Elite and recreational athletes—particularly female, adolescent or vegetarian athletes—involved in regular intensive training programs can be at risk of developing iron deficiency. Although exact iron requirements for athletes are currently unknown, they are most likely higher than the non-athlete and a conservative recommendation would be to at least meet the Australian Recommended Dietary Intake (RDI). Recent evidence suggests that even early stages of iron depletion can reduce performance capacity, particularly during aerobic activity. If untreated, low iron levels can develop into iron deficiency anaemia which can leave athletes feeling lethargic and unable to perform at their best.

What does iron do in the body?

• Transport oxygen around the body (via haemoglobin)
• Red blood cell production
• Involved in enzymes that release the energy for exercise
• Maintain a healthy immune system and fight infection

Who is at a higher risk of deficiency?

• Vegetarians, vegans or those who limit red meat
• People who follow an energy-restricted diet
• People with poor quality food choices and inconsistent eating habits

Why are athletes at risk of iron deficiency?

Athletes are at risk of developing iron deficiency due to a combination of factors including:

• Increased requirements (training stimulates production of red blood cells)
• Growth increases the demand for iron to produce new tissues and blood cells
• Blood loss through minor damage to the lining of the digestive tract during strenuous exercise or from damage to red blood cells in the feet associated with running on hard surfaces (foot strike haemolysis)
• Iron is lost in sweat which may be an issue for heavy sweaters
• Low energy intakes or restricted dietary patterns can make it difficult to eat sufficient iron

What are the symptoms of iron deficiency? How do I know if I have iron depletion?

Sometimes there are no symptoms, or symptoms may be due to ‘normal’ fatigue, overtraining or another illness (e.g. glandular fever). If you have any of the symptoms below it is strongly recommended that you see your GP or Sports Physician to confirm diagnosis through a blood test and discuss treatment options.

• Feeling flat and tired and unable to train as hard as usual
• Poor appetite, increased frequency and duration of colds and infections
• Elevated resting pulse rate, and being pale

How is iron depletion treated?

An Accredited Sports Dietitian can help you increase the intake and absorption of iron from food. If your iron levels are very low your GP may also decide that you need iron supplements (supplements should not be taken unless they have been prescribed by a GP).

What are the best sources of iron?

• Haem iron found in animal protein (e.g. beef, lamb, seafood, pork, poultry, liver) is the most readily absorbed form of iron in food
• Many breads and commercial breakfast cereals have added iron (iron-fortified)
• Legumes, some green vegetables, dried fruits, and nuts can have good amounts of iron, however the iron found in plant foods (non-haem iron), is less well absorbed than iron in meat sources (haem iron)
• Absorption of iron can be increased up to four times by combining iron-rich non-haem food with vitamin C-rich foods in the same meal (e.g. having a glass of orange juice with your breakfast cereal).

Tips for preventing and treating iron depletion

• Increase your intake of iron-rich foods, particularly haem sources
• Eat lean red meat (e.g. kangaroo, beef, veal, lamb) three to four times a week and include other sources of iron on the other days (e.g. chicken, fish, nuts, legumes)
• If vegetarian, eat iron-rich plant foods regularly (e.g. baked beans, lentils and breakfast cereals)
• Add vitamin C-rich foods to your meals to increase iron absorption (e.g. citrus, berries, green leafy vegetables)
• Avoid drinking strong tea or coffee at the same time as iron rich foods as the tannic acid in tea and coffee can inhibit the absorption of iron

Athletes—especially females, adolescents, vegetarians, those with poor eating habits or following an energy restricted diet—are at risk of iron depletion and iron deficiency anaemia. An Accredited Sports Dietitian can help you maximise your intake and absorption of iron to help you train and compete at your best.

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