07/2009 at 22:33

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