glandular fever. If you have any of the symptoms below it is strongly recommended that you see your GP or Sports Physician to confirm diagnosis through a blood test and discuss treatment options. An Accredited Sports Dietitian can help you increase the intake and absorption of iron from food.

If your iron levels are very low your GP may also decide that you need iron supplements supplements should not be taken unless they have been prescribed by a GP. Athletes—especially females, adolescents , vegetarians, those with poor eating habits or following an energy restricted diet—are at risk of iron depletion and iron deficiency anaemia.

An Accredited Sports Dietitian can help you maximise your intake and absorption of iron to help you train and compete at your best.

According to the research, iron deficiency is common in athletes for the following reasons. Hematuria: Athletes tend to experience hematuria, or blood loss through urine, after exertion, and especially after intense workouts. This type of blood loss may occur more often in endurance runners.

When the foot strikes a hard running surface, that impact can cause red blood cells to rupture. Blood lost in this way may lead to iron deficiency or iron deficiency anemia. Gastrointestinal bleeding: Distance runners especially, but other athletes as well, may experience gastrointestinal bleeding.

Loss of blood in this manner can eventually lead to low iron levels or iron deficiency anemia. Heavy sweating: Iron is also lost through sweat. Because athletes sweat heavily during workouts and competitive events, it is important for them to replenish their iron stores either through food or supplements, or a combination of these nutritional approaches.

Hepcidin: The research also suggests that athletes are at increased risk for iron deficiency because of a hormone called hepcidin, which appears to spike after intense physical activity. Hepcidin reduces blood iron levels. Importantly, hepcidin levels seem to peak between three and six hours after a hard workout.

Meaning, many athletes who try to consume iron-rich meals in that time might not be absorbing the nutrient at all. Athletes who develop low iron levels can experience the same symptoms as healthy, sedentary individuals. They may also notice signs of low iron more closely related to their training.

Note that many of the symptoms of iron deficiency can also be caused by over-training, making misdiagnosis common. A blood test can confirm low iron levels. There are two nutritional strategies for increasing iron levels: diet and dietary supplements, the latter of which will be discussed more in the next section.

As mentioned above, getting enough iron through diet alone can be difficult for many athletes, who often eschew certain foods and monitor their caloric intake. And as has also been mentioned previously, levels of the iron-reducing hormone hepcidin can remain increased for hours after a workout, making it difficult for the body to absorb iron from food during that time.

For athletes who train consistently, there may be few windows in which they can properly obtain dietary iron, making supplements a prudent choice. Iron supplements can be used to help reverse low iron levels and to treat iron deficiency anemia in athletes. In fact, research has shown that iron supplementation can reverse any iron-deficiency-related athletic losses and improve exercise performance.

Floradix iron supplements also offer these additional benefits:. If you are an athlete who believes you may have low iron, you should talk with your doctor before adding an iron supplement to your daily regimen. Your doctor may recommend that your iron levels be tested via blood work.

This testing can verify if you are in fact deficient and in need of supplementation, and if so, the appropriate dose of iron to take in supplement form to help return your iron levels to a healthy range. After you begin supplementing with iron, you should also have your iron levels re-checked every three to four months, as you may need to discontinue use once your iron levels are within a healthy range.

While iron deficiency has detrimental effects on the body, the reverse is also true, as too much iron can also cause health issues. Skip to content. F7CE6FEFB-AEBB5D Back to all posts.

Why Is Iron Important for Athletes? Prevalence of Iron Deficiency in Athletes Instances of low iron levels and of iron deficiency anemia—a condition in which there are not enough healthy red blood cells to transport oxygen throughout the body, which develops due to insufficient iron—appear to be higher among athletes than the rest of the population.

Female athletes who eat a vegetarian diet seem to be at the greatest risk for insufficient iron. Sources of Iron Iron can be found in both animal-based foods and plant-based foods.

Why Are Athletes at Greater Risk for Low Iron? What Are the Symptoms of Iron Deficiency in Athletes? General signs and symptoms of iron deficiency include: 5 Fatigue, ranging from mild to severe Sleeplessness Headaches Dizziness Low energy during the menstrual cycle Pale, dry skin and mucous membranes Cracked corners of the mouth Brittle nails and hair, including hair loss Decreased memory, attention, and learning performance Signs and symptoms of iron deficiency specific to athletes include: 6 Decline in athletic capacity, including loss of endurance Decreased exercise performance Higher-than-normal resting heart rate or exercising heart rate athletes usually have a lower resting heart rate than more sedentary individuals Shortness of breath while exercising Nausea Frequent injury Loss of interest in exercise Note that many of the symptoms of iron deficiency can also be caused by over-training, making misdiagnosis common.

Eating More Iron: Foods That Boost Iron Levels There are two nutritional strategies for increasing iron levels: diet and dietary supplements, the latter of which will be discussed more in the next section. The Benefits of Iron Supplementation Iron supplements can be used to help reverse low iron levels and to treat iron deficiency anemia in athletes.

Floradix iron supplements also offer these additional benefits: Non-constipating Free of artificial additives, synthetic preservatives, alcohol, and lactose Kosher, non-GMO, and vegetarian Environmentally friendly packaging Available in multiple formats, including liquids, tablets, and a vegan, yeast-free, and gluten-free formula Iron Supplement Precautions If you are an athlete who believes you may have low iron, you should talk with your doctor before adding an iron supplement to your daily regimen.

Holly J. Melvin H. Mia K. Newlin et al.

If untreated, low iron levels can develop into iron deficiency anaemia which can leave athletes feeling lethargic and unable to perform at their best. glandular fever. If you have any of the symptoms below it is strongly recommended that you see your GP or Sports Physician to confirm diagnosis through a blood test and discuss treatment options.

An Accredited Sports Dietitian can help you increase the intake and absorption of iron from food. If your iron levels are very low your GP may also decide that you need iron supplements supplements should not be taken unless they have been prescribed by a GP.

Athletes—especially females, adolescents , vegetarians, those with poor eating habits or following an energy restricted diet—are at risk of iron depletion and iron deficiency anaemia.

Nearly half of females who exercise may experience iron deficiency. The International Olympic Committee Consensus Statement on periodic health evaluation of elite athletes even recommended routine screening for iron deficiency. This article is also focused on adult athletes and the information discussed may not apply to children.

Iron is a mineral that has several important roles in the body including energy metabolism, oxygen transport, and acid-base balance. Red blood cells transport oxygen throughout the body and are filled with proteins called hemoglobin. Each hemoglobin molecule contains iron.

Oxygen picked up in the lungs binds to the iron inside hemoglobin and then is carried all over the body to supply oxygen to organs and tissues. Iron comes from our diet. Dietary iron can be classified into heme iron and non-heme iron.

Heme iron is found in meat, poultry, and fish. Red meat contains about three times as much iron as both poultry and fish making it one of the richest sources of dietary iron. Heme iron is absorbed by the digestive tract about twice as well as non-heme iron.

Sources of non-heme iron includes fruits, vegetables, and iron fortified foods. Vitamin C assists with the absorption of non-heme iron in the digestive tract so mixing foods rich in vitamin C with non-heme iron containing foods can increase the amount of iron the body absorbs.

Athletes need more iron than the general population. Iron is lost through sweat, skin, urine, the gastrointestinal GI tract, and menstruation. Athletes lose more iron due to heavy sweating as well as increased blood loss in the urine and GI tract. The mechanical force of a footstrike during endurance running, for example, can increase the destruction of red blood cells in the feet, leading to a shorter red blood cell life span.

Female athletes are at even higher risk for iron deficiency as compared to males due to monthly blood loss associated with menstruation. Athletes may also be at risk for iron deficiency due to insufficient dietary iron intake.

Remember, the body is not very effective at absorbing dietary iron. Those following a strict vegetarian or vegan diet can be at even higher risk for iron deficiency due to the decreased absorption of non-heme iron found in plants and fortified foods. Because iron is necessary for oxygen transport and energy metabolism, both of which are critical for fueling aerobic exercise, endurance athletes can experience a decline in exercise capacity and VO2 max, the maximal amount of oxygen the body can use, with iron deficiency.

As iron deficiency becomes more severe, the body cannot make a sufficient number of red blood cells and anemia, meaning low red blood cells, develops.

Athletes with iron deficiency anemia will generally have more pronounced symptoms than those with iron deficiency alone. A craving for ice chips is actually pretty specific to iron deficiency, so any athletes out there who find themselves wanting to eat a lot of ice should definitely have their iron levels checked.

Iron deficiency is diagnosed through blood tests. The most useful of the typical iron study panel is ferritin, which is a marker of iron stores. In the sports nutrition community, there is no clear ferritin goal for athletes.

If a ferritin is dropping significantly during the course of a training cycle, this can also be indicative of developing iron deficiency and the need to intervene, even if the ferritin is within what is generally considered a normal range. It is also worth mentioning that ferritin levels can quickly increase when the body is under stress so results may be falsely high during periods of active infection or inflammation.

The other traditional iron panel tests can be useful in distinguishing iron deficiency from poor iron utilization states. A complete blood count CBC measures the levels of red blood cell in the body and determines whether or not someone is anemic.

Markers of red blood cells in a CBC are hemoglobin and hematocrit. Of note, iron deficiency is only one of the many causes of anemia.

Consultation with a sports dietitian is recommended for athletes with iron deficiency. A sports dietitian can perform a thorough dietary review and make recommendations for ways to increase iron intake.

Replenishing iron levels through dietary means is always preferable to taking an iron supplement. For some, iron supplementation through oral means pill or liquid may be necessary.

Oral iron comes in many formulations that are generally equally effective as long as taken regularly. Milk, coffee, and tea can interfere with iron absorption so should not be consumed along with the iron supplement. Unfortunately, oral iron can be difficult to tolerate due to side effects.

Anecdotally, sports dietitians our clinic has worked with find that a specific iron product called Blood Builder is much better tolerated than standard iron supplements, though there is no directed scientific evidence to back this up.

It is NEVER advised to make a self-diagnosis of iron deficiency. If an athlete is concerned that they might be iron deficient, they should get blood tests to confirm the diagnosis. Taking iron supplements in the absence of iron deficiency can lead to iron overload, which is very dangerous.

The best available evidence says that to avoid this GI toxicity, athletes should take mg every other day and will still have a similar increase in iron stores with less total iron ingested McCormick To maximize absorption, athletes should consume their supplement in the morning, 30 minutes prior to exercise to help potentiate absorption McCormick There are other oral formulations which are less commonly used but may be promising for future management.

Answer A is the correct answer. This vignette is most consistent with iron deficiency anemia. The fatigue and decreased performance could be attributable to any of the answers.

A normal blood glucose excludes diabetes. Overtraining syndrome and relative energy deficiency in sport are unlikely given the correct calorie intake, no changes in her training, no other stress related injuries and a normal body habitus.

Her symptoms, sport of choice, gender and choice of veganism put her at high risk of iron deficiency. Because of the decrease in performance and fatigue she is likely anemic at this point. The patient needs serum hemoglobin and ferritin levels checked and perhaps a further workup if the diagnostic picture is unclear.

Subscribe to our monthly newsletter and get access to all of our posts, new content and site updates. Iron Deficiency Anemia in Athletes. Case Question. Iron Deficiency Anemia. Iron is a critical component of heme formation, the protein chain responsible for carrying oxygen on hemoglobin.

There is a direct correlation between iron stores, arterial oxygen content and maximal contractility of skeletal muscle. Ferritin is a storage protein which accurately reflects total body stores of iron and is a reliable marker of iron deficiency.

It is worth noting that ferritin is an acute phase reactant which can be elevated following exercise or other inflammatory conditions. Hepcidin is a hormone which regulates iron metabolism. Hepcidin increases following exercise and while elevated, impairs iron absorption in the gastrointestinal mucosa Peeling Image 1.

Athletes are considered more susceptible due to increased iron requirements. This is primarily due to hematological adaptations to training and sport requiring an increased oxygen demand.

Iron loss can also occur due to sweating, hematuria and GI bleeding which may seem insignificant but can be cumulative over time Gaudin Foot strike hemolysis has also been implicated. In women, blood loss from menstruation Fallon and decreased iron consumption have also been cited as contributing factors Nickerson Iron deficiency non-anemic athletes typically are asymptomatic.

When anemia is present, athletes will report lethargy, fatigue, weakness and shortness of breath. They will often note a decline in exercise performance, reduced work capacity and inability to adapt to training stress Haas Physical exam may be normal.

Pallor of skin and conjunctiva may be present but is not a reliable clinical indicator in mild anemia. Athletes who should be tested are athletes experiencing an unexplained decrease in performance, individuals consuming a vegetarian diet and athletes with a previous history of iron deficiency.

In athletes with IDNA will have normal hemoglobin and low ferritin while athletes with IDA will have low hemoglobin and low ferritin. What Is less clear is which athletes require screening. Generally accepted is female athletes and males endurance athletes competing at an elite level.

Image 2: Example of iron supplement. Buy on Amazon. Parenteral iron can be administered intramuscular IM or intravenous IV.

It is effective because it bypasses the gut and the GI side effects and can rapidly increase iron stores in a shorter period of time than oral. Indications include athletes with severe ID or IDA, those who need rapid improvement in iron stores, when athletes can not tolerate gastrointestinal complications or when an oral treatment has failed and anemia has progressed.

Transdermal patches represent another option for bypassing the GI tract although the literature and formulations thus far have failed to show much benefit McCormick Finally, prevention is the best treatment and athletes should be encouraged to eat foods rich in heme iron and non-heme iron.

In summary, iron deficiency non-anemia IDNA is highly prevalent in athletes, especially among females and endurance athletes. When the hemoglobin begins to decline and the athletes are symptomatic, it is referred to as iron deficiency anemia IDA.

Symptoms include fatigue and shortness of breath and athletes will exhibit a decline in performance. On laboratory evaluation, both ferritin and hemoglobin will be decreased. It is important to consider alternative diagnoses as well. Treatment involves oral supplementation of ferrous sulfate mg.

The best available evidence says to use alternate day dosing to avoid the GI distress and to take it in the morning, 30 minutes before exercise to maximize absorption. Case Conclusion. Rowland, Thomas.

Sim M, Garvican-Lewis LA, Cox GR, Govus A, McKay AK, Stellingwerff T, et al. Iron considerations for the athlete: a narrative review. Eur JAppl Physiol. Garza D, Shrier I, Kohl HW, Ford P, Brown M, Matheson GO.

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