What Athletes Need to Know About Iron Deficiency

Due to the demands of workouts, athletes are particularly susceptible to developing iron deficiency. This results in anemia. Read on for information on why iron is important and how to get enough.

Whether you are an elite athlete or a weekend warrior, being involved in regular intensive workouts can deplete your iron stores and put you at risk of developing what is known as iron deficiency anemia. You could be feeling anything from lethargy to irritability, or even feeling a loss of interest in exercising all together. As an athlete these feelings are detrimental to your progress and training goals. So what is iron deficiency and how can you avoid it? Well, allow me to “iron” out the facts for you.

Iron is an essential nutrient, which means the body needs to obtain it from the outside, from your diet. If not enough iron is consumed it can cause iron deficiency anaemia to develop. Anemia is a condition that impairs your body’s ability to transport oxygen. Considering that dietary iron recommendations are 1.3 to 1.7 times higher for athletes than non-athletes and 1.8 times higher for vegetarians than meat eaters you can see how if your diet was not spot on, or if you were unaware of the symptoms, just how debilitating this could become.1 It is important to note that iron deficiency is an especially common problem for women and adolescent athletes.

The Role of Iron in the Body

Iron is part of hemoglobin, which is a protein in the blood that transports oxygen to all the cells in your body. The brain has a big demand for oxygen. Without enough iron in your system, you will find it hard to concentrate and feel tired and irritable. Inadequate iron in the body can impair aerobic metabolism by decreasing the delivery of oxygen to tissues and reducing the capacity of muscles to use oxygen for the oxidative production of energy.

Iron is required for:

  • Transporting oxygen in the blood and in the muscles.
  • Creation of red blood cells.
  • Involvement in the electron transport system, which controls the release of energy from cells.
  • A healthy immune system.

Symptoms of Deficiency

The symptoms of iron deficiency are varied and can in some cases be misdiagnosed as overtraining due to the display of many common symptoms. Some of the symptoms of iron deficiency include chronic fatigue, frequent injuries, loss of endurance and power, recurring illness, irritability, loss of appetite, and loss of interest in exercise. The only sure way to diagnose a deficiency is a blood test to determine your iron status.

One thing to remember is that iron deficiency doesn’t just happen overnight. It starts slowly and is exacerbated by poor nutritional consumption. This then forces the body to tap into its reserves. Over time, these reserves become depleted causing the body to manufacture red blood cells that are smaller and carry less than normal levels of haemoglobin.

This might not seem like a big deal but as the average lifespan of a red blood cell is 120 days, over time the smaller and more inferior red blood cells start to out-number the good ones. This severely impairs the body’s ability to carry oxygen around the body, resulting in your heart needing to beat faster to ensure oxygen delivery.

Why Athletes Are at Risk

There are a few reasons why athletes are at a higher risk of experiencing iron deficiency compared to their non-athletic counterparts:

Higher requirements for iron use:

  • Red blood cell mass increases, meaning athletes have higher iron needs.
  • Iron needs are higher during times of growth.

Increased risk of iron loss:

  • Iron is lost in sweat. Athletes with high sweat loss have higher iron loss.
  • Iron can be lost through gastrointestinal bleeding. Gastrointestinal bleeding is common during strenuous exercise due to minor damage to the stomach and intestinal lining.
  • Habitual use of anti-inflammatory drugs leads to iron loss.
  • Foot strike hemolysis, which is caused by repeated pounding of the feet on hard surfaces, can destroy red blood cells, allowing for iron to be lost.

The Difference Between Anemia and Sports Anemia

A person’s iron status can be difficult to assess from a single blood test, as strenuous exercise can increase the volume of plasma in the blood, diluting the levels of hemoglobin. This increase can sometimes incorrectly suggest there is a deficiency. This is called sports anemia. This condition does not need any treatment as it is generally found in people who are only in the early stages of a training program.

Choose Your Foods Wisely

As the body is unable to manufacture iron, it must be supplied by the food we eat. Although iron is widely distributed in foods, some sources are better absorbed than others. Two types of iron exist in foods and they are heme iron and non-heme iron.

Heme iron is found in the muscle meat of animal foods like beef, lamb, liver, seafood, pork, and poultry. 15 to 18% of this type of iron is absorbed. It should be noted that lean cuts of red meat contains three times as much iron as chicken or fish, making it one of the richest sources of iron.

Non-heme iron is found in plant-based foods. Sources include cereal grains and fortified cereals. Eggs, legumes, some green vegetables, dried fruits, and nuts are also good sources. Absorption of non-heme iron from these foods is substantially lower than heme iron at around 5%.

Absorptions can either be hindered or enhanced depending on the food that accompanies the iron rich foods in the same meal. Non-heme iron from plant sources is sensitive to these other components. The inclusion of either meat or vitamin C rich foods in the same meal can increase the absorption of non-heme iron rich foods by up to four times. On the other hand, consumption of tea or coffee can decrease absorption due to the tannins.

Treating the Deficiency

In order to recover the depleted stores of iron in your body some form of supplementation will be needed along with a diet rich in iron containing foods. Supplementation generally involves 100-300mg of iron per day in conjunction with vitamin C to enhance absorption. This is because changing diet alone will take too long to correct the problem. Some doctors give an iron injection but supplements are preferred. Recovering your iron stores is a slow process and can take up to three months.

A medical professional should always be consulted before you supplement your iron, as regular use of un-needed iron supplements can interfere with zinc and copper absorption and may have negative effects on the immune system. In a portion of the population, a genetic disorder called hemochromatosis allows excess iron to be absorbed.2 This iron overload disorder affects around 1 in 300 Caucasians. In this condition, too much iron in the cells and tissues can cause irreversible damage along with a high risk of cancer and heart disease. Always ask your doctor to check your iron status first before you take iron supplements. As a side note it is impossible for a healthy, normal person to absorb too much iron from their diet.

Dietary Tips:

  • Increase consumption of iron-rich foods.
  • Choose a variety of iron-rich foods every day.
  • Eat lean red meat, poultry, or seafood daily.
  • Eat lean red meat at least three to four times a week.
  • If vegetarian, ensure food choices are iron-rich and combined with vitamin C-rich foods.
  • Avoid consuming strong tea or coffee when eating iron rich foods.

As you can now see iron is an important nutrient, but it also shouldn’t be abused by over supplementation. The better route is to make adjustments to your diet. Adequate intake of iron rich foods is the key to maintaining performance and maximizing results.


1. Iron Depletion

2. Iron – are you getting enough?

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