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Iron Deficiency Anemia and the Female Athlete

By Julie Sieben, D.C.

Have you lost your motivation to exercise? Are you chronically fatigued? Have you noticed a decrease in your endurance and a higher than usual exercise heart rate? Are you frequently sick, hair and nails annoyingly brittle, and skin pale? Have you experienced dizziness, shortness of breath or a fast or irregular heart rate? (1)

If you are experiencing any or several of these symptoms you may deficient in iron. While these are symptoms that could be associated with several conditions (and you are encouraged to visit your doctor if these symptoms persist) the female athlete should be aware that they are commonly related to iron deficiency anemia. This condition is not uncommon for the female athlete.

Iron deficiency anemia is the most common form of anemia, particularly for women. The importance of having enough iron in the blood is that iron is a key component of hemoglobin. Hemoglobin is the part of your red blood cells that is responsible for carrying oxygen to and waste products away from working muscles. Iron deficiency anemia can occur when your body lacks the iron needed to make hemoglobin. (2) Female athletes need to have adequate oxygen carrying capacities to fuel their workouts.

There can be several causes for IDA and female athletes have unique concerns.

1.) Inadequate iron in your diet. Our bodies are designed to get the nutrients we need from our diet. Including iron. If you do not have enough iron, over time your body will become deficient. Meat is the best source of iron, particularly red meat. Athletes who do not eat red meat, eat a vegetarian diet or are restricting calories need to take special considerations.

2.) Iron loss. There are of course several ways to lose blood, the most common for the female athlete being heavy menstrual periods. Other less obvious ways we lose blood may include slow chronic bleeds in the body from a stomach ulcer, or colon polyp. It is important to you get checked and treated for such conditions. Endurance athletes, particularly runners who end up performing repeated foot strikes, can ultimately cause red blood cells to break down and iron to be lost. Iron can also be lost through heavy sweating.

3.) Increased iron demand. Working out hard and working out frequently causes increased blood cell production and blood volume, and thus increases demand for iron. Your diet should sufficiently accommodate increased caloric output and increased iron demands.

4.) Pregnancy. Iron deficiency anemia is quite common during pregnancy due to an increase in blood volume of the mother and the increased needs of the fetus. (1) The national institute of health recommended dietary allowances for iron for females ages 19-50 is 18 mg/day. Pregnant women require up to 27 mg/day. The FDA requires that all food labels include the percent daily value (DV) of iron. A good rule of thumb is that if a food has 5% or less of iron than it is a poor source of iron. If a food that has 10-19% of iron it is a good source and greater than 20% is excellent.

Low blood levels of hemoglobin or a low hematocrit may signify an iron deficiency though does not exclusively indicate an iron deficiency. Be sure to get your serum ferritin checked as well, as this test can help distinguish between iron deficiency anemia (in which supplements will help) and other forms of anemia, where supplements will not help and may cause harm.(5) It is important that you see your doctor about your symptoms and if necessary get a prescription or recommendation for the correct dose of iron to replenish your system. Do not self diagnose with this one, for there are several forms of anemia (not just iron deficient) and/or other potential causes for your symptoms. As a female athlete, iron deficiency anemia may be a good bet if you are experience any symptoms mentioned here, especially if you do not eat meat, but only blood work will really tell.

Dietary considerations: Often times we will avoid developing problems in the first place by making informed nutritional choices. As a female athlete, the following information will help keep you on the right track.

As far as nutrients go, that bio-availability of iron varies quiet a bit. In general iron in the form of “heme” (which is derived from hemoglobin) is more easily absorbed that “non-heme” iron. Sources of heme iron include meat, fish and poultry. The iron found in lentils, beans, fruits, vegetables and grains, or in “iron-enriched” foods is “non-heme” and is not absorbed quite as readily.

Easy strategies to increase iron absorption:

The following strategies can be employed to increase the absorption of iron from non-heme groups:

1. Consuming vitamin C with non-heme foods. Grapefruits, tomatoes, spinach will help you absorb the iron from food.

2. Combine meats and vegetables at meals. I.e. Consume both heme and non-heme groups at the same time.

3. Cook with a cast iron skillet.

4. Avoid coffee and tea with meals. If taking supplements, avoid taking your calcium supplement at the same time as your iron supplement. Proton-pump inhibitors and antacids can also inhibit absorption. (4,5)

Heme iron food choices from bang to bust:

Chicken liver (70%DV), oysters (25%DV), lean beef (10-20%DV depending on cut), clams (15%DV) and the dark meat of turkey(10%DV). Fresh bluefin tuna and chicken breast both offer 6% DV. Pork, white canned tuna and shrimp only offer 4% DV. (3)

Excellent non-heme sources. Remember non-heme will be better absorbed when cooked with iron skillet, served with heme iron and not consumed with coffee or tea:

Fortified cereal including oatmeal (excellent), soybeans (50%DV), lentils (35%DV), kidney, lima and navy beans(25%DV), black beans (20%), tofu and spinach (20%). (3, 5)

Herbs that contain iron include, alfalfa, burdock root, cayenne, chamomile and lemongrass. (5).

For more information and food sources visit the National Institute of Health website.

1. (accessed March 2,2011)
2. (accessed March 2, 2011)
3. (accessed March 3, 2011)
4. (accessed March 3, 2011)
5. Bach, P. Prescription for Nutritional Healing. (2006). New York, NY. Penguin Group.