Athletes and Iron Deficiency

How to Get Enough Iron and Avoid Anemia

Iron deficiency is a common problem for women athletes. Studies have routinely found that athletes, especially female athletes, are often iron-deficient or anemic.

Iron is essential for athletic performance. It is the component of hemoglobin in your red blood cells that transports oxygen to your cells and carries carbon dioxide away. The brain also relies on oxygen transport, and without enough iron, you will find it hard to concentrate and feel tired and irritable. Iron is also needed to maintain a healthy immune system. If you don't have enough iron you may be prone to more frequent infections.

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Athletes and Iron Deficiency

A combination of the following factors place athletes at risk of iron deficiency:

  1. Inadequate supply of dietary iron. Athletes who avoid red meat have difficulty meeting the body's iron needs.
  2. Increased demands for iron. Hard training stimulates an increase in red blood cell and blood vessel production and increases the demand for iron. (Iron turnover is highest for endurance athletes training at high intensity).
  3. High iron loss. Blood loss through injury, or menstruation. In endurance athletes, ‘foot strike’ damage to red blood cells in the feet due to running on hard surfaces with poor quality shoes leads to iron loss. Finally, because iron is lost in sweat, heavy sweating leads to increased risk of deficiency.

Symptoms of Iron Deficiency and Anemia

The symptoms of iron deficiency include loss of endurance, chronic fatigue, high exercise heart rate, low power, frequent injury, recurring illness, and loss of interest in exercise and irritability. Other symptoms include poor appetite and increased incidence and duration of colds and infections. Many of these symptoms are also common to over-training, so misdiagnosis is common. The only sure way to diagnose a deficiency is a blood test to determine iron status. If you experience any of the symptoms above, and you are in one of the higher risk categories, you should visit your healthcare provider for lab work.

If your healthcare provider confirms iron deficiency, she will recommend an increase in your dietary iron intake. If your deficiency is severe, you may need supplements. Never use iron supplements unless under the supervision of your healthcare provider, as too much iron can cause irreversible damage and a higher risk of cancer and heart disease.

Good Sources of Iron

The RDA for women and teenagers is 15 milligrams per day. Men should consume 10 mg. Endurance athletes may need slightly more. You can get iron in both animal and plant foods, but the iron in animal sources has an absorption rate of about 20 to 30 percent, while it reaches up to 10 percent for plants. So the more effective way to increase iron status is by eating animal products such as lean red meat, poultry or fish or liver. You can also increase the amount of iron in foods you eat by cooking with a cast iron skillet (especially if cooking acidic foods).

Iron absorption from any foods, whether plant or animal, is decreased if they are accompanied at meals by caffeine. Calcium and zinc also reduce the ability of the body to absorb iron. However, adding fruit (citrus fruit in particular), to meals enhances iron absorption. The best sources of iron in the diet include: Lean red meat, iron-fortified breakfast cereal, nuts, and legumes, (combined these with foods high in vitamin C).

8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading
  • How Is Iron-Deficiency Anemia Treated? National Heart, Lung, and Blood Institute, March 26, 2014.
  • Alaunyte I, Stojceska V, Plunkett A.. "Iron and the Female Athlete: a Review of Dietary Treatment Methods for Improving Iron Status and Exercise Performance." J Int Soc Sports Nutr. 2015 Oct 6;12:38. doi: 10.1186/s12970-015-0099-2. eCollection 2015.

By Elizabeth Quinn
Elizabeth Quinn is an exercise physiologist, sports medicine writer, and fitness consultant for corporate wellness and rehabilitation clinics.