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Poor performances and feelings of fatigue may signal a need to get your levels checked.

It’s common to associate a poor performance with low iron. “I had a bad race, maybe I should check my iron?” “I’m feeling fatigued during workouts—could it be my iron levels?” I get these questions from the athletes I work with a lot.

And while there are countless variables that can contribute to poor performances or fatigue, one thing we do know is that iron is important for runners. If your iron levels are low and you don’t do anything about it, you will eventually feel the negative impact on performance. Here’s what you need to know about both iron and ferritin levels.

What is iron and why is it important for athletes?

Iron is an essential mineral found in red blood cells that is important for oxygen transport in the blood and to muscles, energy production, cognition, and immunity. The reason many of us worry about our levels is that iron is lost in many ways: in the urine, through the menstrual cycle, blood loss in the gastrointestinal (GI) tract, sweat loss, and the breakdown of red blood cells via the impact of our foot strikes. Plus, chronic use of nonsteroidal anti-inflammatory drugs (e.g. ibuprofen, naproxen)—ones often used by athletes—and antacids can also lead to iron deficiency. 
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Iron levels are especially important for female athletes: According to a paper in the European Journal of Applied Physiology, the prevalence of iron deficiency is around 15 to 35 percent in female athletes and 3 to 11 percent in males. Females, endurance runners, vegans, vegetarians, and athletes with low energy availability are at an increased risk for iron deficiency.


What are some key symptoms of low iron?

The classic signs of iron deficiency, with or without anemia, include lethargy, fatigue, negative mood state, and difficulty concentrating. However, runners may notice symptoms that mimic overtraining, reduced work capacity during training, impaired responses to training, and ultimately poor performance. The only way to determine if low iron is the culprit is to have a blood test.

What about anemia?

Anemia is a condition in which the blood doesn’t have enough healthy red blood cells. Although iron deficiency anemia is the most common type of anemia, it is one of many different types. It is possible to have iron deficiency prior to developing a diagnosis of iron deficiency anemia. Over time, iron deficiency will lead to anemia if no action is taken because the body will exhaust its iron stores, known as ferritin.

So what’s the deal with ferritin levels?

Ferritin, as mentioned above, is an important blood marker that indicates iron storage. There is a wide range for what is considered to be a “normal ferritin level,” ranging from 12 to 300 nanograms per milliliter (ng/mL).

“However, linking ferritin levels (e.g. levels greater than 35ng/ml) directly to performance is very challenging, as there are so many things that impact performance,” Trent Stellingwerff, PhD, Senior Advisor for the Canadian Sport Institute Pacific tells Runner’s World.

In fact, high iron levels can be very toxic for the liver and heart. “We aim for ferritin greater than 35ng/ml and clinically normal hemoglobin, but appreciate individual athlete norms as well,” says Stellingwerff.

Thus, a current routine assessment of iron deficiency should include the following blood markers: ferritin, hemoglobin, and transferrin saturation. Iron deficiency occurs in three stages using the following ferritin levels proposed in a recent paper in athletes:

Stage1 - Iron deficiency/depletion: ferritin less than 35 ng/mL, hemoglobin and transferrin levels will still be normal. There is little evidence to suggest you will notice any fatigue at this point, but it’s important to correct and prevent iron deficiency anemia.

Stage 2 - Iron deficient non-anemia: ferritin less than 20ng/mL, low transferrin, and normal hemoglobin. You may start to feel some of the symptoms above and performance may be negatively impacted.

Stage 3 - Iron deficiency anemia: ferritin less than 12 ng/mL, low transferrin and hemoglobin. You will notice key symptoms above including impaired endurance performance.

How often should I have my iron levels checked?

As suggested in a recent 2019 article published in a European Journal of Applied Physiology, high-risk runners should be screened regularly and considerations for the frequency of iron blood screening are based on the athlete’s past history. Although not comprehensive, some guidelines are listed below:

Annually: runners with no history of iron deficiency, no fatigue after an extended rest period

Biannually: previous history or low ferritin (iron depletion stage 1), female, intention to increase training volume or training at altitude within the next 12 months

Quarterly: any recent history of iron depletion/deficiency, vegetarian/vegan, individuals with any evidence of low energy availability, high training volume, and fatigue/lethargy, plans to train at altitude within the next 6 months.

Ferritin, an acute phase reactant protein, can be falsely elevated with inflammation after intense exercise. Thus, it’s important to avoid any muscle-damaging or intense exercise about two to three days prior to your routine blood test. Other suggestions for standardization include testing first thing in the morning and in a well-hydrated state.

Work with your doctor to determine the best course of action and figure out if supplementation is right for you.

Should runners traveling to altitude be concerned about levels?

Training at low to moderate altitudes provides an environmental stimulus to increase red blood cells with the goal of improving performance at sea level. With this increase in red blood cell production, comes an additional need for iron. A review paper by Stellingwerff et al. (2019) suggests checking iron status prior to altitude training to ensure that levels are in the optimal range prior to leaving.

“However, if a runner is just going to altitude for a race or short period of time, the impact of iron is much less,” Stellingwerff says. “Although, all endurance athletes should aim to have ferritin levels well into the healthy and normal range.”

How can runners optimize iron absorption?

You can have a solid iron-rich fueling plan, but is your nutrient-timing and combination of foods on point? Iron absorption may be impaired post-exercise due to increased levels of hepcidin, a hormone released by the liver that regulates the ability to absorb or recycle iron (e.g. increased hepcidin levels will inhibit iron absorption).

Inflammation is believed to be a strong up regulator of hepcidin. According to an article published in Sports Medicine in 2020, hepcidin increases around three to six hours post-exercise and increases towards the end of the day.

Thus, the optimal timing for iron absorption is within 30 minutes after a morning workout when hepcidin levels are low. Runners can optimize iron absorption use the following strategies:
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Avoid dairy, coffee, and tea (which decrease absorption of iron) for an hour before or after a meal.

Cook with a cast-iron skillet or a product like a Lucky Iron Fish, which may be a cost-effective strategy for increasing the iron in conjunction with other methods according to one study.

Consume “heme iron” rich foods such as beef, eggs, tuna, lamb, and kangaroo (if available)

Improve absorption of “non-heme iron” sources (almonds, figs, apricots, kidney beans, green leafy vegetables, tofu, dark chocolate) by pairing with heme-rich sources and/or ~50 milligrams (mg) of vitamin C (1/2 cup of pineapple, strawberries, broccoli, or red peppers).

If taking an iron supplement (prescribed by a physician), take with vitamin C-rich food. Emerging evidence suggests alternate day dosing to be just as effective as daily for raising ferritin levels and better tolerated for runners with a sensitive gut.


Finally, not every bad race indicates your iron is low, but it is a good idea to get checked prior to taking any iron supplements. There is no evidence that higher ferritin levels are better (e.g. aiming for 300), and supplementation is not likely to improve performance in non-depleted runners. Iron supplementation should only occur under physician supervision.

You can have a solid iron-rich fueling plan, but is your nutrient-timing and combination of foods on point? Iron absorption may be impaired post-exercise due to increased levels of hepcidin, a hormone released by the liver that regulates the ability to absorb or recycle iron (e.g. increased hepcidin levels will inhibit iron absorption).

Inflammation is believed to be a strong up regulator of hepcidin. According to an article published in Sports Medicine in 2020, hepcidin increases around three to six hours post-exercise and increases towards the end of the day.

Thus, the optimal timing for iron absorption is within 30 minutes after a morning workout when hepcidin levels are low. Runners can optimize iron absorption use the following strategies:
​

Avoid dairy, coffee, and tea (which decrease absorption of iron) for an hour before or after a meal.

Cook with a cast-iron skillet or a product like a Lucky Iron Fish, which may be a cost-effective strategy for increasing the iron in conjunction with other methods according to one study.

Consume “heme iron” rich foods such as beef, eggs, tuna, lamb, and kangaroo (if available)

Improve absorption of “non-heme iron” sources (almonds, figs, apricots, kidney beans, green leafy vegetables, tofu, dark chocolate) by pairing with heme-rich sources and/or ~50 milligrams (mg) of vitamin C (1/2 cup of pineapple, strawberries, broccoli, or red peppers).

If taking an iron supplement (prescribed by a physician), take with vitamin C-rich food. Emerging evidence suggests alternate day dosing to be just as effective as daily for raising ferritin levels and better tolerated for runners with a sensitive gut.


Finally, not every bad race indicates your iron is low, but it is a good idea to get checked prior to taking any iron supplements. There is no evidence that higher ferritin levels are better (e.g. aiming for 300), and supplementation is not likely to improve performance in non-depleted runners. Iron supplementation should only occur under physician supervision.

With just three days remaining until the BMW Berlin Marathon, anticipation is building for another spectacular edition of one of the world’s fastest marathon races.

The 52nd edition of the race will take place on Sunday, September 27, with a deep international field set to take on the famously fast streets of the German capital.

Tanzania’s Gabriel Geay is among the leading names in the men’s race, bringing a personal best of 2:03:00 to Berlin. His mark, set in Valencia in 2022, places him among the fastest marathoners in the elite field. However, Ethiopia’s legendary Kenenisa Bekele has since been added to the field with a 2:01:41 personal best, meaning Geay is not the fastest entrant on paper.

The men’s field also features Getaneh Molla (2:03:34), Guye Adola (2:03:46), Shura Kitata (2:03:59), Kenya’s Erick Sang (2:04:30) and Olympic 10,000m champion Selemon Barega (2:05:00), setting the stage for an exceptionally deep contest.

For Bekele, however, this return to Berlin carries a significance that goes far beyond the start list. The last time the Ethiopian legend stood on the Berlin start line was in 2019, when he ran 2:01:41—just two seconds outside the then-world record of 2:01:39. Had he gone two seconds faster, Bekele would have become the only athlete in history to simultaneously hold the world records for the 5,000 metres, 10,000 metres and marathon.

Bekele returns to Berlin on Sunday at the age of 44. His most recent race was the New York City Marathon in November, where he did not finish. Berlin, however, holds a special place in his marathon career. He claimed his first Berlin Marathon victory in 2016 and has won the race twice. He also owns the masters world record of 2:04:15, set in London last year.

He will not be the favourite in this year’s race, particularly after Sabastian Sawe was ruled out with a stress fracture. Adola, Molla, Kitata and Geay lead the field on paper, but Bekele’s presence adds another layer of intrigue to a race already packed with established marathon talent.

For Bekele, Berlin is more than another marathon. It is the course where he came closer than anyone to achieving a piece of distance-running history that remains untouched. Some athletes retire from the sport. Some retire toward one course. Bekele is running the second kind of retirement.

In the women’s race, all eyes will be on Tigst Assefa as the Ethiopian superstar returns to the course where she produced one of the most remarkable marathon performances in history. Assefa clocked 2:11:53 in Berlin in 2023, setting a world record at the time and establishing a course record that still stands.

Assefa, a two-time Berlin Marathon champion, will face defending champion Rosemary Wanjiru, who returns to the German capital looking to retain her title. Wanjiru won the 2025 edition in 2:21:05 after previously finishing second in Berlin in 2022 in 2:18:00. Her personal best of 2:16:14 came at the 2023 Tokyo Marathon.

Wanjiru’s challenge will be particularly intriguing given the depth of the Ethiopian contingent. Bedatu Hirpa enters with a 2:18:27 personal best, followed by Dera Dida at 2:18:32, Zeineba Yimer at 2:18:47, Bosena Mulatie at 2:19:00, Misgane Alemayehu at 2:19:08 and Bekelech Gudeta at 2:19:39.

Kenya will also have another strong presence through Evaline Chirchir, whose 2:20:33 personal best places her among the leading women on the start list.

The Berlin Marathon’s reputation for producing fast times adds another layer of intrigue to an already stacked field. With a flat course, long stretches of uninterrupted running and a history of world records, the German capital has consistently provided elite athletes with the ideal conditions to test the limits of marathon performance.

Beyond the headline names, the race will also offer an opportunity for several contenders to make their mark on one of the biggest stages in road running. With experienced marathoners and ambitious challengers sharing the start line, the battle for the podium is expected to unfold at a demanding pace from the opening kilometres through the final stages of the race.

With Assefa returning to the scene of her historic 2023 run, Wanjiru arriving as the defending champion and a deep international cast lining up across both races, Berlin is once again set for a weekend of world-class marathon racing.

Three days out, the stage is set. The fast Berlin streets are waiting.

Kenyan distance runner Isaia Kipkoech Lasoi is set to make his long-awaited marathon debut at the 2026 TCS Amsterdam Marathon on Sunday, October 18, stepping up to the 42.195-kilometre distance for the first time in what promises to be a high-quality international field.

Lasoi arrives in Amsterdam with an impressive credential over the half marathon, having clocked a personal best of 58:10. His transition to the marathon will therefore be one of the major storylines to follow as he takes on a distance more than twice as demanding as the half marathon.

The 26-year-old Kenyan will face a formidable lineup that includes several athletes with marathon personal bests below 2:05. Leading the field is compatriot Geofry Toroitich Kipchumba, the defending champion and current Amsterdam course-record holder after his 2:03:30 victory last year. Kipchumba will return to the Dutch capital looking to defend his title and challenge his own record.

Ethiopia's Haymanot Alew is another major name on the start list, boasting a 2:03:31 personal best from Berlin in 2024, just one second outside Kipchumba's Amsterdam course record.

His compatriot Tsegaye Getachew will also return to a race where he has enjoyed considerable success. Getachew won the Amsterdam Marathon in 2022 and 2024 before finishing second last year in a personal-best 2:04:18.

The field also features Ethiopian marathoner Lemi Berhanu, who owns a personal best of 2:04:33, while Israel's Maru Teferi brings a 2:04:44 personal best set in Valencia in 2024.

With the Amsterdam course known for its fast profile and the race carrying a World Athletics Platinum Label, the stage is set for another potentially fast edition. The marathon starts at the Olympic Stadium, with the course taking runners past landmarks including the Rijksmuseum, along the Amstel River and through Vondelpark before returning to the Olympic Stadium for the finish.

For Lasoi, however, the focus will be on answering one intriguing question: how will his exceptional half-marathon speed translate over the full marathon distance?

His debut will provide the first major indication of his potential at 42.195 kilometres, while placing him alongside an experienced group of elite marathoners capable of producing world-class performances.

The confirmed names currently include Isaia Kipkoech Lasoi, Geofry Toroitich Kipchumba, Haymanot Alew, Tsegaye Getachew, Lemi Berhanu and Maru Teferi, setting up a fascinating international contest in Amsterdam on October 18.

At 103 years old, Germaine Smith has delivered an extraordinary reminder that age does not have to stand in the way of pursuing remarkable goals after completing the Fox Cities Half Marathon in Wisconsin in an impressive time of 2:04:40.

Smith captured attention with her inspiring performance, beginning the race in a wheelchair before getting out and completing part of the 13.1-mile course on foot. Her determination to keep moving forward made her achievement particularly memorable, turning an ordinary race day into a powerful story of perseverance and resilience.

The centenarian's finish was about far more than the time displayed on the clock. At an age when many people have long since stepped away from physically demanding activities, Smith demonstrated a remarkable willingness to remain active and embrace the challenge of completing a half marathon.

Her participation in the Fox Cities Half Marathon offered a powerful reminder that running and movement can remain meaningful at every stage of life. While the race brought together athletes pursuing personal records and competitive goals, Smith's journey stood out for the determination and courage behind her finish.

Completing 13.1 miles at 103 is an extraordinary accomplishment, and her decision to cover part of the course on foot made the moment even more special.

Smith's remarkable achievement is a celebration of the human spirit, showing that the finish line is not always about speed, but also about determination, courage, and the willingness to keep moving forward.

Her story also highlights the inclusive spirit of distance running, where participants of different ages and abilities can share the same course while pursuing their own personal goals. For Smith, the experience was a reminder that taking part in a race can be just as meaningful as competing for a podium position.

At an age when every milestone carries a special significance, Smith's accomplishment offers an uplifting message to people of all generations. Her journey demonstrates that determination and a love for physical activity can continue to inspire others, regardless of age or athletic background.

Beyond the finish line, her achievement serves as a source of encouragement for anyone who has ever questioned whether they are too old to take on a new challenge. Smith's remarkable effort shows that personal victories come in many forms and that the courage to participate can be just as powerful as the achievement itself.

At 103, Germaine Smith has shown that the joy of taking on a challenge has no age limit.

The TCS New York City Marathon is set for a small but significant change to its iconic 26.2-mile course, with runners facing a revised section in the Bronx between Miles 20 and 21.

For 15 years, every New York City Marathon runner passed through the exact same stretch of the Bronx around Mile 20, navigating a short loop that surrounded a neighborhood supermarket and a 24-hour laundromat for much of race day. This November, that familiar loop will disappear.

New York Road Runners (NYRR) is making its first course change to the marathon in 15 years. Instead of looping near East 140th Street, runners will head north on Alexander Avenue, turn onto Third Avenue and then cut south on 138th Street toward the Madison Avenue Bridge.

The adjustment removes two turns from the Bronx section, reducing the number from seven to five. While that may sound insignificant for a race covering 26.2 miles, the change comes at a point when runners are already deep into the marathon and every turn, road surface and change in rhythm can become more noticeable.

However, the primary reason for the change is not to make the course faster or help runners shave seconds from their finishing times.

Bronx resident Jennifer Alicea told The New York Times that the previous route made it extremely difficult to reach her only nearby grocery store on marathon day. NYRR's Metellus, who grew up in the Bronx, described the affected blocks as food deserts and saw the course's required recertification as an opportunity to address the problem.

The timing also carries added significance. This year marks 50 years since the New York City Marathon expanded beyond Central Park in 1976, becoming the five-borough race that has since grown into one of the world's most famous marathons.

The route will still cover the same 26.2 miles through New York's five boroughs, but the Bronx experience will be slightly different. For elite athletes, two fewer turns could mean a smoother rhythm during the crucial closing stages. For thousands of recreational runners, the bigger difference may be felt by the communities living along the course rather than on the race clock.

The New York City Marathon has long been celebrated not only for its elite competition but also for the connection between the race and the communities it passes through. The latest adjustment reflects that relationship, showing how even an established course can evolve while preserving the character of the event.

So, two fewer turns, the same five boroughs and the same 26.2 miles — but potentially one less headache for residents of the Bronx.

For runners taking on New York this November, the question remains: will you even notice those two fewer turns when you reach Mile 20? 

Alison dos Santos carries visible scars on his forehead and parts of his body, but behind them lies a remarkable story of survival that has become an important part of his journey in athletics.

When he was just 10 months old, the Brazilian suffered severe third-degree burns after boiling oil spilled onto him. The accident left permanent scars and could easily have changed the course of his life before it had even begun.

He survived the ordeal, and as he grew older, the scars became a visible reminder of an accident he had endured as a baby. For much of his childhood, they also brought unwanted attention and insecurity. But eventually, athletics gave him something far more powerful: confidence, purpose and an opportunity to define himself through his talent rather than his scars.

That transformation took him all the way to the world's biggest sporting stages.

Dos Santos announced himself among the world's elite 400m hurdlers with an Olympic bronze medal at Tokyo 2020, clocking 46.72 seconds. In 2022, he reached another milestone by becoming world champion, confirming himself as one of the leading figures in an event that had entered an extraordinary era.

Two years later, he added another Olympic bronze medal in Paris, continuing to establish himself among the very best 400m hurdlers on the planet.

Then came Zürich.

On August 27, 2026, dos Santos delivered the race that changed his place in history. He stormed to 45.80 seconds, breaking Karsten Warholm's five-year-old world record of 45.94 and becoming the first man in history to run under 46 seconds twice.

The moment carried another layer of significance because Warholm was in the race. The Norwegian had established the previous world record in the unforgettable Tokyo Olympic final in 2021, a race in which dos Santos himself had won bronze. Five years later, the Brazilian returned to the same record-breaking narrative — this time as the man rewriting history.

But dos Santos was not finished.

Just over two weeks after his historic run in Zürich, he travelled to Budapest for the inaugural World Athletics Ultimate Championship, where the world's leading 400m hurdlers assembled for another highly anticipated showdown.

On September 13, dos Santos once again stood at the centre of the action. He produced another extraordinary performance, winning the men's 400m hurdles in 45.98 seconds and successfully defending his position at the top of an event filled with heavyweight names.

Rai Benjamin finished second in 46.40, while Warholm took third in 46.78. Dos Santos had once again beaten two of the athletes most closely associated with the modern history of the 400m hurdles.

The 45.98 also made him the first athlete to break 46 seconds twice, while ranking as the third-fastest performance ever recorded in the event at the time. His world record of 45.80 remained firmly at the top.

His latest victory therefore added another remarkable chapter to a season that had already produced a world record and a string of elite performances. Dos Santos has combined speed, consistency and resilience to turn 2026 into one of the defining seasons of his career.

And perhaps that is what makes his story so compelling. The hurdles he clears today are visible to the world, but some of the hardest obstacles he has overcome were faced long before he ever entered a stadium. His scars tell the story of what happened to him as a child; his achievements tell the story of what he chose to become.

The scars never disappeared. Neither did the determination of the boy who survived them.

Today, Alison dos Santos is not defined by the accident that marked his childhood. He is defined by the athlete he became — an Olympic medallist, a world champion, a world-record holder and now the inaugural World Athletics Ultimate champion in the 400m hurdles.

From surviving a devastating accident as an infant to standing on the highest level of his event, Piu has spent his life clearing hurdles — long before he ever started racing over them.