Iron Deficiency in Athletes

Iron is an important mineral in the body, crucial for muscle function and oxygen transport. Adequate levels of iron in the blood are necessary for athletes, as iron-deficiency anaemia can reduce physical performance.

The prevalence of iron deficiency in athletes is reported to be between 3 and 11% in males and at 15–35% in females. Female athletes engaged in endurance, aesthetic, or weight class sports are at an inherently higher risk of developing iron deficiency.

Iron deficiency in athletes is normal, and they are prone to it due to various mechanisms, including increased losses of iron during training caused by micro-ischemia, hemolysis, sweating, etc. Furthermore, women are more prone than men because of menstrual bleeding. A link between low energy availability (LEA) and poor iron status in athletes is likely, as the dietary intake of iron may not be sufficient. The inflammatory response that occurs due to training, with increased IL-6 and hepcidin levels, opens a window where less iron is absorbed and recycled. Furthermore, there is an increased utilization of iron for the increased erythropoiesis and rebuilding processes that occur due to training. Training and living at altitude, or in hypoxic environments, leads to an increase in hemoglobin following an increase in erythropoietin (EPO) production.

Iron deficiency can affect several of the abilities that athletes need to perform outside of aerobic abilities, including those related to strength, the immune system, fatigue, and mood status. All these factors can affect endurance, as well as power, speed, coordination, concentration, recovery, and consequently, performance in various sports variables.