Dealing with Iron Deficiency

Iron deficiency… it’s super common for runners, especially female runners.

Both last year and the year before, I had the frustrating experience of being super iron-deficient. (In the summer of 2018, my ferritin level dropped to single digits!) It was terrible. I would get super sleepy every day at work around 3pm, then I had no energy left to do anything after work. Running, even hiking in the mountains wasn’t an option… it didn’t even feel fun anymore, I was so drained.

The worst part was that I couldn’t figure out how to solve it. I had been taking iron pills every evening for 2-years straight, but somehow I was still completely anemic. Sure I was running frequently, but it wasn’t super-crazy mileage relative to what I’ve done in the past (usually about 100km a week on soft trails). Both years, it got so bad that I had to go get rounds of iron infusions at the hospital. Each time, I promised myself I’d work harder to figure it out. I wanted to avoid using hospital resources as a relatively healthy person. Plus, the discomfort of both the condition and the infusions wasn’t sustainable.

This year, I think I’ve finally come to figure out some strategies to prevent iron deficiency, while still being able to run. I checked my iron levels about 2 months ago, and they were super strong!

With a goal of helping anyone who struggles with this, I thought I’d share some of the day to day things I’m doing differently this year. Hopefully this can give you some food for thought, maybe a new idea to try!

Winter off-season & cross-training

Every year in the past, I’d sign up for a 100km trail race sometime in late winter or early spring. I love racing at that time of year, because I tend to respond well to cooler temperatures, and it can be fun to have something to look forward to during the dark winter months.

This year, I did the opposite. Except for the Sun Run (road 10k), I didn’t allow myself to sign up for a single running race before May. My rationale was that it would help me to train just a tiny bit less. Instead of feeling the need to go out and do a super long run for a specific race, I’d be more likely to go out, and just run until I got tired. I know myself well by now, and those winter/spring ultras encourage me a little too much!

ski touring in squamish

One of many fun saturyay ski outings this year. This is Nancy in Squamish.

In the place of a winter running race, I embraced winter. I decided that ski touring would replace a lot of my super-long runs, as it’s super fun, comparable fitness, and also very kind on the body compared to running. I expanded my definition of “miles per week” to include ski touring and nordic skiing miles, and then I replaced some of my usual running fun with the lower-impact sports. Typically, I’d have one rest day per week, plus two days where I’d go ski touring instead of running. To help me resist the urge to sign up for a winter/spring running race, I instead signed up for a couple ski mountaineering races. I’d still get the community aspect I love, but it would direct my energies more toward cross-training sports!

Not only was the cross-training lower impact, but it was also way more fun than running in the zero-degree rain every day. When I did run, I felt super well-rested, and I was running much faster because I was energized.

Now that April is here, I feel mentally rested from the slight off-season, and excited to start running more now!

Small nutrition tweaks

First off, I switched my iron pills to a heme variety, which is sort of gross, but I was desperate. (Heme iron is easier for the body to absorb.) I also bought a gigantic Vitamin C bottle to always take with the iron pills. (It increases absorption to take them together.)

When I thought about my daily nutrition, there were no obvious, large changes to make. I’d already started eating a tiny bit of meat here and there. Then I started reading more about iron inhibitors, and I had a few habits to confront.

squamish farmers market

Squamish Farmer’s Market produce! I tried that black kale, the carrots, and the purple cauliflower. So delish!

First, caffeine inhibits iron absorption. I realized that I drink coffee all day long, so that was likely interfering with my body’s ability to absorb iron from meals throughout the day. That’s pretty easy to fix! I switched to only 1 cup of caffeinated coffee in the morning, then I drink this delicious decaf coffee from Rooftop Coffee Roasters.

Milk also inhibits the body’s ability to absorb iron. When I thought about my eating habits, I realized that every night before bed (and right before taking my iron pill), I was having a decaf hot milky tea, with tons of milk and honey. That one was also pretty easy, I just switched the cow’s milk to oat milk. It’s actually even more delicious now! In fact, I became completely obsessed with oat milk. It’s all I drink now. I’m sure this can’t hurt the overall iron absorption, and it’s delicious.

Obviously this isn’t a comprehensive change in nutrition practices, I was just looking for easy wins. For a full list of foods that inhibit iron absorption, check out this article!

Huge shoes!

It may be a rumour, but I’d heard some people who theorize that running is particularly prone to aggrevating iron deficiency because of the foot landing on the ground and killing red blood cells.

To mix things up for my 10k road race training, I bought a pair of Nikes with a ton of cushioning this winter. I intended to use them for road runs, but I noticed that I wanted to wear them on every single run. They were just so bouncy and fun! Suddenly I was never wearing my minimalist trail shoes. All I wanted was the cushion!

running shoes

Since then, I bought a pair of Hoka trail shoes, and I’ve been alternating the two shoes throughout the week.

I can’t say for sure, but I do think the big cushy shoes have helped.

You got this!

That’s all I can think of for now… If you’re struggling with iron deficiency, I feel you. It sucks. Hopefully my experience can help you consider some new ideas. I encourage you to keep trying new things, and that something will work! My iron levels are healthy this year for the first time in 3 years, and I think these strategies played a big role! If you want to brainstorm other ideas, feel free to comment on this post or chat on Instagram. You can find me over there at




Out of Harmony

The first part of my year felt harmonious, if I could use a word to describe the beginning of my year in general.

Then one day in late spring, I set in motion a bunch of crazy life changes that I was lusting about. Just like that, I went from a big company with pretty normal hours, to a start-up with a more dynamic schedule. I became a gypsy and traveled way more than usual, and I transformed from vegetarian to the whatever-I-can-get diet. I stopped practicing yoga without realizing it, and started running, for work projects!

I thought it would be fun to document all the crazy shit that’s happened to me since. Adjusting to the changes has been a hilarious process that I would have never expected!

  1. Achilles Goes on Strike.
    With the extra miles instead of yoga, my Achilles just went to strike on the picket line, and I don’t blame him. We need more rest! More care! What the f***! After three years injury-free, I spent June sidelined. I took up mountain biking for a short stint and almost bought a dual suspension bike during this phase. Until I could run again, then I came back to my senses!

    this is what a sad injured runner looks like. Yep, an idiot! I’m trying to pace a 50 miler here. Don’t ask.

  2. Blisters from Hell.
    After proclaiming myself free to run again, I immediately went and ran 100 miles in 5 days, because it was work-related, and I can make irresponsible decisions when I have built-up energy like that. Typically free of blisters, I acquired a large, blister-upon-blister that spanned my whole right arch, and then became hugely infected. I limped around San Francisco in socks for the rest of the trip, my feet would not go into any shoe or sandal without an onset of writhing pain. Can you imagine?! That much pain, from a blister?I was so grateful to learn this lesson outside of a race. Just not sure what the lesson is. Don’t worry, I’ll never post pics.

    everything on this pile... ow! jean jacket running = bad. shoes = BAD. pack = hatred after 12 hours.

    everything on this pile… ow! jean jacket running = bad. shoes = BAD. pack = hatred after 12 hours. Feet bad!

  3. Chaffing to an extent that no one should ever experience.
    I’m usually lucky that I don’t experience chaffing. Not anymore! At Trailstoke 60k (became 49k) I actually wore “athletic clothing” items for once, and I experienced the worst chaffing of my life. I won’t go into details, except to say that it was where the shorts make friends with the thighs, and it’s so bad that it’s still forming scabs hide from the public, one week later.No one ever should ever publish a picture of such a thing.


  4. Mountain goat named Dale wanting to eat my salty skin.
    I got tracked by a mountain goat all the way down the alpine on a 13’er in Silverton, Colorado. Seriously, this big thing had its big horns pointed to us, and it tracked us until we got into the treeline. James and Tim had to throw rocks so Angel and I could run away, just like primal warfare. I spend so much time outside and I’ve never had a wilderness encounter, but of course, now I do! Just throw it in the basket with all the other experiences I’m gaining! More on that terrifying story, via Tim’s blog here.evil mountain goat
  5. Eating lots of clams like a champion.
    I had the worst-feeling race that I can remember of all time at Trailstoke, blah! It felt like a hyena was ripping apart my insides, which began at kilometer 0 and carried on until the chaffing pains took over later in the race. That’s funny, I thought, I had just come from time in the high altitude on 13 and 14,000-foot peaks, so I was expecting to feel great. But I felt the opposite, and it was kind of a battle to even make it look ugly. Outside of the race, I started sleeping 10 hours a night and still feeling tired as heck. The next day, my blood test introduced me to my new friend, Iron deficiency! The final sign of my issues adjusting to my new lifestyle. I guess it was bad to replace kale with pop tarts? Now you’ll find me in the whole baby clam isle of the grocery store, (those things are really high in heme iron!) or downing them in the parking lot. Hah! Mostly kidding! I take them home and eat with a spoon.
now that I see, there are lots of recipes using clams that would probably taste better than eating them straight from the can.

now that I see, there are lots of recipes using clams that would probably taste better than eating them straight from the can.

I figure this is all a blessing in disguise. Gotta get all the kinks out somewhere, right? And while these are some of the funny, slightly negative things that happened, there have been way more beautiful things. And as I adjust, I’m sure I’ll learn things like rest, clam-eating, proper footwear, proper clothing…

Happy summer trails!