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How does it feel to be diagnosed with "iron deficiency without anemia"? What symptoms indicate iron deficiency? How to get a ferritin test? How is iron deficiency treated? How long does the iron treatment last and when will your running performance improve?

A good year has passed since my iron deficiency was discovered. In this article, I will tell you how the iron treatment has worked, what kind of ferritin values I have got from the tests, and how iron deficiency affects my running.

Diagnosis: iron deficiency without anemia

I received an iron deficiency diagnosis three months after I got sick with Covid in the spring of 2022. I suffered from long and changing corona symptoms, but some of the symptoms were probably symptoms caused by iron deficiency. The inflammatory process caused by the coronavirus and infection has been found in several studies to have a negative effect on iron values.

My first measured ferritin value was 23 µg/l. The generally accepted limit value for low ferritin is 30 µg/l, a value below which indicates iron deficiency in an adult. A runner's iron values should be even better than usual, because running depletes iron stores.

Ferritin is the absorption and storage form of iron, which describes the amount of iron stores in the body. A low ferritin value can indicate an iron deficiency, while a high ferritin value can indicate, among other things, inflammatory processes in the body. Therefore, high ferritin does not rule out iron deficiency.

Treatment of iron deficiency

Around the time I was diagnosed with iron deficiency, I was so exhausted that I felt the most important thing was to restore my iron stores as quickly as possible, even if it meant eating factory-made blood pancakes. The change to a diet that replenishes iron stores was actually quite painless.

In addition to the dietary change, my iron deficiency was treated with 100 mg Ferrodan iron tablets, which are suitable for most people. Fortunately, my stomach didn't freak out from the large amount of iron. For the first three months, the dose was 200 mg, and after that 100 mg per day.

Along with a change in diet and an iron supplement, my recovery included adequate rest. In terms of running, it meant trail runs of less than ten kilometers / 6.2 miles every second or every third day at the most… uh!

After starting iron therapy, my health improved within half a year, e.g.:

• a devastating exhaustion eased
• my legs didn't feel heavy anymore and I could run properly again
• the asthma-like symptoms and feeling of suffocation disappeared when moving
• resting heart rate dropped close to normal
• I was able to recover from training again without a 1-2 day coma
• the brain fog suddenly just disappeared
• my ears stopped ringing
• the strange problems with my sight mostly disappeared.

In the next measurement, the ferritin had risen nicely to over 80. I went for a blood test right after my power hiking trip in the mountains of Norway. According to some academic study (unfortunately I can't find the source anymore) that heavy training in the mountains could affect the momentary increase of ferritin values.

At that point, I stopped all iron supplements and the iron-rich diet, as the ferritin value was so high. Running was also great - until the dark autumn season. In the next test (this time before leaving for Norway), the ferritin value was only a little over 50. For runners, values at least half as high are recommended.

I can clearly feel the lower ferritin value on trails. After the mountain training in July (which was not the best one though, due to the weather), I recognized the familiar improvement of my running performance. But it still lags behind, it’s not as good as last year, and I can already feel the fatigue of my legs on longer runs.

From this alone, I conclude that it is worth returning to the iron jar again. After all, I don't miss those last spring symptoms one bit!

Iron deficiency without anemia

When ferritin is low, but hemoglobin remains completely within normal limits, we speak of a phenomenon called 'iron deficiency without anemia'. In this state, the amount of stored iron is significantly reduced, but the situation has not yet led to actual anemia. Mere measurement of hemoglobin therefore does not really tell anything.

Runners and active exercisers notice that their iron is low because their running performance is not as good as it should be. Your legs may feel 'strangely heavy', your running does not become energetic after warm-up, your lungs may feel like they don’t fill up well, you feel like exercising after a really bad night's sleep, and after the run you spend 1-2 days exhausted.

Iron deficiency is one of the most common nutrient deficiencies in the world. That's why it's strange that so much negative talk about 'fashion sickness' has been attached to such a common, easily diagnosed and often easily treated health problem.

Symptoms caused by iron deficiency include:

• unexplained exhaustion and fatigue
• slowness of recovery, unrefreshed rest
• shortness of breath, feeling of a lump in the throat, 'forced yawning'
• muscle and joint aches, weakness
• cognitive symptoms such as brain fog, difficulty concentrating
• depression, anxiety
• fast heart rate, dysrhythmias, palpitations
• hair loss, bad nails, pallor
• restless legs
• and so on.

Check, check and check!

Personally, I don't know anyone who would want to suffer from iron deficiency symptoms, or anyone who would want to make up the symptoms. And if the symptoms improve with iron therapy, what's gives?

Women have been found to be more susceptible to iron deficiency than men. Up to a fifth of the world's women suffer from iron deficiency. This is especially due to menstrual bleeding and childbirth, as well as insufficient iron intake in women's diets.

How does running and training affect iron levels?

According to the study, iron deficiency may be more common in athletes than in non-athletes, because heavy exercise and profuse sweating can lead to the loss of iron from the body. In sports circles, strict diets may also be common. Especially women and vegetarians are at risk for iron deficiency.

Another risk group is runners. Running may cause a special wear of iron when the foot hits the ground - we are talking about a phenomenon called 'exercise-induced hemolysis'. The body's iron stores may become depleted, especially during long-term and intense running.

If you are a runner, a woman and avoid red meat - how is your running going?

I am one of the lucky ones who have not had to fight to get treatment. In fact, I probably would never have thought about iron deficiency myself (although I am usually interested in everything related to health), but the initiative to test ferritin came from my doctor.

Testing iron deficiency and ferritin values

Because of my thyroid medication, I see my own doctor every year, who also takes care of monitoring and interpreting the results of lab tests. People have different diseases and other conditions that affect blood test results in different ways. For this reason, it is not advisable to compare the results of your own blood tests with other people's results found on the internet.

However, iron deficiency is a really common problem, which can often be treated quite easily and inexpensively, although it may take a long time for the iron stores to fill up. The improvement of iron stores and the increase in ferritin value is individual - but when the iron values finally rise to good levels, the improvement in the quality of life feels unimaginably great!

Ferritin is easy to measure in a laboratory if you suspect iron deficiency.

Can I go to the laboratory without a referral from a physician?

Yes, you can – at least in Finland. The following is about Puhti laboratory services in Finland. If you are living abroad, you may want to skip the rest of the article! :)

*Puhti offers all laboratory tests without a doctor's referral. You can book an appointment for a *ferritin test online in no time, and you can get the results of the blood test quickly. There is no need to fast for the blood test and it can be taken at any time of the day. Also *a broad iron deficiency and anemia test package is available.

I would like to emphasize that the *Puhti service should not be used to diagnose a disease. Instead, self-monitoring of blood values regularly works well after you have first diagnosed possible diseases and deficiencies under the guidance of an expert (so not yourself) and made a treatment plan.

You should go to the laboratory without a referral to find out the initial situation, if, for example, you’ve got weird problems with your running performance. On the other hand, for example, you can’t ‘feel’ cholesterol values, so by examining blood values, you can find out what you could pay more attention to in your own health.

Although you should not start medicating yourself with large iron supplements, a simple and quick laboratory test can reveal whether it is iron deficiency that is behind the fatigue and difficulty in recovery. This is how you can get started in the treatment of iron deficiency.

After you have first consulted a healthcare professional, in the future you can take a quick *Puhti test every six months and monitor your iron levels and their development. Iron stores are depleted, especially in women and when running.

Why Puhti laboratory services?

*Puhti is a reliable operator with high information safety as well as clear and relatively affordable pricing. There are locations all over Finland, and the appointment can be booked online without a referral from a physician. You can get to the tests quickly without queuing.

You can choose the tests as a ready-made test package, to which you can take additional tests if you wish. You can also plan your own test package completely. Regarding the tests, it is explained in more detail which ones require, for example, fasting.

You can get the results of the blood tests quickly and you can also take them with you to your doctor. You can also order a remote doctor's consultation separately, but it is by no means mandatory.

The active runner’s test package

I am interested in my overall well-being, so I like to monitor all kinds of blood values.

For example, it's a good idea to check your cholesterol values and basic blood test every once in a while, because it's easy to correct eating habits at an early stage if necessary. Especially if there is a family history (e.g., high cholesterol or impaired sugar tolerance), regular health monitoring reveals changes in well-being at an early stage.

*The Puhti health test makes it easier to understand your own state of health and the health of your body. With regular monitoring, first of all, you can see how your own values are placed in reference values and what they mean, as well as with which factors (e.g., diet, exercise, sleep) you can influence values and directly your own well-being.

Puhti offers a test package 'Liikkujan terveystarkastus' (Health check for active people) especially for active exercisers and athletes. The test is available for both *women who exercise and *men who exercise. The test package includes good tests related to performance and recovery, such as vitamin D, magnesium, vitamin B12 and potassium related to fluid balance.

At best, the versatile tests serve as 'health key numbers' for yourself, which help you maintain a good feeling and performance both on and off the trails!

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Disclaimer: I’m not a medical professional, but I’ve been diagnosed and treated for iron deficiency. These are based on general research open to everyone and my own experiences.