Athletes: Could you be iron-deficient?


Athletes who are involved in heavy training may be prone to iron deficiency, which can lead to iron deficiency anaemia, a number of studies have found. Iron deficiency is a condition which is the result of having too little iron in the body. Even a slight iron reduction can affect an athlete's endurance.

Whereas a risk of iron deficiency is usually associated with children, women, and vegetarians, it has been estimated that up to 80% of female athletes and 30% of male athletes may be experiencing iron-deficiency symptoms as well. (Female athletes have an even greater vulnerability due to blood loss during menstruation.)

According to one study, published in the British Journal of Sports Medicine, there have been many reports over the last ten years on anaemia occurring in top athletes of both sexes, even among the members of Olympic teams, performing in various endurance disciplines.

Why do you need iron?

The body needs iron to make haemoglobin, a protein in red blood cells that allows them to distribute oxygen throughout the body. If there is not enough iron available, there is a lack of red blood cells and haemoglobin. As a result, the transportation of oxygen through the body is impaired, leading to various health consequences, including impaired physical and cognitive development.

For the athlete, a shortage of haemoglobin due to iron deficiency will cause the body to work slower and affect his or her performance. Less stored iron can also negatively affect aerobic training by decreasing energy efficiency and increasing muscle fatigue and cramping, explains.

‘Foot strike haemolysis’

“Even a mild shortfall in iron appears not only to reduce oxygen uptake and aerobic efficiency, but also diminishes the body’s endurance capacity,” says Giulia Criscuolo, responsible pharmacist for OTC Pharma SA and keen runner. “Any athlete involved in regular high intensity physical activity has a higher requirement and turnover of iron which is quickly depleted.”

Athletes are especially at risk of developing iron deficiency by a variety of mechanisms, says Dr Jerry Spivak, a haematologist and Professor of Medicine and Oncology at the Johns Hopkins University. “The classic example is long distance runners, who often suffer from something called ‘foot strike haemolysis’, which is the destruction of red blood cells in the feet due to constant impact.”

Athletes who engage in regular intense exercise can also lose iron through sweat, by small blood losses through the digestive tract and by taking aspirin or anti-inflammatory drugs to get rid of soreness (these drugs reduce the body’s ability to absorb iron). For these reasons, their need for iron may be 30% greater.

Athletes most at risk of developing iron deficiency anaemia are female athletes, male endurance athletes and runners.

Could I be iron-deficient?

It is important that you know for sure you are iron deficient, before starting iron supplementation. Overloading your body with iron can be dangerous, as too much iron can damage your liver, pancreas and heart and ultimately lead to organ failure if left untreated.

The easiest way to check for iron deficiency is to go for a blood test at your local clinic, pharmacy or doctor. If the blood test confirms iron deficiency, your doctor may also want to do a physical examination and review your family history to exclude other possible health problems.

There are a number of underlying illnesses that could cause iron deficiency, which “should be excluded before iron deficiency can be safely attributed to the consequences of physical activity”, a team of UK and Austrian researchers reported in a study that was published in Nutrition journal. These include chronic bleeding of ulcers, coeliac disease, benign polyps in the colon and colon cancer.

How to treat iron deficiency

The first line of treatment would be to ensure that your diet is rich in iron. Foods that have a high iron content include red meat, liver, eggs, spinach, dried apricots, raisins, sardines, some breakfast cereals, and wholewheat bread. 

“It is very difficult though to correct iron deficiency anaemia solely with an iron-rich diet,” Criscuolo notes. “Recovery from depleted or exhausted iron stores is slow and can take months to reach previous condition and training levels so supplementation is necessary.”

Iron supplements (most often ferrous sulphate) mainly come in the form of pills or tablets. These, however, often have unwelcome side effects, such as nausea, diarrhoea and constipation, and generally only 10% of the iron is absorbed by the body.

To help increase absorption it is recommended you drink your iron supplements with orange juice (the vitamin C helps absorption) and avoid tea or wine within one hour of taking iron supplements (the tannin in both these drinks can bind iron, making it very hard to absorb.)

Recently a new liquid iron supplement has become available on the South African market. It is a 100% natural, iron-rich mineral water, called Spatone, which has clinically been proven to be far better absorbed by the body (up to 40%), without the unwanted side effects.

If you suffer from severe iron-deficiency anaemia, your doctor may also recommend iron supplementation by injection or intravenous (IV) drip. These are injected either directly into your blood stream through an IV or into the muscle - often the upper arm. This kind of supplementation can only be administered by a medical professional.

(Photo of runner on road from Shutterstock)

(Sources:; www.anaemia.org;;;;;

Read more:

6 steps to increase iron absorption
Iron-deficiency anaemia

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