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It’s difficult to overstate the role iron plays in athletic performance, particularly for runners and triathletes. But recent data is showing that an increasing number of Americans aren’t getting enough in their diets, and it just might be a national health scourge hindering your pursuit of a faster time or new triathlon distance. 

A Silent Health Crisis?

A recently published study in The Journal of Nutrition discovered that the rate of iron deficiency among Americans has been on the rise since 1999, as have the rates of individuals treated for severe anemia and, even more grimly, fatalities attributed to iron deficiency anemia. The researchers attribute this largely to a drop in dietary iron intake: a 9.5% decrease in females and a 6.6% decrease in males between 1999 and 2018.

Why this fall in iron intake among Americans? The investigation found that during the nearly two-decade study period average beef consumption decreased, while Americans ate more chicken, which provides less iron. Also, USDA nutrition numbers from dozens of foods revealed that there was a drop in iron levels in 62% of both animal and plant-based foods analyzed. Modern-day agricultural practices, which are chemical intensive and focus on more yield in a set amount of space, might be impacting the nutritional value of the food in our shopping carts (other nutrients like calcium are likely decreasing as well). As for iron in meats, like a hunk of steak or ground beef, when we feed livestock with iron-poor crops in feedlot settings the iron in their diet declines—like ours. And when we eat these animals, we’re obtaining less of this essential mineral from them because they have less to give.

We should also note that the standard American diet, typically calorie-dense yet nutrient-diluted, won’t do much to keep iron levels in the safe range. Many of us have also switched away from eating fortified breakfast cereals. And now with more people shifting towards plant-based diets, iron deficiency is potentially going to continue to rise, as the form of iron in plants is not as bioavailable to us as is the iron in animal-based foods. Also, phytates, which are compounds naturally present in grains and beans, may reduce iron’s bioavailability even further. According to the National Institutes of Health, vegetarians and vegans need to consume about twice the amount of iron per day than meat-eaters to meet their needs. 

If you’re feeling constantly beaten down, both during the day and during your workouts, there is a chance this iron shortfall is also impacting you. Iron helps make hemoglobin, a component of red blood cells that carries oxygen from the lungs to the rest of the body, including working muscles. Hence, a deficiency produces a feeling of fatigue during your runs that can’t be explained by increased mileage or tackling testy inclines.

An insufficient number of red blood cells results in anemia. It can cause lethargy, pale skin, dizziness, weakness, headaches, and can lead to other more serious health problems if left untreated, including heart failure, according to the U.S. National Heart, Lung, and Blood Institute. A new observational study based on data from more than 12,000 European adults over a period of more than a decade published in the journal ESC Heart Failure, linked iron deficiency with a 24% higher risk of heart disease, a 26% higher risk of death due to cardiovascular disease, and a 12% greater risk for all-cause mortality, compared to those with sufficient iron. Poor iron status is also linked to subpar brain functioning including impaired memory and attention. 

Because many female runners and triathletes lose blood monthly when they menstruate, they also lose the iron within those red blood cells so can suffer from iron deficiency more often than their male counterparts. Research shows that females also typically eat smaller amounts of iron-rich beef. So while women may be more at risk for developing anemia due to social and biological reasons, this investigation in the Clinical Journal of Sports Medicine determined that both male and female endurance athletes are at risk for iron deficiency and anemia, with higher rates appearing in elite triathletes and runners. 

If a blood test reveals you have an inadequate ferritin count (ferritin is a blood cell protein that contains iron), you’ll most likely be instructed by your physician to take a supplement to get levels up to where they should be, keeping in mind that athletes may need higher ferritin levels to support their active lifestyle. But there are also a handful of dietary measures you can follow regularly that will help you raise an iron fist to deficiency and keep you from feeling you are training in slow-mo. 

1. If You Eat Meat, Go (Moderately) Red 

Health professionals often recommend cutting back on red meat consumption for better holistic health (and better planetary health, too). But if you already regularly include meat in your diet, then trading in a serving or two of weekly poultry for beef can help give your iron levels a lift. Case in point: A three-ounce serving of sirloin steak has nearly twice as much iron as the same amount of chicken breast. Branch out and serve up beef liver and you’ll get six times the amount of iron as that found in chicken–about six milligrams in a three-ounce serving.

Remember, most of the studies suggesting red meat consumption is bad news for your heart health are based on diets containing high amounts of red meat, especially highly processed forms like fast-food burgers, bacon and sausages. There is much less evidence that moderate amounts of less processed red meat like steaks and ground beef are harmful, especially if you are eating a varied whole-food diet that also includes plenty of vegetables and plant-based proteins like beans.

2. Shuck Some Oysters

Among the many benefits of oysters, including improving our mood, are their status as iron superstars. Three cooked ounces of these briny shellfish contain nearly seven milligrams of highly absorbable heme iron. Ounce for ounce that is more than beef, and also contains less saturated fat than most red meat sources. Shelling too much of a hassle? You can go with convenient canned oysters. They are great tossed on salads, worked into pasta dishes and soups, or simply forked up straight from the can for a high-protein snack.

3. Combine and Conquer

Of course, a hunk of steak is a stellar source, but you can also get iron from plant-based foods like tofu, beans, lentils, fortified cereals, spinach and some whole grains. There’s a catch, however: only 2-20% of the iron found in plant foods, called non-heme iron, makes its way from your digestive tract into your blood. But Mother Nature has provided an assist: ascorbic acid, or vitamin C, can enhance the bioavailability of non-heme iron. The vitamin C present in edibles such as bell pepper, tomatoes, broccoli, citrus, and berries helps convert plant-based iron into a form that is more readily absorbed. That’s why an investigation in the British Journal of Nutrition found that women who ate iron-fortified cereal with kiwi fruit, which is especially rich in vitamin C, were able to raise their iron levels. This suggests that it may be a good idea to load up a pot of bean-based chili with chopped peppers, serve tofu with a side of steamed broccoli and toss some vitamin C-rich berries onto your morning oatmeal. 

Worth noting is that people with anemia will absorb more non-heme iron from plant-based sources like lentils than those with adequate iron stores. One theory is that this is because a depleted body will desperately try to get what it needs from any source no matter the quality.

4. Eat Enough

Some interesting research suggests that hard-charging workouts can exacerbate poor iron intake. How? High-intensity exercise temporarily promotes inflammation in the body and depletes muscle glycogen levels, both of which may shoot up levels of a hormone called hepcidin that reduces dietary iron absorption. Being in a calorie deficit appears to amplify the impact that this exercise-induced increase in hepcidin has on our iron absorption from dinner. The upshot is that you should be aiming to consume enough calories to better match the energy demands of your training, particularly following a bout of glycogen-depleting exercise. Working with a sports dietitian can help you safely figure out these numbers.

5. Go Small

At present, there is only a small amount of data to compare iron levels in crops grown conventionally compared to those from smaller-scale organic farmers, but the aforementioned study on the dropping iron levels in foods may present a case for sourcing more of our edibles from farms practicing organic production methods with less emphasis on chemical-intensive yield per acre. Small-scale-farm-sourced produce may give you vegetables, grains and legumes with more iron for your buck. Meats including beef, bison, poultry and pork raised using more traditional methods such as grass and free-range feeding may also result in higher amounts of iron than that from feed-lots. This is because wild grasses may contain more iron than the grains fed to most livestock today. It will just cost you a bit more. Good online sources include Belcampo, Force of Nature, and Teton Waters Ranch.

6. Get Sweet on Molasses

While you may associate molasses with holiday cooking (gingerbread cookies, anyone?), you might be surprised that the sticky, richly flavored sweetener is a source of dietary iron, 1 to 1.5 milligrams in a tablespoon serving — much more than other sweeteners on the market. Blackstrap molasses may contain higher levels than lighter versions. You can experiment with using it instead of other sweeteners in baking, mixing it into oatmeal, stirring into pancake batter, and using it in homemade energy bars and balls, glazes for meat and, of course, a batch of baked beans.

Just don’t believe any online chatter that taking molasses by the spoonful is a good way to override anemia. You’d have to take a lot of the sweetener for this to occur and that would put you in the sugar red zone, not to mention being a little gross. Instead, think of it as a sweet way to get a little boost if needed.

Are you getting too much iron? A word of caution about supplementation.

Menstruation, dietary choices, and blood cell destruction from repetitive foot striking in activities such as jogging can lead to poor iron status. To compensate, some people take iron supplements. But, of course, you can get too much of a good thing—especially here. Humans have a limited capacity to eliminate excess iron, so it can build up in your organs if you consume too much. And excess iron over time can lead to health concerns including heart disease, liver failure and even the risk for certain cancers.

Best practices suggest that you should not commence iron supplementation willy-nilly based on hunches and instead rely on blood work to dictate the need for it, based on a diagnosis of anemia, or non-anemic iron deficiency. Halt supplementation once stores are restored and instead make sure to alter your diet in a way that assures you get enough on a daily basis.

And rest assured that it is extremely difficult for iron overload to occur from diet alone, unless you have a genetic propensity to absorb too much, a condition called hereditary hemochromatosis.