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By Elizabeth Quinn, About.com Guide January 26, 2004

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. One of its major functions is to carry oxygen to and carbon dioxide away from all the cells in your body. 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.

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. 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. Heavy exercise may also increase iron needs by up to another 1 to 2 milligrams day).

2. High iron loss caused by 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.

3. Finally, because iron is lost in sweat, heavy sweating leads to increased risk of deficiency.

Symptoms
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 physician for lab work.

If your physician confirms iron deficiency, they 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 doctor, as too much iron can cause irreversible damage and a higher risk of cancer and heart disease.

Get Tested

The only way to rule out an iron deficiency is to get tested. Ask your doctor for a serum ferritin test and get the results from him/her. As runners we are not the average person and need to be sure our iron levels stay level. Women runners should have a ferritin level of at least 30 ng/mL. Men should have at least 40 ng/mL.

Ferritin is a protein found inside cells that stores iron so your body can use it later. A ferritin test indirectly measures the amount of iron in your blood. The amount of ferritin in your blood (serum ferritin level) is directly related to the amount of iron stored in your body. If you values are low, supplementation will be needed. A multi-vitamin does not cut it. Liquid iron mixed with orange juice is the best. Liquid iron can be purchased over the counter and is fairly cheap. There is also a new pill that breaks down fast enough for the iron to be absorbed in the beginning of the small intestine (Ferrochel). Previous pills and multivitamins do not break down in time to be fully absorbed.

Good Sources of Iron
The RDA for women and teenagers is 18 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 15 percent, compared to about 5 percent for plants. So the more effective way to increase iron status is by eating animal products such as lean red meat. 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). See chart below.

Are You Eating Iron-Rich Foods?

The average woman needs 18 mg of iron a day. The average man needs 10 mg; infants and children need 10-15 mg. Use the worksheet below to figure out how much iron you eat every day. If you are not getting enough iron, you may want to change your eating habits. If you are unable to include more iron-rich food in your diet, check with your physician about a possible iron supplement.

	FOOD	AMOUNT	AVG. MG. IRON
GRAINS	Bread (white or whole wheat)	1 slice	0.5
	Bran muffin	1	1.5
	English muffin	1	1.5-1.9
	Tortillas	1	1
	Cooked cereal	1/2 cup	0.7
	Dry cereal	3/4 cup	read label
	Wheat germ	1/2 cup	4
MEAT	Organ meats	3 oz.	7
	Liver	3 oz.	8-9
	Liver sausage	3 oz.	4-6
	Shellfish	3 oz.	4-5
	Red meats	3 oz.	4
	Fish and poultry	3 oz.	2-3
MEAT SUBSTITUTES	Tofu	4 oz.	2.3
	Sunflower seeds	1 oz.	2
	Pumpkin seeds	1 oz.	3.2
	Cooked dry peas (beans, lentils, lima beans)	1/2 cup	2-3
	Egg	1	1
	Nuts	1/3 cup	0.5-2.0
	Peanut butter	1 tbsp.	0.3
FRUIT	Water melon	6" x 1/2" slice	3
	Strawberries	1 cup	1.5
	Banana	1 cup	1
DRIED FRUIT	Raisins, dates, prunes, figs, apricots	1/2 cup	3-4
JUICES (CANNED)	Prune juice	3/4 cup	7.4
	Tomato juice	3/4 cup	1.6
	Apple juice	3/4 cup	1.1
VEGETABLES	Cooked dark leafy greens (spinach, collards, kale)	1/2 cup	3
	Raw dark leafy greens (spinach, collards, kale)	1 cup	2
	Jicama	1/3 cup	0.8
MISCELLANEOUS	Molasses	1 tbsp.	3.2
	Brewer's yeast (dry)	1 tbsp.	1.4
FAST FOODS	Pizza (cheese or pepperoni)	1/2 of 10"	4.5-5.4
	Hamburger	1 reg.	2.5
	Cheeseburger	1 reg.	2.5
	Beef burrito	1	4.6
	Bean burrito	1	2.8
	Beef taco	1	2.9

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