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Is anaemia affecting your workout? How to exercise with an iron deficiency

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Feeling physically exhausted, even though you’re getting enough rest? It might be time to check if you’re one of the 1.62 billion people living with anaemia.

By now, many of us will be well into our 2021 fitness regimes. However, there’s a sizeable minority who won’t have jumped back into the swing of things with the standard new year gusto because we live with a long-term, persistent fatigue that never seems to fade.

If this sounds like you, there’s every chance that you may have endured this for a long time – years perhaps – assuming that it is normal to feel tired all the time. If you are constantly exhausted, you could be one of the 2 billion people around the world who live with anaemia, mostly caused by iron deficiency. Iron deficiency anaemia is a debilitating and chronic condition that most commonly affects pregnant women and those who suffer from heavy blood loss (e.g. during your period), and it leaves us feeling physically exhausted.

Because so many people think it’s normal to feel super-tired, the majority don’t seek out help from medical professionals, which can have a catastrophic effect on health and well-being, particularly when it comes to working out. 


Pamela Windle has had anaemia for a long time. “It went undiagnosed for several years before I knew what was going on, why I was so tired, why my hair was thinning and why I was out of breath and couldn’t run or teach classes,” she says. A former personal trainer and fitness instructor, she was forced to give up teaching classes. “Things got so bad that I struggled to get out of bed and I struggled to stay awake in the evenings.” Eventually, her GP decided that she needed to have an iron infusion as her body couldn’t tolerate iron supplements.

There are different types of anaemia such as vitamin B12 and folate anaemia but the iron deficiency type is the most common. Anaemia is a condition in which the number of red blood cells and haemoglobin is lower than normal. Haemoglobin is needed to transport oxygen to your tissues and if you have too few of these cells, there will be a decreased capacity to carry oxygen to the body’s tissues. Dehydration often accompanies anaemia, which is one reason why it’s so important to stay hydrated and drink water throughout the day.

An illustration of a woman yawning
Feeling tired all the time?


Dr Emma Monaghan, a GP with an interest in women’s health explain that while “iron deficiency has many causes,” for many pre-menopausal women, it’s often linked to menstruation. If you feel more exhausted around the time of your period, she recommends getting checked out by your GP  “to ensure that other causes of iron deficiency are excluded (for example coeliac disease, pregnancy, use of non-steroidal anti-inflammatory medication), and so that management options if the iron deficiency is related to menstrual blood loss can be considered.”

Starting an intensive physical exercise programme can exacerbate the deficiency, so it pays to be realistic and build up gradually over time with the help of a healthy diet. “Eat the rainbow. Eat whole food, mainly plants – and a range of colours,” Dr Monaghan advises.“Iron in foods can be difficult to absorb and can be blocked by other foods. Avoid tea or coffee with iron-rich foods or supplements, and ensure the iron is consumed alongside vitamin C-rich foods as vitamin C aids absorption.” She also recommends cooking in cast-iron pans. 


You probably know someone living with an iron deficiency; according to 2020 report by The World Health organisation and Guts UK called “The Global Anaemia Reduction Efforts Among Women of Reproductive Age”, around a third of women world wide live with it. Why then are we so silent about it? Like a lot of things to do with women’s health, anaemia subject to the old Yentl syndrome, as discussed by Caroline Criado Perez’s book “Invisible Women” whereby women are misdiagnosed and poorly treated unless their symptoms or disease conforms to the men present.


“Untreated iron deficiency can increase your risk of illness or infection,” dietitian Gaby Goodchild explains, “as low iron can impact the immune system. Severe untreated anaemia may also affect the heart and lungs.” For those of us who are plant-based, she stresses the importance of eating rich plant sources of iron. Women actually need more of the mineral than men between the ages of 19 and 50 so it’s really important that we all prioritise getting enough of the stuff in our daily diets. You need to be consuming 14.8mg a day 

Tig and Sam, founders of StrongHer Gym, confirm that often a good diet and appropriate exercise regime can be effective at levelling out anaemia. Tig says that with the proper structures in place, “you will hardly notice the difference… however, if these are not looked at, it can hinder progress significantly and this mainly comes down to the ability to not recover properly.” She goes on to point out that as “anaemia is the effect of the lower production of red blood cells (which transport oxygen), if oxygen and the nutrients packed in a blood cell are unable to get to the muscles, recovery will be harder to take place”. And as we all know, recovery is where the magic happens”.


The StrongHer founders are adamant that your period should never be a barrier to working out either. “You can absolutely train on your period (obviously if you experience extreme discomfort, we would advise you see someone) but as mentioned above, we are losing blood at this point, so you may feel a little sluggish or not as co-ordinated but there are some women who feel on top of the world with the rise of oestrogen. So listen to your body and don’t use the ’I can’t train because I’m on’ excuse. Just adapt and modify; maybe do a slower movement like yoga, mobility or if you are doing strength, drop the weight back slightly.”

For anaemic women, they recommend three full-body strength sessions a week, leaning towards the 10-15 rep range (hypertrophy), hitting the big muscle groups. Think squats, lunges, press-ups. “By working with higher reps, you will be working the body aerobically and helping stimulate the production of red blood cells,” they explain, before stressing the importance of rest days. You might find that it takes you longer to recover than others and that’s OK – use those days to go for a walk or do a yoga class. 

How to move and eat with anaemia


Tig and Sam suggest tracking your cycle and having iron supplements to hand just in case you’re struggling to digest food. While you’re on your period, you lose more blood than usual; with the loss of blood, comes the loss of iron and so a serious focus on enriching your diet with iron for this duration is essential.


Food is such a vital part of any workout. Sam and Tig warn that to get stronger, “you must eat enough for your body and your movement. Restrictive and limited eating places a lot of stress that women tend to ignore on the body. You have to eat enough energy to not just survive but thrive and that means food from all proteins, carbs and fats.” They recommend eating a minimum of 100g protein a day and ensuring that you “eat your flipping carbs!”. 


We should be consuming around 14.mg of iron a day. If you eat meat, you shouldn’t find that too hard to meet – particularly if you’re not squeamish about offal. Seafood lovers can fill up on mussels, shrimps and crab, all of which are rich in iron, while veggies and vegans will want to ensure that they’ve got plenty of beans in their diets. Baked beans are rich in iron, as are lentils, soya beans and tofu. 


If you feel tired, don’t push yourself. It’s really important that we all have proper rest days but it comes even more important with anaemia. Schedule in at least two days a week when you’re not doing strength training or cardio and really make sure that you give yourself a chance to recover properly – stretching, eating enough and getting a good amount of sleep. 

Follow on @StrongWomenUK Instagram for the latest workouts, delicious recipes and motivation from your favourite fitness experts.

Images: Getty

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