Screening for Iron Deficiency in Athletes

Iron deficiency is common in female athletes[1], but can also affect male athletes. Experts agree that athletes should regularly be screened for iron deficiency as part of their routine medical examinations[2]. The consequences of an undiagnosed iron deficiency can lead to deteriorated athletic performances and a diminished quality of life.

Why is iron important?

Iron is important because it performs several functions. It is involved in energy metabolism, the maintenance of our acid-base balance, and the transportation of oxygen. Red blood cells incorporate iron into a protein called hemoglobin. When we breathe, oxygen is attached to hemoglobin and is carried in our blood to our muscles. This process is diminished with inadequate iron levels. The result is that our muscles do not receive enough oxygen during exercise.

How common is iron deficiency?

Iron deficiency is also known as anemia, but it is important to remember that it is not the only form of anemia. In general, menstruating women are much more likely to be iron deficient. Iron is lost during normal menstrual cycles. People who maintain strict plant-based diets are also at risk for iron deficiency. Iron deficiency in men can be an indication of some other unaddressed medical condition, as well as a poorly designed diet.

Athletes feel the effect of iron deficiency more than the general population. A drop in the capacity to deliver iron to working muscles has a direct effect on athletic performance.

 

Symptoms of iron deficiency

Symptoms of iron deficiency include:

·      Fatigue

·      Generalized weakness

·      A drop in athletic performance

·      Shortness of breath

·      Lightheadedness

·      Itchiness

Screening for iron deficiency

Athletes have additional demands on their bodies compared to the general population. As a result, the standard lab range used to determine iron deficiency is often inadequate for an athlete to perform at the optimum. The standard cut-off for normal ferritin levels in males (12ng/ml) and females (10ng/ml)[3] is often too low for an athlete to be able to perform at their best. While there is no agreed-upon standard, ferritin levels below 35-60ng/ml in athletes is generally considered low. A clinical interpretation is required as ferritin levels can be temporarily elevated when someone is highly inflamed or is fighting an infection.

Other useful lab tests include a complete blood count, which can indicate how well your body is using the iron in your diet to make red blood cells. Sometimes there may be adequate levels of iron in the diet, but insufficient levels of other vitamins and minerals that are necessary for the formation of new red blood cells.

 

Treatment

Iron deficiency can be successfully treated when correctly diagnosed. With athletes, I always recommend to be tested for iron deficiency at the start of each season and to have monitoring every 3 months to ensure that iron levels remain adequate throughout the competition season. A thorough review of the athlete of the diet is important to ensure there are adequate levels of iron in the diet. Click the picture on the right to download a list of iron-containing foods from the Dieticians of Canada. If supplementing iron, it is important to avoid taking it with foods that can bind iron and prevent its absorption, such as tea, coffee, or milk.

Oral iron supplementation can sometimes be difficult to take. Frequent side effects from taking iron supplements include nausea, stomach upset, vomiting or constipation. I always choose forms which minimize these effects for patients and make iron more tolerable to take.

I never advise anyone to take iron without proper evaluation as too much iron can be very dangerous to your health. If you take iron supplements, and your iron levels are fine, you could suffer from iron overload.

Dieticians of Canada

* Courtesy of the Dieticians of Canada

Summary

Iron deficiency is very common among athletes and can be successfully treated if properly identified. I work with athletes, to ensure that they have sufficient iron levels to perform their best. Regular screening should be included in every athlete’s training plan. If you would like to be screened, be sure to book an appointment.

Book your screening today

References

1. Petkus, Dylan & E. Murray-Kolb, Laura & De Souza, Mary Jane. (2017). The Unexplored Crossroads of the Female Athlete Triad and Iron Deficiency: A Narrative Review. Sports Medicine. 47. 10.1007/s40279-017-0706-2.

2. The International Olympic Committee Consensus Statement on Periodic Health Evaluation of Elite Athletes: March 2009. Journal of Athletic Training. 2009 Mar; 44(5): 538-557.

3. Pagana, Kathleen & Pagana Timothy (Eds). (2010). Mosby’s Manual of Diagnostic and Laboratory Tests 4thedition. St. Louis, MO: Mosby Elsevier.