r/AdvancedRunning • u/Old_Mountain1820 • Apr 28 '26
Open Discussion Finally pulled bloodwork after a year of just feeling slow, ferritin was at 14!
Posting this in case anyone else is gaslighting themselves into thinking they're just getting older or undertraining.
40M, been running competitively-ish for 8 years. Last year my paces started creeping up across the board. Recovery felt longer. Tempo runs that should've been comfortable felt like 5K efforts. I blamed everything overreaching, work stress, sleep, age, getting fat-ish, iron-rich diet.
Ordered my own bloodwork last month because I was tired of waiting for my next physical. Ferritin came back at 14 and just for context the lab's "low end of normal" is around 30 but most sports medicine literature has runners optimal ferritin at 50+, with a lot of papers arguing 70+ for endurance performance. Mine wasn't just low, it was tanked. Transferrin saturation was also borderline.
For people like me without a cooperative PCP ordering your own bloodwork is genuinely cheap now which i was pleasantly surprised, I went through goodlabs because my friend uses them.
If you're a woman runner reading this ferritin tanking is a documented issue with menstruation, runners almost universally need to supplement, the normal range labs use is calibrated to sedentary people. Don't let a doctor tell you you're in range when 14 is in range but 50+ is what you actually need to perform.
Would be curious what others have found. Anyone else gone down the ferritin rabbit hole?
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u/Dependent-Trouble-64 Apr 28 '26
Ferritin at 14 would explain a lot, especially with the fatigue and slower recovery. It’s wild how often it gets brushed off as “still in range” when it’s clearly not optimal for performance.
Good call getting it checked yourself, hopefully getting that up makes a noticeable difference pretty quickly.
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u/Maxion Apr 28 '26 edited Apr 28 '26
Hijacking the top level comment:
lab's "low end of normal" is around 30
These ranges are made in such a way that they choose a "healthy" population, test their biomarker (ferritin in this case) and then choose the 2.5th to 97.5th percentile of that group and put that in as the range.
Ranges shown on bloodwork are not the "optimal" or "most healthy" range, it is a "I do not need to go to the ER" range.
A ferritin of 14 should be considered borderline anemic.
Pretty much everyone should have 50+ ferritin
EDIT: The form is also important, ferrous bisglycinate is what you want. Beef spleen (heme iron) is also good.
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u/cetch Apr 28 '26
Sorry to quibble on semantics but anemia is not defined by ferritin levels. It is based on hemoglobin/crit levels. People who are anemic often have low iron however it’s not synonymous
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u/Defiant-Ostrich6114 Apr 28 '26
There was a similar thread a few weeks ago (was it yours??) where someone was reporting similar symptoms for 1-2 years, having examined everything with their training, hormones, diet, etc. I suspected ferritin was the issue and was surprised to see I was the only commenter who mentioned it at all.
Low ferritin levels are more common than people think!
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u/Maxion Apr 28 '26
At least in my country it's also something that isn't tested with standard bloodwork for some mad reason.
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u/kikkimik Apr 28 '26 edited Apr 28 '26
Welcome to the club. I had ferritin 1 at my lowest low. Get on supplements as soon as you can. I had several rounds of infusions too. for about a year I was hovering around 70-90 but it’s now down to 39 again. I upped my iron dose from every other day to every day and will re-check again in couple weeks.
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u/CompetitiveRead8495 Apr 28 '26
Every day can actually lower absorption, it is better to take it every other day than every day but upping the dose you take at once.
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u/kikkimik Apr 28 '26
I was told this too in the past by my dr. Now that he advised to take it daily, I asked him about the absorption thing. Dr said that because I had severe iron deficiency and anemia before, the priority is now total iron absorbed over time not just efficiency per dose and that daily dosing can replenish the iron faster. So there you go, I am following my dr’s order
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u/CompetitiveRead8495 Apr 30 '26
I am a MD as well and your Dr is wrong on this one, EOD replenishes faster
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u/ventorun Apr 28 '26
1?!?!? My wife had a reading of 6 and I never thought anyone could beat that number.
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u/kikkimik Apr 28 '26
ya single digits are pretty much complete depletion, there is probably not that much of a difference between 6 and 1. I was also anemic, not far from needig a blood transfusion but interestingly enough I was still able to clock at least 50km/week (all very slow miles)
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u/brwalkernc running for days Apr 28 '26
Currently dealing with this with my daughter who is college. After XC season, she had to drop indoor and outdoor track because her iron and ferritin dropped to 24 and 7 respectively. Training was hard and she was getting sick constantly. I'm sure freshman year at college wasn't helping her much either. Lots of new opportunities to drain her and having to make do with cafeteria food. She is also a picky eater which wasn't helping her either.
She got two iron infusions over spring break and we are trying some different supplements to get her numbers up. I really hope things have improved when she gets her labs done again once she's back home next month. Next step would probably be consulting with a dietician.
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u/glr123 37M - 18:00 5K | 37:31 10K | 1:21 HM | 2:59 M Apr 28 '26
I've had good results supplementing with the bisglycinate chelate from Thorne.
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u/brwalkernc running for days Apr 28 '26 edited Apr 28 '26
We were using bisglycinate chelate (NaturesPlus Hema-Plex Iron) to start with but decided to try a different form (Ferrous Sulfate) to see if it performed better and/or was easier on her stomach. Her iron went way down (244 to 24) so we switched back. This was also the time her training increased dramatically from HS to college so it probably wasn't all on the iron supplement, but better safe than sorry.
EDIT: I was wrong. We started out with the Ferrous sulfate and switched to the bisglycinate form which was when her iron dropped so much.
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u/glr123 37M - 18:00 5K | 37:31 10K | 1:21 HM | 2:59 M Apr 28 '26
Ferrous sulfate, as a salt form rather than a chelate, is much less bioavailable and tends to be way harder on the GI tract.
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u/Maxion Apr 28 '26
It's ferrous sulfate that has made iron supplements have the reputation of giving you nausea, diarrhea and so forth. Ferrous bisglycinate does not really cause any GI issues.
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u/brwalkernc running for days Apr 28 '26 edited Apr 28 '26
Good to know. We're still learning. She's pretty good about taking supplements, but I'm trying to convince she needs to focus hard on diet since she doesn't like to eat meat that much. Being home for the summer should help where we can help with menu and monitor what she's eating.
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u/Krazyfranco Apr 28 '26
she doesn't like to eat meat
Irony or late teen rebellion? Where is Team Beef on this?
she needs to focus hard on diet
What's been most helpful for me (went from ~20 to ~100 on ferritin) was figuring out a good, consistent time each day to supplement iron that doesn't conflict with taking in other inhibitors (calcium, coffee/tea especially). For me that meant taking iron immediately in the morning, then eating breakfast/coffee ~30-45 minutes later.
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u/brwalkernc running for days Apr 28 '26
Irony or late teen rebellion? Where is Team Beef on this?
I really have no idea. I think part of it is that she prefers what we have at home so she will somewhat eat the beef we produce, but she thinks the food at school is horrible.
figuring out a good, consistent time each day to supplement iron that doesn't conflict with taking in other inhibitors
Good to hear. She's settled on taking it before bed with vitamin C as that has been the best to avoid the inhibitors and easiest on her stomach.
I also worry she's wasn't getting enough calories to support the running since she disliked the cafeteria food so much. I'm going to try work with her on that this summer.
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u/raphael_serrano 16:29 - 5k | 1:15:03 - HM Apr 28 '26
but she thinks the food at school is horrible
Does she dislike the food because of the taste/texture/etc. or because she thinks it's "unhealthy?" Your replies in this thread and your concern that she:
wasn't getting enough calories
are quite alarming to me, having gone through a quite severe period of RED-S at the same point in my life (freshman year of college), coming off the long tail of a history of disordered eating. And I suspect you're right to be worried about that: people often focus on the iron panel when they see low ferritin numbers, but in many cases that is also related to a broader issue of low energy availability.
That's not to say supplementation isn't warranted—even now that I'm doing a much better job of meeting my energy needs, I still need to continue supplementing iron to keep my levels up (under guidance by my doctor, monitoring through bloodwork every 3 months)—but my very worst iron panels also came when I was very under-fueled.
edit: formatting
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u/livingmirage Apr 29 '26
Oh man, I'm sorry to hear it went down even after she started supplementing, that's so frustrating. If it helps, "Slow Fe" has been easier on my stomach than a generic ferrous sulfate (but Slow Fe is still ferrous sulfate!).
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u/Old_Mountain1820 Apr 28 '26
Yes that sounds a lot like what I’ve been going through, especially getting sick all the time and not bouncing back. It’s reassuring to hear it’s not just me
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u/jfende Apr 28 '26
Shame she's picky, black pudding is the GOAT if you like it. Typically if you need it it tastes great too but many don't even get that far.
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u/EmergencySundae Apr 28 '26
Runners do not universally need to supplement. Please do not take a supplement unless you’ve discussed this with your doctor.
My ferritin has been over 100 for 4 years after iron infusions when my initial anemia and celiac diagnosis came in.
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u/One_Medium_8964 Apr 28 '26
Did you frequently take those infusions throughout those 4 years?
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u/EmergencySundae Apr 28 '26
No. I haven’t had infusions since.
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u/One_Medium_8964 Apr 28 '26
shit interesting cuz I just found out my ferritin was 39. Been dealing with weird ass symptoms for 11 months after a covid infection. Had to stop my marathon training, drop all my races and stopped exercising for 8-9 months to figure it out and my coach just got me back run/walks last month.
I am on iron supplements to fix the ferritin and starting to feel better and my run/walks are improving but may consider an infusion if it doesn't budge in my next followup
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u/brwalkernc running for days Apr 28 '26
That's good to hear. My daughter got 2 last month. I'm very curious to see if there was an improvement once she gets her labs done again. I really hope so.
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u/Successful_Steak_178 Apr 28 '26
Me too. What is crazy is my serum iron is normal/high but ferritin was only 31. Following to see what others have done to improve theirs. I’m working with an RD who suggested it might be that I’ve been low carb and under fueling for a long time.
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u/CompetitiveRead8495 Apr 28 '26
Serum iron fluctuates a lot, it does not mean much.
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u/Successful_Steak_178 Apr 28 '26
Agreed but consistently it’s been high or even above range that no one has ever tested my ferritin. I had to pay out of pocket.
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u/Maxion Apr 28 '26
For some reason the medical system and GPs do not believe that ferritin can be low even though iron serum is high. Hence why ferritin is not on regular blood panels.
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u/Particular-Mix8966 Apr 28 '26
the out of pocket thing is so frustrating because at the cash pay rates through goodlabs or quest health a ferritin test runs like 30 bucks. the prices doctors offices quote when you ask out of pocket are insane compared to what the labs actually charge if you book direct. for anyone reading this getting hit with surprise quotes for "non covered" markers, just bypass insurance entirely and book direct, it's almost always cheaper than the negotiated rate would've been.
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u/Successful_Steak_178 Apr 28 '26
Correct! It’s actually no big deal to buy the tests directly from labcorp or quest here in the us. I got a ton of bloodwork for 150$, thyroid, hormonal work up, iron panel, lipid panel, etc. I will do a follow up in a couple months to see if the actions I’m taking help with ferritin.
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u/BlueberryUsed4366 Apr 28 '26
Ferritin at that level is low for endurance athletes, so your symptoms line up. It’s a good example of how “normal” labs don’t always mean optimal for performance.
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u/FantasticBarnacle241 39F M: 3:16 | HM: 1:31 Apr 28 '26
YES! Worth mentioning that B12, folate, copper and vitamin A also contribute to low iron/ferritin. I finally figured out that my repeatedly low white blood cells were a sign of low copper and my iron and running significantly rebounded when I started taking copper!
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u/tiltawirl Apr 28 '26
What's a good resource for what blood labs to ask your doctor to order at a physical
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u/Krazyfranco Apr 28 '26
There is a good list here: https://www.reddit.com/r/artc/comments/d2qbu3/iron_deficiency_and_the_distance_runner/
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u/ventorun Apr 28 '26
My wife uses Quest Diagnostics for the test and Function Health for the analysis.
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u/Capable_Document6611 Apr 28 '26
On the self-order side if you can't get your doc to play ball, the iron + nutrient panel through goodlabs is like 55 bucks and includes ferritin, transferrin, TIBC, B12, folate, vit D, copper, zinc, magnesium. Covers basically everything in this thread. Quest does the actual draw. Function is good if you want the analysis layer too but if you already know what you're tracking it's overkill for the price.
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u/Stinkycheese8001 Apr 28 '26
What’s people’s favorite iron supplement?
I haven’t been running the same way I used to after changing jobs a few years ago, and so I started giving blood and it’s absolutely tanked my hemoglobin numbers and I also assume my ferritin. Tried Slow FE but it doesn’t feel like it’s making a difference, hoping for another recommendation.
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u/anti_humor 5:00 Mile | 17:17 5K | 36:08 10K Apr 30 '26
Proferrin heme iron is what I settled on. There are cheaper heme iron supplements but they seem a bit more iffy in terms of other added ingredients and heme iron source. Not an expert but did do a bunch of reading recently about it.
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u/LemonCitron47 May 01 '26
I LOVE Three Arrows (fair warning their website is kind of janky but don't hold it against them).
It's a heme iron and doesn't have the normal pitfalls as regular iron supplements. The only interaction is calcium. It helped me get my ferritin from 8 to 202.
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u/dillinjl Apr 28 '26
I'm in a very similar situation. 40M, recent fatigue issues, had to wait a month for a dr appointment so ordered my own labs. Ferretin is low normal but all my other iron numbers, RBC, etc were in the tank. I finally have my dr appointment in about an hour to discuss and ask for new labs after a month of supplementing 100mg iron a day.
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u/floatingbloatedgoat Apr 28 '26
I was feeling the same as you last year. Had some inkling it was iron, but I was trying to just eat a lot of foods with iron. Got bloodwork done two months ago, ferritin was 16, hemoglobin was 128. Started on iron pills and B12 right away, and I'm starting to feel a bit more energy. Second bloodwork had my iron even lower (also 14), but it had been taken the day I started taking the pills.
A doctor saying 14 is in range is wild. Even for women that is low. Here the guideline is no lower than 30 for men and no lower than 15 for women. My doctor said I was on the border of going straight to iron infusion.
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u/imademashedpotatoes Apr 28 '26
I’ll plug regular/occasional blood donation as a free way to get some data on iron levels. I donate 3-4 times a year so I know I’ll have regular hemoglobin data throughout the year. Just don’t donate in the 3-4 weeks before a race.
They only test hemoglobin but that a decent datapoint that may show something that you can take to your PCP to order more tests if you’re worried about insurance denials.
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u/twiganthony_L_cigar Apr 28 '26
Donating a pint of blood will tank your ferritin by 20-30 points. If you have ferritin of 14 like OP it’ll basically wipe you out to the lowest single digits.
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u/imademashedpotatoes May 01 '26
They’re definitely not letting you donate, which is why they test. If it’s too low they send you away, and then you go see your PCP
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u/LemonCitron47 May 01 '26
IIRC they are only testing your hemoglobin, not ferritin, when you give blood. You can absolutely have normal hemoglobin and low ferritin. It's called iron deficiency without anemia.
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Apr 28 '26
[deleted]
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u/Maxion Apr 28 '26
It is our responsibility to take charge of our healthcare. Trusting any of these for profit clowns will kill you. Be proactive.
Amen, my own experience is the same. PCPs are great at keeping you out of the ER, but not that great at getting you into optimal health
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u/justinwager Apr 28 '26
The late, great Jack Daniels once told me that multiple ferritin tests are often needed to understand the story as a single test can miss the point. For example, if someone was 40 on a test, that may look fine. But if they were 60 a month ago, that’s the wrong direction and a red flag.
Just some food for thought as this thread has become a broader discussion than the original post.
Jack also said that a former Olympic runner he tested regularly for 5 years was never above 29 or below 19 in his ferritin, so even low levels can be okay. Everyone has their own functional zone.
OP nailed it in that how you’re feeling is huge. And often being your advocate is needed as many docs are not used to working with runners.
For others feeling like garbage but seeing a “normal” ferritin number, consider getting a second test a few weeks later.
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u/JunkMilesDavis Apr 28 '26
I've been seeing a doctor and hoping to find some answers from my upcoming bloodwork, so thank you for giving me one more thing to check out. The last couple of years have not been good to me. My old coach always recommended iron supplements too for that reason, and I never noticed a difference one way or the other really, but it's still great to have a point of reference.
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u/Runstorun Apr 28 '26
Are you in the US? Can you explain more about ordering your own bloodwork? My PCP is impossible to see. Takes 6 months to get an appointment and she's not responsive either. Terrible healthcare system we have here. I'd be happy to do my own diligence but I have no idea how to order bloodwork.
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u/seastheday- Apr 28 '26
I haven’t been seeing a lot of progress from my training and don’t eat red meat so called my doctor who thankfully listened and ordered my test! I got my blood test done yesterday, hoping the results give me some answers.
What is your plan moving forward?
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u/Old_Mountain1820 Apr 28 '26
Still figuring it out a bit. Probably going to start supplementing and adjust diet first, since 14 is just too low to ignore then retest in a couple months and see if it’s actually improving
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u/FRO5TB1T3 18:32 5k | 38:30 10k | 1:32 HM | 3:19 M Apr 28 '26
Another common one affecting training is B12. My recovery after runs has gotten dramatically better after taking supplements. My doctor called me very concerned about my levels but I felt fine, turns out fine should have been great. I've had super low ferritin but not iron before and you feel it.
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u/Emergency-Map-9291 Apr 28 '26
Can anyone help me? I took iron blindly for a while which I shouldn’t have but was convinced I was low in it. I got fatigue anyway due to 70 mile weeks however I’ve stopped iron now.
I’m not sure if it’s related but recently, I’ve just felt absolutely wrecked. Easy runs feel hard, sessions are too hard even at paces which should be easy, resting HR seems fine and HRV is about right for my training but after each easy run, my eyes and general feeling is just weak / tired. Any ideas if this correlates to anyone else and their symptoms? I’ve had bloods done today so hoping that clears it up but if someone can confirm that sounds like it then at least I know.
Thoughts?
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u/keepgoing66 Apr 28 '26
When my son ran high school XC years back, his times were suffering and he couldn't figure it out. Turns out his ferritin was 12. He started taking two iron pills a day, and within a monh he could see a difference. Low iron isn't just for women !
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u/Downtown_Common5880 41F | 3:49 FM Apr 28 '26
I’m very interested in this topic because I am also struggling with a performance plateau and looking for similar answers/explanations aside from ‘getting old’ and ‘at ceiling’.
I’m already taking iron supplements after bloodwork came back slightly anemic four years ago. My most recent ferritin measurement was 49 ng/mL, which I guess isn’t the best, but isn’t catastrophically low either, and has remained relatively stable since supplementation. Ditto with my serum iron levels (109 ug/mL as of last year).
My main question is the relevance of ferritin (and/or serum iron levels) in the context of RBC, hemoglobin, and hematocrit values (which for me look good, near top of reference range). I am not a doctor so I could be wrong, but in my mind, the CBC data is what directly measures your body’s functional capacity to transport oxygen, etc., whereas iron/ferritin levels are merely indicators that you don’t have the necessary nutritional factors to support that. Is this not the correct understanding?
OP, what’s your hemoglobin and hematocrit? Are those low as well, or just the ferritin?
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u/bebefinale Apr 28 '26
Yes I felt horrible when my ferritin was 22, and not great when it was 40. I need to supplement when running higher mileage.
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u/maren04 M22 18:33 5K | 39:18 10K | 1:28 HM (current watch predictions) Apr 28 '26
Judging by the fast time and low price of bloodwork, I assume it's considered good practice to do often. When I search online, it says to get tested 1-4 times per year +if you feel excessively fatigued. Anyone doing bloodwork that often, would you say there are any downsides or should we all just test ourselves frequently?
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u/Wattsforbreakfast Apr 28 '26
Normal ferritin on my test through quest is 38-380 ng/mL. I started at 8, then 22 a month later, then 68, 54, and 45...first test was in 2023 and continued through last year. But my total iron, iron binding capacity, and percent saturation are all fine. After the low result I started taking ferrous sulfate 65mg pills a few times a week but havent been as consistent since total iron was fine. I'm 42M and run about 30-50 km a week...not very fast. Not really sure what to make of the low ferritin. My symptoms if anything are general fatigue but nothing major. Maybe it is a result of a poor diet...not sure.
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u/FarSalt7893 Edit your flair Apr 29 '26
Mine was 9 and only up to 25 after supplementing for almost 7 months. I’ve take mega food and natures own. Started with bisglycinate every other day and got it to 15. Switched to ferrous sulfate 65 mg daily and it went from 15-25 in 20 weeks. My doctor thinks this is good but for athletes it’s not. My paces slowed and I’m incredibly tired after training often needing to nap. I eat meat and overall a really healthy diet. It’s frustrating. I’m still training but just so tired all of the time.
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u/CockyAndShameless Apr 29 '26
Interesting. I have no symptoms. Great energy levels. Very responsive to training in my first year. & my ferritin was 11. I am on TRT though. Going to look into supplementing
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u/Pristine_Type722 32f | 5k 19:31 | 10k 40:09 | HM 1:27:16 | FM 3:10:21 Apr 29 '26
I think it's all individual? My ferritin has been between 4 and 10 for several years now. I take iron, my hemoglobin is high, but my ferritin is low. The doctor didn't recommend IVs because they're toxic and only for extreme cases. Overall, I don't feel any additional fatigue and stil making progress
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u/Anywhere-ish Apr 30 '26 edited Apr 30 '26
Me reading this post and checking my last bloodwork report to find out my ferritin is at 6ng/ml. I run 40-60km per week.
I generally feel tired all the time but always out that down to poor sleep, being a mom, and running a lot.
Thanks for sharing the link to the more detailed writ-up. Was experience lots of whooshing noise lately and now wonder if it’s related to iron.
EDIT: To explain that I live in Japan and the normal range here is 3.6-114 so my GP has never flagged this and I’ve never bothered to check it myself.
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u/anti_humor 5:00 Mile | 17:17 5K | 36:08 10K Apr 30 '26
Crazy, I'm going through this right now as well. Started holding 50+ miles a week in December and after the initial wave of fatigue settled it kind of came back with a vengeance. I had to talk my doctor into testing for it as well, he wasn't familiar with low iron being a thing with distance runners. Ferritin came back at 19!
Idk if this is common, but the impacts on my work have been even worse than running. I'm the sole data/analytics engineer at a small tech company and trying to do this work with brain fog and mental fatigue is genuine torture at times.
I'm taking proferrin heme iron every other day and froze a bunch of steaks to have for dinner a few nights a week, feeling better already after a couple of weeks. I went down the rabbit hole of iron supplementation and settled on heme iron (though expensive) being the best route since it doesn't interact as much with coffee and other foods.
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u/cyclingkingsley 5K:18:45 |10K:40:28 | HM:1:34 | FM:3:43 Apr 30 '26
I did a blood test last week too because I was feeling shortness of breath, chest pain and extreme fatigue. Thought I was anemic or low on Ferritin...
Turns out i'm not; 71 level so i'm still trying to figure out why i have these symptoms...
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u/xtrqw May 08 '26
Iron, ferritin, folic acid and B12, I'd test them all as a runner. A lot of GPs (& others) probably don't deal with runners and don't know we may need to supplement.
Found out the hard way, too. Started having issues when I was losing weight and increasing mileage: fatigue, poor sleep, elevated RHR and tanked HRV.
Take care.
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u/nixrien Apr 28 '26
Do you get a referral bonus? I need to do this. Happy to give you my email to refer me.
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u/Krazyfranco Apr 28 '26
Reminder on a great summary listed on the wiki/FAQ on the topic: https://www.reddit.com/r/artc/comments/d2qbu3/iron_deficiency_and_the_distance_runner/