Question

Why are some female athletes susceptible to iron deficiency?

Answer 1

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.