Here's what you need to know...

  1. Low iron will wreck you. When iron levels have tanked, your strength, stamina, and power output will stall out no matter how much effort you're putting in.
  2. Heavy periods and hard training deplete iron levels. Certain females may be chronically depleted and losing more iron than they can keep up with via diet alone. This means finding an effective iron supplement.
  3. Blood tests can reveal deficiency. Ferritin serum levels should be between 50-150 ng/mL for women and men. Get a CBC test to see these numbers.
  4. Many doctors are wrong. They say a ferritin serum levels as low as 15 are fine for females. But women need just as much iron as men. Ferritin below 30 is suboptimal.

If you're exhausted and you're missing workouts, it's probably not because you're weak-willed or incompetent. It could be because your body is seriously screwed up. Don't panic, there's an easy fix.

Thought I Was Dying. Didn't Care.

I was cold, exhausted, and weepy. No energy drink could snap me out of it. No workout could pep me up. These had the reverse effect. I laid on the bed and wondered how people could be alive so easily... because standing felt hard, moving felt hard, being happy felt hard, and thinking felt hard.

When my boyfriend (now husband) called and asked to make me dinner, I didn't know the answer. Deciding was too hard. And I couldn't imagine driving anywhere. So I cried. I wanted to tell him what felt bad, but I couldn't put my finger on it. Nothing hurt, yet everything was terrible.

My arms and legs felt like lead. I walked out on a group fitness class because the mini-barbell was too heavy to hold. Incidentally, that was the week a nurse rejected me from donating blood because my iron wasn't high enough. And finally, sometime during that same week, it occurred to me that there may be a connection between the two experiences. So I started supplementing with iron and within days became more like normal – decisive, happy, strong, and energetic. Though I probably remained iron deficient, supplementing was just enough to dig myself out of anemia.

Now, I'm not a doctor, and I don't recommend blindly supplementing for a deficiency without proper blood tests and a doctor's recommendation. But I've had to relearn the iron lesson over the years, thinking a diet high in spinach and red meat would do the trick. Nope. Low iron is no joke, and diet isn't enough to keep it from creeping up on me. Here's what you need to know to keep it from creeping up on you.

What the Heck Does Iron Do, Anyway?

Iron, an essential part of hemoglobin, helps your blood cells deliver oxygen to your muscles, brain, and all other organs. So it only makes sense that not having enough can slow everything down and make you feel lethargic, weak, cold, and crappy.

It doesn't matter how much red meat you eat, if your iron levels are chronically low you'll need to supplement. If you're a runner, a lifter, a woman who exercises hard, or a woman who has heavy periods, you probably can't out-meat an iron deficiency. Sure, you might feel better with an extra steak here or there, but that's just because steak is delicious – not because your iron is optimal. If it's chronically low, then to get it up and keep it hovering at optimal levels, you'll need to supplement as consistently as a druggie shoots heroin.

Low iron is less common in men because they're not losing blood every month like women. But men who are endurance athletes, regular blood donors, or those who have internal bleeding or other conditions that cause blood loss are at risk for low iron too. Likewise, postmenopausal women can have low iron if they kick ass in the gym or do any endurance sports.

A Slight Deficiency Sucks Too

Even if you're not low enough to be considered anemic, a slight deficiency can cause some junk you're probably not even aware of. Low iron is associated with:

  • Cravings
  • Cold intolerance
  • Constipation
  • Depression
  • Dizziness
  • Fatigue
  • Hair loss
  • Headaches
  • Irritability
  • Muscle weakness
  • Non-restorative sleep

And that's the short list. When my iron dips low, I get mini-blackout spells and dizziness when standing up, which makes loading a barbell or setting dumbbells on the ground after a set of walking lunges interesting. I've also dealt with a fungal infection that lasted a month and made life complete hell. Turns out, those have been linked to low iron, too.

Adequate vs. Optimal Levels

Want to examine your iron levels? The blood test is called a CBC (complete blood count) and a serum ferritin test. Look at your ferritin serum (ferritin is the protein in the blood that carries iron). It should be at a minimum of 30 ng/mL but ideally hover somewhere between 50-150 ng/mL. These numbers come straight from Dr. George Juetersonke, a progressive D.O. He says anything below 30 is too low.

When do you put gas in your car? When it runs out and you break down in the middle of the freeway? Or do you check the gauge and add gas when it's low? Most doctors won't tell you have low iron until your "car" is broken down. You practically have to be anemic before they'll consider getting you to improve it.

Why wait till your life sucks if you can improve your iron when it's merely suboptimal? Problem is, most general practitioners say anywhere from 15-150 ferritin serum is fine. So, if you're at what they consider an "adequate" level of 15, and you feel sluggish, weak, and bummed out, your doctor may diagnose you with something else or tell you you're just fine... because hey, your ferritin serum is adequate! Now, all you need to do is deplete your iron a bit more, feel worse, and maybe then he'll advise you to get it up.

At a ferritin serum level of 18 ng/mL, I've been told my iron deficiency is "moderately severe" and I need to supplement ASAP. So my doctor has begun testing and monitoring my blood levels until he can see that I'm hovering around 80 – five times the amount most doctors think is sufficient – because he wants his patients to kick ass, optimally.

And get this: most doctors say that the healthy range for men is between 50-150 ng/mL. Yet it's okay for women to be as low as 15? Bull. Body size and musculature don't account for such a large discrepancy. Do you really need that much less iron? Heck no. Despite what many general practitioners will tell you, both men and women need ferritin serum levels between 50-150. Doctors differ on this standard, but you'd rather be in the higher range than anywhere near deficiency.

Red Pills

How Do I Get It Up?

These foods contain the most iron: meat, liver, poultry, seafood, dark leafy vegetables like spinach, legumes, and actual human blood if you're a vampire or cannibal. Combining them with foods that contain vitamin C will increase iron absorption. And while dietary iron is great, supplementation may be the only way to get yours high enough and keep it there if your periods are heavy or you're doing a lot of exercise. I'm a carnivorous woman, but five meals of red meat a week just barely keeps me above anemia. So supplementation is essential.

Look for supplements that contain any of the following:

  • Ferrous sulfate
  • Ferrous gluconate
  • Ferrous fumerate
  • Ferrous bisglycinate
  • Supplemental iron that comes from whole food sources like liver or beet root

If your iron levels are extremely low, you may need a serious supplement that contains much more than the typical daily recommended amount. Even at this high an amount it may take several weeks to raise your iron to optimal levels. Once you get it there, you'll likely be able to decrease the amount you're taking to maintenance levels. This is why it's important for you and your doctor to monitor your labs. Excessive iron levels can lead to major problems too.

The unfortunate side effect of iron supplementation is constipation. Luckily there are non-constipating iron supplements. You can also ameliorate the problem with a magnesium-containing supplement at night.

Depression or Anemia?

One in four women in the US are on mood-related drugs. Are a quarter of all American women really depressed, anxious, bi-polar, etc.? These are real biological issues, no doubt, but if they're also a consequence of anemia or another similar problem, then fixing the root will fix its debilitating symptoms too.

So if you don't know you're anemic and you go to a doctor with the feelings described above, there's a chance you could be diagnosed with depression, chronic fatigue, or something else. What if I'd been prescribed Prozac years ago when I cried for no reason, felt apathetic most of the time, and struggled to function normally? I would've had to deal with the side effects of a drug on top of being anemic.

The Hypothyroidism Connection

Your thyroid hormones play a huge role in your metabolism. So hypothyroidism is bad news. The other bad news is impaired thyroid production and low iron levels are intricately linked.

A lot of doctors disagree on which comes first: Does impaired thyroid hormone production lead to low iron levels? Or is it the other way around? Well, yes... and yes. My own doctor has said that a lot of women are misdiagnosed with hypothyroidism when really their iron levels are just low. But there are other doctors who say that low iron is a consequence of hypothyroidism. Both are correct.

It's true – impaired thyroid function (and all the things that come with it, like digestive and gut issues) can keep you from absorbing nutrients, making it nearly impossible for a person to even use the iron they're consuming and supplementing with. Conversely, inadequate iron levels can impair thyroid function.

So if you're going to get you're the CBC test, you'd be wise to get your thyroid hormones checked too. And if you can, find a professional who will help you navigate these things. If you don't get relief, find another professional or do more of your own research on these things.

Get Your Blood Tested

Find a doctor who will make you a proactive participant in solving the root of the problem, or get your blood tested yourself and see firsthand what your numbers are. Be in the loop on your own health because if your doctor is behind the times you'll suffer the consequences.

The best doctors will make you smarter about your own body; the worst will keep you in the dark or give you bad advice. Just remember that if needed, you can go get your blood screened without a doctor's oversight. Know what kind of tests to get and what numbers to look for.

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