Iron Deficiency in Athletes: Causes, Symptoms, and Prevention

Sports nutrition
Healthy eating
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Iron is an essential nutrient involved in various physiological processes that influence athletic performance. Athletes, particularly women, vegetarians, long-distance runners, and teenagers undergoing intense training programs, are at risk of developing iron deficiency. This deficiency can negatively impact performance, especially in endurance activities. If left untreated, it can lead to iron-deficiency anemia, significantly reducing an athlete's physical capabilities.

The Role of Iron in the Body

Iron plays critical roles within our body by participating in:

  • Oxygen transportation to tissues and muscles
  • Red blood cell production
  • Energy production in cells
  • Maintaining a strong immunity

Why are Athletes More at Risk of Iron Deficiency?

Several factors influence an athlete's iron status. Some examples include:

  • Increased red blood cell production during training
  • Iron loss through sweat, urine, feces, and minor bleeding in the digestive system during intense training
  • Mechanical damage to red blood cells caused by foot strike during running
  • Insufficient iron intake (e.g., calorie-restricted diet, vegetarian/vegan diet, high carbohydrate intake, unvaried diet…)

Symptoms of Iron Deficiency

Iron deficiency often doesn't cause any symptoms, but some athletes may appear pale, have an increased heart rate, mood swings, decreased appetite, and fatigue. These manifestations are non-specific, meaning they could be caused by overtraining, stress, sleep or immunity disorders, infections, and many other factors. It's recommended to discuss these symptoms with your doctor to arrange for more in-depth tests.

In case of deficiency, a dietitian can provide advice to maximize your iron intake and absorption. For cases of very low iron levels (e.g., anemia), iron supplements may be prescribed by your doctor.

Nutritional Tips to Prevent and Treat Iron Deficiency

  • Heme iron from animal sources is better absorbed than non-heme iron from plant sources. Thus, it's advisable to consume lean red meat (e.g., beef, lamb, and veal) at least 3 to 4 meals per week, along with other good sources of iron (e.g., poultry, fish, seafood, legumes…) every day.
  • Vegetarian athletes need to ensure they consume iron-rich plants (e.g., leafy green vegetables, legumes, tofu, nuts, iron-enriched grain products like bread and breakfast cereals). It's also recommended to pair non-heme iron sources with a vitamin C-rich food (e.g., citrus fruits and their juices, strawberries, leafy green vegetables, tomatoes, peppers…) at meals to promote absorption.
  • It's best to avoid consuming foods high in polyphenols (e.g., tea, coffee, cocoa, red wine…) as this compound decreases the body's iron absorption.
  • References: Clinical Sports Nutrition, 5th Edition, by Louise Burke and Vicki Deakin
Registered Dietitian Nutritionist