Iron and the endurance athlete
Publication: Applied Physiology, Nutrition, and Metabolism
27 May 2014
Abstract
Iron is a trace mineral that is highly significant to endurance athletes. Iron is critical to optimal athletic performance because of its role in energy metabolism, oxygen transport, and acid-base balance. Endurance athletes are at increased risk for suboptimal iron status, with potential negative consequences on performance, because of the combination of increased iron needs and inadequate dietary intake. This review paper summarizes the role of iron in maximal and submaximal exercise and describes the effects of iron deficiency on exercise performance. Mechanisms that explain the increased risk of iron deficiency in endurance athletes, including exercise-associated inflammation and hepcidin release on iron sequestration, are described. Information on screening athletes for iron deficiency is presented, and suggestions to increase iron intake through diet modification or supplemental iron are provided.
Résumé
Le fer est un oligoélément très important chez les athlètes d’endurance. Le fer est essentiel pour une performance sportive optimale, et ce, à cause de son rôle dans le métabolisme énergétique, le transport de l’oxygène et l’équilibre acidobasique. Les athlètes d’endurance sont plus à risque d’un taux de fer suboptimal et de ses possibles conséquences négatives sur la performance physique à cause de leur plus grand besoin en fer et de leur apport alimentaire insuffisant. Cette analyse documentaire présente succinctement le rôle du fer lors d’un exercice sous-maximal et maximal et décrit les effets d’un manque de fer sur la performance physique. L’auteure énonce les mécanismes sous-jacents à l’accroissement des risques en présence d’une déficience en fer chez les athlètes : inflammation associée à l’effort, libération de l’hepcidine et séquestration du fer. L’auteure donne des renseignements pour le dépistage de la déficience en fer et suggère une augmentation de l’apport en fer par une modification du régime alimentaire ou la supplémentation en fer. [Traduit par la Rédaction]
Get full access to this article
View all available purchase options and get full access to this article.
References
Anderson G.J., Darshan D., Wilkins S.J., and Frazer D.M. 2007. Regulation of systemic iron homeostasis: how the body responds to changes in iron demand. Biometals, 20(3–4): 665–674.
Beals K.A. 2002. Eating behaviors, nutritional status, and menstrual function in elite female adolescent volleyball players. J. Am. Diet. Assoc. 102(9): 1293–1296.
Beard J.L. 2001. Iron biology in immune function, muscle metabolism and neuronal functioning. J. Nutr. 13(2S-2): 568S–579S. discussion 580S.
Beard J. and Tobin B. 2000. Iron status and exercise. Am. J. Clin. Nutr. 72(2 Suppl): 594S–597S.
Brownlie T., Utermohlen V., Hinton P.S., and Haas J.D. 2004. Tissue iron deficiency without anemia impairs adaptation in endurance capacity after aerobic training in previously untrained women. Am. J. Clin. Nutr. 79(3): 437–443.
Brutsaert T.D., Hernandez-Cordero S., Rivera J., Viola T., Hughes G., and Haas J.D. 2003. Iron supplementation improves progressive fatigue resistance during dynamic knee extensor exercise in iron-depleted, nonanemic women. Am. J. Clin. Nutr. 77(2): 441–448.
CDC. 1998. Recommendations to prevent and control iron deficiency in the United States. Centers for Disease Control and Prevention. MMWR Recomm Rep, 47(RR-3): 1–29.
Celsing F., Blomstrand E., Werner B., Pihlstedt P., and Ekblom B. 1986. Effects of iron deficiency on endurance and muscle enzyme activity in man. Med. Sci. Sports Exerc. 18(2): 156–161.
Chinevere T.D., Kenefick R.W., Cheuvront S.N., Lukaski H.C., and Sawka M.N. 2008. Effect of heat acclimation on sweat minerals. Med. Sci. Sports Exerc. 40(5): 886–891.
Choe Y.H., Kwon Y.S., Jung M.K., Kang S.K., Hwang T.S., and Hong Y.C. 2001. Helicobacter pylori-associated iron-deficiency anemia in adolescent female athletes. J. Pediatr. 139(1): 100–104.
Clement D.B., Lloyd-Smith D.R., Macintyre J.G., Matheson G.O., Brock R., and Dupont M. 1987. Iron status in Winter Olympic sports. J. Sports Sci. 5(3): 261–271.
Constantini N.W., Eliakim A., Zigel L., Yaaron M., and Falk B. 2000. Iron status of highly active adolescents: evidence of depleted iron stores in gymnasts. Int. J. Sport. Nutr. Exerc. Metab. 10(1): 62–70.
Cook J.D. and Finch C.A. 1979. Assessing iron status of a population. Am. J. Clin. Nutr. 32(10): 2115–2119.
Cowell B.S., Rosenbloom C.A., Skinner R., and Summers S.H. 2003. Policies on screening female athletes for iron deficiency in NCAA division I-A institutions. Int. J. Sport. Nutr. Exerc. Metab. 13(3): 277–285.
Davies K.J., Maguire J.J., Brooks G.A., Dallman P.R., and Packer L. 1982. Muscle mitochondrial bioenergetics, oxygen supply, and work capacity during dietary iron deficiency and repletion. Am. J. Physiol. 242(6): E418–E427.
DellaValle D.M. 2013. Iron supplementation for female athletes: effects on iron status and performance outcomes. Curr. Sports Med. Rep. 12(4): 234–239.
DellaValle D.M. and Haas J.D. 2011. Impact of iron depletion without anemia on performance in trained endurance athletes at the beginning of a training season: a study of female collegiate rowers. Int. J. Sport Nutr. Exerc. Metab. 21(6): 501–506.
DellaValle D.M. and Haas J.D. 2012. Iron status is associated with endurance performance and training in female rowers. Med. Sci. Sports. Exerc. 44(8): 1552–1559.
DellaValle D.M. and Haas J.D. 2014. Iron supplementation improves energetic efficiency in iron-depleted female rowers. Med Sci Sports Exerc. 46(6): 1204–1215.
Dubnov G. and Constantini N.W. 2004. Prevalence of iron depletion and anemia in top-level basketball players. Int. J. Sport Nutr. Exerc. Metab. 14(1): 30–37.
Eichner E.R. 2012. Pearls and pitfalls: everyone needs iron. Curr. Sports Med. Rep. 11(2): 50–51.
Eliakim A., Nemet D., and Constantini N. 2002. Screening blood tests in members of the Israeli National Olympic team. J. Sports. Med. Phys. Fitness, 42(2): 250–255.
Fallon K.E. 2004. Utility of hematological and iron-related screening in elite athletes. Clin. J. Sport. Med. 14(3): 145–152.
Fallon K.E. 2008. Screening for haematological and iron-related abnormalities in elite athletes-analysis of 576 cases. J. Sci. Med. Sport. 11(3): 329–336.
Finch C.A., Miller L.R., Inamdar A.R., Person R., Seiler K., and Mackler B. 1976. Iron deficiency in the rat. Physiological and biochemical studies of muscle dysfunction. J. Clin. Invest. 58(2): 447–453.
Fischer C.P. 2006. Interleukin-6 in acute exercise and training: what is the biological relevance? Exerc. Immunol. Rev. 12: 6–33.
FNB. 1989. Recommended Dietary Allowances. National Academy of Sciences, Washington, DC, USA.
FNB. 2000. Dietary Reference Intakes: Applications in Dietary Assessment. I. o. Medicine., National Academy of Sciences, Washington, DC, USA.
FNB. 2001. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Nickel, Silicon, Vanadium, and Zinc. N. A. o. Sciences. Institute of Medicine, Washington, DC, USA.
Gardner G.W., Edgerton V.R., Barnard R.J., and Bernauer E.M. 1975. Cardiorespiratory, hematological and physical performance responses of anemic subjects to iron treatment. Am. J. Clin. Nutr. 28(9): 982–988.
Garvican L.A., Saunders P.U., Cardoso T., Macdougall I.C., Lobigs L.M., Fazakerley R., et al. 2014. Intravenous iron supplementation in distance runners with low or suboptimal ferritin. Med. Sci. Sports. Exerc. 46(2): 376–385.
Gropper S.S., Blessing D., Dunham K., and Barksdale J.M. 2006. Iron status of female collegiate athletes involved in different sports. Biol. Trace Elem. Res. 109(1): 1–14.
Hallberg L., Rossander-Hulten L., Brune M., and Gleerup A. 1992. Calcium and iron absorption: mechanism of action and nutritional importance. Eur. J. Clin. Nutr. 46(5): 317–327.
Hinton P.S. and Sinclair L.M. 2007. Iron supplementation maintains ventilatory threshold and improves energetic efficiency in iron-deficient nonanemic athletes. Eur. J. Clin. Nutr. 61(1): 30–39.
Hinton P.S., Giordano C., Brownlie T., and Haas J.D. 2000. Iron supplementation improves endurance after training in iron-depleted, nonanemic women. J. Appl. Physiol. 88(3): 1103–1111.
Hinton P.S., Sanford T.C., Davidson M.M., Yakushko O.F., and Beck N.C. 2004. Nutrient intakes and dietary behaviors of male and female collegiate athletes. Int. J. Sport. Nutr. Exerc. Metab. 14(4): 389–405.
International Olympic Committee 2009. The International Olympic Committee (IOC) consensus statement on periodic health evaluation of elite athletes: March 2009. J. Athl. Train. 44(5): 538–557.
Kim S.H., Kim H.Y., Kim W.K., and Park O.J. 2002. Nutritional status, iron-deficiency-related indices, and immunity of female athletes. Nutrition, 18(1): 86–90.
Klingshirn L.A., Pate R.R., Bourque S.P., Davis J.M., and Sargent R.G. 1992. Effect of iron supplementation on endurance capacity in iron-depleted female runners. Med. Sci. Sports. Exerc. 24(7): 819–824.
Leong W.I. and Lonnerdal B. 2004. Hepcidin, the recently identified peptide that appears to regulate iron absorption. J. Nutr. 134(1): 1–4.
Looker A.C., Dallman P.R., Carroll M.D., Gunter E.W., and Johnson C.L. 1997. Prevalence of iron deficiency in the United States. Jama, 277(12): 973–976.
Lukaski H.C. 2004. Vitamin and mineral status: effects on physical performance. Nutrition, 20(7–8): 632–644.
Lun V., Erdman K.A., and Reimer R.A. 2009. Evaluation of nutritional intake in Canadian high-performance athletes. Clin. J. Sport. Med. 19(5): 405–411.
Malczewska J., Szczepanska B., Stupnicki R., and Sendecki W. 2001. The assessment of frequency of iron deficiency in athletes from the transferrin receptor-ferritin index. Int. J. Sport. Nutr. Exerc. Metab. 11(1): 42–52.
Margeli A., Skenderi K., Tsironi M., Hantzi E., Matalas A.L., Vrettou C., et al. 2005. Dramatic elevations of interleukin-6 and acute-phase reactants in athletes participating in the ultradistance foot race spartathlon: severe systemic inflammation and lipid and lipoprotein changes in protracted exercise. J. Clin. Endocrinol. Metab. 90(7): 3914–3918.
McClung J.P. 2012. Iron status and the female athlete. J. Trace Elem. Med. Biol. 26(2–3): 124–126.
McClung J.P., Karl J.P., Cable S.J., Williams K.W., Nindl B.C., Young A.J., and Lieberman H.R. 2009. Randomized, double-blind, placebo-controlled trial of iron supplementation in female soldiers during military training: effects on iron status, physical performance, and mood. Am. J. Clin. Nutr. 90(1): 124–131.
McInnis M.D., Newhouse I.J., von Duvillard S.P., and Thayer R. 1998. The effect of exercise intensity on hematuria in healthy male runners. Eur. J. Appl. Physiol. Occup. Physiol. 79(1): 99–105.
Mettler S. and Zimmermann M.B. 2010. Iron excess in recreational marathon runners. Eur. J. Clin. Nutr. 64(5): 490–494.
Milic R., Martinovic J., Dopsaj M., and Dopsaj V. 2011. Haematological and iron-related parameters in male and female athletes according to different metabolic energy demands. Eur. J. Appl. Physiol. 111(3): 449–458.
Nachtigall D., Nielsen P., Fischer R., Engelhardt R., and Gabbe E.E. 1996. Iron deficiency in distance runners. A reinvestigation using Fe-labelling and non-invasive liver iron quantification. Int. J. Sports Med. 17(7): 473–479.
Nemeth E., Valore E.V., Territo M., Schiller G., Lichtenstein A., and Ganz T. 2003. Hepcidin, a putative mediator of anemia of inflammation, is a type II acute-phase protein. Blood, 101(7): 2461–2463.
Newhouse I.J., Clement D.B., Taunton J.E., and McKenzie D.C. 1989. The effects of prelatent/latent iron deficiency on physical work capacity. Med. Sci. Sports Exerc. 21(3): 263–268.
Papadopoulou S.K., Papadopoulou S.D., and Gallos G.K. 2002. Macro- and micro-nutrient intake of adolescent Greek female volleyball players. Int. J. Sport. Nutr. Exerc. Metab. 12(1): 73–80.
Peeling P., Dawson B., Goodman C., Landers G., and Trinder D. 2008. Athletic induced iron deficiency: new insights into the role of inflammation, cytokines and hormones. Eur. J. Appl. Physiol. 103(4): 381–391.
Peeling P., Dawson B., Goodman C., Landers G., Wiegerinck E.T., Swinkels D.W., and Trinder D. 2009a. Effects of exercise on hepcidin response and iron metabolism during recovery. Int. J. Sport. Nutr. Exerc. Metab. 19(6): 583–597.
Peeling P., Dawson B., Goodman C., Landers G., Wiegerinck E.T., Swinkels D.W., and Trinder D. 2009b. Training surface and intensity: inflammation, hemolysis, and hepcidin expression. Med. Sci. Sports Exerc. 41(5): 1138–1145.
Perkkio M.V., Jansson L.T., Brooks G.A., Refino C.J., and Dallman P.R. 1985. Work performance in iron deficiency of increasing severity. J. Appl. Physiol. 58(5): 1477–1480.
Pitsis G.C., Fallon K.E., Fallon S.K., and Fazakerley R. 2004. Response of soluble transferrin receptor and iron-related parameters to iron supplementation in elite, iron-depleted, nonanemic female athletes. Clin. J. Sport. Med. 14(5): 300–304.
Punnonen K., Irjala K., and Rajamaki A. 1997. Serum transferrin receptor and its ratio to serum ferritin in the diagnosis of iron deficiency. Blood, 89(3): 1052–1057.
Rietjens G.J., Kuipers H., Hartgens F., and Keizer H.A. 2002. Red blood cell profile of elite olympic distance triathletes. A three-year follow-up. Int. J. Sports Med. 23(6): 391–396.
Roecker L., Meier-Buttermilch R., Brechtel L., Nemeth E., and Ganz T. 2005. Iron-regulatory protein hepcidin is increased in female athletes after a marathon. Eur. J. Appl. Physiol. 95(5–6): 569–571.
Rowland T.W. and Kelleher J.F. 1989. Iron deficiency in athletes. Insights from high school swimmers. Am. J. Dis. Child. 143(2): 197–200.
Rowland T.W., Black S.A., and Kelleher J.F. 1987. Iron deficiency in adolescent endurance athletes. J. Adolesc. Health Care, 8(4): 322–326.
Rowland T.W., Deisroth M.B., Green G.M., and Kelleher J.F. 1988. The effect of iron therapy on the exercise capacity of nonanemic iron-deficient adolescent runners. Am. J. Dis. Child. 142(2): 165–169.
Rudzki S.J., Hazard H., and Collinson D. 1995. Gastrointestinal blood loss in triathletes: it’s etiology and relationship to sports anaemia. Aust. J. Sci. Med. Sport. 27(1): 3–8.
Schobersberger W., Tschann M., Hasibeder W., Steidl M., Herold M., Nachbauer W., and Koller A. 1990. Consequences of 6 weeks of strength training on red cell O2 transport and iron status. Eur. J. Appl. Physiol. Occup. Physiol. 60(3): 163–168.
Schumacher Y.O., Schmid A., Grathwohl D., Bultermann D., and Berg A. 2002. Hematological indices and iron status in athletes of various sports and performances. Med. Sci. Sports Exerc. 34(5): 869–875.
Selby G.B. and Eichner E.R. 1986. Endurance swimming, intravascular hemolysis, anemia, and iron depletion. New perspective on athlete’s anemia. Am. J. Med. 81(5): 791–794.
Sinclair L.M. and Hinton P.S. 2005. Prevalence of iron deficiency with and without anemia in recreationally active men and women. J. Am. Diet. Assoc. 105(6): 975–978.
Skikne B.S., Flowers C.H., and Cook J.D. 1990. Serum transferrin receptor: a quantitative measure of tissue iron deficiency. Blood, 75(9): 1870–1876.
Spodaryk K. 2002. Iron metabolism in boys involved in intensive physical training. Physiol. Behav. 75(1–2): 201–206.
Steen S.N., Mayer K., Brownell K.D., and Wadden T.A. 1995. Dietary intake of female collegiate heavyweight rowers. Int. J. Sport. Nutr. 5(3): 225–231.
Steensberg A., Toft A.D., Schjerling P., Halkjaer-Kristensen J., and Pedersen B.K. 2001. Plasma interleukin-6 during strenuous exercise: role of epinephrine. Am. J. Physiol. Cell Physiol. 281(3): C1001–C1004.
Stupnicki R., Malczewska J., Milde K., and Hackney A.C. 2003. Day to day variability in the transferrin receptor/ferritin index in female athletes. Br. J. Sports Med. 37(3): 267–269.
Suominen P., Punnonen K., Rajamaki A., and Irjala K. 1998. Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits. Blood, 92(8): 2934–2939.
Tanaka T., Roy C.N., Yao W., Matteini A., Semba R.D., Arking D., et al. 2010. A genome-wide association analysis of serum iron concentrations. Blood, 115(1): 94–96.
Telford R.D., Sly G.J., Hahn A.G., Cunningham R.B., Bryant C., and Smith J.A. 2003. Footstrike is the major cause of hemolysis during running. J. Appl. Physiol. 94(1): 38–42.
Toft A.D., Falahati A., and Steensberg A. 2011. Source and kinetics of interleukin-6 in humans during exercise demonstrated by a minimally invasive model. Eur. J. Appl. Physiol. 111(7): 1351–1359.
Weight L.M., Byrne M.J., and Jacobs P. 1991a. Haemolytic effects of exercise. Clin. Sci. (Lond.). 81(2): 147–152.
Weight L.M., Darge B.L., and Jacobs P. 1991b. Athletes’ pseudoanaemia. Eur. J. Appl. Physiol. Occup. Physiol. 62(5): 358–362.
Wilkinson J.G., Martin D.T., Adams A.A., and Liebman M. 2002. Iron status in cyclists during high-intensity interval training and recovery. Int. J. Sports Med. 23(8): 544–548.
Willis W.T., Brooks G.A., Henderson S.A., and Dallman P.R. 1987. Effects of iron deficiency and training on mitochondrial enzymes in skeletal muscle. J. Appl. Physiol. 62(6): 2442–2446.
Woodson R.D., Wills R.E., and Lenfant C. 1978. Effect of acute and established anemia on O2 transport at rest, submaximal and maximal work. J. Appl. Physiol. 44(1): 36–43.
Woolf K., St Thomas M.M., Hahn N., Vaughan L.A., Carlson A.G., and Hinton P. 2009. Iron status in highly active and sedentary young women. Int. J. Sport. Nutr. Exerc. Metab. 19(5): 519–535.
Zhu Y.I. and Haas J.D. 1998a. Altered metabolic response of iron-depleted nonanemic women during a 15-km time trial. J. Appl. Physiol. 84(5): 1768–1775.
Zhu Y.I. and Haas J.D. 1998b. Response of serum transferrin receptor to iron supplementation in iron-depleted, nonanemic women. Am. J. Clin. Nutr. 67(2): 271–275.
Ziegler P., Sharp R., Hughes V., Evans W., and Khoo C.S. 2002. Nutritional status of teenage female competitive figure skaters. J. Am. Diet. Assoc. 102(3): 374–379.
Information & Authors
Information
Published In
Applied Physiology, Nutrition, and Metabolism
Volume 39 • Number 9 • September 2014
Pages: 1012 - 1018
History
Received: 22 April 2014
Accepted: 27 May 2014
Accepted manuscript online: 27 May 2014
Version of record online: 27 May 2014
Notes
This paper is a part of a Special Issue entitled Nutritional Triggers to Adaptation and Performance.
Copyright
© 2014.
Key Words
Mots-clés
Authors
Metrics & Citations
Metrics
Other Metrics
Citations
Cite As
HintonPamela S.. 2014. Iron and the endurance athlete. Applied Physiology, Nutrition, and Metabolism. 39(9): 1012-1018. https://doi.org/10.1139/apnm-2014-0147