Why are some female athletes susceptible to iron deficiency?
Iron deficiency is common in athletes. Nearly half of females
who exercise may experience iron deficiency.While females are
at
higher risk for iron deficiency due to monthly loss of blood with
menstruation, male athletes can also suffer from it.
The International Olympic Committee 2009 Consensus Statement on
periodic health evaluation of elite athletes even recommended
routine screening for iron deficiency.
Athletes need more iron than the general population. Iron is
lost through sweat, skin, urine, the gastrointestinal (GI)
tract, and menstruation. Exercise, particularly high intensity and
endurance types, increases iron losses by as much as 70%
when compared to sedentary populations. Athletes lose more iron due
to heavy sweating as well as increased blood loss in the
urine and GI tract.Red blood cells also break down more quickly in
those who exercise. 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. Athletes,
particularly menstruating female endurance athletes, need to
be
extremely mindful of iron intake in order to meet their bodies’
demands. 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.
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. Traditionally, levels less than 15 ng/mL are
considered diagnostic for iron deficiency.Most labs report the
normal
ferritin range between 15-150 ng/mL for females and 15-300 ng/mL
for males. Even if a lab printout states the ferritin is
‘normal,’
it may actually be too low depending on the athlete, the type of
exercise they perform, and their current physical symptoms.
In
the sports nutrition community, there is no clear ferritin goal for
athletes. Given that certain athletes may need more than
double
the iron than less active populations, a reasonable ferritin goal
would be at least 30-40 ng/mL, if not higher. Every athlete’s
physiology and training demands are different, so ferritin goals
vary person to person and can be individualized. 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.
A complete blood count (CBC) measures the levels of red blood cell
in the body and determines whether or not someone is anemic.
Markers of red blood cells in a CBC are hemoglobin and hematocrit.
Of note, iron deficiency is only one of the many causes of
anemia.
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