Iron Deficiency + The Athlete: Part II

If you recognize the food on the left side of the plate above as red lentils (a red lentil soup), then you may also know it to be a rich source of the mineral iron. 

I’ve written about iron in detail before, but a recent research paper on  impaired iron and endurance athletes reminded me that I need to periodically review this topic. 

Nearly all of my female clients in the past few years have come to me with iron deficiency, iron-deficiency non anemia, or iron-deficiency anemia. This has been true whether they are endurance athletes or not. And whether they’re highly active or not.

Here’s a refresher on the difference between those three:

Stage 1: Iron Deficiency: Iron stores in the bone marrow, liver, and spleen are depleted, indicated by ferritin values less than 35 ng/mL, Hemoglobin values > 11.5 g/dL and transferrin saturation >16%

Stage 2: Iron-Deficient Non-Anemia: Red blood cell production decreases as the iron supply to the bone marrow is reduced, indicated by ferritin values less than 20 ng/mL, Hemoglobin >11.5 g/dL, and transferrin saturation < 16%

Stage 3: Iron Deficiency Anemia: Hemoglobin production falls, resulting in anemia, indicated by ferritin values less than 12 ng/mL, Hemoglobin <11.5 g/dL, transferrin saturation less than 16%. 

While iron deficiency may be much more likely in women, it’s not a female-only issue. 

It used to be that when there were signs, symptoms, and laboratory results indicating deficiency of a nutrient, I did just the typical nutritionist thing of recommending eating more foods rich in that nutrient, increasing bioavailable co-factors in the diet, adjusting timing of nutrient intake so absorption increases, and according to the circumstances, recommending varying amounts of supplementation. 

Generally, that’s a pretty good and standard game plan.  But to a certain extent in many cases, it was band-aiding the real issue. Or at least not getting all the way there. 

Why is nutrient absorption impaired in the first place?  Did the individual merely need to increase nutrient intake and we’d solve the problem? Was it just an issue of increased demand or not eating foods rich in that nutrient?

What I started finding was that even with continued intake of iron-rich foods, or in some cases high-dose supplementation, we’d still have low levels of iron (and often of other nutrients).

So what’s happening here? 

It wasn’t until I had continued professional training on gut health and malabsorption that I began having some personal aha moments. 

When I began addressing the issue of nutrient deficiency from the standpoint of improving the person’s digestion and absorption and calming the nervous system (which is so incredibly entwined with gut health), absorption of iron and many other nutrients drastically improved. 

We were finally treating the issue. 

Which is to say, that still doesn’t mean it’s easy. Figuring out which puzzle piece or perhaps multiple puzzle pieces of the GI system are impairing absorption of nutrients and digestibility of food can take some time and it can take some persistence. But it’s so worth addressing. 

Here are some factors that might be causing impaired absorption of dietary and supplementary iron and/or increased need.  Check all that apply for you. The more that apply, the more likely absorption and/or intake of iron will need addressed.

  • Female of menstruating years 
  • Endurance athlete
  • Digestive Symptoms – Pain, Bloating, Gas, Loose Bowel Movements, Undigested Food in Stool, etc.
  • Have low stomach acid (quite common and most people are completely unaware)
  • Follow a vegetarian, vegan, or plant-based dietary pattern
  • Omnivore who avoids red meat
  • Fast eater or eats while distracted or stressed
  • Low estrogen or testosterone levels
  • Supplemental intake of other minerals at the same time as iron, not-including nutrient cofactors when consuming iron rich foods or supplements, and/or consuming foods and beverages that prevent absorption at meals rich in iron
  • Taking prescription medication(s) – depending on the medication if may impact nutrient absorption or change physiology so there’s an increased need
  • Lack of knowledge about how to eat a balanced diet or poorly planned dietary pattern
  • INFLAMMATION! – Particularly inflammation of the gut (may be asymptomatic or not obvious)

Want to Know More?

If you’d like a refresher on iron, check out my first article on this topic.

Need help with iron or absorption of other nutrients? Within my nutrition practice, I specialize in endurance athletes and digestive imbalances. If you’ve struggled with chronically low iron or poor absorption of other nutrients, I encourage you to reach out to me for more personalized support.

Knowing When (and how much) Salt to Consume

Confused about whether you need additional salt in the summer or when you’re active? Or have you been avoiding salt because it’s been considered “bad for health”? 

What are the roles of salt? 

  • Salt is one of the six essential tastes or flavors. This means we need it for digestion to work properly, and it also makes food and meals taste “balanced/good.”
  • Salt is a required electrolyte for balancing water + fluids throughout the body
    • Salt helps to keep us supple and to create flexibility in the joints – no added salt dries us out and is depleting. This is because sodium holds onto water in the cell.
    • Sodium helps with water absorption from the gut. When you drink something that contains sodium and carbohydrate, you will have increased absorption of water and once it is absorbed, the water will be better retained. 
  • Salt aids in digestion and elimination of wastes
    • It’s a co-factor for transporting glucose (a simple sugar from broken down carbohydrates) across the small intestine lining to be absorbed.
    • It’s a co-factor for transporting amino acids (the building blocks of protein) into the cells to be utilized via the sodium-potassium pump in a ratio of 3:2, sodium : potassium. 
    • The salty flavor stimulates the appetite. 
  • Salt helps to support muscle contraction and muscle strength.
  • Salt helps to clear the subtle channels of the body of stagnation – these are often overlooked in modern western medicine, but are quite important in eastern medicinal traditions. 


* Salt is lost through sweat in varying amounts that are individual to you. What’s really interesting (depending on how you look at it of course) is that people that tend to be salty sweat-ers tend to crave salt more, potentially indicating they desire more salt because they lost more. But counter to this, consuming more salt leads to sweating out more salt in the skin. So it’s not yet entirely clear if you’re craving salt because you lost a lot, or you lost a lot of salt through sweat because you ate a lot of salt.

For highly active individuals, it’s really important to replenish salt and other minerals that are being lost through sweat. In addition to sodium, we also lose potassium, chloride, magnesium, calcium, iron, and others through sweat, and these minerals are all considered electrolytes, meaning they conduct an electric current when dissolved in water.

The electrolytes that are lost in the highest concentrations through sweating are sodium, chloride, and potassium, in that order. The others are lost in much smaller amounts. Because salt is primarily sodium and chloride, salt is needing to be replenished in the highest amount after sweating.

What about when I’m craving salt? Does that indicate I need to eat more of it? 

Not necessarily. Take a look at what foods or drinks  you are craving. Is your desire for salt satisfied by adding an extra ⅛ – ¼ tsp. per serving of mineral/rock salt to your meals during the cooking process?
An additional way to add extra salt to your diet is by adding rock salt and rock sugar in small amounts in warm water. You can then let them sit at room temperature if you don’t want to consume a hot drink. Or sign up for my newsletter. I’m sharing an easy homemade electrolyte drink this week.

If your cravings are not relieved by the above and you’re craving salty junk food such as chips, french fries and fried potatoes, pretzels and snacky foods, it’s likely that this is a craving representing imbalance in the body at the moment, and eating more of these foods is not going to sustainably satisfy the imbalance. 

Craving salt all the time might also indicate a need for additional zinc, and it would be good to check in with your nutrition professional to check your zinc levels and determine other symptoms of zinc imbalance – simply supplementing with additional zinc can lead to other mineral imbalances over time so it’s wise to work with an expert on this. 

Symptoms of too much and too little salt 

  • Too little sodium can lead to hyponatramia (low blood sodium), dizziness, muscle cramps, nausea, vomiting, loss of appetite, seizures, or coma
  • Too much sodium can lead to hypernatremia (high blood sodium), hypertension (high blood pressure), and nausea 
  • Too little chloride can lead to muscle spasms with loss of consciousness
  • Too much chloride can lead to hypertension (high blood pressure)

Quality Salts to Cook With and Eat

  1. Himalayan Pink Salt has the same potassium concentration as the human body – it also contains other trace minerals and electrolytes that are essential for fluid balance. 
  2. Redmond Real Salt (from Salt Lake City area in Utah) is similar to Himalayan Pink Salt and is also recommended.
  3. The last best choice is sea salt. Sea salt is very similar to table salt (sodium chloride), with a little more of the other electrolytes. It is less processed than table salt but our modern oceans are not as pure as they once were and thus, sea salt is going to be less of a good choice than mineral (rock) salt. We’re even starting to find microplastics in sea salt! 
  4. Table salt is the least expensive salt at the supermarket and made of sodium and chloride. It’s also what is used in nearly all pre-packaged, restaurant, and processed foods–Table salt is realistically more harmful than it is helpful. It has virtually all the other minerals stripped out of it, and has undergone intensive mining and refining processes. 

How Much Salt Should I Eat/Drink?  

The answer to this is that it depends on you, and it’s not super easy to gauge just exactly how much salt you need. I recommend ⅛ teaspoon per person cooked into meals at breakfast and ¼ teaspoon at lunch and dinner as a starting point. If you add no additional packaged/processed foods and no other salt in meals, you will inherently meet the lower end of the recommended daily amount per day using these amounts. 

Most of us are adding additional inherently salty foods to our meals such as olives, pickles, etc., or eating foods that have salt-added as part of the processing, so still keeping with the suggested amounts to add when cooking meals, you’ll likely still be within the recommended sodium amount. 

If you’re a salty sweat-er, or highly active, gauge your desire for salt, and whether it’s relieved by adding additional high quality mineral salt to foods rather than through snack foods, or mix up a batch of the electrolyte homemade electrolyte drink, if you’re a newsletter subscriber, to drink throughout the day or during workouts.

Next Steps

This is by no means a comprehensive review or personalized advice. I encourage you to reach out to me for more personalized support, especially if you need assistance with how to adjust your salt intake in and around exercise or based on your symptoms of imbalance.

What does Healthy Digestion Look Like?

What’s considered “normal” in our modern culture doesn’t necessarily mean it’s healthy or optimal. 

What are signs that your digestion is working optimally?

  • Healthy appetite 
    • being ready for a morning meal by 7-9 am, feeling hungry again 3-6 hours later and at steady 3-6 hour intervals throughout the day. 
  • Steady energy throughout the day
    • no fatigue or big drops in energy after eating or mid-afternoon, or difficulty waking up or getting going 30 minutes after waking.
  • One to three bowel movements daily, which pass easily and are formed like a banana
    • no visible food, mucus, fatty film, or off colors
  • Clear skin
    • free of acne, itching, inflammation, and rashes
  • Focused mind and inspired thinking
  • Your athletic performance is reflective of your training
  • Balanced hormones and menstrual cycle (if a menstruating female)
    • no PMS or menopausal symptoms

What are signs that your digestion is not working optimally?

  • Lack of appetite, or only tolerating very small amounts of food before feeling full 
  • Fatigue throughout the day, or crashes of energy after meals or during certain times of day; 
    • difficulty getting going in the morning
  • Sluggish or rapid digestion 
    • feeling hungry again within 1-2.5 hours after a meal, or like food sits in your stomach after a meal, resulting in excess fullness
  • Less than one bowel movement daily, difficulty passing a stool, or having to go multiple times per day
    • diarrhea, loose stools, deer pellets, visible food, mucus or greasy film; colors other than chocolate brown
  • Digestive Symptoms
    • bloating, gas, reflux, pain, cramps, gurgling, nausea, food intolerances
    • cravings for certain foods; particularly sweet or salty flavors
  • Skin Irritations
    • eczema, psoriasis, rashes, hives, acne
    • tooth Indentations on the tongue’s edges; a white, black, gray or yellow coating on the tongue
  • Brain Fog or Irritability, Depression, Anxiety, Scattered Thoughts
  • Your athletic performance is suffering despite training, or you continue to encounter performance or training set-backs
  • Hormonal Imbalances and menstrual cycle symptoms 
    • PMS or menopausal symptoms 


Are all of these really related to digestion? 

The answer is yes! The ability to take food and break it down into nutrients, and assimilate it into the body to be used as energy is the basis for building healthy body tissue (and thus a healthy body!) The health of your gut microbial community and intestinal lining directly impacts your health, hormones, and ability to tolerate food.

Next Steps

Do you find indications that your digestion isn’t working optimally? Within my nutrition practice, I specialize in endurance athletes and digestive imbalances. If you routinely struggle with any of the above symptoms,  I encourage you to reach out to me for more personalized support.