My Personal Story With Iron Deficiency Anemia: From Chewing on Ice to Restless Leg Syndrome and More

In this episode, I share my personal experience with iron deficiency anemia, from chewing ice every night and dealing with restless legs to learning how low iron was affecting my running performance. As a plant-based runner with thalassemia trait, I've struggled with iron issues for most of my life. And it's also one of the most common nutrition challenges I see among female athletes.

In this episode, you'll learn:

•  The most common signs and symptoms of iron deficiency 
•  Why runners (especially female runners) are at higher risk 
•  The difference between heme and non-heme iron 
•  The best plant-based sources of iron 
•  How vitamin C can dramatically improve iron absorption 
•  Foods and drinks that can interfere with iron absorption 
•  When iron supplements may be necessary 
•  Why low iron is not a failure of a plant-based diet 

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Transcript

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In my late 20s, I was eating a plant-based diet, training consistently, working out a lot, just started getting into running, doing basically everything right in terms of my health. Or so I thought. I would want to chew on ice and I would eat that and chomp on it all night and didn't even think anything of it until one day I started thinking that something was a little off. I also would wake up in the middle of the night and my legs would be a little achy. I was having a hard time staying up past 9 p.m. There was some weird stuff going on. All of this is my story with iron deficiency anemia. I wanted to get into this on a podcast because it's something that I've struggled with my basically my entire life, and more so in my adult life as a plant-based athlete. And it's something that comes up constantly with the clients that I work with. Almost every single female athlete I have worked with who is on a plant-based diet is deficient in iron and is working on how to eat more iron-rich foods and take iron supplements if they need to. So this is a topic I wanted to touch on because it comes up a lot. As a plant-based runner peepet, people immediately think that my diet is to blame for a lot of things, for me not being fit enough or not performing well enough, and especially for iron deficiency. But it's a little more complicated than that. So let me start with my own personal story. And again, I'll go into kind of where this all started for me and what the iron deficiency felt like, and then how I rectified it and what I see come up with a lot of runners. So let's start with my what makes my situation a little bit different than some of the other runners out there is that I have something called thalassemia trait, which is an inherited blood disorder that affects how your body makes hemoglobin. Essentially, my body makes less hemoglobin than a lot of other people, than the normal amount. I've never once had hemoglobin in the normal range. But the hemoglobin is actually bigger. So sometimes with thalsemia trait, you have enough iron in your body for you to function properly. But the other part of it is that it can make diagnosing anemia a little bit more complicated, but thalassemia trait does make you more prone to being anemic. Now, as a child, I knew that this was a possibility that I would have this trait because my mom has it. So I was lucky enough to know this from the get-go without doctors having to assess that maybe something's off with her iron. Why is her hemoglobin so low? They kind of tested me for it, knew that I had it, and it's been something that I've been able to manage over time. So as a kid, I ate meat because my parents served meat, but there were times that I went through iron deficiency spells where they told me to eat more iron. I remember my dot my pediatrician as a kid told me to eat watercress, which is a bitter leafy green because it's really rich in iron. But generally, as a kid, I was able to manage the iron through just my diet alone. I didn't have to take many supplements, but I also wasn't a runner. That's a the difference from then until now. But this thalassemia trait has made it so that I have struggled with iron deficiency for most of my life. I know what a lot of the symptoms feel like. And this is the one thing when it comes to iron, is that if you were deficient of, say, magnesium, you may not really even know it. You may not feel it. But when you are deficient in iron, there are signs that pop up, and iron deficiency can make you feel kind of crappy. Essentially, you're fatigued all the time. Your workouts may feel really difficult. You may struggle to recover after a workout because you're constantly tired. You may be cold a lot. Some weird things that pop up. One of the things is I've noticed hair loss when I become iron deficient. I have noticed that I had something called pika, which is essentially the craving to chew on non-food items. That's why I was chewing on food. Restless leg syndrome is another symptom. That's one that I had where I was waking up in the middle of the night with the achy legs. This was really this happened to me a lot during pregnancy because when you're prone to be iron deficient and you also are pregnant, it's hard to get enough iron because the the baby is essentially stealing it from you. So there's a lot of things that come into play when you're iron deficient that make you feel not so great. In terms of why runners are at a really high risk, and and athletes in general, because you are using iron, basically, iron is being transported throughout your body to help your body get enough oxygen. That's why your muscles need it to get more oxygen in so you could take in that oxygen and perform at a high level. If you're not getting enough iron, then you're not getting enough oxygen throughout the body. And it's it's impacting blood flow. The body is constantly keeping a baseline level of all of this, but you are losing some iron through things like sweat. Or for runners specifically, or for athletes where you are doing something that your foot is you're running a lot, there's something called foot strike hemolysis, which essentially is that red blood cells break down in the bottom of your feet every time your feet hit the ground, this repetitive movement. For female runners specifically, which is why we see iron deficiency, is because you lose blood every month through menstruation, and with that, you are losing iron. Now, this happens to be prevalent within most female athletes, but it's even more prevalent for plant-based female athletes. And the reason for that is because there's different types of iron in the diet. There's heme iron, which comes from animal foods, like eating chicken, fish, beef, those that's heme iron, your body's able to absorb that iron pretty well. And that iron is generally enough to keep to prevent a deficiency. But for plant-based sources, they still have iron, but they have something called non-heme iron, which is a plant-based source of iron that your body doesn't absorb as well. So whereas you may be absorbing 75% of the heme iron, maybe you're absorbing 35% of the non-heme iron. So the recommendation actually for vegans and vegetarians is to take in 1.8 times the recommended 18 milligrams of iron for females. So we could just round that up and say it's about double, about 36 milligrams of iron that you're supposed to be getting in a day. It's hard to get that amount from plant-based foods, and you can, you absolutely can, but there's certain things that come into play in terms of how iron is also absorbed in the body. So this isn't just always a plant-based issue. Runners in general are at greater risk for low iron, but plant-based runners are at higher risk than that. All of this to say, it doesn't mean that plant-based athletes can't get enough iron. It just means you have to be more intentional about how you take in your iron. You're not necessarily definitely gonna get a deficiency. I do see it, it is really common, but it's not always gonna happen to every single person. So there's certain things that you have to know in terms of iron intake. One is the foods, the plant-based foods that contain iron. Plant-based foods that contain iron are things that a lot of us are eating on a daily basis anyway: lentils, tofu, tempeh, beans, soy-based foods, pumpkin seeds, hemp seeds, quinoa, cereals that are fortified with iron. But on top of that, you want to also pair iron with vitamin C. Vitamin C actually increases the absorption of iron. So, going back to my story, when I was diagnosed with an iron deficiency anemia, because I have this low hemoglobin, we always looked at ferritin levels. My doctor and I looked at the ferritin levels, which is essentially how much iron you have stored in your body. My ferritin levels were so low, they were like two out of two. Normal is 20 or above. I had to take in a high dose of an iron supplement called ferrosulfate, which is 65 milligrams, much more than the recommended amount in a day, to help my body make up for that deficiency. But my doctor also suggested that I pair that iron pill with a vitamin C pill because the vitamin C pill would help the iron get absorbed quicker and better. Vitamin C just works to help your body absorb that iron. So if you're doing this through food, it's as simple as pairing things like tofu stir fry, tofu has the iron, with maybe putting some bell peppers in there, which have the vitamin C. Lentil soup, which is high in iron. Maybe you're cutting up some carrots or sweet potato and putting it in that lentil soup. Or tomatoes, that's the vitamin C. Oatmeal iron paired it with strawberries, vitamin C. See where I'm getting at? This is a this is a game changer in terms of making sure that you're getting enough iron in your diet. But then there's also things that can inhibit the absorption of iron. For instance, if you are a vegetarian and you do dairy, calcium actually decreases the absorption of iron. So, say you are trying to have some sort of bean tacos, black beans have a lot of iron, but you put cheese on top, that can decrease the absorption of the iron. That's something to keep in mind. Or maybe in the mornings you're having something that has iron in it, like your oats, but you're also making it with milk or yogurt. If you don't have a lot of calcium in your diet, that's it may not factor into it. But the other part to keep in mind here is that one last thing is coffee and tea actually decrease how your body absorbs iron. So if you get to a point where you are deficient and your doctor is telling you to take an iron supplement, which you should not do unless your doctor tells you to, because you can overload with iron, you do not want to take that iron supplement in the morning with your coffee and your tea because it will actually counteract your body's ability to absorb that iron. So it's just things you got to think about. For me, I actually take the supplements right before I go to bed. Um, I make sure that there is some food in my stomach because iron supplements can be a little harsh on the stuff on the stomach, but that's around the time when I'm making sure that, you know, I'm not having any coffee and tea. I do pair it with a vitamin C so that it helps increase the absorption. All of this comes into play once you know that you actually have a deficiency. Obviously, before you have a deficiency, you're still and you're a plant-based and you're an athlete, you want to be intentional about your iron intake and then also be intentional about pairing it with vitamin C. But if you know that you have a deficiency because you went to the doctor, you got a physical, they did your blood work, and they saw that you have a deficiency in iron, you're going to probably be put on supplements. And supplements, iron supplements can be harsh on the stomach. They can cause constipation, which means that you have to make sure that you're getting enough fiber in your diet. Some people even may end up doing something like a mirror axe to make sure that they stay regular. And that you're eating iron, you're taking iron supplements with food because it can cause some nausea. And then you're also gonna monitor your blood work. So you don't want to be guessing like, is the iron supplements working? Is my deficiency gone? You're gonna be making sure that you're following up every few months to see if you actually need to continue taking the supplements. Because if the iron deficiency goes away, it's not something that you have to do for life. Food is the foundation, but when iron is low, supplements can help. Diet alone isn't enough. I tend to I've gone off and on of these diet, the these iron supplements throughout my life. When I was pregnant, I took them the whole time because you are more prone to iron deficiency. Then I'll go off of them when my iron level gets up. If it gets low again, I'll go back on them. But you can't basically you cannot rectify a severe iron deficiency with diet alone. It really has to be a supplement that helps you get in there and fix everything. So, all of this, what I wish I knew earlier, a few things. One, I wish that I recognized the symptoms earlier. When I was in my 20s, I never would have thought anything was wrong with me. I had a roommate at the time and I remember saying to him, have you noticed that I'm chewing on ice a lot at night when we watch TV? And he was like, Yeah, it's a lot. He noticed because he heard it every single night, but it took me a while to realize that that was something new and different. So it is important to be in tune with your body and paying attention to when a new thing pops up that makes you feel maybe not the best. I wish I knew that being tired at night and not being able to stay up past 9 p.m. was nor not normal. I was I had a job at the time that was making me get up really early, like 5 30. So I thought it was just that. But now I see with kids where, you know, sometimes you have sleepless nights and you could still function. When I was severely iron deficient, I could not function. And then I also wish I knew that this does affect performance in terms of running. You are slower, you're feeling more fatigued, you just feel like, oh, I'm just out of shape. You're not out of shape, you're just iron deficient. And when you fix it, you feel so much better. And lastly, I wish I understood that iron deficiency isn't a failure of a plant-based diet. It's just something that I need to manage, meaning that you don't have to be iron deficient on a plant-based diet. It happens a lot for me because of this dysemia trait. It's not for everyone. Not everyone is gonna end up that way. But you can be intentional about what you do and what you eat without making yourself iron deficient. So today I still run, I still eat plant-based, and I still pay close attention to iron. The goal isn't really perfection for me. It's about knowing what the symptoms are. And if I see them pop up again, being in touch with my doctor, making sure that I'm taking the supplements when I need them, making sure that I'm including plenty of iron-rich foods, and making sure that I work with other athletes to help them recognize these symptoms because it is something that is manageable, but when you're not managing it, it really can affect your lifestyle. So I want to hear from you. Have you ever struggled with low iron as a runner? Let me know in the comments. And if you want more evidence-based, plant-based fueling tips, please subscribe, rate, review. It does help me get out to more people, and I'm happy to share more more struggles and stories like this with all of you. So thanks so much for listening today. And I can't wait to hear from you. And let me know if you know you you have any stories, your iron stories. I always love hearing what other people are going through.