Iron deficiency and anemia are not the same thing. Anemia can be viewed as a more severe form of iron deficiency, but it can also have other causes, such as inadequate levels of certain vitamins or related to other medical issues. Iron deficiency is measured by a blood test that looks for a molecule called ferritin, which is a protein in the blood that contains iron.

A normal level of ferritin is between 11 to micrograms per liter for women and 24 to micrograms per liter for men. Blood tests for anemia look at the quality and volume of red blood cells. The blood tests for anemia are hemoglobin and hematocrit, which are part of a complete blood count.

In addition to fatigue and slow recovery after workouts, iron deficiency and anemia may be responsible for other side effects including reduced immune function, brittle hair and nails, rapid heartbeat, dizziness and shortness of breath.

Bleeding in the gastrointestinal tract, which may be due to ulcers or cancer, can be a cause of iron deficiency anemia. Goolsby says. Foods that are high in iron fall into two categories: those with heme iron and those with nonheme iron.

Heme iron comes exclusively from animal products — red meat, poultry and fish. Nonheme iron occurs naturally in some foods, including beans, whole grains and leafy greens.

Nonheme iron is harder for the body to absorb, so you need to eat more of it to get the same benefit. Skolnik points out that combining iron-rich foods with those that are high in vitamin C makes it easier for the body to absorb the iron. The International Olympic Committee Consensus Statement on periodic health evaluation of elite athletes even recommended routine screening for iron deficiency.

This article is also focused on adult athletes and the information discussed may not apply to children. Iron is a mineral that has several important roles in the body including energy metabolism, oxygen transport, and acid-base balance.

Red blood cells transport oxygen throughout the body and are filled with proteins called hemoglobin. Each hemoglobin molecule contains iron. Oxygen picked up in the lungs binds to the iron inside hemoglobin and then is carried all over the body to supply oxygen to organs and tissues. Iron comes from our diet.

Dietary iron can be classified into heme iron and non-heme iron. Heme iron is found in meat, poultry, and fish. Red meat contains about three times as much iron as both poultry and fish making it one of the richest sources of dietary iron.

Heme iron is absorbed by the digestive tract about twice as well as non-heme iron. Sources of non-heme iron includes fruits, vegetables, and iron fortified foods.

Vitamin C assists with the absorption of non-heme iron in the digestive tract so mixing foods rich in vitamin C with non-heme iron containing foods can increase the amount of iron the body absorbs. Athletes need more iron than the general population. Iron is lost through sweat, skin, urine, the gastrointestinal GI tract, and menstruation.

Athletes lose more iron due to heavy sweating as well as increased blood loss in the urine and GI tract. The mechanical force of a footstrike during endurance running, for example, can increase the destruction of red blood cells in the feet, leading to a shorter red blood cell life span.

Female athletes are at even higher risk for iron deficiency as compared to males due to monthly blood loss associated with menstruation. Athletes may also be at risk for iron deficiency due to insufficient dietary iron intake.

Remember, the body is not very effective at absorbing dietary iron. Those following a strict vegetarian or vegan diet can be at even higher risk for iron deficiency due to the decreased absorption of non-heme iron found in plants and fortified foods.

Because iron is necessary for oxygen transport and energy metabolism, both of which are critical for fueling aerobic exercise, endurance athletes can experience a decline in exercise capacity and VO2 max, the maximal amount of oxygen the body can use, with iron deficiency.

As iron deficiency becomes more severe, the body cannot make a sufficient number of red blood cells and anemia, meaning low red blood cells, develops. Athletes with iron deficiency anemia will generally have more pronounced symptoms than those with iron deficiency alone.

A craving for ice chips is actually pretty specific to iron deficiency, so any athletes out there who find themselves wanting to eat a lot of ice should definitely have their iron levels checked. Iron deficiency is diagnosed through blood tests.

The most useful of the typical iron study panel is ferritin, which is a marker of iron stores. In the sports nutrition community, there is no clear ferritin goal for athletes. If a ferritin is dropping significantly during the course of a training cycle, this can also be indicative of developing iron deficiency and the need to intervene, even if the ferritin is within what is generally considered a normal range.

It is also worth mentioning that ferritin levels can quickly increase when the body is under stress so results may be falsely high during periods of active infection or inflammation. The other traditional iron panel tests can be useful in distinguishing iron deficiency from poor iron utilization states.

The time of day — morning is preferable. Hydration — athletes should be well hydrated. Prior exercise — hours rest from exercise prior to the blood sample is preferable.

If exercise is necessary, then only low to moderate intensity exercise should be completed in the 24 hours prior. Muscle-damaging e. eccentric exercise should not be completed in the days prior because this increases inflammation.

Therefore, the measurement may reflect the stress or inflammation and not an iron deficiency. Illness — the athlete should be showing no signs of illness or infection. There are different stages of iron deficiency. The most severe state is iron deficiency anemia IDA which results in a host of symptoms, including weakness and fatigue.

Two earlier stages can be identified that are precursors to IDA. These are collectively referred to as iron deficiency nonanemia IDNA.

The first and least severe stage of iron deficiency is marked by a fall in serum ferritin resulting from a reduction of total body iron stores, but other iron indices such as haemoglobin remain normal This stage is called nonanemia.

The second stage, also non-anemia, is marked by low serum ferritin but also low serum iron or decreased transferrin saturation and increased total iron binding capacity TIBC. Once iron stores and transport iron have been sufficiently depleted, the body can no longer keep up with the demands of hemoglobin synthesis, and the third and final stage IDA results.

Peeling et al. These are:. See infographic for the cut-off values used for each stage. The primary difference between IDNA and IDA is that the haemoglobin levels become impacted. Once this occurs, it can start to impact exercise capacity because the body is not able to deliver oxygen around the body as efficiently.

It is a good idea to plan periodic testing of iron status with your sports physician, especially if you are female, vegetarian, have a high training volume and are involved in endurance sports. In the next blog we will discuss how iron deficiency can be prevented or treated.

Peeling P, Dawson B, Goodman C, Landers G, Trinder D. Athletic induced iron deficiency: new insights into the role of inflammation, cytokines and hormones.

Eur J Appl Physiol. Sim M, Garvican-Lewis LA, Cox GR, et al. Iron considerations for the athlete: a narrative review. Garvican LA, Lobigs L, Telford R, Fallon K, Gore CJ. Haemoglobin mass in an anaemic female endurance runner before and after iron supplementation.

Int J Sports Physiol Perform. McClung JP, Karl JP, Cable SJ, et al. Randomized, double-blind, placebo-controlled trial of iron supplementation in female soldiers during military training: effects on iron status, physical performance, and mood.

You can get in touch with me at: hello megankuikmanRD. Your email address will not be published. A paper that I started working on during the first COVID lockdown was recently published in the Journal of Sports Medicine click here for full access.

The pandemic had just hit Ontario, and I needed Read more…. While iron deficiency is a common problem among athletes, many athletes unnecessarily take an iron supplement. On the other hand, when iron supplements are actually needed, best practice protocols are not always followed.

As a Read more…. I had the privilege to be a co-author on a paper that audited the representation of females in scientific studies examining dietary supplements. This audit specifically examined dietary supplements that have good scientific evidence to Read more….

The ultimate guide to iron supplementation Published by Megan Kuikman on April 7, April 7, Categories: Megan Kuikman. Megan Kuikman Hello! Leave a Reply Cancel reply. What's on your mind? Related Posts. Megan Kuikman Markers of low energy availability in overreached athletes A paper that I started working on during the first COVID lockdown was recently published in the Journal of Sports Medicine click here for full access.

Megan Kuikman Representation of Females in Dietary Supplement Research I had the privilege to be a co-author on a paper that audited the representation of females in scientific studies examining dietary supplements.

Anecdotally, sports dietitians our clinic has worked with find that a specific iron product called Blood Builder is much better tolerated than standard iron supplements, though there is no directed scientific evidence to back this up. It is NEVER advised to make a self-diagnosis of iron deficiency.

If an athlete is concerned that they might be iron deficient, they should get blood tests to confirm the diagnosis. Taking iron supplements in the absence of iron deficiency can lead to iron overload, which is very dangerous. There are also certain people that are genetically hardwired to absorb more iron and are at risk of iron overload even in the absence of high iron intake.

Iron deficiency in athletes, particularly of the endurance variety, is common. Increasing iron in the diet is an important step in avoiding iron deficiency. Even so, our bodies only absorb a small portion of the iron we eat.

Working with a sports dietitian can help an athlete find ways to increase dietary iron intake and absorption. Iron deficiency can make an athlete feel exhausted and decrease exercise capacity, but is easy to diagnose and generally not complicated to treat.

If an athlete ever sees frank blood in their urine or stool, they should seek medical attention right away for a thorough evaluation. This can be very anxiety provoking in those unaware of this side effect as black stool is usually an indication that there is blood in the stool and may signal a GI bleed.

Petkus DL, Murray-Kolb LE, De Souza MJ. The Unexplored Crossroads of the Female Athlete Triad and Iron Deficiency: A Narrative Review. Sports Med.

The International Olympic Committee Consensus Statement on Periodic Health Evaluation of Elite Athletes: March Journal of Athletic Training. Hinton PS. Iron and the Endurance Athlete. Appl Physiol Nutr Metab. Paziradeh S, Bruns DL, Griffin IJ.

Overview of Dietary Trace Minerals. Up To Date. Waltham, MA: Up To Date. Accessed on: August 13, Schrier SL, Auerbach M. Causes and Diagnosis of Iron Deficiency and Iron Deficiency Anemia in Adults. Accessed on August 13, Treatment of Iron Deficiency Anemia in Adults.

Up to Date. Accessed on August 14, A normal level of ferritin is between 11 to micrograms per liter for women and 24 to micrograms per liter for men. Blood tests for anemia look at the quality and volume of red blood cells. The blood tests for anemia are hemoglobin and hematocrit, which are part of a complete blood count.

In addition to fatigue and slow recovery after workouts, iron deficiency and anemia may be responsible for other side effects including reduced immune function, brittle hair and nails, rapid heartbeat, dizziness and shortness of breath. Bleeding in the gastrointestinal tract, which may be due to ulcers or cancer, can be a cause of iron deficiency anemia.

Goolsby says. Foods that are high in iron fall into two categories: those with heme iron and those with nonheme iron. Heme iron comes exclusively from animal products — red meat, poultry and fish.

Nonheme iron occurs naturally in some foods, including beans, whole grains and leafy greens. Nonheme iron is harder for the body to absorb, so you need to eat more of it to get the same benefit.

Skolnik points out that combining iron-rich foods with those that are high in vitamin C makes it easier for the body to absorb the iron. On the other hand, substances in tea and coffee can block iron absorption. People trying to get more iron in their diets should avoid drinking these beverages with meals.

Taking too much iron can even lead to organ damage.