Which Athlete is at Highest Risk For Iron Deficiency?

Written by Ben Bunting: BA, PGCert. (Sport & Exercise Nutrition) // British Army Physical Training Instructor // S&C Coach.

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Iron plays a vital role in oxygen transport to the body's muscles and organs. It's also essential for brain function and the immune system.

Low iron levels can lead to a variety of symptoms. They include fatigue, chronic muscle pain, reduced stamina, irritability and decreased appetite.

Symptoms of an Iron Deficiency

You might have symptoms of an iron deficiency if you don't eat enough foods that contain iron, your body can't properly absorb iron (such as in celiac disease), or you lose iron through your blood (such as from an injury, heavy menstrual periods, or bleeding inside your intestines).

Women who are pregnant or breast-feeding also need extra iron to help their growing baby.

A doctor can tell if you have an iron deficiency by checking your iron level and other tests.

Your doctor might order blood tests to check your haemoglobin levels and other blood counts, like your platelet count.

Haemoglobin is a protein that carries oxygen throughout your body, so low haemoglobin levels can cause you to feel tired or listless.

In extreme cases, you might have shortness of breath because the fewer red blood cells in your blood mean less oxygen is being carried.

Your doctor may order a bone marrow aspiration or biopsy to look for a lack of iron in your marrow.

The procedure involves taking a small amount of fluid or solid bone marrow tissue to examine the number and size of blood cells and for abnormal cells.

Depending on the cause of your iron deficiency, your doctor may recommend taking oral supplements or a multivitamin containing iron.

These can help you create an iron "store" and restore your iron levels.

However, you must identify the underlying cause of your iron deficiency before starting treatment so your body can heal itself.

Why Are Female Athletes at Risk of Iron Deficiency?

Women athletes are often at higher risk of iron deficiency and anaemia than non-athletes.

This is mainly because of monthly blood loss during menstruation and increased exercise-induced iron loss.

Iron is an essential nutrient and is needed to transport oxygen in the body. It is also important for muscle function and energy production, particularly during intense physical activity such as athletics.

Without enough iron, the body cannot produce and use red blood cells or deliver oxygen to the muscles effectively.

The human body has a limited capacity to store iron, so it needs to get it from the diet. The main sources of dietary iron are found in heme (from animal meats and seafood) and non-heme (from plants).

Heme iron is absorbed more easily than non-heme iron. This is why consuming foods rich in heme iron, such as meat, poultry, and fish, can help improve iron levels.

Other sources of heme iron include fortified cereals and dark green leafy vegetables, such as spinach, broccoli and kale.

Athletes are at greater risk of iron deficiency because they require more oxygen during training and competition, which requires more red blood cells.

Those with lower iron levels may feel more fatigued and unable to train at their peak level.

Female athletes can increase their iron intake by modifying their diets and improving meal composition to optimise iron absorption.

They should aim to eat a wide variety of foods to ensure they get the right balance of protein, carbohydrate, and iron.

They should also avoid eating foods that inhibit iron absorption, such as tea, coffee and chocolate.

They should also eat foods high in vitamin C, such as citrus fruits and strawberries, which help iron absorption.

Athletes can implement these dietary modifications with their nutritionist. 

Alternatively, an athlete can take oral iron supplements to increase iron intake and/or maintain iron status.

Athletes should know the symptoms of iron deficiency and get regular testing and treatment. They should also eat a nutritious diet, especially before and during exercise, to support iron levels.

Why are vegan athletes at risk of an iron deficiency?

Plant foods contain iron in a form that is less bioavailable than iron from meat or fish, so it is important to ensure you consume enough to meet your needs.

High fibre foods like bran can inhibit iron absorption, and certain plant chemicals, called phytates, can also inhibit it.

Athletes should make sure they are getting enough iron through their diets and take a supplement to improve iron absorption if needed.

Another important mineral for athletes is zinc, which is also found in plants and is vital for growth, protein synthesis, enzymatic reactions, and healing wounds.

In addition to iron, vegan athletes may need to take a multivitamin to get all the nutrients they need for optimal athletic performance.

They should also consider taking iodised salt, which is necessary for healthy thyroid function.

Creatine, an amino acid that is commonly used to improve performance, and taurine are other supplements that vegan athletes can take.

Does Training at Altitude Increase the Risk of an Iron Deficiency?

During high-altitude training or living, athletes stimulate erythropoiesis, which results in the production of red blood cells (RBCs) and haemoglobin (Hb), the protein that transports oxygen from the lungs to the rest of the body.

As a result, athletes need more iron to support the increased production of these essential components.

Athletes may be susceptible to an iron deficiency, which can lead to fatigue, shortness of breath, and impaired recovery from training or exercise.

Ideally, athletes should be tested before any altitude training to determine their current iron status. 

When a deficiency is diagnosed, the athlete should start taking an iron supplement.

A physician will recommend the appropriate iron dosage based on their assessment of ferritin and other iron markers.

Increasing an iron supplement dose can have negative health effects, so it’s best to start with a small amount and gradually increase it as needed.

One possible reason for a deficiency is that an athlete’s blood volume may decrease, making it harder to get enough iron from diet alone.

Therefore, athletes planning to train at high altitudes should increase their iron intake and drink plenty of water to help replenish fluids lost from their bodies.

It is also important to consume enough carbohydrates during an altitude training camp, as this will help fuel increased haemoglobin production.

A trained endurance athlete can gain up to 10% of their normal haemoglobin mass during a 3-week altitude training session.

In addition, athletes should avoid iron-containing foods and drinks during high-altitude training, as these can contain toxic levels of heme iron that can cause a number of health problems.

For example, excessive amounts of heme iron can impair the liver’s ability to metabolise iron, which can have long-term consequences for an athlete’s health and performance.

Lastly, athletes should consume ample antioxidant-rich foods during altitude training, as they can reduce oxidative stress.

This is especially true at low- to moderate altitudes, where oxidative stress is more prevalent.

Little research has examined the impact of nutrition and/or supplements on optimising altitude adaptations to low- to moderate altitudes in elite athletes.

In contrast, the nutritional impacts of mountaineering training at altitudes above 3000 m have been extensively studied.

These studies have provided a detailed description of the changes in energy, carbohydrate and fluid utilisation, as well as specific nutrient requirements.

Despite the considerable evidence highlighting the need for enhanced iron consumption during altitude training, there are no clear guidelines as to the most effective dose of iron that can optimise an athlete’s HBmass response to hypoxic training. 

1. Soccer Players

Soccer players play a sport that involves a lot of fast movement, and they need to be strong and powerful.

These athletes also need to perform well in a variety of positions and know how to work with their teammates to win games.

They must also maintain control and focus in stressful situations, as well as have stamina during a long game or tournament.

These skills and more are vital to being a successful soccer player, and they can be developed and improved over time.

Athletes who are involved in endurance sports are at a higher risk of iron deficiency.

This is because increased plasma volume during endurance training can dilute red blood cells, making haemoglobin and hematocrit appear low on test results.

However, athletes who are not involved in endurance sports can still be at risk of iron deficiency. These athletes should have their iron levels tested before they begin a new season or within a few weeks of starting a training program.

They should also consume a healthy diet rich in protein, carbohydrate, and fat to support their athletic performance.

They should aim to eat between 1.2 and 1.7 grams of protein per kilogram of body weight daily, and they should eat enough carbohydrates to fuel their workouts.

They should also drink enough water to stay hydrated during training sessions and competitions.

2. Tennis Players

Athletes who play aerobic sports (such as tennis, rowing, handball and some swimming and track and field events) are at the highest risk for iron deficiency.

The main reason for this is that they are more likely to exhaust iron stores in a shorter period of time when performing these sports than athletes who do not.

Symptoms of iron deficiency include fatigue, weakness, dizziness, and lightheadedness when exercising. The condition can also cause headaches and mood deterioration.

Blood tests can detect iron deficiency by measuring haemoglobin and serum ferritin. Low levels of either one indicate iron depletion in the body and that you need more iron in your diet.

In this case, you should consult a doctor or an accredited sports dietitian to develop an appropriate iron supplement plan.

You can also eat iron-rich foods such as a lean cut of beef or pork three or four times a week. Also, eat vitamin C-rich foods with your iron-rich meals to enhance absorption.

3. Baseball Players

Athletes are at a higher risk for iron deficiency than non-athletes because they lose so much iron through sweat, urine, and gastrointestinal tract bleeding (for example, runners often have blood in their stool after races).

Female athletes are also at a greater risk because they menstruate and can use up their iron reserves.

In addition, athletes may not get enough iron if they have certain chronic medical conditions or bone marrow disorders.

Additionally, older adults may have low iron levels because of age-related iron deficiency.

If left untreated, it can progress to anaemia. This condition can be a serious concern for athletes because it decreases aerobic capacity and causes loss of energy.

When an athlete is diagnosed with iron deficiency, he or she should be treated with iron supplements to replete iron stores.

Taking iron supplements along with a healthy, balanced diet can restore hematocrit and haemoglobin within a few weeks. However, it can take up to 12 months to fully replete iron stores.

Athletes who experience symptoms of iron deficiency should be referred to their physician for a complete blood count (CBC).

The lab will evaluate haemoglobin, hematocrit, and ferritin. They will also look for other signs and symptoms of iron deficiency, including fatigue that worsens with exercise.

4. Football Players

Iron is an important mineral that plays a key role in transporting oxygen throughout the body. It also supports energy metabolism and acid-base balance.

People can develop iron deficiency because they don't get enough iron from food or because conditions make it hard for their bodies to absorb it.

Gender, age, lifestyle, family history and two inherited diseases called haemophilia and von Willebrand disease are all factors that may increase an athlete's risk for developing iron deficiency.

Female athletes are at particular risk for iron deficiency because they lose blood every month during menstruation, which reduces their overall dietary iron intake.

They should take extra care to ensure they get enough dietary iron, especially if they follow a vegetarian diet or eat low-protein foods.

Athletes who are at risk for iron deficiency should consult with their doctor about getting blood tested to determine if they have an iron deficiency or not.

If the test shows they do, they should be given a supplement that provides adequate iron.

Iron deficiency can go undetected for a long time because symptoms usually appear only when haemoglobin is low, which occurs at a stage called early functional iron deficiency without anaemia.

At this point, an athlete has less capacity to deliver oxygen to the muscles and performance suffers.

5. Basketball Players

During exercise, the body uses iron to make red blood cells. Without enough iron, it may not be able to transport oxygen to the muscles, causing fatigue and decreased performance.

Several factors can increase an athlete’s risk of iron deficiency or anaemia. These include age, gender, dietary habits and training level.

One of the most important aspects of a healthy diet is getting enough iron from foods high in vitamin C, which can help your body absorb non-heme iron more effectively.

Other good sources of iron are organic chicken, fish, eggs, beans, vegetables, and whole grains.

The symptoms of iron deficiency can be difficult to diagnose, so it’s important to get a blood test done. A doctor can check for low iron levels and other health problems that may be related to low iron.

Female athletes, especially those who bleed heavily during menstruation, are at the highest risk for iron deficiency or anaemia. This is because they usually consume less iron overall than male athletes.

Athletes who have increased their iron intake or are starting to train harder should be tested for iron deficiency.

They should also be monitored for signs of iron deficiency, such as increased fatigue and decreased performance.

They should also avoid foods that reduce iron absorption, such as tea and coffee, as well as phytates found in certain grain products.

Nutrient recommendations

In addition to consuming plenty of fruits, vegetables, whole grains, and lean proteins, athletes should meet their daily recommended intakes for vitamins, minerals, and micronutrients. A diet rich in these nutrients can improve performance, prevent injury, and support overall health.

Carbohydrates

A well-balanced diet can provide athletes with the carbohydrates they need to fuel intense training and competition. Good sources of carbohydrates include whole grains, legumes, and fruit.

Protein

A high-protein diet is essential for athletes, as it helps repair and build muscle tissue. Protein-rich foods include lean meats, fish, eggs, and dairy products.

Fats

Athletes should eat enough healthy fats to support energy needs and keep blood sugar stable. Good sources of healthy fats include nuts, seeds, avocado, and fatty fish.

In addition to a balanced diet, athletes should drink plenty of water throughout the day and during exercise.

This matters because dehydration can reduce cognitive function and impair athletic performance. All people should drink at least 8-10 cups of fluid per day.

They should also drink additional fluids during exercise to replace the fluid they lose through sweat. You can calculate this through your sweat rate.

Conclusion

Athletes - especially females, adolescents, vegetarians and those with poor eating habits or following an energy restricted diet - are at a higher risk for iron deficiency.

This is because the body absorbs dietary iron at lower levels in athletes than in non-athletes.

Dietary Iron Intake: Athletes need a high intake of dietary iron to replenish their bodies' stores and meet their oxygen needs.

This includes heme (animal) and non-heme (plant) iron from foods such as lean meat, poultry, fish, wholegrains and fortified cereals.

Haemoglobin and Oxygen Transport: Without adequate amounts of iron, your blood may not carry sufficient oxygen to the muscle cells. This can affect your training, endurance and recovery.

Symptoms of Iron Deficiency

Athletes experiencing any symptoms of low blood iron should seek immediate medical attention. These include fatigue and a reduced ability to perform tasks.

Women who experience heavy menstrual bleeding are also at a greater risk for iron deficiency. This may be because women absorb dietary iron less efficiently.

Hematuria, or blood loss through the urine, is also common in athletes, as well as gastrointestinal bleeding, which can lead to low iron levels and iron deficiency anaemia.

Fortunately, iron deficiencies can be resolved with simple dietary changes and iron supplements.

You can take it orally or in liquid form. Consult a sports dietitian to determine the best option for you.