Understanding Iron Deficiency in Athletes
Iron is an essential mineral that our bodies need for growth and development. It plays a crucial role in many bodily
functions, especially for athletes. This article explores the impact of iron deficiency on athletes, with a focus on
endurance athletes and how they can manage this condition effectively.
Iron and its Role in Athletes
Iron is a key component of hemoglobin, a protein in red blood cells that transports oxygen throughout the body. Each
hemoglobin molecule is capable of binding four molecules of oxygen, thanks to the four iron atoms present in each
molecule. This makes iron crucial for athletes, especially those in endurance sports, as they constantly demand oxygen
delivery to their working muscles.
Endurance Athletes and Iron Deficiency
Endurance athletes are particularly susceptible to iron deficiency. The body continues to produce hemoglobin, even at
the cost of depleting iron reserves, to keep up with the oxygen demand of working muscles. This creates a scenario
where low ferritin (stored iron) levels result in an inefficient supply of oxygen to muscles, affecting performance.
Iron Deficiency Without Anemia
Iron deficiency without anemia is a condition where ferritin levels are suboptimal, but hemoglobin levels remain
normal. The low ferritin levels make the hemoglobin molecules less efficient in binding and delivering oxygen, resulting
in a decline in athletic performance.
In addition to this, ferritin is involved in the "buffering" and removal of lactic acid, a byproduct of working muscles. This
dual problem of reduced oxygen supply and impaired lactic acid removal can cause fatigue and muscle burn, slowing
down the athlete.
Iron Deficiency With Anemia
Iron deficiency with anemia is a more severe condition where ferritin, serum iron, and hemoglobin levels are all low.
This creates a situation where there are fewer hemoglobin molecules to deliver oxygen, and the ones produced are low
in oxygen saturation. This compromises the athlete's performance even more.
Optimal Ferritin Levels
While there's no concrete consensus on what constitutes low ferritin, most health authorities recommend levels
between 70-150. Symptoms of fatigue become more apparent when levels dip below 40 in males and 20 in females.
Why Endurance Athletes Are More Prone to Anemia
Several factors make endurance athletes, particularly teenagers, more prone to anemia:
1. Footstrike Anemia: This refers to the destruction of red blood cells when the feet strike the ground during
running.
2. Competition with Growth: Both the thyroid and immune systems require iron to function properly, which can
deplete ferritin reserves.
3. Increased Demands for Hemoglobin Production: Endurance sports demand more hemoglobin to support
oxygen delivery. Unlike anaerobic sports, aerobic sports require a lot of oxygen.
4. Inadequate Intake: The absorption of iron from animal products is superior to that from non-heme sources such as
lentils and vegetables. The absorption of iron from fortified foods depends on the type of iron and accompanying
ingredients, which is often inadequate.
5. Menstruation: In female athletes, menstruation can lead to iron loss, making it more difficult to retain ferritin.
Iron Deficiency Summary
In summary, iron deficiency without anemia occurs when ferritin levels are less than 40 with a mid-normal range
hemoglobin. This condition compromises the delivery of oxygen to muscles and the removal of lactic acid.
On the other hand, iron deficiency with anemia is more severe. It occurs when ferritin levels are below 40 in males and
20 in females, with hemoglobin and serum iron levels also being low. This condition severely affects the delivery of
oxygen to muscles and the removal of lactic acid.
Iron Supplementation
Iron supplementation can help manage iron deficiency, but it must be done carefully. Some genetic conditions can lead
to excess iron storage, overproduction of hemoglobin, or the production of too many red blood cells. In these cases,
taking iron supplements could be dangerous.
Most over-the-counter iron supplements have poor absorption, can cause stomach issues, and are unregulated. It is
advisable to use supplements that are regulated and have a good absorption rate.
Monitoring Iron Levels
Iron levels should be monitored regularly, with labs drawn every 3-6 months. Athletes, especially boys, can go to a
reduced schedule once their levels are optimized.
Article Contributor Michelle Resendez, FNP Wingfoot Wellness in Gilbert, Arizona
Resources
For further information, you can check out the following resources: https://www.redcrossblood.org/donate-blood/blood-donation-process/before-during-after/iron-bl
ood-donation/iron-rich-foods.html
https://www.nps.org.au/australian-prescriber/articles/non-anaemic-iron-deficiency#:~:text=Iron%
20deficiency%20without%20anaemia%20is,should%20be%20identified%20and%20managed.
https://www.highperformancewest.com/link-of-the-day/2020/10/4/low-ferritin-and-iron-deficien
cy-anemia-in-distance-runners-a-scientific-guide-for-athletes-and-coaches