Combating Iron Deficiency

Athletes, particularly female endurance athletes, are at an increased risk of becoming iron deficient. Professional triathlete and nutritionist Pip Taylor explains how to make sure you’re getting enough iron while training.

Written by: Pip Taylor

Q: I got into triathlon a couple of years ago and have never had more fun or been more fit. For a few seasons I was able to race and train as much as I wanted, but this year I have been constantly tired and my times in training and races have got slower. My training partner thinks I am low in iron and should take some iron supplements. What do you think?

A: Fatigue is often the constant unwanted companion to many triathletes. Training, work, etc., will take their toll, and triathletes, being triathletes, will generally take the more-is-more approach, risking overtraining and chronic tiredness. However, prolonged tiredness and lethargy can also be signs of a number of other issues, including low iron, so this is something that is worth getting checked out. Your friend might be right—it could be your iron stores, but don’t rule out other causes without definitive evidence.

Make an appointment to see you doctor, one who has a good understanding of sports and your personal athletic goals as well as how to interpret blood test results in this context. Explain your symptoms and your training volume and intensity and any other factors that could be contributing to fatigue, such as stresses from work or family. Never self-diagnose and never let a training partner diagnose you (unless she is also your doctor).

Iron is an essential mineral, vital not only for sports performance but also for general health. Most of the iron in your body is incorporated into hemoglobin, the blood protein that delivers oxygen to all body cells and removes carbon dioxide, allowing the utilization of fats and carbohydrates for energy production. Iron is also found in the myoglobin of muscle cells (which also store oxygen), and is stored as ferritin. Thus, in a regular blood test both hemoglobin and ferritin levels are assessed to determine iron levels.

Iron is continually lost from the body and needs to be replaced via dietary intake. If dietary intake is inadequate or absorption is compromised so that losses exceed absorbed iron, then iron stores become depleted, resulting in symptoms such as lethargy, pale skin, compromised immune system and a decline in sports performance. On the flip side, too much iron in the body can be toxic and can have very serious consequences.

Athletes, particularly female endurance athletes, are at an increased risk of becoming iron deficient. This is because in addition to losses through sweat, feces and urine, menstrual bleeding and loss of red blood cells through exercise-related impact all contribute to further losses of iron. Vegetarians or athletes who avoid iron-rich foods such as red meats or are just on a restricted diet are also at risk due to possibly inadequate intake and absorption.

Iron in food comes in two forms: heme and non-heme. Heme iron is found in animal flesh such as red meats, chicken and fish and is easily absorbed. If you like liver and kidney, then stick with them—they’re extremely rich in iron. Plant foods can also contain high levels of iron but in the non-heme form, which is poorly absorbed by the body, thus the need for a well-planned diet, especially for vegetarians. Many commercially prepared foods such as breads and breakfast cereals are iron-fortified.

In addition to eating lean red meat, other dietary manipulations can help boost absorption. For example, vitamin C enhances iron absorption, so include some vegetables with your steak or some orange juice alongside your iron-enriched breakfast cereal. Similarly, avoid drinking tea and coffee with your meals as the tannins can reduce iron absorption by as much as 50 percent. Bran may also need to be limited as it, too, binds to iron, thus greatly reducing its uptake. Even your cookware can play a role; using cast-iron frypans and skillets means that some iron will leach into your cooked foods.

If necessary, your doctor might recommend taking an iron supplement for a period of time, in addition to following an iron-rich diet. If you are supplementing, make sure you simultaneously consume some vitamin C and do not continue to self-medicate. Follow up the initial supplementation period with another blood test. An iron overload is extremely dangerous and can lead to serious consequences as iron builds up and slowly destroys vital organs such as the heart, liver and pancreas. Excess iron will also compromise absorption of other essential minerals such as copper and zinc, leading to further imbalances. Other effects of supplementation can include gastrointestinal upsets. Even though iron deficiency and iron supplementation may be common among endurance athletes (particularly females), make sure you are professionally diagnosed and assessed.

I would recommend that every athlete has regular checkups, including blood work, with a good doctor who understands athletes and the demands of their sport. Symptoms of any number of conditions overlap and can be confused with others, either more or less serious, so it’s really important to never self-diagnose. Supplements, even though readily available for purchase, are like any other drugs or medicines with the potential to cure or the potential to harm if used incorrectly.