Anemia for Athletes: What it Feels Like from A Runner’s Perspective

So you might be wondering what prompted my post about anemia, and may have some sneaking suspicions. Well.

I’ve got a sad story for you today.

It’s the story of my Houston Marathon.

Yes, it’s been two months. Yes, I’ve come to terms with it. And yes, I’ve actually moved beyond it. But here it is:

Houston Marathon was going to be a breakthrough for me. I know because I had decided. I had put my head down, trained through the summer (no small feat in Houston), and worked hard. I had taken on a new training program with higher mileage than ever before, and I was consistent with my speed workouts (for once). All of this without stress fractures, which have previously plagued me whenever I got into a groove of training hard. Everything was going perfect, right?!


As you can guess, that wasn’t the case. I was really tired. A lot of workouts felt a lot harder than they used to. In the beginning of training I figured that it was still hot and my body just wasn’t handing fast paces in the heat and humidity well. But they never really got easier. I would have to stop and regroup to finish my workouts, my easy runs felt nearly impossible, and I just wasn’t having fun. But I was SO excited that I had been able to keep it up without falling apart!

Obviously I was tired. I was working full time, training a LOT for a LOT of hours, spending 6-7 hours in the car per week to get to work and school and the track, and thrown in there was a 26-hour cross country road trip home for the holidays, and another to come back to Texas. Who wouldn’t be tired?

A glimpse into the training of an anemic athlete

Still, my confidence in my goal to go sub-3:10 was waning. Things just felt hard. I wasn’t sore, but I wasn’t fast. I put the effort in and didn’t get a lot of speed. You know how sometimes you go out and just run and are amazed at the end that you ran so fast? Those runs hadn’t happened for me in a really long time.

My last long run, an 18-miler with 8 miles at goal pace is a perfect example. I wanted to be around 7:00-7:10 for those fast miles, and this is how they went: 6:48. 6:41, 6:50 (scared that I won’t be able to finish the miles, I go out too fast), 7:05 (stop), 6:53 (stop), 6:54 (several stops), 6:44 (stop – make up my mind that I’ll push all the way through the last mile), 6:53 (ok so one stop partway through not so bad..right?). I spent a lot of time on these waiting around, blaming it on being afraid of the traffic on the windy country roads we were on, or the wind, or anything. The truth is, I didn’t feel right. I was tired. It wasn’t working. And this is typical of how my workouts would go: they start out on pace, then end up with a million stops and starts because I was putting in my full effort but not getting the hard-but-doable feeling you’re supposed to get. And slowing down didn’t necessarily make it feel better, just less bad. Not that “bad” was exactly how I’d describe it.

The worst part of it was mental. These are paces that I should not have trouble with. I wasn’t feeling anything in particular to make me go slow – my lungs would fill with air, my legs weren’t burning any more than they normally would, but I just wasn’t moving fast. I was putting in 100% effort and getting 80% reward. It starts to make you think that you’re the problem. That you’re not tough enough, or that you’re not training enough, or that you’re “being a little bitch” – which I repeatedly told myself during these sessions. You can see how it leads to a pretty bad downward spiral, because in reality you’re being too tough and working too hard because you don’t realize that something is truly wrong, and negative self talk won’t ever get you where you’re trying to go.

Taper and race day

I figured I’d feel better once I got to the taper, but really my short jaunts during that time were still a bit of a struggle. Even so, I got to race morning confident in my goal. It was hot and humid, but I had a plan – I was going to go for it regardless; I didn’t train to run a mediocre time, I trained hard to test my limits. I’d start conservative then bring the pace down over the first 5 miles, hold it there, and finish strong.

Well, at least I started conservatively! I could tell by mile 3 that I didn’t have it in me. I was trying to drop my pace and I couldn’t do that, and told my friend at the 10k mark that I didn’t think I’d finish. Somehow I made it another 10 miles (plus 1 beer) on the course before I decided that I really was doing myself no favors and pulled out.


Later that week I tried to go for an easy 4 miles and couldn’t even make it the whole way, which is when I really started to think that anemia was a possibility. A quick trip to the blood donation center proved my suspicions, and I started supplementing.

Red Flags

I should have seen the signs. Maybe I did but chose to ignore them, since I was so excited about my progress. Here are some things I should have recognized and taken as an indicator to supplement:

  1. Pica – For me it’s always the ice chewing. I was severely anemic in college (but didn’t know it for a while) and would literally fill my water bottle with ice from this one ice machine (Sonic ice anyone?? THE BOMB.) I can’t adequately describe it to you if you haven’t had the issue, but you just crave ice all day and it is the MOST satisfying thing you’ve ever done when you finally get to chomp it. Honestly it’s kind of sad now to not have pica because that was a source of true pleasure. Also, now that I’m not compulsively eating ice I have to be more diligent with my hydration.
  2. Slower times – If you KNOW you can bust out 4×1000 in under 4′ each with no issue, and you’re having trouble doing that, don’t automatically blame yourself. Maybe if it happens once or twice that you’re off your marks you should get some extra sleep and brush it off, but if you’re struggling in workouts constantly it might be overtraining (which admittedly I probably was suffering from) or it could be something else too. Never hurts to dig deeper.
  3. VO2 Max – So I have a Garmin with heart rate in the wrist, and it calculates your VO2max for workouts. I have no clue exactly how it does this except that it’s based on heart rate and pace, or how accurate it is, but it’s based on my heart rate and so I figure it has to hold some water, right?? It makes sense that my HR at given paces would have to be higher when I’m anemic, and that definitely shows. Here are images of my readings taking a total nosedive, and coming back up after I started supplementing. It’s like it dropped off a cliff! This is the first time I’ve had this sort of data to look at, and will certainly be paying attention.


The recovery process

From a biological standpoint, recovery requires supplementing. From a mental/love of running standpoint, recovery requires being nice to yourself. Be intuitive with it! If you don’t want to run, don’t run. If you’re anything like me, you’ve spent quite a while pushing really hard and beating yourself up and being pretty unhappy with the results. When it comes down to it, most of us aren’t getting paid to do this, and sports are supposed to be fun. So make it fun.

For me, “make it fun” meant run just a couple miles (seriously: 2-3) with the dogs on days when I wanted to, which ended up being around 3 days a week. I added in more yoga and strength training, things I love that I hadn’t had time for before. Even as I started to feel better and more capable in my running, I would only run fast if it felt good – I never set out with a particular workout in mind. I made a point to run with friends as much as possible. If it felt too fast, I backed off. If I felt like I could push it a little bit and I wanted to, I tried to run a little harder. I did other things for FUN, like pacing a friend for the second half of a marathon, running a relay, and hitting the trails (where mother nature always laughs at your intended pace anyway). I encourage you to do the same: switch things up, go by feel, and try as hard as possible to have more fun than everyone else.

Lauren, why should I care about ANY of this??

I’m sharing this recap not just to help myself remember what I feel like when things are going wrong, but in hopes that someone else out there can read this and identify their symptoms. Getting healthy after being anemic is not difficult, but can take a really long time if you don’t catch it early enough. The cost of supplements is well worth feeling like yourself again and getting back to achieving your goals!

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